Preview
BUR-L-000679-23 07/05/2023 03:53:51 PM Pglof40 Trans ID: LCV20232007691
Dr. Ramesh Parchuri, MD
Medical Expert Report:
Ms.Sandra Choates
122 Danton Lane Mullica Hill Nj. 08062
DOB:10/09/1965
Congested Heart Failure.
Case Number: BUR L000679-23
A. Materials Reviewed
I, Dr. Ramesh Parchuri, MD licensed (MD033552E) have review the following materials in developing
my opinions in this case:
1 Medical records, medical bills, operative pictures, and radiology films from Sandra Choates
admission at Deborah Heart and lung Hospital from November 8, 2021, until October 20, 2021
2. Medical records, medical bills, and radiology films from Sandra Choate's treatment at Deborah
Heart and Lung Hospital from November
3 As discovery is ongoing, I reserve the right to supplement the materials I have reviewed in
rendering my opinions.
T understand that Plaintiffs and counsel team is currently obtaining additional records and bills from
several providers, including, but not limited to Deborah Heart and Lung Hospital. Capital Health,
Pennsylvania University Hospital
Therefore, I reserve the right to supplement this report to include opinions about those bills and that
treatment.
Tam a physician Dr. Ramesh Parchuri licensed to practice medicine in the state of Philadelphia,
Pennsylvania. I currently have 2 offices stationed in the Philadelphia area.
Ihave substantial experience as an M.D. including psychiatric services. Heart and Lung.
Tam familiar with the standard of medical care I currently evaluate and treat patients for many
conditions like Sandra Choate's conditions.
B. Summary of Records.
Sandra Choates presented to Deborah Heart and Lung Hospital on November 10, 2021, with signs and
symptoms consistent with congestive heart failure, this included a history of nausea and vomiting, and
right upper quadrant abdominal pain. Shortness of breath, chest pain, and weakness in the lower
extremities. CT scan Based upon this information, the patient was admitted to the hospital and scheduled
for observation and further testing. Along with a Swan-Ganz catheter procedure.
BUR-L-000679-23 07/05/2023 03:53:51 PM Pg2of40 Trans ID: LCV20232007691
The surgery took place on November 10, 2021. Initially, the dissection was performed by a resident
Deborah Hospital, who admittedly had little to no experience performing the procedure. However, after
approximately 20 minutes of attempting, the operation was taken over by another doctor on the team.
Following her operation, the patient’s clinical condition rapidly deteriorated. She underwent numerous
radiological studies between November 10, 2021, and November 21, 2021, including, a HIDA scan, an
ERCP, and an MRI. The results of these tests in addition to the patient’s lab work overwhelmingly
confirmed that she had sustained a severe injury. In addition, Ms. Choates also was transferred to
Capital Health Hospital with Stroke like symptoms due to being over Medicated with severe mental and
physical trauma. She was then placed under a new physician's care team as follows.
Capital Health
1. Abroo N Muzaffar
2. Kulpreet Barn, MD
3. Dr. Mazhar
Despite this evidence, the patient was then transferred to a higher level of care at Deborah Heart and
Lung Hospital until November 21, 2021. At that point, she required additional treatment, including
antibiotic therapy, until she was able to undergo more testing and treatment.
1 It is my opinion breaches of the standard of medical care substantially delayed Ms. Choates
treatment and proximately caused her to undergo additional treatment for months until she was
able to obtain another doctor.
I have reviewed all the medical records for the treatment Ms. Choates received at Devorah Heart
and Lung Hospital. Based upon a reasonable degree of medical certainty, treatment, including
administering the wrong medication breaches the standard of medical care.
As discovery is ongoing, I reserve the right to supplement and/or amend my opinions. | understand that
Plaintiff's counsel is currently obtaining additional records and bills from several providers, including,
but not limited to Deborah Heart and Lung Hospital. Capital Health Hospitals, Pennsylvania Hospital
Therefore, I reserve the right to supplement this report to include opinions about those bills and that
treatment.
Thereby certify that this report is a complete and accurate statement of all my opinions, and the basis
and reasons for them, to which I will testify under oath.
Signature: Du. Lumeah Parchuns, WP
Dr.Ramesh Parchuri, MD
License # MD033552E. DEA AP 2419338
NPI:1437224300. UPIN: E63643. CAQH: 1121939
BUR-L-000679-23 07/05/2023 03:53:51 PM Pg3of40 Trans ID: LCV20232007691
Page 1 of 2
Continuity of Care Document (Ambulatory Clinical Summary)
Created On: November 5, 2021, 4:57pm
Demographic Data
Patient Name Choates, Sandra E
Sex Female
Birthdate June 29, 1955
Race Black or African-American
Ethnicity Not Hispanic or Latino
Preferred Language English
Vi Detail
“Visit Date / Time Facility | Location Visit Provider Contact Information|
[Phone]
November 5, 2021 DHLC Ambulatory ACS-EPS Clinic Kazemian, Pedram 609-893-6611
1:51pm — ~
Author
Organization
Address
Deborah Heart and Lung Center
200 Trenton Road ||
Browns Mills, NJ, 08015
Phone |_(609)893-1200
Support
Name Relationship Role | Address Phone
Varjavand, Primary Care Personal t 219 N. Broad Street, 6th Floor (215)762-5037
Nielufar Provider Relationship | Tower Health - Cntr for Women
| Philadelphia, PA, 19107
Care Team Providers
Care Team Member Name Role Phone
Kazemian, Pedram Attending Physician (609)893-6611
Plan Of CarepLease NOTE: The "Scheduled Date for Test" date on "Future Orders" items is
the approximate date that your provider would like the testing/appointment
scheduled: The appointment(s) has not yet been made. The Deborah Scheduling
Department will contact you to schedule these appointments. If you are not
contacted 2 weeks prior to the "Requested For" date, please call 609-621-2080
option 4 to schedule your appointment(s).
Reported Medication(s)
Current Medications Not Addressed this Visit
Medication Directions Qty Ref. Start Date
isosorbide mononitrate 60 mg tablet,extended release 24 60 mg orally daily March 5,
br 2021
allopurinol 300 mg tablet 300 mg orally daily March 5,
2021
atorvastatin 40 mg tablet 40 mg orally daily March 5,
2021
colchicine 0.6 mg tablet 0.6 mg orally daily as needed March 5,
for Pain, Mild | 2021
— — — | for gout_
BUR-L-000679-23 07/05/2023 03:53:51 PM Pg4of40 Trans ID: LCV20232007691
Patient: Choates,Sandra E Page 2 of 2
» insulin lispro (Humalog KwikPen (U-100) Insulin) 100 unit/ 36 units subcutaneously three March 5,
mL subcutaneous pen times a day 2021
sacubitril 97 mg-valsartan 103 mg tablet 1 tab orally twice a day March 5,
2021
insulin glargine U-300 conc (Toujeo Max U-300 SoloStar) 80 units subcutaneously daily March 5,
300 unit/mL (3 mL) subcutaneous pen 2021
dulaglutide (Trulicity) 0.75 mg/0.5 mL subcutaneous pen 75 mg subcutaneously weekly October 11,
injector 2021
clopidogrel (Plavix) 75 mg tablet 75 mg orally daily 30 July 15,
2021
potassium chloride 20 mEq tablet,extended release 20 még orally daily 30 October 27,
2021
magnesium 250 mg tablet 250 mg orally daily 30 July 23, {
2021 |
cholecalciferol (vitamin D3) 25 mcg (1,000 unit) capsule 50 mcg orally daily 60 July 23, |
2021 |
aspirin (Aspirin Low Dose) 81 mg tablet,delayed release 81 mg orally daily October 21, |
2021
sotalol 120 mg tablet 120 mg orally daily 30 October 21,
2021
metoprolol succinate 200 mg tablet,extended release 24 100 mg orally nightly 30 October 21,
r
2021
bumetanide 1 mg tablet 1 mg orally daily 30 October 22,
2021
spironolactone 25 mg tabiet 25 mg orally daily 30 [0 October 22,
2021
PLEASE NOTE: The medications listed on the "Reported Medication(s)" section
includes BOTH those medications ordered or changed by your Deborah Heart and
Lung Center provider AND those medications identified by you (the patient) or
your representative,
Vital Signs
Vital Reading Result Reference Range Collection Date/Time
Height 163 cm November 5, 2021 4:31pm
Weight 107.1 kg November 5, 2021 4:31pm
Temperature 87.0 F 97.5 F-99.6 F November 5, 2021 4:31pm
Pulse 91 BPM 60-100 November 5, 2021 4:31pm
Respiration 16 RPM 12-24 November 5, 2021 4:31pm
Pulse Oximetry 99 % 95-100 November 5, 2021 4:31pm
Blood Pressure Systolic 100 100-140 November 5, 2021 4:31pm
~Blood Pressure Diastolic 70 60-100 November 5, 2021 4:31pm
_Body Mass Index 40.3 November 5, 2021 4:31pm
Notice
This clinical summary is based on the medical information that was available in
the Deborah Heart and Lung Center Electronic Health Record at the time of
printing. For an official copy of your medical record, please contact our
Medical Records department.
