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FILED: NASSAU COUNTY CLERK 11/05/2021 01:12 PM INDEX NO. 611506/2018
NYSCEF DOC. NO. 65 RECEIVED NYSCEF: 11/05/2021
EXHIBIT N
FILED: NASSAU COUNTY CLERK 11/05/2021 01:12 PM INDEX NO. 611506/2018
NYSCEF DOC. NO. 65 RECEIVED NYSCEF: 11/05/2021
Sat 09 Feb 2019 04:28:30 PM UTC Page 4 of 177
From HylaFAX Enterprise
Nick Roselli OT - Queens
61-18 190th Street
Fresh Meadows, NY 11365-2724 Daily Note /
Phone: (718)454-0842
Fax: (718)454-1704 Billing Sheet NR-OT
Patient Name: BONAVITA, DINO Date of Daily Note: 05/17/2018
Date of Birth: MHIH Injury/Onset/Change of Status Date: 07/21/2017
Referring Physician(s): GREENBERG, BURT M. MD Diagnosis: ICD10: Z47.89: Encounter for other orthopedic
aftercare, S66.300D: Unspecified injury of extensor muscle,
fascia and tendon of right index finger at wrist and hand level,
subsequent encounter, S66.304D: Unspecified injury of
extensor muscle, fascia and tendon of right ring finger at wrist
and hand level, subsequent encounter, M25.441 : Effusion, right
hand, not elsewhere
M25.641 : Stiffness of right hand,
classified, M79.644: Pain in right finger(s)
Surgery: (Date/Type) 1 0/31/201 7 extensor tendon repair of R. Date of Original Eval: 11/20/201 7
Visit No.: 46 Treatment Diagnosis: ICD10: Z47.89: Encounter for other
orthopedic aftercare, S66.300D: Unspecified injury of extensor
muscle, fascia and tendon of right index finger at wrist and hand
level, subsequent encounter, S66.304D: Unspecified injury of i
extensor muscle, fascia and tendon of right ring finger at wrist
and hand level, subsequent encounter, M25.441 : Effusion, right
hand, M25.641 : Stiffness of right hand,not elsewhere
classified, M79.644: Pain in right finger(s)
Insurance Name: MAGNACARE DIRECT PLUS
Subjective
Specific Physician Orders: Yes;
Before the Injury/onset/change of status date, the patient was able to perform the following activities:
Carrying, Moving & Handling Objects:
Current Functional Limitations:
Carrying, Moving & Handling Objects:
Home Health Care: No
Medical History: No Known Significant PMH To Affect Treatment
Complicating/Personal Factors: No Known Complicating Factors Affecting the Plan of Care
Mental Status/Cognltlve Function Appears Impaired? No
Objective
Precautions Surgical Precautions: Extensor Tendon Protocol
DOS; 10/31/17 ->s/p Right EDC III 2'repair -12+ Wks Post Op
Units
CPT® Code Direct Timed Codes
1
97032 E-Stim Manual
2
97110 Therapeutic Exercise
See Flowsheet
1
97112 Neuromuscular Re-Education
See Flowsheet
1
97140 Manual Therapy
1
97530 Therapeutic Activity/Kinetic
See Flowsheet
Units
CPT® Code Untimed Codes
1
97010 Hot/Cold Packs
Hot
1
97018 Paraffin Bath
1
97026 Infrared Light
CPT copyright 20 1 Z American Medical Association. All tights reserved.
Assessment
Assessment/Diagnosis: Pt shows PROM>AROM
Pt presents c mod stiffness of ring finger.
Pt seen for first time since April. of
Persistent pain c AA/PROM to digit. Gradual increase in GS/PS of hand.
ring finger.
Pt reports going for surgery for TFR to index.
