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HomeMy WebLinkAboutCC 5 CLAIM #92-62 02-01-93TO: HONORABLE MAYOR AND CITY COUNCIL FROM: CITY ATTORNEY SUBJECT: CLAIMANT: LOYD NITZEN; CLAIM NO: 92-62; D/L: 07-02-92; DATE FILED W/CITY: 12-30-92; CARL WARREN FILE NO: S 73921 CLB After investigation and review it is recommended that the above -referenced claim be rejected and the City Clerk directed to give proper notice of the rejection to the claimant and to the claimant's attorney. r /r 7y r TAMES RKE, City Attorney JGR: jab:012193 (CL -9262. jab) Enclosure: Copy of Claim cc: Carl Warren & Co. Finance Director City Manager CONSENT CALENDAR N0: S 2-1-93 A- G E N DA-�-1- i3 _ Enter - Com DATE: JANUARY 21, 1993 _. TO: HONORABLE MAYOR AND CITY COUNCIL FROM: CITY ATTORNEY SUBJECT: CLAIMANT: LOYD NITZEN; CLAIM NO: 92-62; D/L: 07-02-92; DATE FILED W/CITY: 12-30-92; CARL WARREN FILE NO: S 73921 CLB After investigation and review it is recommended that the above -referenced claim be rejected and the City Clerk directed to give proper notice of the rejection to the claimant and to the claimant's attorney. r /r 7y r TAMES RKE, City Attorney JGR: jab:012193 (CL -9262. jab) Enclosure: Copy of Claim cc: Carl Warren & Co. Finance Director City Manager City of 1 ustin cL., AGAINST THE CITY OF TUS: (For Damages to Persons or Personal Property) The law provides generally that a claim must be filed with the City Clerk of the City of Tustin within 6 months after the incident or event occurred. Be sure your claim is against the City of Tustin, not another public entity. Where space is insufficient, please use additional paper and identify information by paragraph number. Completed claims must be mailed or delivered to the City Clerk, City of Tustin, 15222 Atno Avenue, Tustin, California 92680 WHEN COMPLETING THIS FORM, PLEASE TYPE OR USE BLACK INK TO THE HONORABLE MAYOR `AND CITY COUNCIL, City of Tustin, California: The undersigned respectfully submits the following claim and information relative to damage to person and/or property: 1. a. NAME OF CLAIMANT: LOYD T. NITZEN, II b. ADDRESS OF CLAIMANT: C. CITY/ZIP CODE: e. DATE OF BIRTH: f. SOCIAL SECURITY NO: 2. Name, telephone and post office address to which claimant desires notices to be sent (if other than above): Michael D. McEvoy, Rick K. Carter, Murchison & Cumming, 200 W. Santa Ana Blvd., Ste. 801, Santa Ana, CA 92701 3. This claim is submitted against: a. The City of Tustin only. b. The following employee(s) of the City of Tustin only:. C. X The City of Tustin and the following employee(s) of the City of Tustin only: (Claimant is presently ignorant of the identities of the emolovees of the Citv of Tustin, whose acts and/or omissions caused and/or contributed to the subject incident of July 2, 1992.) 4. Occurrence or event from which the claim arises: a. DATE: July 2, 1992 b. TIME:__ Approximately 2:00 p.m. C. PLACE (Exact and specific location): Bolt Avenue Sot1thboLnd and Warren Street. d. HOW and under what circumstances did damage or injury occur? Specify the particular occurrence, event, act or omission you claim caused the injury or damage (Use additional paper if necessary): (See Attachment -1#1 to this claim form.) e. WHAT particular ion by the City, or it- oloyees, ci_used the alleged damage oL jury? (See sub section d, above.) 5. Give a description of the injury, property' damage or loss so far known at the time of this claim.- If there were no injuries, state "no injuries". (See Attachment #2 to this Claim Form.) 6. Give the name(s) of the City employee(s) causing the damage or injury: (See section 3, above.) 7. Name and address of any other person injured: Michael Guthrie, 17521 Brent Lane Tustin CA 92680. 8. Name and address of the owner or any damaged property: Claimant, address previously stated; Michael Guthrie, 17521 Brent Ln, Tustin, CA 92680 9. Damages claimed: a. Amount claimed as of the date: $200,000.00 b. Estimated amount of future costs: Unknown. c. Total amount claimed: , $200,000.00 d. Attach basis for computation of amounts claimed (include copies of all bills, invoices, estimates, etc. A comprehensive set of claimant's medical records are attached hereto, collectively, as Exhibit "B", and incorporated herein b�. 10. Names and addresses of all witnesses, hospitals, doctors, etc. referencx _ (See Exhibit "A" and "B" herein.) WARNING: IT IS A CRIMINAL OFFENSE TO FILE A FALSE CLAIM!! (Penal Code Section 72; Insurance Code Section 556.0) I have read the matters and statements made in the above claim and I know the same to be true of my own knowledge, except as to those matters Stated to be upon information or belief -and as to such matters I believe the same to be true. I certify under penalty or perjury that the foregoing is TRUE AND CORRECT. Executed this • 29th day of TF/ FI CLAIMANT'S SIGNATURE LO_ T. N ITZEN, II B1:CLFORM Revised 4/29/91 December , 19 92 , at Tustin, California. City of Tustin CLAIM FOR MONEY OR DAMAGES ATTACHMENT 11 4 d. How and under what circumstances did damage or injury occur? Agents and/or employees of the County negligently obscured the vision of motorists, including, but not limited to, claimant, at the intersection stated aboveAdditionally, Additionally, those same agents and/or employees failed to take the necessary precautions, such as signs, cones, lane closures, flagmen, and the like, to compensate for the aforementioned obscured vision of motorists. Claimant is informed and believes, that said agents and/or employees of the County were sanitation workers supervised by one Eddie Torres. The majority of said obscured vision resulted from the placement by said agents and/or employees of the County of a large vehicle in the center of the intersection. As claimant approached said intersection, he attempted to make a left-hand turn from southbound Holt onto eastbound Warren. As a result of the aforementioned obscurement, claimant was unable to see oncoming traffic. Additionally, because of the nature of the obscurement, it appeared to claimant as if the intersection was clear and it was safe to attempt to make Che left hand turn. In fact, the intersection was not clear and as claimant attempted his left hand turn, he was struck by a vehicle traveling northbound on Holt. Since the aforementioned agents and/or employees of the County were operating within the City of Tustin, the City has the obligation to insure that adequate safety precautions were taken. The agents and/or employees of the City of Tustin whose responsibility this was failed to take such precautions or insure that they were taken by the agents and/or employees of the County. Additional information is contained within Traffic Collision Report #92-05030(OIT27021), a true and correct copy of which is attached hereto as Exhibit "A" and incorporated herein by reference. Claimant: Loyd T. Nitzen City of Tustin CLAIM FOR MONEY OR DAMAGES ATTACHKENT 12 5. Give a description of the injury, proper -w damage or loss so far known at the time. of this claim. If there were no injuries,, state "no injuries" (1) (2) (3) (4) (5) (6) (7) Claimant: Laceration, right mastoid region with foreign bodies imbedded and fractured mastoid bone; Right ear laceration; Closed head trauma; Multiple minor traumas, abrasions and lacerations; Residual scaring; Dizziness; and Potential hearing loss. Loyd T. Nitzen STATT OF CALJFOR.wU► TRAFFIC COLLISION REPORT ►AOS ' 0. SPECIAL CONDMONS 40 ICU %As Fit ~JVDICtAL- DRSTRICT NUMBQ I 2 TUSTIN CENTRAL NO KR1. HAR MISD COUNTY DIST BEAT 92-05030 0 ORANGE 10 01 OIT27021 COLLISION OCCVRRED ON: MO DAY YEAR TD.4EG40M "CIC I OFFICER I D. L HOLT AV 07102192 1358 3022 00677 C A DAY OF WEEK TOW AW.%Y 1110TOGRAPILS BY: MILEPOST INFORMATY)N: � 'D' 5 iT' T F' Rq Yrs [ ] No ELLETT (12 ; :, O N Q( STATE "Y REL AT V%-TERSECTION WTTH: i OR: WARREN AV YEc NO _ [ NONE 1 DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEE YR MAKE/MODE]JCOLOR L CEd3E NUMBER ST.* PARTY C G -88, CHEV;,NOVA,WHITE,,,, NAM E(FIRST.MIDDt.ELAST) LOYD T NITZEN II' OWNER'S NAME [ ] SAME AS DRJVER PEDFS- 'rl STREET AIX)WXM GREAT WESTERN PARKED CITY/STATFW OWNER'S ADDRESS [ ] SAME AS DRIVER VFi1 9642 COZYCROFT AV, CHATSWORTH, CA 91311 BIC'Y• SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE DRSPO OF VE)nCLE ON ORDERS OF: [) OFFICER pq D ivu [ ]OTHER ``I M BLN BLU 6-02 200 BLUEBIRD TOW 714 838-91E aniER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DFFECTS: SOME APPARENTKI RE) -ER TO NARRATIVE [ () NONE �E � DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED ARE [ ] vw [ ] NONE [ ] MINOR l[lmoD.f)mA;oR INSURANCE CARRIER POLJCY NUMBER I CREAT WESTERN PgTOTAL DM TRV ON STRM OR HIGHWAY SPD L.MT PCF 140 S HOLT AV 21801a PARTY D;kNmR•S LJCENSE NUMBER STATE MSS SAFETY VEH YR MAKE/MODELJCOLOR LICENSE NUMPER Sl 2 ICA U H. 75, FORD,COURIER,YELLOW, 1B69671 rAMECFMST.MW0LE.cJAsn MICHEAL D GUTHRIE ' OWNER'S NAME SAME AS DRIVER S" -M ADDRESS PARKED CTTY=ATFIl1P OWNER'S ADDRESS SAME AS DRJVER 'J" BICY- SEX HAIR HEIGHT WEIGHT BIRTHDATE RACE DLSPO OF VEHICLE ON ORDERS OF: [ ] OFFICER ['J DRIVER [ ] OTHER `� M BRN[Zi6-01 170 BEN WARNERS TOWING 714 542-72 OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT REFFJR TO NARRATIVE CHIP DESCRIBE VEWLE DAMAGE SHADE IN DAMAGED A! TYPE [ ] UNK [ ] NONE [ ] MINOR [ ] INSURANCE CARRIER POLICY NUMBER NONE I Pq MOD. [ ] MAJOR [ ]TOTAL DOR TRV ON STREET OR HIGHWAY PD LMT f40 PCF N HOLT AV PARTY DRIVER'S LICENSE NUMBER, STATE CLASS SAFETY VEH YR MAKFJMODEL/COLAR LICENSE NUMBER 3 ... .... 'OFFICIAL CM ... ........ . DRIVER [) NAME(FIRST.MMOL.ELASTi NOT TO BE DUCLiCAT>_O, CQ IED PEDES- STREET ADDRESS tt J.1 ,.,... _ �• °�'��. ,�. • except S TR�A�1 ••t tt1P er.nrecr, uIttTIt�n�.;�i{O�n of the 1 J OWNER. ilbD1:ESIS O C . �. to PARKED V t� CTTY/STATE/ZlP Irlmr d to the Orp.--tt(Tient rl•••-, BICY- SEX HAIR EYES HEIGHTWE)GFiT BIRTITDATE RACE DISPO OF V90CLF ON ORDMS OF: [ ] OFFICER [ ] DRIVER [ ]OTHER clist [I I L OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT [ ] REFER TO NARRATTVE C14u� Tl'P£ DESCRIBE VEHICLE DAMAGE SHADE IN DA) 'S [ ] [ ] UNK [ ] NONE [ ] MINOR INSURANCE CARRIER POLICY NUMBER I [ ]MOD. [ ] MAJOR E ]TOTAL DIIt TRVJ ON OR HIGHWAY SPD LT PCF LMT PREPARE7R'S NAME DISPATCH NOTIFIED RE1R>rWE>t'S DATE REVi1 ��j,' 1 GALLIHER C 00677 . Yar I SO N/A &,-, E :?F CALJf i ,F r IA I RAF1='IC COLLISION CODING D ... rl DATE OF Olt K-L%AL McuN-.Vr TWE04Wt NC1C NUMNEX OFfX.'Lx I.D. NVMItFX 07 - 02 - :2 1358 3022 00677 92-05030 0%%'NE)t3 NAMf_ASr RE.CS ✓— "TY PATRICIA THELE2r'. 1 14 4 4 2 HOLT AV, TUSTIN CA 91-2660 NOTTl IFD YES DFSCRIFTION OF DAMAGE Dn .. OE Moderate damage to bushes. SEATING POSITION SAFETY EQUIPMENT EJECTED FR'J1,1 VEH OCCLR'�►,J.TS M/C BICYCLE - 1{F]�1ET I - DRIVER 2 to 6 - PAStE>:GF RS A - NONF IN V]741C'LE L - AA. RAG DFPL0V D- B - UNKNOw'w M - AM RAG NOT D F-,0YM DRIVER NOT FJECTR] 7. STA. WGN. REAR C - LAP RrLT t1FD N - OTItF-R V . NO I • FULLY EJECTED 2 - PARTIALLY EJECTED 1 2 2 1- RR. OCC. TRK. OR VAX D- LAP RF -'T NOT USED P - NOT ItFQUTRED W . YES 3 9 • POSrnON UNKNOWN E • SHOULl)rT- HARNESS USED -UNKNOWN 4 3 6 O. OTHER F - StfOtTI-r-ER I{AF NFCS NOT USED CIWD RESTRATN'T PA.V:ENGER G - LAPMIKAWEIF NnRNESS USED Q - Eq VMIC-LE L=.ED X - NO 7 H - LAPM;OULDER HARNESS NOT USED R - LN %'i}ih:'LE N'7T J'SED Y . YES J - PASSfVr RESTRAINT USED S - 1N V-r?ti.ZE USE K - PASSfVE RESTRAINT NOT U'.D T - M rMrROPU USE U - NONE Pi VT: *CLE rj'F-MS MAKK D BELOW WIIICII ARE FOL LOV'TO Ry AN AS?TMt5k C'1 5t14UlD BE EXPLAINED IN THE NARRATE i PRIMARY COLLISION FACTOR MOYt:+t¢� 1-07i !iLMSER p'1 OF rARTY AT FALR.T TRAF1IC CONTROL DrN'ICZX "TE OF VRInCL9 COL1T18IRECEDINC ON 1 f131 23 3 2 j A VC SL, -TION V10UTEb CITED X I A CINTROIS t 1.'NCTIONINO A PAMENGrP. CAILMTH. WGN. It A STOPPED 1 ,' 218 01 a NO 11, CINTttNFLrc^ONo B PSFNrY.RW/TTrL.F* X B PROCEiDING STRAIGHT B OT)MR PAPPOPER DRfVFN(?' I C CONTROLS OP.CVILM C MOTORCYCLE / SCOOTrA Y C RA.N OFT ROAD C OTHIT THAI. DRIVEX" I D NOCONTROLS PRESE T/FACTF )R � D Pr�7iUPOR PA.NELT11UCK E P'n'_'XLT/PANE TRIC. WIT1.R. F TRLVI; OR TRLll7; TRACTOR D MAKING klGIFTTL'RN (k E MAKING LETT TURN F MAKING U TURN D l!N1�►:0u N' TYPE OF COLLISION E FEL ASLFET+ _ A Ei,AD-OH Y WEATIIER (MARK I TO 2ITEMS) B 5:(Y SWiP£ G T7Ui./TIt1C.TFACTOR W /T13. G BACKING A CLF.&K i c FSAk END H Sn"_ DL BUS H SLOWING I STOPPING B CLOUL`Y X D LP.OADSIDE 1 Crf'rr"x BUS 1 PASSING 07713ER VE)DCLE C RAINING E KIT OBJECT ) Eu�EGEHCY VE)0_-L.E J CHANGING LANES r, SNOATNG F OTTERTURNED K K --Y. CONST. EQL^PMEKT K PARKL*IG 1-'AliEJ1TR E FOG / V1SlE: ,ITY: G %7JLY_'LE / I'MFSTX'A.N L EICYCiE L ETSTERINv T7~AFTh: F OTHER`: H CTMO:. M C MER VEHICLE P:r-;S, RJAN M OTHER UNSAFE TURNING N XII+G 1.TO OPPOSING LAKE I TND IMOTOR %T.HICLE INVOLVED "TTHN LICIrrINt; I A NON-COLIISEON 10 IROQED O PARKED t1. ! A DAYUGiIT B PEDE.R'F:IAN O': i{ER ASSOCIATEn (TACTOR P MERGING B DUSK- DAWN X C 07ITM MOTOR VENN-n.E _11.2 3 MARK 1 TO 2 TTEMS Q TRAVLZTMG W'RO►NC WAY R OTHER': { C DARK - STRUT UGl1TS D MOTOR 1'rH ON OTHE3, ROADWAY A VC SECTION V)OLATION: C. T E D DAR): - No STREET uGiTTS E FARXM MOTOR VE3110 1: pp� E DARK - STYET UGETTS NOT EL'NCT)Of; F TRAIN B Vc SECT ION VIOLATION: CITE X 123152A N O C Nr SECTION VIOLATION. C;TE ROADWAY SURFACE G BICYCLE H ANn"IA SOBRI ti' -DRUG Ill (MARK 1 TO 2 T-f.M!) X fA DRYPI11'SICAL B WET -213 I A HAD NOT BEET Dfti*t1CJNG I C SNOWY • 1CY I FIXMOBJECT: ( i �. € E %^S. OBSCURED: LG/vEH � X. ( 8 /1RD. LrNr R INFLUENCE D SLIPPERY f1!VD0I',OiIY•ETC.) F NATTE.N-Mltll C HYD -NO" UNDFJt INFLUENCE! kOADWAY CONDFT)ONB � t 1 O" Ira OBJECT: G 'TOP A GO TRAFFIC I D RhD • WFA7FML'tiT UNK' r}9RSTRIA.N*3 ACT JOKE H / LEAVING RAMP I E UNn v.. mm 1vFLLENCE" MAF.K 1 TO 2 ITEMS { A HOLES. DEEP It L*TS' . A NO PED M7JAN INVOLVED I I",F"OUS COLLISION F IMPAIF..+REN'T - PHYSICAL' 18 LOOSE MATERIAL ON RDwl" B' CROSSING IN XW A V: %*TTEkSECTIOX � J !NF AMPIAR WTTH ROAD G IMPAIRML%*T NOT KNOWN i C OBSTRUCTION ON ROAVWAY- ` C C>:OZE40 IN XWALK NOT AT I1rTERSECTION K D`ECTTVE VEH.'EQL11P.: CTI E � 1 iI H NOT APF•:,YASL E { D CONSTRLV_-M ! - REPAIR ZONE �1 r'(`iT i L SLEEPY / FATL•:UED [ F E RO)UCED ROADWAY NA IDI D CROSSC'NG I -OT IN CROSSWALK L LNC;VOLVED VEH14• .., '- I;.PT.CMCt'`Tl.MATION 1 F FLc}�D�D' DN E IN R OA . ECLU'DES SHOU'„DF7t M rJi WEY, • ; . .. � - �, { 1 f i( A' HAZkKDOUS MATMAL jG OTHER': F NOT If: ROAD N !-3NEAPPARE+t^Trr•I') nl^ W1`�'►t ''t� ►`Y t ' . X Ill NO UNUSUAL CONDMONS 1 G APPR0AC I NGI-EAVING SC'IEJOL PC O NAWAYI FItKI SF:.rTCH � I{ � �_ - . MlSCi1.2AtiEDL:3 •. I , . i' .Z - - wisp. AEfJ µGCT 1 - -- - - � ...�__.� __._--- ;i ATE. OF CAIffORXIA INN UREDI"TTI`'ESSES/PA S SENG ERS o, DATE OF COLLISION NUMBER orrCER I.D. NUMBER 07 — 02 — 92 1358 1 3022 00677 92-05030 EXTENT OF INJURY ('X' ONE) INJURED WAS ('X' ONE) M'TTNESS ONLY PASSENGER ONLY AGE SEX FARY NUMNIA SEAT POS. SAFETY [.QUIP. EJr FATAL SE�TF.RE OTWER VISIBLE COMPLAINT INJURY INJURY INJURY OF PAIN DRIVER PASS. PID. BDCE OTWA 31 M X X 1 1 G 0 NAMFJD.O.B./ADDRESS TE F"40NE LOYD T NITZEN II ( ( NIVRED ONLY) TRANSPORTED BY: TAKEN TO: MEDIX AMBULANCE WESTERN MEDICAL DE_tr'RIBE INJURIES: Skull fracture and numerous lacerations to head. Complaint of dizz iness. 43 IM X X 2 1 H 0 NAME/D.O.B./ADDRESS TEIJEPHONE MICHEAL D GUTHRIE ( TAKEN TO: MEDIX AMBULANCE WESTERN MEDICAL DESCRIBE INJURIES: Fracture to right foot. NAMEID.O.BJADDRESS TELEMONE ( ) (INJURED ONLY) TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: NAME/D.O.B./ADDRESS TELEPHONE l ) (INJURED ONLY) TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: SAL COPY tit I 1'o F'= vt)roCATrT, r.O-, I!:f_l N • • NAM E�D.O.BJADDRESS ' TELEPHONE (LVJL'RED ONLY) TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES: PP17ARER'S NAME LD NUMBER MO. DAY YR.R�'S NAME MO. DAY YR. GALLIHER C 00677 1 07-02-92 NOT TO SCALE I ( DR # "a-osa3o l I � RD 10 l BEAT i l O PI p v.z 0 O �--- 22.75' O O 9 O — - l l ( l l l l l 1. I l is' O WARREN AV �� I l o nL C% nr r l ►tt . t "T, To Sr. DUr[.I( A, En. Ct1 {r� tP any pt '^rP•- .,.r I�1 Ac r)n rr 7tr r. r ►i..% Perri ;�..;t,n , {- (T-,IIv t l t'-.0 r� i(�• ci to 1110 r't '►rzd isto O t ) L�^jrTrtrtl•. ttt UPP;1 d"- l l l - l t lHOLTYrARR.CAD 13' I t9' CEG 0677 070392 C• 1, 'r, r.r HOLT AV WORK OROAD AHEAD SIGN Z LEFT LANE CLOSED AHEAD SIGN OO.C. SANITAT101 TRUCK O TRAFFIC CONES I ( DR # "a-osa3o l I � RD 10 l BEAT i l O PI p v.z 0 O �--- 22.75' O O 9 O — - l l ( l l l l l 1. I l is' O WARREN AV �� I l o nL C% nr r l ►tt . t "T, To Sr. DUr[.I( A, En. Ct1 {r� tP any pt '^rP•- .,.r I�1 Ac r)n rr 7tr r. r ►i..% Perri ;�..;t,n , {- (T-,IIv t l t'-.0 r� i(�• ci to 1110 r't '►rzd isto O t ) L�^jrTrtrtl•. ttt UPP;1 d"- l l l - l t lHOLTYrARR.CAD 13' I t9' CEG 0677 070392 C• 1, 'r, r.r FACTS Notification: The call was received as an injury traffic collision at 1359 hours, dispatched at 1359 hours, arriving at 1402 hours. All speeds and measurements are were made by the use of a steel Scene: The scene was as depicted in th Parties: approximate. All measurements tape and rolatape. n1f i�:�r�t, l. f'i':.' c' t ) 0 pt: e factual,diagram "R '�-"'� i , ^., ( ' j1r;z�.� rL.tiC�l �r'•t!•:ItfTinil( Till( 1:' {t!1;:r1'!•r' f•'.''rrrii`if i0 lulu V�,�arttll'211( (1l 1:1.., Pi was identified by a valid CDL, P2 was identified by a valid California Identification card. Both parties were established as drivers by self admission. Physical Evidence: 5(f ive) 12 oz. cans and 2(two) 16 oz. cans of Budweiser beer was found in V-2. Other Factual Information: P-2 (GUTHRIE) was 14601.2 c.v.c./Driving when privilege suspended or revoked for driving under the influence, with excessive blood alcohol, or when addicted, authority section; 13352(A)(5). There was an Orange County Sanitation Co. truck parked facing S/B in the N/B 11 lane, in the intersection at Warren Av. There was a crew with the truck, working on the sewer line. The vehicle license # is E078629, unit 1269. The workman in charge of -the vehicle was Eddie Torres. Statements I spoke with D-1 (NITZEN) at Western Medical Center. He said he was S/B on Holt AV at Warren AV attempting to turn E/B onto Warren. As he approached the intersection he saw an Orange County. Sanitation truck stopped in the middle of the intersection of Holt AV and Warren AV. Before making a left turn, he stopped behind the sanitation truck, looked around and under the truck,saw no traffic N/B on Holt AV and attempted to make a left turn. As he began to make the left turn, he suddenly saw V-2, and was hit broadside. He stated he did not have time to stop before being hit by V-2. I spoke with D-2 (GUTHRIE) at Western Medical Center. He said he was N/B on Holt AV in the #1 lane at approx 35-40 mph. As he approached the intersection of Holt AV and Warren AV he saw a sign that read "LEFT LAINE CLOSED ". He moved into the #2 lane and was approximately 10 (ten) feet from the Sanitation truck when•he first saw V-1. He tried to turn left to avoid hitting V-1 but was unable to. He stated he never had a chance to apply his brakes. OPINIONS AND CONCLUSIONS summary: D-1 (NITZEN) was S/B on Holt AV in the 11 lane. D-2 (GUTHRIE) was N/B on Holt AV in the #2 lane. D-1 was stopped at the intersection of Holt Av and Warren Av. As D-1 attempted to turn E/B onto, -Warren Av he was hit broadside by D-2 who was traveling at approximately 40 (forty) M.P.H. Both drivers had their vision obscured by the O.C. Sanitation truck parked in the roadway. This obscurement would have affected traffic in both directions. Point(s) of Impact: The point of impact was determined by statements and scuffs in the roadway. 1119" W of the ECL of Holt Av 3214" N of the SCL of Warren Av Intoxication Narrative: D-2 (GUTHRIE) had the moderate odor of an alcoholic beverage on his breath and his eyes were bloodshot and watery. He seemed slightly "Dazed" and his speech slightly slurred, however, I was unable to tell if those characteristics were from intoxication or possibly from his injuries. I believed D-2 was possibly DUI, but was unable to have him perform field sobriety tests due to the injuries sustained in the collision. 