Safe And Secure Medicine Disposal
Unused medications that remain in your medicine cabinet are susceptible to theft
and misuse. To prevent medications from getting into the wrong hands, New
Jersey's Office of the Attorney General and Division of Consumer Affairs urge
you to properly dispose of your expired and unwanted prescription medicine at a
nearby Project Medicine Drop location.~ DROP OFF IS SIMPLE, ANONYMOUS AND
AVAILABLE 24 HOURS A DAY~ 365 DAYS A YEAR, NO QUESTIONS ASKED. Simply bring in
your prescription and over-the-counter medications and discard them in an
environmentally safe manner. Always scratch out the identifying information on
any medicine container you are discarding. For a list of Project Medicine Drop
locations, please visit www.NJConsumerAffairs.gov/meddrop.
BUR-L-000679-23 07/05/2023 03:53:51 PM Pg5of40 Trans ID: LCV20232007691
200 Trenton Road
Browns Mill, NJ o8o15
Hearta
Lung nd
Center 609-893-1200 Page i of 3
Patient: Sandra £ Choates
Acct Mi voco1asssoig
Med Reo Mi M000320299
Locati aM - 3 n
Primary Provider: Baiatsky, Igor
— _ _. He, _ — oe. bate 10/
en
a. - _
Patient Signature Page
Patient Name: Sandra E Cho
ates
Guardian Name:
The above-named patient and/or guardian has received
the following
Patient Instructions:
Received with this Packet on 10/
22/21 at 11:14
Heart Failure
Sotalol (By mouth)
Activity Restrictions or Add
itional Instructions:
Follow-up with electrophysi
olo gy clinic in 1 week and
received an appointment heart failure clinic in 1 week.
remi nder or unable t ‘0 kee If you have not
Department at 609-62 1-2080, p your appointment please call S
options #4 cheduling
Follow-Ups:
Sandra E Choates has been referred
to the following clinics/speciali
sts for follow-up care:
1. Nielufar Varjavand + MD
Date:
219 N. Broad Street, 6th Floor
Tower Health - Cntr for Women
Philadelphia, PA 19107
215-762-5037
Prescriptions:
1. bumetanide
1 mg oral daily #30 tab
1mg
Tablet
Refills: 0
2. metoprolol succinate
100 mg oral nightly #30 tab
200 mg
tablet extended release 24 hr
Refills: 2
BUR-L-000679-23 07/05/2023 03:53:51 PM Pg6of40 Trans ID :LCV20232007691
200 Trenton Road
‘owns Mille, NJ 8015,
609-893-1200
Page of 3
Patient Sandra &
Acet Wwam, vo Leossole
Med Ree uum 326299
Locatzon - 3 Main
Primary Provider Balatsky, }gor
we a Dave 10/20/21
a ce -
3. sotalol -
120 mg oral daily #30 tab
120 mg
Tablet
Refills: 3
4. spironolactone
25 mg oral daily #30 tab
25 mg
Tablet
Refills: 0
Follow-' Up Tests and/or Proced
ures that have been ordered:
ECG 12 lead EKG Routine
Balatsky,Igor
B-Type Natriuretic Peptide
Routine
Balatsky,Igor
Basic Metabolic Panel
Routine
Balatsky, Igor
Complete Blood Count Auto
Diff Routine
Balatsky,Igor
Hepatic Panel Routine
Balatsky, Igor
Magnesium Routine
Balatsky,Igor
Sched EPS Re Eval Routine
Balatsky,Igor
Sched Heart Failure Re Eval
Routine
Balatsky,Igor
Care Plan Goals:
The ability to resume daily activities
as detailed in the discharge plan and
discharge instructions.
Additional Documents Given:
Patient Discharge Instructions
Home Medications List
BUR-L-000679-23 07/05/2023 03:53:51 PM Pg7of40 Trans ID LCV20232007691
200 Trenton Road
rowns Mil, NI o8or5
ung Center 609-893-1200 Page of 3
Patien Sandra & Choares
Acct 18: 8278
Bed Ree iam HOG 34
Location 3M 3 Hare
Primary Provider Balatsky, tyor
oa. ee Date 10/20/21
a va a
I have read and understand the
instructions given to mi je by my
i
caregivers,
Sandra lO
E Choates
Print Patient Name a wc
monn a oe
Patient (or Guardian) Signature a
en ee _ —.
“Date/Time
Caregiver/RN/Doctor Signature
Date/Time —
Printed on 10/22/21 at 11:14
BUR-L-000679-23 07/05/2023 03:53:51 PM Pg 8of40 Trans ID: LCV20232007691
Page 1 of 6
(AD) BY=\ovese-\a}
Name: Sandra E Choates
Acct Num: V00018958918
Med Rec Num: M000320299
Location: 3M - 3 Main
Primary Provider: Balatsky,Igor
Date: 10/20/21
Heart Failure
WHAT YOU NEED TO KNOW:
Heart failure (HF) is a condition that does not allow your heart to fill or pump
properly. Not enough oxygen in your blood gets to your organs and tissues. HF
can occur in the right side, the left side, or both lower chambers of your heart. HF
is often caused by damage or injury to your heart. The damage may be caused by
heart attack, other heart conditions, or high blood pressure. HF is a long-term
condition that tends to get worse over time. It is important to manage your
health to improve your quality of life. HF can be worsened by heavy alcohol use,
smoking, diabetes that is not controlled, or obesity.
¥ ¥
mt, ity
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YNWN
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Normal Heart c HF Heart
DISCHARGE INSTRUCTIONS:
Call 911 if:
® You have any of the following signs of a heart attack:
© Squeezing, pressure, or pain in your chest that lasts longer than 5
minutes or returns
© Discomfort or pain in your back, neck, jaw, stomach, or arm
© Trouble breathing
© Nausea or vomiting
BUR-L-000679-23 07/05/2023 03:53:51 PM Pg9of40 Trans ID: LCV20232007691
Page 2 of 6
{A} BY-\oYee=a1
Name: Sandra E Choates
Fi Acct Num: V00018958918
Med Rec Num: M000320299
Location: 3M - 3 Main
Primary Provider: Balatsky,Igor
Date: 10/20/21
© Lightheadedness or a sudden cold sweat, especially with chest pain or
trouble breathing
Seek care immediately if:
® You gain 3 or more pounds (1.4 kg) in a day, or more than your healthcare
provider says you should.