Encouraged compliance c attendance
Patient Education; Continue HEP as instructed
00004
by
FILED: NASSAU COUNTY CLERK 11/05/2021 01:12 PM INDEX NO. 611506/2018
NYSCEF DOC. NO. 65 RECEIVED NYSCEF: 11/05/2021
From HylaFAX Enterprise Sat 09 Feb 2019 04:28:30 PM UTC Page 5 Of 177
Nick Roselli OT - Queens Patient Name: BONAVITA, DINO
61-18 190th Street Date of Birth:
Fresh Meadows, NY 11365-2724 Document Date: 05/17/2018
Daily Note/
Phone: (718)454-0842
Fax: (718)454-1704 Billing Sheet
Rehab Potential: Good
Patient Problems:
- Decrease ROM, Decreased grip strength, decreased MS of R. hand/Digits
- Experiences extreme pain in R. hand/digits which interferes c holding utensil,toothbrush, and manipulate fasteners
- significant Stiffness of R. hand/digits which interferes c holding utensil, toothbrush, and manipulate fasteners
Short Term Goals:
1 : (6 Weeks) | 55% | Increase ROM of R.hand/dig its to allow for better gripping of utensils, toothbrush, opening jars/bottles |
2: (6 Weeks) 1 50% j Increase Grip and Pinch of R. hand to allow ability to performsustained resisted activities in ADL/Work |
3: (4 Weeks) j 35% | Reduce pain and discomfort of R hand/digits to allow ability to perform tooluse, and sustained resistive
|
activities.
4: (4 Weeks) | 50% | Reduce stiffness of R. hand/digits, to improve abiltiy to hold utensils, toothbrush and fasten buttons |
5: (6 Weeks) j Goal Met | Pt will wear Orthosis F/T as required by Extensor Tendon Protocol |
Long Term Goals:
1 : (12 Weeks) | Goal Met | Pt. will follow Extensor Tendon Early Mobilization Protocol|
2: (12 Weeks) j 55% | Maximize functional use of R. hand during ADL/Leisure/Work j
Plan
Instructions: Progressing Patient Next Visit
Nick Roselli, OTR, CHT
License #005312-1
QOOOScally Signed by Nick Roselli, OTR, CHTonMay 17, 201 8 at 3:04 pm
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FILED: NASSAU COUNTY CLERK 11/05/2021 01:12 PM INDEX NO. 611506/2018 NYSCEF DOC. NO. 65 RECEIVED NYSCEF: 11/05/2021 EXHIBIT N FILED: NASSAU COUNTY CLERK 11/05/2021 01:12 PM INDEX NO. 611506/2018 NYSCEF DOC. NO. 65 RECEIVED NYSCEF: 11/05/2021 Sat 09 Feb 2019 04:28:30 PM UTC Page 4 of 177 From HylaFAX Enterprise Nick Roselli OT - Queens 61-18 190th Street Fresh Meadows, NY 11365-2724 Daily Note / Phone: (718)454-0842 Fax: (718)454-1704 Billing Sheet NR-OT Patient Name: BONAVITA, DINO Date of Daily Note: 05/17/2018 Date of Birth: MHIH Injury/Onset/Change of Status Date: 07/21/2017 Referring Physician(s): GREENBERG, BURT M. MD Diagnosis: ICD10: Z47.89: Encounter for other orthopedic aftercare, S66.300D: Unspecified injury of extensor muscle, fascia and tendon of right index finger at wrist and hand level, subsequent encounter, S66.304D: Unspecified injury of extensor muscle, fascia and tendon of right ring finger at wrist and hand level, subsequent encounter, M25.441 : Effusion, right hand, not elsewhere M25.641 : Stiffness of right hand, classified, M79.644: Pain in right finger(s) Surgery: (Date/Type) 1 0/31/201 7 extensor tendon repair of R. Date of Original Eval: 11/20/201 7 Visit No.: 46 Treatment Diagnosis: ICD10: Z47.89: Encounter for other orthopedic aftercare, S66.300D: Unspecified injury of extensor muscle, fascia and tendon of right index finger at wrist and hand level, subsequent encounter, S66.304D: Unspecified injury of i extensor muscle, fascia and tendon of right ring finger at wrist and hand level, subsequent encounter, M25.441 : Effusion, right hand, M25.641 : Stiffness of right hand,not elsewhere classified, M79.644: Pain in right finger(s) Insurance Name: MAGNACARE DIRECT PLUS Subjective Specific Physician Orders: Yes; Before the Injury/onset/change of status date, the patient was able to perform the following activities: Carrying, Moving & Handling Objects: Current Functional Limitations: Carrying, Moving & Handling Objects: Home Health Care: No Medical History: No Known Significant PMH To Affect Treatment Complicating/Personal Factors: No Known Complicating Factors Affecting the Plan of Care Mental Status/Cognltlve Function Appears Impaired? No Objective Precautions Surgical Precautions: Extensor Tendon Protocol DOS; 10/31/17 ->s/p Right EDC III 2'repair -12+ Wks Post Op Units CPT® Code Direct Timed Codes 1 97032 E-Stim Manual 2 97110 Therapeutic Exercise See Flowsheet 1 97112 Neuromuscular Re-Education See Flowsheet 1 97140 Manual Therapy 1 97530 Therapeutic Activity/Kinetic See Flowsheet Units CPT® Code Untimed Codes 1 97010 Hot/Cold Packs Hot 1 97018 Paraffin Bath 1 97026 Infrared Light CPT copyright 20 1 Z American Medical Association. All tights reserved. Assessment Assessment/Diagnosis: Pt shows PROM>AROM Pt presents c mod stiffness of ring finger. Pt seen for first time since April. of Persistent pain c AA/PROM to digit. Gradual increase in GS/PS of hand. ring finger. Pt reports going for surgery for TFR to index. Encouraged compliance c attendance Patient Education; Continue HEP as instructed 00004 by FILED: NASSAU COUNTY CLERK 11/05/2021 01:12 PM INDEX NO. 611506/2018 NYSCEF DOC. NO. 65 RECEIVED NYSCEF: 11/05/2021 From HylaFAX Enterprise Sat 09 Feb 2019 04:28:30 PM UTC Page 5 Of 177 Nick Roselli OT - Queens Patient Name: BONAVITA, DINO 61-18 190th Street Date of Birth: Fresh Meadows, NY 11365-2724 Document Date: 05/17/2018 Daily Note/ Phone: (718)454-0842 Fax: (718)454-1704 Billing Sheet Rehab Potential: Good Patient Problems: - Decrease ROM, Decreased grip strength, decreased MS of R. hand/Digits - Experiences extreme pain in R. hand/digits which interferes c holding utensil,toothbrush, and manipulate fasteners - significant Stiffness of R. hand/digits which interferes c holding utensil, toothbrush, and manipulate fasteners Short Term Goals: 1 : (6 Weeks) | 55% | Increase ROM of R.hand/dig its to allow for better gripping of utensils, toothbrush, opening jars/bottles | 2: (6 Weeks) 1 50% j Increase Grip and Pinch of R. hand to allow ability to performsustained resisted activities in ADL/Work | 3: (4 Weeks) j 35% | Reduce pain and discomfort of R hand/digits to allow ability to perform tooluse, and sustained resistive | activities. 4: (4 Weeks) | 50% | Reduce stiffness of R. hand/digits, to improve abiltiy to hold utensils, toothbrush and fasten buttons | 5: (6 Weeks) j Goal Met | Pt will wear Orthosis F/T as required by Extensor Tendon Protocol | Long Term Goals: 1 : (12 Weeks) | Goal Met | Pt. will follow Extensor Tendon Early Mobilization Protocol| 2: (12 Weeks) j 55% | Maximize functional use of R. hand during ADL/Leisure/Work j Plan Instructions: Progressing Patient Next Visit Nick Roselli, OTR, CHT License #005312-1 QOOOScally Signed by Nick Roselli, OTR, CHTonMay 17, 201 8 at 3:04 pm Powfeiaa by