'tus e : ased on my observation of the scene, coupled with involved party statements, and the physical evidence present, I believe the collision was caused by D-1 (NITZEN), in violation of C.V.C. 21801(a) -Failure to Yield the right of way to oncoming traffic while making a left turn. Other AssociatedTFactors .A.F. to this collision are P2 in violation of 23152,�d) C�C��DUI; and a large vision obscurement h driversj.:-.!-. . to bot "' �� - Lit "'`'C �•rr''• "'r►r{- t: 11 ►� rr,- ,.r�,., f �+f 1 •:nR (I •, 't• l r.. t.t•' r.c Even though P1 may have cautiously made'the turn,--he-.-Is still required by law to yield to oncoming traffic•which might•be a hazard. In this case both drivers faced an unusual'=situation because of the workcrew and large vehicle in the roadway. P1 probably should not have attempted a turn at this intersection due to the reduced visibility. P2 (by his own admission) was travelling at a speed which was probably too fast for traffic conditions present, specifically the reduced roadway (one lane closed) and the vision obscurement. Recommendations: Review by the District Attorney' Office for filing of the following charges: P1- 21801(a) CVC -Right . of Way P2- 23152(a)CVC-DUI; 14601.2(a)CVC Driving with a Suspended CDL (Suspended for prior alcohol offense); 27315(d)CVC-Failure to wear seatbelt. Review by Traffic Supervisor. C. Galliher #677/A.Bryant x`945 !' ' t' ' • t4nt t� ..• .! a v .ir oar r -on or �WnSTi:"'N ►,'•U ::Th-•ShNTA AP1� ZIP C 1I - 1 L� i� )i,l c Ar'PPCW[0 n►sH NO 09jp-0:')w 1 R t � v. •• y A;,'�ijT r. cT. - TUB 9.— 1 1 ., A : 7746-6-111 L. 9420602-001111 1 SANTA ANA CA •.1''711 � ' ~ c' �, 1 , VE CaZAALlip ' •p i6 .iT FIRSI MANAL ►. {+ PAT4441 Hca t h1 LOY') T T 1 +A WTI 1V 1111 t ., ti •10.*► 1.d+:)tA." IA�C-1264-0kbIt t►• Y• f � 7 • — 14 1 7 14 1 11 11 G T.. �. .. c; :� r 7— ;, r•,..1 t .. c►ir11� NTk + POW ro IoAlL IWAIJ ,a 1 •.�., .. •n ,eft i •411!1•% ,r Mu .a + 404:1 nA�'.i AUA. PKVY a>� ~b^M T I Y T k C A VALUL AUTit A c.�e AN{T LbA�•l S�6C �'�1 64' -1�, W GE6i.Rr•1t0.1 "#PtLOOL .Js.tM SJ TQM{ Cf"WJ • &.1 A, RFC1DV'7ftY ROCIM = 710 3 31 TO s I s j i 't;t.,',:•1.11�'��t>•'�Lftj•.'. .•.rr..hr..h►..1�ii ,( r~ rCi►.ti+i�R.4Lai,.f ' r L• •f :1�.` �. -,M�, + s_ s • • `,- .. f•:'.,{• •. i •.. i'tiiil►`��ifr• �y'1 .. : .� .• � .•.I�.:A,�: •�v[i.'l/:.. t'. 1�.A•1Fr • r,.•.�:. . r• •i ••.;,•� :! .. ra . Tyr • • •r. � • •f•.., a�•:. ,;•• v: : .. r.. r.► -•. ,,• ... Tf:TAt. •7 1 I nut.;'� . • 60 H A2 961 ur CNA I NSUR&NCE Y Y : : 106#424"A') 1 q.t 49►A5 3?2-p , : • '• 1141 k JU Ii 1 A6 M+i1!•iLD1M+WE 1•{..*11011 LL 60 GERIrit,N•WG NMq ►.Y WKhn••.Avk •p M$0."4A";CI WKV'MO Gr.CAT V -t ST.f'N UANKs H 11, =4n373c`2,7 Xc3kK Ct:;Y. ' i t Ep 712 a • pV f D /N ►' ' A I FREAT WFSTERN SAYINGS 70 146,4 m r. m scjup I KA 5 ►AIN COME 0 1 17b To Ila R7'1 .791 873.5t t` 74.9 �EA12.o DPN SKL OASM rX V/11 COMA 13:)1o.51 CDk CO DATE9 YOLIN:7 ^c.T?Rii)T'K''�l'i' X10.2.>_ 17—(;? A6.6q 77—C7t ?6941 1 :•7-07 • ' TT♦ 9{1 M DO Ojt f j1t;1>3� M•• R� M , AJFW- YAM.1►•RQWM PAPK. f:UNG H M+3 �• MOKUN.C. STAY OATES' CNA I NSU'. ANC 111@41 T►tT1011fTN A ►ll t K 0 y � 9, f) P, E ♦ ATTN! c6mr-� GLAa M^ 1 1fvUr.i AMrV Pe n. dnx 6,!5oo F (---, I HI I i K ;) R r- h V �/ U : 1 -� • �` •-- •• •••• •• a.�•••. q.n•. s•a ../n rrt ••c �c.•aC n►T<• IV 1�. I'%& '~ AMI, • 11M A f.1Ri ft.••.•T . t» -e2► ,.FA -1450 PAYER COPY prTAtP.T x c~,,TE APPROVED OMB N3 nVIA-077P 'dr-c.TrnH WFD CTit—Sk-NTA ANA P.O. PDX C-1191 Z 279251 1 P 9420602-••11-0 `2 11 ► "', • SANTA ANA CA VIP -111 77-4 971 -44!J%';)? It P1019f I LAST =Wl FIR0�"_ r r It, E N i T7_rM► L DY7 T I I ;: G 1• • D A/ 70 M . rMum CMAS RM00 )JiczyD t6w-cb 12&C--fVML .N t IR 1►. a YY{ 1 f 13, Al 11040LIC.N 1 t- '',, M r. C7..�.11 � .4 v I �1 • � t,1 I<. --?w •i •wY' i�•�-05-77 Cd! ~:yITE 1 t U t►l► DAIL , W L ;jlc:�.v hANKf�I �k4•1/TM •1 ,,,, .�, 1 .Aa Lilt � _ T1 T w :. ro 's• Au ,,. . 1 f 1 • j lnl w• 1 • � c r Roc, 4^^ 'N=1ARRA0A nK'dY >fr�?bC T w. • i �t v I N t C As YALIA o AMT A, IT cr AM, c AAA. 9"6n0.u1 &A0'}G l ..• oEuu•vTlol. v+M VXIE, ►; et►+n, Aa tutAL c►IA#%AS Kc•.o-•-SUs+—rvYi? �c'� as v. oo t �.) 1 64 ". u i POSTIGV ;lot" T.00 206 2 2100;00 NURSING INCREM ?34 3 7Sfa;CV IV SOLUTIONS i 759 1 33x;00 K = D/aVR ,,VPPLY r:=► � • SUPPLY/QYHER { ?_79 12 9ap0 LADCRATORY .300 3 LAB/CHEMISTRY = 301 ;`� 3 0 2 1 .1 Q 25 0 j, r.. :..,�..r .t.. : �.. ,.• .., *- C:Y LA 8/N..HATOL O 305 4 1730;; tr , ' PATHOL/ttYST0L 31 P. 1 210 E • ' DX' X_ti AY 31 :� t, 5:3;0 0 = i ►' . •'•�.•; X=•RJ�YlCHEST ���� s ..,.,•.ie.r.�_..... �..:. ,.... .. .44. foo. • j i¢' :3 .. , , �3t�:kit 7.T O .. •..•..../ :. - 't:�A:i�..> :,..,;.. i : l.,a.�J.� �`i�ha :,»iiilCi�.} CT SCAN/HEAD 35! 2 126500 OR SsrRVICt S i 716 9 22AdnG i ANESTHESIA y{ /� 37 0 - I J 24;2 C , i +�+ i t _Wjp RF'SPIRATORY SVS 410 4 16 (X.,.l 0 OTH7R EMER 0011 3 6 'y: ^0 PAG•—. 1 tS'= '' ill;•;..TL)TAt_ i BlF fi 1 OT V V►'1 61 lP4);-PA%`AFkP--T4F 61 EST. AAAMW CNA INSURANCE Y Y A> rOVf•kfJ 1 MAW . rt:r{AI PAEL f.fa %A 141 •SS•.••K. -IUNU AI• fosckp #.&A,E 10 04LU40MU ChAGW ►W • GREAT MFSTE'•?N 11A'4K. ***# M O� X4'0373927 VORK CWAP [a-Zr E A " kaE 14 CONDY A I FR AT WFSTE;RN SAV I NCS 76—, 01. ► a ow 1,541cXXIC 01:74 )f 1 R7�. 9 ;73951 74.9 E8�`�: ►..I OPN 51KL i*'1�Sf= FX* W/O COMA FSt`1.�1 9L � Duflce v r f • a t wukDATE 9 '' WOUND DE RIDE-M=NT 86.2? i n7-0:111360 89 1 07-02 26.41 07-1 F1 IALATWIJI Atnw 9A 9. 1�isy IC4" PD. 6) 2z 11*7153i 1 pi;;( t104 ►0 IVARK* EUNG. H MLS ` CNA I NS " vE lw l► D ►J G 1.1,%Y roftouo" A f B •i, PF D. AT"TN: COMM CLAIMS ,.. `-• P. no Box 6500 �.�L1.1- - -- - UO X iWAZ_ x+•e ?►+cti►-��so PAY?:4 COPY f.ir'`Pf SEK'%+.� �► ti De c ATL^.N MSD CTR -SANTA- ANA P O Q. LAOX C-11912 ANTA ANA CA 92711-L'000 i'ATT*-:NY GILL D�-TAIL TRANSI►CTIO :S PArr 3 PATI-�NT 942,06/02 CYCL 1 FINAL. C,UARA►tl7t1h 3161145 , NI TZ9: 0o LCYD T IT t•F`.�:'I�T W c•Tr PN f'-►1VK• **4#'f •'. IoVIN'z Cr, r bgC-JJU� hAi OF CPT -4 CfiAk n- CCttIF'TIL1N �?'J.Zi�'C1TY �XTENO;O COW NUMEI:: R nuI CF t," PT A 37{: TOTAL,_ . Z�S • :: 7/^3/q2 4nC+02'y3 n��OPc'R.IJ'iL IPfJ r^•5MG/ML 39.00 7/73/92 4 '�0C- 307 %c:FAZULIN 1 GM VIAL 6 s 160-0 7/03/42 4000483 Nt.:OSTIrNINR IMG/ML 1 5 97.50 7/03/92 4000605 TRIMETHOBE.N,ZANID 200HG/ 1 19.50 7/; J 4C.:t'7:6 LID:)CAIN*7 IV ISM 2"-:P.L 1 lf'•L'� 7/:r3/�i2 403574 LIDOCAINE S+L;LN 4% SfJ L 1 ?7023 T/'•;;/9? 4n^.351 C I t3FL.U'- 4N F VIRF,T H:► 4 36I1 I 3OF'LU:ZAN- CA ADL iC'M114 4OC311J4 SUCCINYCHOL.INE: Z7MG '� 65•�'t1 4 C, Cti5F►4 mf.OG;'SSZNG Fr"•' n 404.r� 4.7:04743 V: CURONIVH XNJ i 'S1 •-75 7/''•3/0? 40047nS THIOPENTXL INJ 1 4 73*00 3/92 4004 857 POT Cl_ Z SM50/1:: ML_ VU 3 54.75 ,3/92 4005180 TUAOCURARINE 3MG/KL I 13.00 7/03/42 4DOS213 MI DA7_OLAR SAG/ML I ?.Q•7:S 7/:3/92 LIDOCAINT IX 3r+;L SDV 1 16.v4 7/03/92 4005467 POVIDONE tOD SOL. BOTTLE 1. 22.00 7/43/92 4005618 RICARS LOCAL. AMES 1 16.75 4006541 CLYCOPYWICLATE 0.2MG IN 5 4705 0 '-;•3MCG/ML INJ 3 58.5'3 y fry¢/q2 400?307 CrFA70LIN 1GM VIAL. 1 36.00 7! :•4/ 1' 4 P! *f�C�.SSINC F:-!.'.: 5:. a (L.:' 7/05/42 40003L7 CLFAZOLIN IGH VIAL 2-- 72.00CF 7/45/92 4004364 PROCRSSING FRE 3- 1500000 7/C:S/92. 40:'4557 rDT Cl- .?•)W-;Q/13ML VU 18.25Ci 7/35/9.: 4J 6t;2 SCD CL (-&9% 10ML SDV ? 21.5? '�►/I S/ya 4006727 ACETAMINOPHEN 32 5MG 4 •.G•O 7/.G/G 4:1C 117 CS.PFIALr-.XTN SC -..MG CAP52.. L 7/CI,/92 43-5727 ACCTAMINUPH';t.t ZCPTO 4e):` 10TAL 1.45FI01'' 7/33/92 40X i5 iV SOL D5/-.1.45% iDr^KL 3 IT4.75 7/;:3/9 402?C4 2 TV SCL ^. G't NACL 1 :0'ML. .'_ 103.50 7/53/5; 4C�►:C=71 IV YU3IN' CCNTINU i=LO 2 766513 7/03/92 4020785 IV SOL OS/K SGML 5 187.50 7/:14/9? 4,:?.0S8,; TV SnL DS/W SCML 1 37.5', 3/05/99- 4020011; IV SOL D5/0.457: 1C:)C•ML 1-- 58.: SC ;;5/92 4r�.:1�Ra IV SOL Q5/W• S OML 75.000 /Q6/y2 4020070 XV TUDIN1: !� CCNDARY 7/, V/02 4020:.71 IV TU+:+iNG CONTINU FL O �'• 51n.1� 5T�RN P.7b CTR-SAIJTA ANA P.U. fiox C-1 1912 SANTA ANA CA 48".711--74 : l2/22/9,611 PATIENT BILL nt.:TAIL T#7'AN5ACTIOWE, PAGE ►�.'f Y ".NY ��a r>" ! CYCLt- I := I NiAL GUF..^. ANTOR 31 6914 % • NI TZ.�N. LfJYD T 11 G^,: AT r+"'FT�CN '! 1F.V INl- CA 9; 631--: 0000 r)AT V OF CPT -4 CHARS_: V'" SCP IPT WN OUANT I TY EXTENDED Uc p V I C-:: C Otho:. NLIMF, :? P RI C!= C�PTN 30:.4 TOTAL ?Ty.'`:► 30:124236 SVCTIC74 LINE ll rU!7C.'f? 1 .17.x?" 7I?^/92 34.'1 10i1 D Ater HrAD-NECK 1 a7.00 7/C 2/S+2 3023381 SUTURE-- MINOR 1 260.00 7/02/92 302346X PACK MINOR 2 285* 00 7/Jz/v7 3 0A135(11 Sq N:,nR-0lGlT PLIL'-,- i itO.SO L'-•' PT d 3n.2 Ti)TA[. 7/02/92 3060242 IV PUMP RENTAL DAILY i 55.00 3D6124¢ IV PLIMP ncNTAL DAILYI 55.E+0) 7/•,14/S12 3,1640242 IV PUMP rt 7NTAL DAILY 1 5S*03 7/75/9? 306!1242 IV PUMP ''CENTAL UILILY 1 Sa•70 DEPtO 306 TOTAL 220.00 7/':Z/921 97 J7f, 3Sv4 co .3 VZNI PUNCTUR c 54.00 7/02f92 99001 3564001 SPECIAL HANDLING FEE 2 60.00 7/03/92 9407;. 3504000 VENIPUNCTUC!E 1 27.00 7/03/92 9'00[►t ;iS040r.1 SPECIAL HANDLING F:=:i I 3C.00 D'=P11 35:: TOTAL 1'r1.r1i 7/LL/92 05023 3510717 COC WITHOUT DIFF 1 34.50 7/32/92 850^9 3514635 CBC VITH DIFF 1 65.00 7/;•?•/7% t�1 ��0:, 351 Oi rb Qnl1T2N' U.^.INALYS I S I 39.00 7/0,/92 135'52:: 3510717 CEC VITHIUT DIFF 1 34.53 D -I PT A 35: Tt:TAL 173. 7/%;2/9? -t:'if+:! 7/:22/y2 :s-'-•.-;7 3532987 SATCH-T 1 1113.130 U�PT9 353 TOTAL 17R•3'' 71:::/9&Z P-3 354SS76 TYP=: r, S:CRT —N 7/_ /S2 138.3.):. 360SZ69 G--%OSS EXAM ONLY 1 21.50 n7pT ' 361, TOTAL1.57u 7/:2/92 3706175 [=MSkC••�NCY STATUS F�'r-. 1 3f1•G�: i 1i' TL�N V.C:D C.TK—SANTA AN. I.O. ��CX C-• i i 9 1 :? SANTA AN4 CA 92711—"C'C' • P.A T I i.Vi GILL DETAIL TPANSACT I ONS PAGE 1 P o T 1 C.NT C Cc I F I NAL GUAkA NTOR 31 5 914 � ; NITL'�h� L:}YG T i t r,P'AT Wt:STcitN BANK* 4:4!'? 'PARKA to PKWY *26f) ' !V t N!-* CA 9760"x -:�00r, n OFCPT- 4 CHAf;G :: 07. SC:: i PT I ON DUAN T I TY EXT FNDr:D ATC• PRICr S: �VICr COO L Num.W. F., 7/: a./:)2. 1111G,L%; �--T :_,T--N:.URU/SPINAL LI TPID 1 1.:?�-�0•i:3 7^ 2/92 111 1.-�91 TRAUMA NV',c-,i:* CAF-.,--- 1 250 n:) T/:�3/92 1 1 I 1 C R2 ST 5T-N.7.:UR0/SP 1 NAL 50 -PO 1 1.050.00 7/C-3/911 •2 1111091 'TkAUNA GrN HURSE CArr 1 25C9d0. 64p.GJ f.%7 ST 5T-•-St.M 1 -PP 1VA-rF- i 1 250.0.0 7/04/92 I. i l 1 D91 .� TRAUMA GEN NURSE CARE or. 0>To I I I TSTAL :3.49C: • .. . T/•6)2/92 242! 717 SURD MINOR 1/4 HP 9 ^•29f•.L��J DF=.PTg 242 TOTAL 2•?85•�U 7/.ti3/q2 c:n771,.� r2�':CUvc R.Y f24 ALflL 1/4 tic! t 53.t`O y/C.3/92 2477131• P/R C1.LL CAGE 1 1 13R•C7 12i.d0 :3092 2477133 R/R PULSE OX I MSTRY Do.rPT# 247 TOTAL :112.0: . 7/02/92 2509148 ANESYH MACHINE USE: 1 9 107&00 135.00 7/02/92 99070 2609164 CZNEQAL GAS 1/4 HR 1 87.00 7/;;2/92 260923" A?4,;:STHSIA KIT Dip'—'PTO A6m% T 3TAL 329. C O 7/3Z/92 300001t: OANDAG Krf'.LIX ROLL 1 10000 7.00 7/C Z/92 3000116 DRESS 4X4 GAUZE x0/PK 2 10900 7/f. 2192 3^..71?a Cac:SS FLUs%FS Ki=RLIX 1 33.4 0 ' NGG 'f V ::: P. o W/CUFF 1 190.00 7/x}2/92 30CC 236 IV CATH JELCO 2CGX1 1 44.00 T 7 30llt,i�: 1 I PRIG SOL•9XSC 49.,07 ?/��/��: 3n 09C SZ:R 9L WATr-R 15^:.SCC ET S 1 3100~ T/'12l92 i0��•i i••? INFVS PUMa I V;, 1 7900 7/::2/91 30011.34 fl�Aly PEh?.O5_ 1/4XI2 1 7/02/92 30P 11 35 DRAIN Pc NRO: r: 1 /^XI 4 I ?. C C 14.00 T/021g2 30,1203. SYRINGE IRRIG SOCC AFSP 2 -r/C 2/42 30'1354 SUCTION YAi�KA°U ZR TIS' 1 6. VO 7904 7/:2/92 300141:= SUCTION TURINu 11 F: 1 10.00 7/03/92 3000010 BANDAGE_ KERLIX POLL 1 ?!°.U7 7/ ;-3/q< 3000116 Df=CSS 4X4 GAVZt I : /I'K 4 3.OA 7/-;3/92 3000Z1 3 IV INFUSION PLUG 1 14.00 3/92 3005:7 0 DRESSING TEGAD-HRM 2X3 2 47.00 /' 3/92 _' 3041033 IRR SOL.g% SC 10�' GCC 5L 1 790E -T/OS/92 37..0116 DRESS 4X4 GAUZ' IC/PK1 994E 7 r 92 30 1OZ5n ST FRI ST,'rP 1/2X4 I 2 6.09E 7 5/9:'. 3002392 SCT SSC^ S G1 SQ 1 c. !r=; T;.►2►v N -:D CTR -SANTA AN. • POO • box C-11912 SANTA ANA CA 92711-r;, ; "' PATIt..NT E:IL.L n=TAIL TIANSACTI(,N) PAGE T`� : I ►rT 94 NYTZ�y:* IkVx��: t3A.NK• PKWY C.a V,C•A�-%.�00'i , 7AY: %F CPT --4 CiiA;: G:: D_'SCRI PT IGN ELUANT I TY LXTENW:p Pi?IG� 7/;►x/92 7 -:;? 7/'J2/V2 7/x•2/92 7 /(* J/V2. 7 T1+;1.: 7202r 75499 7 ;:1 I :: 412C': 1!i 41��57 41'"'Cr21 4171994 4 1 ;31 C SKUL!_ 2 VI::MS Cti!=ST %. VY''w A? n', P+ SPINE CERVICAL LATCRAL TRAUMA A':SPONaf: MA.ND t bLa COMPL71 F. 1 2 3 13�:. 194.0G 158.Co DEPT# 412 TOTAL. 740,%00 7:,4`x5 7:.49A -428452 4 2t'4 571" CT irRAIN W/O CONTRAST CT FAC=' V/0 CONTRAST 1 594.UO 671.rC3 Dr'PT* 4211 TOTAL 10265.00 7/:::T /9c 3/92 1.)476k 540.448, 5434503 PUL 7- OXINITRY E VALUATI EM .RGC.NCY W DICAL ASCT 1 Y 45 00 53.r•0 A --PTO 540 YOTAL 98.00 7/c. 3/92 7/03/92 5412.1:22. 5412023 NURSG nXYG:N Hli S/U NURS OXYGEN FOUIPME 2 1 1:i•GC ,4900 C"`PTO 541 TOTAL G?. �.:• 7/02/92 600EI 07 TRAUMA R� SI1S ADMIT 1 3.75Q.04 D pro 6Ut, TOTAL 3�7�►a.GV 6C't811'i TC:AUMA MINOR ACTIVATa 1 3�I25.00 D =PTA' 601 TOTAL 7/7 7/92, 7/•.'7/'x^ 7/C17/92 7/t: 7/9^. 7/07/92 7/:_`7/>2 h 7/17-7/ye- 7/07/92 7/h;: 64634 C 645:4073 6453C.S' 3 6463106 6463114 G46111 6463146 6464151 6464 1 SI L=LTECT� 00`7"S g.CG ADULT IV Ttl::+� e.�►MiN—�;: !:ULP.:� NASAL CAK'!\IULA r? sp C; RVICAL COLLAR STIFF UNDE:RPAUS Slit (CRUX) TV CATH OUTCK H-: ADI : n ADULT W.'NIGUARD IV SOL NS 7. 7 1'��` � 1 1 1 1 + A � . r. , ,r, :5.00 62.•�� S.00 17.c:1 6.04 X44.75 DP7ir f, 4,; TOTAL. 1 85.7> 1`/3-1 S12- 930,)Ar:) CNA INSUPANCF PYMT 19.?49.45CR PA T I CCT 94 2.060 2. 117 1 T7 M n T O T A L---�..-•-------�_.....� -«'� -f..►= i ��r;� A . i� u . 1, -:, , _ _ �-b, j -u-,-,- ��. .ger' VE.IS, TE'QN 9t'D CTk-SAKT A A), P.110 FtCX C-11912 • SANTA ANI. CA 92711—f V*,% n 2. _'c^./S►^. vATTENT DILL Dt—'TAIL SUMMMkRY PAGE f�ATI ANT Si47.fl'L `�: CYCL 1 E= 14e.L GUAPANTOR ::1 6101 'i .) ,'PAT RrP NIT"Zf=N• LJYD T It K�:AY wCST�Rh t:1A'Vx. *4** IVVIN: CA 9.'7660-000f% b SC�tIPTIU�I DUANTITY :=XTrN0CU PRTC 1 1 1 Nz•:UPJ/0_ RTHb STH FLOG -k .3 4 P•.: • C 24? SURGr_:?Y L ?FCOV`"�ZY SVC;; �! ?�'�'►;t5.:.�,; 2.47 RECOVERY ROOM S(:4V 1 C _5 3 312 +'v 0 ?. 60 AN STHc S I Ot OGY 1 2 3 29 + r." 3:171 M* ')ICAL SUPPLILS. 26 179.G0 302 • SUPPLIES -• SURGERY S 739.00 306 SUPPLIES •-- SPECIAL 4 220.00 CLI141CAL LAr3 S'.RVTC�S 171.:`. 351 LAb -•- HER4TOLOGY 4 173.00 354 LkS -- CHEMISTPY :? 17RI-30 li!;4 L# -a ^ I MRUNOLO.;Y 1 1; 2. S j 361.1 PATHOLDGICAL LAO S-ER.VICES 1 .'!1.5.'1 :_3 7'1 ;1L000 SANK. = 3e* U 401.1 PHARMACY .53 1.4t, 8,!!-;. 4;.2 PHARAACY 12 , t Q. w5 412 S2ADTOLOGY - DIAGNOSTIC 5 740.00 428 COMPUTED TOMOGRAPHIC SCAN 2 10265000 5401 R;SOIRATCnY THERAPY 2 08.00 541 RESPIRATORY THrJRAPY-•NftSWG •i3.:,� 604 E_XErRGF.NCY• SERVICES 1 3.750*00 h - I TRAUMA CENTER 1 a46 P RkMEDIC f1AS�7 STATIONS 9 185.7E Y 0 T A 1_ 1 VC JUL 0 7 1992� JUL 161992 AUG 1 ? i392 AU G 311992 '� x Lloyd 7/07/92 �• Mr. Nitzen is a follow-up trauma fro_-- 11^-♦^rn Medical Center. He has been experiencing slight dizziness when he stands up fast or turns rapidly. This is minimal in nature. The swell- ing is down in his cheek and theKe's no sign of infection present. Sutures were removed. The facial nerve is completely normal as is sensation to the face. His ear also has normal sc:zsation. I'll see him again for further. evaluation Qf his progress. I•ZP: ri 7/16/92 Hr. Nitzen is doing well. There is no sign of dizziness and the facial nerve functions well. He has normal sensation throughout. The patient will be evaluated again in approxi- mately a month. M.JP: ri* 8/17/92 The patient didn't show for his appointment today. 8/31/92 Mr. Iiitzen is doing well. The scar is maturing nicely. There still will be an evident scar but shouldthoface1}Hetime. He has still full motor and sensory function o e has soae complaints of varible hearing complaints. I told him we would check this out as indicated. I'll see him again for further evaulation. MJP:ri DATE OF OPERATION/PROCEDURE: 7/292 pnOPERATIVE DIAGNCCIC: OPEN WOUND RIGHT MASTOID AREA WITH FOREIGN BODIES PRESENT. 1, O_ EN 2, PUNCTUR-= WOU24D TO RIGHT CHEEK WITH FOREIGN POSTOPERATIVE DIAGNOSIS= 1. OPE N WOUND RIGHT MASTOID ARES. W'I'TH FOREIGN BODIES PrR2ESE2JT. Z. PUNCTURE ti.'OUND TO RIGHT CHEEK WITH FOREI PROCEDURE: AL 1. EXPLORATION RIGHT PREAURICULAR CHEEK WOUNDS WITH D WITH M V REMOVAL GLASS PARTICLES AND EXPLORATION OF RRIGAPPROXZ TELY 1 CENTIMETER OF OF GLASS PARTICLE. COMPLEX REPAA.R OF WOUNDS AND COMPLEX REPAIR APPROXIMATELY S CENTIMETERS RIGHT C..EEK OF SUPERIOR NECK INFERIOR REGION WOUNDS. SURGEOAI MICHAL PLECHAS, M.D. ANESTHESIA: GENERAL BY E. LEE, M.D. FINDINGS AN -D INDICATIONS/PROCEDURE INcle D TAIL: He was struck just Patient was in a motor vehi On the right ear and across t?':c right cheek. �'fractured tof f beneath 9 of .these areas it was found that s at mastoid slightly oblique angle from ith minimal displacement. It wad there were particles of W the horizontal. In the depths of the woLn The segnent of the sternocleidomastoidza had been glass found.4 transected• On the anterior of the right cheek in arotid gland. A i area, there were two pockets found deep in . fromthisarea. There was number of particles of glass were This considerable swelling but no obvious parotid fluid les k fol lowed area t was closed with deep S--0 invertedPDS skin was trimmed of interrupted 7 -O's for the - _ devitalized edges. . -Next the wound- over the mastoid was trimrzed - devf tali g laced in_the sternocleidomastoid Inverted 6-0 PDS sutures were p just beneath the deep MU and then in the deep structures aced ' in the deep dermis dermis • Next inverted 6-0 PDS were p 4 inch followed by interrupted and running 7-0 Prolene:.. A laced. Penrose drain was placed in the depth and an ear dressing p CONTINUED DIC.AL CENTER /SANTA APIA NITZEN, IZYD T• , II iiESTBRN 2SE SANTA AICA, CALIFORNIA OPERATION/PROCEDURE REPORT 27 82 91 M ' - 0 U PAG E 2 CONTINUED Patient tolerated the procedure well. He was taken to the Recovery Room in good condition. - HICHAL PLECHAS, M.D. MP/biro D: 07/05/92 1541 82031 T: 07/06/92, 2007 CC: WMC TRAUMA SERVICE BILLING DEPARTMENT WESTERN MEDICAL CENTER/SANTA ANA hIZTZEN, LOAD SANTA AHA, CALIFORNIA 27 82 91 HICH.AL PLECHASM.D. OPERATION/PROCEDURE REPORT , J DATE OF CONSULTATION: 7-2-92 REFERRED FROM: E. PARK, M.D. REFERRED TO: K. PLECHAS, M.D. REASON FOR CONSULTATION: Re -consult for open wound, right neck/head region. HISTORY OF PRESENT ILLNESS: I This 31 -year-old male was involved in a motor o o mastoid region. accident. •The was called to evaluate a wound in the g mastoid is fractured and there are foreign ha bodies in the Hound. was The patient had no loss nit adof lousness attended in. the Park, M.D., the brought to the trauma trauma surgeon. PHYSICAL EMMINATION: HEAD, EYES, EARS, NOSE, AND THROAT: The patient has a hole over the right mastoid. The mastoid is fractured t and seen. n the basand here are a number of probable glass particles fel any touching deep in the wound the patient experiences decreased hearing. He relates this to "having water" in his ear. The asses across the patient hears well with he earand do -.-n onto aceration h erLe cheek with an mastoid, over the infi abrasion to the cheek. There is also considerable -swelling of the right cheek region with a number of perforation though into the deep tissue. The zygomatic arch is in place and al ,and reactive - to he infraorbital rims are intact. The pupils are equ light and accommodation. No diplopia.is ful rangP -There is not al sensaiion mandble of the left face. There master paof in - in the region. The with no TMJ pain but definite patient has what he feels to be his normal occlusion. NECK: - Supple without pain -other then the sternocleidomastoid tat on theright auscul- mastoid. THORAX: Lung fields clear to There is a slight tenderness across the Regular rate and rhythm. anterior chest secondary to the seatbelt. ABDOMEN: Soft without other then some superficial tenderness - tenderness or distention belt he low abdomen. again secondary to the • seataDa°ns with percussion. Costovertebral angles and rib GENITOURINARY/RECTAL: Deferred to the aa.