©® Your heartbeat is fast, slow, or uneven all the time.
Contact your healthcare provider if:
® You have symptoms of worsening HF:
© Shortness of breath at rest, at night, or that is getting worse in any way
© Weight gain of 5 or more pounds (2.2 kg) in a week
© More swelling in your legs or ankles
© Abdominal pain or swelling
© More coughing
© Loss of appetite
© Feeling tired all the time
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Page 3 of 6
{AD} BY=\eve\sla)
Name: Sandra E Choates
Acct Num: V00018958918
Med Rec Num: M000320299
Location: 3M - 3 Main
Primary Provider: Balatsky,Igor
Date: 10/20/21
© You feel hopeless or depressed, or you have lost interest in things you used
to enjoy.
© You often feel worried or afraid.
® You have questions or concerns about your condition or care.
Medicines: You may need any of the following:
® Medicines may be given to help regulate your heart rhythm. You may also
need medicines to lower your blood pressure, and to get rid of extra fluids.
®@ Take your medicine as directed. Contact your healthcare provider if you
think your medicine is not helping or if you have side effects. Tell him or her
if you are allergic to any medicine. Keep a list of the medicines, vitamins,
and herbs you take. Include the amounts, and when and why you take them
Bring the list or the pill bottles to follow-up visits. Carry your medicine list
with you in case of an emergency.
Follow up with your healthcare provider or cardiologist as directed: You
may need to return for other tests. You may need home health care. A healthcare
provider will monitor your vital signs, weight, and make sure your medicines are
working. Write down your questions so you remember to ask them during your
visits.
Go to cardiac rehab as directed: Cardiac rehab is a program run by specialists
who will help you safely strengthen your heart. The program includes exercise,
relaxation, stress management, and heart-healthy nutrition. Healthcare providers
will also make sure your medicines are helping to reduce your symptoms.
Manage your HF:
® Do not smoke. Nicotine and other chemicals in cigarettes and cigars can
cause lung damage and make HF difficult to manage. Ask your healthcare
provider for information if you currently smoke and need help to quit.
E-cigarettes or smokeless tobacco still contain nicotine. Talk to your
healthcare provider before you use these products.
BUR-L-000679-23 07/05/2023 03:53:51 PM Pg1lof40 Trans ID: LCV20232007691
Page 4 of 6
LAD) BY-\eveye-\al
Name: Sandra E Choates
Acct Num: V00018958918
Med Rec Num: M000320299
Location: 3M - 3 Main
Primary Provider: Balatsky,Igor
Date: 10/20/21
® Do not drink alcohol or take illegal drugs. Alcohol and drugs can worsen
your symptoms quickly.
© Weigh yourself every morning. Use the same scale, in the same spot. Do
this after you use the bathroom, but before you eat or drink anything. Wear
the same type of clothing. Do not wear shoes. Record your weight each day
so you will notice any sudden weight gain. Swelling and weight gain are
signs of fluid retention. If you are overweight, ask how to lose weight safely.
Weigh Yourself Daily
D>
G oe
r
\ 4
\\
t
Lf 4
ke
>
®@ Check your blood pressure and heart rate every day. Ask for more
information about how to measure your blood pressure and heart rate
correctly. Ask what these numbers should be for you.
®@ Manage any chronic health conditions you have. These include high
blood pressure, diabetes, obesity, high cholesterol, metabolic syndrome, and
COPD. You will have fewer symptoms if you manage these health conditions
Follow your healthcare provider's recommendations and follow up with him
or her regularly.
BUR-L-000679-23 07/05/2023 03:53:51 PM Pg12o0f40 Trans ID: LCV20232007691
Page 5 of 6
LAD) DY-\oeye-\al
Name: Sandra E Choates
Acct Num: V00018958918
Med Rec Num: M000320299
Location: 3M - 3 Main
Primary Provider: Balatsky,Igor
Date: 10/20/21
© Eat heart-healthy foods and limit sodium (salt). An easy way to do this
is to eat more fresh fruits and vegetables and fewer canned and processed
foods. Replace butter and margarine with heart-healthy oils such as olive oil
and canola oil. Other heart-healthy foods include walnuts, whole-grain
breads, low-fat dairy products, beans, and lean meats. Fatty fish such as
salmon and tuna are also heart healthy. Ask how much salt you can eat each
day. Do not use salt substitutes.
Drink liquids as directed. You may need to limit the amount of liquids you
drink if you retain fluid. Ask how much liquid to drink each day and which
liquids are best for you.
Stay active. If you are not active, your symptoms are likely to worsen
quickly. Walking, bicycling, and other types of physical activity help maintain
your strength and improve your mood. Physical activity also helps you
manage your weight. Work with your healthcare provider to create an
exercise plan that is right for you.
e Get vaccines as directed. Get a flu shot every year. You may also need the
pneumonia vaccine. The flu and pneumonia can be severe for a person who
has HF. Vaccines protect you from these infections.
Join a support group: Living with HF can be difficult. It may be helpful to talk
with others who have HF. You may learn how to better manage your condition or
get emotional support. For more information:
@ American Heart Association
7272 Greenville Avenue
Dallas, TX 75231-4596
Phone: 1-800-242-8721
Web Address: http://www.heart.org
© 2017 Truven Health Analytics LLC Information is for End User's use only and
may not be sold, redistributed or otherwise used for commercial purposes. All
illustrations and images included in CareNotes® are the copyrighted property of
BUR-L-000679-23 07/05/2023 03:53:51 PM Pg130f40 Trans ID: LCV20232007691
Page 6 of 6
[AD DY-\evee-\0
Name: Sandra E Choates
Acct Num: V00018958918
Med Rec Num: M000320299
Location: 3M - 3 Main
Primary Provider: Balatsky, Igor
Date: 10/20/21
A.D.A.M., Inc. or Truven Health Analytics.
The above information is an educational aid only. It is not intended as medical
advice for individual conditions or treatments. Talk to your doctor, nurse or
pharmacist before following any medical regimen to see if it is safe and effective
for you.
BUR-L-000679-23 07/05/2023 03:53:51 PM Pg14o0f40 Trans ID: LCV20232007691
Page 1 of 3
Continuity of Care Document (Ambulatory Clinical Summary)
Created On: October 13, 2021, 4:40pm
Demographic Data
Patient Name Choates, Sandra E
Sex Female
Birthdate June 29, 1955
Race Black or African-American
Ethnicity Not Hispanic or Latino
Preferred Language English
Visit Detail
Visit Date / Facility Location Reason For Visit Provider Contact
Time Visit Information
[Phone]
October 13, DHLC Ambulatory ACS-Cardiac RO7.89 - Xu, Lei 609-893-6611
2021 2:45pm. Clinic Other chest
pain
Author
Organization Deborah Heart and Lung Center
Address 200 Trenton Road
Browns Mills, NJ, 08015
Phone (609)893-1200
Support
Name Relationship Role Address Phone
Varjavand, Primary Care Personal 219 N. Broad Street, 6th Floor (215)762-5037
Nielufar Provider Relationship Tower Health - Cntr for Women
Philadelphia, PA, 19107
Care Team Providers
Care Team Member Name Role Phone
Xu, Lei Attending Physician (609)893-6611
Reason For Visit
cardiac re-evaluation
Plan Of Care
PLEASE NOTE: The "Scheduled Date for Test" date on "Future Orders" items is
the approximate date that your provider would like the testing/appointment
scheduled: The appointment(s) has not yet been made. The Deborah Scheduling
Department will contact you to schedule these appointments. If you are not
contacted 2 weeks prior to the "Requested For" date, please call 609-621-2080
option 4 to schedule your appointment(s).
