Exhibit,Appendix: LUXAMA, PAUL vs CENTURION OF FLORIDA, LLC

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                                | CEROCUET. ZAM ANO FOR UKEEOKM. . COUMTY,.. EL OREDA

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Original: Inmate (plus one eofaylor Correctional ing itt
CC: Retained by official responding or ifthe response is #0 an informal grievance then forward to be placed in inmate’s file

This form is also used to file informal grievances in accordance with Rule 33-103.005, Florida Administrative Code.

Informal Grievances and Inmate Requests will be responded to within 15 days, following receipt by staff.

You may bin Sutras review of ou compat yeising fom DCI, Regs fr Adminitrative Remedy or Apa, ompltng the fam a
required by Rule 33-103.006, F.A.C., attaching a copy of your informal grievance and response, anid forwarding your complaint to the warden or assistant warden no
Inter than 15 days after the grievance is responded to. eee A 4]

DC6-236 (Effective 11/18)
Incorporated by Referenice in Rule 33-103.005, F.A.C.; v ¢

f ' DEPARTMENT OF CORRECTIONS |

/ OFFICE OF HEALTH SERVICES. .
é INMATE SICK-CALL REQUEST
/
ff “Date: Y- b--O Time:

InmateName:_Lugonra ,fae/ pee: LF 070 /
Housing assignment: D22/0L _ :
a Job assignment: Cort. gg eee

Problem:

Pass/pass renewal Low pres. : a Low 3
Date renee initials SP stamipSCowee oD

Medicati ral
seamen renew Date Triagedle Initials 5 Stamp SG ru:
Need information (explain):_. Date Seen*|© Initials Sc. Stamp $ Cond” 0 we
Levelt Emergent___. TH By
Mental Health Urgent _ :
Dental : ue : Level 3 Routine .

peo oe aK

_ Medical (explain): ZL bes oe be have my Ceug tetany fiat. as

Bor. 3, 2020 bit tovid- -le therged that. | Alou) Yee Skin biboisen rag *
Byes ace bee irivo, Masera teal and Caxse5 ing a Ponny odor.’ EF ead
+ Se te heder because. wg Fieger s ace il Subalen alot, onl” the,
Bhgecs AatZ plas ere. able, Ye Use DB bey nat fed ti pny een) i
of those, Fhagerd » Tle Eire natel fo wy doclabe. Limaer 6. parbivlly .
numb. Ler Lad Hyg. rebleia lerlore, Has Surgery.

When did problem/symptoms start?

Inmate Name. Luton y fu { . Distribution: Original—Nursing Supervisor © *
pc#_L703e1 Race/Sex_6/n Pink—Inmate (special housing only-otherwise
Date of Birth. 3-2-$0. destroy copy)

Institution. roy) or : = This form is not to be amended, revised, or altered

without approval by the Office Health Services-

“eve - | Apo. 5|

DC4-698A (Revised 6/11/08) Incorporated by Reference in Rule 33-402.101, F.A.C.. DEPARTMENT OF CORRECTIONS -°
OFFICE OF HEALTH SERVICES -

INMATE SICK CALL REQUEST 2

} Date: Gr ada KO ‘ime:

y /

f tomate Nene, Le Kou Z. ff, DOH, Lose,

{ce Housing assignment: J 222/ Ze. cae _*
/ ob assignment: Gra Ff
/ | Triage Level: (Circle 1)
fo bl . : : :
/ mee : _ bEmergent auigen Gems _— :
/ “Oo Passpasrnoval. . 8 pate seen farts Zny sxiseimp: ‘yt er AN
C1 = - Medication renewal Date Recieved ly 7 —feyor C.l.
( ‘Sx/Stamp:
1 ~—_— Need information (explain): ee a S-+—s- Connell, RN
. , . Taylor Cl.
oO Mental'Health © .
Oo Dental
Medical (explain): My Aawid! Heol hod the, Surgery bot
{ ec lad, bot RA fager whore Sea. Surgery flan"

done 53It deb vr Lhe ks wh C2 Fok tele _ .
: Ma fee hue. Lisێ folly extended oe ofhor fans ages.

Feed aite Plc

When did problem/symptoms start?_ Sprce_ ho Surgery

Inmate Name. : Distribution: Original—Nursing Supervisor
DC# : Race/Sex Pink—Inmaté (spectal housing only-otherwise
Date of Birth. : destroy copy)

{ Institution . “This form is not to be amended, revised, or altered

MS : without approval by the Office Health Services~;

— "Ta )

At ean mt a einen Trnnenarated by Reference in Rule 33-407.101. FACwoo

FLORIDA DEPARTMENT OF CORRECTIONS

- CLINICIAN’S ORDER SHEET . oe
USE BALL POINT PEN.ONLY-PRESS FIRMLY—NO MORE THAN CNE ORDER PER LINE.

ao Inpati
x |Bioo ts ([H Outpatient
List Allergies Here
Each | Bac hapa, Sulla
x Order as. |-*>,-
STAT | trae ‘ A

“A. _
Date/Time’ se Si
Notdd: \ear] 1
WY VY FT as
DC4714B awl IW Distribution: White Orginal—Pharmacy__ Canjary/-Medicdl Record
~ This form is not amended, revised, or altered without approval of the Chief of Health Services Administration.
‘ . 7 “ _FLORIDA DEPARTMENT OF CORRECTIONS
5 CLINICIAN’S ORDER SHEET
a <_ USE BALLPOINT PEN N ONLY. PRESS FIRMLY—NO MORE THAN ONE-ORDER PER LINE
Institution-7~ >, F LJ inpatient iV A765 4,
T Cay 2. Fy neem, | imename (VA, Keagl
Tin allecie = DC# £641
i Dorm
Initial
Each Diagnosis: * ~
star | spaced

Noted:__. = A os

DC4-714B (Revised 11/7/17) " Distfibution: White Original—Pharmacy 7 Canary—Medical epi J 7]F° >RIDA DEPARTMENT OF CORRE” ~10NS
CQNSi _ TATION REQUEST/CONSULTAN, ¢ REPORT

Specialty Service: 67/7/40 “© | Sending Institution: (_7 fret Date of Requests. ADS)
Reason(s) for consultation: Acuity: A
Evaluate and recommend diagnostic plan. Emergency :- . As LAS [-G:
Evaluate and recommend treatment plan, _. | Bit
Other (specity): . C|Routi . IG
. Visit Type...

: : Initi eT
Follow-up consults require justification i ULES f
*Optometry/Ophthalmology — attach DC4-702A Post.O) - [
Condition is (check one): [] Acute Trauma Acute lines

Pt be bee

Bho of ph eine ines (include onset, Present.

ee in A/F ieee dle te avd 4 ; -
Con bap Gl 2 ah poe. ie
Diagn re ratory; X-ray, Pei or omens) oe foe mF Bee

Failed (ew oe ape refs Pr ‘Sed, >

Frovialorial diagnosist T

Health Care Provider Signature/Stamp: .

roval Signature/Stanip:_”
AUTHORIZATION FOR SPECIALTY EVALUATION

CHO/Designee Aj

I, the undersigned, have had explained to me and understand that I require

which cannot be accomplished at _.

lalso understand that should hospitalization and/or surgery be necessary, a ‘Sepa

prior to such hospitalization and/or surgery. | therefore. consent.to be referred toa
or such other health sare goscaryh may
care services as may en cessaryh fo evalu:

ate omy health status.

Signature of Patient:,

Signature of Witness:

NAME: LUXAMA, PAUL

170301 B/M
: 03/02/80 AGE: 39

Alternative Treatment Plan:

vospaTe:__ J i fe. — Clase.

DC4702 (Revised 9/12/19) Page 1 of 2.

This form is not to be amended,

Comedy  t econ“ CONSULTANT'S REPOPT

‘NO > PROCEDURES) MAYBE PERFORMED WITHOUT PRIG..‘APPROVAL BY THE REGIONAL j
Le =MEDICAL L DIRECTOR or UTILIZATION MANAGEMENT. .

OMIM TEN6 USS vs Gucave.
PLACEMENT, 5 BEAM 4 Cecmsrmern

“De#: L70301—B/M
DOB: 03/02/80 AGE: 39

pt Consultant ‘Recommendations Reviewed: Date
re Clinician Name & Stamp
Recommendations Ordered

—< - Date Submitted to UM. -
“Bosra: Gieveea an Pape2 of: 3” oe Date/s Scheduled Completed Yes No__
: , See DC4-701 for Alternative Treatment Plan Yes__ No__

. This f form is not te be vps ‘Yevised, or altered without approval of the Chief of Health Services sami, | iS
a : : L 4,REC YION AND MEDICAL CEN IR
ADMISSION HISTORY AND PHYSICAL

same ame LLAXLING Haul DC#: 10 0. L

PHYSICAL EXAMINATION
Age: 40. Weight: es _T: P: R: BP:
General Appearance: Ov Ax, NAD

Skin/Lymph Nodes: WOW L

esa: NA “Bye: PERBLA .

Nek: Movil w]vo LAD

coewtang: CTP biloteza]

Back: UNIL
nex: 222 who m/e Ae
Abdomen: Ct) Boy 4 quadrats He. MIMD

wma fale LT howd, ROM Lt Teele Pngee.
Vascular: WNL

Newroogiat: Onpouoelabo

ASSESSMENT/DIAGNOSIS

“Adhesions ve Rophieo. Hee teudan. pt Lidac

“leg Talo pre tevolysis posite silieove

a p (acemodt J. Ryan, MD
Orth
Date: Staff Signature and Stamp: ¥P lige S °

(]OUTPATIENT

FLORIDA DEPARTMENT OF CORRECTIONS
RECEPTION AND MEDICAL CENTER-MSU.

OPERATIVE REPORT
NAME: LUXAMA, PAUL :
NUMBER: 70301
DATE: 11-06-20

PREOP DIAGNOSIS: Absent left, index finger, active range of motion to DIP
following previous FDS tendon transfer and FDP intércalary

graft,

POST OP DIAGNOSIS: Rupture of left, index finger FDS and FDP flexor tendon
reconstruction with extensive adhesions,

SURGEON: Justin Zumsteg, M.D.
ASSISTANT: Ricardo Hurtado,
ANESTHESIA: General.
PROCEDURE PERFORMED:
1. CPT Code 26442: Tenolysis to left, index finger FDS tendon through finger, palm
and wrist.
2. CPT Code 26442: Extensor tenolysis left, index finger FDP tendon through finger,
palm and wrist.

3. CPT Code 26180: Excision of left, index finger FDS tendon,
4, CPT Code 26180: Excision of lett, index finger FDP tendon.
5. CPT Code 26390: Placement of silicone rod in preparation for delayed teidon

. grafting.
6. CPT Code 26502: tet, index finger pulley reconstruction with use of palmaris
~ longus tendon graft.
ESTIMATED BLOOD LOSS: 20 ce.
SPECIMENS: None.
IMPLANTS: None,
COMPLICATIONS: None apparent.

INDICATIONS FOR PROCEDURE: Mr. Luxama is a-40-year-old male who previously was
_ ina knife fight, per his report, and had laceration of his flexor tendons of his index finger. He
previously underwent sepair and reconstruction with transfer of the FDS to the neighboring
middle finger FDS tendon and intercalary grafting to the index finger FDP tendon. Following
this, he did not undergo any hand therapy and states that he has not had any motion to the finger.

We discussed treatment options including both. operative and non-operative. He expressed a
strong preference for surgical management. We discussed different treatmerit scenarios, based on
"intraoperative findings, ranging from tenolysis to single stage tendon grafting to two-stage tendon
reconstruction, I discussed the specifics of this and described to the patient that in the event of
tendon reconstruction, it may even be possible that a third procedure for tenolysis would be
necessary. I discussed with him that there is possible impact on the remaining digits to his fingers
and that even with access to extensive therapy, he may not get functional motion back to the
finger, He states he understands this, but has a strong preference-to attempt to improve the
function of his finger, despite the somewhat unpredictable course that his treatment may follow.

[Ape-/2]

Continued page two:FLORIDA DEPARTMENT OF CORRECTIONS
RECEPTION AND MEDICAL CENTER-MSU

OPERATIVE REPORT
NAME: LUXAMA, PAUL
NUMBER: L70301
DATE: 11-06-20

Page two:

I reviewed the risks, benefits and alternatives. The risks-include but are not limited to infection,
damage to surrounding structures, wound complications, failure of repair or reconstruction,
failure to regain function, postoperative stiffness, postoperative pain, need for further surgery, and
ho guarantee of results. Patient understood and desired to proceed. Written, inforrned consent was
obtained,

PROCEDURE IN DETAIL: Patient was identified preoperatively and the surgical site marked
with a permanent marker. He was brought to the operating theater where he was positioned
supine on the bed. General anesthesia was induced, All bony prominences were well -padded-and
preoperative antibiotics were administered. He'was prepped and draped in the normal sterile
fashion. Final, preoperative timeout was conducted confirming the ‘operative site and the
operative intent sith all agreeing to proceed.

Patient's limb was exsanguinated with Esmarch ‘and a well-padded brathial tourniquet was
inflated to 250torr. The patient's previous Bruner iricision through the palm was incised with a
#15 blade. Full thickness subcutaneous flaps were elevated. This dissection was quite tedious
given the extent of scaring within the previously, multiple traumatized field with the original
injury and subsequently. surgical intervention. As there was extensive scarring present, the
excision was extended proximally and distally to attempt to get to.a more normal appearance and
to better define the anatomy. Tle Bruner incision. was extended distal all the way to the pulp at
the distal end of the finger. Full thickness subcutaneous flaps were’ elevated at the finger, taking,
care to identify and protect the neurovascular bundles. Here, the flexor tendon sheath was noted
to have quite a bit of scarring overlying it. The plane was dissected proximally and the previous
FDS tendon transfer was seen to have ruptured. The FDP tendon to the index finger was also
identified and noted to be encased in a densé tunnel of'scar. A separate longitudinal incision was
placed proximally to allow access of FDS and FDP tendons proximally. These were identified.
Traction was then placed on the FDP tendon of the index finger proximally, No motion was seen
distally. A thorough tenolysis of the FDS and FDP tendons was then performed through the
flexor tendon sheath of the finger. This was quite tedious given the extent of the scarring present,
Tenolysis was performed through multiple transverse windows in the flexor tendon sheath and
completed using a series of tenolysis knives, The tenolysis continued proximally through zone IIT
and the transverse carpal ligament was released overlying the. carpal tunnel to allow for access to
tendons through the carpal tunnel. Tenolysis was performed through the Balm,as well, which was
also quite tedious, Great care was taken to protect the surrounding neurdVascular structures,
Affer the tenolysis had been completed, the FDP tendon was grasped atraumatically and traction
applied proximally at its entrance to the fracture tendon sheath. Good glide was seen distally and
at the flexion of the PIP and DIP was observed, Traction was then placed on tle index finger at
the FDP tendon proximal to the wrist and minimal motion was present to the index finger, despite
good tendon glide. The precious intercalary graft to the index finger FDP tendon was assessed
and found to be incompetent, resulting in a large amount of pseudo tendon between the proximal
and distal index finger FDP tendons.

Continued page three:

OUTPATIENT

Lape. /3]FLORIDA DEPARTMENT OF CORRECTIONS
RECEPTION AND MEDICAL CENTER-MSU

OPERATIVE REPORT
- NAME: . LUXAMA, PAUL
NUMBER: 170301.
DATE: 11-06-20

Page three:

As. such, it was felt that flexor tendon: reconstruction would be necessary in order to provide
active range of motion to the index finger. The decision was therefore made to. perform excision
of the FDS and EDP tendons distally. The FDS and FDP tendons were each delivered to their
distal attachment sites and stiarply excised. Care was taken to leave a cuff of the FDP tendon
distally to facilitate future inset of the tendon graft. A size 4 mm, silicone Hunter Rod was then
passed proximally through the intact portion of the flexor tendon sheath and delivered into the
forearm with the use of a tendon passer, This was secuted distally to the bone using a 2.0 mm
screw. The Hunter Rod was trimmed to the appropriate length, After the tenolysis had previously
been completed, it was noted that given the extensive adhesions which were present, there was
now substantial portions of the flexor tendon sheath which were completely absent. The decision
was made to proceed with flexor tendon sheath pulley reconstruction. The palmaris longus tendon
was identified in the proximal wound and then harvested through two additional, small transverse
incisions, This was then cleaned of any: muscular attachments, The tendon was then passed
multiple times around the middle phalanx with the graft passing dorsal to the extensor
mechanism, It was then passed obliquely from the middle phalanx circumferentially around the
proximal phalanx to complete the. pulley reconstruction. While tension was applied to the
proximal and distal tendon graft, multiple 4-0 Fiber wire sutures were. utilized to secure the graft
to itself. The proximal and distal tails of the pulley reconstruction were each secured to the
periosteum. using 4-0 FiberWire Suture. That completed the pulley reconstruction. Proximal
traction was placed on the silicone rod and appropriate flexion was seén through the PIP ard DIP.
Final images were obtained on Mini C Arm Fluoroscopy confirming appropriate position of the
rod and of the screw distally. The tourniquet. was deflated. The wound was thoroughly irrigated
with sterile saline. Bipolar electrocautery was used to obtain hemostasis.

The skin was re-approximated using 4-0 Nylon suture. .50% plain Marcaine for local anesthesia,
Sterile dressings were placed. The patient was placed into a well-padded dorsal blocking splint.
The procedure concluded. Patient was allowed to emerge from anesthesia and taken to the. PACU
in stable condition. No intraoperative complications were noted.

POSTOPERATIVE PLAN: Paticnt will follow up in the Ortho Clinic in one week. He should

be immediately referred to hand therapy, He should begin working immediately on passive range

of motion exercises to the index finger to maintain passive mobility in anticipation of future

reconstruction to the left index finger. This should be cénsidered at approximately three
. months from this procedure today. ~

SEMd fu / QD
Justin’ Zimsteg, M.D.

JZ:pj Dz 11-06-20 Ts: 11-10-20
RMC Lake Butler, FL. DC4-715A

OUTPATIENT

Lr y]ry wp.

FLORIDA DEPARTMENT OF CORRECTIONS

Lo Chronological Record. of Health Care .
~. allergies: OU) ‘ noe ee oo. fos eo :
patetig. | T)Ci ofe—tnysical py nS oe : .
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Vo te. Motoralti rwtioN
Haining PROM, fo Oindex. SEE
: Ll eB comp aims evict?

—— —
Inmate Name L-UXQ u : S- Subjective Data
pc# LTO ace/Sex, O- Objective Data
Date of Birth. . A- Assessment of S and O Data

Institution LM C-MIGIN : P- Plan
oe _ L ~ + E-Education- oo 4

This form is not to be amended, revised, or altered without approval
by the Office of ti-alth Services-Administration

DC4-701 (Revised 10/31/08) : . : [7 App. h 6)- Allergies: Ou

Treatment Plan Discussed
Withrinmate
xX

at

= : with Ingrete
ré-arV__ lpnc. ln sees ts anree ¢ ee Otne an a

. 12 p _ *
Inmate Name Laxama U wie §- Subjective Data
pc#_L-10 ace/Sex, iM! O- Objective Data
Date of Birth - A- Assessment of S and O Data
Institution_| . P- Plan

cose Las eer ess >) EeEducation- ---- = - t :

.. This form is not to be amended, revised, or altered without approval -.
by the Office of ti -alth Services-Administration

_ 0042705. (Revised 10/84/08) -- oeso, 4 }

vd

FLORIDA DEPARTMENT OF CORRECTIONS
Chronological Record of Health Care... *

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| nM CME CIAM AAR
“BOK fend ie Nore—Phig D
“16 My AM Aer alitl Gore,* gy

. 3
wa AIM, D0 e tz
Y “oad Onn Cen PTE

S- Subjective Data

0-L70301 TM 01 06/19/07 }————— O- Objective Data

LUXAMA, PAUL —_——_ c
' - t of S and O Dat:
B/M DOB 03/02/1980 (40) __ A ssesemen of S and O Data
' E-Education - 4
‘This form is not to te amended, revised, or altered without approval

by the Office of ti -alth Services-Administration 7]

DC4-701 (Revised 10/31/08)pg fpeb no Note -Paaa theca
a1 Ot! Lew ae

AD Oxi ae ELPA MRE eS
A) Wh PAllSalk
yo t cla ee diaee plue diginieg afen)
DH ender ah 1d oA IO"Y
Br ~ PaivRicu eST V2 L
TL J
Cen 2a PF) Conme Glen PT Ac
Inmate Nam 0-1,70301 TMO1 06/19/07 Bnet ee
aia LUXAMA, PAUL fy Asveument ofS and OData
qetation B/M DOB 03/02/1980 (40) [P-Plan
E-Education

'DC4-701 (Effective 4/8/10)

Incorporated by Reference in Rule 33-602.210FLORIDA DEPARTMENT OF CORRECTIONS _
Chronological Record. of Health Care, ~~

DATES Lue Bak, Dia cal Theeaps se
lafezo lS el [ae ts aefthy belle’ —-
$3010. Tx Consikel OF PRom ty all Juels ot Bal st

BMG | ER Presi wd GT IF Mohd Wet

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Ledana/ Of, nd tab fo feeds |
: aN ae hae Sb bes | bot Ie R pena? Tob bil’

Tie ball a ADE Pr)

Pat F
Pease Siig

-» a7 fifeveo ETC: pemnela Thera

i JIS FeOC
B10 OTK or ql act per v4/9/R0a0
Ah VGN
XQ igMs @ ts nals pVyor:
Pi CONT,

Inmate,/Name E 76307 Loxton Pavol : : S- Subjective Data

pc#{ ] O30 { Race/Sex. ‘DI “A O- Objective Data
Date of Birth alBO . A- Assessment of § and O Data

Institution K MC - : P- Plan
E-Education- 4

‘This form is not to be amended, revised, or altered without approval
by the Office of H-alth Services-Administration

DC4-701 (Revised 10/31/08) - . lf Aop. / 9]x oo
l

4 ~ . “| 5
FLORIDA DEPARTMENT OF CORRECTIONS
__ Chronological Record. of Health Care a
Allergies: OY ty . fe a0 : J.
paren | U/C Nore= at Thay ye - wp
alBfqoxo| ai My-Whaer- ee palin oF UE
| OF PROM > Cart Noniet Tex
425 ____ Fiiblockiag ARorl 1 O2"— fies ened = e
y Ce same xo! .
Yo EEEM <6 dvs CUTS p VTatt

. Inmate Nai - §- Subjective Data
DC#. O- Objective Data |
Date of Birt A- Assessment of S and O Data
Institution. . P- Plan
E-Education- \

This form is.not'to he amended, revised, or altered without approval
by the Office of H -alth Services-Administration

DC4-701 (Revised 10/31/08) [/ Ap ¢- 20]FLOix{DA DEPARTMENT OF CORRECTIONS
Chronological Record of Health Care

Allergies:

Suit fpP sve),

DATE/TIME

Ii\s\20 (2 - Bore ee TAL lace

Awyidllin Sve x21) TAG D> on Glos

| leeperfen zoonie «to. 4 pes Te!

Fe Zh, urate palpits »

GQ Suns
Got

— T ‘Seniorpente

Inmate Name. ly Xeam2 PS \ S- Subjective Data

pc#_L7030 1 7 Race/Sex_ Oy O- Objective Data

Date of Birth,

Bl anj FO A- Assessment of S and O Data

Institution.

Rive P- Plan

DC4-701 (Effective 4/8/10) Incorporated by Reference in Rule 33-602.210 .

E-Education

[App21]FLORIDA DEPARTMENT OF CORRECTIONS»

“S38 : - CLINICIAN’S ORDER SHEET
USE BALL POINT PEN ONLY-PRESS FIRMLY—NO MORE THAN ONE. ORDER PER LINE
Institution: Date: ‘Time: -| () Inpatient
. (1 Outpatient _| Mmmate Name.
. List Allergies Here , . "| DC#
. +Dorm
Initial . Fe
Each Diagnosis:
Order as

STAT | transoribed

Date/Time Nurse Signature/Stamp : . Clinician Signature/Stamp Date/Time:
Noted: 2 _ __
“DOHTI4B Revised 11727) Distribution: White Original—Pharmacy Canary—Medical Record

This form is is not to be amended, reviséd; or altered without approval of the Chief of Health Services Administration. -
FLORIDA: ‘DEPARTMENT OF CORRECTIONS

CLINICIAN’S ORDER SHEET
. "USE BALL POINT PEN ONLY-PRESS FIRMLY—NO MORE THAN ONE ORDER PER LINE
Institution: Date: Time: J Inpatient
. “~ a Quipatent Inmate Name.
|. List Allergies Here .. © . . DC#.
Diagnosis:
3
‘Date/Time - _ Norse Signature/Stamp Clinician Signature/Stamp
Noted:, : = _ »
* “DC#714B ‘Revised WHA). Distribution: White Original Pharmacy Canary—Medical Record

‘This form is-not to be amended, revised, or altereid without approval, of the Chief of Health Services Administration.

“FLORIDA DEPARTMENT OF CORRECTIONS.
. ,CLINICIAN’S ORDER SHEET.
USEPA POINT PEN ONLY-PRESS FIRMLY—NO MORE THAN ONE ORDER PER EINE = _ :

! tution: — Time: (Inpatient
PRN TES ret] (So Aa NEF Onpacene_| Tomato? DENT
ist Allergies Here ° DC#_ TAL
| pone LUXAMA, PAUL
i < ( fy cl VU S Diagos  DE#LT0301
Order as Y : B/M DOB: 3/2/198

STAT | transcribed a
wee WES one

one p+ ind al) AL ‘
Hh -
Ty (Le. 9p
Nurse Signature/Stamp Clinigian Signature/Stamp DateTime:

DC4-714B (Revised 11/7/17) - - Distribution: White Orginal (Canary—Médical Redord

write fo. ben amend“STATE OF FLORIDA TS ]8E: toma, pat,

OCH: 170301 B/M

ae SRATING ROOM RECORD ** '208: 03/02/e0 AGE: 49

RAY: NONE
CODES APPLIED BY,
==> comina _N hs
SS toninet OC
Ro Safety Bap Se
() CONTAMINATED DIRTY A Bntse BREANRU
SURGEON(S) Rec X* Rash
ASSISTANTS) +H | 2 Abrasions
ANESTHESIOLOGIST(S) Uy —  Lacerations
CIRCULATOR q 5< Pressure Sore
SURGICALSCRUB| A Reddened = AY
ELECTROCAUTERY #: © pad —— .

POSTOP DIAGNOSIS 
REP: C ) SHAVE Down | Down (| OCYU
yy IRRIGATION: L Cope enh ton ti amount)
3 FOVDINETODING SCRUB .

)POVIDINE-JQDINE SOLUTION
FOTHER 5 WSUS
ANES.: (MAC GEN (/) EPI

PROSTHESIS/IMPLANTS: | | "

) SPINAL () LOCAL CO OTEER

YURGICAL POSITION: _.] 0) SUPINE () PRONE COUNTS: |. ()NA

)LT LATERAL CORTLATERAL * SPONGES #1(Q (CORRECT () INCORRECT

)LITHOTOMY COOTEER #2 ()CORRECT _() INCORRECT
: SHARPS #1 (FCORRECT _() INCORRECT

‘OSITIONAL ADDS(S): ON! #2_() CORRECT _() INCORRECT

)AXROLL  ( A ore

INSTRUMENTS: (CORRECT _() INCORRECT

)BEANBAG. (4PILLOWS

y

NURSE'S INITIALS

LOCATION OF PADS vt

IVFLUDS: _| TOTAL INFUSION:

)ELBOWS _() HEELS

()SACRAL

)POPLITEAL () OTHER
PECIMEN: | _ (4’NONE

() TAKEN BY SURGEON’

(71000 CCRL_(.) OTHER

DRESSING/DRAIN:

) SENT TO

i - ~e —t 7

)C&s

)PATHOLOGY

) OTHER

ERT OPERATIVE NOTES - A +00

(EDICATIONS:

22S EOD LUNG

Al
) Ft +0 OL WTS SI

a) Ou ONeSsH .

mT

Ll potential positioning injuries prevented? ope” | NO

RR via stregcher, 7 ) self ( ) roller VQ7\

LOG: VF eepy ()gectng () alert ()verbalping > -
Time. irculator.
spon? Anesthesiologist surgigal emu ¢ Other

in intact at all-cautery:ground sites? CBR NO:

me Out Observed Ces NO.

Jergens avoided and reactions prevented? . pas]. - NO- "Operative extremity () cold ()eool (Ywarm () pale (blue
‘eop & Postop diagnosis same as surgery? WES }-——NO ~ Good Capillary Refil? (4776s (-) n0

vecimens properly.to-lab?... pss = vn ss YES ‘Accompanied by: (SNE An Falogit

IRSE’S SIGNATURE: . (.

-948 (11102)

—— SIGNATURE: DR. 7 — _ 7] -
oO Stik [Aep-23 |]3FORMED WITHOUT PRIOR APPROVAL BY THE REGIONAL
ECTOR or UTILIZATION MANAGEMENT.

stall

’ Ny Ye 9220 5%
ma rf Ahn oved.

- Tnmat| 0-L70301 TM 06/19/07 Consultant Recommendations Reviewed: Date

. DCE! LuxaAMA, PAUL + | Clinician Name & Stamp
Dated B/M DOB 03/02/1980 (40) L Recommendations Ordered
Institi cL :
EOS DATE: _. * Date Submitted to U.M.
C4702 (Reviséa. 9/12/19) Page 2 of 2° . . Date/s Scheduled Completed Yes No__

See pean 01 for Alternative Treatment Plan Yes _ No

pat ©

y , This form is not: to be amended, revised, or altered without approval of the Chief of Health Services alteRIDA DEPARTMENT OF corricrid

_ OFFICE OF HEALTH SERVICES
INMATE SICK-CALL REQUEST .

Date: » Mf = 7-20 Time:

Inmate Name: Li kownra Ld DCH LAK

Housing assignment: kK BAL Job assignment:

oa dE

Do you need an interpreter for your Sick Call visit? (Sign language, Spanish, etc.)) [Yes FaNo
If so, what type:

~ Did you require assistance completing this form? (Blind, Quadriplegic, etc.) Lives Exo
If so, why: :

Problem:
- J _ ‘Pass/pass renewal

Medication renewal

oO
oO Need information (explain):
Oo

Problem with ADA/Disability equipment or supplies (explain the problem):

o Mental Health

Oo Dental

“Ln La Yesterday Z Aah Seg oa tH ait bs bard
Donat hee. nat: ot. iL. “My thease Las Ia
also. hs, E Need a No hand CPP 295
When did problem/symptoms start? Eversince Yow hbpka, we. grit az Loo.
Mrestooi

bevy gier-Sirce’

To be completed by Triage Nurse: \, Kevin Sears RN
Triaged by: (Print name and licensure) Se ame on Date) //= 03 -f020°@_O8FP
‘Assigned Triage Level: o Routine Urgent Oo Emergent
Date patient assessed by nurse: Signature/Stamp. of Nurse Completing Sick Call:
Inmate Name_Loxewes 1 Pace ( Distributién: Original—Nursing Supervisor
pc#__L70304 ____ Race/Sex YM Pink—Inmate (special housing only-otherwise
Date of Birth, FQ. . destroy copy)
Institution, WAC This form is not to be amerided, revised, or altered

without approval of the Chief of Health Services

nina [Ap.5)

NIC4-69RA (Revised 4/20) Incorporated by Reference in Rule 33-402.101, F.A.C.NSULTANT’S REPOR? -

PERFORMED WITHOUT PRIOR APPROVAL BY THE REGIONAL
DIRECTOR or UTILIZATION MANAGEMENT. =

-| Consultant Recommendations Reviewed: Date

Bo
Dat 0+L70301 ‘M1 06/19/07 Clinician Name & Stamp

Ins LUXAMA, PAUL’ Recommendations Ordered
‘EO, B/M DOB 03/02/1980(40) Date Submitted to UML
PA. . Date/s Scheduled Completed Yes No__

See DC4-701 for Alternative Treatment Plan Yes i

‘This form is not to be amended, revised, or altered without approval of the Chief of Health Services vad VF 76]AUDIGUS

Hearing Test Report

145 W 27th Street, 8th Floor, New York, NY 10001
855-971-0451 | contact@audicus.com

Patient Name & Identifier #: PAUL LUXAMA L70301
Patient Age: 40

Unique Hearing Test ID: HR-2012-146840

Patient Location: RMC

Date of Test: 12/9/2020

Hearing Test Results:

Side | 500Hz | 1000Hz | 2000 Hz | 4000 Hz | 8000 Hz PTA Qualified Status
Left 70dB | 70dB 75dB | 60dB | 55dB 69 Test
Ear . Pending Completed

: Retest 7
Right | 65dB | 60dB 70dB | 55dB | 40dB 63. Test
Ear Completed
Reviewed By: Marianne Cramer, AuD Date Review: 12/2/2020 8:39 AM

0 fr Cr eam BY
Testing Notes: This test was successfully completed. Please retest as the inmate says the
hearing in his right ear is OK. Both ears show a similar loss. Thanks.

Testing Requirements:

* Device volume is set to 50%

e Audicus equipment is being used with each patient

¢ Patient is being tested in a reasonably quiet space

Cc

Assessment outputs listed above will be used to program a hearing aid to the specific patient's hearing curve. It's the responsibility
of the test administrator to conduct the assessment with the testing requirements. The Audicus hearing test assessment is based on
“meeting the above testing requirements to ensure a controlled environment. When the assessment is administered under these
testing requirements, (1) the comfort interval for falling within equivalent hearing loss ranges (ie. World Health Organization (WHO)
Standards) as stated above is 90% and (2) the comfort interval for falling within +/-1 of the WHO ‘hearing loss bracket is 100%; the ~
variability can be addressed by providing multiple adjustments of +/-10 dB via the volume button on the device.

*The following results are based on the assessment of the Audicus Online Hearing Test

[422AUDICUS

Hearing Test Report |

115 W27th Street, 8th Floor, New York, NY 10001
855-971-0451 | contact@audicus.com

Patient Name & Identifier #: PAUL LUXANIA L70301
Patient Age: 40

Unique Hearing Test ID: HR-2012-147199

Patient Location: RMC

Date of Test: 12/16/2020

Side | 500 Hz [1000 Hz | 2000 Hz 4000 Hz | 8000Hz | PTA |: Qualified Status
[Left | 75dB | 65qB | 70dB | 55dB | 55qB-] 66 Test
Ear —_— | Pending Completed
Right | 650B | 60dB | 35¢B | 45dB | 45aB | 55 | ENT Test
Ear _|. Completed
Reviewed By: Marianne Cramer, AuD Date Review: 12/16/2020 3:21 PM

Mame Cheney

Testing Notes: These results show hearing discrepancies between each ear. Is there a record of .

his surgery from the surgeon who did the procedure? Please check with site provider. If the
surgeon clears him, he is approved. Both ears have similar hearing loss.

Testing Requirements:

e Device volume is set to 50%

¢ Audicus equipment is being used with each patient

e Patient is being tested in a reasonably quiet space

Cc

Assessment outputs listéd above will be used to program a hearing ’aid to the specific patient's hearing curve. It's the responsibility
of the test administrator to conduct the assessment with the testing requirements. The Audicus hearing test assessment is based on
meeting the above testing requirements to ensure a controlled environment. When the assessment is administered under these
testing requirements, (1) the comfort interval for falling within equivalent hearing loss ranges (ié. World Health-Organization (WHO)
standards) as stated above is 90% and (2) the comfort interval for falling within +/-1 of the WHO hearing Joss bracket is 100%; the
variability. can be addressed by providing multiple adjustments of +/-10 dB via the volume button on the device,

“The following results are based on the assessment of the Audicus Online Hearing Test

4¢p-29)a4
FLORIDA DEPARTMENT OF CORRECTIONS
Chronological Record of Health Care -.

Allergies: So (fev

DATE/TIME Co ee
ulielee lor seae tne Stet Gut fstaess theoat cs beeen
“opm [si My (cer ene Frets lek its Bleeds a
D\ALe-Fe-4o  136/er
er i e6 NOG Roo -fEc8
“Chemis 9 ei REORFRSERD. + pe:
- —— WL L R. Kevin Sears RN
Zz AZ CEE] anc
Inmate Name. Loxemer Paw : S- Subjective Data
pc#__} 16254 __ Race/Sex_ QM O- Objective Data
. Date of Birth, 3{240 : A- Assessment of S and O Data
Institution AE P- Plan
E-Education
DC4-701 (Effective 4/8/10) Incorporated by Reference in Rule 33-602.210

| Yiee i]pee rl
FC DA DEPARTMENT OF CORREC\ NS:
RECEPTION AND MEDICAL CENTER-MSU 2

OPERATIVE REPORT -  Ureyy
- RR py
NAME: | LUXAMA, PAUL
| NUMBER: 2. 0.» “L70301°,
DATE: ‘ 01-29-21 =»:

PREOP DIAGNOSIS: . Infected Hunter Rod with draining sinus; left index |
. finger. .
POST OP DIAGNOSIS: © Same.

SURGEON: James Ryan, M.D.

ASSISTANT: . Ricardo Hurtado.

ANESTHESIA: Local MAC, Dr. Ong.

PROCEDURE: Removal of hardware and portion of rod, left index

"finger, with debridement of wounds.

COMPLICATIONS: None.

OPERATIVE NOTE: Patient under satisfactory MAC anesthesia. The left hand was prepped
and draped in the usual sterile fashion. A block was performed at the level of the metacarpal head
to block the index finger with 10cc of a mixture of half 1% Lidocaine and half 50% Marcaine.

The skin incision was on the volar surface of the index finger, starting at the DIP joint on the
volar surface of the crease, in line of the previous scar. A 1 centimeter incision was made in each
direction. The granulation tissue was removed. There was a draining sinus which extended down
to the Hunter Rod, but did not appear to affect the joint. This was near the screw which had been
attached into the distal phalanx. The screw was removed and the metal portion of the Hunter Rod
was removed. The remaining portion of the Hunter Rod was left intact, as there was no extensive
granulation tissue over the Hunter Rod. These areas were thoroughly irrigated and debrided.
There was no sign of any osteomyelitis where the screw was placed in the distal phalanx. After
thorough irrigation, the wounds were closed with 4-0 Nylon. Bulky, soft tissue dressing was
applied. Estimated blood loss was minimal. Tourniquet time was 30 minutes. No intraoperative
complications.

James D,

IR:pj

D: 01-29-21 -01-21
RMC Lake Butle

DC4-715A,

. lar. 2r o
FLOKWWA DEPARTMENT OF CORRECTIV.:S
Chronological Record of Health Care:

Allergies: Ss EA

“DATE/TIME eae RECEPTION AND_ MEDICAL CENTER

ila : GHRONIC CLINI r
youn: Nee er Ones os “Ga ac fuss ‘Egeon “Soret -
Tf Pe GR pp: 14)/43 “wrt

: : __R Kevin Sears RN
STAMP / SIGNATURE __ BMC:

jalsiapo 1S we eMN (atdatart ne pnd’ ¢ Cheong we Delon PJ1O ge

hend cmg it en 40 Bie cownsyay Ob nappa Deore se Aue —
emote en ae Dalpracen - Pi denus ow hun, te the DIY

cen, OE clo Date s .

):

Fio}p- an Nex jangts & pen wee apes “DSeecs
Brronc pi deen Dato? cit ptr P

cae eimigeyes EP»
eo ee esi Se
yo BMC :
ws WY ——— T. Carley
. APRN

S- Subjective Data

in _ :

Di0-L70301 T™ 01 06/19/07 O- Objective Data

Di LUXAMA, PAUL { . O pesesement of S and O Data
Inp/M DOB 03/02/1980 (40) _ P- Plan

: E-Education

DC4-701 (Effective 418/40) Incorporated. by Reference in Rule 33-602.210 : [;
ep)o My

* RIDA DEPARTMENT OF CORRECT! i

OFFICE OF HEALTH SERVICES
INMATE SICK-CALL REQUEST.
Date //- AF ~ SO Timex : _ :
: inmate Name: Lew fo Lokawnas ‘De#: : LIZ,
Housing assignment: A BATL: - Job assignment:_- C7

Do you need an interpreter for your Sick Call visit? (Sign language, Spanish, etc.) Oves Jao
If so, what type:

Did you require assistance completing this form? (Blind, Quadriplegic, etc.) [Yes [Zino
If so, why: :

Problem:
oOo Pass/pass renewal

Medication renewal

Oo
o Need information (explain):
o

Problem with ADA/Disability equipment or supplies (explain the problem):

Mental Heat Er Ra gor
Cl Dental ,

Medical (explain): $4i7/ have a shecve Erdig thet boc raf healed
Conerplelel, frend my Stergtenss. and is sf 1) [ees

When did problem/symptoms start?_EvgrSiree ary, Steger E

To be completed by Triage Nurse:
Triaged by: (Print name and licensure) = R. Kevin Sears RN, (Wate) _(¢ | 2s xo
Assigned Triage Level: §@=Routine o Urgent oo Emerge MC Kevin Sears RN
Date patient assessed by nurse: _\2-\\ Signature/Stamp of Nurse Completing Sick Call: _p| i | RM
Inmate Name, Distribution: Original—Nursing Supervisor Ic
DC#. Race/Sex, Pink—Inmate (special housing only-otherwise
Date of Birth, destroy copy)
Institution, . This form is not to be amended, revised, or altered .
without approval of the Chief of Health Services
Administration.

DC4-698A (Revised 4/20) Incorporated by Reference in Rule 33-402.101, F.A.C. [‘p. 33)rr RIDA DEPARTMENT OF CORRECTIOF “i
OFFICE OF HEALTH SERVICES

INMATE SICK-CALL REQUEST
Date:__/-2 = 49 Titne:__-
Inimate Name: Lvkanta. fal. : £0 Sof
“Housing assignment: A G2Z/ 7e— “Sob assignment: C74

Do you need an interpreter for your Sick Call visit? (Sign language, Spanish, etc.) [Yes JaNo
Tf so, what type:

Did you require assistance completing this form? (Blind, Quadriplegic; etc.) (Yes ae
If so, why: ———

Problem:
o Pass/pass renewal

Medication renewal

Oo
‘Oo Need information (explain):
o

Problem with ADA/Disability equipment or supplies (explain the problem):

oO Mental Health

Dental

o Medical (explain):_peed! to See. lector may Pree 1 hl! Soller
and perv. ending S_ S41 Shh biby oer. Feel Sova. yar andl
Liscon tyre trom e2 Kod othe. placed.

When did problem/symptoms start?__Sinee ety L- Surpes

Zz

To be completed by Triage Nurse: NeD* Kevin Sears RN

Triaged by: (Print name and licensure) RMC on (Date)_ 72-28-2012 (2_oser

Assigned Triage Level: fARoutine = a Urgent oO Emergent evin Sears RN
ignature/Stamp of Nurse Completing Sick Call: J

Inmate Name, Distribution: Original—Nursing Superisor

DC#. Race/Sex. Pink—Inmate (special housing only-otherwise

Date of Birth, destroy copy)

Institution, This form is not to be amended, revised, or altered
without approval of the Chief of Health Services

Administration.

DC4-698A (Revised 4/20) Incorporated by Reference in Rule 33-402.101, F.A.C. |; ff t . 33]ate were

: f..
FLGxiDA DEPARTMENT OF CORREC1ONS
Chronological Record of Health Care

Allergies: Ce

DATE/TIME _ _ . .

talilac [eb seeas mo srece Gxt
0938 [Si Sy wetve eeQog ts strocmes ov + _

OLS. 416-16 AY - B= tale __

AL© pled mB Gugee with ncoteD pe&eO “Debate
Be6A Sieposem Chen Sone (eee - Ne Opprsmg cs pers
SeSorbS ln pect. _

P= BaiDends Beertiacme tute CSF tm pyeat ne
+o be setae. :

Es COocmrbe® fo be ames oe pers SiS cE BAssceeso$
4 Prerteacen # 40 €6 pect. to Me Dre AS mEEDED -

Verha(ezes: seeds die Dng ei

—— SF ren HT
_RMG

=

tf
Inmate Name. { S- Subjective Data
DC# _'__ Race/Sex, B\ (* O- Objective Data
Date of Birth Zig A- Assessment of S and O Data
Institution. Are P- Plan

E-Education

DC4-701 (Effective 4/8/10) "Incorporated by Reference in Rule 33-602.210 [, 3SE SP reas. . TR er eee ee

0-L70301 TM 01 06/19/07 MEDICAL CENTER.

LUXAMA, PAUL RY AND PHYSICAL :
B/M DOB 03/02/1980(40) ”
Inmate Name DOR
PHYSICAL EXAMINATION

ages 4 wer 100. % B Rr BR;
Genirit Appearance: (Vy N23, MAD _.
Skin/Lympih Nodess_ UNL

ent’ NUT - PCRLLA..
pot

Chesi/Enngs: Y /
“pede WNL
Pei. Gr) 05 x 4 quadealts, s_seft, ATID

=e "ga Fads Zaalla., Wan
Vasentar:__[

Neurological Uae

Siete dunce UF ae ge
oe wood ancl Comoe sooo Lapt inde

printers, a

Pcl Seon
Dates ta Site ind Stems fhe Latina

BC4-0030- (12/05) Page 2 of 2

[ App. 35). . 1
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| aie, Sel cen a
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: REF 212042 [LOT] 6L18920 Gy2ez2-08-31 ,

MICRO QUICKANCHOR® Plus (#4/0) Suture

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|

[p26]» NOPWRIGHT Wight retealogy ne

HSA
PT400000 & 2027-08.06
1661885 4] 2019-08-08

HUNTER Passive Tendon Implant

Size: 4mm x 26em
ATTACH TO PATIENT RECORD @) fraxfe]

D 22x mm Corteal sc(Ri
AbLO-0% -0|

Ap. 372/12/2021 3:31 PM -> |X 46332 Final Report Rage 1 of 1
: é

i
_¢ [ \ * de ( . : 46332-RMC - MAIN AND HOSPITAL
. Tl ent sare ‘SOUTH EAST REGION “7765 S COUNTRY RD 231
. sm 4400 140TH AVE
IM A G IN G CLEARWATER, FL 93760 LAKE BUTLER, FL 320545721
(200) 940-0869"

Claim Number : 34244216

Date of Service : da12/2021 me - MN L70301
Patient Name : LUXAMA, PAUL ‘DOB: 09/02/1980 Gender. M
Room::
Ordering Provider: THOMAS F WINTERS. MD - (NPI: 1073629234)
interpreting Physician: CONSTANTINA. LAMPROPOULOS, MD - (NPI: 191294274
Report Date: 2/12/2021 3:27:04 PM
RADIOLOGY REPORT

HAND MINIMUM 3 VIEWS, LEFT
Comparison: The previously seen surgical screw compared to 1/8/2021, has been removed.

Results: Left hand .

There is mild soft tissue swelling. There aré no significant degenerative changes.
There is no bone abnormality to suggest a recent fracture or dislocation.
Conclusion: Unremarkable hand.

Electronically signed by CONSTANTINA LAMPROPOULOS, M.D. 2/12/2021 3:27:04 PM EST.

RECEIVED

FEB 15 2021
RMC RADIOLOGY

CONFIDENTIALITY NOTICE: This report (including any accompanying files or documents) is intended for the use of TridentCare or the Intended recipient, and may
contain information that is privileged or otherwise confidential. If you are not the intended recipient, or person responsible for delivering this report to the intend
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number and the date and destroy this report (including any accompanying files or documents).

If you have questions regarding these results or would like to consult with a Rely Radiologist please call 972-468-3590 Page 1 of 1

[v.28]
\

| —1

“Ero-t7oa0: ™
LUXAMA, PAUL,

06/19/07
Dt B/M DOB 03/02/1980 (40)

wii

ire farim tent to be amendeil'revised. or altered without aparoval af the Chief of Health Services Aimintstrafigh.

Consultant Recommendations Reviewed: Date _
Clinician Name & Stamp
Recommendations Ordered.

Date Submitted to UML.
Date/s Scheduled «Completed Yes ____ No

See DC4-701 for Alternative Treatment Plan Yes rT

[a4]___ been answered fo my

(LUXAMA, PAUL ZPARTMENT OF CORRECTIONS :
1B/M DOB 03/02/1980 (40) AT, PROCEDURE(S) AND ANESTHESIA
Patient ssdmmeDate__ SI VA

vec enaninZze rp [EH ff tno sot) LOE

explained fo ms. Tqnderstand snch risks nmi Tconseat to the proposed operation and/or procodsire(s). ‘The answers Lhave given to all
rr eE thd of mo ae toe the best of any knowndge an bre not witeld sry s-bemsscn .

vo piyriia as lined oe sof compos cooing ing om aro of is sis © b> PES
ipslnding but not limited to i i sae or ven Gea despite the prooodnre being performed in socordmoe with en acoepist
standard of practice. Saeed that tho explanation fiat I ave reonived is not exhamtive and there m=y bs other, more remote
risks, I have had the opportmity to a eatin rogming the proposed operation ml procedae(s) and all my qpestions have

J amfhorize md direct the surgeon and/or bis associates or assistants i provide euch additional services for me esis deemed.
{morc en tot So rT tating, bt sted fe pefomnene af pcos fvetvingrlony sn ASSIST

omar te niminton of lon, rpm ot es emt mi eof refs, seats en mein ws dome
advisable with the exception of .

[have been advised of ho risks snvotwed with the adzinistration or tramsfosion of blood and/or blood prodacts, end I consent to the

_prosedares(), ia accomdmoe with the medisal staff roles and regulations.
For thie purpose afadvancing modival edocaton, Loonsiat tothe aimittmes of approved obsarvers to he operaing TOR.

tify foat I heve read or have hati read to me fis Consent for Operation Procedure(®) and Anesthesia form and I fully

the ") ition oS

Fitness Sipskiure/Date/Time

*). Ryan, MD
. ht Orthe

DC# :
Date of Birth| without approval of the Deputy Director of Bath
Teatition. DOB 03/02/1980 (40) eres Afcinstraticn

LUXAMA, PAUL

FOR USE BY RMC.ONLY _ce A

DEPARTMENT OF CORECTIONS
RECEPTION MEDICAL CENTER
SURGICAL PATIENT DISCHARGE PLANNING SUMMARY

Date: o- oO). Bow:
Tnmat NAME! LUXAMA, PAUL

Patient's Name: ___ DCH: L70301 | -B/M _
Operative Procedure: DOB: 03/02/80 AGE: 39 _

POSTOPERATIVE IN STRUCTION: iS:

YOU ARE URGED TO FOLLOW CAREFULLY THE INSTRUCTIONS WHICH ARE CHECKED ON
THOS SHEET.

27 Observe operative site for excessive bleeding, x Observe affected extremity for
(Slow general oozing that saturates the dressing circulation or nerve impairment:
completely or frank bright red bleeding:) in Change in color
either case apply pressure to the area, elevate it if Numbness or tingling
possible and go the the Urgent Care. Coldness
. Increased Pain

p> Observe operative site for signs of infection: If these symptoms persist go to the
Increased temp. 101 Urgent Care Immediately. .
Increased pain : .
Redness Dy Keep operative area clean and dry. unt) Seon
Swelling : Do not remove dressing unless en
Foul Odor or drainage, instructed to do so by physician. De
If these symptoms appeat go to the Urgent Care
immediately, = Keep operative site elevated for

coe 12-24 hours on extra pillow
_ Apply ice to operative site x’s__—_hirs.
— May change nasal drip pad as needed,
_ No activity
} _ Take sitz baths _x’s daily and

_ Avoid sneezing or blowing nose. : after each bowel movement.
If any problems occur please go to the Urgent Care — Keep operative site dry,

i? or OPC immediately. It is your responsibility to
follow discharge instructions

YP - gotlow Up Appointment ,

luestions, please tell immediately. If is your Tesponsibility to follow.

OTHER INSTRUCTIONS FOR FOLLOW-UP CARE: “an Mods x ,

A ckupo, “Remain in Sohn © all Imos

pe tual copa. aa,
0

2 »
wenn O IVY INDate:

AN

U.S. MEDICAL GROUP
SURGICAL