•nitting trauma physician's exam. EXTREMITIES: The patient has no significant injury to his uo },ac f,il l ranQe_of motion good circulationL good scnsatio:t and FL -^=tion. NEUROLOGIC: TI:e patient appears LU puncture normal sensation of the face and even rhe ear although zhe 1 ic lar nerve. Cranial nerve wound is directly at the posterior au CONTINUED WFSTERN MEDICAL CENTER/SANTA ANA SANTA ANA, CALIFORNIA - NITZEN, LOYD 527-2 27-82-91 - CONSULTATION i • PAGE 2 CONTINUED noted, he has good VIZ is fully ull intact with normal function. As hearing. SSICN: REGION WITH FOREIGN BODIES E.'SEDDED IMPRE RIGHT yASTOID 1. LACEPATTIOtyjj.STOID BONE . AND FpACTURED . setting to block and eX�lne the in the PLAN: was made on the f loon s ain especially Attempt erienced too much p Also, to wound. The patient exp ssible to block this area. adequate ion and it was �Po n bodies and to do an he mastoid reg adequately search for the foreig For this reason, eneral anesthesia. will be debrided, repair the patient needs g There the area ending. The P operating room. Lab work is p is taken t nd hrepP on the floor and then in ed a aired as indicated- explored ostope patient will be followed p the office. M_ pf gC�iAS. M.D. lip ss ' d= 7-5-92 1531 R2028 tt 7-6-92 0604 - - R SAi:TA APiA K ZT Z EN , LOYD 527-2 '. WESTERN2SEDICAL �SAMA ANA CALIFORNIA 27-82-91 r PLECHAS, H.D. (;DNSULTATIOhi _ - T=�-._ GREA- ' COK TRA,.'-L h'• / &O.ds..ew"'= - - • 'Ap 10 boof�" ed as • c �ItAVELE/ •ax�ti-rot '..T77z.. FLE IC 'M WEALTH c-&J*-7-- Pte. n Tris Group mw*At Bencdo P+an s a3r*+rws1~se b+ ris T7r+�ws k,rxra+�c� Company. borcc. mr&om ..*+c ae covr.e urxw Vw be- ane s or r.,4 P;u. are sr',se +o benei:'Y Ths Card oots r+ot cawrsspc f or ar r, N. ry or bwyfe r Aorrryaort PkNne cax sw pnor * numbw &.-low" sr4 pr" t-W rsorr. goon bur. ro tont d hi t srd NOW A P. Ww , C Pro.rd«r 1awsst Cal Pw:l r ^&#*caw ts4w torq amptoras Or rye s+r,a•ose s Wrwn y resporv.dirsy a a[ Psaars Acvocom =VERED PERSONS S" YOLK baneboo*W for a oes=vooof co.rsd seresom F+e+err+D.r. tr+s+tt an swarm es to Lmev Pro-C-00 Provos. ►VZDra.:t IL-+d Pr►.�m Tho PMA WIC pa•y a prasiw Portion d Tour cc-woe a zDerws I yaw uaas The T►srs:rs P*++r*.c ti*r�•wtt of Do=-m and KospQW& TheTravelers j ' _ KICHAL J. P: rCHAS, M.D. 801 N. TUSTIN AVENUE SUITE 304 SETA ANA, CA= FCnTdIA 92705 pxTILYT INFORMATION Name , 0 Y/ Rome Address / - Z f p Drivers License No. Tel ephone # Marital Status Age Sex—AL ��J Birthdate %�' hd--' CD / Occupation Social sec. No. - Employer Tel ephone # ` / Responsible party _ or Spouses ?;r„me 5 f-,-;,&Z*eTelephone# ,Ancia.l Security No. .:teas Employer Occupation - Address Telephone# In Cgme en . �w Name ase a �� 7t7�r � -� % % . � Zip Ref erred BY: X=Q Of InZUra.nce Address Zip - Fcliey .--- Group No. P0 --IF Holder taw IMTIl�'f HIS A. ORY Family Doctor: �%� �%i� JE= �..���0 /� f /Li • ' Reason for consulting Doctor: /j/� . -• • -�-n ��..r Please list any medical conditions you have (High Blood Pressure, Diabetes, etc.) : 410 /l eS�7- Please listmedications you take: 7-t)an i ._ -17 Please list any allergies you have: AAD /lam' Previous surgeries:��/� Previous hospitalizations: �✓^t% Any serious illnesses: Any illnesses in family: Do you smoke? How much For how long Do you braise easily? AID Female• N r of children �..—'.� /t✓ /¢ . ; Date (de ?a CiiAL j. PLE Ch i S . M.D. Sol N. TUSTIN AVE';UE SUITE 304 SANTA ANA, CALIFORNIA 9705 AUTWR1ZATIOX TO RELEASE OR RECEIVE IUtrOR O" TION /ation in theicot�rse of ay �•, to release or receive, for I hereby authorizey�e Michal J. PlPlechchf,ns , . an insurance purposes, y Lecome examination ur treatwent. Ttlis nuthor ZAsoonsha� necr-ssaryto fcfulfill irmediately.ard shall remain in etfec�. 9 the obligations required by the a tiv ' t e -s -undertake on my behalf . Date Signed � AUTHORIZATION TO PAY hereby authorize payment direct? ; t�1cha1 J. Pleed; ca M.D., of I her Y • -3Clud Major H �..ical benefits, if surgical and or nedical benefits, +; .n'3 �v, othezuise pa eble to ae for h+s ser;.'1servibPs.ut nI understand that I asci: rhle a d c:::.uowary charge fo «these financially responsible for the hir .as r.ot-/c�vered this �'� is ti i� %z t riginal. authorization. A rhotocopy of this '-=gin ; � . r `� -' gd rrxANcIAL A NT - The undersigned agrees, utiether he igns as agent or as a patient, "that %� � to tie patient, he hereby in consideration of the services td be rend. Bred t of e p ie r in individually cbl=yatee slarhi=serates lf to ar�d the o he of � e• accordance With the r q' Date v Signed `� OANTA ANA TU --,TTN RAD101.00Y rfF..C:Ti_Al. G3r-,'-)I tp NAIAE: NITZEN II, LOVD T SE_X: tai DOB: ROOM: 515232 WRAY 44,: 3,14410 REQVESTTtJG PHYSICTAN: t:)/,.Rl(, Et NG1 t-1. ATTENDING PHYSICIAN: N � DATE CSF EXArA: n'7-nc^_- r,0? EXAM: CT FACE ORD%*: 4'71'700 WITHOUT CONTRAST EXAM DATE: 7/2/q? H I STORY: Trauma. Utilizing E. 9660 �r:�Iltt9i" , c ol?t iglJ0111 3 mtn axial ` r-alln wsar•3 obtainecl at 3 tun Intmi vols tttrott m tra., ro-of r,f ttie orni is tr+rotu.jo Tries mandible. FINOINGS: ' Minimally Ciispiac re a vertic:+'lly orte.nt.PV fr:lr1-Urrs t.hr•cat. gn tttiei riial-tt mastoid tip is sec.n . There Js actir i s sties a i rec:;t. l.y c0j8cent to the riryht mats toAo t.iTrion.re i5 .5orT. ti:;3tjt; swelling. There is Gpaci f ir%+tJon of the inreurior rPAillitoid air cells. The bony structures. of t.he, f w --e, spnc i f i cal ly tnab zy4lorr,;-� ano z.ygc m.—I r i c; arches, appear i ntc+ct . The of t tint als,ri appeor inti%r.x There is no evict"trice of :iir flula 5r -,m i wit.viirt thh froill.1751 . ethmoid, sph-noin, or ma.;;i 1 Lary sintjzmt i. Ttle tia mal bones arspesar int-1r.t . Tse :,ept tam is mi 0l i na In position. The mandible also �c}��.�eF►r int.e,%et wi tsjout evi rend: of act,te fracture.. Bntrt joint,* ars► rr1,:5 i nt.zj i r)e47 . The Dony orbits 6npsar i punct wi t tinut ewi c-je:t"cc ou of t+euth rract tare . Tete intraorbital fat planes are, n1st. tnc:t.. The entraocular musclha intact. Both globes eipp#5ar tinvemarl(ttihle . i rr,i-oort t iravia) Western Medical Center Santa Ana. ColHornlo RADIOLOGY REPORT Form No. 7630.0106 (10187) BILLING COPY PATIENT I.D. NAME MED. RECORD NO. DOCTOR RM. v :;ARTA ANA Tt)STTN FiAnTOI-C-P&V GR ,!.IC NAME: rJI -rZEN I , Lr.,`#'n T R(X)Iv{ 15T�232 `:I -`i . �1 t ►C�t3 . :(FcAY it : 314416REQUESTTNO PI-IVSTCIAt4 : PAR{ Flcc��.-t {1 . , n1. p AFTENDING PHYSICIAN: NS DATE_ C,F EXAIA: 07-Q?-•�2 &EXAM: CT FACE WITHOUT Cr)NTRAST ''Fti?':T : 47 t •��;q (Continued) CONCLUIS70N: '. rrf111trne]1 t Y ctp 1 l`3 C (a O t r %3 C tfire t1,%1c>1 V t r,�� t F'. H r i ,� t t t: to �, t: n i ri tip wit. {1, OPerifiCetion of if,a ma�roid air, c, 'ell inferiOl'].y. AS:Ar:iL4t.ekj t.isstAe Swelling With r5oiopi1gt,fe �7��;r•i.;S. fOU. racture. � e r w i s e rc a �. t i v e f h C i h i CT Can . 1\10 E� :! i e r� �� a Of 0: 7/2/92 . J (Ja 07-03-92 M.U. PATIENT I.D. Western Medical Center Sonfo Mo, Col tomb NAME RADIOLOGY REPORT MED. RECORD NO. Form No. 7630.0ins finia*?i Dig f ,►.,r% ,.,,.,., DOCTOR RM. Sl XTEMEN1 071:1: ACCOUNT NO. Sa'STA ANA TUSTIN KAU "A!-0 GV,.JP STATEMENT DATE 1450 N TIJ.3T14 AV 1"44-z ► ;'132' U1 1-2 942061J2 110/1?/32 SANTA ANA EA �?Z701 1-714-835-6699 95-2315954 MAKE: CHECK PAYABLE 10: SANTA ANA TUSTIN RAO "fir=U GROUP LJYI) T NITZO: l II AMOUNT REMITTED $ PLEASE DEI ACH 101' I'C)RT WIN AND I IF.l I )RIA WITI I Your nEMITTANCE. RETAIN l I IIF: 1`011 T ION OF `:1 Al F:A•iF Nr f (.in Y01.111 TAX RECORDS. ACCOUNT NO. STATEMENT DATE PATIENT PHONE NO. PATIENT 1-01-2942U602 10/12/92 714/)44-2' 50 'NI TZON II, LCYD � i DATE * PROCEDURE CODE DESCRIPTION DX CODE AMOUNT 7/02- 92 1 9. 052 RADIUU-.1GY TK A U M A LH4RGE 137.00 7/02/92 1 70250-26 SKULL 2 VIE14S 47.00 7/02/97 1 72020-26 CERVICAL SPINE CROS TA3LE LAT 56.J0 7/02/92 1 7202U-25 CERV IC4L SPINE CROSS TATTLE LAT 5 6.30 � 7/02/92 1 71010-26 C:4ES T 1 VI E -W A/P 28 0 7/02/92 1 70110-26 MANDIBLE COMP MIN 4 VIEWS 15 1.0, 7/02/92 1 70450-25 CT HCEAJ OR DRAIN W/0 CONTRAST 22 7*00 7/02/92 1 70436-26 CT MAXILLOFACIAL AP.=A W/O CONT 2 38.00 8/18/92 999977 WORKERS COMP PAYMEINT 9 7.17CR 8/13/92 9832'77 WORKERS COMP UIS4LLt?WatiC� � 150.1-33CR 8/25 /9? 9;9917 C0N14ECT ICUT GENERAL PA 15 7*57CR 3/23/92) '3B 8817 CONNECT i Ci1T GENERA III.,QJ— 39 7.43CR �v Q F_FERRING PHYSICIAN DATE ADMITTED DATEDISCHAIRGED PHYSICIAN PERFORMING SERVICE :i t.•1' ARK, EUNG .4 .'.0 07/02/92 07/09/92 '3FUGMAV► JOSEPH J M:) 47.00 ACL 4ESTERN 4`OIC4L CENTER • n ACE T t sSmTAL ,OUTPTIE'I DATE OF BIRTH INJURY D. OF _ ;wcE 1001 N TUSTIN AVENUE SANTA ANA CA 92705 Nl*" i CVTMT�fM1 ►r,1g+'ITAL -E E"Ge c"R`OAom 01/10/61 07/02/92 S of"CE %. OTNEN GP.;. --4T W =_ S T E R N S EMPLOYER ► C L`i l': 62-445240—K7 PRIMARY NSURANCE ► S�CONnnnr lo' SANTA ANA TUSTI:N RADT01.0:3Y MEDICAL GROtio NAME: N ITZEN , LOYD T EX: M RCX'IM: 3T3232 XRAY 0: 314410 REQUESTINO PHYSICIAN: PARK, EU1,10 14 . , PIE • D ATTENDING PHYSIS= TAN : 114S DATE:. OF EXAM: 07-02-cit EXAM: CHEST 1 VTEW AP OR PA EXAM DATE: 7/2/42 HISTORY: Trauma- A s1119lo AP view of thh chcSt w.��s or,t.�it�9h. Th�Iv5art size, Z i5 norrn.�1. Mediastinum and hila are unrnrnarK,it;ile. Pul-monary »f3!;CU1Hture is normal. There is no evidence of fOC.31 cotI;.:o1 idat ion or pif-,rtr.:=:1 effusion. The c}iest &ppears norrnel . IMPRESSION: Normal chest. 0: 7/ 10/92 da 07- 1 1-92 PATIENT I.D. Western Medical Center Santa Ana. Ccutornla NAME RM. RADIOLOGY REPORT MED. RECORD NO. Form No. 7530-0105 (10/87) BILLING COPY DOCTOR SANTA At -'A TU' -->Tl tJ RAUTr►L.C►GY FITC-,T,'AL oI ot.,p NAME: NTTZEN , LOYD T C. : rn DOG: ROG'idl: 5T3232 1.XRAY 4*: 3 i u� 1!i REQUESTING PHYSICIAN: PARK, E, f;Jc; F{ . , rn . n . ATTENDI14G PHYSTCTAN : WS DATE CIF- EXAM: 07-02-q,;, EXAM: CERVICAL SPINE CROSS TABLE LATERAL ORD#k : 47 1 64t -i 1 EXAM DATE: 7/2/92 HISTORY: Trauma A single lateral view1of the cervical spirno was ot-,ta,inhh. The cervical spino was v i sf.jal t :.nry to the l ewes]. of trio top of C-7. Prevertebral soft t is3uts are urirnmarkat)Jej. Thnro is no 'ov ja,,srjr,►,5 (.)If fracture or suhluxr►tidn. Intervertebral disc sP&Ces t+ppex-ir unremarkable. It further evaluation 15 r-,err��r�ry, Ball rervtc:sj spina series is recorrynence-a l i IMPRESSION: + Negative lateral. cervical spine to tF',P level C,r C. D: 7/2/92 Ua 07- 1 1-92 tATCHAE . El -,":CK, r•1. D . Western Medical Center Soma Ma. Coffrorria RADIOLOGY REPORT Form No. 7630.0106 (10/67) BILLING COPY M7-- . PATIENT I.O. NAME MED. RECORD NO. DOCTOR RM. W SANTA ANA TUSTTI•J RAnJ(-)L C,i,%1 N►EL7�-:nt. c RCS+JU iJAME : NTT -T N , LOYD T ROO�►1: 5 T5 c^ 3 2' REQUESTING PHYSICIAN: PARK, EUINO H . , M.D. XRAY # : 3 144 10 ATTENDING PHYSICIAN: NS DATE Or EXA114: 07-0"-C,12 EXAM: SKULL, 2 VIEWS ORDO : 4716-71,1 EXAM DATE: 7/2/92 HISTORY: Traurva Two v i ows of th0 Skull 'wnre ohta i fincd . Theme Is no PV i denco of sic1111 fracture or eutural niastasis. 7/10/92 i da 07-11-C)2 rnTCNF.�:L i3t_Ac_k• , M19. D . PATIENT I.D. Western Medical Center Sonlo Am. ColNomla NAME RADIOLOGY REPORT MED. RECORD NO. Form No. 7630.0106 (10/87) BILLING COPY DOCTOR RM. SANTA ANA T1)->TZ1J RADTOLOiY P:iFi?i��;l. GROUP NIA;AE: NITZEN ZI, LO`✓D T :.EX: M ROOM: 575232 f.�GEi: kR�.Y 0: 314410 REQUESTING PHYSICIAN: PARK, EU. -IG E1 . , Iti1. D ATTENDING PHYSICIAN. NS DATE OF EXAM: 07-0c--4,2 EXAM: CT BRAIN ��Rt1 4'71 r,►Gj WITHOUT CONTRACT EXAM DATE: 7/2/92 HISTORY: TrnUma. Ut S 1 i z ! nn the G.E. et)840 :3canlier, , rant i guoU.3 axial scans were of-iT.a i nr��1 from the base of the skull to the vertex . FINDINGS: The fourth, third acid lateral ventricles appn.yr normal in sizh A. 1")h conf iguration. The cisternal spaces are mairetaineld. The ceretort-1 sulci are not widenecd or of faco(j. No focal high or low attenuatect lesions tyre noted intra-aKfally. tic) focal mass les ion, are' smen . No intra-axial f ] «i d collect i ons are noted. No mass effect ' or midline shift. is apprecieteh. CONCLUSION: Negative non-contrast head CT scan. tao ev iaence of acutd intracranial hemorrhage. 1 (report continued) Western Medical Center Sonto Ano. CoiMorn{o RADIOLOGY REPORT Form No. 7630-0106 (10187) R11 11Nr. r`npv 4TIENT I.D. NAME MED. RECORD NO. DOCTOR RM. SANTA ANA TtJST7N HAD70(.C)`.\, 14EUICAL GrZi7-.1P NAME: NITZEN II, LGYU T SEX: rn DGB: R0GA1: 5TZ232 REQUESTING PHYSICIAN: PARK f EUNi-5 H. , W D . XRAY 0: 314410 ATTENDING PHYSICIAN: WS DATE CII- EXAIA: 47-02—Q2 EXAM: CT URA TN WITHOUT CONTRA ST . GRD44 : 471C-99 (Continued) D: 7/2/92^ as 07-03-92 viv=t_rJ C. W01,40, s i . i i page 2 PATIENT I.D.* Western Medical Center Santo Ana. Cotttorrtio NAME RM. .RADIOLOGY* REPORT MED. RECORD NO. Form No. 7630.0106 (10!67) BILLING COPY DOCTOR 1ioN of � ;JUL! J. 4 1992 10L PAI ILNT iii Co jjU , F '' "I►►)► V J4 � .Q I. ;- n � yt _ 7I4 c4 1 - fez MX11 N ar Ms W►w aN Mwy •rrr.t+wor"rt.Cuq TC TRH FA F:U11 ►� ;; rvwr ..... ►o��rw w.ra LOT= T Van~ ^avow to aoC U!C Mumma wt.x.or "M ♦ Amu "Tt I r wa • rr of •urn �j �nn�en i..tio.�w rwrir arnoraw •oo•.r as rt .w •r4ML- 1 aow%o "►..o►ai •? 0 It I M trKJy A l'<l..Q yi I -3- -= a-caa� o. n rr I No*" n�a.•a.a ' a rt woen.cv ..o..a I f6Wffr0&n" r.O JbC7 wa.aoow-.r I LEANNA NIT -ON SP NULTIFLE TF.AUMAAUTOI ..5 K�DIX • TRAVELERS nt'AL DIAGNOSIS v omv M W A a.exi 549373427 ICA 106000 combar-o ft"Wc nu — NO ABBREVA MUS — ccw-ra,r.o PwrV WA DISCHARGE SUMMARY hrMc pw* w r.rR XITZON I I , LOTD T -- i illy # r acrs�, Imm �,oM roc Mosrrr w¢i►tto�►: xnoot o►SCwtwpto rr+t o+cc..,u►oro �.rrn.ow ►r+.s�+►>t a.o•..Mt I i ^i 1.9 r o 141 TZ EN • LOYD T I I tLKA-4�M c„►t9 Mi?; 6CIIAF.GEU 7/ 5/92:- �Ioq 1942-0602 M 31 PARI: SUNG H MD c ###IF 11�F1r1F1t1►r�MM�►Mir1F*Ms►*M�►i/ 131_OOD BANK +*a.+► 4.*��rx wr+�watr�►•ar**r** -------------- TYPE AND SCREEN ---------------------- ___ _ STATE LAW REQUIRES THATTE. -:,TED -THE WOMAN TETED bE INFORMED -- - ---- JlS TO THF PH (D! TYPING TEST f Cr --IJ _T 3 . JUL 2 1440 GROUP (ABO) 3 RH s A POSITIVE • F►14T I DOUY SGF�EEN s NGT DEI ECT >>>>»»>>>»»»>»>i>>»» CHEMISTRY 4NORMAL VALUES ARE LISTED ON REVERSE SIDE OF THIS REPORT). . NA KRU'`1/ 2 11R PP UNITS CL COZ CREAT &UN CkLAT GLLK-0-E GL•Ut-OSE MMOL/L MMOL. /L MM OL L G P c ------ ------ ------ MMOL M -/-L-- MG/DL MG/PL - JUL 2 1440 139 3.�3 iCf7' '2G 1 .O r 16 ---- ------ ------- -1 148H SERUM URTNE O=.MOL : AMYLASE LIPASE AMMON I A LO NORMAL t 30 :- H IGH NOR. M ,. —fir JUL 2 1440 � ! �. �. p^ — --, —r�r+ r `-.. , ;•. ... •- .. , CANCELLED TESTS tr'>PS4+R�rar?��r�E►+o•aCC':Q'E'�',,.�r„�2�RA► .C��'?"!C��+��2�a�a�t�c�� R ...;L 3 , :•40 CDC .. CANCEL hE R J tt N I CE • , t- •CANGELLE:D VIA CPU INTERFACE � a� a, aaaaa aaaa a+�a��a#A 14EDICAL RECORDS COPY � •. .. •• . r•. ..•r:.l� :I .l, t..• .•..w1. yy .1., s{1. f..••• .1 •. • •�. II. 16 _ ...... a •� ;.�. •.- C .'. � ..• .. .r, �• _ iI. .� .i. r. -„j. '�•• r�i y • '• `t-, ►••'• �. . .•••��. . •. -:� •,•. n -. .� ate •1. • •1 •a"�'. .. ... ir... .. .... .. •:a• `. T fir' .' ./•�• i •, .. ,. t � .. ' ' .. PA' SENT .. , • ' . N I T?EN • LOYD T I I 10 Nom” iCIC."KA �4TE 194206Cl ASF�tCA� RfCOq(G%C\rr+NIrMP.:R R,¢' Zt1 I...` 1•i l�:!.!.� H t.l [l. *. St'f ln�%, !,t v R ►A STP{;.:• �f U . f4l TZCN, LOYD T' I T n•1F �� �• ,` f ,�, ' �� •:� PARE' EUN63 Fi MD REPO C(JtJrA 3 p - 1 71- ,c+ails, ,�' « � � +� ,� �l r ' � { . • • . HEMAT6(.O6y WBC{7 �Mi*xri�lir«Mi�1t<ir�Miwx !_.OW RDC ,� AGE H NORM , 4.5 CT {"ACV MCF MC(iC / . > IGH NORM ♦•40 13.9 FLATLET COUN! L"*ITS'S 1T_ / 2715 3L v �.._O 52.4 f 4, .,r 145. , X10**3- Xit�*+r6 GM/DL / �_.?? 3F.n _ EL 4�0 .'UL 2 1440 7.6 4 7�p ------ - -----� --G ---_ X10 •3 HEMATO(:Z 4431-; 614` 3 7"— J1JL Z 2204. y�;ItT R���IcCI`E MANUA,CL�'� 1-c ,•, 2.3 37. 4H X33 _---- 1 1 ..jH 4 �6 5 JUL 3 0611 1 I .9H 5 44.5 40.5L g T I 1 - 31.E 39. 7LD I �'F=,P�..-t•.. .. x•30 • • A'L NORMALS .. i — R13C MOnpHOi_OrY9L Z 1440 SEGS• ^ ------ / bA�EOSINOPHIL-- 0 PHIL : 1 0-6 y - LYMPHOCYTES • s 31-15-40• .. 0:. ". •. MONOCYTES = 8 _- .-.► -k- . ••;•-:,;...-a----- RDW-CV ! • . RDW 125 5 -145 ... _ i ; • 37.2 .. .37:0-54.0 .• - _ 0 OF 4117 V •- .. aaa• URINALYSIS • - 3 i �G C.GLOR ln T— — ------ --- t._RM',La— '..~' AFPEf1Rn�ICE �. = �'CLLC'.! ' rEECIRIC • LEAK .. - .._.:•• PH utAVI TY -.1.01:-1.02 . r pOTC I f J ._ c :.... C.UGCir` : NEC, MG/DL` _ ... -$. :, : _..,.•, _ . • �- - BIL IkURIt,I .. _... _ _ �.EG ljD NITRITE ••-' C�C)ILIr4r-i Jw • •' . : �'jEt3 . kPG'S t O.2 MG/DL NEG, 1 SO1sAMOU3 EPITHELIAL Y�- • rHrr U_2 l �7 41 r:3::'S PRCOf'tMTrV! LYA"+oSts roaTOPcwATMt assn Msuc ABED Forc i 9n body right ma s to i d GR= DESCRIPTION The specimen is receirc►d in formalin and consists of six (6) irregular fragments of clear blue glass r4nging to size fr % 0.3 x 0.2 x U.1 ca. to 1.0 z 0.7 X 0.3 cn. A 0.3 c*. fra5r.�ent of tan skeletal muscle is grossly Identified. Gross only, no sections taken., GF.OSS D IAGNOS I S Fr^,it6,' NTS OF GLASS. ' I D E1iTI FI ED. • - P.S/re - 7-6-92 /. DATE OF CONSULTATIONS REFERRED FROHt REFERRED TOt 0 7-2-92 E. PARK, K.D. H. PLECHAS, H.D. REASON FOR CONSULTATIONS Re -consult for open wound, right neck/head region. HISTORY OF PRESENT ILLNESS: This 31 -year-old male was involved in a motor vehicle accident. I was called to evaluate a wound in the tight mastoid region. The mastoid is fractured and there are foreign bodies in .the wound. The patient had no loss of consciousness ir. the accident. He was brought to the trauma unit and attended to Eung Park, M.D. , the m traua surgeon. PHYSICAL EMMINATION: HEAD, EYES, £ARS,• NOSE, AND THROAT: The patient has a hole over the right mastoid. The mastoid is fractured in the base and there are a number of probable glass particles felt and seen. With any touching deep in the wound the patient experiences decreased hearing. He relates this to "having water" in his* ear. The patient hears well with the ear. Laceration passes across the mastoid, over the inferior ear and down onto the cheek with an abrasion to the cheek. There is also considerable swelling of the right cheek region with a number of perforation through into the deep tissue. The zygomatic arch is in place and symmetrical. The infraorbital rims are intact. The pupils are equal and reactive'to light and accommodation. No diplopia. There is normal sensation of the left face. There is full range of motion of the mandible with no TMJ pain but definite master pain in the region. The patient has what he feels to be his normal occlusion. NECK: - Supple without pain other then the sternocleidomastoid at the right mastoid. THORAX: Lung fields clear to auscultation. HEARTS Regular rate and rhythm. There is a slight tenderness across the anterior chest secondary to the seatbelt. ABDO::EN: Soft without tenderness or distention other then some superficial tenderness again secondary to the seatbelt across the low abdomen. Costovertebral angles and rib pain with percussion. GENITOURINARY/RECTAL: Deferred to the admitting trauma physician's exam. EXTREMITIES: The patient has no significant injury to his extremities. He has full range. of motiorn�good circulation` good sensation and function. 1tEUR0LGIC: The patient appears to have normal sensation of the face and even the ear although the puncture wound is directly at the posterior auricular nerve. Cranial nerve CONTINUED WESTERN MEDICAL CENTER/SANTA ANA NITZEN, LOYD 527-2 SANTA A2{A, CALIFORNIA 27-e2-91 CONSULTATION M. PLECHAS, H.D. r © Q CONTINUED PAGE 2 VII is fully intact with normal function. As noted, he has good hearing. . IMPRESSIONt 1. LACERATION, RIGHT MASTOID REGION WITH FOREIGN BODIES EMBEDDED AND FRACTURED MASTOID BOIvE. P LAN t Attempt was made on the f loon setting to block and examine the wound. The patient experienced too much pain especially in the mastoid region and it was impossible to block this area. Also, to adequately search for the foreign bodiea and to do an adequate repair. the patient needs general anesthesia. For this reason, he is taken to the operating room. There the area will be debrided, explored and repaired as indicated. Lab work is pending. The patient will be followed postoperatively on the floor and then in the office. i . MPtss M. PLECHAS, M.D. .dt 7-5-92 1531 R2028 t: 7-6-92 0604 WESTERN MEDICAL CO-UTER/SAIrrA AXA SANTA AIiA, CALIFORNIA CONSULTATION NITZEN, LOYD 27-82-91 M. PLECRAS, M.D. 527-2 I SANTA ANA TUSTTN RADIC)Lr-KY MEOTCAL =RotjA NAME: NITZEN, LOYD T �GCY�: 5T-%232 XRAY M DOB: XRAY • : 314410 REOUESTINO PHYSICIAN: PARK, EUNG H. M.O ATTENDING PHYSICIAN: NS DATE OF EXAM: 07-02-92 EXAM: CERVICAL SPINE GRD+►: 4?t69! CROSS TABLE LATERAL EXAM DATE: 7/2/92 z _ S HISTORY: Trauma. A single lateral view of the cervical spine was oUtaine--a. The cervical spine was visualizer to t►ie level of the top of ^7. , Prevertebral soft t iz5vas are unre-narkable Thern is no ev t Oence of fracture or SublU iation. Intlvrvert^brei eisc =vaces acpear • unre:rorkaoje. If further evaluation i3 nrces3-zry, ft,tll ccrvic•51 spine ser i cs i s reco: nenoca . IEIMSION iieQative lateral cervical spine to the level of C D: 7/2/92 •' 11` , d3 07--1 1-42 MICHAT;il- BLACK, M O. M. . TIEM LIX Wo -stem Mo2dical Confer Soo 63 Ana. cr' :0gVIG NA K' E ,rr RM. , D p C.