Reported Medication(s)
Current Medications Not Addressed this Visit
“Medication __| Directions _ — — _ — __ [Qty [ Ref. | Start Date _]
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Patient: Choates, Sandra E Page 2 of 3
, isosorbide mononitrate 60 mg tablet,extended 60 mg orally daily March 5,
release 24 hr 2021
allopurinol 300 mg tablet 300 mg orally daily March 5,
2021
atorvastatin 40 mg tablet 40 mg orally daily March 5,
2021
colchicine 0.6 mg tablet 0.6 mg orally daily as needed for March 5,
Pain, Mild 2021
for gout
insulin lispro (Humaiog KwikPen (U-100) Insulin) 36 units subcutaneously three times March 5,
100 unit/mL subcutaneous pen a day 2021
sacubitril 97 mg-valsartan 103 mg tablet 1 tab orally twice a day March 5,
2021
insulin glargine U-300 conc (Toujeo Max U-300 80 units subcutaneously daily March 5,
SoloStar) 300 unit/mL (3 mL) subcutaneous pen 2021
dulaglutide (Trulicity) 0.75 mg/0.5 mL subcutaneous mg subcutaneously October 11,
pen injector 2021
potassium chloride 20 mEq tablet,extended release 20 mEq orally daily 30 June 3,
2021
clopidogrel (Plavix) 75 mg tablet 75 mg orally daily 30 July 15,
2021
metoprolol succinate 200 mg tablet,extended 200 mg orally daily 30 July 15,
release 24 hr. 2021
furosemide (Lasix) 40 mg tablet 40 mg orally daily 60 July 23,
2021
patient was instructed to take an
extra dose for ankle swelling
magnesium 250 mg tablet 250 mg orally daily 30 July 23,
2021
cholecaiciferol (vitamin D3) 25 mcg (1,000 unit) 50 mcg orally daily 60 July 23,
capsule 2021
PLEASE NOTE: The medications listed on the "Reported Medication(s)" section
includes BOTH those medications ordered or changed by your Deborah Heart and
Lung Center provider AND those medications identified by you (the patient) or
your representative.
Vital Signs
Vital Reading Result Reference Range Collection Date/Time
Height 165 cm October 13, 2021 3:14pm
Weight 110.7 kg October 13, 2021 4pm
Temperature 96.9 F 97.5 F-99.6 F October 13, 2021 4pm
Pulse 85 BPM 60-100 October 13, 2021 3: 14pm
Respiration 18 RPM 12-24 October 13, 2021 3: 14pm
Pulse Oximetry 98 % 95-100 October 13 2021 3: 14pm.
Blood Pressure Systolic 122 100-140 October 13 2021 3: 15pm.
Blood Pressure Diastolic 85 60-100 October 13, 2021 3: 15pm
Body Mass Index 40.7 October 13 2021 3: 14pm
Notice
This clinical summary is based on the medical information that was available in
the Deborah Heart and Lung Center Electronic Health Record at the time of
printing. For an official copy of your medical record, please contact our
Medical Records department.
Safe And Secure Medi e Disposal
Unused medications that remain in your medicine cabinet are susceptible to theft
and misuse. To prevent medications from getting into the wrong hands, New
Jersey's Office of the Attorney General and Division of Consumer Affairs urge
you to properly dispose of your expired and unwanted prescription medicine at a
nearby Project Medicine Drop location.~ DROP OFF IS SIMPLE, ANONYMOUS AND
AVAILABLE 24 HOURS A DAY~ 365 DAYS A YEAR, NO QUESTIONS ASKED. Simply bring in
your prescription and over-the-counter medications and discard them in an
environmentally safe manner. Always scratch out the identifying information on
any medicine container you are discarding. For a list of Project Medicine Drop
BUR-L-000679-23 07/05/2023 03:53:51 PM Pg16o0f40 Trans ID: LCV20232007691
Patient: Choates, Sandra E Page 3 of 3
‘locations, please visit www.NJConsumerAffairs.gov/meddrop.
BUR-L-000679-23 07/05/2023 03:53:51 PM Pg17o0f40 Trans ID: LCV20232007691
IMPORTANT NOTE: THE FOLLOWING INFORMATION IS INTENDED TO SUPPLEMENT, NOT
SUBSTITUTE FOR, THE EXPERTISE AND JUDGEMENT OF YOUR PHARMACIST OR OTHER
HEALTHCARE PROFESSIONAL. IT SHOULD NOT BE CONSTRUED TO INDICATE THAT USE OF
THE DRUG IS SAFE, APPROPRIATE, OR EFFECTIVE FOR YOU. CONSULT YOUR HEALTHCARE
PROFESSIONAL BEFORE USING THIS DRUG.
Patient: SANDRA CHOATES
PATIENT EDUCATION MONOGRAPH
Milrinone Lactate
Date: Wednesday, November 24, 2021
Rx: 399320
GENERIC NAME: Milrinone (MIL ri none)
COMMON USES: It is used to treat heart failure (weak heart).
BEFORE USING THIS MEDICINE: WHAT DO I NEED TO TELL MY DOCTOR BEFORE I TAKE THIS
DRUG? TELL YOUR DOCTOR: If you are allergic to this drug; any part of this drug; or any other
drugs, foods, or substances. Tell your doctor about the allergy and what signs you had, TELL
YOUR DOCTOR: If you have heart valve problems. TELL YOUR DOCTOR: If you have had a recent
heart attack. This is not a list of all drugs or health problems that interact with this drug. Tell your
doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins)
and health problems. You must check to make sure that it is safe for you to take this drug with all
of your drugs and health problems, Do not start, stop, or change the dose of any drug without
checking with your doctor.
HOW TO USE THIS MEDICINE: HOW IS THIS DRUG BEST TAKEN? Use this drug as ordered by
your doctor. Read all information given to you. Follow all instructions closely. It is given as an
infusion into a vein over a period of time. HOW DO I STORE AND/OR THROW OUT THIS DRUG? If
you need to store this drug at home, talk with your doctor, nurse, or pharmacist about how to
store it. WHAT DO I DO IF I MISS A DOSE? Call your doctor to find out what to do.
CAUTIONS: Tell all of your health care providers that you take this drug. This includes your
doctors, nurses, pharmacists, and dentists. Have blood work checked as you have been told by
the doctor. Talk with the doctor. Check blood pressure and heart rate as the doctor has told you.
Tell your doctor if you are pregnant, plan on getting pregnant, or are breast-feeding. You will
need to talk about the benefits and risks to you and the baby.
POSSIBLE SIDE EFFECTS: WHAT ARE SOME SIDE EFFECTS THAT I NEED TO CALL MY DOCTOR
ABOUT RIGHT AWAY? WARNING/CAUTION: Even though it may be rare, some people may have
very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical
help right away if you have any of the following signs or symptoms that may be related to a very
bad side effect: Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or
peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing,
swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
BUR-L-000679-23 07/05/2023 03:53:51 PM Pg18o0f40 Trans ID: LCV20232007691
Very bad dizziness or passing out. Fast or abnormal heartbeat. WHAT ARE SOME OTHER SIDE
EFFECTS OF THIS DRUG? All drugs may cause side effects. However, many people have no side
effects or only have minor side effects. Call your doctor or get medical help if you have
any side
effects that bother you or do not go away. These are not all of the side effects that may occur. If
you have questions about side effects, call your doctor. Call your doctor for medical advice about
side effects. You may report side effects to the FDA at 1-800-332-1088. You may also report side
effects at https://www.fda.gov/medwatch.
OVERDOSE: If you think there has been an overdose, call your poison control center or get
medical care right away. Be ready to tell or show what was taken, how much, and when it
happened.
ADDITIONAL INFORMATION: If your symptoms or health problems do not get better or if they
become worse, call your doctor. Do not share your drugs with others and do not take anyone
else's drugs. Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you
are told to do so. Check with your pharmacist if you have questions about the best way to throw
out drugs. There may be drug take-back programs in your area. Some drugs may have another
patient information leaflet. Check with your pharmacist. If you have any questions about this
drug, please talk with your doctor, nurse, pharmacist, or other health care provider.
Copyright 2021 UpToDate, Inc. All Rights Reserved.
All rights reserved.
Issue Date: November 3, 2021
This information should not be used to decide whether or not to take this medicine or any other
medicine, Only your health care provider has the knowledge and training to decide which
medicines are right for you. This information does not endorse any medicine as safe,
Preview
BUR-L-000679-23 07/05/2023 03:53:51 PM Pglof40 Trans ID: LCV20232007691 Dr. Ramesh Parchuri, MD Medical Expert Report: Ms.Sandra Choates 122 Danton Lane Mullica Hill Nj. 08062 DOB:10/09/1965 Congested Heart Failure. Case Number: BUR L000679-23 A. Materials Reviewed I, Dr. Ramesh Parchuri, MD licensed (MD033552E) have review the following materials in developing my opinions in this case: 1 Medical records, medical bills, operative pictures, and radiology films from Sandra Choates admission at Deborah Heart and lung Hospital from November 8, 2021, until October 20, 2021 2. Medical records, medical bills, and radiology films from Sandra Choate's treatment at Deborah Heart and Lung Hospital from November 3 As discovery is ongoing, I reserve the right to supplement the materials I have reviewed in rendering my opinions. T understand that Plaintiffs and counsel team is currently obtaining additional records and bills from several providers, including, but not limited to Deborah Heart and Lung Hospital. Capital Health, Pennsylvania University Hospital Therefore, I reserve the right to supplement this report to include opinions about those bills and that treatment. Tam a physician Dr. Ramesh Parchuri licensed to practice medicine in the state of Philadelphia, Pennsylvania. I currently have 2 offices stationed in the Philadelphia area. Ihave substantial experience as an M.D. including psychiatric services. Heart and Lung. Tam familiar with the standard of medical care I currently evaluate and treat patients for many conditions like Sandra Choate's conditions. B. Summary of Records. Sandra Choates presented to Deborah Heart and Lung Hospital on November 10, 2021, with signs and symptoms consistent with congestive heart failure, this included a history of nausea and vomiting, and right upper quadrant abdominal pain. Shortness of breath, chest pain, and weakness in the lower extremities. CT scan Based upon this information, the patient was admitted to the hospital and scheduled for observation and further testing. Along with a Swan-Ganz catheter procedure. BUR-L-000679-23 07/05/2023 03:53:51 PM Pg2of40 Trans ID: LCV20232007691 The surgery took place on November 10, 2021. Initially, the dissection was performed by a resident Deborah Hospital, who admittedly had little to no experience performing the procedure. However, after approximately 20 minutes of attempting, the operation was taken over by another doctor on the team. Following her operation, the patient’s clinical condition rapidly deteriorated. She underwent numerous radiological studies between November 10, 2021, and November 21, 2021, including, a HIDA scan, an ERCP, and an MRI. The results of these tests in addition to the patient’s lab work overwhelmingly confirmed that she had sustained a severe injury. In addition, Ms. Choates also was transferred to Capital Health Hospital with Stroke like symptoms due to being over Medicated with severe mental and physical trauma. She was then placed under a new physician's care team as follows. Capital Health 1. Abroo N Muzaffar 2. Kulpreet Barn, MD 3. Dr. Mazhar Despite this evidence, the patient was then transferred to a higher level of care at Deborah Heart and Lung Hospital until November 21, 2021. At that point, she required additional treatment, including antibiotic therapy, until she was able to undergo more testing and treatment. 1 It is my opinion breaches of the standard of medical care substantially delayed Ms. Choates treatment and proximately caused her to undergo additional treatment for months until she was able to obtain another doctor. I have reviewed all the medical records for the treatment Ms. Choates received at Devorah Heart and Lung Hospital. Based upon a reasonable degree of medical certainty, treatment, including administering the wrong medication breaches the standard of medical care. As discovery is ongoing, I reserve the right to supplement and/or amend my opinions. | understand that Plaintiff's counsel is currently obtaining additional records and bills from several providers, including, but not limited to Deborah Heart and Lung Hospital. Capital Health Hospitals, Pennsylvania Hospital Therefore, I reserve the right to supplement this report to include opinions about those bills and that treatment. Thereby certify that this report is a complete and accurate statement of all my opinions, and the basis and reasons for them, to which I will testify under oath. Signature: Du. Lumeah Parchuns, WP Dr.Ramesh Parchuri, MD License # MD033552E. DEA AP 2419338 NPI:1437224300. UPIN: E63643. CAQH: 1121939 BUR-L-000679-23 07/05/2023 03:53:51 PM Pg3of40 Trans ID: LCV20232007691 Page 1 of 2 Continuity of Care Document (Ambulatory Clinical Summary) Created On: November 5, 2021, 4:57pm Demographic Data Patient Name Choates, Sandra E Sex Female Birthdate June 29, 1955 Race Black or African-American Ethnicity Not Hispanic or Latino Preferred Language English Vi Detail “Visit Date / Time Facility | Location Visit Provider Contact Information| [Phone] November 5, 2021 DHLC Ambulatory ACS-EPS Clinic Kazemian, Pedram 609-893-6611 1:51pm — ~ Author Organization Address Deborah Heart and Lung Center 200 Trenton Road || Browns Mills, NJ, 08015 Phone |_(609)893-1200 Support Name Relationship Role | Address Phone Varjavand, Primary Care Personal t 219 N. Broad Street, 6th Floor (215)762-5037 Nielufar Provider Relationship | Tower Health - Cntr for Women | Philadelphia, PA, 19107 Care Team Providers Care Team Member Name Role Phone Kazemian, Pedram Attending Physician (609)893-6611 Plan Of CarepLease NOTE: The "Scheduled Date for Test" date on "Future Orders" items is the approximate date that your provider would like the testing/appointment scheduled: The appointment(s) has not yet been made. The Deborah Scheduling Department will contact you to schedule these appointments. If you are not contacted 2 weeks prior to the "Requested For" date, please call 609-621-2080 option 4 to schedule your appointment(s). Reported Medication(s) Current Medications Not Addressed this Visit Medication