� SANTA ANA TIISTZN RADIOLOOY MEDICAL CROUP NAME: NITZEN, LOYD T FK>0Mr 3TS232 SEX: M O -D9: 01-10_j061 - REOVESTING PHYSICIAN: PARK. EUNO N. M p. XRAY 314410 14410 ATTENDING PHYSICIAN: 14S DATE OF EXAM: 07-02-92 EXAM: SKULL, 2 VYEWS ORD*: 4?1aGs EXAM DATE: 7/2/92 HISTGRY: Trauma. . TWO views of the skull were obtained. Tnere is fracture no evioence of or sutural oiasta�ta. 3ku]1 D: 7/10/92 • da_ 07 -ii -92 _ MICR L 6LACK, M.D. WQstem r,;'^dlccl Center IIADIGIL-CGY [.-PC: -&:T . . 'tri �.•, PAT 1-& UT 1.Q NAME RECORD NO. U 1 RM 0 0 0 SANTA ANA TVSTIN RAC)IOLOGY MEDICAL OnC•Vp SEX: M Doe. NAME: NITZEN , LOYD T XRAY 0: 314410 pc>>A: ST5232 REOVESTINO PHYSICIAN: PARK, - EUNO H. M.D . AT -TENDING PHYSICIAN: NS - ; DATE Or EXAPA: 07-02-92 ORD*: 4716q2 EXAM: CHEST 1 VIEW AP OR PA EXAM DATE: 7/2/92 - I HISTORY: Trauma. of the Cheat was obtained. Tne heart SiZe is normal. .- A single AP view hila are unremarkable • ptjln^nary vesct�lature is wr0ia3t inuM and evioenCe of focal con3olioation or pleural norr l: There is no The Cnest appears nprmai. effusion. Y , IMPRESSION: Normal Chest. • MICHAE 6LACK, M D. da 07-1.1.1-92 PARENT LM western Tvlledical Center NAME Sarja k+n• ccron-4a _ MED. RECORD h0. RADii016-0 Gy R7 0 i IT ,.. i� .-1-�c r►ra RM. SANTA ANA TUSTIN RADIOLOGY MFOICAL GRR :O_IP NAME- Pj ITZEN I I , LOYD T SEX: M cm -5e: ROC*i: 3TS232 XRAY �: 3144tp REOUE£TING PHYSICIAN' PARK, EVNO H. M. 0. ATTENDING PHYSICIAN: NS . `DATE OF EXAM: 07 -OZ -92 - EXAM.. CT FACE WITHGUT CONTRAST .1 OROM 4'71700 • 1 EXAM DATE • 7/2/02,1 �� - �`•• Y�'• �'• ��\�• �l• �'�'• '� 1:J,�•-� -,r`L�► .. - -t HISTORY: Trauma. .; VtiliZing the O.E. 0800 scanner, contiguous 3amm axial • -obtained at 3 mrn intervals through the root of the orbitsathrougn the n+anib1a. FINDINGS: Minimally disp2ftced vertically oriented fractures through the I right ma5totr1 tip is seen. There is raoiopaque Cobris seen directly adjacont to the right me3roid ti p. There is as3ociated soft atfssue There is -5"Octatea opacification of the interior �►stoid air air coltl s. cells. y' - , Tne bony structures of the race, speCi f ically the z� Aom3 and zvgc.meL is arch^s, ap�+aar intact. The walls of the sinuses .51so einp^ar intact. There is . e no .ovicscnce of air fluid levels seen within th^ frontr►i, . ethrno i d , ia, or 1 �apheno - Tne na 5,11 bones appeari ntact. The natal Sc ptum is Position. The n'�noible also appears intact 1 Witholjt evioen'oiof ecu to fracture. Both tomporomanoibulor joints are I maintained. The bony orbits appear intact without evioence of.acute fracture The . intraorbital fat pianes are distinct. The extraocular musclaa appear Intact. Both gloDea appear unremarkable. 1 (report-continueo) Westem WixHcai Center fonro AM CoWorrro RAD1OLOGGY Pr:por, ' fo►r, P,.,. Iin•p7l !1TTI ":r vm, rmy,;i 'IAN PATIENT I.D. NAME RM. MED. FIF00"P.0 NOL Westem Medical Center S000 Arc. Co*vT*o RADIOLOGY pr--por AT PATIENT LO. NAME L C, 0t; low % U 0 0 SAI/TA ANA TUSTIN nADIOLOGY MEDIC -AL GnCq-ra NAME: NIT: EN II, L O,'D T ROOM: 5Tn232 SEX- M C*0013: REQUESTINO P"v'rTC1AN: PARyXRAV E I_." C) M r> 314410 ATTENDI?4(). PHYSICIAN: NS "NZATE OF EXAM: 07-02-92 EXAM: CT FACE .Sol WITHOUT CONTRAST ORDO: 471700 (Continued) CONCLVSION : Minimally Ctt- placed fraC r tu OP8CIftCation a involvi"gt . h ek. r of thd r%83tOf0 air calls j t tip w,tnCj tissue inferiorly. As5OCj8te 5wellin9 with raolopaque. CebrjS soft r • 2. OtfterwiSe fracture. negative facial CT Scan. NO evidence of ."najbUlar D 7/2/92 I Cla 07-03-92 VIVIVN C. U-10610, M.D. page 2 Westem Medical Center S000 Arc. Co*vT*o RADIOLOGY pr--por AT PATIENT LO. NAME L C, 0t; Wostem hledcal Conter Scrft Arm:% Cceronro RADIOLOGY ni, -. i PKTIENT LIX NAME tin SANTA ANA TUSTIN RADIOL00Y MEDICAL ORC-P1-10 NAME: HIT7FN II LOYD T SE 'M ROOM: ZT5232 XRAY 4*: 314410 REQOESTING PHYSICIAN: PAFIK, EUNG*H., M.D. ATTENDING PHYSICIAN: NS bATE OF EXAM: 07-02-02 EXAM: Cr BRAIN C)Roo: 160c" WITHOUT CONTRAST rp A EXAM DATE: 7/2/q?, (04 HISTCAY: Tra Luna. Utilizing the O.E. 9800 Scanner, contjquou-e*j5jKial scans were obtained from the base of the skull to the vertex FINDINGS: The fourth, third and lateral ventricles anpear not -mal In size and Configuration. The Cisternal .-oaces are maintained. The cerelaral sulci are not wicenea or efracea. No foCal high or low attenuated lesions are noted intra -axially. No focal M355 lea ions are seen. No intro -axial flvifl collect tons are noted. No ma=5 affect or midline shift iS appreciated. CONCLUSION: Negative non-contrast head CT t --an. No evia^,rCe of acute intracranial F (report continueay Wostem hledcal Conter Scrft Arm:% Cceronro RADIOLOGY ni, -. i PKTIENT LIX NAME tin SANTA ANA TUSTIN RADICL C.Dy toEDICAL C,Roup NAME: NIT:EN II, LOYD T ROOM: 575232 _ rsFX� M OUB . • REQVESTINp PHYSZCZAN: V4RK, EUt�C. f•�M D. XRAY M �. = f 44 10 ATTENDING PHYSICIAN: Ng *DATE OF EXE tA: 07-02-02 EXAM: CT BRAIN + WITHOUT CONTRAST 4RDh r ♦71 op (Continued) 4 D: 7/2/9216 Oa 07-03-02 _ • VIVIEN C. WONG, pe9e 2 •► Welte rn Aredicaf Center PATlEXT I.D. i &arch &-Kk C 0a"I o NAME • !SAA. - - a RADIOLOGY f � L.'.P0 _...r _ �.,_E� PfC^�n r:p ATTr-NT .[K)C7l�7 �' OVA TRMaNT EUNO H. PA1 K M.D., INC. Fellow Awttritwrr Cn1%K• 01 Sbergro11! 1126 EAST 17TH $TnEET, SUITE W•123 f,ANTA ANA. CALIFORNIA 92701.22M (714) 641-4313 - s414 314 Loyd T. kitron II ® st•L �.►Ts rAMILY w�Ir•sw ollscwlrT60" cHAwOts c K K in I T cv++wcNT .ALAMCt •nor.• ���, Iop Smw IALANCK •IfOVO"T romwAwO f R VNIt ] Canwltatlwt 9 AM?k- 9�ZSsi?- •t. to OUG. ST irr> i� -- -- S - '�'t►f �Ga cyclo ST -vD "PTv- # ea zaaD. A DD ►ORM• Inc i7174189 -- Irewswu Fwrttf - - - �- 10- "— - - i a r1.AA96 P^Y L^sr A.a/OuP1T TNts COLUMN �•�+i' 0"Ice Vhtt tp.t41 Tuppll.r Fio.okal V" NwalrN Horn• VNit C►ft1u1 CMe t Cwnp. 010$_ E.•1. Iop Smw sur9Icsl hoc"Uroe A9610 Swr" f R VNIt ] Canwltatlwt MMC E,u.w Mosph•1 "MR I+rm.*+t ew ncoou.it - Irewswu Fwrttf BE .. i 1 J - _ —. . _ .. _. .. _- . . .. 1-%iiL.:.j 1. -._:1v%: •%L�:U.•L' t i .menti Itrp •17[MwO /�•.•... .•w Yt+�w� ar n 0 ant � :rii..w 6" *env ..Ts.wo .a.NCrr. �• L T T T 1: 1 1' T t T .von ADORE ► -%own MA.[( LACERATION. tow"= COL war[ MISCELLANEOUS -INAL DIAGNOS?S -Vr UMMARYro'cf"m. DAm- 1ASo•i FCA ►+OSMALZAT W. c►.+c"Tir+o.+aa wccvu�s ►e�o�.[came�n��rr we.o�T�.�: -- ONDMOw ON DOCKAF09: ATTL1Or0 P%-nWCL4W s.o..Anne :rt D.rouwr.Eo 105 (4•"90) DISCHARGE SUMMARY f :INAL D►AGkOStS — NO ABBREVIATIONS — �IA.A�rtr: MMARY J W*=AT=DAM 501+ roOq ►"+OSMAla.T+oft 1,CAucr x.100404. M940 ift%owl.EDTW"T Pff RENMPK -a:10� oesc�iuoE .�.. 7 T" y , ATT'[HDAdO V"Y* CLA^ lKrMITUFw rc t � X01 /► rt 6K/4 MC ♦AD u0 'e fto ND .wrn 944 k%AAPACI aw 04 ATIt6•W40 w.vfiCyM 84~91k11 A" somIpeDan AD"I DA to ki l/ r ►AThIf AAAQ P0p1rfA 1►AM K &CMIC C;A" OrC^AMW OATt Y%" T . i R / ...1, , : 1 ,_ toC UAC MJMIA 1lauaoll PM V. ADI DA TI TMArbKl11 hum wvw%oy 11 p.1o,r R+O.Q C:.. 5a / .+.Lon11 rAAM o+ WIT" A000W .a newx•Amcv COWACT 1111 "O"A" ,'it+ Iii:_ T: orn..a o►.0.10. HULTIFLE TRAUMA RT EAR LA ERlTi0N. CLOSE -D HEAD TRAUMA s1/.,ricY m "AM OpAL1 1apso" ONOUP aLamm tl D%Mb&C ...w %*AN `:: S CELLA::EOUS INS URA 101 1400 NI ZEE?I , LOYD T Il AsTrm w roic n CONAM&TOM P"T"ChM Caft"& "P"ramo" OOMI�TINO ►MY7K,1AI1 1 DISCHARGE SUMMARY f :INAL D►AGkOStS — NO ABBREVIATIONS — �IA.A�rtr: MMARY J W*=AT=DAM 501+ roOq ►"+OSMAla.T+oft 1,CAucr x.100404. M940 ift%owl.EDTW"T Pff RENMPK -a:10� oesc�iuoE .�.. 7 T" y , ATT'[HDAdO V"Y* CLA^ lKrMITUFw rc t :Ir HAf'E A5:>L;:; ol DISC- gRG.E INFORMATION: ' XSCHARGED TIDE: XSC ARGED V11- O AUB"Tp { xs R R O STRETC - _ • • . GED TO: O HOMF�SaF CAR' O IK7 ERMEDUTE CARE FACILM D D7 ;tRED O t��TH AGENCY O ACUTE CARE FACILRY O OTS - . O SKILLED NLF&NG FA,b 0; O LEFT AC"!kST ADVICE marA�L W TO woevRK our VY �•,A / Y ?oE Of �RI1,,Qr+QR'S„T,ON - • ' - . ' - ' O vy PRIVATE AUTO O 04MF34 JUINCIE O TA)a • O OTHER O ONAPAMED O FAMILY _ O FRIEND - p OTHEA - -• DATE ,.><'►� _ SIGNAnE R.N. � t �aY• �. AC'(.'OV'11 nG Al �tal/+.0 M.h •��. r►.�r.y too I) Wt V.L A. N(.•ql• M) - • Two NO W.r 64 NAA KAOT aM N7v A R r ftO.+O... 1 K6441 IRnt�tA AOS em1p1 o•rR &MDTD.re ""G r Ar*W? µM! AC M.0 (Alt ^K D+aCw.Mt DATI T1r( LO-: i II Vc R I Ane.rt ADCA&M OOWTI nor Ti♦rr+a..a - 1 ' <0-- see— NUN"" P"". AM DAT, rm"twain AUTM n..o,.A.•.0.. ohmftoem" P..O.me W -,VMA KAP 8a/LOvtJ4 ADom" .�---- <AidKt t:'ONTAGZ 1Kl AOcrKfi �Ai:;eh 2�iT.rF2: F ..rT*.c ouanwt� HULTIFLE TRAUXA RT EAR LACER.AT:LN, CLOSED HEAD i RAUNA Z' T niftep 6 On KA.ta oAo.r $a mon MAtn !::SCELLA::EvU5 INSURA 70I:1,1-00 3JIICE1.1 LOYD T II WrTm PWV@ICAN wrrloc" w"~caw eo.►w�LT..n rNrsu.wr DISCHARGE SUMMARY ZKAL D{AGNOSTS — NO AWREvu TONS - I J WARY - •��Tm wTt o« FOR HO&MA&RA ,w: �rLr�ts rf�owne�►-ticwr RENDERED. -*W ON oiSICwinoE TWA POCHAAGED `) ATTXNC0 G ►xrt.a. A lwQO"rvw[ 7 �l0 i (4�9ti) -+J i I ti AW;F L III it 1,10 'v4/1 RE C"COIL)'s ',-.I NT. YE L) L PLw.,,Aw,1Gw~W Doe The br6s you reorr"19i, 6 *1 y 0 P."t "ie 10 ow twtwoom- 2. Pr -Vest YOU; O'ftt sr -All Arn(lonts CO clear kpp-op, $or " t -s! sw— ".Oqws �wr IF 1000C Actov-soy. WO-Oty wag $0 koN &K."Oft priC tfvon a 6pht. t.^nd frwrAi &rV0 W -n 0 0-V1 No wigorfxoa P". ?wavy k". of st-.�-V Ctssr I_Nqugl- 7 -up. Uaf11tWTy IU.Ce. bn*Ar). Man moo. tw&W. VQ(AbOo. QVV*r- 0,.M k^ -v Y1.1 V" eCtft. Vl-'X- ---w kocssid, e4sctrorAo (i e g&uxa-CM. Norma. I us"a sa,*Y. MiJk. rP-1ztwo Pa. r -P9401. ooupO. $OM*OUL&. LV8L k - _ I Ln PEDIATRIC: �LIBWsd L"I posetiod U,"J. Cf&CAAXS. 04C. No slootb w,in pain Do rot &W* 24 hours C) 4. Enowrage Nods. -] Wart can 60 on kwrwly. L -6d rrik cl". C)s. 0"rpawV soo4t- Rios. biArisrAs. toiews 0 UffA Vejorma ba -OW' acycio VV- Vx:rLM ria". QYMV%O&VM 0 1 you ere *x* to your gtorrAti. you vimhd hevw novw—..aall V ad 6041 one hour. than "obo-Visov. --wv. 10r gv, Arg cftW &Qaln wth &-n" afftourrts 01 cio&r 6Q� w - r --.-n g1.04y progress bD kA C) May tot arn 10 in ------------------ 0 wtion dad is oDm,,. sqA00'. 6^ blanc 0 -et broo r -)"n it rogvw 6.0c. ,- tyros taYI forukp;u. w- no gym or plarpround FOLLOW UP APPOINT ki ENTS: REFERFU%LS: C3 HOME HEALTH 3- OTHER REFERRALS DATE WHOWHAT LOCAT"!J� PI-+DNE NA -VE OF AGENCY PHOW- 6 t INSTRUCTIONS- PLEASE SEE FURTHER INSTRUCTIONS REGARDING YOUR CONDITiON ON A .`,cPAFiATE SHEET. C3 A-tdorr*W C*MPI*ft 0 F*- CW* -Vi C3 Vo ntrtp &Dw,-h" 0 Sac* and Mock 0 Head IrqLffW 0 Wound Can O Gare & s** 0 Froctme C3 Cruch PmcauMorte ❑ Lkr+rry Tract k*pcbon 0 Ere Can 0 06,--w COWENTS: ONAL BELONGINGS SENT.- 0 Wow wd I h Pmtwt wtM F&mfy O Sooj* El WA O oro W-MICATION: 1 TAKEALL MEDICATIONS AS ORDERED. CMM -c LAST DOSE GrnM 11AEDI'CAT)ON 6 7 8 9 10 11 — 121 1 2 1 3 1 4 5 1 6 1 7 8 1 9 10.1 11 12 USED FOR P L P(TERPRETER"S STATEMEqT I have rwiew th" 1,0M Urs<dkeKfSt&1nfd iltsa t Jreloo of same. 9 an kvwprvw it provided to &ssg rw ndryp&.�+ : I rwvo Vw%!Btod the ir"OrTMUN01M prol-onted or&4Y to -,w WKJ`rvid - I have also mbd Nm4w n* Discharge Insmxz-on Form in i&N-ja2e and oxpZaw,*d ft cont& -ft lo tw7vtw. To r* boC of my know%dge and te4ef h&Ww UnO*f- ate V.X stclod r�s K cow f -An psowt kxsczgw rvlaAorsslK� -- CAR" ktter�reter Western Medical Center • Sor*0 Ana. ccirloff)io Westem Medical Center/Anaheim X-<t)9irn. Coworr4a PATIENT DISCHARGE INSTRUCTIONS OrF-';G1N'A1- / HEALTH. Irl—EICORDS ----Orr PA11ENT LD. '67 .7 7' 7/OZ.,r9Z Ln f(ITIEft Ito LOYD T K - 031T J p A 9z r. Cot H H0 775 1 ENC V 7' • h _ -cJ YIN- AV :)ISD -LARGE INFORMATION: . xSCHARGED TtAAE: 7` �� -. • . S --K RGfU VII- O AmBE LATORY q ' . _' O STRETOHEi .. - 4SCHAAGED TO, O HOMEISEU -. :•: ' :. _ . _ - . CARE O INTERMM ATE CARE FACUTY O EXPIRED _ O HOMEh1EALT H AGENCY O ACUTE CARE FAC UTY O OTNfft O SKILLED Nt1RSING FAC O LEFT AGAINST ADVICE _ By O PRIVATE AUTO O AMBULANCE O TA)O O OTHER _ _ O UNACC.OMF*MED O FAMILY O FRIEND O OTHER - ' '• . DATE --- R.N. -10, "A SIG NATURF �, It r• Ll tt 1•l �.. L Nt VIA. ftp .14L, M) w. - :*..tl ut Wllrte: w MT •nc»w+oM�t.KyM •a,�r.tl spa 4"1"Data A,Wtz t.y ._.._ _ A Tim 4AM1 Lv.:( pommy t�Ay f1; AC 4 e ww WC.MAAO. DA to T14 .. _ ... 1&ftc R A f: .Tl+fT AooaaCOW" _ . �ea. . I tto..a n►en.ow - - ' oc- t!C NLMWM Pwuo 04 May. Adl OAR C... Tna.TrtM A1ft►L cr1C►U1 ttttp0 � — a6twOU1C� h�"007J .. ., 5� 4'0'"A K.w mkw%.0'TM AUOwafi !; !NS(nCT cco"ACT NLL ADD""* =nJ:;i:T 141.z%1': .rrt.to a.o..o” HULTIFLE TRAUMA RT EAR LAC RATION. CLOSED HEAD 7RAUNA ••I.a►ts wft"m O0, "WnNoRa11IMCw1aK11 `:: S CELLA EDUS INS URA 701:14 00 k&Aw N l TEE2I . LOYD T 11 WTVM PWV OAM CONVAT" ntf►St MN comwNLTm ftfntck" oDM1JCT1q MT7t(1Y1 • DISCHARGE SUMMARY NAL LNALiNUt35 - Nt7 ABBREVNTKNVS - / �wA1rT: . 'M w PKMW 68MAXWO C011 tXATVf4&- MMARY $ s V=ATM OAT :o« row HO�STALRAWO t MANT rOW0004: zvuics •++For..®nirre�noetM Ea: -- -lowoM ctscp.AAOF- TC, 14 1ttAf1 :{ f 11lif D I('-)- {i!. �: .1/ Ni t.�)tt,lti*,) N y DcrT: AE; finpularrC.vr+td awt The tixd� nor*►�wll� aat. L^-% Root and have tklp 10 ev hattr+oorn. —. t 1. Yom 2. Progress Your (J-01. 13*V-" —) anvi0 rtmc unto d cb�tr W .Kid Mor Vie fist tires ho%" rid '►r vove+s b iuk utA,lde and ttwn a 6Vhl. trwn0 rn.•h, and tr...n a rov/lar Orrt. ;7 (�wKxdoor .Ct•.wp. ctll�Nu-V-Mr)ua DLaT• N"Vy WWVj or •tr.rrtg f/ ` Char l hunt i uU. r+,�P+d N��. Ulurt►.rTy A,•�e. trotn. M in ta+`o. r.a»r, pop.•c�.. Q -per O ta,+wt to•tav Yuv ut:a►at t.c+rvrrY wr•)ontaw i,.— dL. recvo�r.. tla.n ►s �t a owu•ao.. v�a�o+r.►. p No...,.i. • o.,t . wa. .uti.tY Fu{f l�,i . I,t�l. r*►aRehwnals. Yr'PA. soups. tomx►ia. --- LUhV s:e'+d D)et. PoacYi«d WW, twat. o adtw s. VAC- PEDIATRIC: O a No al0otV0j In pnrt rn+ocal)or» Do not dmk xioo i for 24 tr>,ra a'w a+rpowy. tntwi cin w on Lpwnp. O S. Avoid oonatpat` V hada: Rim. hiinlnaa, haled rnik ct►e+o". ❑ L -T* vVoroua 0= -VV' D•c" end Inr0 Mr -V- 01'tm'—* - Q t, K you M a..ch to Yda,s at.-xhach. You should hsvo nor" at at1 for al toad one hour. then start all a.W ►?a,n t.nm snvd aRourm of t7 -►at 60u)d rvo con alo.rfy prvp'ess b kA liu"boaro-r19' bAAWV,. b► Q trlay ren" to scho0i on . . wrraan choid a ocn»• . 11sc� a ISjM bland 0,01 and Men a rVQ%Ai.r diet. iorta:i.. bLd no gyre or ptat'ground xCV- -'i for FOLLOW UP APPOINTMENTS: REFERRALS: O "--AAE HEALTH D OTHER REFERRA-S 04TE WHO Mfi{AT LOCATKJ PHONE NAME OF AGENCY PHONE 14':STRUCTIONS: PLEASE SEE FURTHER INSTRUCTKONS REGARDING YOUR CONDITION ON A SEPARATE SHEET. O Ab*xTdnal Comptarrib 0 1~ Contra O Vcr wxV a Diar*t+sa O Bads and Nock O Hued Vq ff . O Wound CW* O Ca+t t SPhM O SprWn a Fnmcbxe O Cru1d► Prtacaunons D Urinary Tract Inl.cslon Q EYa Cme O oew I.:?"ENTS: PERSONAL BELONGINGS SENM O Hoe- Withl" O Horn. with Fang► O Sowtp O WA O Oris MEDICATION: TAKE ALL MEDICATIONS AS ORDERED. Cm= LAST DOSE c>JVEM MEDICATION 8 7 8 9 110 11 12 1 2 3 4 5 6 7 8 9 t0 11 12 USED FOR ..---- ' 7 7= i%' F;*=%:5V Q Nun* SVrmrbxv. •• P itrskian s+ atur.: tM ERPRETER-S STATEMEWT I'um mviewed bl-is Soffn. t&nd .9 a of same. M an.. ktorpreter is provided to as,saA VW individual: 1 hrv* bwrtslated ttie irriorrrution presented oraly to the ind►vidus - i tis* read himrrw the Discharge Instruction Form in _hath knquage and ezpi=tned its mttsn% Daft P eritK',u to hrrAw. To the Did of my knowledge and beoef h&Ww under- . x ood lois WQWIabon. it other thin paserd, r6c*w rowbonship. Daft biterp►ettx Western Medical Center Slants Ana. coworriio Westem Med�ic�a�l Center/Anaheim A PATENT LD. .. : • --- <t:94R0b02 7ietr92 - 'Ln KI'it IEh Iie LOTD T 'tV ..--. -- K e i 1 T J .....aJ.''P A ce r 1*•iC H rp PATIENT" DISCHARGE INSTRUCTIONS r� Te t � t FHS x ..�`T%-.')2 7 T I[j - R�tot (10/E9) ORIG►NAL / HEALTH RECORDS ,.,.+�7t`T•9• . ♦ ►r,�►s.–,�.-.� : • .....'—,."'+r-sit-�R--v.l- :- - . .. , _ .a-c2r-�`. _ . . , r. .. - • ... /T:"-r'�'-' • �• r--..--- - ----------------- ..•�� - Tom•._ .... •. r. .•'• �r _ .. .�• -. •,• DISCHARGE INFORMATION: DISCHARGED TIME: :�> O AL48ULATpRY _ -{EML.(>tAIA - .. ~ • O STRETCHER .. .. xSOiAAGm Tp: O 110ME/SELF CARE /O 1tJTERMEDIATE CARE FACILITYD _EXPIRED _ D HOMEJNEALTH AGENCY O ACUTE CARE FACury D OTHM D SKILLED NURSING FAC O LEFT AGAINST AD ICE - « tv ►�09vrtK ExrT erD tA•ZAX ARn _ D PRIVATE AUTO O AMBLILA ►CE O TA)0 •� er O OTHER D UNK UPANIED O — • FAMILY O FRIEND o oT»Efl 7 i • DATE_ f { ; s _ `• SIGNA I L)HF R.N. .. «. t IL _ r I TNAL DfAGNQS;S N0 AWREVlAD0NS — l 4M w+Adto" Panoua OOW"LCATTat& UNIARY f otci� a, aaTti *N root "oSMALJ7AT o+L =Taio"+oaecw- Tat ocs. �rTtJOD4c P"Y010 SKW"rW7 KD 1 lot A,, I" I aat fw a.f ft.fr ♦nt»o..fo.�_;%-par fkrfrtA FT t,.wiwo.►t .f�To.n iw •� aaa ��.. Aa L Pomftw.Aw o•n Taft LT 1I R ..�►� . _.�. 1 ' or- w_ -jws&X ""Good ►way. "m a►n TR"T%Wp T wrx rf.no.rff ►..as afrewof! ► "go"t-� Com. S� W%f>Taw "A" sw ta"A Ai ft" MUTT.* o.•r•+.ow ; MULTIFLE TRAUMA RT EAR LACERATiLIl. CLOSED HEAD TRAUMA .•r<irTs %owam om wre ro►tT 00.400" owou► WRAN w K�.ow+sw ww `:I S CELL?.1:EOUS INSURA ) 701 : 14 0 1':I IEEN , LGYD T II WTIn" raraxmm comovATTV pfroc"m co"ftk MO P"rsfcb.r comma lT1q rM sock*M DISCHARGE SUMMARY ' TNAL DfAGNQS;S N0 AWREVlAD0NS — l 4M w+Adto" Panoua OOW"LCATTat& UNIARY f otci� a, aaTti *N root "oSMALJ7AT o+L =Taio"+oaecw- Tat ocs. �rTtJOD4c P"Y010 SKW"rW7 KD 1 i ! JAC - _ ..6 '�'rh K,.:,►lM11.0 •17l.s•V.O /�•r•..,.�.•Y1R.y v hlwt� K� 6.0 1. oat■ OA rt 11.N oto wK Sri tiurr w.- 3 a Ii I`! : EO ♦ii1 M,/+O M�bICYa. t R -k E�.'::';, i{ `S,� .:,�:a t I _��' _tj ( — �,� K •C 1�C 0.1 w.. M'fiJVAOt W i! Tti! K W- MAJft ��� = r. -1,-L� -A::EN I I . LOYD T Mw" � KS �DOr1[ M 1 1. ►_ � : ►o[v � wTs TKe•r,AOre .�.rtx lrrtiG�lw h.0.4 cel+7�9Z7CI/GAG,./00 .�nnar wti�oorrt p745- t OTr* **Aa w. aTrr .oc•lc �. ovcv �- : — I T.'�.I7 _ aTwo �^ MULTIPLE TRA RT EAR LACERATION. CLOSED HEAD iRAU�'A nous owou► Ialritw Gw *OAK suwswrt MAN= AN= Ca %"A MISCELLANEOUS INSUR.A � OtJC7 �w TOI : 1400 NI TZEN I I , LOYD I rrnma ►wrsmc" �r.rcw T..o rxrsrcw+ pOrtKttT*10 rwn.io.rt oo. �nw.Yrr.ca.n DISCHARGE SUMMARY INAL DIAGNOSIS -n0A-sWREvuTiorvS- wreY, Ew c�,.aww Maw ca�a,c�►>nots: - I M MA RY PATE: .