Directions Qty Ref. Start Date isosorbide mononitrate 60 mg tablet,extended release 24 60 mg orally daily March 5, br 2021 allopurinol 300 mg tablet 300 mg orally daily March 5, 2021 atorvastatin 40 mg tablet 40 mg orally daily March 5, 2021 colchicine 0.6 mg tablet 0.6 mg orally daily as needed March 5, for Pain, Mild | 2021 — — — | for gout_ BUR-L-000679-23 07/05/2023 03:53:51 PM Pg4of40 Trans ID: LCV20232007691 Patient: Choates,Sandra E Page 2 of 2 » insulin lispro (Humalog KwikPen (U-100) Insulin) 100 unit/ 36 units subcutaneously three March 5, mL subcutaneous pen times a day 2021 sacubitril 97 mg-valsartan 103 mg tablet 1 tab orally twice a day March 5, 2021 insulin glargine U-300 conc (Toujeo Max U-300 SoloStar) 80 units subcutaneously daily March 5, 300 unit/mL (3 mL) subcutaneous pen 2021 dulaglutide (Trulicity) 0.75 mg/0.5 mL subcutaneous pen 75 mg subcutaneously weekly October 11, injector 2021 clopidogrel (Plavix) 75 mg tablet 75 mg orally daily 30 July 15, 2021 potassium chloride 20 mEq tablet,extended release 20 még orally daily 30 October 27, 2021 magnesium 250 mg tablet 250 mg orally daily 30 July 23, { 2021 | cholecalciferol (vitamin D3) 25 mcg (1,000 unit) capsule 50 mcg orally daily 60 July 23, | 2021 | aspirin (Aspirin Low Dose) 81 mg tablet,delayed release 81 mg orally daily October 21, | 2021 sotalol 120 mg tablet 120 mg orally daily 30 October 21, 2021 metoprolol succinate 200 mg tablet,extended release 24 100 mg orally nightly 30 October 21, r 2021 bumetanide 1 mg tablet 1 mg orally daily 30 October 22, 2021 spironolactone 25 mg tabiet 25 mg orally daily 30 [0 October 22, 2021 PLEASE NOTE: The medications listed on the "Reported Medication(s)" section includes BOTH those medications ordered or changed by your Deborah Heart and Lung Center provider AND those medications identified by you (the patient) or your representative, Vital Signs Vital Reading Result Reference Range Collection Date/Time Height 163 cm November 5, 2021 4:31pm Weight 107.1 kg November 5, 2021 4:31pm Temperature 87.0 F 97.5 F-99.6 F November 5, 2021 4:31pm Pulse 91 BPM 60-100 November 5, 2021 4:31pm Respiration 16 RPM 12-24 November 5, 2021 4:31pm Pulse Oximetry 99 % 95-100 November 5, 2021 4:31pm Blood Pressure Systolic 100 100-140 November 5, 2021 4:31pm ~Blood Pressure Diastolic 70 60-100 November 5, 2021 4:31pm _Body Mass Index 40.3 November 5, 2021 4:31pm Notice This clinical summary is based on the medical information that was available in the Deborah Heart and Lung Center Electronic Health Record at the time of printing. For an official copy of your medical record, please contact our Medical Records department. Safe And Secure Medicine Disposal Unused medications that remain in your medicine cabinet are susceptible to theft and misuse. To prevent medications from getting into the wrong hands, New Jersey's Office of the Attorney General and Division of Consumer Affairs urge you to properly dispose of your expired and unwanted prescription medicine at a nearby Project Medicine Drop location.~ DROP OFF IS SIMPLE, ANONYMOUS AND AVAILABLE 24 HOURS A DAY~ 365 DAYS A YEAR, NO QUESTIONS ASKED. Simply bring in your prescription and over-the-counter medications and discard them in an environmentally safe manner. Always scratch out the identifying information on any medicine container you are discarding. For a list of Project Medicine Drop locations, please visit www.NJConsumerAffairs.gov/meddrop. BUR-L-000679-23 07/05/2023 03:53:51 PM Pg5of40 Trans ID: LCV20232007691 200 Trenton Road Browns Mill, NJ o8o15 Hearta Lung nd Center 609-893-1200 Page i of 3 Patient: Sandra £ Choates Acct Mi voco1asssoig Med Reo Mi M000320299 Locati aM - 3 n Primary Provider: Baiatsky, Igor — _ _. He, _ — oe. bate 10/ en a. - _ Patient Signature Page Patient Name: Sandra E Cho ates Guardian Name: The above-named patient and/or guardian has received the following Patient Instructions: Received with this Packet on 10/ 22/21 at 11:14 Heart Failure Sotalol (By mouth) Activity Restrictions or Add itional Instructions: Follow-up with electrophysi olo gy clinic in 1 week and received an appointment heart failure clinic in 1 week. remi nder or unable t ‘0 kee If you have not Department at 609-62 1-2080, p your appointment please call S options #4 cheduling Follow-Ups: Sandra E Choates has been referred to the following clinics/speciali sts for follow-up care: 1. Nielufar Varjavand + MD Date: 219 N. Broad Street, 6th Floor Tower Health - Cntr for Women Philadelphia, PA 19107 215-762-5037 Prescriptions: 1. bumetanide 1 mg oral daily #30 tab 1mg Tablet Refills: 0 2. metoprolol succinate 100 mg oral nightly #30 tab 200 mg tablet extended release 24 hr Refills: 2 BUR-L-000679-23 07/05/2023 03:53:51 PM Pg6of40 Trans ID :LCV20232007691 200 Trenton Road ‘owns Mille, NJ 8015, 609-893-1200 Page of 3 Patient Sandra & Acet Wwam, vo Leossole Med Ree uum 326299 Locatzon - 3 Main Primary Provider Balatsky, }gor we a Dave 10/20/21 a ce - 3. sotalol - 120 mg oral daily #30 tab 120 mg Tablet Refills: 3 4. spironolactone 25 mg oral daily #30 tab 25 mg Tablet Refills: 0 Follow-' Up Tests and/or Proced ures that have been ordered: ECG 12 lead EKG Routine Balatsky,Igor B-Type Natriuretic Peptide Routine Balatsky,Igor Basic Metabolic Panel Routine Balatsky, Igor Complete Blood Count Auto Diff Routine Balatsky,Igor Hepatic Panel Routine Balatsky, Igor Magnesium Routine Balatsky,Igor Sched EPS Re Eval Routine Balatsky,Igor Sched Heart Failure Re Eval Routine Balatsky,Igor Care Plan Goals: The ability to resume daily activities as detailed in the discharge plan and discharge instructions. Additional Documents Given: Patient Discharge Instructions Home Medications List BUR-L-000679-23 07/05/2023 03:53:51 PM Pg7of40 Trans ID LCV20232007691 200 Trenton Road rowns Mil, NI o8or5 ung Center 609-893-1200 Page of 3 Patien Sandra & Choares Acct 18: 8278 Bed Ree iam HOG 34 Location 3M 3 Hare Primary Provider Balatsky, tyor oa. ee Date 10/20/21 a va a I have read and understand the instructions given to mi je by my i caregivers, Sandra lO E Choates Print Patient Name a wc monn a oe Patient (or Guardian) Signature a en ee _ —. “Date/Time Caregiver/RN/Doctor Signature Date/Time — Printed on 10/22/21 at 11:14 BUR-L-000679-23 07/05/2023 03:53:51 PM Pg 8of40 Trans ID: LCV20232007691 Page 1 of 6 (AD) BY=\ovese-\a} Name: Sandra E Choates Acct Num: V00018958918 Med Rec Num: M000320299 Location: 3M - 3 Main Primary Provider: Balatsky,Igor Date: 10/20/21 Heart Failure WHAT YOU NEED TO KNOW: Heart failure (HF) is a condition that does not allow your heart to fill or pump properly. Not enough oxygen in your blood gets to your organs and tissues. HF can occur in the right side, the left side, or both lower chambers of your heart. HF is often caused by damage or injury to your heart. The damage may be caused by heart attack, other heart conditions, or high blood pressure. HF is a long-term condition that tends to get worse over time. It is important to manage your health to improve your quality of life. HF can be worsened by heavy alcohol use, smoking, diabetes that is not controlled, or obesity. ¥ ¥ mt, ity We eo i YNWN Ned KK Sa Normal Heart c HF Heart DISCHARGE INSTRUCTIONS: Call 911 if: ® You have any of the following signs of a heart attack: © Squeezing, pressure, or pain in your chest that lasts longer than 5 minutes or returns © Discomfort or pain in your back, neck, jaw, stomach, or arm © Trouble breathing © Nausea or vomiting BUR-L-000679-23 07/05/2023 03:53:51 PM Pg9of40 Trans ID: LCV20232007691 Page 2 of 6 {A} BY-\oYee=a1 Name: Sandra E Choates Fi Acct Num: V00018958918 Med Rec Num: M000320299 Location: 3M - 3 Main Primary Provider: Balatsky,Igor Date: 10/20/21 © Lightheadedness or a sudden cold sweat, especially with chest pain or trouble breathing Seek care immediately if: ® You gain 3 or more pounds (1.4 kg) in a day, or more than your healthcare provider says you should. ©® Your heartbeat is fast, slow, or uneven all the time. Contact your healthcare provider if: ® You have symptoms of worsening HF: © Shortness of breath at rest, at night, or that is getting worse in any way © Weight gain of 5 or more pounds (2.2 kg) in a week © More swelling in your legs or ankles © Abdominal pain or swelling © More coughing © Loss of appetite © Feeling tired all the time BUR-L-000679-23 07/05/2023 03:53:51 PM Pg10o0f40 Trans ID: LCV20232007691 Page 3 of 6 {AD} BY=\eve\sla) Name: Sandra E Choates Acct Num: V00018958918 Med Rec Num: M000320299 Location: 3M - 3 Main Primary Provider: Balatsky,Igor Date: 10/20/21 © You feel hopeless or depressed, or you have lost interest in things you used to enjoy. © You often feel worried or afraid. ® You have questions or concerns about your condition or care. Medicines: You may need any of the following: ® Medicines may be given to help regulate your heart rhythm. You may also need medicines to lower your blood pressure, and to get rid of extra fluids. ®@ Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Follow up with your healthcare provider or cardiologist as directed: You may need to return for other tests. You may need home health care. A healthcare provider will monitor your vital signs, weight, and make sure your medicines are working. Write down your questions so you remember to ask them during your visits. Go to cardiac rehab as directed: Cardiac rehab is a program run by specialists who will help you safely strengthen your heart. The program includes exercise, relaxation, stress management, and heart-healthy nutrition. Healthcare providers will also make sure your medicines are helping to reduce your symptoms. Manage your HF: ® Do not smoke. Nicotine and other chemicals in cigarettes and cigars can cause lung damage and make HF difficult to manage. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products. BUR-L-000679-23 07/05/2023 03:53:51 PM Pg1lof40 Trans ID: LCV20232007691 Page 4 of 6 LAD) BY-\eveye-\al Name: Sandra E Choates Acct Num: V00018958918 Med Rec Num: M000320299 Location: 3M - 3 Main Primary Provider: Balatsky,Igor Date: 10/20/21 ® Do not drink alcohol or take illegal drugs. Alcohol and drugs can worsen your symptoms quickly. © Weigh yourself every morning. Use the same scale, in the same spot. Do this after you use the bathroom, but before you eat or drink anything. Wear the same type of clothing. Do not wear shoes. Record your weight each day so you will notice any sudden weight gain. Swelling and weight gain are signs of fluid retention. If you are overweight, ask how to lose weight safely. Weigh Yourself Daily D> G oe r \ 4 \\ t Lf 4 ke > ®@ Check your blood pressure and heart rate every day. Ask for more information about how to measure your blood pressure and heart rate correctly. Ask what these numbers should be for you. ®@ Manage any chronic health conditions you have. These include high blood pressure, diabetes, obesity, high cholesterol, metabolic syndrome, and COPD. You will have fewer symptoms if you manage these health conditions Follow your healthcare provider's recommendations and follow up with him or her regularly. BUR-L-000679-23 07/05/2023 03:53:51 PM Pg12o0f40 Trans ID: LCV20232007691 Page 5 of 6 LAD) DY-\oeye-\al Name: Sandra E Choates Acct Num: V00018958918 Med Rec Num: M000320299 Location: 3M - 3 Main Primary Provider: Balatsky,Igor Date: 10/20/21 © Eat heart-healthy foods and limit sodium (salt). An easy way to do this is to eat more fresh fruits and vegetables and fewer canned and processed foods. Replace butter and margarine with heart-healthy oils such as olive oil and canola oil. Other heart-healthy foods include walnuts, whole-grain breads, low-fat dairy products, beans, and lean meats. Fatty fish such as salmon and tuna are also heart healthy. Ask how much salt you can eat each day. Do not use salt substitutes. Drink liquids as directed. You may need to limit the amount of liquids you drink if you retain fluid. Ask how much liquid to drink each day and which liquids are best for you. Stay active. If you are not active, your symptoms are likely to worsen quickly. Walking, bicycling, and other types of physical activity help maintain your strength and improve your mood. Physical activity also helps you manage your weight. Work with your healthcare provider to create an exercise plan that is right for you. e Get vaccines as directed. Get a flu shot every year. You may also need the pneumonia vaccine. The flu and pneumonia can be severe for a person who has HF. Vaccines protect you from these infections. Join a support group: Living with HF can be difficult. It may be helpful to talk with others who have HF. You may learn how to better manage your condition or get emotional support. For more information: @ American Heart Association 7272 Greenville Avenue Dallas, TX 75231-4596 Phone: 1-800-242-8721 Web Address: http://www.heart.org © 2017 Truven Health Analytics LLC Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of BUR-L-000679-23 07/05/2023 03:53:51 PM Pg130f40 Trans ID: LCV20232007691 Page 6 of 6 [AD DY-\evee-\0 Name: Sandra E Choates Acct Num: V00018958918 Med Rec Num: M000320299 Location: 3M - 3 Main Primary Provider: Balatsky, Igor Date: 10/20/21 A.D.A.M., Inc. or Truven Health Analytics. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you. BUR-L-000679-23 07/05/2023 03:53:51 PM Pg14o0f40 Trans ID: LCV20232007691 Page 1 of 3 Continuity of Care Document (Ambulatory Clinical Summary) Created On: October 13, 2021, 4:40pm Demographic Data Patient Name Choates, Sandra E Sex Female Birthdate June 29, 1955 Race Black or African-American Ethnicity Not Hispanic or Latino Preferred Language English Visit Detail Visit Date / Facility Location Reason For Visit Provider Contact Time Visit Information [Phone] October 13, DHLC Ambulatory ACS-Cardiac RO7.89 - Xu, Lei 609-893-6611 2021 2:45pm. Clinic Other chest pain Author Organization Deborah Heart and Lung Center Address 200 Trenton Road Browns Mills, NJ, 08015 Phone (609)893-1200 Support Name Relationship Role Address Phone Varjavand, Primary Care Personal 219 N. Broad Street, 6th Floor (215)762-5037 Nielufar Provider Relationship Tower Health - Cntr for Women Philadelphia, PA, 19107 Care Team Providers Care Team Member Name Role Phone Xu, Lei Attending Physician (609)893-6611 Reason For Visit cardiac re-evaluation Plan Of Care PLEASE NOTE: The "Scheduled Date for Test" date on "Future Orders" items is the approximate date that your provider would like the testing/appointment scheduled: The appointment(s) has not yet