�o.i.a+ FtCf$/TTILL.JZATl01f: - Iccans:f K11F0111i1ED?ItEATYE1fT �a�we0: - � -- - mrnow o« orsaKAPXK: I TlW MCKA WO ATTrnwowro PWTS&CL&A 01614ATUn[ r � / K.D. 135 (4.90) I CONDITIONS OF ADMISSION (Continued from other sic -k+) 7. FINANCIAL AGREEMENT- The undersigned agreos, whether ho!she s►qns as spent or as pato-it. that in cons►doration of the ser- vices to be renderec to the patent. he.15he hereby ►ndividuatiy obligates himsettlnersoft to pay the account of the hospital in Accu: d- ance with the regular rates and terms of the hospital. Should the account be ruterrtni to an attorney or collection agency for colitic - tion, :he unders+gned shall pay actual 4s &-►d eoli.et'chon expenses. All delinquent accounts shall beer interest at the Ietga! rate. NON -COVERED CHARGES: In the event that insurance does noc cover particular procedures, medications, antkx tsenric&s. the unGersigned hereby agrees to be personally re �o:js►bte for payment ot. such crnarges, if not proh+:::ted try law. AUTHORIZATIOt: TO PAY HOSPSTAL BASED PHYSICIANS: The under, tgned autnonzed dirc+ct payment of &ny insurance benefits otherwise payable to the undersigned under my current insurance policy. tie made cirecily to my Foysician, Radiologist, Pathologist. ;knasthesiologist, or other Hospital based physician, for professional services rendered. Payment not to exceed my indebtedness to the above mentioned assignees. The undersigned also agrees to be individually oDltgeted to pay any balance of said professional service charges not covered by insurance, unless prohibited by law or the terms of an insurance contract between an insurer and the undersigned's p'�ysician, radiologist, pathologist, anesthes►oloq:st or other hospital based physician. AUTHORIZATION TO MAKE PAYMENT DIRECTLY TO HOSPITAL BASED PHYSICIANS IS HEREBY GIVEN. Patent will receive separate billings for these services. t� ASSIGNMENT OF INSURANCE BENEFITS: The undersigned authorizes, whether he/she signs as agent or as patient, direct pay- ment to the hospital of any insurance benef- s otherwise payable to or on behalf of the undersigned for this hospital zation or for these outpatient services, including emergency services it rendered. at a rate not to exceed the nospital's regular charges. It is agreed that payment to the hospital, pursuant to this authorization, by an insurance company shalt discharge said insurance com- pany of any and all obligations under a policy to the extent of such payment. It is understood by the undersigned that hetshe is financially responsiwe for charges not covered by this assignment. IL HEALTH CARE SERVICE PLAN OBLIGATION: This hospital maintains a list of the heafth care service plans with which It has contracted. A fis; of such plans is available upon request from the financial office. The hosp!W has no contract, express or implied, with r.t'ty plan that does not appear on the list. The undersigned agrees that hetshe is tndrvidualiy obligated to pay the full cost of all services rendered to him/her by the hospital it he/she belongs to a plan which doers not appear on the above mentioned IisL Z0. PARTICIPATION IN MEDICAL EDUCATION PROGRAM/: It is understood that this hospital is a teaching institution and that unless the hospital is notified to the contrary in writing, the undersigned may participate as a teaching subject in the medical education program of the hospital and may receiva treatment by residents. if approved by the undersigned's attending physician. and those C'ins_' t students acting under appropriate supervision as required by such medical education and clinical training programs. The undersigned certifies that he/she has road the foregoing, received a copy dwreed, and is the patient, the patient;;s 4ga- re-praw-t- _ -- tab e,•or is duly authorized by lire patient, -as t e patier1 'general Kent to execute the above arjd accepf.t>' terrris. SIGNATURE. PATI ENMARENTJCONSEP.VATORIGL14RD N::: TIME: IF SIGNED BY OTHER THAN PATIENT, INDICATE RELATIONSHIP: Financial Responsibility Agreement by Person Othef than 2e Patient, or the Patient's Legal FeprLsentative: I &gree to accept financial responsibility for services rendere to the patient and to accent the terms of the Financial Agreement, F`siQn- rr*M of Insurance Benefits, and Health Care Service Plan Obligation Provisions ab -_-Y& DATE: TIME: SIGNATURE* FINANCIALLY RESPONSIBLE PARTY WITNESS: A COPY OF THIS DOCUMENT IS TO BE DELIVERED TO THE Pf.TIENT AND ANY OTHER PERSON WHO SIGNS THIS DOCUMENT. Western Medical Center sorda hna Cdlton-60 Western Medical Center/Anaheim hnohetcn. carorNo CONDITIONS OF ADMISSION K&LTe FEcr^ ;W -t•..✓ _w S DcFa COAW • PATENT _Ytt �A►n> NT I.D. r,;:.•� 942 Qb02 7/02/92.... .N LTZF-J�i I I . LOYD T K 031Y G P t RK . (UNG H MD - 176191 E NG � t • T-iL;. J YSICIANS ,�,\t A ADNQT" DAT f •/7Z11- ?*rsoa �- Providing__ cn Penin trier 'attzltdt IC•W%40 O'') :IIstru � rs..rr� na.o� to .+i�►rai• •.�. �L �ti cin s t •'" T! Give e•e-,r.. adult in-patient �5e brochure: -your .'".at.• xi9bt to Hake Docisioas About Medic E arocaur• given al 2. F21 24 of the followings t � iatcrntt is x have A..dvsn a lou. ^i s and does not wish addit.i on.1 E l Patisat does not have jLdvance DSrec Patient given brochures -X& tiveJ recuest.d adds k Lag to Advaaca Directive .. i � o E j Patient �dvaace n;.. (See part a) �s z do ---_ 7 S2 DLZLV_a HAVE ADVArTCE DIRF�-nyE Rafsrral for additional :ntormatr . .• . -on i- applfca.bles - ♦��..i 7vp•at disc-sssion . to a Sasciil Ca_ a .Patient rscardin (s.;. Saaa� s.«.•�� Ps..�c _ _ 9 right to :a =•-s2ste Advance+� 0..►t��r1 �0 Fletss caeaaant here as to raaaopnsat of discussion is deferred due torective .site= for de.etral: condition• e: ANCE IREC1iVE - - - - - n�s., ror H.a� c,.e. +^•;tet-.t..,c.) Ods Plaq chart that Advance Di: actve exists sticker on top i(7tD of chart, ) xists b . Y placing AD orange E - SPY of Advance Directive in :.ort Ot chart, j Patient and/or represent:ties g . to hospital as soon as instructed to bring 1ldva physician passible. nce Directive notified: E j kd"Lnco ve a a reviewed E vitt • patient due tai change E j Ad Other: =fission to Special�C1rQ Unitu Patien I I t request - . i ) western Medical Center Santa Ana ADVANCE DIRECTIVE IN QUIRY WMC ------------ ft2 92 WfN 1 . 10Y0 T M 031Y PA Qr . E l.tiC H �p l 181 t ENC M V22:Irh I. YScrr attcnd'4 ptn-sician is Dr. '��Z�- and Your �► w-Tervising physician or surgccm is Dr. L'�,�- �-- ` '� •�,t?� I The hospital rruirrL ns personnel a:nb l &cilities to ls`ist your phy%v,iens and surgcons in their per�-trnunct of various surgical operations and other special d;apnostic or thcmpcutic pmccdurts. Thcsz o;vmlj ins zr-.,.l pn)ccziures rosy all irmlve risks of unsuccessful results, complications, injury, or e••en death, from both I.;.Lr-n and unforeseen tosses, and ao varrxnry or fuarantcc is made as to rrsult or curt. You have the right to be informed of such risks as well as the nature of the operation or pr i cdurc, the expected benefits or chats of such operation er procedure, and the mailable alternative mc:thKZs of tzcatrnent and their risks and benefits. Except in c;.xs of cmcrFency, operations or procedures arc not pclo mcd until you have had tb-- opportunity to receive this inforTn.ation and have given your consent. You have the nght to consent to or to refuse any proposed operation or procedure at any time prior to its performance. 3- Your physicians and surgeons have rocommunded the operations or procedures set fi,r^ i below. Upon your autfiori ation and concert, this operation or procedure. together with any diffcm-nt or farther procedures whicb in the opinion of the supervising physician or surgeon may he indicated due to 3;7y emergency. %vill be performA on you. The operations or procedures will be performed by the supervising phy-sician or surgeon named above (or in the event that the physician is urahk to perform or complete the procedure, a qLa ified substitute supervutng ph)sician or surgeon), together with associates and assistants, including anesthesiologists, pathologists amd radiologists from the medical staff of WESTERN MEDICAL CENTER to whom Lh` supervising physician oc =Vm may assign desigmttcd responsibilities. The person in ancridssicc for the purfusc of p=' form r:g specialized wediical scmwm such as armcsthmis, radiology or pathology are not agents, servants, or employees of the hospital or ymw supervising physician or wrgcon. Tbey ane indc-pen icnt contractors and therefore art your agents., servants, or ca4Awem 4• By your signatzuc below you authori the pathologist to use his o: her discretion in disposing of any member, argaa, or otter tissue rcmoYcd from your person during the operation or pm)ccdure set forth below. • := 3. To tam sure that you fully undcrstarid the operation or procedure. your physician will fully cxpl do the operation cc proozdurt: to you bcfore you decide whc icer or not to give consent. If you have any questions You are uzour•ttged .. - Amd expected to aA them. 6� Bove signature oa this form indicates (1) that you have read and understood the information provided in this lbrrn, • (2) that the operation or procedure set forth below has been adequately explained to you b)• your physician, (3) that ym have had a chance to ask questions, (4) that w.rt have reocived all of the information you desire concerning the opcnLtion or procc&are and (S) tr`' you authorize and consent to the perforrnancc of operation or procedure. Opctibon or re l►; �— Signature: : Z�D If Signed by other Dent, indicate . .�JtDCS3: _ Weeem Medical Center � + Cobo sores�,�4 �b 02 7/02/9z lino. rrro � t WesteMedioal Center/Anaheim � r. - k � T 1 �>r 1�. t o r D T rn - �r� caaor�ro.-­ C 31 Y C M J PARK. E UNG K KD AUTHORIZATION FOR AND CONSENT Td � .:2.782 9.1 EKG ST#920602 SURGERY OR SPECIAL DIAGNOSTIC OR _ r r ,.-:• ;- THERAPEUTIC PROCEDURES :�—,1,21 (7=) _ 0RIGINAL / HF_ALTii RECOR�S LECTION 1: VAL U I ►LES------------------ VAIWItJOS socurod in wife �'ulrvts5►es •orr, hcxne Pallent Contuct .oa=th Envelope No. On sdmias�ort'ouring hosptatrzat►on or Fopresen: Security Signator Sery With: I -t . Date: 0 atc Phone- SECTION 2: PATIENT'S CLOTHING/fAISCELLANEOUS PROPERTY (Circle Prop" a Cued; Appropriate 80)L04.) Glass &CAxtact tenses: None tures: Norx4 cone: L R wn. �, , `: �lpper 0 wrth rr, p ! of Pairscared D Lower 0 s0aimd 0 Color Sen: Horne ❑ Swt Home D CLU l HtS (Peas Gtrc ie or Check Box.) Wry Pt WMC Seared Caaslster p Pants,packs [... ❑ • •.� ose ❑ 0 ergar�ertt3 0 _ 0. ❑ 3riCQeiPatiaJs: Norte` Uppw, tvww ❑ Wim pt. ❑ Pernuv nt ❑ secured 0 Sent Horne D sent Horne Wry Pt W " Se ared SenHomesIspe Q0 D Rad-ck,* kRamr 0 0 ❑ CarwwaikerronAches ❑ Uwcrpur" 0 0 ❑ ❑❑ ❑ Ir- - D D SECTION s acv • Western Medical Center/Santa Ana recommends that no valuables be keptwith valuables in their safe. I understand riat wMC/SA cannot be held res Yfo and offers a Sem'i`s to kxic your valuables, not so waxed. I further understand that an responsible for any personal property. inciuding Is done � my own risk. y Personal property. Includirig valuables, that I keep in my possession ThO . ab:vs W and disposition of property, hdudin� valuables. as listed In Section 1 andd Section 2 'accuratoompte:ePaDent arb • Tkne: Alfl Responsible Party:Hosp`tw Time: SECTION 4: TRANSFER RECORD t o' =�' • ° +M.1 t�c�, vanvar, rw reo.w+r, urA �,ee by �e ro ac—c-i►�� ce Z2 -woo"bsied as ri Lis DQLIAr• C•r1 3tSSrpr�, Df+�E 71ME FROM TO SENT BY RECEWED BY VALUABLES SECT -ON 2 feenng Aids: None Ni D wro, pt 0 Right D Seox*d D telt D Sent Home 0 to KE=opbom,L .OrM1Af ,S: U 2 nb n 7/02/92 SECTION 5: RELEASE OF PROPERTY, INCLUDING VALUABLES ii 1 T-10-4- I t e L O Y D - I the retwn of all property. l '-- _ K 0 31 i G Date: Time: Patient or Respons:'ble Par•y-� • y Pk RK . E UNG H KD :_:,•4 .l Witness: - ST #920602 '. Western Medical Censer PAT1EN"r Sorito Aria. Cow r " �i ` ul� 100, ! .ENrS VALl1ABLE/PROPERTY RECORD mlte-Olvk °y'`.twt Csrwy-Depwtr*nt Pir*-pat4ftt's Copy Form No. 6000-0101 . m i ',4' kAA T E A � Lr ST1920602 9A206C2 c�--7 S' �>—� ®it i 1 E-�;_'..rr,.�.• - ���i• .i. i%.�v•r� �•.:.Ir; �;t :7 r.[ I.r ' •� t 1 'on Nn_ .--=—_ -••► v� r� . •'l T n.i CY1 t'. E- F''!_f'��) I ( _ •, r ' � t..., • tom.,.......•., t I �' (� r.lTv C 1 : IJI{V ��� .. .:�. r,•� IArT () CTV (j s t; I D r7rATH _ �ACUIi I1! :IICAL rLj' C,,,!n / T1t cr' ( t1NN -- I` e,. ., ..• .. ..:1,. (•,• 04 1 r 44f .1 `_,Aj • I •1 pi. A IXF •••.. (.III r �' ' ANG Tolo O: A$+t).A,C 0 04^ f TES QN(PI nt OF IIINtSS. Hj 0 COCNF 0LwtLGS DPACFUAKER Does _ 05f12 t TA. --ic t V u[DS L; / /.''E:'1. /-- 6- PI3lr.1ARY SURVEY ffNORMAL ALERTO C AEjP:.T ❑ NORMAL pRlErr T''"" AIIERGo, j r . ' f'v i C T%TA: 08ST _ "'`VA�M D f'lPLACEMtJ "� ` ti "CONDARY SURVEY NORMAL D trtrEr `'lJL O S'IUAT6001 P ❑HOT O LABORED K-.... :...•... tiI NXK)I,/S C,;IL, S<URRFD ❑C:" B ❑ RAPID NEURO J!J-p O., ENF TOt4 ODOR ❑ COUSED �q R �aL 0 SKul LOW Q LETHARGC p VIOL f Cc"q ✓- ASSENT NC o L7Pu E PO$T ICTAL L 0 FLUSHED HEAD D o 0-<ORMAL 11 UNCONSCIOUS 0CAf+0TIC vEc Rv NECK 00— ��SPIPIE C ❑ B-OUNRRE10 Np G ❑PAIN MECHANISM M ❑ NORMAL p IARE(3 ❑ L40TOR LOSS ?ENDERNESS ❑DRY C CHEST p .�� ' n S /� ISSU. eT t EB'.al� CC 0 NUMBNESS =AT BELT WORN -7 S�tpIST L LUNGS "' ' ` `"."• a `VC I s O'N O I/. WETMIAPH :�JPlL.$ �ER� /'✓� �4/L't-- ` w LPM VIA CAAN►v AASK L It .. ABD o � C PP : BVIPA _. . STAB DP04-10INT 00MID p SUCT,ONNO L /,v BACK. �s Rt 103KB DOCONST 0[] RESP')NDS ❑ CPR SPINE Q C A JL�. OtLATFO CCSLIKn>.I ❑EMT- D , ED CO ODcATARACT C REFUSED CARE TRAC / SP PELVIS PrU ❑ 10 &JNO S12E MM (] REL SIGNED ❑ OTHER STAB EXTREM 00 GLASGOW GLUCOSE�A. ALS AIRWAY ``* ��.�'s� TIME (! DT ) ( ) TIME EYES t E T &ZE MM I V THERAPY TIME '":4-lA L SALINC MOTOR ET/EOA BY � S�='t GAUGE '`- tO:w SITE RATE VEF#BAL _ htG % # OF A ` PTS : so • TOTAL / cx.oT TZrea: VE . IED BY 250. / 1110-10, Mo TTRtE PULSE REPS B/ P —�--+U TAL FLUID INTAKE . • •-: •• s . 11 E K G TIME TREATMENT / RESPONSE / rJfO rl C� J cv" Oso v co" LAL A-SSESSIrIEA TS it T COMMENTS/DETAILS T — 7 .v RADIO Ef.IT-P L/ PT. EMT•P ALARM - :.. ( 902-H + REC CTR TR9NSPQRi COMr�t9OE • .. 10-97 11 t (/ •0-97 HOS? {/TG-- 1.45 . EMT/P RAO p; _ �C U EiY ETA ❑ AMp l7 CODE 3 0 PHONE !; DD'T!ONRL PAGES CONT BH 1 FR1;SI-I�17 16A-5 j� AIR AMB I /L�s � ,¢ L E]FREO SHARE .< ra x:I -�• �..-o.-,s,r.e*r,ne�.. mac.•, TRAUMA TEAM ADMIS,9I014 AS:,t:.SSk1LNT — F'Aor 1 s_ GRAPHICS_ 9 71N, S' <v',va;lcn -f J A,,rt,a: ,L� ' �'� Patient arnvedle-ik, via �C-'ltd,-►�,1� DtsignstedBSri ltD Tri As: Trauma NeurC Vehlcit'Other: M G vs Bicycle Mopeo He:meT cat^�;i�. Ur►ve? Passenger. Fror,LBack GSW: caliber/unknown SW with Assauft Fall feet onto Comments: OS MAL CARE: :kl �G-Onont� Umin NC ET EOA Mask BaC,,P.Pres. Ass't/Contr I CollaHead-bed Sandbags �tkboard coop ;- Inflated: LL RL ABD Hare: Splint only Tract,on C OU►er care: ASSESSMENT: Wt. Ibs! Kg Last ata LMP. Prep: Histo hone k Cardiac Drups/ETOH Ps}..h Seizure ATU S r•,s ^.� uncooperawl .,arpic combative cofth sed hysterical u x min. S ..CH SKlt�L'qL0R MOTSTOPE herent crrr. �l// norma ercnt otk slient pale moist slurred ashen diaphoretic cryfnp ftushed weVermronment nor -English cap rtf : CHAMPION CO RMENTS norm TRAUMA SCORE cold / NEUROLOGICAL CHECK RIGHT LEFT Ifflo Minim onnimmm ►�a�nrj�� M;wnaooM -=no��c� mo M W. M_ MWS: CIJ WNL ' A ABN COMMENTS Neuro -0 O Head T_3�o O NeckOf O O e- --�-�-�- ALL.ERGIES: Chest �JD LAST TET: Lungs 3 O A L 1(p L R C'rjL)q O WNL N/A Abdomen —tl' O Bk/Spine ey'O Pelvis O Extrem. C7 PSY/Sor. . �o 1 • Abrasion 5 = Ecchymosis 13 • Puncture 2 s Avutsion 6 • Edema <;0 •:�u=mbn 14 - SW 3 = Burn 7 . Fx/Disloc •ess 15 4 • Contusion 8 . GSW 12 • Pain6 •Bleeding NOTIFICATION TIMES:-- CHP/DC IMESCNPIDC Sherltt/PD r Ba i a i ere 'en valuables iWChaptain oner i ornea donor Refused D Time of Death COMMENTS AJ T/rAUN A CONTROL NURSE / AT' � W aooarra sw in as of No+ dro +0 Cowirw,t y gips a: own kl�,r�o (7 type _ 1 EP,116 P" t (Ito1) NMt►-M*6cW R*cord Copy Canary -Trauma Q!..ce Copy Pink -EA. Nursing Copy $1#920602 9420602 U A T E �-7 dc)-? `•war '�..�' � �� `l ►� \ �i TRAUMA TEAM ADMISSION ASSESStr1ENT — PAGE 2 TIME Vt'NTILATION �R+r at L'n "3 NRsa1 ,"1 Mask ET. Tub•./ -- y Dr. — Cricothyrot by Dr. . Crest ' ae RT / E SuctUn L [7 c Suction y Dr. Tt15 1—, CIRCULATION TIME STABILIZATION LJ.JCvcio nnindor N•a :!neck S'w.-icer Cj On , ►,t r,6ST 0 APP30d O IrAa:ed Sl :nt to MAST renaved n Hare O Other Pencardx<,entesrs by Dr. By Dr. n,-)rac.)tomy ty Dr. Traction apP', to CrR txyun (S -e Cud+ac Flow S.-i"t) i) To, t7 Pin n Orw TIME EVf LUATION M E Suction p OB Pos 0 OB Ne; ey 0 1 or / to draJna;o P*dwn•al Q Tap 0 Lavao Amt In p 10ccACg NS In used alt,.r Color Rr_ A, for gross blood 1 P rNeg (� naer Tone Stool for 08 Back exami%ed l RADIOLOGIC,'SPECIAL STUDIES X -Tab!• C -Spine 01 92 fr�pears no fx per Tr. Sure. XA st 92 93 gas;.ull Ab4tICUB Pe" IVP Cysto RL O arm p hand O too Q femur LL O wn. Cl. K" Q p terrx,r of EKG (12 load) .ena! tu.e if type By By Cx. T JI1y' TREATMENT Wa,>►Cs ned .neued Repaired by Dr. Tet. Prop►tyf Site: E'Y Hypenet SAO. 8 AnbWtic v LAB STUDIES,SLOOO BANK T1nTrauma tab D, -,w work cenC.e1 Tr. Sur ---\�N Void Ccbr � G's rt r2 /3 Pulse Oxunetry B*od Bunk RED BLUE GR�rN ,Aed 'ood Re• med to Bank INTAKE SuOlotat Soh. Field Tod L_I.Ll♦ /0D L�,1 /AFJ Sublatal Blood • a Auftwu nxar out ReinArsed EST. BLOOD LOSS Chest Tube Rt Lt Wounds Surgical ' TOTAL "i}rs TVAUTAA TEAM Called: {!� *Trauma Surgeon. Dr. _.__.I RnIdertt (Surg.), Dr. _ Mesthesioloplsir Dr. -- ve,dsat c6% Dr. Nfthvsurgeon, Dr. cc °w Soh cc Ta. Bank B•ood Tot A:.m Bsood BLOOD UNIT 1 Date: _ -,P-�%— V OWNW-twfl-l/;,�1'a ))(U- d on LP&cW bed ADDR10NAL OBSERVATIONS -'9-- C, - 7-- ew Number IV site: as line, are, inserted and labaL. Label Art line 'A" 13 TIME ARRIVE.- CT SPECIALS X-RAY OR 5�!�5cU PICU FLOOR AMA DCMDME TRANSFER TRurSFER TO: - � • � itJ � i z ��, L Ow1.r Pharmwist s ,i'�` O:►er Radiology Tecta. 7�� * d y d►s• ��r � Scribe Lab Teft j i ./ �t -1 its Pape 2 (1161) Mut.-M96cal Record Copy Canary-Traurna Oft,.^s Copy Pink-E.D. Nurs:ry Copy +re...•r•-�..-.,-.s.s�....�.+�,_rr.+------._.�...-.....�-.�-.---�,��,r.^err--•. _ _-+.-r•..-�_.--.-....--�-+...�--..�._....���,.r.--�-�--^-�-••�r�v.--•r---+.•.----�.�r-+_�-.---..-.,.-..��--• C W2Craw t:.tN►? 4 - +M 1� Flexion (pain) 3 1% tis Extension (pacQ 2 . .. _ .:,.. None _ _._ ... ---- -- - - ...._._.: _ :..'.. _ -• - - Total Trauma Score 4.16 CH" Total Glasgow Coma ••. • • - •~ Ape iny"rs Scale Points f :r�;•,._. 0 1 5 10 14-15 f r: ,e • t : A. Its d head 9/h 81h 61A 61A - 11-13 • 4 . _ 8. Its of one thigh 23/4 3114 4 ..41.4 8-10 • 3 . - C. 1h of one log 211& 21h 23A 3.. 5-7 • 2 3-4 SION 0 1 :- Heart Rata A—h&" B*;oW 10o Dew 100 - _ • _ N . Reap. Eftcd A 6:oW. frroo. Cryir,Q • - 1 ` Muncie Tone IJmp Sort e FU3L Active Rellax " No R"Por" Some Motion YI¢ C7 Color 8Lw, Pala Hands U4AA Pr k _ - ' n7 - -4 . - .-. .. - ... - - . - ... .. • _ .. • .. rte. .. ..N.-. .. . .- y •!'. 1 .'. .. . . r _ ... � U Ll I ....-. Grading of Open Fractures Trauma Scoto Respiratory 10.24/min. 4 Type 1 S•• -.a: wounCs t Cm or less Rate 24-35/min. 3 Lv+ e-x�;y trscxrtia r 36 min. of 4Yeater 2 Miru7-W soft tissuo trauma ' 1 - 9!mIn. 1 . . Typo 2 Extrslw wound ; None 0 ' No c,'fi-aftzed basus Respiratory Normal 1 • Ltt)s torekgn ffud ai Expansion Exp Revacitw 0 " Type 3 Mas&yrs wound ; Systolic 90 rnm Hg or Qraatar 4 De•.-."Lzs0 ttnoo ; - Blood P»saurs 70-69 mm Hp 3 - Foreu; n mea dol 50-69 mm H4 2 Him ar►e�y trauma _ - � 0-tD mm H4 1 . a. ,"saw misalrq � r, • � _ t3. perlosteaJ szripplrlq - . N o Pulse 0 C• vsscuair Capillary Normai 2 Rules of Nines x: Refill Delayed t None 0 Mug vs. Pedlatrlc Stuns . Glasgow Coma SCSIs _ Eye 4 Openlnp. To Voice 3 1 To Palm 2 A A .. - None , tem '"' + Verbal s , omen. sww 2 +s +M Response Cont,;sed 4 +M tw ••�+.: • tN +K w •....• tM Inspproprtate Worft 3 _._. ! M kKor-s,-ehen&lbl9 Words ! .. e+. *.. r•. s s s e None 1 .• . motor obeys Comm" i y Response I —11?e; Palet i C W2Craw t:.tN►? 4 - +M 1� Flexion (pain) 3 1% tis Extension (pacQ 2 . .. _ .:,.. None _ _._ ... ---- -- - - ...._._.: _ :..'.. _ -• - - Total Trauma Score 4.16 CH" Total Glasgow Coma ••. • • - •~ Ape iny"rs Scale Points f :r�;•,._. 0 1 5 10 14-15 f r: ,e • t : A. Its d head 9/h 81h 61A 61A - 11-13 • 4 . _ 8. Its of one thigh 23/4 3114 4 ..41.4 8-10 • 3 . - C. 1h of one log 211& 21h 23A 3.. 5-7 • 2 3-4 SION 0 1 :- Heart Rata A—h&" B*;oW 10o Dew 100 - _ • _ N . Reap. Eftcd A 6:oW. frroo. Cryir,Q • - 1 ` Muncie Tone IJmp Sort e FU3L Active Rellax " No R"Por" Some Motion YI¢ C7 Color 8Lw, Pala Hands U4AA Pr k _ - ' n7 - -4 . - .-. .. - ... - - . - ... .. • _ .. • .. rte. .. ..N.-. .. . .- y •!'. 1 .'. .. . . r _ ... DATE OF CONSULTATION: 7-2-92 REFERRED FROM: E. PARK, M.D. REFERRED TO: M. PLECHAS, M.D. REASON FOR CONSULTATION: Re -consult for open Wound, right neck/head region. HISTORY OF PRESENT ILLNESS: This 31 -year-old male was involved in a motor vehicle accident. I was called to evaluate a wound in the right mastoid region. The mastoid is fractured and there are foreign bodies in the wound. The patient had no loss of consciousness in the accident. He was brought to the trauma unit and attended to Eung Park, M.D., the trauma surgeon. PHYSICAL EXAMINATION: HEAD, EYES, EARS, NOSE, AND THROAT: The patient has a hole over the right mastoid. The mastoid is fractured in the base and there are a number of probable glass particles felt and seen. With any touching deep in the wound the patient experiences decreased hearing. He relates this to "having water" in his ear. The patient hears well with the ear. Laceration passes across the mastoid, over the inferior ear and down onto the cheek with an abrasion to the cheek. There is also considerable swelling of the right cheek region with a number of perforation through into the deep tissue. The zygomatic arch is in place and symmetrical. The infraorbital.rims are intact. The pupils are equal and reactive to light and accommodation. No diplopia. There is normal sensation of the left face. There is full range of motion of - the mandible with no TMJ pain but definite master pain in the region. The patient has what he feels to be his normal occlusion. NECK: Supple without pain other then the sternocleidomastoid at the right mastoid. THORAX: Lung fields clear to auscultation. HEART: Regular rate and rhythm. There is a slight tenderness across the anterior chest secondary to the seatbelt. ABDOMEN: Soft without tenderness or distention other then' some superficial tenderness again secondary to the seatbelt across the low abdomen. Costovertebral angles and rib pain with percussion. GENITOURINARY/RECTAL: Deferred to the admitting trauma physician's exam. EXTREMITIES: The patient has no significant injury to his extremities. He has full range of motion, good circulation, good sensation and functku". NEUROLOGIC: The patient appears to have normal sensation of the face and even the ear although the puncture Wound is directly at the posterior auricular nerve. Cranial nerve CONTINUED WESTERN MEDICAL CENTER/SANTA ANA SANTA ANA, CALIFORNIA NITZEN, LOYD 527-2 1�y 27-82-91 CONSULTATION M. PLECHAS, M.D. CONTINUED PAGE 2 VII is fully intact with normal function. As noted, he has good hearing. IMPRESSION: 1. LACERATION, RIGHT MASTOID REGION WITH FOREIGN BODIES EMBEDDED AND FRACTURED MASTOID BONE. PU.N : Attempti`ws made on the floor setting to block and examine the wound. The patient experienced too much pain especially in the mastoid region and it was impossible to block this area. Also, to adequately search for the foreign bodies and to do an adequate repair the patient needs general anesthesia. For this reason, he is taken to the operating room. There the area will be debrided, explored and repaired as indicated. Lab work is pending. The patient will be followed postoperatively on the floor and then in the office. MP:ss M. ECHA.S, M.D. d: 7-5-92 1531 R2028 t: 7-6-92 0604 WESTERN MEDICAL CENTER/SANTA ANA NITZEN LOYD SANTA ANA, CALIFORNIA 527-2 27-82-91 CONSULTATION M. PLECHAS, M.D. .. xIrkfil f - CV ! � 74 f A— I f Western Medical Center iar*o Am CoWxrio Western Medical Center/Anaheim Arx*wkTM Cowoffilo PHYSICIAN PROGRESS NOTES RC -131 (12/87) w►nEW I.D. NAME MED RECORD NO. RM. )ST#9206CZ 9t 20 tC 2 ,., •� �-^ �� NCfTES DATE TIME �12 0< V11-7 C', ss - 1007 c � ' Gi\/+� C •3tf0it: -Y :t d 100 Liss 'J iiion: I � • ��i,SS1�IC8i� A ------------ e - Ele_._. pwnEW1JX 94?050 7/02/92 Westem Medical Center �l j 1 E NC Y j Soryo Ana. CaMat�o NAME M .31Y �aM. Westem Medical Center/Anaheim ",Eo. RECORD No. = t E t4= w E,,,d,oM Coram STi�� PHYSICIAN PROGRESS NOTES DI Ft -, RC -131 (12181 0 DATE Uj,1 TIME NOTES 1 T JA y f G v (ol� -� v �- P 01%01— Sook W000, Western Medicos Center PAUD-; '-•'. Y So AM CoWomia J' 9 4 2 t, 7/ /92... rl,sE N1 T . Western Medical Center/Anaheim t I11 LOYO T �►�cXs«ra QjfY C " �1 EUNG H mD --- �. PHYSICIAN PROGRESS NOTES 278291 ENO �- ::,•=:►. S T i 9 2 0 4 0 2 .:. ....;.:.;. Forth No. 6000-0117 (12/87) :•~--�; .. :_ - ": '4 _.. %TE T ..,, E NOTES _ o , �I W w Cf %C>,L 7_ Ir Western Medical Center P11 :s •�..., w ;�'v 7/02/92 - _ _ Scroo AM j .W„M4?Ob02 I T Z' E N 11, �oYo 1 - Western Medical Center/Anaheim � PHYSICIAN PROGRESS NOTES i .,, 275291 ENG w RGA t12An Please b.-,Wpsoh-,t pen ORDER DATE ORDER TiDfITE DOCTOR: PLr.o.,;r, STtT.-7 TRAU,ovIA EME:73.1'-��.ENCY PROTOCOL ORDS- :S: Do all those 1. PVC's - 6 or mc: e per minute 3 consecutive PVC's or chez-kcd. E multifocal PVC's In presence of chest p3in or R -on -T Flbe"memorr a. Adminis',er Ud-Dr-a;ne to5lus of 75m, g.- W.P. If not controlled In 2 min. rnwavy repeat 50.-r.g. May repeat 50mg: bolus q 2 min. to maximum of 225,-rg. b. Start rV Infusion of Igm Lidocaine In 25 -3 -cc 410,1-W, titrate to control PVC's - not to exceed 4mg./ml?n. c. Obtain ABG's If not on pulse oximeter. Z Ventricular tachyc2rdia a. ff patient Is alert -follow PVC protoc*1 and dvck b. If patient becornes unconscious or B/P less than 90mgm/Hg systolic immediately administer precxdW thump. c. If precordial thump Is unsuccessful, cardiovert at 'yy 50-200 wait/sec. & If all treatment unsuccessful Inftlate Code Blue. 3. Ventricular Fibrillation a. Administer precordial thump. ai b. If precordial thump is unsuccessful defibrillatte at 200-360 watts/see. c. Initiate Code -Blue. Western Medical Cenfer U -to Afte, Carge"" Western Medical Center/Anaheim 1190 PATIENT LD. 7/j -4 1, 1 P �;T Form NO: 7G10-0123 9 4 2 e." 6 0 2 OnDER ORDER DOCT011t PLEArC STATF PFJTTVif-!!-. C: tOtIlDC DATE TIME Id TRAULIA-EpilER"�r--ICY--PilOTD—C)L 0 F.) 0) 0 n Li a -, hnn FVIL Bcad-Ralta jes A TI IV. no S2LC2iCII'ii21 Imp_ . C -D P. Tol U'T a. Initiate Code Blue, 6. Hypctens;on (symptomatic with sys-toli-- sp less 90mmr/Hg a. For non-cardiac-patierTt glvo 500-m- Normal S3.1im to Infuse over 10-15 min. MU repeat X's I. 7. Respimtory Distress (consisting of sho-taies3 of breath end difficul!y breathing. a. Obtain ABG's & chcest X-ray. b. 01gen: nasal cannula at 2 LPM or mask at 4 LPM 8. Notify Trauma Surgeon If any of abcvp- occur. Wesfern Mieclical Cenfer lkm$a Anc, CorilomSo I esfern.M.eclical Center/Anaheim Aftowm. confamw '-2/90 PHYSICIANS ORDERS Form NO. 7010-0123 (i ass) ,( f PATIENT IM. arms f 5 T C. r::m J'u-11 %, - 114 Lw � PHFOPrz-iATWE UAwGNOSIS POGTDOPfRATNE DV.co4o" . . . l T�Sst,Ertr••--�-^ Foreign body right mastoid GROSS DESCRIPTION - The specimen is received in formalin and consists of six (6) irregular fragments of clear blue glass ranging in size from 0.3 x 0.2 x 0.1 cm. to -1.0 x 0.7 x 0.3 ci. A •0.3 cm. fragment of tan skeletal muscle is -grossly identified. Gross only, no sections taken. GROSS DIAGNOSIS = FRAGMENTS OF GLASS, IDENTIFIED. RS/ye 7-6-92 -_. ..f - -n'i. � . •x•-17 . •i. '..i. ..: r.� ••� .j'.I•� N..1 ,•.7•S/�. v:..lIASL '+. 1"� • zt4 i•• l y: _ :►. fit-'' q'/ •r:. •*( :. �5• ... A•yr�-• _'•Y':".� '..•ti':�c'r. ... :• j PAS- • 7-2-92 PATHOLOWT LID. CODE CUTE OF SEF HUN KIK LLD. *WL SME NL &W,. RO,5ZRT STROUP. K0. w-UkST - -- F&R= WM.L NITZEN, Loyd 83RTHOATE LEX I M NOSPaA. NO. 19420602 CATOi Pi HOSMAL Ph_r5JCLAJgS OP E. PARK, M.D. 07 ',7 — L'Z_(W PATHCLOGY REPORT ACC. NO. S-3610-92 0 UNITED ` EES T GtiN MEDICAL CENTERS I Please use ballpoint pen Unleat indicted in rigmt hand column, autherm2tion is given to dispens* another brand of drug identical in form and content :ER OR^t=i E M LAK ' , a►^tA P?OMCOL ORDERS: No C.L-gc EC jrvAti s �) - •6. Transfusion Servicet. Do all those checked znd filled in. () 1. 01 at LP%1 via: I C- Low e.=ectation (Green) - Tie and Screen. �. Ca rdiomoni tor, doc=ent irregularities. 8. Y-Rav: lateral cervical smine with a�-n tzaction, A/P chest, ' Indwelling urinary catheter to drainage. 1 Other: 4. Lab, urine: UA, other: �. Lao, -01000: t -D69 rants , Biu t Lrca tops clot tuDe ' Other: s �) - •6. Transfusion Servicet. ' s. DMEDIATE NEED (Red) - 2 Units (0 neg) PC and T&C 6 Units. b. Anticipated Feed (Blue) - T&C 2 Units (Type Specific available in 10 minutes, Crossratch in 50-4S minutes). C- Low e.=ectation (Green) - Tie and Screen. ' �) 7. Solution -warmer for main I.V. lines, blood products. 8. Y-Rav: lateral cervical smine with a�-n tzaction, A/P chest, ' 1 Other: 9. Respiratory:. oximetry other: 14� Signature: ` PHYSICIAN'S ORDERS -,r_ = "e 94n602" UNl': %V$$ E=,N `.tECICAL CE'J --=-.:;S � �.1�7..•.. r.�...--r.�r.-n ...+1•: iw..T.---.-�^w!1,�� �7�i .�.�r�,�.�.. —. _.. _ n..-T1�-+t. :'YT �+. . ✓ -s UNITED WESTERN MEEDICAL CENTERS P?e"* u3e ballpoint pen (k1"S incictted In right hand column, authorwtlon to Qivon to dispe &not brand o1 6" identical in form and content ` - P SICIAN'S ORDERS - Y ERSS GREEN NITED WESTERN MEDICAL CENTERS 11/90 .oar ..n AG is A vn O�tit TW& NA M E* 1 + . , � - "1 NO GO E�tJ�Ya CATS nDDITICNAL S/TU ORDERS: PAGE 1 of 2 Do all those checked and filled in: , ' 1. Maintain I.V. lines with solutio:/rate • C) 2. Maintain CVP with solution/rate / •� () 3. Autotransfuse blood from chest tube. () A. _Maintain arterial line per hospital prcycedure and ©onitor. {) S. Nasogastric tube to suction. �) 6. Chest tube L R to suction at L/water. () 7. -f Peritoneal lavage fluid to lab for: R$C WBC? amylase ... tsar, • (j E. Apply/inflate MAST/ASG ga=ent. (� 9. Aovly Hare/other traction splint to R le (� 10. Avply to: O 11. -splint Betadyne scrub and dress wounds Vrf 12. Remove contact lenses if worn. () 13. Suction airway PRN. O 14. EKG now. r Continued on next page i f S ` - P SICIAN'S ORDERS - Y ERSS GREEN NITED WESTERN MEDICAL CENTERS 11/90 .oar ..n AG is A vn CAI Q. NA M E* 1 + . , � - "1 a '000 I X UNITED WESTERN &III&H-DICAL CEWERS Please use ba!lpolnt pen Linless Indicsted In right hand column. &Whor"tfon is glvvn to disponso argnhw brand of drug Identical In form and contwvt C14TE Mz G&A DATE IJ 7—le7kJoe 5/1-U ORDERS, ccntin-led: PGE 2 of 2 IS. Medications: O A. Dip tet O.Scc (IM) NAME ST#92O6C2 b. Hypertet 2SOu (IM) 9420602 O c. Tet tox O.S ccM) CASE* W-1; -1 (,-r-d. Antibiotic: ,�vf sz� O e. Other: 16. CT of: 17. To Radiology for: 18. To O.R.; per mi it read: to r,> lee, A 19. Admit to ICU Floor NW Peds rcu' O 20. Other: Si gnzture�. ZZ e77-- 42) PHYSICIANS GRDERS EJZ46 GREEN Us'-HTED WE ME-C.'CAL CENTERS 11 0/90 .6 DATE IJ 7—le7kJoe (—S r.1 NAME ST#92O6C2 9420602 CASE* W-1; -1 r,> 1 UNITED WESTEiN MEDICAL CEN ; ERS Please use ballpoint pen Unless indicated In nght hand column, authorization Is elven to dispense t another br" of drug Identical in fonts and c-ntenL SEA CFt06R to - CRITICAL CARE TRAUMA ADMISSION ORDERS: PAGE 1 NO ECA"ALE of 3 ;. Do all those checked and filled in.. 1 1. Amit to ICJ /CCU/PICU i 2. Activity: / S � ���.If' 3. Position bei: () ( )- 4. S. 01 01 at LPM via Ventilator orders per Dr: Oximetry. 6 • VS q: - 7. Neuro check q 1 hr. 8. Neuro/circulation check injured extremr ties q 2hr. 9. Urine output q 1 hr., total I b 0 q 12 hr. () 10. NG to suction, _ L01, Medium �) 11. Chest drainage output q 1 hr, total q 12 hr. () 12. Maintain chest tube suction R L at G/water. (} 13. Other drains: () 14. Maintain arterial line per hosvital 1S. Elevate injured extremities �' � 73 T •••E uxan0 TA - 1715z.vI E�� ., `77 -� • PHYSICIAN'S ORDERS ,v z STto20602 �A-r ;. 4420602 UNITED WESTEERN MEDICAL CENTERS Please use ball-point pen Unless Indicated in right hand column. authorization is given to dispense another brand of drug identic=1 in form and content_ �^ER c,rF op --13; r.ME NO GGwC='C E -C CRITICAL GkRE TRAUMA ADMISSICV ORDERS (Con't) : PGE ' of 3 () 15. M lab work: (} 16. AMCXR x d I () 17. Keep units of blood on hold -at all tines I () I8.• Consults for specialized services: �) 19. Consult Head Tratnna Tea= - Trau^a Rehab (} 20. Social Services Consult PHYSICIAN ORDERS '-INI _D WEE =N �.tE^tCAL. CE":"E c, - � •� t Z �Nl `rice• _ .. —. - .rl Tt92.sd _ 9420602 UNITED WESTERN MEDICAL C` NTEn^ S Please use bellpo;nt pen Unlabs tnd;CatrC to r�t1t hand column, avthor""On 11 Clwn to C:apanse anot"r brand of drug ;d#flttW Ir.:,, — .,,u contrnL G -x nuc 1 i CRITICAL C,;.RE TRAL'At-N .APNIISS It,` ORDERS (don't) : PAGE 3 of 3 20. Xaintain I.V.s G 21. Diet/Oral intake: t) ! 22. Metrication . •C 23. Ilnt hiotics: A %v19 24. U!l the on -duty Tra=a Surgeon for problems which arise after S:rO p.m. or on weekends. Sign tune: )/� �►� .. � 1 1 � ••' 1 4t EkG •: - - t:- r,,t 8 � AUI r Z �ti1. SIG(ANS .O, E-, j PNY NAME "i 1 b 602 .a8 Gnr=` t NITl:Z- WESTZAN UEC-C.tIL C--N-Z-�; '1p - r7. T fit J\ L Please use ballpoint pen DO NOT USE E T 11 M A F1 ER G< CH E IMP DOCTOR: PLEASE STATE Prr?TINI:-?;T CLI'11CA" L I I 1:7 -En r4o7E:D %Vf**N ORDERING RADIOLOGY Pp.ocrCURES. C0 N U R E.S TOE TIME S:%-JNATUFjF IIIC.I. 101 v It I m x 0-L ------------------ 10 .............. Western Medical Ce er $0NO Am C�owwjo ern Medic0l Cent r/Anahelm PHYSICIANS ORDERS s� L C. Ta P!: r4 031T PA Pic r $rt1?z:602 "Z. Ad Y Please use b.911point pen DO NOT Ur7 TI -..Q 1 •:40777 T t I N L F'-7. A r:.0 S 14. NOT ED ORDER ORDER DOCTOR: PLEASE- STATE PERTINENT CLI WCAL INFORVATION R DATE TWE ORDEWNG RAUIOL.01,�Y P110CEDUIES. I -E J 1;?A E SIGNA[URE -------------- L F9MENT I.D. /T 2 7 X I V, i tv -D olstern Medical Center 10 So&o Ana.Co'doff% Western Medica; Cenier/Anaheim ArwotwM COWOMAO PHYSICIANS ORDERS F9MENT I.D. /T 2 X I POST ANESTHE-ScIIA C;, U.111T h:'Urloint tlen ORDER ORDER DOCTORt PLrk--,E %-TATF P1 ?�T r, DATE TIME V, C;;4 r Tj.f 0 1:I1I'sC•! ':..Y f "Es DA.T E 11%4 '-IG NAI VRE MA 0 olm Ar-K Cjj -foni! cq in Z' -Q VO rcx`,;t2Sliju nt with r DJC ry before di PULMONARY CAM, Mi--t C2 by mask � atubato,/cip-mrdin a !o OcOl when 1. respq. t corn reaches followinQ' her. pcx=ete.-. ; ez-. ANAI'GESM* 1I Patient Controlled Ancji2esia (,see a- co=mm PC orde Morphine Sulfate m WP DM. Daum may re q. u to otal [4 Meperidine (r)..,.rol) /1) IVP prn may repeat q✓ m u tc 0 Other. ng tot,- Drope.-idol mg MP Pcm nausea/vo=ting El may repeQt 0 Metocloprcmaide (Reglmn) mg TVP Pm nausea/vorr.itincT M 0 Other. AIM-NTHMA OR ARp ,FST.. Lnstilule ACLS or Hospital Protocol immediately.-C)#: n �fy Anesthesiol LAB: 0 STAT Hrd 0 STA; SMA' f 0 STAT ACCUCIJzcK- 0 STAT Arte.rial BI STAT Blood glucose 0 Offier. i X-RAY.- 0 STAT chest-410-ray Other b15CHK8cj: rmn" Ina -L"I'TO: 0 OLr&"PAT1D;T 0 FLOOR 0 CCU jb� IF PATIM 17-HfM UNDIMGONE REGIO AL BLOCr-kDF- TiMj AFFEC-jDj:X7j:.. mu-- MOVE SIGNATUpX: SIGN : MMk�j f' 0 92 Western Medico Cenfer PAI I I AAq. Conf,,js YD - T .,� p`f K 4/92 -2 , 76291 EMC PHYSICIANS ORDERS st '92 ' 06 0 2 jr L♦S L11. -� 'ij X11 iTi_ L Please use ballpoint pen =Mm-- DO NOT USE-: SHEET UNLESS RED NUM&I-R SHOWS 04RDE F3 GflDtA DOCTOR: PLEASE STATE PUTTINENT CUMCAL . INFORPI-A DATE TWE PRC)CE, T ON Vg*HC-N ORDERING RAMOt, FD -cC.y )U RES. NWISES 7 =7 DATE TWE 13, SJGf4.QUAE 24* CHAT,' T C. jr. . . . . . . . . . . . ........... In. or F All 00 ililll 01 ------------ FAR= ................ .. .......... . .... =01 1111111 ��Ci�rnwr�n�=-� I�� JrA�=M- UAW W� Western Medical Center PATIENT I.CX 30roo &xx Cofforria Medical Center/Anaheim t ZF tf* .Western Anotokn COWOM10 tOro T PHYSICIANS ORDERS 031Y EMG W� I•LJ��VaV.��.� tl�.i..itiJt..: �IC':�� N D D kt...1_ Please use ballpoint pen - ^ R.OT CL rr_- TEii;i CJi- C -T U141 r_ -A RED — SHOW ORDER OF`.UER �+ _.-.------- - - -- . ------.--------- ------ -- - -- _—•-----�f—. _ - _ I , CRATE TIME DOCTOR: PLEA:;E STATE Pr=RTtfiFt:T CLINICAL I"cO! .-IAMIN _ — _ �=OPUFR N� D i D —_ 1YHEN ORZ% L Please use ballpoint pen DO NOT Uf�--- Tf-::!Z 11*HEET A :)RVER ORDER DATE TIME DOCTOR: PLE-Af.-!E STATE WHEN Pt RT114r_!iT CLIN--Al. 1N50F?!-*.AT1ON 1'1"%CCF-.rj:jNES. CMDEP C)ATE_j NCIF0 TIME NUR",ES SIGNATURE WIEWT I.D. 24' CSL -t'. --,-;T C! '41 9f 20602 7,/oz/i;z Ln DATC 16 LOYD T tv 1k R` PAR<, 1,? :� 1 000 62 J • PI -A 17-D .......... ................. 110 i6A Westem Medical Center SCr*0 A -PK% CCWOn-0 Western Medical Center/Anaheim An0-,e*n CoWwoo PHYSICIANS ORDERS WIEWT I.D. '41 9f 20602 7,/oz/i;z Ln 16 LOYD T tv PAR<, 1,? :� 1 EKG v J UNI wEs N M ED t CAL CZN', 4' 11 C-iECX L.., � n�-r• x3/1 ). �.�.��• . , � • ! . � � . i �; � � • Z.�Qtlt tGr' .`.uI'-yt17 ,. 3. Other cormen-`s ='��/ t. Hist. -Ory end Fhys ice. _ -- S. Uri na Lysis Yt� ar �a P��cy Test • ar !�. EYoad 0r -dared .• es ori, 7• List al l"jes Oft ,int, stz� "none' 'T5- a• itlan: type. 9. tests "7- X-44 ,c I CS or p- 10. EZ �q 11. TSRf 1Z. . Yo i ata t= ti an Cath • -�.` mlicttians tnd timcs i. •Mlzi tZatz attar prt-:p rre:tj cats C t--*- ta¢ �` !u 1lep tiT C^^Wsy , ,-•r 1L ' Prgsx�. i:= _ ,tu.-Contact I esa .La -4't In Dispcsiticrt �� Lilt of Prc3t*trsZs ?� I6.. YZI uat; i es : tv neA cn t- t: 77. Ytlm ies rtta�-inid Cn person es ar List: es cr do I E. Mk i r Pins ,;d i SS � y i q i e= q Na i ro I,= tMa aw r'.nmo rra 14. i d&ntf ff cit; art N-=b*r j Band including Yes or' hosirt tatI M=t)tr cecUd With .art I G,TION !'i�tl"t�$G $ICi/� i�F < y���,�° or ho 2S?. Shave urL A111Y(j j?"4 C' CD t, Q)e-ck C-..mrr,, I. U 3. "'1 4. I 16 17. 1�. 19. R. hurz�r D OPMAT ION TLSL? b a ? 7/02/42 i7 O.R. V g � -_. NI T� N 11 . LOYD T SVC / K 0 31 Y G •SL` MACK FOR VITAL SIGNS. PkRK . E uNG H MD r' -- 278291 ENG I PRE—SURGICAL fir_ ► IST STt420602 r. kC•'Cc ale3 • L rel. L. .1 -. 7 �E+-Eiii.';. � F ::.S' NOTE r Ilk T-H/i PFOPCSZoALUERCIES: ,AICA 'IONS :./ROLM . UUV 'iFDI HISTORY: / 1 `• r A•4ESTH=1C HISTORY: FHYS ICAj, Exm LAB : , �� "' •'` (' r �' !' .�, f"l:' :1 N�o fil , A&NESiu•..ETIC P"V: ASA 2 3 4 5 IVES a�'D CCIDURE, dI.?tR ..�:A2 RE'a..�'A:J? RISKS UP ?0 AND LyCLLLl! LIG AZSCUSSED uZ H PAIItKr.. Yi$ NO -- -•� r agar a.esi.cr ANESTHES IOLOCY PROCRESS NOTES ?ev. 7/84 ' ggpob�2 ���z/4 . tit tlf ti r t. LCrC T Z P4 aK . 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L I N E AJR WAY r1w." $'INK ;/IiAL LEVEL OF COf45CIOW--,Nf-SS' "LAC71ING IIAAE: c:) -- PALE I N Af--,A L ,-TYP L OF ANI-�Tf-.� SIJ & !Wrlk�jLkt' DUSKY ENC10T R A,CH son mmmvmm�mmm ammsmm�r Mmmw on Ems mosommossmsommommons on ■ mm MEMMEMEMMEME mmmmm�mm mm� dmmmm� WOMEN M��Mm NOW m mmmmmn n� mmmm�mm-� mmnsm� ago mmommomommommommummom no= u lm wMmmmmm�mm M�m go Immu mmmmmmmm mmm mmm mmm MMMMMMMM mmmmmm CYANC',iC NASOT RACH oN T RA,—H OFF Cvp IV 'Har'd n,* t Arm Necot COOL DRY LR A - qT Aj SG - SV"m L Tym Grven On Arrival In G,*vn Reme ..-win im CA. To PACU PACU PACU lo kl%,Vn dim -L el son mmmvmm�mmm ammsmm�r Mmmw on Ems mosommossmsommommons on ■ mm MEMMEMEMMEME mmmmm�mm mm� dmmmm� WOMEN M��Mm NOW m mmmmmn n� mmmm�mm-� mmnsm� ago mmommomommommommummom no= u lm wMmmmmm�mm M�m go Immu mmmmmmmm mmm mmm mmm MMMMMMMM mmmmmm ,tC: 7t.f�� ���► . __i W I i ` `.. - - 7 - . PLACE EK13 W0ft 7URt1iG STRFP HERE - 7 ► � .: ".� :7/03/01 _ 0:00 _ Source: ECG_ Lead: II 25 mm/sec_ _ MAHUAL_-recordi WSCHARGE CMTERfA SCORE PRESS&MG -. :N• • i. ` -' A--d,e b A -en LOC'ATK)N TYPE DRAINAGE: � NO - Neuro Status as Pro Op 2f (OrcW One) ; Arovaabls c Sttmuladion 1` ti ' L40ve5 4 Limbs • laa-s 2 Limbs t . SP 20=a Pte -Up EP 20-50% Pre -Op Stable (orcfe) Ye; o TOTAL INTAKE TOTAL OL`TPUT P.^R2 Spinal. Ep•dural (a TS) OR t � Pate Dusky 12t. Moloyd Sensation Relu Deoo C.obteame b ugna Sr►ettoM+ BreatMnQ DISCHARGE TIME: SIGNATURE: _ K Ve r a•nr t♦ n, rT'J7Ai (go it 6+1 I• PACU REPORT GIVEN BY- t11T RECEIVED 6Y _ � TIME: i DATE OF OPERATION/PROCEDURE: 7/2/92 PREOPERATIVE DIAG`N'OSIS: 1. OPEN WOUND RIGHT MASTOID AREA WITH FOREIGN BODIES PRESENT. 2. PUNCTURE WOUND TO RIGHT CHEEK WITH FOREIGN BODIES PRESENT. POSTOPERATIVE DIAGNOSIS: 1. OPEN WOUND RIGHT MASTOID AREA WITH FOREIGN BODIES PRESENT. 2. PUNCTURE WOUND TO RIGHT CHEEK WITH FOREIGN BODIES PRESENT. PROCEDURE:. 1. EXPLORATION RIGHT PREAURICULAR CHEEK WOUNDS WITH REMOVAL OF GLASS PARTICLES AND EXPLORATION OF RIGHT MASTOID WOUND WITH REMOVAL OF GLASS PARTICLE. COMPLEX REPAIR OF APPROXIMATELY 1 CENTIMETER OF RIGHT CHEEK WOUNDS AND COMPLEX REPAIR APPROXIMATELY 5 CENTIMETERS OF SUPERIOR NECK INFERIOR REGION WOUNDS. SURGEON: MICHAL PLECHAS, M.D. ANESTHESIA: GENERAL BY E. LEE, M.D. FINDINGS AND INDICATIONS/ PROCEDURE IN DETAIL: Patient was in a motor vehicle accident. He was struck just* beneath the right ear and across the right cheek. On examination of these areas it was found that the mastoid bone was fractured off with minimal displacement. It was at a slightly oblique angle from the horizontal. In the depths of the wound there were particles of glass found. The segment of the sternocleidomastoid had been transected. On the anterior of the right cheek in the preauricular area, there were two pockets found deep in the parotid gland. A number of particles *of glass were removed from this area. There was considerable swelling but no obvious parotid fluid leak. This area was closed with deep 6-0 inverted PDS sutures followed by interrupted 7-01s for the skin. The skin was trimmed of devitalized edges: Next the wound over the mastoid was trimmed. Inverted 6-0 PDS sutures were placed in the sternocleidomastoid muscle and then in the deep structures just beneath the deep dermis. Next inverted 6-0 PDS were placed in the deep dermis followed by interrupted and running 7-0 Prolenes. A 1/4 inch Penrose drain was placed in the depth and an ear dressing placed. CONTINUED WESTERN MEDICAL CENTER/SANTA ANA NITZEN, LOYD T.,II SANTA ANA, CALIFORNIA 27 82 91 OPERATION/PROCEDURE REPORT MICHAL PLECHAS, M.D. CONTINUED PAVE 2 Patient tolerated the procedure well. He was taken to the RtsL:uvviY Room in good condition. MP/biro , D: 07/05/92 1541 R2031 T: 07/06/92, 2007 CC: WMC TRAUMA SERVICE BILLING DEPARTMENT .. —WESTERN MEDICAL CENTER/SANTA ANA NITZEN, LOYD T. , II SANTA ANA,- CALIFORNIA 27 82 91 OPERATION/PROCEDURE REPORT MICHAL PLECHAS, M.D. Pi4EOPEkATNE M43.40SS r J6Tor'EAAME D,64 6t r�.�. ►.r..,�o Foreign body right mastoid GROSS DESCRIPTION The specimen is received in forzr.3lin and consists of six (6) irregular fragments of clear blue glass ranging in size from 0.3 x 0.2 x 0.1 cm, to .1.0 x 0.7 x 0.3 cm. A 0.3 "cm. fragment of tan skeletal muscle is grossly identified. Gross only, no sections taken. GROSS DIAGNOSIS FRAGMENTS OF GLASS. IDENTIFIED. P.S/ve 7-6-92 - �... : r• . -�:- �• ti'.:... V••-'+�'•.t •.• .fC •L ;`.i s4 .. �•S.,►ti.. '.•Y'�' r •.::':r .-.. ..,�... , • _ -. - ... - - • � - .. . • PAS / 7-2-92 C01>E CUTE OF SMvICEFf,SN ICK LLD. *X L SSC— ZML UZ, ROS:RR i STAOUP. KD. •+E -LAST FutST MKXXF I &ATn-)ATE ZZX ►+0SnCS1kLaO, NITZEN, Loyd M 19420602 )CAr ra N ►.',-7�PrTAL Prct srcwls OP E. PARK, M.D.�? ').71_ x+►xi.t-,oti µ9q PATHC:_.OGY REPORT ACC. h0. S-3610-92 y (1•t♦ IM►►l; tNLY 'ttvh i�lvT W .�i►.Gt UN. "'.Sl HI S►k OG)ST: YE S i4 O H. / /Vat aT BEG/W SUH(;. HEGAN E•JftG ENDED ANISIN. FNUED H►tUNt SUr, LAT. U1N OTNi+t P►tF� -•� 1,�PHISONEX O NONE Q�w 5 x GEL 61Dl) '� ��1'?�OTHER SOi.I.'T10NS O Er.J COA05 CUTJ� GGROUND S)iE C,.'tOt/NI) : fIPOSTOPNoDi YES M(lhfTOR S✓9 OTNCR 1 70tMN1QUET R / R L TIMEUP TIMEAf'F'•JED 8YTESTQi, GAUGED YES PRE-0PERAIrA DdAGNOS POST OPEPATM DOGNOStS: 1 OI•ER�►T10P(: PATSE1:T AUL RGIES VE R**D: Q\ CGATHETER / OUTPUT Cj INSERTED BY: TIME: DRAINS / -•C ' L' PACKING MEDICAT?ONS: , ARMBOARD RIGHT <LEFT FETY STRAP SECURED YE No 13 ARM TUCKED AT R L BY SIDE AND PADDED A"EST1iESA AXSP DtG I EF -JI S/8 GZN Q= Q LOCAL ET MASK NET VERIFIES SELF(_YES2 NO OPE4 ATION VERIFIED YEfa NO PATIENT IDEKTIFIED BY PHYSIC" M.D. ARTERLAL L1KE: R L BY: IOEKTABANO CHECK x 8Y: NURSES NOTES: A _ U EJ Sc R L BY: hWtAhtiS CSTI RUMENT COUNT CORRECT"Va SCRUB NURSE PONCE COLMT CORRE EEDLE COU CORRE,t U Y , M A ply CIRCULATOR R. LIST All SPECMAEMA (IISS4 10 Ct+TURE. FOREIGN DNF O `.� - 80DIE . TC.) OTHER PEOPLE IN ROOM RAY IN O.R. YES N�OTYPE %TIEh'T TRANSFERRED TO: TIME ��A7RICI.! CCU WARD CASE CLASSIFICATION •�,..,_� • ,,:_ Westem Medical Center Santa Arx% CoUtosNa stern Medical Center/Anaheim Anot*kA Califom;a OPERATING ROOM NURSING RECORD ilrvrrtt�i j—�j E,^r• c PATIENT LIX c142MO2 7/r)2/i;2 k LIE f4 1 1 9 IGrG T F:s. K Co )IY J RD IP4G K, E N c K Iwo L t Eam K OCCTDR 1%.Yt413b-`2 t SANTA ANA TVSTIN RADIOLOGY MEDICAL GROUP NAME: NITZEN, LOYD T. SEX: M DOB: ROOM: 3T3232 XRAY M: 314410 REQUESTING PHYSICIAN: PARK, SUNG H., M.C. All LADING PHYSICIAN: NS DATE OF EXAM: 07-02-92 EXAM: CERVICAL SPINE CROSS TABLE LATERAL 4?1691 EXAM DATE: 7/2/92 - HISTORY: Trauma. - A single lateral view of the cervical spine was obtained. The . cervical spine was visualized to the level of the top of C7. Prevertebral soft tissues are unremarKable. There is no evidence of fracture or subluxation. Intervertebral disc spaces appear unremarkable. If further evaluation is necessary, full cervical spine series is recommended. ZWRESSION. ' Negative lateral cervical spine to the level of C. - Q: 7/2/92 t . da 07-11-92 MICHA BLACK, M.D. PATIENT I.D. . :. Westem Medical Centel Sorft AM C000rrho NAME ,RM. RADIOLOGY REPORT MEQ RECORD NO. z -7? z 9 7 S Fortes No. 7630-OIM (10.1871 �IEALTH RECORD DOCJR t•P r SANTA ANA TUSTIN AADIOL00y MEDICAL OROVP NAME: NITZEN, LOYD T R00M' ST3232 REQSEX: M Doe: t1E3TZNCt PHYSZCZAN: PARK, ATTENDINGPHYSICIAN : NE�JNQ H • . M.D. XRAY 314410 DATE OF EXAM: 07-02-92 EXAM: CHEST t VIEW AP OR PA •' ORD*: 471492 EXA" DATE: 7/2iv2 HISTORY : :. Trauma . .. .. •, •.. .. ' . A single /0.P vie .. .. ....' . •. . ,._ •• _. . Mediastinum ano of the chest Was hila are obtained. The hoer norn-el. There unremarkable. t size is effusion, is no evidence of Pulmonary vascuieture normal• The chest a^ focal consoliaation or is rPeara normal. Pleural RE882ON : No ramal cheat . 7/10/92 - MrC4%iAE BLACK, ".D. _ Westerrm Medical Center PAT'E'T J.D. sarro AM CoWoftft . • -• NAME RADIOLOGY REPORT REPOn [p-�- .. MEO. RECORD Np Z 7630-0106 t101871 HEALTH RECORD DoCTOfl (3 SANTA ANA TUSTIN RADIOLOGY MEDICAL GROUP C.) NAME: NITZEN, LOYD T SEX: M ROOM: 375232 DOB: REQUESTING; PHYSICIAN: PARK, EUNG H. , M D. XRAY M : 314410 ATTENDING PHYSICIAN: NS SATE OF EXAM: 07-02-92 EXAM: SKULL, 2 VIEWS ORD*: 471693 EXAM DATE: 7/2/92 HISTORY. Trauma. Two views of the skull were obtained. There 13 no evidence or skull fracture or sutural diastasis. D: 7/10/92 - qw da 07-1 1-92t. _ MI -L BLACK, M.D. .. L Westem Medica! Center . Sana Am Co omio RADIOLOGY REPORT Form No. 7630-010,3 (10/87) HEALTH RECORD P AT tEN 1 I.D. - NAME RM. I v l MED. RECORD NO. 2 7 - L .1 DOCTOR , XAM : CT FACE OR[>* : 471700 WITHOUT CONTRAST EXAM DATE: 7/2/92 HISTORY: Trauma. Utilizing the O.E. 9600 scanner, contiguous 3 mm axial scans Were obtained at 3 mm intervals through the roof of the orbits through the Brand i bio . - •• FINDINGS: jimally displaced vertically oriented fractures through the right h...&stoid tip is seen. There is radiopaque debris seen directly adjacent to the right mastoid tip. There is associated soft tissue swelling. There is associated opacification of the inferior mastoid air cells. " The bony structures of the face, specifically the zygoma and zygomatic arches, appear Intact. The W8115 of the sinuses also appear intact. There is no evidence of air fluid levels seen within the frontal, ethmoid, sphenoid, or maxillary sinuses. The nasal bones appear intact. The nasal septum is mialine in position. The mandible also appears intact without evidence of acute fracture. Both temporomandibular joints are maintained. The bony orbita appear intact without evidence of acute fracture. The intraorbital fat planes are distinct. The extraocular muscles appear intact. Both globes appear unremarxable. '(report continued Vestern Medica! Center Sarno Ano. CA*orr RADIOLOGY REPORT F*rm No. 7630-0106 (10187) HEALTH RECORD ���+^: ,l'�T.2'aG: "i`. - .tom—i-..ray •�.— —...ams.+•-1aw�-.�.w��-v-....—..�..:�p� /� SANTA ANA TUSTIN RA0IOL03V MEDICAL GROUP AME: NITZEN II, LOYD T SEX: M DOB: DOM: 5T52)2 XRAV 0: 314410 REQUESTING PHYSICIAN: PARK, EUNG H., M.D. ATTENDING PHYSICIAN: NS DATE OF EXAM: 07-02-92 XAM : CT FACE OR[>* : 471700 WITHOUT CONTRAST EXAM DATE: 7/2/92 HISTORY: Trauma. Utilizing the O.E. 9600 scanner, contiguous 3 mm axial scans Were obtained at 3 mm intervals through the roof of the orbits through the Brand i bio . - •• FINDINGS: jimally displaced vertically oriented fractures through the right h...&stoid tip is seen. There is radiopaque debris seen directly adjacent to the right mastoid tip. There is associated soft tissue swelling. There is associated opacification of the inferior mastoid air cells. " The bony structures of the face, specifically the zygoma and zygomatic arches, appear Intact. The W8115 of the sinuses also appear intact. There is no evidence of air fluid levels seen within the frontal, ethmoid, sphenoid, or maxillary sinuses. The nasal bones appear intact. The nasal septum is mialine in position. The mandible also appears intact without evidence of acute fracture. Both temporomandibular joints are maintained. The bony orbita appear intact without evidence of acute fracture. The intraorbital fat planes are distinct. The extraocular muscles appear intact. Both globes appear unremarxable. '(report continued Vestern Medica! Center Sarno Ano. CA*orr RADIOLOGY REPORT F*rm No. 7630-0106 (10187) HEALTH RECORD ���+^: ,l'�T.2'aG: "i`. - .tom—i-..ray •�.— —...ams.+•-1aw�-.�.w��-v-....—..�..:�p� /� CO.. 0 SANTA ANA TVSTTN RADIOLOGY MEDICAL GROUP SEX: M NAME: NITZEN II, LOYD T XRAY It: 314410 ROOM: 5T5232 PHYSICIAN: HYSICIAN: PARK, EVNO H. M.D. ATTENDING PHYSICIAN: NS DATE OF EXAM: 07-02-92 0RD* : 471700 EXAM: CT FACE _ WITHOUT CONTRAST (Continued) C )NCLUSION : displaced fracture involving the right mastoid tip With �. Minimally Associated soft m opacification of the aStOid air ce116 inferiorly. • tissue swelling With radiopaque deems. negative facial CT scan. No evidence of manaioular P. OtnerWiae fracture. .. - D: 7/2/92 VIVI N C. WON(3, M.D. csa 07-03-92 , :.. page Q ' pxnEKT La , Western MedlCai Center NAME fit. . Sono Ano. Cc"Omio MED. RECORD Na RADIOLOGY REPORT" DOCTOR HEALTH RECORD,r-.-. --...� p-..•�- �- Form No. 7630 -OIC -5 i11)/87!_.... _ ,- .. --. ..._ . r;- .----?�^ •-.e,..r.,--.,...-.,--ter•---- _ SANTA ANA TuSTIN RADIOLOGY MEDICAL GROUP SEX: M pig: NAME: NITZEN II, LOYD T XRAY M: 314410 ROOM: nT5232 M . D. REQUESTING PHYSICIAN: PARK, EVNO H•. ATTENDING PHYSICIAN: NS DATE 0-F EXAM: 07-02-02 ORD*: 471699 EXAM: CT BRAIN WITROUT CONTRAST- EXAM AAS= HISTORY: Trauma. - he G.F. Q800 scanner, , cont i quous ax lel scans were obtained UtiliZin9 t , from the baso of the sKull to the vertex. FINDINGS:vcntri- ear normal in size and The fourth, third and lateral configuration. The Gistal spacoscare males intained. Tht cerebral �- . sulci are not widened or effaced. NO total high or low attenuated lesions are noted intra -axially. No focal mass lesions are seen. No intra-axial fluid collections a _ - - -• re t appreciated. �OtCd. lyp S5 effect or midline shift is app ` '+ C CONCLUSION: � - � - , non-contrast head CT scan. No evidence of acute intracranial Negative - •• - hemorrhage. - . •• I.. t - it •.. •. -- . -._ - �. _ .. .• `• • - .� �-- . .. - ( report continued) KnENT I.D. .. _ Western Medical Center NAME .: RM. sorft Ate. MED. RECORD NQ -RADIOLOGY REPORT DOCTOR ato6 I�o�871 HEALTH RECO_ Fwm No. 7630 �,,�. R-ti....-•-r�+.;..►.T-rr_,-.-- .�....-. EL^NTA ANA TUSTIN RADIOLOGY MEDICAL GRCPUo AME: NIT7EN II , LOYD T SEX: M DOB : JOt�t: 3T3232 XRAY o. 314410 REOVESTINO PHYSICIAN: PARK, SUNG H., M.D. ATTENDING PHYSICIAN: NS DATE OF EXAM: 07-02-92 'CAM: CT BRAIN bJIT(-LOUT CONTRAST"-` ORD*: 47 1699 (Continued) D:. 7/2/92 Oa 07-03-92 VIVIEN C. WONp, M.D. page 2 PATIENT (•G. ftstem Medical Center Savo M0. Caw&nio NAME RM. RADIOLOGY REPORT MED. RECORD NQ .T No. 7630.0106 (10/671 HEALTH RECORD DOMR 7?c)-q . .. � Tss'�•r�zc."�....-,.T.., ..... ..mat NITZCN9 LON'D T Il 1940602 M 31 ti AAJ 7/ FARI'%' SUNG H MD REPORT CONTAINS DATA FROM 7/ 211992 TO 7/ 3/19Y. HEMATOLOGY'' WBC RBC HGD- HCT MCV MCH MCHC PLATLET COUNT! LOW NORM t 4.6 4.40 13.9 41.0 80 27.0 3Z.0 145 HIGH NORM : 10.7 6,80 I7.2 52%. 0 <pT I:tl--%, 0 1 �P­p 36.0 4 _-20 UNITS 9 X10**6 GM/DL x FL. . PG X - .. , xlo*-*3 - ------ - - -------------- JUL -------JUL Z 1440 7.6 4.70 15.Z 40.6L 86 3 37.4H 337 • HEMATOCRIT RECHECKED M A Nlj;; L L Y 'UL 2 2104 11.3H 4.65 14.5 40.5L 87 31.2 35.8 33Z JUL 3 0611* 11.9H 4.51 1:3.6L 39. TL es 34.3 31010, 'DIFFERENTIAL NORMALS RBC MCIRPHL-q-OGY _-------•--------------------- --------------------------- * - JUL 2 1440 SEGS'" vq.48-T6` EOSINOPHIL t 1. 0-6 -LYMPHOCYTES s 3115-z_lz40 _ MONOCYTES RDW -CV A. 12.5-14.5 RD '-SD I 3T. e 37.0-54.0 URINALysrs' URINALYSIS t)NITS:' NORMALS ------------------------ ------ ------------ - ,i j LIL 3. 1340 COLM YELLOWAPPEARANCE s CLEAR SPECIFIC GRAVITY 1.020 PH -8 5 PROTEIN I'NEG* GLUCOSE NEG G/lx_ XETONES' f -NEG BILIRURIN t. NEG BLOOD I NEG -NITRITE-NEG NEG LROB I L I NOGEN O.Z MG/DL <,c 1 ZIP /HPF - 0-2 S"QUAMOUS EPITHELIAL s < 1 /HPF 0-5 FlNAl: COPY 10T REMOVE DO. N A IZ. NUMBER LOCATION DATE NITZEN9 LOYD T 11 194ZO60Z 7/. 8/9;, MEDOCAL RECOR06,GROuP NuuSEA 278291 H. Mt M.D. K S4EISANI M D R M STROUP FA n A-fMEDICAL PAT► ,OG.STS 0 1,%Cl NZ -AP -4 rt)STI%j AVE. CLINICAL LABORATORY _Lk Jiff 'N*k SANTA A',IA C.A 02;�SPATIENT 5'ljwAAA y Pi:p,,-)RT j\` f L O Y D I- I I ,. •.,,, , •.ZIGCHAF,�(;EU 7/ 6/9:� :,..� 7/ ►:/ 19420, 0Z M 3 2 PARI"* SUNG H MD 2 op ***�rw**+►ir+►*+�+►+►w�►«** 13LOI3D BAND ���,�r+r*y�r�r*�.�rw�►�r,t•+r*�c+� -------------- TYPE AND SCREEN --------------------- , STATE LAW REQUIRES THAT THE WOMAN TESTED BE INFORMED — — AS TO THE RH (D) TYPING TEST PESULTS. _IUL 2 1440 GROUP -(ABO).. & RH t A POSITIVE , ANTIBODY SCREEN s NOT DETECT :.. »»>»»>»»»»»»>»»> CHEMISTRY ..• <«««t�;t« ;«<�< :«<<<.«<< (NORMAL VALUES ARE LISTED ON REVERSE SIDE OF THIS REPORT) . RUN/ 2 HR PP K C. - COZ GREAT BUN CREAT' GLUCOSE GLUCOSE JNITS MMOL/L MMOL/L- MMOL/L MMOL/L MG/DL MG/DL - MG/DL ----------- ------------- ------ JJL 2 1440 139 3.8 !OT 23 1.0--- ------ ---- .-------------- 16 148H OSMOL OSMOL AMYLASE L I PASSE AMMONIA _O NORMAL ' s41GH NORM - - - - 30 r • ;+L .:. :..,,;. JNITS :. �"- _f �. -135 t . •- - _.. .4. v. _! _. `1.i. •-.. j• .` t f ,w ♦. ..-i-�1••. • •:a ar;:✓�. •:•r:.• i - •R•a _j .!• UL 2 240' ..... - �M- �.:��,,.� h • — —.: ---- ----- *a 190 ppi�a�i{� pp�pQppQQ�p -+.. .CCE�r'�•CC@CL��:C• y .. ... :a. •,.� •1•,: .y,.w .._.-. - .. -• _ .... -. '@@@'@@@�'@@@@ - CANCELLED • TESTS@@E'@@@@@@ �'Ca@�'@@�'@@@C�@► UL- 3 1300 CBC " • . - . • .BLOOD CANCEL: PER JANICE RN '',:.• _ - • {�: �- ,. -,. i_..�...a`. „-CANCELLED VIA CPU INTERFACE, -� -- ############# ####### MEDICAL RECORDS COFYti • 7' •' 1 \• fes`+ter, p.t�1 _•.� ..• ... ._. -.� • - • ' • _. - , - ._ _ • f. ...-ti,.:, �..w �r '. � . _ ._ ,.w .� _•f �_ •�'•.. •�l. art 1•. .� ~• .=I j.•.\� . • , ,- ••_'•-a•J��. ?.•l� ?!• f 1 �.•�. �... t.�r-�i"tet: .�..i. -�..• •.' ,, •,-:a••j _ •: :Y••.. '. - .. .. � ^... - .. .. N I TZEN 9 LOYD T I I - co: NuMeFa LacAT1o►� - DATE 19424642 T/ E/9 > .. - WDCAL RECORd040UP NUMBER > •�Crc� K KIM, M.D. K. SHEICANI, M.O. R.M. STROUP. M.D. Qt.a[14� MI�K� PA7HoLoGt575 M-jTjL/jtN-r! A,A.A 1001 NORTH TUSTiN AVE CLINICAL LABORATORY S►,r••. ANA CA 97705 PATIENT SUMP-iARY REPORT RES?iF� T pR� TH i:,PY D.t• T1m� . ' 'T'h r••w py Th a rw o 1 t o N Cc e { i PI. teac-hing re-oardl W60wn Meacd Ca -met $or-- AW162. CAWPOffwo Diagnosis: Wes$wn MocbDd C4ctw/Arx*wwm Arsomew1n. CcAlomvo I NTRAVENOUS FLUIDS FLOWSHEET Allergies: -153 (4.9 t)- - (See reverse S40 for Codes) HEALTH RECORD c Sians/Svrn S 0 tlri,4, rY crt4 r. ion 1 i I Zv-i* 11NO,; i M OM 0 RK 9 E UNG " "D 278291 ENG SY#920602 No AO , fs,cri• (� ,tom 07?0it, 15toO':'3 14 v✓_^ // .7 A-il ;)CED Signature Initials Signature Initial Signature Inrials ►p Initia ` ADMWIS�TiDh PERIOD Note: _ - ; Pia P= •&mac Pan Assesxrw+t .:• : �+ :;: -y "'64141CATE UCT1C�!J srrE--R oa L 1- Lm" Pain i o. ►+Cx Pain J 9 4 2 0 6 0 7/02/92 . tLTOfp 3. 41AC CHEST S. UPPER OUTER N ! T 10 N I 1 . i.0Y0 T 4. ABOOM u. ouAowwT/ eAnahm 1 t K 0 31 Y G - THIGH a. I.Y. TUBING CJ•iANL,E tt �.;..�. ••-�•�,.�tC stem Medical Center Western Medical Center i , i PARK* E UN G H MD . �_r Santo 278241 ENG Ano. Cortorrro Anor,e,rn = < (451) MEDICATION ADMINISTRATION RECORD - ...._.... • . �.._ -=;:��...�► � HEALTH !!ECnRD ,';;i'/:/:C1- -) k -11 rat i cot�c#Jrt StPO L I i L L: \t .I \APEL A); 1,6�O AL . . - . . . i I 0 Kim RN6 . kulif ADMINISTRATION PERIOD 1 - 10 scale PTO & PW ArWgedm c IV TREIA" Pain ^""&7wg rC4CATE PUECTX)N SrrE---A OR L I - Lsfte Pm 10 & Most Pain 1. DELTOID 3. IUAC CREST S. UPPER OUTER 2- A8DOWNAL4. THIGH OUADR.ViT I NAMENITZEN 11, LOYD T *4 astrI.V.e. TUBING CHANGE X7 l ulcal Co%, enter SantAno. CaWorr4a West8m Medical Center/Anaheim cse 00 4 20602 Ate: 031 -Sex': N Ar<g)em. Ccgjfomla MEDICATION ADMINISTRATION RECORD roll, EUNG K AD n No. 6000-0114 ("2) DOCT -' TT T- 71 T.1F jj T) rage I of 1 I, I it' Sig t e I CHECKED 'ti Signature Initials Signature N INDIA Illi ALLEIGY ADMINISTRATION PERIOD - 1 • to scars Note- � PiiD �*&"ff SCHEDU —= ".ATE WJECTiON SITE—A OR L 1 - Least Pan to • moia Par+ AcW232 :LTOtD 3. K= CREST & UPPER OUTER L ABOOMmAL 4. THiGHOUADiIANT HAmE KITZEN II, LOYD T & LY. TUBING CHANGE Westem Medica! Center WGSIem MedfCaf Center/Anaheim Sonto Ano. Cautomlo Anohe+m. C0l►fornio cAsE .Q39420602 Aft: 031 Sext K MEDICATION ADMIhNISTRAI-ION RECORD Form No. 6000-0114 (5.^32) oo✓:"um, EUN6 K AD lwce l of 2 ;ac 32SAi ;YlIKOL 7 Ttt 019 rf1 Ord v + L If INCH M06 iKLERGY ADMINISTRAT}ON PERIOD • 1-1aScaw Pro & Pas: M+alpes Pain Aisessnww 1p' SATE 9WECTION SITE—R OR L 1 a La" Pain 10 • Most Psi t. DELTOID 3. IUAC CREST & UPPER OBER OVADDRANT i ABOOIiMNAL <. THIGH 6. LY. TUBING CHANGE Yesfem Medical Center Western Medical Center/Anaheim Sonto Ana. Cd,tocrwa Anone►m. Co:rtomto MEDICATION ADMINISTRATION RECORD xrn tic. 6-'x^4-0114 (5192) i7T�T T r+r♦ I Iff KM X232 kAx4ENITZEN II, LOYD T Cask 4X9420602 Agrt 031 Stxt fI CK"C' 411, EUNS H ND I �.'ir i��iMt lv:• ��,i� t tii.��,�%r '.� ►Jil.�•�.1 •;. /•,� � ♦ � . , .. . 'A S. �• 1_.01 t� .3 GO .•:41 to 0I:�,4 -- — Lt 10TA551UN EL ��� �otfv �..o I I _ 7/02 / IV SITE CHU[ t GAILY Qs00 IV Dim% EFANGE --- LAILY #L CT1s ' +1 1+ t 1 . 1 COCKED lure Inftial Signature Inf Ws Signature Initials Signature Initials d - — i Ak4ft f�'d INCH 0196 ALLEISY ADMINISTRATION PERIOD - 1 - 10 scale • Pre: Postmaig"y Ir THEIRrY Paan A"sunwx :ATE PL ECTION SITE—A OR L 1 - Least Pain 10 - Most Pan . ELT04D 3 KAAC CREST & UPPER OUTER QUADRANT � fltlEli II, LOYD T 2. ABDOMINAL 4. T}t1GH 6. I.V. TUBING CHANGE Westem Medical Centef W@Stem Medical Center/Anaheim c,_stIJ420602 Ale: 031 Sezt N Scnta Ano. Cowomio AmVieLm. Col+fofnio MEDICATION ADMINISTRATION RECORD '��Ic, EUflo x ►D Form No. 600L} 114 (5.'92} HrALTY R �:.�"'?D page 1 of 1 Aharq;es - - --- ---- �- --• ADMINISTRATil7NPERM • t -10 scar. Pro d Post Anajge Note: Pain Aaaess,rert IND6CATE INJECTION $fTE--A OR L 1- Lo" Pain 10 - Most Pain I. DELTOID 3. K= CREST S. UPPER OUTER OUADRANT 2 ABDOMINAL 4. THIGH d LV. TUBING CHANGE Westem Medical Center Western Medical Center/Arvaheim Sonto Ana. Cakfomia fvw:oeim. Cat,fornio MEDICATION ADMINISTRATION RECORD =orm No. 600-9-0114 rS�o�i SUENLED NAM.NITZEU II; LOYD T 019420602 11►: 031 CA' -'.0 NO. �,-<-JA11, [Ups H AD t STS232 ROOM Sex: M OW A I A 15 11 A I :o- . c a : , ; � � t 'r 1: C ' .. • :: ; . ; ^ C � l,r ver AY111rJt10fl (scZ.t tc � --;-- -•- ---- 4 �t� I 4.. to ?�s ,?:ol to l..�til:ra +: 1:JAIL 1 ....v• i'r:i1tL;E �I 5G A� 5:00 .�.: 1r t - t I t7 l000l< SIgna Init' Is Signature Initials Si nature Initials Signature Initials l CHECKM 44 I Mo rYAYr &AtM At ♦ Aharq;es - - --- ---- �- --• ADMINISTRATil7NPERM • t -10 scar. Pro d Post Anajge Note: Pain Aaaess,rert IND6CATE INJECTION $fTE--A OR L 1- Lo" Pain 10 - Most Pain I. DELTOID 3. K= CREST S. UPPER OUTER OUADRANT 2 ABDOMINAL 4. THIGH d LV. TUBING CHANGE Westem Medical Center Western Medical Center/Arvaheim Sonto Ana. Cakfomia fvw:oeim. Cat,fornio MEDICATION ADMINISTRATION RECORD =orm No. 600-9-0114 rS�o�i SUENLED NAM.NITZEU II; LOYD T 019420602 11►: 031 CA' -'.0 NO. �,-<-JA11, [Ups H AD t STS232 ROOM Sex: M r, --- ADMINLSTRATION PERM 1-10sc&l@ �. PIP & POO Araige Pm AL%",T t IMATE !N.lECT*N SRE—A OR L 1 - Lomas; Pain 10 • Dost Poin 3. DELTOID 3.43AC CREST & UPPER OUTER 2 ABDOMINAL t. THKL4 OU ADRANT 4 I.V. TUBING CHANGE Medical Center Western Medical Censer/Anaheim Sonia Arm, C�7ornlp Ano.-.9im. CcMorrjo MEDICATION ADMINISTRATION RECORD Ilk KEDS S,TM232 NAMEKITIEX II, LM. T 019410602 Ase: 031 Sexs I CASE NO. carr; EUNS H n 15:01 to 23:00 :3:cl to c1:v. • • - ... - . � I1DMINtSTR/lT?ON PERIOD 1 • 10 Scams NOW P» a Pw Pain AsswA"mrt RC1CI1T- INJECTION SITE ---R OR L 1 Loast P -n 10.1.1wt Pain I- DELTOID 3 IU -LAC CREST b. UPPER OUTER 2- ABOOKuNAL 4. TKIGH OUADRANT 6. LV. TUBING CK&NGE Westem MediCal Center Westem Medlccd Center/Anaheim Sonya Ano. Colnorr► a Area�. CWOrryp MEDICATION ADMINISTRATION RECORD Fa --'n "0. 6000-0115 (5.''32) I sem, KoWiEIf I TZEK, LOYD T II 019420502 Ate: 031 CASC -7, Sex: K ST5272 is CHEMISTRY FLOW SHEET DATE -• TIME NA I ItaS—typmEdl) K (3 5-5 0 mEa/L ) CL (95--V5-EWL) •— O02 Q't-V r DEQ IL) _ 6L GLLIC t6S-1 b ffV( II 22 CREAT (0 $---12..,q,o1) WBC 0--9todcmn) I fqp iE is-16�d1) ) 1 tF 12-14491 ; MCI IRA si—Sr.oi�) IF X-46 rd Q Plateisl (u ' }. PROrr"E 19-12 secs ) 1 �3 PTT ." fo x CPK MB ccJ O CPK to—loo C u ) m LDH 1 1 to—loo C U) j J sGor 0.9o:x,L•..1 fo.—roo c u ) ' TheopsYN-V Le.* CA f µv ptw alantin Lrw+ }! ! 1 1 � 1 i a �- TV d---------------- iC M00[ ACn my a �- ui PT RESP RATE w CPAP/PEEP j co PCO, Q Pot i Z g SAT 1 - -- -- — •r �J�•�LO tilts •C.,•♦ . rj El _� 1 .- ECG 11 /RS' - .. 0292 13114140 ECG 78 NIW 117S / 63S C 97S) . Sa02 X" :.. • _ .. .. .. ..�� .. .. ... t- �- - .. _ _. .... 13HZ"�D WES=v XMICSL M -=S FSG ?iMrjT 5"8 PS STio20602 o42C602 'f.RAU MA T-- ti.� jjr AN �� - �. MMM/ ' • - y Oro � VAI �G-/.'I%II • ti... � ; � /f MrA '4 ' S#A• .�MOM ' '! s cwaliww // N / AA_7ASULA TF Y Ass, AAA6L'k_ArE! p,-fP-!f.<w -w/- . , . XTty _&4T 6- EATX-4- ................ r LA -G _pq Hr-LO-3,jb..., 0 S.� ----------- 1P ) Western Me-dccl Centel Soma Aeta. ::�o Wee,ern Mediccl Center/Anaheim Ae4r%"". C PATIENT PROGRESS RECORD DATF_ j. 7 PATIENT LD. Lr. NITZ'Ep, 'I. LOYD T f1Q NAME K "v'31Y j PARKO.CuNG H "D Am. 27-P291 ENC v WED. RECORO N�T # 9 2 01 6 G 2 DOCTOR - PAT I_:::7 N-1 P 3SFESS F.���RD �c D -cc ICH�r:.�TAT1�:A��tARS ✓) e TH.'S tS A R� JRA C�= Tr{_' vATl�l. _, oR�.%,_...5 OR L.A:JC O� ROGR� . , ✓i. I lr!= AA Ah•S -. H. Dfic�Y1'JLm �TATVS E)C�S w►r: THE PATIF►r:% RE:,EI�✓ CARE w► RLJATtot: To THE SrGN�rLIRE ` U_a :A`/�JUPiI►�v Uci�. RS N✓ 11*�L:SUA:'.:vATt��tS 094A►'�•�ES y� R -c ►AA:�[ �Q /d�Tr_D c�-� [J h—C.E-'cJ � �� • +.-�--- 4l ism.,' ''�•'-��-- • ,"�� moi`, n ,1 1 ' .".(I/t4� LAP -7 G 'c.t im Om , i t . r Sv-%ature Initials S' re Signature G•iECDaj,`,t t,Nv�G\ (� �, J,, � � � InitialsInitials Signature - - -' BY: Initials ADM 1NISTRAT}QIY PERIOD NOW Pm a Poeq A.-arpee;o ?IN KEDS Painww -- �ro+o��o►� SnZ--R On t_ t� io . Most Pte, ST527Z 3 iLU1G CREST S. UPPER OUTER ABDOMINAL QUADPAW KITIEIir LOYD T II - 4. THKiH a. f.V. TUBING CHANGE �r"rt - Westefn Medical Center Western Medlcal Center/Anaheim Santo Ana. CaWor,nto 019420602 Ale: 031 Sex: X Arxen&fs�2) EUSE �:0.MEDICATfON ADMINISTRATION Cp�p EUf6 H �ForaNo. 5�-0114 ' hge 2 of 2 r►lrrrt j ►, ,.,A ►r. Start 4tn� u 0):41 to IS:(•C c I41 to 23:04 23:01 to 0••10 LIf: ttK IU! 'AllCCSE =,1�ttEtS* NE8 ka>i J'' J 1:40 VIVA UL 7/04 ' i t US8:0S IrEE0: Aal i 3:00 r— )ia , i t . r Sv-%ature Initials S' re Signature G•iECDaj,`,t t,Nv�G\ (� �, J,, � � � InitialsInitials Signature - - -' BY: Initials ADM 1NISTRAT}QIY PERIOD NOW Pm a Poeq A.-arpee;o ?IN KEDS Painww -- �ro+o��o►� SnZ--R On t_ t� io . Most Pte, ST527Z 3 iLU1G CREST S. UPPER OUTER ABDOMINAL QUADPAW KITIEIir LOYD T II - 4. THKiH a. f.V. TUBING CHANGE �r"rt - Westefn Medical Center Western Medlcal Center/Anaheim Santo Ana. CaWor,nto 019420602 Ale: 031 Sex: X Arxen&fs�2) EUSE �:0.MEDICATfON ADMINISTRATION Cp�p EUf6 H �ForaNo. 5�-0114 ' hge 2 of 2 X , VITAL SIGNS Purse Temp. - Oral o - Rec'al A - Axi la HOUR 00 1 - ISO 105 tq ( I 102 1 11Q '1 t01 , 1 . 100 i I '• ' 100 so i 1 1 j 1 Ir so I 40 j PdMPM T*NSJ I�IK6101 Inj I W.000 PRESSURE 1 /V V V Western Medical Center sorxo Mo. corwrro PATLEXT LD. _. �{ o b O2 7/ 0 2/ 9 2 L N Western Med.icaf Center/Anaheim wutE N I T Z E H lit L 0 Y D T K C 31 Y J RM. M,an.rn. Ga�forrw CLINICAL RECORD gyp, RECQ t L :; N G 17 E 2 9 1 H~ ENG W : N • _-: - DOCTOR S T 14 2 0 6 0 2 ;:`� _ RC -15 (10M) A .__. 1r(��ttf!'rlt AV.�r had U,t�iCU1(j US.iID A COmplilfnt5 as a fr'SUit Ot t7kir► y of the to;lowfng? Flease co,ttw* .C-•prop.r:►te t�xiesl g or o Known / /' �► // Atkim,�.e3 Antibiotics (Pen�uttin, Keflex, Sutfa) Narcotics (Demvol• Morphine, Corietne) Local Anesthetics (Navacarne. Lidocaine) N ^gids (A:4xn t. Ibuprofen) Tetarws Antitoxin bdinlewl dine * K other. Please explain: R1=CENT tiTtOr1S;; - - ..... n me past SLX months, has the Pati6r,; been treate4 with: CVMy Narrw of Last doss � Taken Arrtibioti (Penicillin, Keflex, Septa, Ciproftoxacin) - t"7 ArdicOnvutsants (Dilantin. Phenobarbital- Cart arnazepine) ❑ ❑ 8ko0d Pressure Medications (B-btock . ACE inhibitors, Diurefim. «-1 Blocicers� Centrally Acting Agerm) ❑ E3lood El Thinning Medications (Coumadin) _ ❑ ❑ Breathing Medic=t;ons (Albuterol, AtroYerrt, T1tk'°ptryflx�e) - t"'� El ❑ Berth Control Pills (testerone Supp;ements) - ❑ ❑ Diabetic Medications (Insulin, Glucotrol. Diabenesa) .. ❑ Heart Medications (Digoxin. Calcium Channel Blockers) El( ❑ Nene MedicationsBenznd' larepines, Neuroleptics, Arttidtpressarris, LRhium) ❑ . ❑ Steroids (Prednisone, Cortisone) _ LJ Ulcer Medications (Tagamet Zantac)El.' ! El • ❑ Other Ailed - - ❑ Flistory of intravenous drug uSe: ❑ Yes El WL _ a 4 ' DX: Date: Signature: R.NA-V.N. westem Medical Center Mo. Coe. oio PAT1EKTri .0.Sonto .r. _ medical Center/Anaheim . , 9 2Ipb O 2 7/02/92western ,. coNtor� t t 11 L 0 Y D j MEDICATION HISTORY � ::;..; -,.. p N y - - - .eve' - - �e'�►na*leatth Records. Pink-Phamtiacy copy �,..__ �f-r•�,. 2 �8Z 91 $T#920602 E N �• • _ . . C ` = - •- �' - .. 1'��.a♦ may'+.-....�•�.. J�^► D I 4*08JUTY STATUS W%MIlLAATORY C A 64-kATDRY WITH ASSIST 0 TRANSFER WITH ASSIST ❑ BEDREST 2 ASStSTtVE DEVICES O NONE ❑ CRUTCHES ❑ CANE ❑ V"L KER O WV-- O OTHER. 1 L►M+TATKXNS: NONE O WEAKNESS O FAT►�,;,E O OTHER COM&AENT. 4 DOES PATIENT HAVE ENOUGH ENERGY" DESIRED ACTIVJTI'► L, YE'S ❑ NO, COMMENT. S. AC7TIES OF DAILY MING 4t - WAXPENDENT. A - ASSIST—]E�oErfTl D+tNG T Na DRESSING TOtLETING :OMMENM VISUAL PAMRMENT. E'JNONE ❑ WEARS GLASSES ❑�coNTAAcrs. RIGHiT LEFT O BUNG R*w LEFT HEARING MAPAtRMENT: �.r q5 E ❑ HARD OF WAAING ❑ DEAF: RIGHT LEFT ❑ USES HEARING AID RIGrfT - LEFT ❑ NONE 2 ES. COMMENT' A. PPXrJMTAT1NG FACTORS: S. HOW IS POJN CONTROLLEtr E BARRIER: NO ❑ YES, COMMENT: 'PECLkL DIET: NO ❑ YES. SPECJFY: )ErrTURES: f l +� O LPPER O LOWER PA -Rn s O UPPER O LOWER NY RECENT CHANGES IN APPETrrE/EATING WITTERNW ❑ NO O YES COMMENT: EPORT'S OF: ❑ INDIGESTION ❑ NAUSEA O V'OMITtNG ❑ SORE MOUTH ❑ DIFFICULTY SV.A LOWING ❑ DIFFICULTY CHEIMNG =:,ENT %VFJG►iT CHANGE O YES COMMENT: +M EMS "TYEL: 046PROSLEMS ❑ DIAARHEA ❑ CONSTIPA'10N O PAJN ❑ BLOOD IN STOOL ❑ HEMORRHOIDS ❑ CTHER ME ST BOWEL MO`VEWt kOOER: tJ NO PROBIMES G DYSURIA O DRIB$LP G O RETENTION O FREouENCY ❑ BURNING ❑ INCONTINENCE O NOCTu;tIA ❑ OTHER COMMENT. ERVErmOHS: NONE 0 LAxATIvEs 0 ENEMAs 0 OTHER. coMMENT. t9lA PATE LIP 16 t. �. ❑ Actrvrty w*oae...r,cy ❑ A,rw.y c*orw cs, ww^oc vo ❑ s,*-e—v pow' --k two ct" ❑ C.rGwc Ovtau!- o+croomed 1CP) ❑ DT ws.on.' ea,r.ty do c.( ❑ Gft stccrm-go. er►Toe••.o tCq ❑ Hom+ M.✓`W.-ce nwwq--n-r.t wnp.aod O Mob -14y. i Vw-d o "col ❑ son cwv 6 -%ac soouty in (Cp) ❑ 0~. U AAsAt►OA r1 con* P. p6in O rte. WrVw .e rebel ❑ Kn .4odgo d.�lctt ❑ Pobrrw br w*xy ❑ S«ruory - pf+rzeptuel anwsborw ❑ Thoug" proom«dl •dMrstTom in ❑ Orm- ❑ Ahwm on in boWy wno. O ALW rt*� dvf of ❑ FkW voka* s=ow (CM ❑ knpai,*d ov olo." ❑ IMecwm pow."" for ❑ Nutrition r+e n r om h i n a,.n boar requ.►:meM ❑ Nutrition aherstcra n mors rwt boc'r row;rrrwrA ❑ Orsl mucro a membrana, - altsrsborr in ❑ Skin int Vfty. WV&wnwx d ❑ Ovw- ❑ Bowl oliminat . ❑ BOWW dT�bM derrh" ❑ Bo",w et-micubm inoonbnono. ❑ urinary 04min.bm aherst.on in psttem of OOH ..,w...... W�.r. r.....L ..►.'✓..:, _.`--��s+v�� ..cru __.r - :r«. _ PA HEART N►IYTf+til�' .f �J H,.,U�1W L' OT►+LR CO'J'AENT 2. HEART Sou,IrA C p C T ASSESSE 0 �SSE.,,SfD. C04�MEM. I �D } () 1 FAOEMAKER. D YES',-r--NO V EXTREMITIES . WARu t PVOK D OTl•'ER 09 b«++A CRT >3 aw- 94c). CokojE fT. PER'I'�+fRAL PURSES 2<P lf£!.{T. STTK>%40 PJLAT ❑ OTV4M. CooANCENT. I- FWSPiPATORY PRO&_ryk ❑ YES 0% Wwwwa .�.^m �j co►DR mac.). SENT. 2 8AEAT SOtJN05: aCLEAA ALL LOBES • EOLIAL BrtATERALLY D OTHER COUL EW: a °^ FbC*-(T: LEFT: ,, �- 1. A i NE ROM WTrH SYX4k*-� Or STRENGT)t -E YES G NO 1.g. --Axwa WC). COMMENT 2. LEG LW-ASUREhaEprrS O roX ASSES D R aL 0L 1. L Evs OF IExTED D OTHER ,-.� (04 a+«+•-.d �.cr,rplc, trxsopor+.ti...Ic.�, COMx�vtT. 2 SPEECH: J2- t APPROPRIATE D OTHEY-I C,,x .T. I KPIL CHECKS, el;�z 0 OTHER R)GW T LEFT .. ABLE TO FOLLOW COMMAND&�� Poo. c.Omw T. s AultNONE ,17� - O ❑ �''t'E�CO+.ttreENT. IL AARAESTNk N - -eNp YES, C00AMNIT 7. DffiAAOR APPROPRIATE TO SITUAT)ON: `:J YE5 D NO. COMMIT. I- &*-XXL* 4*UBRAtyEs MOW- NO PROMEyaS O L CO+. MENT 2 SKrt O No PROF O WAWkDRY O OTHER (09. co+4 dm..ar ra,, ,ccf�„o p d' �-ti �►s ry+n4++a .d.n,A Olr-). COMMENT. w 1WAGCAL WOUNaS: VES COMMENT. j t DECLS"USrSKIN — 1 T�rrs�ocCORUT�ort p Y S. WrTUTE SKW CARE DOCUMENTATPON REI:�ORO. 4 t. BOwEl SOUNpS IVE G NAC,Tr T COMMENT. NOPd-0iSTENDED. NON-TENDER Q OTHER COMMENT. - S L RIN£ YELLOW TO AUMR O U[+lABLE TO ASSESS O OT}M COkW4ENT. <. INTSivETITIOnM- �cl(-ATHErER O NASOGASTRIC TUBE D COLOSTOMY y O GASTROSTOMY O OTHER COMMENT. iw� _ _ .�'i •r.�l:�� —_- _.C'�M'V.-'2•.L�_��.=+�+i.�1Y.r:v�►reva.+lO��.. __ �.�•��.�_ _..ay.irrw,.,'. ►1- yw .. _- __—.rww....... ...� .r '•--�1L_. _ ."�_a�. :.�GTrD►: !'Lh,It"1JL :•![7ali' ►J:�';X�'.[.:.:.!l�) !�':. i t .. . ►s.R [:i i/:!.'► c T.'J E, / tit•: 0,41 ,1'! / i1 .•,: 10, • / GD �y TIME ,/a a .M ,1,,W FIRST NAME 3/ G AGCCAAPAN[ED BY L� a /T AGE LANGUAGE ' 1? -3-11- 7-0 13 �= o ACTUAL VITAL SIoCN TPR SP RIGHT ARM BP LEFT AFt11 HEKIW vv£STATED ADatrTTED PER ❑ AMBULATORY ❑ WHEELCHAIR Q(GUERNEY I.D bAND ON O YES ❑ NO ALLERGY &kNL) ON D YES O NO EXPLANAT10N TO PATIENT OF: NURSE CALL O NO " O WA PHONE d � O No O WA N► -LO BED � ❑ NO O WA EMERGENCY CALLryes O NO O WA VISMING HDJRS PJ Yes O No O WA 1�; HOURS O NO O WA TELEVI.SkoN 21-9' O No O NIA,�---- 6 TO E ONO U ►�vn W-DICATION BROUCwT IN WITH PATIETIT O YES O No v�W- IF YES. DISPOSIT►ON OF MEDS UPON ADMISSION O PHARMACY C1 HOME $ Q �iAl. ES SE t�1.AL� AT Q E D SI D E f cres�+oo� . o•-cMoo�.. wnr.00... o.Tan.00... CA* i,..oc... wow•o[ DENTURES U UPPER U LOSER U PARTIAL Li &RIDGE 0 CAPS C MIA ARTIFICIAL EYE O YES O NO O WA CONTACT LENSES O YES O NO O WA EYEGLASSES O YES O NO O WA HEARINrG AID D YES O No O WA r ARTICPCIAL LIM8 C YES C NO O WA PUR—GE/LUGGAGE 0 YES D No O WA 241" CLOTH04 O YES O No O (Pbwrr D"Crlbr) OTHER ❑ YES O NO WA R ■ L l � L OR NA SIGNATURE + + jYQ Q!Y C ATE . .✓. '`' • ►` t St �' �VSIi7�i DIA Rte-• oku wALrw �1mssxtmT' ll `' :t SEC'it V71 �. IjjST BE COI►>;-'�.F BY A REb �, { 1 VOORVANT: PATIENT O FAMILY MEMBER O FRIENO O UNABLE TO OBTAIN I '� C HEALTH MAINTENANCE, ALTERATIONS IN 2 REASON FOR HOSPITAUZAnpN (st+w by Dmtw4fr4om *): - O H"rJ1LTH MAhIACiDdENT. i DEFIGT s. HOW DOES PATIENT DESCRIBE GENERAL HEALTH? O NONCOMPLIANCE 4. HAS PATKNT BEEN ABLE TO FOLLOW PRESCRIBED MEDSlTREATMENTS: O YES O NO. WHYS ti Z49: ❑ POTENTIAL FOR INFECTION O POTENTIAL FOR IKJURY ❑ OTHER s. LESS OF. O ToaA—,,a HOW mucro O ALCOHOL: MOW MUCH DLG r MOW LONG? Mow LONG? !� •`-� oC `7j 6. HOk*E ENviAONMENT: O LIVES VMIi SPOUSE O LIVES ALONE fftIVES WIN FAMILY O SNF O BOARD AND CARE D OTHER - 7. PAnENTS Dts IAFiG PLANS O fTJME 0 SNF O BOARD AND CARE O HOME NURSE C OTHER- REFERRAL TO SOCIAL SERVICES. WA O SOCIAL WORKER O DISCHARGE PLANNER O REFERRAL ENTERED INTO COMPUTER OF - n C'4-5 04- I. PERT* ENTIC-QJSURGICAL HISTORY: tem Medical Center Western Medical Center/Anaheim Srnta Am Cotikxnio Ariott'oky%, Catitort Western Medical Center/Bartlett sonto Akoo• Coloomla INITIAL PATIENT A.qqt~.qgtAl:NT PATIENT LD..•- = - 02 0 1 y o; ITIA pgkr.F U =r-% G -1 PATTEP?4S R—SWIS DIAGNOSIS I S I SLEEP 0 No FwAof.$LEAA 0 LK F ICULTY FALL ING ASLEEP 0 DoF F tCULTy STAVING ASLEEP DDOLS NOT FEEL RESTED AFTER SLEEP 0OTHEj:LCO#.oAENT D Z VMA -VAT HELPS YOU SLEEP? 0 oc,.- L1 J 01 b.- < I. WlrW MOST CONCE,;.*qS YOU AaotjT YOUR K.LNESS4l0SPjTAL1ZATjoto 0 An.,ty 13 Fuel 0 Osbjrbwxe in 0 f. %"0 DO You RELY ON FOR &Xlpo{fiT? cl Cornmun —1 vwbw - 2. "OW DOES YOUR X114ESS+K)SPITA-LIZATION AFFECT YOUR FAMILyr-443WK-ANT CTHER� O I" pane-mok Oftwabons 0 GmwiV 0 Pwwft'G. OW03am in 11 S0c*I "WOMOM knp.,wW 0 socw mowbm cj vo*x*. pow*.-. for 0 00mr 1- 00 YOU FEEL IVJ HAVE A LAT OF STRESS IN YOUR LIFE? 0 No 0 YES. COMMENT: C49WV. WWFmcbw wx*v%ojW co V) 0 coo� won -ca," Im* Z DO YOU FEEL Y(>J DEAL Suzy WrTH STRESS7 0 YES 0 No. WovaiT. 0 2 t DO YOU FEEL 'VU k�' YC>j 1 KJVE THERE BEEN ANY RECENT LOSSES IN2 YOUR LIFE? ❑0 No YES. COMW4NT. D 4_ T YOU C>o Me W"AT DO YCXJ 0`0 "lEN YOU ARE UNDER STRESS? I. HOW DOES YOUR kLNM'r4OSPITALLZAT)ON AFFFC;T Yojp. c N -r. --EXJY7 Mody D L P -we v&J-0 ft-&omw r.j .2- FDO -LE- PREG&Ah-T. 0 yES 0 No ul LAST ME?4S--S. 0 somw 0 O&,*r I- IS REL?GK -)""oOR`TANT IN YOUR LIFE? 0 No 0 YES, FAITH 2- Do YOU K41 ANY SPECLAL RE00JESTS REGARDjNQ YOUR RELIGION DURING THIS ► 0 spolujoi dab"" 0 No 0 < HOSPI"TALLZATION? 0 O&wr > 0 NO 0 YES, COMMENT: SEcnoN L*,:, 'PATIENTS jKr WSK TD DVVIELOP ppxsll,,,tmE SOPES "D ren cl -ntma s^,n. bA w�c" a or prsw%qw. WVLAO hve Vo ft "ftbar" of sken bvftc—y - r>rwo-orw CA00se rry bwA,: oftpc-� the PAI-ents BOMA -ots, vve 9. D4T*N PARAUET R C-0 P--cw Cor%obm ipmem pme-w") CLIN,� C�C)NpirK>,4 jtAm Fts Good (--%or) Mobwev PAJJA Fmk frr-&XW bA sttm) 0 FLA - -c.w%lTma�w Sun �4 t) ac*ft,* .............................. 0 ftOr (Chror-_,Vwvo,, ......... L--md rx-.w-w.-o --in gmwsub.%m G000 (-o- r"a�,mp - -%ha) C F— t000rty __ rw movw 0--y --m Asa-wwwo 4 ............. rot v%ha) .......................... cl, cv--O,� (to co,,�) ... = Aw. I — ... I u.wwwlce (oo--w &-ld'or b.0dowl ........................ 0 Nor" Is" SO fte0orld) ...... ....... 1 0 Srn C*-..Oo 11.001.0. ,r 0=A-0rbW (<2 Per N hoLos) .................. 2 of Pow7tp sur,*l LJO-Adwy 1>2 Per 24 homrs) ....... OWlllooe ino . .... .......... 2 No u�o .............. 4 ) . ............ 3 ................ 6 1) Acmr-4y A-4kAmwv ............ Cr*.ffbo ...................... 2 ..................... 4 .... .. .. .. .... Nutmoom (kw bgo w%a aze) Good Ism%, orv%u aoow..y W40'................................ 0 F&r jewwowwo - of 66" 1,2 co ffwwj P6" V., ftma TOTAL: • r• t ' •� •r �� C `1 IZZ \ \� S r 1 T v ^� n �• •„ �' -+ r it y T C 7 _N �MM O x Z sj m it o r C c C3 .. C3 c s' H M f- n w � � �• •„ �' -+ r it y A _N �MM O x Z sj m it rm 0 = m < > Fn —0 fR i�0 Z � � • F- 0-4 - 0-4 N n A j 01 rn n �` -� r) �• - c A00RESSCrSRgPH 523 2 M m . a. P I•� = CIO �s ru .. � . o 0 �z� S r CT_ i v T � 1T_ a N cr ' • _ .. Z 4 ►i w P, TOf • 4 N t ! .. C Ati ►+►GFIER PIASE OR e✓PT �- -- -- O'L000 PREswat coots - V .,YSrpLtc DIASTOL PC' £ I BLACK . MIF f tdQ I � _ 1 –7 i HED - ARTERIAL EINE GREEN - DYNAJAAP 2r2o <TiEkRAT1JR[ O o.e# too 0 R Recto I 1 C Ax Aad ► i 1 -- U8 Epr- I 1 I t LOWER. PULSE OR 8-p 1 ! I i I + 3 `� 0 U MP or CVP Q ►— 1 2 ; ! I 1 Locat,on j I I, i I' I t } _ - 19 to IZ r itv^'I ATt iCoior 1it Leval O! Cont. t? 0 CP i13 � •' I� � I( I I I Flu" L Arras RIL dement Leg R • 1 L C i o 121 Emesm Ptev,ous — U 0 NG OUTPUT 24.Output r 0 Chest Tube C) Stool dif 77 C `c t . NURSES 29 SIGNATURE C) �> > mo ` 35 j 1 — _IL, 0 OYD 0 31 Y j r. Fl RK . E UNG H KD 'I F •_• `�' �.`i� 216291 EKG ....- —,•+-r--r� 41 Li .y _ s• 4 2 0 6 3 2 N[ 1RSE'S PROGRESS NOTES r'HFMISTRY FLOW SHEET -- 1 DATE TIME I yD' ,'� ► I r,1A 1135-15ornEO&I K (15-50mEqIl) I � � 1 CL (9S—V6 mEWLJ CO2 (,1-27 rmE%/LJ f BL QLL1C (65-1 a myon 4f/ i `T" `b f SUN (8-22 1 CREAT 105-12t WCP) , wec (_&.--10000rcrnen) LU .j y°"`Ne` >. tM 14-16gmid�) ►q� jF 12-14 gm/dl) (M. 41-54 voi w► HQ (F. 35-46 vOd %) (145000— 3.500M icr+m) ` • J 'S• 1 L -r1 �1 u. ' PROTIUE (9-12 secs) MT (Up to 35 secs ) _ i Q CPK M13 0 CPK (0-100 c U P 1 1 LON (0-100 c U 1 SGOrr 10-100 c U) — f DogoxonL4vel ThspphyllWo Leve( , G mg ReC Dianbn Level FSO, ' CC o �T a CC Q. LIJ CC ; MODE AC AMV PT RESP RATE 1 CPAP/PEEP Ui N Q z `t Ph PCq ` ' BE t f C, SAT r' 1 f-• V"T DAr TEti►P J A urlp — 1Kn_ 11rip _`, i.k7p - iar` ►++C.NEm PULSE OA d/P� ?C)0— _ -- _ --- .. T - R000 PRESSURE COOSs ISO A+ Jk ,� • :+ Y SYSTOLIC I _ H := r E ' DIASTOLIC I I tQ UCK - CUFF ! 1 REO -ARTERIAL LINE tIQ i + ��"' -•� ! � :.4f EN . OYNAMAP 1 Q T hwvtATURE 0- Oral C o � Axsj" V� P1►rnOrwy k+w e0 1- ! 0 E LOWER. PVLSE OR d* ! IiT! G Q CDVCx Ab Q1 e I airrelh S"Xv � p ! Lo,—,Ion Sti 4 __ G AArrr►od -' Soutufl• Ant /CdcJ ( Lsre1 of Com 12 t PLgwz Z .i k'OverneM .. L Z!,_ ' Z Temp C Q NG m =3 cwt Tue. U 24 25 -3/.25 26 Sito,ol u ►+r. To4M V O Y 1 � NURSES SIGNATURE 29 pz 0700 C'E 10 1900 } 32 07M • -L• ...` ..5. - 3334 - L 35 - i �SfTy -v �' .• L .t' . 36 -a. 1 " .•.'ice i1". 3' 7/x2/92 38 . - Nt TZEN t t , LOTO T t M _40'u ? PARK. Et:.%1G H too 41 - 278291 EKG y NURSE'S PROGRESS NOTES -" : Vit. s '►"• ;' .(r r .�.:. 'l_, • '.r.. �'v:� L+i .T:" `-• ,••r i V. ,'l �•,}• �.!T '� "� J _ - _..a .. ` J>On t +"�.1r �: rK�.% i . f� • r r+h:�l 4 EOUIPMENT IN USE 4 "OUR CRi� �r.:L C%•RE RECO"' 1 NURSE'S PROGRESS NOTES ��„- - -'l.r_?_�i��i:•,ti.�t�nL' 't• � 'r`>. t .fes.. ,�.�r. r: _ - .�. .+ � � �%�tLer�ii tia� � Laa � 3 a' fir• � :� • *' .:. N _ ` A r " / Ael (I /` • ' / ol I ? V 00, 00, /SSG - 0I f��_ o0op olov IF �GL- «jlool 14 . 5' 017 Gig-� v • GsiL[ r A , �<..Al `�Cih . —. 'Ae,,i - CHEMISTRY FLOW SHEET pItTE ytTIME ' I i NA 1135-150 mEa�l; f ' K (1S—S 0 mEa�L) CL (45-106 mEQ&) (,w W-27 rnEa/L) 8L_ GLUC 165-110 mmol) OUN M-22 mg,01) CRECAT (0 S-1 2 PVol) wec (5—Kmmcffwn) (M 14-169mtaq "o° IF 12-14gmial) j 1m. 41-54. IF 35-46 wo, �►) < f l .35500000= �cr"m) _ } PAOTWE (9-12 sacs ) f.0 FTT (UP to 25 secs ► . a 4 CPK me CPK (0-100 c u LON (0-100 c U) I i SGar 10-100 C u ) 0"on ce I f D&Wib 1 J CL FK4 f Q TV A+OOE AUWV f (((n F'i RESP RATE I I W- V. CP11PIPEEP = ) �Ph Pcq, - I A O? SAT I — -12 N n Nr. Tow NURSES SIGNATURE 1900 1900 am 820502 7/02/92 cn • t TZEN i i. LOY 03 ly �, 1�424fENG W N T#920602 ,. ` NURSE'S PROGRESS NOTES w ■ ■ ■ ■ ■ ■ ... .EOUIPMENT IN USE. 0700 WO ... IV CREDITS r� ELASTIC STOCKINGS ,� FOgLEY CARE Ail i v r �SWAIR 07 11` '111111111 IS1 /......G _ 11 am 11111I.F.1121 'Ali jd di SAO- zf iglpllll! I 91 _•. / U1.0m PAP WE / / f `' POOR, �i P -W,0111 lIllIll lIll A !1 �ll 11p .1 11lid dl;d ill,_ i, Ila' RAIN .� -sr A l • /� pai 20 On 2111. ��� CHEMISTRY FLOW SHEET DATE TIME I NA 113S- 150 mf dl) K (1S-SOR+Ea1) CL (95-106 -Eq&) ( - CO2 G't-V "EG/L) &L GLuC C*S-- 110 mWdl) BUN CREAT (0 5-1 2 rWal) WBG (5-100o0^tm111 W� (Id JA— 16pwdl) (F 12-14 p.r+.dt) y HCS IM •1—S4 not �) (F 75---46 ra 350ow /Cff#m) r } PRaT1AAE 0-12 secs) , PTT (L)P b SS sacs 1 Q m CPK SAB O m ..i ..i CPK 10-10o c U) LDH (0-100 c u) SGOT (a-ao c u ) ' i Dopoxn Leve r )'b'r'a Lw�t Ca � I ROC r a► F107 Q (C TV MODE ACnMV i NPT RESP (TATE CL' CW►P/PEEP f V) Ph a - co PCO, Q P 0�, SAT ! LI W -03 41i - VIAIL ASIX -1.3,.W KIK:i'^tlt{1 ^Iw•♦.F.K •t&ZLNT •rl'XIaT1Qnt .yet 1 AOLMNE NURSING CARE ACTTvrnr I r _ i F Y Wessem Me-diccl Centel Westem Medicct Cerfef/Ancheim Ara+. -n. Cak--o PATIIHENT PROGRESS RECORD ........................................................................... NtT2�� 11. LOYD T NAAAE K '%'#31Y J PARK. EukG F. -D -1 AA MED. RECORD2 7 0 2 9 1 ENG X "RI#921,602 DOCTOR L� ry N PA i IEN'T rR.7uRSjS RE JRL ...t -. PR��C+Lr.S 1- INDNDIAT!}. AvnEARL 1 'WS :S A Rc;�R^ D". H- PATI.-? . J PR�GR� OR:A:x .7' n .j-- .'' C)C-,S A►:' THE PATIEK- RECEIVED CAA. r.1 a T�:r-'c THE SiGN�. ;UF�E ✓.. 1 ��= 1 : M_Il`.> H� PKf��LTS , ATL..+ J M_�.. 1`/►J'IP�1► , RD Q5 N✓ U'' •5:11 0,"Ir-RVATt:)II Or- A"""M"MEQ N`=RC MA 1E C)� ►. TEG "-_i -71 �r � J,.• � � /LPA ,.27:T— _ _-- L• ,,.,�'/Ji' %jam -tom; ,�� --� j 111 � ✓ . J L JS _ 1 11'11+• � f...000"�Pr EOG 11 /RSP .... t3 m✓aV? 62 Al , 9Z 13814140 EAG 7d NUp 117S / 63S � ( 97S) . SaOa XXX_ .: .. . r • f ..i __. _ . ma= WES "I I H=I= M"."3s EEG MagIT'QMM4G SZSZ'S Si#9206%"02 4120602 T -RA U A T E Ar. - F.'