been made. The Deborah Scheduling Department will contact you to schedule these appointments. If you are not contacted 2 weeks prior to the "Requested For" date, please call 609-621-2080 option 4 to schedule your appointment(s). Reported Medication(s) Current Medications Not Addressed this Visit “Medication __| Directions _ — — _ — __ [Qty [ Ref. | Start Date _] BUR-L-000679-23 07/05/2023 03:53:51 PM Pg15of40 Trans ID: LCV20232007691 Patient: Choates, Sandra E Page 2 of 3 , isosorbide mononitrate 60 mg tablet,extended 60 mg orally daily March 5, release 24 hr 2021 allopurinol 300 mg tablet 300 mg orally daily March 5, 2021 atorvastatin 40 mg tablet 40 mg orally daily March 5, 2021 colchicine 0.6 mg tablet 0.6 mg orally daily as needed for March 5, Pain, Mild 2021 for gout insulin lispro (Humaiog KwikPen (U-100) Insulin) 36 units subcutaneously three times March 5, 100 unit/mL subcutaneous pen a day 2021 sacubitril 97 mg-valsartan 103 mg tablet 1 tab orally twice a day March 5, 2021 insulin glargine U-300 conc (Toujeo Max U-300 80 units subcutaneously daily March 5, SoloStar) 300 unit/mL (3 mL) subcutaneous pen 2021 dulaglutide (Trulicity) 0.75 mg/0.5 mL subcutaneous mg subcutaneously October 11, pen injector 2021 potassium chloride 20 mEq tablet,extended release 20 mEq orally daily 30 June 3, 2021 clopidogrel (Plavix) 75 mg tablet 75 mg orally daily 30 July 15, 2021 metoprolol succinate 200 mg tablet,extended 200 mg orally daily 30 July 15, release 24 hr. 2021 furosemide (Lasix) 40 mg tablet 40 mg orally daily 60 July 23, 2021 patient was instructed to take an extra dose for ankle swelling magnesium 250 mg tablet 250 mg orally daily 30 July 23, 2021 cholecaiciferol (vitamin D3) 25 mcg (1,000 unit) 50 mcg orally daily 60 July 23, capsule 2021 PLEASE NOTE: The medications listed on the "Reported Medication(s)" section includes BOTH those medications ordered or changed by your Deborah Heart and Lung Center provider AND those medications identified by you (the patient) or your representative. Vital Signs Vital Reading Result Reference Range Collection Date/Time Height 165 cm October 13, 2021 3:14pm Weight 110.7 kg October 13, 2021 4pm Temperature 96.9 F 97.5 F-99.6 F October 13, 2021 4pm Pulse 85 BPM 60-100 October 13, 2021 3: 14pm Respiration 18 RPM 12-24 October 13, 2021 3: 14pm Pulse Oximetry 98 % 95-100 October 13 2021 3: 14pm. Blood Pressure Systolic 122 100-140 October 13 2021 3: 15pm. Blood Pressure Diastolic 85 60-100 October 13, 2021 3: 15pm Body Mass Index 40.7 October 13 2021 3: 14pm Notice This clinical summary is based on the medical information that was available in the Deborah Heart and Lung Center Electronic Health Record at the time of printing. For an official copy of your medical record, please contact our Medical Records department. Safe And Secure Medi e Disposal Unused medications that remain in your medicine cabinet are susceptible to theft and misuse. To prevent medications from getting into the wrong hands, New Jersey's Office of the Attorney General and Division of Consumer Affairs urge you to properly dispose of your expired and unwanted prescription medicine at a nearby Project Medicine Drop location.~ DROP OFF IS SIMPLE, ANONYMOUS AND AVAILABLE 24 HOURS A DAY~ 365 DAYS A YEAR, NO QUESTIONS ASKED. Simply bring in your prescription and over-the-counter medications and discard them in an environmentally safe manner. Always scratch out the identifying information on any medicine container you are discarding. For a list of Project Medicine Drop BUR-L-000679-23 07/05/2023 03:53:51 PM Pg16o0f40 Trans ID: LCV20232007691 Patient: Choates, Sandra E Page 3 of 3 ‘locations, please visit www.NJConsumerAffairs.gov/meddrop. BUR-L-000679-23 07/05/2023 03:53:51 PM Pg17o0f40 Trans ID: LCV20232007691 IMPORTANT NOTE: THE FOLLOWING INFORMATION IS INTENDED TO SUPPLEMENT, NOT SUBSTITUTE FOR, THE EXPERTISE AND JUDGEMENT OF YOUR PHARMACIST OR OTHER HEALTHCARE PROFESSIONAL. IT SHOULD NOT BE CONSTRUED TO INDICATE THAT USE OF THE DRUG IS SAFE, APPROPRIATE, OR EFFECTIVE FOR YOU. CONSULT YOUR HEALTHCARE PROFESSIONAL BEFORE USING THIS DRUG. Patient: SANDRA CHOATES PATIENT EDUCATION MONOGRAPH Milrinone Lactate Date: Wednesday, November 24, 2021 Rx: 399320 GENERIC NAME: Milrinone (MIL ri none) COMMON USES: It is used to treat heart failure (weak heart). BEFORE USING THIS MEDICINE: WHAT DO I NEED TO TELL MY DOCTOR BEFORE I TAKE THIS DRUG? TELL YOUR DOCTOR: If you are allergic to this drug; any part of this drug; or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had, TELL YOUR DOCTOR: If you have heart valve problems. TELL YOUR DOCTOR: If you have had a recent heart attack. This is not a list of all drugs or health problems that interact with this drug. Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems, Do not start, stop, or change the dose of any drug without checking with your doctor. HOW TO USE THIS MEDICINE: HOW IS THIS DRUG BEST TAKEN? Use this drug as ordered by your doctor. Read all information given to you. Follow all instructions closely. It is given as an infusion into a vein over a period of time. HOW DO I STORE AND/OR THROW OUT THIS DRUG? If you need to store this drug at home, talk with your doctor, nurse, or pharmacist about how to store it. WHAT DO I DO IF I MISS A DOSE? Call your doctor to find out what to do. CAUTIONS: Tell all of your health care providers that you take this drug. This includes your doctors, nurses, pharmacists, and dentists. Have blood work checked as you have been told by the doctor. Talk with the doctor. Check blood pressure and heart rate as the doctor has told you. Tell your doctor if you are pregnant, plan on getting pregnant, or are breast-feeding. You will need to talk about the benefits and risks to you and the baby. POSSIBLE SIDE EFFECTS: WHAT ARE SOME SIDE EFFECTS THAT I NEED TO CALL MY DOCTOR ABOUT RIGHT AWAY? WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect: Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat. BUR-L-000679-23 07/05/2023 03:53:51 PM Pg18o0f40 Trans ID: LCV20232007691 Very bad dizziness or passing out. Fast or abnormal heartbeat. WHAT ARE SOME OTHER SIDE EFFECTS OF THIS DRUG? All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if you have any side effects that bother you or do not go away. These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-332-1088. You may also report side effects at https://www.fda.gov/medwatch. OVERDOSE: If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened. ADDITIONAL INFORMATION: If your symptoms or health problems do not get better or if they become worse, call your doctor. Do not share your drugs with others and do not take anyone else's drugs. Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets. Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area. Some drugs may have another patient information leaflet. Check with your pharmacist. If you have any questions about this drug, please talk with your doctor, nurse, pharmacist, or other health care provider. Copyright 2021 UpToDate, Inc. All Rights Reserved. All rights reserved. Issue Date: November 3, 2021 This information should not be used to decide whether or not to take this medicine or any other medicine, Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe,