CONDENSED - Canvas

·..1/.

CONDENSEDIn The Matter Of:

Powers, et al. v.American Family Mutual Ins., et al.

Video Deposition ofGINA A. UTRIE, MD.

August 30, 2011

Verbatim Reporting, Limited2 East Mifflin Street, Suite 102

Madison, WI 53703(608) 255-7700 FAX (608) 255-7749

V ~·E·J R:' B ·'A -T··- I·· MREPORTING. LIMITED

www.Verbatim-Madison.com

Powers. et al. v•. American Family Mutual Ins., et al.

Video Deposition of GINA A. UTRIE, M.D.August 30, 2011

Reported by: Rowan L. Bright, RPR, CRR, CLR

Involuntary Plaintiffs,

Madison, WisconsinAugust 30, 2011

crottiorl!boardmanlawfirm. com

APPEARANCES

ROGER S. FLORES, AttorneyAMERICAN FAMILY INSURANCE,

6000 American Parkway, Hadioon, Wisconsin 53783,appearing on behalf of Defendants Amorican FamilyMutual Insurance COmpany and l<aJ:en Bierman.(608) 249-2111 [email protected]

ROBERT J. l<ASIETA, Attorneyl<ASIETA LEGAL GROUP, LLC,

7818 Bi~ Sky Drive, Suite 112, MadisonWiscons1n 53719, appearing on behalf of thePlainUffs.(608) 662-2286 [email protected]

CATHERINE M. ROTTlER, AttorneyBOARDHI\H LAJf FIRM, LLP,

One South Pinckney Street, Fourth Floor,Madison, Wisconsin 53703, appoaring on bohalfof Defendant State Farm Mutual InsuranceCOmpany.(608) 356-3917

Video Deposition of GINA A. UTRIE, M.D. - 8130/11 Page 3

1 VIDEO DEPOSITION of GINA A. tJ'l'RZE, M.D.,

2 called as a w~tness, taken at the ~nstance of the

3 PlainUff, undeJ: tbe provisions of Chaptor 884 of the

4 Wisconsin Statutes, pursuant to Notico, boforo Rowan L.

5 Bright, a Cortifiod Realti.mo Reporter and Notary Public

6 in and for tho State of Wisconsin, at Doan Clinic Eaot.

7 1821 South Stoughton Road, City of Madison. County of

8 Dano, and State of Wisconsin. on tho 30th day of Auguot,

9 2011, commencing at 3:37 in the afternoon.

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23Also present: Mary Lou Condon, videographer

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DJlHB COUN'1'Y

Case No. 10-CV-2569Case Code: 30101

CDCU1T COURTBRANCH 1

Video Deposition of:GINA A. UTRIE, M.D.

-vs-

AMERICAN FAMILY HUTUAL INS. CO.,lOIREN BIERHI\H, and STATE FARM

HUTUAL INSURANCE COMPANY,

Defendants.

-vs-

LESTER POWERS andMARION SWENSON.

Plaintiffs,

CENTERS FOR MEDICARE AND

MEDICAID SERVICES, AETNA LIFEINS. CO., SAFECO INS. CO.OF ILLINOIS, KRAFT FOODSGLOBAL INC., MEDICAL PLAN, andDEAN HEALTH INSURANCE, INC.,

STUB 01' WISCONSIN

(A~tached to the original transcriptand copies provided to all counsol)

(0l:i9inal transcript filed with Attorney Kasiotaand copies provided to Attorney Flores and

Attorney Rottier)

Handwritten medical opinions 6/06/11

Dean Hoalth records

cor scan results

Page 4

(Exhibit Nos. 1 through 11marked for identification)THE VIDEOGRAPHER: This is the

videotaped deposition of Dr. Gina A. Utrietaken on August 30, 2011, at Dean ClinicEast, 1821 South Stoughton Road in the

City of Madison, County of Dane and State ofWisconsin, commencing at 3:37 p.m.

This is the case of Powers, et at,versus American Family Mutual InsuranceCompany, et at, Case No. 10-CV-2569 inCircuit Court for Dane County, Wisconsin.The deposition of Dr. Utrie is being taken onbehalf of Plaintiffs pursuant to Notice.

My name is Mary Lou Condon, thevideographer, and the court reporter isRowan Bright with Verbatim Reporting,Limited, Two East Mifflin Street, Madison.

Will the attorneys please state theirappearances.

MR. KASIETA: Marion Swensonappears today by Attorney Bob Kasieta.

MR. FLORES: Roger Flores appearingon behalf of American Family and Karen Bierman.

MS. ROTTlER: And Cathy Rottier

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EXHIBITS

(Withdrawn)

(Withdrawn)

Univorsity of Wisconsin rocords

DoscripUon

Arlington EMS records

Ms. Swenson's modical bills

CT scan results 1/01/11

Clinic note 9/08/09

CT scan rosults 7/3/09

Gonstead Chiropractic records

Video Deposition of GINA A. UTRIE, M.D. - 8/30/11

1 I N D E X

2 WITNESS

3 GINA A. UTRIE, M.D.

4 Examination by Hr. Kasieta

5 Examination by Hr. Flores

6 ExaminaUon by Ms. Rattier

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1 appearing on behalf of Defendant State Farm.2 THE VIDEOGRAPHER: And would the3 reporter please swear in the witness.4 GINA A. UTRIE, M.D.,5 Called as a witness, being first duly6 sworn, testified on oath as follows:7 EXAMINATION8 By Mr. Kasieta:9 a Please tell us your name.

10 A Gina Utrie.11 Q You are a physician?12 A That is correct.13 Q Dr. Utrie, if you would, please, take us through14 your educational background.15 A Absolutely. I did my undergraduate here at the16 University of Wisconsin. I did my medical school17 here as well, actually, and I did three years of18 an internal medicine residency, which is the19 standard, and then I did an additional year as a20 chief resident.21 a Where did you do your residency?22 A Here at the UW-Madison.23 Q You referenced something called internal medicine.24 What is that?25 A That - internal medicine is the care of adults,

1 Q You referenced in a prior answer "board2 certification." What does that involve?3 A So in order to become - well, in order to become4 board certified, you have to have completed your5 residency, and then there is a two-day exam6 administered by the State that you have to pass to7 be board certified.8 Q When did you receive your certification?9 A I believe 2004. It was the fall when I started at

10 Dean.11 Q Now, give us some idea. if you will, how much of12 your practice involves dealing with folks who have13 the kinds of injuries that we're going to talk14 about that Marion Swenson has.15 A It would be challenging for me to give you an16 actual percentage. I wouldn't want to put a17 number on it. But I can tell you that it's very18 common for me to see people who have been injured19 from a fall or a car accident who have already20 been evaluated in the emergency room to rule out21 surgical injury. such as a neck fracture. a broken22 arm, a broken leg.23 But the ER and the orthopedic say, "Nope,24 nothing bad like that that needs immediate25 treatment. Let's treat your symptoms and have you

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1 18 and older, largely non-pregnant adults,2 although we do care for some pregnancy-related3 conditions.4 Q And tell the jury a little bit about your5 practice. if you will.6 A Absolutely. So like most primary care physicians7 in internal medicine, I would say there are three8 components to the practice. We do quite a bit of9 preventive care, keeping healthy people healthy.

10 We do quite a bit a chronic care for managing11 chronic conditions like diabetes, heart disease,12 emphysema; and we do a considerable amount of13 acute care, illness and injury that's non-life14 threatening.15 Q When did you begin in the area of internal medicine?16 A So I completed medical school in 2000 and began my17 internal residency in the end of June of 2000. I18 became - so I graduated from my residency in19 2004. became board certified in 2004.20 Q What does it take to become a chief resident?21 A So chief residents are selected from among each22 class of residents. I believe there were 25 in my23 residency class, and then three are selected to do24 an extra year that is a leadership role and25 teaching role.

1 follow up with your primary physician."2 Q I should have asked you this earlier. Where do3 you practice now?4 A I practice here in Madison for Dean Clinic, the5 east side clinic on Stoughton Road.6 Q Good. Doctor, I'm going to be asking you some7 questions during our deposition, your testimony,8 today about your opinions. And whenever I ask you9 something that calls upon you to give an opinion.

10 please only give an opinion if you hold that11 opinion to a reasonable degree of medical12 certainty; okay?13 A Agreed.14 Q All right. In the same way. we're going to be15 talking about a car crash in which Ms. Swenson was16 involved in. When I reference the car crash,17 unless I say otherwise, I'm talking about the car18 crash of July 3,2009; okay?19 A Okay.20 Q Thanks. Now, you have, as I understand it,21 treated Ms. Swenson. You know her?22 A I do.23 Q Okay. Give the jury some insight, if you will,24 please, into your relationship with Ms. Swenson.25 A I met her in about 2007 when she first became my

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1 patient; and quite honestly, prior to this injury,2 I saw her infrequently. She was relatively3 healthy, did not need much of my time.4 Q And then on July 3,2009, there was this crash,5 car crash. Vou heard about that?6 A Correct.7 Q What do you know about it?8 A I know that she was a passenger in the car. What9 I know is only - is largely based on what she has

10 told me. Her report to me when I first saw her in11 follow-up was that another car slid into her lane12 and then there was aT-bone that resulted - that13 was the accident that resulted in her injuries.14 Q And in addition to the records that you created15 for your treatment for Ms. Swenson, have you also16 had access to the other healthcare providers'17 treatments for Ms. Swenson?18 AVes.19 Q And in addition to that, did I provide you a copy20 of Ms. Swenson's sworn deposition testimony so21 that you could look at that if you wanted to?22 A Yes.23 Q Okay. And I provided you with a copy of the24 healthcare bills for Ms. Swenson as well?25 A Correct.

1 A That's my handwriting.2 Q And are the opinions you express in this3 handwriting on Exhibit No. 10 opinions you hold,4 as we've discussed now, to a reasonable degree of5 professional or medical certainty?6 A These are my medical opinions.7 Q So that's --a A Correct.9 Q All right. Thank you.

10 MR. KASIETA: Now, I'd move the11 admission of No. 10, please.12 Q Let's talk about the car crash and what happened13 to Ms. Swenson in the car crash; okay? What is14 your understanding of her injuries from that car15 crash?16 A So she was immediately evaluated in an outside17 facility, a small-town emergency room. And their18 diagnosis was that she had sustained some rib19 fractures, which were confirmed with a CAT scan.20 She largely had chest wall pain initially;21 however, over time, it became increasingly clear22 that there were other issues as well.23 She has, on the right side mostly, neck pain,24 pain over a muscle on the backside of the shoulder25 called the trapezius. She has pain along her

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1 Q Okay. Now, let's go back to talking about2 Ms. Swenson specifically. During the time that3 you treated her, before and after the accident,4 did she strike you as being an honest historian,5 somebody who reported her symptoms honestly and6 candidly?7 A Yes.a Q And what significance is that to a physician, an9 internal medicine specialist like yourself?

10 A Well, it's extremely significant because a very11 large part of how we make our decision is based on12 what the patient tells you. You can't feel what13 they feel or know what they know. You have to be14 able to rely on what they describe to make your15 judgments and recommendations.16 MR. KASIETA: Let me offer an17 exhibit at this time.18 Q Take a look, if you will, please, at Exhibit No. 10,19 which has been marked.20 A Okay.21 Q It's the original of a document. It bears on the22 top June 6, 2011; and initially it's from my23 office to you, and then there's handwriting on24 there.25 Is that your handwriting?

1 shoulder blade, and she has a rotator cuff tear in2 the right shoulder.3 Q Did she have any of these problems before the car4 crash of July 3, 2009?5 A Not to my knowledge.6 Q Did she, Ms. Swenson, require treatment from you7 or, to your knowledge, anybody else for symptoms8 related to these items before July 3 of 2009?9 A I had not seen her for any of these issues prior.

10 Q You understood you were her primary care physician?11 A Correct.12 Q All right. Let's sort of break down the things13 you listed in that prior answer.14 A Uh-huh.15 Q Let's start with those broken ribs. How many16 broken ribs were there?17 A It is my understanding from the CAT scan report18 that there were three, Nos. 5,6 and 7.19 Q Now, what can be done to help with a broken rib?20 A Treatment of broken ribs is entirely symptomatic,21 pain management and time.22 Q And pain management included, in the case of23 Ms. Swenson, what?24 A I believe initially anti-inflammatories opiate25 pain medications.

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1 Q Opiate pain medications, in terms of the spectrum2 of modest pain medications like maybe an aspirin3 all the way up to the most powerful pain4 medications, where did these opiate medications5 fall?6 A They certainly fall further along the spectrum7 towards the more powerful pain medications.8 a Can one cast broken ribs?9 A No.

10 a Now, it's always difficult to talk about pain and11 get someone else to understand pain; but as12 somebody who's undoubtedly seen folks in pain over13 the years, help the jury to understand the kind of14 pain that goes along with three fractured ribs,15 5,6 and 7.16 A The pain is quite significant for most people who17 sustain such an injury and oftentimes it's many18 weeks, on average I would say between four and19 eight weeks, before people really start to feel20 better. Any type of movement is often painful,21 sitting up, changing position, breathing,22 especially early on, can be quite uncomfortable.23 a Is it ordinary that sleep patterns are affected by24 fractured ribs?25 A That's certainly very possible.

1 with.2 a At the risk of being terribly indelicate, how old3 is Ms. Swenson?4 A I believe she's currently 82.5 a You talked in a prior answer about chest wall6 pain.7 A Uh-huh.8 a Is that separate and apart from the broken ribs?9 A Yes and no. The ribs certainly give pain in the

10 chest wall, which I would consider to be anything11 in the upper torso. She also had just some12 bruising to the soft tissues that occurred above13 and beyond those fractures, which gives relatively14 similar symptoms to what you see with a rib15 fracture.16 Q Does it make the pain from the broken ribs worse?17 A I would not say that is true. I would say that18 the broken ribs hurt a lot, and I would say the19 chest wall hurts a lot. So you just have a lot of20 things that hurt.21 a Okay. All right. Now, moving on to the right22 neck pain you talked about, separate and apart23 from this trapezius muscle you mentioned, tell us24 what the issue was with the right neck pain for25 Ms. Swenson.

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1 Q So somebody would likely have trouble sleeping?2 A Yes.3 a What happens if somebody with broken ribs - three4 broken ribs sneezes?5 A Very uncomfortable.6 Q Coughs?7 A Very uncomfortable.8 a Would you expect somebody with three broken ribs9 to be driving comfortably?

10 A Unlikely.11 a Now, how does Marion Swenson's age factor in to12 how she was affected by the fracture of those13 three ribs?14 A Well, certainly any patient who is at an - who is15 older, things don't work as well as they did when16 you were younger and there's not as much of a17 buffer, is how I explain it to patients. You18 know, if a 20 year old breaks some ribs, they can19 compensate. They've got other parts of them that20 work well. They tend to recover more quickly.21 As patients age -- as patients age, that's22 not as true. It takes them longer to recover.23 They often already have some limitations due to24 their age, and now it's adding something further25 that they don't have the same capacity to cope

1 A It is my medical opinion that there are probably2 two things that contribute to her right neck pain,3 both bony and, what as doctors we call, myofascial4 pain. So the bony pain is what's documented on5 the CT scan that was done at the outside hospital6 to rule out a fracture; that there was no7 fracture, but there was significant amount of8 arthritis, which sometimes is symptomatic and9 sometimes is not. It's just in a baseline state.

10 I think that underlying arthritis was11 exacerbated by her injury and started causing her12 pain. Oftentimes what happens then as well is13 because of the trauma itself; and because the body14 tries to put a guard against the pains in the15 bone, the muscles and what's called the fascia,16 it's like a Saran wrap around the muscle, becomes17 irritated and inflamed. So myo- means muscle, and18 -fascia is that wrap, hence myofascial pain. I19 think those two things contributed to her neck20 pain.21 a Give us some sense, if you can, about the severity22 of that neck pain for Ms. Swenson.23 A It was really quite significant. It was very24 uncomfortable for her to tum or rotate her head.25 She even had discomfort at rest, and it was

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1 refractory to many of the usual things that we2 would do for management.3 Q What does that mean?4 A Did not improve, as would be expected with some of5 our usual management.6 MR. KASIETA: I understand we're7 getting some noises from somebody's phone.s Let's go off the record for just a moment,9 please, and see if we can't eliminate that.

10 THE VIDEOGRAPHER: We are off the

11 record at 3:53 p.m.12 (Recess)13 (Question read)14 THE VIDEOGRAPHER: Weare back on

15 the record at 3:55 p.m.16 Q Doctor, let's move on, please, to talking about17 this trapezius muscle. Tell us where that is,18 please.19 A It's probably easier to show.20 Q Okay. Good.21 A It's back here basically (indicating), kind of22 behind the shoulder, between the neck and the23 shoulder.24 Q And muscles frequently run from one area to the25 other. What is the location where the trapezius

1 Advil and Aleve and things like that, and with2 stronger opiate medications as needed and physical3 therapy.4 Q And just as I asked you before, understanding it's5 tough to put these things into words, how6 significant was that injury for Ms. Swenson, now7 focusing on the trapezius muscle?8 A It was considerable, and it was prolonged.9 Q How long?

10 A Well, the accident was in 2009; and she continues11 to have that pain, so over two years.12 Q So far?13 A So far.14 Q Now, you talked also about the shoulder blade as15 being a problem. What was the problem with the16 shoulder blade from the accident, the crash?17 A The shoulder blade itself is fine. That's a bone.18 The problem is with the muscles that are around19 the shoulder blade that are responsible for20 helping to move the shoulder and the shoulder21 blade.22 Again, in an injury like this, it's very23 common for that muscle and its attachment points24 onto the bone to become irritated, much in the25 same way that I described the irritation for the


,...("

1 starts and ends, if you will?2 A More or less, beginning here (indicating) in the3 neck and running across the upper back or back4 side of the shoulder.5 Q All right. And if the - if the jury reaches over6 with one hand over the opposite shoulder, is -7 that muscle that you feel just beyond the top of8 your shoulder, is that the trapezius?9 A That is correct.

10 Q All right. What was wrong with the trapezius11 muscle from the accident with Ms. Swenson?12 A Based on the report of her symptoms and my exam13 findings, it had become irritated and inflamed.14 Oftentimes, that's a result of what we call15 microtrauma. meaning. you know, the muscle didn't16 tear in half, but there's little-bitty tears in17 there that become irritated and inflamed and18 result in pain.19 Q And what can you do for that as a physician?20 A Conservative management. Physical therapy can be21 helpful. Medications can be helpful. Sometimes22 chiropractory, acupuncture, those types of things.23 Q How did you treat it in the case of Ms. Swenson?24 A So we started with medication,25 anti-inflammatories, which are medicines like

1 trapezius.2 Q You also mentioned in that prior answer a rotator3 cuff tear. Now, this one might take a little more4 time. Let me try to break it down a little bit.5 What is, first of all, a rotator cuff? Maybe6 baseball fans have heard of it.7 A Right. So the rotator cuff is basically four8 muscles that hold the shoulder in place. The9 shoulder consists of kind of a shallow pool with

10 the top arm bone having a round head in it that11 sits like this, and then the muscles sit outside12 of that to hold it in place and to allow it to13 move up and down and to rotate.14 Q And what happens when one suffers a rotator cuff15 tear?16 A Patients would experience pain and limited range17 of motion, loss of range of motion.18 Q So the muscle tissue, though, actually tears?19 A It's not actually the muscle. It's really more20 the tendon that generally tends to tear. So21 muscles are attached to bones by a connective22 tissue called a tendon. So the rotator cuff is23 the muscle with its tendon attaching to the bone.24 Generally, it's the tendon that tears.25 Q Now I'd like to go back through these things and

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1 you tell me, if you will, please, whether each of2 these situations still presents problems to3 Ms. Swenson to this day; okay?4 A Okay.5 Q The 5, 6 and 7 rib fractures?6 A That pain has resolved.7 Q The chest wall pain?8 A That pain has resolved.9 Q The right neck pain?

10 A That persists.11 a The trapezius muscle pain?12 A That persists.13 Q The problems that you describe around the shoulder14 blade?15 A Those persist.16 a And the rotator cuff tear?17 A That persists.18 Q Is Marion Swenson a candidate for surgery on that19 rotator cuff?20 A That is a difficult question to answer. It gets21 into the territory of just because we can doesn't22 mean we should. If you ask an orthopedic surgeon,23 "Could that rotator cuff be fixed," from a purely24 technical standpoint, yes. But I think it's25 complicated by her age, her other health problems.

1 Q Help the jury to understand, if you will, please,2 as best you can how you think - and you can break3 them down, if you like, deal with them together,4 if you think that's a more efficient manner - how5 you think they'll practically affect her, based on6 your experience and your knowledge.7 A Certainly. I anticipate those impacting her life8 in several different ways. First of all, I think9 she will always live with some degree of pain that

10 she did not have prior to the accident in each of11 these sites.12 I think it will - it already has and I think13 it will continue to limit many of the activities14 that she enjoyed prior to the injury. I think it15 will also require her, quite honestly, to have16 more doctor visits and more labs than she would17 have otherwise.18 She requires follow-up with me to monitor19 these medications and her progress with therapies,20 as well as laboratory studies to monitor some of21 the medications that she is on or has been on.22 a What kind of medication is she on now for those23 things that were caused by the accident?24 A I would need a chart to be able to tell you what2S she's exactly taking right now. I can tell you in

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1 Whether or not it's worth doing, whether or not it2 would actually make her better, is very unclear.3 Q Is it a risky surgery?4 A Any time a patient is exposed to general5 anesthesia, particularly one of an older age or6 with additional medical problems, there is7 certainly risk involved. There's also a very8 prolonged and difficult recovery period,9 particularly with shoulders.

10 Q Now let's go back through them one final time, all11 of these problems, the ones that at least persist12 to this day, and I'd like you to tell me, please,13 whether you have an opinion that they'll be14 permanent, that they'll be with her for the rest15 of her life; okay?16 A Uh-huh.17 Q Let's go backwards this time. The rotator cuff18 tear?19 A I anticipate that will be permanent.20 Q The problems with the shoulder blade?21 A I anticipate those to be permanent.22 Q The trapezius muscle problems?23 A I anticipate that will be permanent.24 a And the right neck problems?25 A I anticipate that will be permanent.

1 the past she's just used, as we discussed, opiate2 medications. Those were initially prescribed by3 an outside pain clinic, which I continued when she4 stabilized.S The last time I saw her, she was no longer6 taking those, not necessarily because she was7 really better, just because she didn't want to8 deal with side effects. She has, at various9 times, taken anti-inflammatory medications; and

10 with those, symptoms and kidney function and liver11 function need to be monitored with laboratory12 studies.13 a What are the side effects of these opiate14 medications?15 A The most common ones include constipation,16 sedation. Some patients develop nausea. Foggy17 thinking, I would add that as well.18 Q Is there a risk of addiction?19 A There is, though quite small.20 Q Now, going through the treatment now, the medical21 care that Ms. Swenson required because of the car22 crash, you understand she required ambulance23 transport away from the site of the crash?24 A Uh-huh.2S Q And she -- in addition to that, she went to a


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1 hospital. Was she an inpatient?2 A Not to my knowledge.3 a All right. And after that, you treated with her?4 A Uh-huh.5 a And did you make referrals to others?6 A I did.7 a And you referred to Dr. Jeffrey Stitgen, did you?8 A Correct.9 a And who is he?

10 A He's one of our orthopedic surgeons.11 a And what was the reason for making that referral?12 A Because of the concern regarding her rotator cuff.13 a And Dr. Stitgen, as an orthopedic surgeon,14 primarily does what?15 A An orthopedic surgeon is responsible for surgical16 repair of injuries sustained in joints.17 a Did you, in addition to that, refer to another18 doctor?19 A She saw a second orthopedic surgeon quite a bit20 later for a procedure.21 a That was Dr. Timothy Docter?22 A Correct.23 a All right. And he too was an orthopedic surgeon?24 A Correct.25 a All right. Now, the procedure you referenced,

1 a Okay. Sure. And have you seen that before. that2 phenomenon?3 A Certainly. And oftentimes injections like that4 are kind of a band-aid measure. They improve5 things temporarily, but oftentimes the symptoms6 return. In this case, my hope was that - she'd7 had some benefit from physical therapy. She had8 plateaued. My hope was that with an injection,9 she may be comfortable enough that she could

10 pursue a IitUe bit more physical therapy, knowing11 that we had done nothing to fIX the tear that was12 in there and it was quite likely to start13 bothering her again at some point.14 a All right. Now, a few more questions about the15 kinds of treatment she received and the - the16 nature of that treatment. You've referenced on a17 couple of occasions now your chart, and so we'll18 have to talk a little bit about the computer age.19 A Oh, yes.20 a Do you have, like in the old days, your medical21 records or chart of her care in a hard copy format22 here at Dean?23 A There's no longer such a thing as a paper chart.24 a All right.25 A Everything is electronic. All of my notes are

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1 what is that procedure?2 A That she saw with the second orthopedist?3 a Correct.4 A So she had what's called a subacromial injection.5 So let me explain what that is. Basically6 sometimes when a patient is having a lot of pain7 and limited range of motion, it's useful to put8 some numbing medicine and some steroid medicine in9 the area where the problem is.

10 So basically they didn't go into the shoulder11 joint but underneath here, where that tendon is12 and the rotator cuff that we mentioned was an13 issue, to put some medication in there to help14 minimize pain and hopefully help improve range of15 motion.16 a What kind of relief, if any, did Ms. Swenson get17 from that -- those injections?18 A May I refer to my notes?19 Q Yes, by all means. Certainly.20 A I believe -I believe she had some. I would--21 I'm sorry. I cannot recall exactly how much22 benefit she had.23 a Your recollection is she got some benefit?24 A I believe she had some, but it was by no means a25 permanent -- a permanent cure.

1 electronic.2 a You ordinarily, of course, do not just print it3 all out?4 A No.s a All right. And that's what you were referencing6 preViously about a chart?7 A I'm sorry. I'm not quite following the question.8 a That's okay. Let me clarify that.9 A Yes.

10 a I asked you about present medication, and you said11 you'd have to consult her chart.12 A Correct. And what I mean by that is the13 electronic medical record. That's where all of14 her information is contained.15 Q Thanks.16 A Uh-huh.17 Q Now, in terms of additional treatment, I want to18 just ask a few more questions here. You mentioned19 physical therapy. In Ms. Swenson's case, what was20 that for?21 A The same problems that we have been discussing.22 The neck pain, the trapezius pain and the pain23 around the scapula often kind of travel together.24 It's common to see them all affected at once; and25 so it was to address that, as well as addressing

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, .

1 the rotator cuff.2 Q And did you ever prescribe physical therapy for3 Ms. Swenson before this car crash of July 3, 200914 A I do not believe so.5 Q And there's something - I saw some reference to6 something called a TENS unit.7 A Uh-huh.B Q What is a TENS unit?9 A So that's a modality or a method that sometimes a

10 physical therapist will use. It's an actual11 device, and what it does is it sort of stimulates12 some of the nerves going to the skin and the13 muscles in the area of pain.14 And it's kind of like creating static or15 interference like you might have on a radio. And16 the theory is in doing that, that that pain signal17 doesn't get through quite as well. And it's also18 a very useful thing in managing myofascial or19 muscular pain as we've been discussing.20 Q Did Ms. Swenson have a TENS unit?21 A I believe she did.22 Q And do you agree with the use of a TENS unit to23 try to control pain in her case?24 A Absolutely.25 Q Now, how does it - how does it work physically?

1 clerical job and, I believe, also doing some care2 for her grandchildren intermittently and she was3 driving.4 Since this injury, her ability to drive was5 significantly limited, and it's my understanding6 that she's no longer driving at all because of her7 limited range of motion in her neck and shoulders.8 She doesn't feel safe doing so.9 She has not been able to return to her

10 part-time work because of the physical11 requirements of it that the pain simply will not12 allow, and sadly she's not dancing very much.13 Q Do you agree with those limitations?14 A I - I think they are appropriate. She has15 symptoms that are not controlled when she does16 those things; and consequently, she doesn't do17 them.18 Q Do you believe those limitations to have been19 caused by this car collision?20 A I believe that the car accident caused the pain21 that she experiences and the pain that she22 currently is experiencing has resulted in these23 limitations.24 Q You're aware she sold her house, are you? Did she25 tell you that?

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1 I mean, not the physics of it, but just from the2 patient's perspective, what do they have to do3 with a TENS unit?4 A It's a device that has to be attached directly to5 their person.6 Q How is it attached?7 A I do not know.8 Q All right.9 A I believe there is a strap. The physical

10 therapists would be able to elaborate on that.11 Q Are there pads that are actually affixed to the12 person's body?13 A I believe so.14 Q Okay. Now, this may be a difficult question. Do15 your best, please. You're someone who has seen16 Ms. Swenson for a couple of years before the car17 crash of July 2009, and you've seen her now since18 that time up to the present time as her primary19 care physician. Compare the lady that she was20 with the lady that she's become since that car21 crash.22 A Well, certainly the quality of her life has23 changed. Prior to the car crash, she would dance.24 She had a partner with whom she would dance a few25 times a week. She was working part-time at a

1 A I actually did not know that until I read through2 her statement.3 Q How will the permanent problems she has because of4 the car crash affect her ability to do household5 tasks, the routine things?6 A I anticipate that she will be limited. Oftentimes7 with chronic symptoms like this, increases in8 activity and kind of overdoing it can result in9 increases in pain. It's sort of like hitting the

10 sweet spot. You don't want to do too little, and11 you don't want to do too much. You kind of have12 to figure out what's just right, and that's often13 challenging.14 Q Do you have any expectations about whether this15 pain that she's got related to the car crash is16 likely to get worse, stay the same or get better17 as she progresses?18 A I anticipate it will stay the same.19 Q And the future treatment for her related20 specifically to things that you attribute to the21 car crash, if I understand you correctly, the22 medication and the follow-up care, the additional23 doctor's appointments?24 A Uh-huh. She - if I may add, she may require25 additional physical therapy in the future as well,



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'"(1 depending on her progress and how things play out.2 MS. ROTTlER: Object to that--3 THE WITNESS: Okay.4 MS. ROTTlER: - response as not5 stated to the appropriate degree of6 certainty.7 THE WITNESS: Okay.8 MR. KASIETA: Sure.9 Q I - we go back to what the Court - the law

10 requires for opinions.11 A I understand.12 Q Is - do you have any additional opinions about13 her future that you can state that are more likely14 than not to that reasonable degree of certainty or15 probability?16 A Should she - let me clarify. Pain like she has17 often fluctuates over time. The overall course18 would be stable, but it may get better or worse19 from time to time to a small degree; and should20 she have a fluctuation where she goes through a21 period where it's a bit worse, she may require22 some additional physical therapy.23 MS. ROTTlER: Same objection.24 THE WITNESS: Okay.25 Q The objection really is based on the word "may."

1 accident?2 A Yes.3 Q Caused by the accident?4 A Yes.5 Q And the medical bills for the conditions, which6 are in front of you that relate to those7 conditions, caused by the accident as well?8 A Yes.9 Q All right. Thanks. I did it a little better that

10 second time.11 MR. KASIETA: Those are all of the12 questions that I have. Thank you so much.13 EXAMINATION14 By Mr. Flores:15 Q Good afternoon, Doctor.16 A Hi.17 Q My name is Roger Flores, and I represent the18 defendants. American Family and Karen Bierman.19 You testified that you first met Ms. Swenson20 in 2007, and that would have put her at 78 years21 old when you first started caring for Ms. Swenson.22 Would you agree with that?23 A Yes.24 Q What do you know about Ms. Swenson's medical25 history for those 78 years in regards to prior -

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1 And if it's "may," that's fine. I just want to be2 sure that you understand that if you're saying3 "may," it's different than "should."4 A "May" is the correct word.5 Q Very good. Thank you.6 Now, I have an Exhibit No. 11 which is, I'll7 represent to you, medical bills for her care.8 These have been shared with counsel. And just in9 sort of a summary fashion. the treatment that you

10 afforded Ms. Swenson that you described as being11 related or caused by the collision, the expenses12 associated with that treatment were also caused by13 the collision, were they? That was really bad.14 A Could you please restate that?15 MR. FLORES: No objection.16 Q That might win an award for terrible question.17 All right. Let me -- let try it in English this18 time.19 A Okay.20 Q I'm going down to the expenses.21 A Okay.22 Q You've indicated, as I understood it, that the23 conditions that you afforded treatment for were24 related to the accident. Were the expenses25 associated with that treatment also related to the

1 prior neck complaints of pain?2 A I know what is contained in the electronic medical3 records through Dean; and on review of that, I did4 not have any documentation about prior neck5 issues.6 Q So if Ms. Swenson had treated somewhere other than7 Dean for neck pain during those 78 years before8 she started seeing you, you wouldn't have the9 benefit of those records; correct?

10 A In this case, that is correct.11 Q And what do you know about Ms. Swenson's past12 medical history in regards to right shoulder13 problems or pain?14 A To my knowledge, she did not have right shoulder15 problems or pain prior to when I - to when I16 began evaluating this particular issue. In the17 time between 2007 when I met her and 2009 when18 this became an issue. I never saw her for any19 complaints for her neck or shoulder.20 Q And when you say "no prior problems," do you mean21 at all or do you put a time limit on that, say,22 for the five years before you met - you'd met23 Ms. Swenson?24 A I would -- I don't put a time limit on it. But25 when a patient comes to me with an injury or pain,

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1 a standard question is: "Have you had anything2 like this before?" And they either say yes or no.3 If they say yes, you try to flesh that out. You4 try to figure out if this pain is the same or5 different. And she, to my knowledge, has not had6 pain like this before.7 Q And if there was reference to prior - or to8 chronic neck pain in Ms. Swenson's records in,9 let's say, maybe those 30 years before she started

10 treating from you, would you want to know that?11 A From a holistic standpoint, yes, I would want to12 know that.13 Q And same question, if Ms. Swenson's records14 documented chronic right shoulder problems before15 this accident, would you want to know that16 information?17 A More information is always helpful.18 Q And would that information be important to your19 treatment and care of Ms. Swenson?20 A Yes.21 Q Would that information be important in terms of22 the opinions you're providing in this case?23 A Maybe.24 Q And why do you qualify it by "maybe"?25 A Because it's always helpful to know as much as you

1 A Uh-huh.2 Q Question No. 1 on -- on the first page of3 Exhibit No. 10, your answer where you indicate,4 "Neck pain secondary to exacerbation of5 significant cervical osteoarthritis," can you6 please tell the jury what, I guess, first off7 cervical osteoarthritis is in lay terms?8 A Absolutely. It's wear and tear arthritis of the9 bones in the neck.

10 Q And then osteoarthritis, does that - what kinds11 of symptoms manifest in something that?12 A Sometimes it can be completely asymptomatic. It's13 quite - I quite often see an older patient that14 you're doing an imaging study for something else;15 and you say, "Oh, look. You have all kinds of16 arthritis in that neck or back, but it doesn't17 seem to be giving you any trouble.n

18 Sometimes the pain can be quite significant.19 Sometimes it's as the arthritis itself develops20 that it's painful. Sometimes it's been sitting21 there for a while, and some type of trauma or22 injury sort of flares it up and it becomes23 symptomatic after years of being quiet.24 Q What's your understanding as to whether25 Ms. Swenson's neck pain or osteoarthritis, if you

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1 can about a patient. And if she had prior neck or2 shoulder or knee or chest wall pain, I always want3 to know those things. However, it's quite clear4 to me that in the two years that I knew her before5 that, they were not active issues and they6 suddenly became new, acute, active issues when I7 saw her after the accident.8 Q So from 2007 when you first met Ms. Swenson to the9 time of the accident, July 3 of 2009, are you

10 aware of whether Ms. Swenson had any neck pain11 that she sought treatment for dUring that time?12 A Not through the records to which I have access.13 Q Same question with regard to right shoulder14 complaints.15 A Same answer.16 Q So you have no knowledge of any neck pain or right17 shoulder pain during -- during that two-year18 period from when you first met her in '07 to the19 time of the accident?20 A Not that she saw me for.21 Q When I'd like to do -- actually, your report22 that's dated June 6, 2011, what exhibit number is23 that? Is that No.6?24 A 10.25 Q 10. Thank you.

1 will, was asymptomatic before this accident?2 A It is my understanding that - to my knowledge, it3 was asymptomatic prior to the accident.4 Q And where you indicate, "Neck pain secondary to5 exacerbation," can you tell the jury what that6 means in lay terms, please?7 A Exacerbation means "made worse."8 Q And in this case, how are you able to tell whether9 Ms. Swenson's cervical osteoarthritis was made

10 worse from this accident?11 A Because prior to the accident -- let me back up.12 Osteoarthritis, wear and tear arthritis, does not13 develop overnight. So when it was seen on the CT14 at the outside hospital, you assume it was there15 before. She did not have symptoms before, and she16 did subsequently.17 Q And you indicate, "Significant cervical18 osteoarthritis." Why do you indicate or why do19 you use the word "significant"?20 A Because that's what was indicated on the outside21 CT scan. I believe that was how the radiologist22 described it, and it gives a description of the23 degree.24 Q And going to the right rotator cuff tear that you25 reference there in your response to


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1 Question No.1, do you know when that right2 rotator cuff tear was diagnosed subsequent to the3 accident?4 A I believe - may I look at my notes?5 Q Of course.6 A I believe it was a couple of weeks later.7 Ms. Swenson originally saw me on the 15th of July8 and then actually saw one of my physician's9 assistants on August 3. And I believe it was the

10 X-ray ordered at that August 3 visit that was11 suggestive of a rotator cuff tear and clinically12 was confirmed when she saw orthopedics later that13 month.14 Q And how is it that you're able to relate15 Ms. Swenson's right rotator cuff tear to this16 accident?17 A Again, based on symptoms. She didn't have18 symptoms related to this before. She had an19 accident, and now the symptoms are present.20 Q And when you say "symptoms." can you tell the jury21 what sort of symptoms you're talking about22 specifically in regards to Ms. Swenson?23 A Pain over the front and side part of the shoulder,24 particularly with range of motion, particularly25 with flexion of the shoulder, as well as limited

1 that often evaluates trauma there depending on the2 degree, and I know she had some medical imaging3 CAT scans.4 Q Now, when - when you're talking about the rib5 fractures and the CT scan, are you talking about6 the CT scan of Ms. Swenson's chest?7 A Yes.8 Q What I'd like to do is hand you a record. It's9 actually an - an X-ray of Ms. Swenson's chest

10 performed on July 3, 2009. And for the record.11 it's Bates stamped M130 in the upper right comer.12 Why don't you go ahead and take a look at13 that record, please. Let me know when you're14 finished.15 A Okay. I'm set.16 Q Okay.17 MS. ROTTlER: Is that marked as an18 exhibit?19 MR. FLORES: Not that one, no.20 Q That chest X-ray indicates negative for fractures;21 is that correct?22 A That is correct.23 Q And do you see any reference to rib fractures in24 that chest X-ray record?25 A Not on the chest X-ray.


1 range of motion of the shoulder.2 Q Where was Ms. Swenson first treated following this3 accident?4 A It was in a small outside emergency room, I5 believe, in Waupun, Wisconsin. I'd have to6 reference the chart to be certain about that.7 Q Why don't you do that.8 A It's in my electronic medical record.9 Q I see.

10 A If someone has a copy of the CAT scan report or11 the emergency room report --12 Q And I was actually going to get into that. But13 before we do that - actually, according to the14 records we've collected for Ms. Swenson, she was15 transported by ambulance to the UW ER here in16 Madison. Were you aware of that?17 A I was aware that she had gone to an emergency18 room. I apparently remembered incorrectly which19 emergency room.20 Q Are you able to tell the jury what you know as to21 the examination and work-up that was done for22 Ms. Swenson at UW?23 A She was evaluated by an emergency room physician.24 I would have to review the chart to know if it was25 the ER doc, the trauma surgeon. There's a team

1 Q Okay. Thank you. What I'd like to do now is2 shift gears a little bit to Ms. Swenson's past3 medical history because I think it's relevant in4 this case. And we'll begin with what's been5 marked as Utrie No.1, and this is Gonstead Clinic6 of Chiropractic.7 And if you'd please - well, actually, can8 you tell the jury - you may have answered this9 already - have you seen these records before

10 today?11 A They were made available to me.12 Q When?13 A A week and a half ago, two weeks approximately.14 More than a week -- a week ago.15 Q Okay. And had you requested those records, or16 were those records provided to you voluntarily by17 Attorney Kasieta's office?18 A They were provided to me voluntarily.19 Q Okay. If you would, please tum to Bates stamp20 page P2 in the upper right corner.21 A Uh-huh.22 Q Now, this records identifies Ms. Swenson in the23 upper left corner; is that correct?24 A Correct.25 Q And under "Symptoms" - well, actually, let me

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1 back up. There's a reference to an auto accident2 on October 5, 1979.3 Do you see that?4 A Yes.5 Q And the record also references for symptoms,6 "Tight shoulder since 10/5/79."7 Do you see that?8 A I do.9 Q And if you'd please turn to the next page, P3

10 A Uh-huh.11 Q - again, in the initial symptoms there, there's a12 reference to tightness in shoulders.13 Do you see that?14 A Yes.15 Q And if you look straight up above to the top of16 the page, it's dated, it's kind of cut off, but it17 looks like it's 4/5/05.18 Is that right?19 A Correct.20 Q Now, did you review these Gonstead Clinic21 chiropractic records when they were provided to22 you?23 A I did not.24 Q Any particular reason?25 A There's a lot of information here. I reviewed

1 up to some four months before this accident?2 MR. KASIETA: Same objections.3 A This would be new information to me.4 Q All right. What I'd like to do, since you haven't5 had the benefit of reviewing these records, is6 just go over a few of them for the benefit of your7 opinions in this case and for the benefit of the8 jury; okay?9 A Uh-huh.

10 Q I see that - it appears that some of mine are cut11 off. So bear with me here, if you would, please.12 And actually, why don't I have you do this. Why13 don't you take a look at pages P5 and P6. See if14 you see any reference to cervical pain in those15 notes, please.16 A I do not know that I could comment on that since17 these are chiropractic notes and they document in18 a far, far different manner than medical notes. I19 do not know if - he indicates "C," which I assume20 is "cervical." I don't know if that means that21 those are levels he treated or whether they were22 things that were actually painful. I can't23 comment.24 Q Did - did you ask Ms. Swenson if she'd had any25 prior treatment for neck pain before this


1 what I thought would be relevant to my testimony.2 Q Would - would you be surprised if these records3 document cervical or neck pain going back to4 March 28, 1983, all the way up to February 3. 200915 MR. KASIETA: Object to the form of6 the question and to relevance.7 Q Would you be surprised?8 MR. KASIETA: Same objection, also9 foundation.

10 A I'm unsure if I'm supposed to answer in this11 stage.12 MR. KASIETA: Oh, yes. Do, please.13 A Oh, okay. I'm sorry. Could you please restate14 the question?15 Q Certainly. The Gonstead chiropractic records that16 were provided to you, would you be surprised if17 they document neck pain for Ms. Swenson going back18 from 1983 up until February of 2009, some four19 months before this accident?20 A That would be new information to me.21 MR. KASIETA: Let me object to the22 form of the question, relevance, foundation.23 Q Same question, would you be surprised if the24 Gonstead chiropractic records referenced right25 shoulder pain going back to the '80s all the way

1 accident?2 A I do not recall.3 Q Is that something that would be part of your4 examination and care of Ms. Swenson? What I'm5 getting at is: It would be part of the history?6 A Possibly.7 Q Why do you say "possibly"?8 A Well, when a patient is acutely injured, your goal9 is to take care of what the injury is. And the

10 information that you have before you in getting11 that better. you ultimately are trying to improve12 those symptoms when that are present, whether13 they've been present or not before.14 Q But in this case, you're -- you've testified that15 Ms. Swenson didn't have any prior neck pain before16 the accident and that this accident caused her17 permanent neck pain. You've testified to that;18 correct?19 A To my knowledge, she did not have neck pain prior20 and she does have neck pain now.21 Q And I apologize for the silence. As you can see,22 the - the chiropractic notes are in handwriting.23 Now, what do you know about the accident that24 Ms. Swenson was involved in back in 1979?25 A Nothing.


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1 Q Let me ask you this: Are you able to confirm a2 fall in a driveway three days ago with a complaint3 of right lower cervical and upper thoracic pain4 and right shoulder pain from that record?5 A I can confirm that it says the -- "falling forward6 on driveway." The abbreviations that he uses7 certainly could be translated to mean that, but8 these are not abbreviations that I would use in a9 medical record. So I cannot say with certainty

10 that that's what he means, he or she.11 Q Okay. Why don't we do this. Why don't we fast12 forward to - sticking with Exhibit No.1,13 Bates stamped P20 in the upper right corner, and14 let me know when you're there, please.15 A Okay.16 Q And looking at the reference to the date of17 February 3, 2009, some five months before this18 accident, you see there on 213/09 where there's a19 reference to "right shoulder ache"?20 A 2I3/09?21 Q Correct.22 A Again, you're asking me to interpret chiropractic23 records, which is not a part of my training. I24 see an R circled for "right," what I suppose could25 be described as -- I think it says S-H-A. If

Q And what I'd like to hand you is a recordBates stamped H59; and this is from May 4, 1994,and these are part of the records that werecollected through UW Health. And this one has"Physicians Plus" at the top.

Why don't you go ahead and take a look atthat record and let me know when you're finished.

MR. KASIETA: Did you give me acopy of this one?

MR. FLORES: Not that one, no.MR. KASIETA: Oh, okay.

12

34

5

67

8

9

10

11

12 A Okay.13 MR. KASIETA: May I just take a14 quick look, please, before your question?15 MR. FLORES: Of course.16 MR. KASIETA: Thank you. Thank17 you. I'll just object to this line of18 questioning on relevance because of the date,19 1994. Thank you.20 Q Is there any reference to neck pain in that21 record?22 A Not that I see.23 Q All right. Why don't you hand me back the record,24 and I'll point it out to you.25 A Okay.


1 Q And I see that I've got the wrong record. Again,2 I apologize to you and the jury. These records3 are - we have a lot of records for Ms. Swenson.4 We only go back about 25 years. So I apologize5 for that. And you were right. There is no6 reference to neck pain in that record. Let me7 continue with my examination here.8 Were you provided with a copy of9 Ms. Swenson's deposition testimony in this case?

10 A I was.11 Q And did you happen to review that?12 A I did.13 Q Did you see in that examination reference to14 treatment with Gonstead Chiropractic for prior15 neck pain that Ms. Swenson testified to?16 A I saw a reference to it, although I'm not -- I17 would have to read it in more detail. My memory18 is that she said he treated her neck. To me. that19 doesn't necessarily mean that there was pain.20 Q If you'd go to, again, what's been marked21 Exhibit No. 1 and P17 in the upper right comer --22 A Okay.23 Q - and looking at the 9/4/01 entry there, do you24 see that?25 A Uh-huh.

1 that's what a chiropractor uses for "right2 shoulder ache," then that's what it says.3 Q And why don't you go to the record, same page,4 it's the date 4/9/09.5 A Okay.6 Q And do you see there a reference to "continued7 mild cervical pain"?8 A Ido.9 Q And that information of mild cervical pain on

10 February 3 of 2009, that's new information to you,11 is that correct, as we sit here today?12 A Do you mean the cervical pain of April 9, '09?13 Q Yes. I'm sorry. April 9, '09. Thank you.14 A That is new information to me.15 Q And that would be some three months before this16 accident; correct?17 A Yes; and I would report that the chiropractor does18 describe it as mild.19 Q And why would you do that? Why do you qualify20 your answer there?21 A Because I think that's in significant contrast to22 the pain for which she was seeing me. I would not23 describe the pain for which she has been seeing me24 as mild.25 Q All right. Why don't we - why don't we go now to

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1 what's been marked as Exhibit No.3, and I'll hand2 you Exhibit No.3. These are the --3 A Do you want this back?4 Q Thank you. These are the Arlington EMS records,5 at least one page of them. If you'd tum to page6 013 in the upper right corner --7 A Okay.8 Q - and can you read the summary of events there to9 yourself and let me know when you're finished.

10 A Okay.11 Q Do you see any reference to "fractured ribs" in12 that summary of - of events?13 A No.14 Q And do you see what - what Ms. Swenson is15 referencing in terms of her complaints there in16 that summary of events?17 A The record states that the patient was complaining18 of chest pain, said it was radiating to her19 shoulders and back.20 Q Why don't we go to Exhibit No.4. These are the21 UW records. And you can hang on to those22 exhibits. Thank you.23 A Okay.24 a Now, at the UW ER. were you aware that Ms. Swenson25 had an orthopedic consultation? Were you aware of

1 M96 in the upper right corner.2 A Okay.3 Q Looking under - at the top of the record. "HPI,"4 what is that? If you could, explain what HPI is5 to the jury.6 A History of present illness.7 Q The history of present illness as documented there8 on this record indicates, "Only subjective9 complaints of chest and back pain"; is that correct?

10 A That is what it says.11 Q And going to the next record, it's M102 in the12 upper right corner.13 A 102?14 a Yes, it's the next page. M102, upper right15 comer.16 A Okay.17 a There's a reference to "Orthopedic A and P."18 Do you see that?19 A Uh-huh.20 Q When it indicates, "Ms. Swenson, a 79 year old21 with mild (sic) thoracic tenderness and age22 indeterminant findings on CT of Land T spine,"23 what does "age indeterminant" mean?24 A Unknown how long they have persisted, whether25 they're new or old.

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1 that?2 A I may have been at the time I initially evaluated3 her because I did request her UW records.4 a And she also had a trauma consult. Were you aware5 of that?6 A Same answer.7 a And also an OT consult. Were you aware of that?8 A Same answer. That would be standard of care for a9 level 1 trauma center.

10 Q And were you aware of that -- and we've already11 talked about Ms. Swenson's chest X-ray from12 7/3/09, which was negative for fractures; correct?13 A Correct.14 Q And Ms. Swenson also had a cervical X-ray which15 was negative for fractures; correct?16 A I believe so, yes.17 Q She also had a thoracic X-ray that was negative18 for fractures; correct?19 A If you are reading from the electronic medical20 record - although, I do believe there was a21 chronic compression fracture. And again, without22 the record in front of me, I cannot recall, but I23 believe it does involve one of her thoracic24 vertebrae.25 Q Why don't we go to Exhibit 4 on the first page,

1 Q And if you'd go to page M116 in the upper right2 comer, I believe it's two pages after that one?3 A Uh-huh.4 a Now, under the "HPI comments," and particularly5 where it references "MVA," do you see that?6 A Uh-huh.7 Q Is that a yes?8 A Yes.9 Q Where it says, "Pertinent negatives include no

10 chest pain, no abdominal pain, no loss of11 consciousness and no shortness of breath," what do12 you take that to mean, based on your education and13 experience?14 A I take that to mean exactly what it says, that15 this provider documented no chest pain, no16 abdominal pain, no loss of consciousness, no17 shortness of breath, though I question the18 accuracy of that documentation.19 Q Okay. And go to record M120 in the upper right20 corner, please.21 A Okay.22 Q The first imaging of the CT scan of the cervical23 spine demonstrated multi-level degenerative disc24 disease but no evidence of acute fracture.25 Do you see that?


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1 A Yes.2 Q What does that mean in lay terms, Doctor?3 A It means that there is wear and tear arthritis of4 the bones of the neck; and what they mean by5 multi-level is there are multiple bones in the6 neck and that there is wear and tear arthritis7 involving more than one of them.8 THE VIDEOGRAPHER: Excuse me,9 Counsel. About five minutes of tape.

10 MR. FLORES: Thank you.11 A And none of them are broken.12 Q Okay. And going to the bottom of the page, do you13 see the discharge date there?14 A Yes.15 Q It looks like Ms. Swenson was discharged two days16 after this accident; correct?17 A Okay.18 Q Well-19 A That's correct. That's what it says.20 Q Meaning - let me, I guess, stop here. You've had21 the benefit of reviewing Ms. Swenson's UW ER22 records-23 A Uh-huh.24 Q - before today; correct?25 A Yes. When I initially evaluated her in 2009, I

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1 requested the records.2 Q And - and do you have those with you?3 A I do not have them with me. They are scanned into4 our electronic medical records.5 Q When's the last time you reviewed them before6 today?7 A I would say a week and a half ago before I met8 with counsel to refresh my memory regarding the9 nature of her injuries and the time course to

10 date.11 Q You'd agree - well, you'd agree that Ms. Swenson12 did not sustain any fractures to any part of her13 spine? Would you agree with that?14 A I would agree with that.15 Q Okay. Now, you indicate that Ms. Swenson16 sustained rib fractures from this accident;17 correct?18 A That is correct.19 Q Do you have the CT scan that that -- documents20 those fractures?21 A Again, it would be in our electronic medical22 records.23 Q And, in fact, the record I've shown you previously24 regarding Ms. Swenson's chest X-ray, again, M1302S Bates stamp page, that chest X-ray was negative

1 for fractures; correct?2 A Correct; although, frequently fractures do not3 show up on an X-ray and do show up on a CT.4 Q Well, you have a binder to your right there.5 A Correct.6 Q What's in the binder?7 A So this includes information that was given to me8 which excludes the documentation that I already9 had. The UW records might actually be in here. I

10 did not look because they were scanned into my11 electronic medical record and I reviewed them that12 way. There is also Ms. Swenson's statement, the13 bills --14 Q Well, are you able to do a scan of those records15 and tell - tell me and the jury whether you have16 a document or an imaging study that confirms the17 rib fractures that you've testified to?18 MR. FLORES: Why don't we stop now19 and start another tape. Thank you.20 THE VIDEOGRAPHER: this Is the end

21 of Tape No.1 of the deposition of22 Dr. Gina Utrie. We are off the record at23 4:55 p.m.24 (Recess)25

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1 (EXhibit No. 12 marked2 for identification)3 THE VIDEOGRAPHER: This is the4 beginning of Tape 2 of the deposition of5 Dr. Gina Utrie. We are back on the record at6 5:05 p.m.7 Q Okay. Dr. Utrie, we're talking about alleged rib8 fractures to Ms. Swenson. You went to find a9 record. Can you tell the jury what you found and

10 identify it, please?11 A This is the CAT scan of her thoracic spine.12 Q And what in that CAT scan leads you to conclude13 that Ms. Swenson sustained rib fractures from this14 accident?15 A It's based on the way the radiologist describes16 the fifth, sixth and seventh ribs.17 Q And is there any reference to -- is there any18 specific reference to "rib fracture," in those19 terms, in that record?20 A This particular radiologist non-specifically does21 not use the word "fracture."22 Q And again, just to confirm, the chest X-ray that23 was done of Ms. Swenson, if she sustained rib24 fractures, as you suspect, would those have been2S identified in the chest X-ray that was done on

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1 Ms. Swenson?2 A Not necessarily.3 Q And why is that?4 A Because oftentimes fractures or cracks in the rib5 cannot be seen on a chest X-ray. They require6 additional imaging, often a CAT scan. The changes7 can be subtle.8 Q Other than that record you're holding that doesn't9 specifically say "rib fractures," are you aware of

10 any other records that specifically diagnose11 Ms. Swenson with rib fractures?12 A No.13 Q Now, as part of the work-up that was done of14 Ms. Swenson at UW ER, the OT consult, were you15 aware that that record states or reports, "Bad16 shoulders with arthritis and stiffness" as a17 baseline for Ms. Swenson?18 A No.19 Q And you're sure that you've reviewed the OT20 consult record from that date at UW?21 A I don't - I actually don't recall. I remember22 looking and seeing that there was one there. I do23 not believe I specifically read it word for word.24 Q Do you know what Ms. Swenson's diagnosis was on25 7/3/09 at the ER?

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1 fractures, vertebral spine in an MVA," which2 stands for motor vehicle accident.3 Q And going to the next page, M121 4 A Okay.5 Q - where it states, "Hospital course," when it6 says she was admitted for observation, spinal7 clearance and serial examination after her spine8 were cleared, what does that mean, if you could9 please explain to the jury?

10 A What that means is there was no evidence of acute11 fracture -12 Q And-13 A - in the spine.14 Q She was discharged - well, do you see any15 reference to fractured ribs there?16 A They do not comment on that.17 Q And she was discharged home on 7105/09; correct?18 A It appears that's what the record states.19 Q Do you know what follow-up care was prescribed for20 Ms. Swenson at the UW ER?21 A I would have to look at what they documented. I22 am sure they told her to follow up with her23 primary care physician. That's speculation on my24 part.25 Q Well, why don't we go to your records, and I'll

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1 A I would need to review the record to be precisely2 sure since I did not personally evaluate her.3 Q And would that require you to go back up to your4 office?5 A Not if it's contained either in here or in here.6 Q Well, yes. I think it's important that the jury7 hear based on the records what Ms. Swenson's8 diagnosis was at the UW ER.9 A Okay. Do you have that document readily available?

10 Q Well-11 A Because whatever it documents is what their12 diagnosis was.13 MR. FLORES: Kathy, feel free to14 jump in if you have that record. There's15 about 200 pages, so I'll try to find it here.16 MR. KASIETA: Look at 120.17 THE WITNESS: Okay. Thank you.18 MR. FLORES: Thank you.19 MR. KASIETA: In the middle of the20 page.21 A I see the bottom third, "Hospital diagnosis,22 status post motor vehicle collision, with no23 traumatic injury", is what their record states.24 Oh, sorry. Didn't know that's what I was looking25 at. This diagnosis says, "Traumatic compression

1 hand you what's been marked as Utrie 5.2 A Okay.3 Q And let me find my Utrie 5. Go to M97, please, in4 the upper right corner.5 A Okay.6 Q And can you identify this record for the jury,7 please?8 A This is my electronic medical record documentation9 in our first visit after her motor vehicle accident.

10 Q Now, your record documents. under the subjective11 portion, some new posterior right rib fractures12 Nos. 5 through 7.13 Do you see that?14 A Uh-huh.15 Q Is that a yes?16 A Yes. That was a yes.17 a Have you seen any record to date that specifically18 identifies ribs 5 through 7?19 A Yes.20 Q Okay. Where is that record?21 A That thoracic spine CAT scan.22 Q The one we were talking about before?23 A Correct. It references ribs 5, 6 and 7.24 Q But again, you don't see a reference to "fracture"25 there; correct?

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1 A They report changes in those ribs.2 a You interpret "changes" to mean "fractures"?3 A Possibly, by the way they describe it. It's4 unfortunate they did not use the word "fracture."5 Radiologists do that sometime.6 a Are you able to say to a reasonable degree of7 medical probability based on the records you8 reviewed that, in fact, Ms. Swenson did sustain9 rib fractures from this accident?

10 A I believe that she sustained rib fractures.11 a And what is that based on again?12 A Again, based on what I see in the CAT scan.13 a Okay. Going to the objective portion of your14 record-15 A Okay.16 a - it looks like Ms. Swenson had tenderness to the17 left upper part of her chest where the seatbelt18 would have been, is that correct, at least,19 according to the record?20 A That sounds reasonable. I'm just trying to - oh,21 yes. Yes, the last line of my exam. Okay.22 a Do you see - is there any complaint by23 Ms. Swenson of right shoulder pain on July 15, 2009124 A This is dated July 17, 2009, and there is not a25 complaint of shoulder pain at this time.

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1 a Well, when it indicates "7/17/09,10:43 a.m.2 signed," what does that mean?3 A Oh, that means that's when I signed it. That's4 when I completed the documentation and signed it.5 The visit dates could be different. You may be6 correct.7 a And did you see any reference -- strike that.8 What was your assessment of Ms. Swenson on --9 in the record that's signed 7/17/09, particularly

10 Assessment No.1?11 A My assessment is documented as chest wall and back12 pain, secondary to a recent motor vehicle accident.13 a And was there any reference in your assessment to14 Ms. Swenson's shoulders, either right or left?15 A Not on that date.16 a And if you'd go to record M92 in the upper right17 comer, looking under the encounter note about18 four lines down where it begins, "She did had19 immediate," do you see that?20 A I do.21 Q That references right chest pain. Do you see22 that?23 A It does.24 a And that's different than the left - left chest25 pain that Ms. Swenson complained of to you in the

1 7/17/09 record; is that correct?2 A I stated left. This provider documents right.3 This provider is not me, I will make clear. So I4 can't - I do not know what happened in the room5 that day.6 a Do you also see that the chest X-ray and pelvis7 X-ray were unremarkable? Do you see that?8 A That is what is documented. I do see that, yes.9 a Thank you. Do you know how Ms. Swenson injured

10 her right shoulder in this accident, the mechanism11 of injury?12 A I do not.13 Q Do you know when Ms. Swenson first started14 complaining of right shoulder pain after this15 accident, at least that's documented?16 A It is first documented in this 8/3/09 note.17 Q So that would be some roughly 30 days after the18 accident; agreed?19 A Correct.20 a Would you agree that the further away you get from21 a traumatic event, the less likely that later, new22 onset complaints could be related to that23 traumatic event?24 A I would not agree.25 a Why not?

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1 A Because sometimes there are early injuries that2 are substantial that you don't realize other3 things have been injured. For example, the chest4 wall pain she had was significant and limiting.5 She probably didn't move her shoulder or neck very6 much for some time. So I certainly have seen7 cases where these complaints come up later.8 a Now, the CT -- at least according to this N929 record of 8/3/09 where it says CT of the thoracic

10 and lumbar spine showed old compression fractures11 at the T12 and L1.12 Now, do you see that?13 A I see that line.14 a Do you know if those old compression fractures15 were symptomatic for Ms. Swenson before this16 accident?17 A I'm not aware that they were, no.18 a And looking at the assessment plan on the bottom19 of page N92 and going to the top of N93, can you20 read the second sentence that begins, "The21 shoulder" and continue on to the next page? You22 can read it out loud, please.23 A "The shoulder wasn't bothering her when she saw24 Dr. Utrie last. Will check an X-ray of the right25 shoulder out of completeness. I suspect this is

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1 all related to her motor vehicle accident."2 Do you want me to continue?3 Q Oh, no. That's okay. And was that - was that an4 accurate statement that's indicated there, that5 Ms. Swenson didn't complain of right shoulder pain6 when she'd last seen you before this visit?7 A That is correct.8 Q Now, there was an X-ray done of Ms. Swenson's9 right shoulder; correct?

10 A Correct.11 Q And I believe I have those records. It's N4512 through N47. And looking at N45 under the13 impression, Impression No.1, can you read that14 out loud for the jury and then indicate what that15 means in lay terms, please?16 A liThe documentation states indirect signs of a17 rotator cuff tear with the head of humerus18 articulating with the undersurface of the acromion19 process."20 So what that means is sort of the tip of the21 shoulder here is the acromion. The head of the22 humerus is the top of the arm bone that sits like23 this (indicating). Normally there's a space24 between those where the rotator cuff tendon sits25 and where a fluid-filled sac, called a bursa,

1 A Without a prior X-ray, you cannot determine if2 these are new or old.3 Q And can you read the Impression No.2 out loud4 just for the jury?5 A "Degenerative changes of the AC joint,n and that6 stands for acromial clavicular joint.7 Q And what does that mean in lay terms. Doctor?8 A So again, as I just discussed, the acromion is9 sort of the tip of the shoulder here and the

10 clavicle is the collar, collarbone. So the11 shoulder blade back here comes around and12 attaches. That's the acromion. The clavicle13 comes across and attaches. And then those two.14 where they meet is called the acromion clavicular,15 AC joint for short,16 Q Well, when it references "degenerative changes,"17 what does that mean?18 A Wear and tear arthritis.19 Q And are you able to tell whether those20 degenerative changes of the AC joint were there21 prior to this accident?22 A One would presume so because wear and tear23 arthritis is not a traumatic change acutely. It's24 something that develops over time.25 Q And again, it's your understanding that

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1 sits. So I think of those two bones like the2 bread of a sandwich and those two soft tissue3 structures like the meat of a sandwich.4 So normally there should be space between the5 bones where those things live. You can't see6 those soft tissue structures on X-ray. What the7 radiologist is saying is that those two bones are8 basically squished together; and when you see that9 on X-ray, that's an indication that there's likely

10 a tear of the rotator cuff tendon that goes11 through there. That's called the supraspinatus12 muscle.13 Q Would you agree that without a prior right14 shoulder X-ray, you're not able to rule out15 whether that first impression that you just16 testified to was there before the accident but was17 symptomatic?18 A I'm sorry. I've got my positives and negatives19 confused. Can you please repeat that?20 Q Sure. Are you able to - without a prior right21 shoulder X-ray before this one, would you agree22 that without that prior right shoulder X-ray,23 you're not able to rule out whether the24 impressions that were found in the right shoulder25 were there before the accident?

1 Ms. Swenson didn't have any problems with the2 right shoulder before this accident; correct?3 A Not for which she had seen me for evaluation.4 Q Why don't you go to record N78 through 83. please.5 And actually. I'll direct you to N79.6 A Uh-huh.7 Q And in the upper right corner, do you see your8 name and the date of 9/08/09?9 A Yes.

10 Q Under the subjective portion of the record - and11 again, if you could, please, for the benefit of12 the jury, when the record says "subjective," what13 does that mean in lay terms?14 A It's largely the history as presented by the15 patient.16 Q Okay. And it looks like on 9/8/09 Ms. Swenson17 came in to see you for an evaluation of neck pain;18 is that right?19 A That's what it states, yes.20 Q And a few lines down it also states, "She was not21 complaining of neck pain at that time." meaning22 your prior visit with Ms. Swenson; is that right?23 A That's correct.24 Q Do you know, at least based on this record in your25 care and treatment of Ms. Swenson. when her neck


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1 pain began after this accident?2 A I cannot give you an exact date. I can tell that3 - if I can review the prior record, I believe it4 was present when she saw the physician's5 assistant, but I'm not sure without reviewing the6 record. And let me review my documentation. I7 don't believe she says - I don't believe I8 document an exact date. I do not see an exact9 date.

10 Q Oh, thank you. And the record also states, "She11 describes the pain mostly over the trapezius12 bilaterally."13 Do you see that?14 A Yes.15 Q Is that in reference to the neck pain that she's16 complaining of?17 A Yes.18 Q Okay. Could you explain that to the jury in lay19 terms, please, what she's - what she's describing20 there?21 A Sure. So the trapezius, as I explained earlier,22 is this muscle behind the shoulder that you can23 reach over and feel here. And no patient is ever24 going to come in and tell you they have trapezius25 pain. They come in and tell you they have neck

1 Q Now, could you go to - strike that.2 You're familiar with Dr. Docter's care of3 Ms. Swenson; is that right?4 A I had reviewed his note, yes.5 Q And Dr. Docter testified that - or pardon me.6 Dr. Docter indicates in his records that7 Ms. Swenson had some major improvement and8 dramatic pain relief from physical therapy; is9 that right?

10 A That is his opinion.11 Q In fact, Dr. Docter also indicates in his 9/2210912 record that surgery was not necessary due to13 excellent function, despite a complete tear; is14 that right?15 A That is what he states.16 Q What does that mean in lay terms, Doctor, if you17 could please tell the jury?18 A It means that it's his opinion that she had19 improvement in her symptoms. I do believe,20 however, under his assessment and plan, if I'm21 remembering correctly, he documents that in one22 area but then later describes slight improvement23 in function. I don't have the record ahead of me,24 only the notes that I took thinking they might be25 relevant to that question.

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1 pain or they have shoulder pain; and then by exam,2 you sort out anatomically where exactly it is.3 Q And where it says "She also has been found to have4 a tom rotator cuff in the right shoulder," do you5 see that?6 A Correct.7 Q Again, would you agree without a prior right8 shoulder X-ray, you're not able to rule out that9 that tom rotator cuff wasn't there before the

10 accident?11 A I would agree.12 Q And again, towards the bottom part of the13 subjective portion of that record, again, 9/08/09,14 it states, "eT of her neck from UW demonstrated15 significant arthritis but no other abnormality."16 Do you see that?17 A I do.18 Q When it says "no other abnormality," what do they19 mean by that, based on your education and20 experience, Doctor?21 A That's basically -- basically my interpretation,22 meaning that there was no fracture. That would be23 what would be clinically relevant. Someone24 reading this record would want to know if she hurt25 her neck, is there a fracture, and there was not.

1 Q Now, if you would, please, go back to the records2 Bates stamped with the M, please, and in3 particular - and that, for the record, again, is4 Exhibit NO.4.5 A Okay.6 Q If you'd go to M231, please 7 A Okay.s Q And if you'd go to M232 as well -9 A Okay.

10 Q - this record is dated March 2,2010, and this is11 a visit that Ms. Swenson had with Dr. Arndt at UW;12 is that right?13 A That's what's documented.14 Q And sticking with page M232 again, second line15 beginning, "She underwent chest X-ray," do you see16 that?17 A Yes.18 Q Do you see where it says, "She underwent chest19 X-ray, thoracic CT scan and lumbar CT scan without20 any fractures identified"?21 Do you see that?22 A I do.23 Q And if you could, go to M234, please. This is24 still part of the March 2, 2010, visit.25 A Okay.


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1 Q And under the assessment portion in particular 2 A Uh-huh.3 Q - what is the first paragraph of the assessment?4 Can you please indicate for the jury what5 Ms. Swenson's assessment is there?6 A She documents, "Marlon Swenson is an 80-year-old7 female who developed neck pain after a motor8 vehicle accident in July 2009. She did not have9 any fractures at the time of the accident but

10 imaging was significant for severe multi-level11 degenerative changes and complete loss of disc12 height at C5-6 and C6-7, as well as uncovertebral13 hypertrophy and facet hypertrophy causing moderate14 bilateral neuroforaminal narrowing at C4-5, C5-615 and C6-7.n

16 Q And the next paragraph that begins "The17 degenerative changes,· can you read that out loud18 for the jury, please?19 A "The degenerative changes have been present for20 many years, but she was asymptomatic prior to the21 accident. It is likely that after the accident22 she had changes in the cervical spine mechanics or23 a whiplash injury that caused her degenerative24 changes to now be symptomatic."25 Q Thank you. Now, the last sentence of that

1 accident.2 Is that - is that fair?3 A That's what it states.4 Q Now, if you'd please go to the assessment portion5 of the record, it's M230.6 A Okay.7 Q The assessment, can you please summarize that for8 the jury, if you would, in lay terms?9 A So it again states that she's 80 years old with

10 right-sided neck pain developing after the motor11 vehicle accident. Her imaging shows the wear and12 tear arthritis type changes that we have already13 discussed; and the details here, all the medical14 jargon, what it's describing is where in the bone15 the arthritis changes are.16 And then it goes on to say she has pain in17 the muscle and, excuse me, the tissue around the18 muscle in the right side of the neck and over the19 trapezius.20 Q And then the second paragraph of the assessment21 where it says, "Overall her symptoms have been22 persistent and she has continued to have23 difficulty,n do you see that?24 A I do.25 Q And the next sentence states, "Momings are the

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1 paragraph you were just reading from, can you read2 where it begins "She has intermittent numbness"?3 Can you read that out loud for the jury, please?4 A "She has intermittent numbness and tingling in the5 right hand while reading the newspaper, which is6 more consistent with carpal tunnel syndrome than7 radiculopathy."8 Q What does that mean in lay terms, Doctor?9 A It means that when she holds the paper, that she

10 gets numbness and tingling in her hand. But this11 physician is pointing out that radiculopathy would12 indicate that it would be coming from the neck;13 whereas she believes this is a more peripheral14 cause, meaning she believes the nerve is getting15 pinched in the wrist at the carpal tunnel causing16 this symptom rather than coming from the neck.17 Q Thank you.18 A Uh-huh.19 Q Now, if you could, please go to M228, please.20 A Okay.21 Q Under the history of present illness, that22 document, towards the bottom again, documents23 degenerative changes found in Ms. Swenson's neck24 that have been there for many years, but it also25 indicates that she was asymptomatic prior to the

1 worst time, which is consistent with2 osteoarthritic symptoms."3 Do you see that?4 A I do.5 a What - what is Dr. Amdt saying there, again,6 based on your education and experience?7 A She is saying that the patient - she's8 reiterating that the parent reported mornings are9 when she's most symptomatic and that it did not

10 particularly surprise this provider because wear11 and tear arthritis symptoms can sometimes be worse12 first thing in the morning before somebody gets up13 moving around and kind of loosens up and gets14 their joints lubricated.15 a Would you agree that Dr. Arndt's indicating that16 Ms. Swenson's report of neck pain being worse in17 the morning, that in his opinion those complaints18 of consistent with osteoarthritic symptoms?19 A Her opinion appears to be that the osteoarthritic20 symptoms are contributing but do not appear to be21 the entire cause; because in the paragraph prior,22 as I mentioned earlier, she also describes muscle23 and soft tissue pain over those neck muscles and24 trapezius. So that's saying multi-factorial.25 There's multiple things contributing to this


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1 patient's pain.2 Q Would you agree that even if this accident hadn't3 happened, that Ms. Swenson was a candidate for4 having neck pain due to the wear and tear changes5 found in her neck?6 A That's a very leading question to which the answer7 has to be yes. Anybody with arthritis could get8 pain, sure.9 Q So even if this accident hadn't happened,

10 Ms. Swenson could have had neck pain currently and11 when you saw her, based on the wear and tear12 changes that were present in her neck and that13 were found in the X-rays; right?14 A It's my medical opinion that without some sort of15 trauma, it's unlikely these would have become16 symptomatic.17 Q And again, your opinions in this case are based on18 Ms. Swenson not having had any neck pain before19 this accident; correct?20 A To my knowledge.21 Q And why do you say to your knowledge?22 A Because I was - she had never - I was - she had23 never complained to me of neck pain prior to this.24 She had never mentioned that as a concern. It was25 not documented in the electronic medical records

1 Q Are you able to say what portion of the ongoing2 neck pain symptoms are related to the wear and3 tear changes versus the injury that she allegedly4 sustained in this accident?5 A I could not put a number on it and give you a6 percentage of it. I think given the physical and7 functional limitations that she currently8 experiences, most of the pain comes from the9 myofascial muscular pain, the rotator cuff pain.

10 But there's such a close relationship between that11 arthritic pain and the muscle pain, irs kind of12 like a chicken and an egg thing. I mean, you just13 - it's very difficult to say.14 Q Thank you.15 A You're welcome.16 Q Now, you're aware that Ms. Swenson had a fall in17 January of this year; correct?18 A I'm aware.19 Q And according to the records, Ms. Swenson's neck20 wasn't injured or aggravated in any way from that21 fall; correct?22 A If that's what's documented.23 MR. FLORES: That's alii have at24 this time. Thank you very much, Doctor.25 THE WITNESS: You're welcome.

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1 that I had available to me when I first met her2 and as I have cared for her since.3 Q And, in fact, you were provided with the Gonstead4 chiropractic records before today's deposition -5 or sometime before today's deposition, and you6 didn't bother to look at those; correct?7 A Well, when you care for 2,500 patients and work8 14- to 16-hour days, I reviewed what I thought9 would be relevant.

10 Q Again, would you agree that it would be relevant11 if Ms. Swenson had neck pain for, let's say,12 10 years before this accident?13 A It might be relevant to deciding whether or not14 someone is at fault for causing her neck pain in15 this particular situation, but it really was not16 particularly relevant to my care because my job is17 to deal with the issue at hand. She has pain.18 Honestly, whether it was there for 10 years or19 10 minutes, it's my job to figure out what's20 causing it and do what I can to try to treat it.21 a Would you agree that at least some part of22 Ms. Swenson's ongoing neck pain symptoms are23 related to the wear and tear changes found in -24 in her neck?25 A Yes.

1 EXAMINATION2 By Ms. Rattier:3 a Dr. Utne, I'm going to try very hard to keep this4 short, if I can.5 A Thank you.6 Q From all of the records that you have in front of7 you, can you see quickly what is the actual date8 of birth for Marion Swenson? It must be on those9 records.

10 A It is. Let me look at our records because I'm11 more familiar with how they're set up. 7/26/29.12 a So July 26. 1929; correct?13 A Correct.14 a And if the accident happens on July 3 of 2009.15 then she was about three weeks shy of her 80th16 birthday when the accident happens?17 A That sounds correct.18 a And you started becoming her treater or primary19 care physician in 2007, about two years, a little20 bit more than two years before the accident?21 A Correct.22 Q So she was about 78. 77 years old at that time?23 A In that range, yes.24 Q And did she share with you the fact that she was25 going for periodic chiropractic treatments when

\lin-(,.SlTipt I' Verbatim Reporting, Limited(608) 255.7700

(21) Pages 81- 84



Video Deposition of GINA A. UTRIE. M.D. ·8130/11 Page 85 Video Deposition of GINA A. UTRIE. M.D. ·8/30/11 Page 87

1 you first became her care provider?2 A I - I cannot recall. I do not believe so.3 Q Okay. I wanted to show you just a few documents.4 You've looked at a whole bunch of them. I'm going5 to try to keep this as short as I can. The first6 one's been marked as Exhibit 7, Doctor.7 MR. KASIETA: Thank you.8 A Okay.9 MR. FLORES: Thank you.

10 Q I'm a loud talker, so I'm going to 11 A All right.12 Q - keep on going this way.13 A All right.14 Q What's been marked as Exhibit 7 is a - a CT15 result; and it says, "CT cervical spine."16 Do you see the date on it is July 3, 2009?17 A I do.18 Q And we can agree that's the date of the accident;19 right?20 A Yes.21 Q So this is taken almost, you know, very quickly22 after-23 A Yes.24 Q - she reaches the hospital for immediate care;25 correct?

1 there's a finding of advanced or severe2 degenerative disease in the neck on the date of3 the accident, then can we conclude as almost a4 certainty that the accident did not cause the5 degenerative disease?6 A Yes.7 Q The degenerative disease was there for years8 before the accident?9 A Yes.

10 Q And the word "degenerative," just in the English11 language, means it's going to degenerate, which12 means it's going to get worse?13 A From an anatomic standpoint, I think that is a14 true statement. From a symptomatic standpoint, I15 would not agree with that statement.16 Q And what you're pointing out there is not17 everybody with severe degenerative disease is18 symptomatic for neck pain?19 A Correct.20 Q But if you have severe degenerative disease in21 your neck, it's not unusual for you to be22 symptomatic?23 A Sure.24 Q Okay.25 A I agree with that.

Video Deposition of GINA A. UTRIE. M.D. - 8130/11 Page 86 Video Deposition of GINA A. UTRIE. M.D.• 8130/11 Page 88

1 A Yes.2 Q And if you look on the second page of Exhibit 7,3 it talks about what is found.4 A Okay. Under "Findings," yes.5 Q And it talks again about severe multi-level6 degenerative disc disease with complete loss of7 disc height at two levels, which are identified as8 C5 and C6 and C6 and C7, and that's referring to9 two cervical discs; correct?

10 A That's correct.11 Q And "cervical" means "neck" -12 A Correct.13 Q -- to the ordinary person; right?14 A Correct.15 Q And when it uses the qualifier there of "severe,"16 is what the person reading this record is trying17 to say is that it's not mild. It's not moderate.18 It's not significant. It's severe?19 A Correct.20 Q A high level of disease?21 A Correct. Sometimes a radiologist will use22 "severe" and "significant" as interchangeable,23 depending on the context. But I agree. It's not24 mild. It's not moderate.25 Q Okay. And to be sure I understand this, if

1 Q Degenerative disc disease. is that also called,2 another phrase that we've heard here today,3 cervical osteoarthritis?4 A Yes, those are interchangeable.5 Q And what you've described that as is wear and6 tear, in other words, part of the aging process,7 that the disc space and the height between the8 discs kind of wears away as you - as the years9 roll on?

10 A That's mostly true. That part of the statement is11 true, but it's incomplete. It also can be caused12 by remote trauma. Anything that's wear and tear,13 not just age, but trauma, a job.14 Q 50--15 A Over -- you know, yeah.16 Q In this particular case, looking at the results on17 the CT scan for Ms. Swenson on the day of the18 accident. we may not know what caused her to have19 severe degenerative disc disease --20 A Correct.21 Q -- but we know she had it?22 A Correct.23 Q Okay. And it's not unusual for a woman who is24 near 80 to have severe degenerative disc disease25 from a variety of causes?


\Iill-l-';\'I"ipri'.

. .. Powers, et al. v.

. American Family Mutual Ins., et al.Video Deposition of GINA A. UTRIE, M.D.

August 30, 2011

Video Deposition of GINA A. UTRIE, M.D. - 8130/11 Page 89 Video Deposition of GINA A. UTRIE, M.D. - 8130/11 Page 91

1 A Correct.2 Q Okay. In the case of Ms. Swenson, neck pain was3 not one of the complaints she voiced immediately4 after the accident; is that true?5 A That is true.6 Q She had some chest bruising from the seatbelt and7 she had a shoulder complaint; but initially, at8 least, she had no neck complaints?9 A Not to me.

10 Q Okay. The next record I wanted to show you,11 Doctor, has been marked as Exhibit 8; and it's a12 note of a visit that you had with Marion Swenson13 on September 8 of 2009.14 Did I identify it correctly?15 A Yes.16 Q Okay. If this office visit was on17 September 8 of 2009, then just marking back from18 the date of the accident of July 3, can we agree19 that this is about two months and a week later?20 A Yes.21 Q All right. And at this time, you say in your22 assessment and plan that she's complaining of neck23 pain, but then you go on to say symptoms really24 did not appear until a month after her car25 accident; correct?

1 A Uh-huh.2 Q If neck pain in a person with severe degenerative3 disc disease shows up a month or two months after4 the accident, it's possible, isn't it, Doctor,5 that it could have come from something other than6 the trauma of the accident?7 A It is possible.8 Q Okay. In fact, you probably have a lot of9 patients in the 2,500 that you say you deal with

10 who have complaints of neck pain who've not been11 in an accident?12 A That Is true. There's a multitude of reasons for13 neck pain.14 Q Correct. It can be kicked into being symptomatic15 if you sleep wrong sometimes?16 A Possibly.17 Q When a person has underlying osteoarthritis in the18 neck to the degree that Ms. Swenson does, it's not19 surprising if that person voices complaints of20 neck pain from time to time. Would that be true?21 A That would be true.22 Q Okay. Dr. Utrie, do you know whether Ms. Swenson23 was receiving any physical therapy for her neck in24 the first six months after the accident?25 A I believe -- let me review my timeline here. This

Video Deposition of GINA A. UTRIE, M.D. - 8130111 Page 90 Video Deposition of GINA A. UTRIE. M.D. ·8130111 Page 92

1 A That's what it states.2 Q All right. And you wouldn't have any reason to3 dispute the accuracy because you write the records4 soon after the office visit; true?5 A That is correct.6 Q Okay. Do you think it is a correct statement that7 her complaints of neck pain, that is,8 Ms. Swenson's complaints of neck pain, did not9 surface until about a month after the accident and

10 weren't reported to you until two months after the11 accident?12 A Based on this documentation, I believe that's13 correct. Again, I don't have the record from the14 physician's assistant who saw her at the beginning15 of August. By my memory, that's only shoulder16 pain that they discussed; and the patient called17 it neck pain, but it's really this trapezius pain18 and shoulder pain. So I believe your statement is19 correct.20 Q And if you had thought that there was some neck21 pain that the physician's assistant had seen, you22 would have checked that record before you had your23 office visit with her --24 A Correct.25 Q - in September? Okay.

1 is why I wrote down the dates. I believe she had2 one visit. My review of my electronic medical3 record, I made a note for myself 8/24/2009 that4 she had one physical therapy visit. I do not know5 if that was to address her neck or shoulder pain. I

6 Q But then no more for the balance of the year?7 A Correct. My documentation is January 6 she8 returned to physical therapy, January 6 of 2010.9 Q Okay. So then that would be about six months

10 post-accident; correct?11 A Uh-huh, correct.12 Q When it comes to getting physical therapy for I13 complaints of neck pain, no matter what caused it,14 is it better to start sooner rather than later?15 A Any time a patient has pain, the sooner you can16 treat it, the better.17 Q Right. So if she had experienced neck pain in the18 year 2009, it would have been better for her to19 get the PT then as opposed to waiting until20 January of 201 O?21 A For her level of comfort, certainly.22 Q Okay. The recent injury that you -- that you23 mention that she had, what injuries did she24 sustain as a result of the fall on either25 Christmas - New Year's Eve or the day before?

,\Jin-t'-Snipt ;; Verbatim Reporting, Limited(608) 255.7700

(23) Pages 89 - 92


Video Deposition of GINA A. UTRlE, M.D.August 30,2011Video Deposition of G/NA A. UTR/E, M.D. - 8/30/11 Page 93 Video Deposit/on of GINA A. UTRIE, M.D. - 8130/11 Page 95

(Deposition adjourned at 5:53 p.m.)

MR. KASIETA: That's it. Thankyou.

MR. FLORES: Thanks.THE WITNESS: Thank you.THE VIDEOGRAPHER: The deposition

of Dr. Gina Utrie is adjourned at 5:53 p.m.We are off the record.

1 Q I've got one question for you, promise. After all2 of the questions that you've had from both of3 these defense lawyers, did you change any of the4 opinions you stated previously?5 A I did not.6

7

89

10111213

1415

16

17

18

1920

21222324

25

1 A So again, I would need to review the record for2 the details; but by my memory, it was an3 exacerbation of her underlying shoulder pain --4 Q Okay.5 A - was her biggest complaint.6 Q And the accident, the automobile accident on7 July of 2009, did not cause this recent fall?8 A That is correct.9 Q And to the extent it exacerbated any of the

10 musculoskeletal complaints that she had attributed11 to the accident, we've got now a second cause,12 correct, for some of those problems?13 A Correct; although, she was clearly still14 symptomatic from those original injuries prior to15 the fall.16 Q Right. And so what happens now with the fall is17 we have some more things superimposed and creating18 a more muddled picture of what relates to what?19 A I would agree.20 Q Okay. Can we agree that the injuries from her21 recent fall - and I think she had a broken left22 shoulder - are not related to the automobile23 accident we're here about?24 A That is correct.25 MS. ROTTlER: I think that's all -

Page 96

Certified Realtime Reporter,Notary Public, State of Wisconsin

Video Deposition of GINA A. UTRIE. M.D. - 8130111

1 STATE OF WISCONSIN )) ss.

2 COUNTY OF DANE )

3 I, ROWAN L. BRIGHT, 4 Cortifiod Roll1tilllO Roportor lUld

4 No~ary Public in and for ~o SU~O of Wisconsin, do

5 horoby cortify ~at ~o forogoing doposition was takon

6 beforo laO a~ Delln Clinic Eas~, 1821 South S~ugh~n

7 Road, Ci~y of MAdison, Coun~y of Dllno, Ilnd SU~ of

8 Wisconsin, the 30th day of AUgus~, 2011; thAt it WAS

9 ~akon at tho requost of tho Plaintiffs, upon verbal

10 intorrogatorios; that it was takon in shor~And by lllO, a

11 compo~on~ cour~ roporter and disinterested porson,

12 approved by all parties in in~rest and thereafter

13 converted to typowriting using computer-aided

14 transcription: that said doposition is a truo rocord of

15 tho doponont's tostilllOny; that ~o appoArances woro AS

16 shown on pago 3 of the doposition: that tho doposition

17 was taken pursuant ~o Notice; that said

18 GINA A. UTRIE, H.D., beforo oxam1nation, was sworn by

19 ilia to testify to tho truth, the whole truth, and

20 nothing but the truth relative to said cause.

21 Da~ed Sep~ember 7, 2011.

222324

25

Page 94

MS. ROTTlER: And with that, I willclose. Thank you very much.

THE WITNESS: Thank you.EXAMINATION

By Mr. Kasieta:

Video Deposition of GINA A. UTRIE. M.D. - 8130111

1 wait a minute.2 Q I have one more exhibit I was going to show you,3 Exhibit 9. And this happens to be just the CT4 scan taken very recently after this fall; and5 again. it shows very advanced multi-level6 degenerative change with narrowing in the disc7 spaces, again, showing the severe level being the8 same severe levels that were there before the auto9 accident occurred?

10 A Right.11 Q Okay. This shows that the degeneration is12 continuing as you would expect it to continue;13 correct?14 A I don't believe -- I cannot say that it's any15 worse than the 2009 CT because I don't believe16 they were directly compared.17 Q Okay.18 A It just, again, states she has bad arthritis in19 her neck.20 Q All right.2122232425


Min-I-SITipt: 1i



14:18 95:11,14 actual (3)

0 200 (1) A 7: 16;29: 10;84:762:15 6 actually (18)

07 (1) 2000 (2) abbreviations (2) 5:17;20: 18,19;22:2;

38:18 6:16,17 6 (9) 51:6,8 30:11;32:1;38:21;41:8;

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1 8:25;35:20;36:17; 31:4;32:4 acupuncture (1)38:8;84:19 7 able (16) 18:22

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10 (9) 52:10;57:25;65:23,24; 86:2 abnormality (2) add (2)

10:18;11 :3,11;38:24, 77:8;84: 14;85:16;89:13, 7/05/09 (1) 74:15,18 24: 17;32:24

25;39:3;82:12,18,19 17;92:18;93:7;94:15 63:17 above (2) addiction (1)

10/5179 (1) 2010 (4) 7/17109 (3) 15:12;45:15 24:18

45:6 76: 10,24;92:8,20 66:1,9;67:1 Absolutely (4) adding (1)

10:43 (1) 2011 (3) 7/26/29 (1) 5: 15;6:6;29:24;39:8 14:24

66:1 4:5;10:22;38:22 84:11 AC(3) addition (4)

102 (1) 25 (2) 7/3/09 (2) 71:5,15,20 9: 14,19;24:25;25:17

55:13 6:22;50:4 54:12;61:25 access (2) additional (8)

10-CV-2569 (1) 26 (1) 77 (1) 9:16;38:12 5: 19;22:6;28: 17;

4:11 84:12 84:22 accident (85) 32:22,25;33:12,22;61 :6

11 (2) 28 (1) 78 (4) 7: 19;9: 13;10:3;18:11; address (2)

4:1;34:6 46:4 35:20,25;36:7;84:22 19:10,16;23: I 0,23; 28:25;92:5

12 (1) 79 (1) 31 :20;34:24;35:1,3,7; addressing (1)

60:1 3 55:20 37:15;38:7,9,19;40:1,3, 28:25

120 (1) 10,11 ;41 :3,16,19;42:3; adjourned (2)

62:16 3 (17) 8 45: I ;46: 19;47: I ;48: I, 95:11,14

14- (1) 8:18;9:4;12:4,8;29:3; 16,16,23;5 I:18;52: 16; administered (1)

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15 (1) 46:4;51: 17;52: 10;53:1, 89:11,13,17 64:9;65:9;66: 12;67: 10, admission (1)

65:23 2;84: 14;85: 16;89: 18 8/24/2009 (1) 15,18;68: 16;69: I ;70:16, II:ll

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82:8 17: 11 80 (2) 83:4;84:14,16,20;85: 18; 5:25;6:1

17 (1) 3:55 (1) 79:9;88:24 87:3.4,8;88:18;89:4,18, advanced (2)

65:24 17:15 80s (1) 25;90:9,11;91:4,6,11,24; 87:1;94:5

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4:6 4 80-year-old (1) 83:19 23:5;32:4

1929 (1) 77:6 accuracy (2) affected (3)

84:12 4 (4) 82 (1) 56:18;90:3 13:23;14:12;28:24

1979 (2) 49:2;53:20;54:25;76:4 15:4 accurate (1) affixed (1)

45:2;48:24 4/5/05 (1) 83 (1) 69:4 30:11

1983 (2) 45:17 72:4 ache (2) afforded (2)

46:4,18 4/9/09 (1) 51:19;52:2 34:10,23

1994 (2) 52:4 9 acromial (1) afternoon (I)

49:2,19 4:55 (1) 71:6 35:1559:23 9 (3) acromion (5) Again (33)

2 52:12,13;94:3 69: 18,21 ;71 :8,12,14 19:22;27: 13;41: 17;5 9/08/09 (2) across (2) 45: II ;50: I ,20;5 1:22;

2 (4) 72:8;74:13 18:3;71:13 54:21 ;58:21,24;60:22;

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2,500 (2) 12:18;13: 15;21 :5; 75:11 38:5,6 72:11;74:7,12,13;76:3,

82:7;91:9 45:2;64: 1,3,12,18,23 9/4/01 (1) activities (1) 14;78:22;79:9;80:5;

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51:18,20 60:6 9/8/09 (1) activity (1) 93:1;94:5,7,18

20 (1) 5:53 (2) 72:16 32:8 against (1)

.\ I i Il-l· -St' r ipl·" Verbatim Reporting, Limited(608) 255.7700

(1) 07 - against

Video Deposition of GINA A. UTRIE, M.D.August 30,2011

• Powers, et al•• v.American Family Mutuallns.,.et al.

16:14 anti-inflammatory (1) asymptomatic (5) 60:15;62:7;65:7,11,12; birth (1)age (10) 24:9 39: 12;40:1,3;77:20; 72:24;74:19;80:6;81:11, 84:8

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agree (24) 4:20 attorneys (1) bear (1) board (4)29:22;31:13;35:22; appearing (2) 4:19 47:11 6:19;7:1,4,758:11,11,13,14;67:20, 4:23;5:1 attribute (1) bears (1) Bob (1)24;70:13,21;74:7,11; appears (4) 32:20 10:21 4:2280:15;81:2;82:10,21; 4:22;47:10;63: 18; attributed (1) became (7) body (2)85:18;86:23;87:15,25; 80:19 93:10 6:18,19;8:25;11:21; 16:13;30:1289:18;93:19,20 appointments (1) August (4) 36:18;38:6;85: I bone (7)

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ahead (3) 31:14;33:5 45:1;94:8 19:24;30:20;81:15 bones (7)43: 12;49:6;75:23 approximately (1) automobile (2) becomes (2) 20:21;39:9;57:4,5;

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ambulance (2) arthritis (17) 48:24;49:23;50:4;53:3, 47:5,6,7;57:21;72:11 breathing (1)24:22;42:15 16:8, I0;39:8,16,19; 19;55:9;60:5;62:3; best (2) 13:21

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among (1) 15;80:11;81:7;94:18 5:14 13:20;22:2;24:7; broken (15)6:21 articulating (1) backside (1) 32:16;33:18;35:9;48: II; 7:21,22;12: 15,16,19,

amount (2) 69:18 11:24 92:14,16,18 20; 13:8;14:3,4,8;15:8,6:12;16:7 aspirin (1) backwards (1) beyond (2) 16,18;57: II ;93:21

anatomic (1) 13:2 22:17 15:13;18:7 bruising (2)87:13 assessment (13) bad (4) Bierman (2) 15:12;89:6

anatomically (1) 66:8,10,11,13;68:18; 7:24;34: 13;61: 15; 4:24;35:18 buffer (1)74:2 75:20;77: I,3,5;79:4,7, 94:18 biggest (1) 14:17

anesthesia (1) 20;89:22 balance (1) 93:5 bunch (1)22:5 assistant (3) 92:6 bilateral (1) 85:4

answered (1) 73:5;90: 14,21 band-aid (1) 77:14 bursa (1)44:8 assistants (1) 27:4 bilaterally (1) 69:25

anticipate (7) 41:9 baseball (1) 73:1222:19,21,23,25;23:7; associated (2) 20:6 bills (4) C32:6,18 34:12,25 based (18) 9:24;34:7;35:5;59:13

anti-inflammatories (2) assume (2) 9:9;10:11;18:12;23:5; binder (2) C4-5 (1)12:24;18:25 40:14;47:19 33:25;41: 17;56:12; 59:4,6 77:14

age - C4-5 (2) Verbatim Reporting, Limited(608) 255.7700

.\ 1ill-l-Sl'ript II

fowers, et al. v.American Family Mutual Ins., et al.


CS (1) 48: 14;50:9;81:17;88:16; checked (1) 42:14;49:4 conditions (5)86:8 89:2 90:22 collision (4) 6:3,11;34:23;35:5,7

CS-6 (2) cases (1) chest (30) 31:19;34:11,13;62:22 Condon (1)77:12,14 68:7 11:20;15:5,10,19; comfort (1) 4:15

C6(2) cast (1) 21 :7;38:2;43:6,9,20,24, 92:21 confirm (3)86:8,8 13:8 25;53:18;54:11;55:9; comfortable (1) 51:1,5;60:22

C6-7 (2) CAT (9) 56: 10,15;58:24,25; 27:9 confirmed (2)77:12,15 11:19;12:17;42:10; 60:22,25;61 :5;65:17; comfortably (1) 1l:19;41:12

C7 (1) 43:3;60:11,12;61:6; 66:11,21,24;67:6;68:3; 14:9 confirms (1)86:8 64:21;65:12 76:15,18;89:6 coming (2) 59:16

call (2) Cathy (1) chicken (1) 78:12,16 confused (1)16:3;18:14 4:25 83:12 commencing (1) 70:19

Called (12) cause (5) chief (3) 4:8 connective (1)5:5,23;11:25;16:15; 78:14;80:21;87:4; 5:20;6:20,21 comment (3) 20:2120:22;26:4;29:6;69:25; 93:7,11 Chiropractic (10) 47:16,23;63:16 consciousness (2)70:11;71:14;88:1;90:16 caused (12) 44:6;45:21 ;46:15,24; comments (1) 56:11,16

calls (1) 23:23;31:19,20;34:11, 47: 17;48:22;50:14; 56:4 consequently (1)8:9 12;35:3,7;48:16;77:23; 51 :22;82:4;84:25 common (4) 31:16

came (1) 88:11,18;92:13 chiropractor (2) 7: 18;19:23;24: 15; Conservative (1)72:17 causes (1) 52:1,17 28:24 18:20

can (54) 88:25 chiropractory (1) Company (1) consider (1)7: 17;12:19;13:8,22; causing (5) 18:22 4:11 15:1014:18;16:21 ;18:19,20, 16:11;77:13;78:15; Christmas (1) Compare (1) considerable (2)21 ;21 :21 ;23:2.2,25; 82:14,20 92:25 30:19 6:12;19:832:8;33:13;38:1;39:5, center (1) chronic (6) compared (1) consistent (3)12,18;40:5;41:20;44:7; 54:9 6:10,11 ;32:7;37:8,14; 94:16 78:6;80: 1,1848:21 ;51 :5;53:8,21; certain (1) 54:21 compensate (1) consists (1)60:9;61 :7;64:6;68:19, 42:6 circled (1) 14:19 20:922;69: 13;70:19;71 :3; certainly (13) 51:24 complain (1) constipation (1)73:2,3,22;77:4,17;78:1, 13:6,25;14:14;15:9; Circuit (1) 69:5 24:153;79:7;80:11;82:20; 22:7;23:7;26: 19;27:3; 4:12 complained (2) consult (5)84:4,7;85:5,18;87:3; 30:22;46: 15;51:7;68:6; City (1) 66:25;81 :23 28:11;54:4,7;61:14,2088:11;89:18;91:14; 92:21 4:7 complaining (5) consultation (1)92: 15;93:20 certainty (6) clarify (2) 53:17;67: 14;72:21; 53:25

candidate (2) 8:12;11:5;33:6,14; 28:8;33:16 73: 16;89:22 contained (3)21: 18;81:3 51:9;87:4 class (2) complaint (5) 28: 14;36:2;62:5

candidly (1) certification (2) 6:22,23 51 :2;65:22,25;89:7; context (1)10:6 7:2,8 clavicle (2) 93:5 86:23

capacity (1) certified (3) 71: 10,12 complaints (16) continue (5)14:25 6:19;7:4,7 clavicular (2) 36: 1,19;38: 14;53:15; 23: 13;50:7;68:21;

car (22) cervical (18) 71:6,14 55:9;67:22;68:7;80:17; 69:2;94:127: 19;8: 15,16,17;9:5,8, 39:5,7;40:9,17;46:3; clear (3) 89:3,8;90:7,8;91:10,19; continued (3)11;11:12,13,14;12:3; 47:14,20;51:3;52:7,9,12; 11 :21 ;38:3;67:3 92:13;93:10 24:3;52:6;79:2224:21 ;29:3;30:16,20,23; 54: 14;56:22;77:22; clearance (1) complete (3) continues (1)31: 19,20;32:4,15,21; 85: 15;86:9,11 ;88:3 63:7 75: 13;77: 11 ;86:6 19:1089:24 challenging (2) cleared (1) completed (3) continuing (1)

care (26) 7:15;32:13 63:8 6: 16;7:4;66:4 94:125:25;6:2,6,9,10,13; change (3) clearly (1) completely (1) contrast (1)12: 10;24:21 ;27:21; 71 :23;94:6;95:3 93:13 39:12 52:2130:19;31:1;32:22;34:7; changed (1) clerical (1) completeness (1) contribute (1)37: 19;48:4,9;54:8; 30:23 31: 1 68:25 16:263: 19,23;72:25;75:2; changes (18) Clinic (6) complicated (1) contributed (1)82:7,16;84:19;85:1,24 61 :6;65: I,2;71 :5,16, 4:5;8:4,5;24:3;44:5; 21:25 16:19

cared (1) 20;77:11,17,19,22,24; 45:20 components (1) contributing (2)82:2 78:23;79: 12,15;81 :4,12; clinically (2) 6:8 80:20,25

caring (1) 82:23;83:3 41:11;74:23 compression (4) control (1)35:21 changing (1) close (2) 54:21 ;62:25;68:10,14 29:23

carpal (2) 13:21 83: 10;94:22 computer (1) controlled (1)78:6,15 chart (8) collar (1) 27:18 31:15

case (17) 23:24;27:17,21,23; 71:10 concern (2) cope (1)4:9,11;12:22;18:23; 28:6,11;42:6,24 collarbone (1) 25:12;81:24 14:2527:6;28: 19;29:23;36: 10; check (1) 71:10 conclude (2) copy (6)37:22;40:8;44:4;47:7; 68:24 collected (2) 60:12;87:3 9: 19,23;27:21;42:10;

'.lin-I-Scrip! jj Verbatim Reporting, Limited(608) 255.7700

(3) cs- copy


Powers, et al•• v.American Family Mutual Ins.,.et al.

49:9;50:8 8,9;84:7;85:16,18;87:2; 40:22 42:25 13:22;68:1corner (14) 89:18 despite (1) Docter (4) easier (1)

43: II ;44:20,23;50:21; dated (4) 75:13 25:21;75:5,6,11 17:1951:13;53:6;55:1,12,15; 38:22;45:16;65:24; detaU (1) Docter's (1) East (3)56:2,20;64:4;66:17;72:7 76:10 50:17 75:2 4:6,18;8:5

correctly (3) dates (2) detaUs (2) Doctor (14) education (3)32:21;75:21;89:14 66:5;92:1 79:13;93:2 8:6;17:16;23:16; 56:12;74:19;80:6

Coughs (1) day (5) determine (1) 25:18;35:15;57:2;71:7; educational (1)14:6 21:3;22:12;67:5; 71:1 74:20;75:16;78:8;83:24; 5:14

counsel (3) 88:17;92:25 develop (2) 85:6;89:11;91:4 effects (2)34:8;57:9;58:8 days (5) 24:16;40:13 doctors (1) 24:8,13

County (2) 27:20;51:2;57:15; developed (1) 16:3 efficient (1)4:7,12 67:17;82:8 77:7 doctor's (1) 23:4

couple (3) deal (4) developing (1) 32:23 egg (1)27:17;30:16;41:6 23:3;24:8;82: 17;91:9 79:10 document (8) 83:12

course (6) dealing (1) develops (2) 10:21;46:3,17;47:17; eight (1)28:2;33:17;41:5; 7:12 39:19;71:24 59:16;62:9;73:8;78:22 13:1949:15;58:9;63:5 Dean (6) device (2) documentation (9) either (4)

Court (3) 4:5;7: 10;8:4;27:22; 29:11;30:4 36:4;56:18;59:8;64:8; 37:2;62:5;66:14;92:244:12,16;33:9 36:3,7 diabetes (1) 66:4;69:16;73:6;90:12; elaborate (1)

cracks (1) deciding (1) 6:11 92:7 30:1061:4 82:13 diagnose (1) documented (12) electronic (12)

crash (19) decision (1) 61:10 16:4;37:14;55:7; 27:25;28:1,13;36:2;8:15,16,18;9:4,5; 10:11 diagnosed (1) 56:15;63:21 ;66: II ;67:8, 42:8;54: 19;58:4,21;11:12,13,15;12:4;19: 16; Defendant (1) 41:2 15,16;76:13;81:25; 59:11;64:8;81:25;92:224:22,23;29:3;30:17,21, 5:1 diagnosis (6) 83:22 eliminate (1)23;32:4,15,21 defendants (1) 11 :18;61:24;62:8,12, documents (8) 17:9

created (1) 35:18 21,25 58:19;62:11;64:10; else (3)9:14 defense (1) different (6) 67:2;75:21;77:6;78:22; 12:7;13:11;39:14

creating (2) 95:3 23:8;34:3;37:5;47:18; 85:3 emergency (7)29:14;93:17 degenerate (1) 66:5,24 done (8) 7:20;11:17;42:4,11,

CT (19) 87:11 difficult (5) 12: 19;16:5;27:11; 17,19,2316:5;40:13,21;43:5,6; degeneration (1) 13: 10;21:20;22:8; 42:21;60:23,25;61:13; emphysema (1)55:22;56:22;58:19;59:3; 94:11 30:14;83:13 69:8 6:1268:8,9;74: 14;76:19,19; degenerative (21) difficulty (1) down (8) EMS (1)85: 14,15;88: 17;94:3,15 56:23;71 :5, 16,20; 79:23 12:12;20:4,13;23:3; 53:4

cuff (23) 77:11,17,19,23;78:23; direct (1) 34:20;66:18;72:20;92:1 encounter (1)12:1 ;20:3,5,7,14,22; 86:6;87:2,5,7,10,17,20; 72:5 Dr (20) 66:1721 :16,19,23;22: 17; 88: 1,19,24;91 :2;94:6 directly (2) 4:4,13;5: 13;25:7,13, end (2)25:12;26:12;29:1;40:24; degree (10) 30:4;94:16 21 ;59:22;60:5,7;68:24; 6:17;59:2041 :2,11 ,15;69:17,24; 8:11;11:4;23:9;33:5, disc (10) 75:2,5,6,11 ;76:11 ;80:5, ends (1)70: 10;74:4,9;83:9 14,19;40:23;43:2;65:6; 56:23;77:11;86:6,7; 15;84:3;91:22;95:11 18:1

cure (1) 91:18 88:1,7,19,24;91 :3;94:6 dramatic (1) English (2)26:25 demonstrated (2) discharge (1) 75:8 34:17;87:10

currently (4) 56:23;74:14 57:13 drive (1) enjoyed (1)15:4;31 :22;81: 10;83:7 depending (3) discharged (3) 31:4 23:14

cut (2) 33:1;43:1;86:23 57:15;63:14,17 driveway (2) enough (1)45:16;47:10 deposition (11) discomfort (1) 51:2,6 27:9

4:4,13;8:7;9:20;50:9; 16:25 driving (3) entire (1)D 59:21 ;60:4;82:4,5; discs (2) 14:9;31:3,6 80:21

95:10,14 86:9;88:8 due (3) entirely (1)D13 (1) describe (5) discussed (5) 14:23;75:12;81:4 12:20

53:6 10:14;21: 13;52: 18,23; 11 :4;24: I;71 :8;79:13; duly (1) entry (1)dance (2) 65:3 90:16 5:5 50:23

30:23,24 described (5) discussing (2) during (6) ER(9)dancing (1) 19:25;34: 10;40:22; 28:21 ;29: 19 8:7;10:2;36:7;38:11, 7:23;42:15,25;53:24;

31:12 51:25;88:5 disease (13) 17,17 57:21;61: 14,25;62:8;Dane (2) describes (4) 6: 11 ;56:24;86:6,20; 63:20

4:7,12 60:15;73:11;75:22; 87:2,5,7,17,20;88:1,19, E especially (1)date (17) 80:22 24;91:3 13:22

49: 18;51:16;52:4; describing (2) dispute (1) earlier (3) et (2)57: 13;58:10;61:20; 73:19;79:14 90:3 8:2;73:21 ;80:22 4:9,1164:17;66:15;72:8;73:2, description (1) doc (1) early (2) evaluate (1)

corner - evaluate (4) Verbatim Reporting, Limited(608) 255.7700

.\ 1ill-I-Srripl I<

Ppwers, et al. v.'American Family Mutual Ins" et aI.

Video Deposition of GINA A. UTRIE, M,D.August 30, 2011

62:2 experienced (1) 31 :8;62:13;73:23 5:6 gives (2)evaluated (5) 92:17 female (1) follow-up (4) 15:13;40:22

7:20;11: 16;42:23; experiences (2) 77:7 9:11;23:18;32:22; giving (1)54:2;57:25 31:21;83:8 few (6) 63:19 39:17

evaluates (1) experiencing (1) 27:14;28:18;30:24; form (2) goal (1)43:1 31:22 47:6;72:20;85:3 46:5,22 48:8

evaluating (1) explain (5) fifth (1) format (1) goes (4)36:16 14:17;26:5;55:4;63:9; 60:16 27:21 13:14;33:20;70:10;

evaluation (2) 73:18 figure (3) forward (2) 79:1672:3,17 explained (1) 32:12;37:4;82:19 51:5,12 Gonstead (6)

Eve (1) 73:21 final (1) found (8) 44:5;45:20;46: 15,24;92:25 exposed (1) 22:10 60:9;70:24;74:3; 50:14;82:3

even (3) 22:4 find (3) 78:23;81 :5,13;82:23; Good (4)16:25;81:2,9 express (1) 60:8;62: 15;64:3 86:3 8:6;17:20;34:5;35:15

event (2) 11:2 finding (1) foundation (2) graduated (1)67:21,23 extent (1) 87:1 46:9,22 6:18

events (3) 93:9 findings (3) four (5) grandchildren (1)53:8,12,16 extra (1) 18:13;55:22;86:4 13:18;20:7;46:18; 31:2

everybody (1) 6:24 fine (2) 47:1;66:18 guard (1)87:17 extremely (1) 19:17;34:1 fracture (14) 16:14

evidence (2) 10:10 finished (3) 7:21;14:12;15:15; guess (2)56:24;63:10 43: 14;49:7;53:9 16:6,7;54:21 ;56:24; 39:6;57:20

exacerbated (2) F first (24) 60:18,21;63:11;64:24;16:11;93:9 5:5;8:25;9:10;20:5; 65:4;74:22,25 H

exacerbation (4) facet (1) 23:8;35:19,21 ;38:8,18; fractured (4)39:4;40:5,7;93:3 77:13 39:2,6;42:2;54:25; 13:14,24;53:11;63:15 H59 (1)

exact (3) facility (1) 56:22;64:9;67:13,16; fractures (30) 49:273:2,8,8 11:17 70:15;77:3;80:12;82:I; 11:19;15:13;21:5; half (3)

exactly (4) fact (6) 85: I ,5;91 :24 43:5,20,23;54: 12,15,18; 18:16;44:13;58:723:25;26:21 ;56:14; 58:23;65:8;75:11; five (3) 58:12,16,20;59:1,2,17; hand (9)74:2 82:3;84:24;91 :8 36:22;51 :17;57:9 60:8,13,24;61:4,9,11; 18:6;43:8;49:1,23;

exam (4) factor (1) fix (1) 63:1;64:11;65:2,9,10; 53: I ;64:1;78:5,10;82: 177:5;18:12;65:21 ;74:1 14:11 27:11 68: 10,14;76:20;77:9 handwriting (5)

EXAMINATION (9) fair (1) fixed (1) free (1) 10:23,25;11:1,3;48:225:7;35:13;42:21;48:4; 79:2 21:23 62:13 hang (1)50:7,13;63:7;84: 1;94:24 fall (13) flares (1) frequently (2) 53:21

example (1) 7:9,19;13:5,6;51:2; 39:22 17:24;59:2 happen (1)68:3 83: 16,21 ;92:24;93:7,15, flesh (1) front (4) 50:11

excellent (1) 16,21;94:4 37:3 35:6;41 :23;54:22;84:6 happened (4)75:13 falling (1) flexion (1) function (4) 11:12;67:4;81 :3,9

excludes (1) 51:5 41:25 24:10,11;75:13,23 happens (7)59:8 familiar (2) Flores (15) functional (1) 14:3;16:12;20: 14;

Excuse (2) 75:2;84:11 4:23,23;34: 15;35: 14, 83:7 84:14,16;93:16;94:357:8;79:17 Family (3) 17;43:19;49:10,15; further (3) hard (2)

Exhibit (22) 4: 10,24;35:18 57: 10;59: 18;62:13,18; 13:6;14:24;67:20 27:21;84:34:1;10:17,18;11:3; fans (1) 83:23;85:9;95:8 future (3) head (4)34:6;38:22;39:3;43:18; 20:6 fluctuates (1) 32: 19,25;33:13 16:24;20: 10;69:17,2150:21 ;51: 12;53:1,2,20; far (4) 33:17 health (2)54:25;60:1;76:4;85:6, 19:12,13;47: 18,18 fluctuation (1) G 21:25;49:414;86:2;89:11;94:2,3 Farm (1) 33:20 healthcare (2)

exhibits (1) 5:1 fluid-filled (1) gears (1) 9:16,2453:22 fascia (2) 69:25 44:2 healthy (3)

expect (2) 16:15,18 focusing (1) general (1) 6:9,9;9:314:8;94:12 fashion (1) 19:7 22:4 hear (1)

expectations (1) 34:9 Foggy (1) generally (2) 62:732:14 fast (1) 24:16 20:20,24 heard (3)

expected (1) 51:11 folks (2) gets (4) 9:5;20:6;88:217:4 fault (1) 7:12;13:12 21 :20;78:10;80:12,13 heart (1)

expenses (3) 82:14 follow (2) Gina (6) 6:1134:11,20,24 February (4) 8:1;63:22 4:4;5:4,10;59:22;60:5; height (3)

experience (5) 46:4,18;51: 17;52: 10 following (2) 95:11 77: 12;86:7;88:720:16;23:6;56:13; feel (7) 28:7;42:2 given (2) help (5)74:20;80:6 10: 12,13;13:19;18:7; follows (1) 59:7;83:6 12: 19;13:13;23: 1;


(5) evaluated - help

Video Deposition of GINA A. UTRlE, M.D.August 30,2011

Powers, et al•. v.American Family Mutuallns.,.et al. '.

26:13,14 44:22;64:18 infrequently (1) 82:17 kind (14)helpful (4) identify (3) 9:2 issues (5) 13:13;17:21 ;20:9;

18:21,21 ;37:17,25 60:10;64:6;89:14 initial (1) 11 :22;12:9;36:5;38:5, 23:22;26:16;27:4;28:23;helping (1) lUness (4) 45:11 6 29:14;32:8,11;45:16;

19:20 6: 13;55:6,7;78:21 initially (7) items (1) 80:13;83:11;88:8hence (1) imaging (7) 10:22;11:20;12:24; 12:8 kinds (4)

16:18 39:14;43:2;56:22; 24:2;54:2;57:25;89:7 7:13;27:15;39:10,15ID(I) 59:16;61:6;77:10;79:11 injection (2) J knee (1)

35:16 immediate (3) 26:4;27:8 38:2high (1) 7:24;66:19;85:24 injections (2) January (4) knew (1)

86:20 immediately (2) 26:17;27:3 83:17;92:7,8,20 38:4historian (1) 11:16;89:3 injured (5) jargon (1) knowing (1)

10:4 impacting (1) 7:18;48:8;67:9;68:3; 79:14 27:10history (8) 23:7 83:20 Jeffrey (1) knowledge (11)

35:25;36:12;44:3; important (3) injuries (9) 25:7 12:5,7;23:6;25:2;48:5;55:6,7;72:14;78:21 37:18,21;62:6 7:13;9:13;11:14; job (4) 36:14;37:5;38:16;40:2;

hitting (1) Impression (4) 25:16;58:9;68:1;92:23; 31:1 ;82:16,19;88:13 48:19;81:20,2132:9 69:13,13;70:15;71:3 93:14,20 joint (5)

hold (4) impressions (1) injury (17) 26:11;71:5,6,15,20 L8:10;11:3;20:8,12 70:24 6:13;7:21;9:1;13:17; joints (2)

holding (1) improve (4) 16:11;19:6,22;23:14; 25:16;80:14 Ll (1)61:8 17:4;26:14;27:4;48:11 31 :4;36:25;39:22;48:9; judgments (1) 68:11

holds (1) improvement (3) 62:23;67: 11 ;77:23;83:3; 10:15 laboratory (2)78:9 75:7,19,22 92:22 July (17) 23:20;24:11

holistic (1) include (2) inpatient (1) 8:18;9:4;12:4,8;29:3; labs (1)37:11 24:15;56:9 25:1 30:17;38:9;41:7;43:10; 23:16

home (1) included (1) insight (1) 65:23,24;77:8;84:12,14; lady (2)63:17 12:22 8:23 85:16;89:18;93:7 30:19,20

honest (1) includes (1) Insurance (1) jump (1) lane (1)10:4 59:7 4:10 62:14 9:11

honestly (4) incomplete (1) interchangeable (2) June (3) language (1)9:1 ;10:5;23:15;82:18 88:11 86:22;88:4 6:17;10:22;38:22 87:11

hope (2) incorrectly (1) interference (1) jury (27) large (1)27:6,8 42:18 29:15 6:4;8:23;13:13;18:5; 10:11

hopefully (1) increases (2) intermittent (2) 23:1;39:6;40:5;41 :20; largely (4)26:14 32:7,9 78:2,4 42:20;44:8;47:8;50:2; 6: 1;9:9;11 :20;72:14

hospital (6) increasingly (1) intermittently (1) 55:5;59: 15;60:9;62:6; last (6)16:5;25:1;40:14; 11:21 31:2 63:9;64:6;69:14;71:4; 24:5;58:5;65:21 ;62:21 ;63:5;85:24 indelicate (1) internal (7) 72: 12;73:18;75:17;77:4, 68:24;69:6;77:25

house (1) 15:2 5:18,23,25;6:7,15,17; 18;78:3;79:8 later (8)31:24 indeterminant (2) 10:9 25:20;41 :6,12;67:21;

household (1) 55:22,23 interpret (2) K 68:7;75:22;89:19;92:1432:4 indicate (8) 51:22;65:2 law (1)

HPJ (3) 39:3;40:4,17,18; interpretation (1) Karen (2) 33:955:3,4;56:4 58:15;69:14;77:4;78:12 74:21 4:24;35:18 lawyers (1)

humerus (2) indicated (3) into (9) KASJETA (22) 95:369:17,22 34:22;40:20;69:4 8:24;9: 11;19:5;21 :21; 4:21,22;5:8; I0: 16; lay (10)

hurt (3) indicates (8) 26:10;42:12;58:3;59: 10; 11:10;17:6;33:8;35:11; 39:7;40:6;57:2;69:15;15:18,20;74:24 43:20;47:19;55:8,20; 91:14 46:5,8,12,21 ;47:2;49:8, 71 :7;72: 13;73: 18;75:16;

hurts (1) 66: I;75:6,11 ;78:25 involve (2) 11,13,16;62:16,19;85:7; 78:8;79:815: 19 indicating (4) 7:2;54:23 94:25;95:6 leadership (1)

hypertrophy (2) 17:21;18:2;69:23; involved (3) Kasieta's (1) 6:2477:13,13 80:15 8: 16;22:7;48:24 44:17 leading (I)

indication (1) involves (1) Kathy (1) 81:6I 70:9 7:12 62:13 leads (1)

indirect (1) involving (1) keep (3) 60:12idea (1) 69:16 57:7 84:3;85:5,12 least (8)

7:11 inflamed (3) irritated (4) keeping (1) 22:11;53:5;65:18;identification (2) 16:17;18:13,17 16:17;18:13,17;19:24 6:9 67: 15;68:8;72:24;82:21;

4:2;60:2 information (13) irritation (1) kicked (1) 89:8identified (3) 28: 14;37: 16,17,18,21; 19:25 91:14 left (7)

60:25;76:20;86:7 45:25;46:20;47:3;48: 10; issue (5) kidney (1) 44:23;65: 17;66:14,24,identifies (2) 52:9,10,14;59:7 15:24;26:13;36:16,18; 24:10 24;67:2;93:21

helpful -left (6) Verbatim Reporting, Limited(608) 255.7700

\ Iill-l '-Sl'ript H

Powers, et al. v.'American Family Mutual Ins., et al.


"(leg (1) 86:6 Marion (7) 10:9;26:8,8 80:12,17

7:22 lot (7) 4:21;7:14;14:11; medicines (1) Mornings (2)less (2) IS: 18,19,19;26:6; 21: 18;77:6;84:8;89:12 18:25 79:25;80:8

18:2;67:21 45:25;50:3;91 :8 marked (11) meet (1) most (6)level (4) Lou (1) 4:2; 10:19;43:17;44:5; 71:14 6:6;13:3,16;24:15;

54:9;86:20;92:21 ;94:7 4:15 50:20;53: 1;60:1;64:1; memory (4) 80:9;83:8levels (3) loud (6) 85:6,14;89:11 50: 17;58:8;90:15;93:2 mostly (3)

47:21 ;86:7;94:8 68:22;69: 14;71 :3; marking (1) mention (1) 11:23;73:11;88:10life (3) 77: 17;78:3;85:10 89:17 92:23 motion (7)

22:15;23:7;30:22 lower (1) Mary (1) mentioned (6) 20: 17,17;26:7,15;likely (7) 51:3 4:15 15:23;20:2;26:12; 31 :7;41 :24;42:1

14:1;27:12;32:16; lubricated (1) matter (1) 28: 18;80:22;81:24 motor (7)33:13;67:21 ;70:9;77:21 80:14 92:13 met (9) 62:22;63:2;64:9;

limit (3) lumbar (2) May (18) 8:25;35: 19;36:17,22, 66: 12;69:1;77:7;79:1023:13;36:21,24 68:10;76:19 26:18;27:9;30:14; 22;38:8,18;58:7;82:1 move (5)

limitations (5) 32:24,24;33:18,21,25; method (1) 11 :10; 17: 16;19:20;14:23;31:13,18,23; M 34:1,3,4;41 :4;44:8;49:2, 29:9 20: 13;68:583:7 13;54:2;66:5;88:18 microtrauma (1) movement (1)

Limited (7) M102 (2) maybe (5) 18:15 13:204:18;20:16;26:7;31 :5, 55:11,14 13:2;20:5;37:9,23,24 middle (1) moving (2)7;32:6;41:25 M116 (1) MD(l) 62:19 15:21;80:13

limiting (1) 56:1 5:4 Mifflin (1) much (12)68:4 M120 (1) mean (23) 4:18 7:11;9:3;14:16;19:24;

line (4) 56:19 17:3;21 :22;28:12; might (6) 26:21;31: 12;32:11;49: 17;65:21;68: 13; M121 (1) 30: 1;36:20;50:19;51 :7; 20:3;29: 15;34:16; 35: 12;37:25;68:6;83:24;76:14 63:3 52:12;55:23;56:12,14; 59:9;75:24;82: 13 94:22

lines (2) M130 (2) 57:2,4;63:8;65:2;66:2; mild (7) muddled (1)66:18;72:20 43:11;58:24 71 :7,17;72:13;74:19; 52:7,9,18,24;55:21 ; 93:18

listed (1) M228 (1) 75:16;78:8;83:12 86:17,24 multi-factorial (1)12:13 78:19 meaning (5) mine (1) 80:24

little (9) M230 (1) 18:15;57:20;72:21; 47:10 multi-level (5)6:4;20:3,4;27:10,18; 79:5 74:22;78:14 minimize (1) 56:23;57:5;77:10;32:10;35:9;44:2;84:19 M231 (1) means (17) 26:14 86:5;94:5

Iittle-bitty (1) 76:6 16:17;26:19,24;40:6, minute (1) multiple (2)18:]6 M232 (2) 7;47:20;5]: 10;57:3; 94:1 57:5;80:25

live (2) 76:8,14 63:10;66:3;69: I5,20; minutes (2) multitude (1)23:9;70:5 M234 (1) 75: 18;78:9;86: 11 ;87: 11, 57:9;82:19 91:12

liver (1) 76:23 12 modality (1) muscle (21)24:10 M92 (1) measure (1) 29:9 11:24;15:23;16:16,17;

location (1) 66:16 27:4 moderate (3) 17:17;18:7,11,15;19:7,17:25 M96 (1) meat (1) 77: 13;86:17,24 23;20: 18,19,23;21: 11;

long (2) 55:1 70:3 modest (1) 22:22;70:12;73:22;]9:9;55:24 M97 (1) mechanics (1) 13:2 79:17,18;80:22;83:11

longer (4) 64:3 77:22 moment (1) muscles (8)14:22;24:5;27:23;31 :6 Madison (4) mechanism (1) 17:8 16:15;17:24;19:18;

look (15) 4:7,18;8:4;42: 16 67:10 monitor (2) 20:8,11,21 ;29:13;80:239:21;10:18;39:15; major (1) medical (30) 23: 18,20 muscular (2)41:4;43: 12;45:15;47: 13; 75:7 5:16;6:16;8:11;11:5,6; monitored (1) 29:19;83:949:6,14;59: 10;62: 16; making (1) 16:1;22:6;24:20;27:20; 24:11 musculoskeletal (1)63:21 ;82:6;84:10;86:2 25:11 28: 13;34:7;35:5,24; month (4) 93:10

looked (1) management (5) 36:2,12;42:8;43:2;44:3; 41: 13;89:24;90:9;91:3 must (1)85:4 12:21,22;17:2,5;18:20 47: 18;51 :9;54:19;58:4, months (9) 84:8

looking (9) managing (2) 21 ;59: II ;64:8;65:7; 46: 19;47: I ;51: 17; Mutual (1)50:23;51: 16;55:3; 6:10;29:18 79: 13;81: 14,25;92:2 52: 15;89:19;90: 10;91 :3. 4:1061 :22;62:24;66: 17; manifest (1) medication (5) 24;92:9 MVA (2)68:] 8;69: 12;88:16 39: 11 18:24;23:22;26: 13; more (24) 56:5;63:1

looks (4) manner (2) 28: 10;32:22 13:7;14:20;18:2;20:3, myo- (1)45: 17;57:15;65:16; 23:4;47:18 medications (13) 19;23:4,16,16;27:10,14; 16:1772:16 many (6) 12:25;13:1,2,4,4,7; 28: 18;33:13;37:17; myofascial (4)

loosens (1) 12: 15;13: 17; 17: 1; 18:21;19:2;23:19,21; 44: 14;50:17;57:7;78:6, 16:3,18;29:18;83:980:13 23: 13;77:20;78:24 24:2,9,14 13;84: 11,20;92:6;93: 17, myself (1)

loss (5) March (3) medicine (8) 18;94:2 92:320: 17;56:10,16;77:11; 46:4;76: 10,24 5: 18,23,25;6:7,15; morning (2)

;\ lin··[ '-Sl'ript l-' Verbatim Reporting, Limited(608) 255.7700

(7) leg - myself

Powers, et al. v.American Family Mutual Ins.,.etal. '.


77:14 17:8,10;39:6;45:16; 13:23;86:13 55:14;56:1;57:12;58:25;N new (10) 47:11;59:22;95:12 original (2) 62:20;63:3;68:19,21;

38:6;46:20;47:3; offer (1) 10:21;93:14 76:14;86:2

N45 (2) 52:10,14;55:25;64:11; 10:16 originally (1) pages (3)69:11,12 67:21 ;71 :2;92:25 office (6) 41:7 47:13;56:2;62:15

N47 (1) newspaper (1) 10:23;44:17;62:4; orthopedic (9) pain (153)69:12 78:5 89:16;90:4,23 7:23;21 :22;25:10,13, 11:20,23,24,25;12:21,

N78 (1) next (8) often (8) 15,19,23;53:25;55:17 22,25;13:1,2,3,7,10,11,72:4 45:9;55:11,14;63:3; 13:20;14:23;28:23; orthopedics (1) 12,14,16;15:6,9,16,22,

N79 (1) 68:21 ;77:16;79:25; 32:12;33:17;39:13;43:1; 41:12 24;16:2,4,4,12,18,20,22;72:5 89:10 61:6 orthopedist (1) 18:18;19:11;20:16;21:6,

N92 (2) noises (1) oftentimes (7) 26:2 7,8,9,11;23:9;24:3;26:6,68:8,19 17:7 13:17;16:12;18:14; osteoarthritic (3) 14;28:22,22,22;29:13,

N93 (1) none (1) 27:3,5;32:6;61 :4 80:2,18,19 16,19,23;31:11,20,21;68:19 57:11 old (11) osteoarthritis (9) 32:9,15;33:16;36:1,7,13,

name (4) non-Ufe (1) 14:18;15:2;27:20; 39:5,7,10,25;40:9,12, 15,25;37:4,6,8;38:2,10,4:15;5:9;35:17;72:8 6:13 35:21 ;55:20,25;68:10, 18;88:3;91:17 16,17;39:4,18,25;40:4;

narrowing (2) non-pregnant (1) 14;71 :2;79:9;84:22 OT(3) 41 :23;46:3,17,25;47:14,77:14;94:6 6:1 older (4) 54:7;61:14,19 25;48:15.17.19.20;

nature (2) non-specifically (1) 6: I;14: I5;22:5;39:13 others (1) 49:20;50:6,15.19;51:3,4;27:16;58:9 60:20 once (1) 25:5 52:7,9.12,22.23;53:18;

nausea (1) Nope (1) 28:24 otherwise (2) 55:9;56:10,10,15,16;24:16 7:23 one (27) 8:17;23:17 65:23,25;66:12,21.25;

near (1) Normally (2) 13:8;17:24;18:6;20:3. out (21) 67:14;68:4;69:5;72:17,88:24 69:23;70:4 14;22:5.10;25:10;41 :8; 7:20;16:6;28:3;32: 12; 21;73:1,11,15,25;74:1,1;

necessarily (3) Nos (3) 43:19;49:4.9,10;53:5; 33:1;37:3,4;49:24; 75:8;77:7;79:10,16;24:6;50:19;61:2 4:1;12:18;64:12 54:23;56:2;57:7;61:22; 68:22,25;69:14;70:14, 80:16,23;81:1,4,8,10,18,

necessary (1) note (5) 64:22;70:21;71:22; 23;71 :3;74:2.8;77:17; 23;82:11,14,17,22;83:2,75:12 66:17;67:16;75:4; 75:21 ;89:3;92:2,4;94:2; 78:3,11;82:19;87:16 8,9,9,11.11;87:18;89:2,

neck (88) 89:12;92:3 95:1 outside (7) 23;90:7.8,16,17,17.18,7:21;11:23;15:22,24; notes (8) ones (2) 11: 16;16:5;20:11; 21 ;91 :2,10,13.20;92:5,16:2.19,22;17:22;18:3; 26:18;27:25;41 :4; 22: 11 ;24: 15 24:3;40:14,20;42:4 13,15,17;93:321 :9;22:24;28:22;31:7; 47:15,17,18;48:22;75:24 one's (1) over (15) painful (3)36:1,4,7,19;37:8;38:1, Notice (1) 85:6 11:21.24;13:12;18:5. 13:20;39:20;47:2210,16;39:4,9.16.25;40:4; 4:14 ongoing (2) 6;19:11;33:17;41:23; pains (1)46:3,17;47:25;48:15,17, number (3) 82:22;83:1 47:6;71:24;73:11,23; 16:1419,20;49:20;50:6,15,18; 7: 17;38:22;83:5 only (6) 79: 18;80:23;88:15 paper (2)57:4,6;68:5;72:17.21,25; numbing (1) 8: 10;9:9;50:4;55:8; overall (2) 27:23;78:973:15,25;74:14.25;77:7; 26:8 75:24;90: 15 33:17;79:21 paragraph (5)78:12,16.23;79:10.18; numbness (3) onset (1) overdoing (1) 77:3,16;78:1;79:20;80:16,23;81 :4,5,10,12, 78:2,4,10 67:22 32:8 80:2118,23;82:11,14,22.24; onto (1) overnight (1) pardon (1)83:2,19;86:11;87:2,18, 0 19:24 40:13 75:521 ;89:2,8.22;90:7,8.17, opiate (6) parent (1)20;91 :2,10,13,18,20,23; oath (1) 12:24;13:1,4;19:2; P 80:892:5,13,17;94:19 5:6 24:1,13 part (15)

need (5) Object (4) opinion (10) PI7 (1) 10: 11 ;41 :23;48:3,5;9:3;23:24;24:11;62:1; 33:2;46:5,21 ;49: 17 8:9,10,11;16:1;22:13; 50:21 49:3;51 :23;58: 12;61: 13;93:1 objection (4) 75: 10,18;80:17,19;81:14 P2 (1) 63:24;65: 17;74:12;

needed (1) 33:23.25;34:15;46:8 opinions (10) 44:20 76:24;82:21 ;88:6,1019:2 objections (1) 8:8;11 :2,3,6;33:10,12; P20 (1) particular (7)

needs (1) 47:2 37:22;47:7;81:17;95:4 51:13 36:16;45:24;60:20;7:24 objective (1) opposed (1) P3 (1) 76:3;77:1;82:15;88:16

negative (5) 65:13 92:19 45:9 particularly (8)43:20;54:12,15,17; observation (1) opposite (1) P5 (1) 22:5,9;41 :24,24;56:4;58:25 63:6 18:6 47:13 66:9;80:10;82:16

negatives (2) occasions (1) order (2) P6 (1) partner (1)56:9;70:18 27:17 7:3,3 47:13 30:24

nerve (1) occurred (2) ordered (1) pads (1) parts (1)78:14 15:12;94:9 41:10 30:11 14:19

nerves (1) October (1) ordinarily (1) page (18) part-time (2)29:12 45:2 28:2 39:2;44:20;45:9,16; 30:25;31:10

neuroforaminal (1) off (7) ordinary (2) 52:3;53:5,5;54:25; pass (1)

N4S - pass (8) Verbatim Reporting, Limited(608) 255.7700

Ppwers, et al. v.'American Family Mutual Ins., et ai.


7:6 83:6;91 :23;92:4,8,12 post (1) procedure (3) 78:7,11passenger (1) physically (1) 62:22 25:20,25;26:1 radio (1)

9:8 29:25 post-accident (1) process (2) 29:15past (3) physician (10) 92:10 69:19;88:6 radiologist (5)

24:1;36:11;44:2 5:11;8:1;10:8;12:10; posterior (1) professional (1) 40:21 ;60:15,20;70:7;patient (15) 18:19;30:19;42:23; 64:11 11:5 86:21

9:1;10:12;14: 14;22:4; 63:23;78:11;84:19 powerful (2) progress (2) Radiologists (1)26:6;36:25;38:1;39:13; physicians (2) 13:3,7 23:19;33:1 65:548:8;53: 17;72:15;73:23; 6:6;49:5 Powers (1) progresses (1) range (8)80:7;90:16;92:15 physician's (4) 4:9 32:17 20: 16,17;26:7,14;

patients (7) 41:8;73:4;90:14,21 practically (1) prolonged (2) 31 :7;41 :24;42:1;84:2314:17,21,21;20:16; physics (1) 23:5 19:8;22:8 rather (2)24:16;82:7;91:9 30:1 practice (5) promise (1) 78:16;92:14

patient's (2) picture (1) 6:5,8;7: 12;8:3,4 95:1 reach (1)30:2;81:1 93:18 precisely (1) provide (1) 73:23

patterns (1) pinched (1) 62:1 9:19 reaches (2)13:23 78:15 pregnancy-related (1) provided (7) 18:5;85:24

pelvis (1) place (2) 6:2 9:23;44:16,18;45:21; read (12)67:6 20:8,12 prescribe (1) 46: 16;50:8;82:3 17:13;32:1;50:17;

people (4) Plaintiffs (1) 29:2 provider (5) 53:8;61 :23;68:20,22;6:9;7:18;13:16,19 4:14 prescribed (2) 56:15;67:2,3;80: 10; 69: 13;71 :3;77:17;78:1,3

percentage (2) plan (3) 24:2;63:19 85:1 readily (1)7:16;83:6 68: 18;75:20;89:22 present (11) providers' (1) 62:9

performed (1) plateaued (1) 28: 10;30:18;41:19; 9:16 reading (5)43:10 27:8 48: 12,13;55:6,7;73:4; providing (1) 54:19;74:24;78:1,5;

period (3) play (1) 77:19;78:21;81:12 37:22 86:1622:8;33:21;38:18 33:1 presented (1) PT(1) realize (1)

periodic (1) please (51) 72:14 92:19 68:284:25 4:19;5:3,9,13;8:10,24; presents (1) purely (1) really (9)

peripheral (1) 10:18;11:11;17:9,16,18; 21:2 21:23 13:19;16:23;20:19;78:13 21 :1;22:12;23:1;30:15; presume (1) pursuant (1) 24:7;33:25;34:13;82:15;

permanent (9) 34:14;39:6;40:6;43:13; 71:22 4:14 89:23;90:1722: 14,19,21,23,25; 44:7,19;45:9;46:12,13; preventive (1) pursue (1) reason (3)26:25,25;32:3;48:17 47:11,15;49:14;51:14; 6:9 27:10 25:11;45:24;90:2

persist (2) 56:20;60:10;63:9;64:3, previously (3) put (9) reasonable (5)21:15;22:11 7;68:22;69:15;70:19; 28:6;58:23;95:4 7: 16;16:14;19:5;26:7, 8:11;11:4;33:14;65:6,

persisted (1) 72:4,11;73:19;75:17; primarily (1) 13;35:20;36:21,24;83:5 2055:24 76: 1,2,6,23;77:4,18; 25:14 reasons (1)

persistent (1) 78:3,19,19;79:4,7 primary (6) Q 91:1279:22 Plus (1) 6:6;8: 1;12:10;30:18; recall (5)

persists (3) 49:5 63:23;84:18 qualifier (1) 26:21 ;48:2;54:22;21:10,12,17 pm (7) print (1) 86:15 61:21;85:2

person (6) 4:8; 17: 11,15;59:23; 28:2 qualify (2) receive (1)30:5;86:13,16;91 :2, 60:6;95: 11,14 prior (35) 37:24;52: 19 7:817,19 point (2) 7: 1;9:1;12:9,13;15:5; quality (1) received (1)

personally (1) 27:13;49:24 20:2;23: 10,14;30:23; 30:22 27:1562:2 pointing (2) 35:25;36:1,4,15,20;37:7; quick (1) receiving (1)

person's (1) 78:11;87:16 38:1;40:3,11 ;47:25; 49:14 91:2330:12 points (1) 48: 15,19;50:14;70:13, quickly (3) recent (4)

perspective (1) 19:23 20,22;71:1,21 ;72:22; 14:20;84:7;85:21 66: 12;92:22;93:7,2130:2 pool (1) 73:3;74:7;77:20;78:25; quiet (1) recently (1)

Pertinent (1) 20:9 80:21;81 :23;93:14 39:23 94:456:9 portion (7) probability (2) quite (16) Recess (2)

phenomenon (1) 64: 11 ;65:13;72: 10; 33:15;65:7 6:8,10;9: I;13:16,22; 17:12;59:2427:2 74: 13;77:1;79:4;83:1 probably (4) 16:23;23: 15;24:19; recollection (1)

phone (1) position (1) 16: 1;17: 19;68:5;91:8 25: 19;27:12;28:7;29: 17; 26:2317:7 13:21 problem (4) 38:3;39: 13,13,18 recommendations (1)

phrase (1) positives (1) 19:15,15,18;26:9 10:1588:2 70:18 problems (17) R record (71)

Physical (17) possible (3) 12:3;21 :2,13,25;22:6, 17:8,11,15;28: 13;18:20;19:2;27:7,10; 13:25;91:4,7 11,20,22,24;28:21;32:3; radiating (1) 42:8;43:8,10,13,24;45:5;28:19;29:2, I 0;30:9; Possibly (4) 36: 13,15,20;37:14;72: 1; 53:18 49: 1,7,21,23;50: 1,6;31:10;32:25;33:22;75:8; 48:6,7;65:3;91: 16 93:12 radiculopathy (2) 51 :4,9;52:3;53:17;

\ lin-l -Scripf:: Verbatim Reporting, Limited(608) 255.7700

(9) passenger - record


Powers, et al. v.American Family Mutual Ins.,.ef al.

54:20,22;55:3,8,11; 35:6;41:14 5:20;6:20 94:10,20 saw (17)56:19;58:23;59:11,22; related (12) residents (2) right-sided (1) 9:2,10;24:5;25:19;60:5,9,19;61:8,15,20; 12:8;32:15,19;34:11, 6:21,22 79:10 26:2;29:5;36: 18;38:7,62:1,14,23;63:18;64:6,8, 24,25;41:18;67:22;69:1; resolved (2) risk (3) 20;41 :7,8,12;50:16;10,17,20;65:14,19;66:9, 82:23;83:2;93:22 21:6,8 15:2;22:7;24:18 68:23;73:4;81:11;90:1416;67:1;68:9;72:4,10,12, relates (1) response (2) risky (1) saying (5)24;73:3,6,10;74:13,24; 93:18 33:4;40:25 22:3 34:2;70:7;80:5,7,2475:12,23;76:3,I0;79:5; relationship (2) responsible (2) Road (2) scan (19)86:16;89:10;90:13,22; 8:24;83:10 19:19;25:15 4:6;8:5 11:19;12:17;16:5;92:3;93:1;95:12 relatively (2) rest (2) Roger (2) 40:21;42: I 0;43:5,6;

records (44) 9:2;15:13 16:25;22:14 4:23;35:17 56:22;58: I 9;59:14;9:14;27:21;36:3,9; relevance (3) restate (2) role (2) 60:11,12;61:6;64:21;37:8,13;38:12;42:14; 46:6,22;49:18 34:14;46:13 6:24,25 65:12;76:19,19;88:17;44:9,15,16,22;45:21 ; relevant (8) result (5) roll (1) 94:446:2,15,24;47:5;49:3; 44:3;46:1;74:23; 18:14,18;32:8;85:15; 88:9 scanned (2)50:2,3;51 :23;53:4,21; 75:25;82:9,10,13,16 92:24 room (8) 58:3;59:1054:3;57:22;58:1,4,22; relief (2) resulted (3) 7:20;11:17;42:4,1 I, scans (1)59:9,14;61:10;62:7; 26:16;75:8 9:12,13;31:22 18,19,23;67:4 43:363:25;65:7;69:11;75:6; rely (1) results (1) rotate (2) scapula (I)76:1;81:25;82:4;83:19; 10:14 88:16 16:24;20:13 28:2384:6,9,10;90:3 remember (I) return (2) rotator (23) school (2)

recover (2) 61:21 27:6;31:9 12:1 ;20:2,5,7,14,22; 5:16;6:1614:20,22 remembered (I) returned (1) 21:16,19,23;22:17; seatbelt (2)

recovery (I) 42:18 92:8 25:12;26:12;29:I;40:24; 65:17;89:622:8 remembering (1) review (10) 41 :2,11,15;69:17,24; second (8)

refer (2) 75:21 36:3;42:24;45:20; 70:10;74:4,9;83:9 25:19;26:2;35:10;25:17;26:18 remote (1) 50: 11 ;62: 1;73:3,6; Rottier (9) 68:20;76:14;79:20;86:2;

reference (25) 88:12 91 :25;92:2;93: I 4:25,25;33:2,4,23; 93:118:16;29:5;37:7;40:25; repair (1) reviewed (7) 43:17;84:2;93:25;94:21 secondary (3)42:6;43:23;45: 1,12; 25:16 45:25;58:5;59: 11; roughly (1) 39:4;40:4;66: 1247:14;49:20;50:6,13,16; repeat (I) 61: 19;65:8;75:4;82:8 67:17 sedation (1)51:16,19;52:6;53: II; 70:19 reviewing (3) round (1) 24:1655:17;60: 17,18;63:15; report (9) 47:5;57:21;73:5 20:10 seeing (4)64:24;66:7,13;73: 15 9: 10;12:17;18: 12; rib (18) routine (1) 36:8;52:22,23;61 :22

referenced (5) 38:21;42:10,11;52:17; 11:18;12:19;15:14; 32:5 seem (I)5:23;7:1;25:25;27: 16; 65:1;80:16 21 :5;43:4,23;58:16; Rowan (1) 39:1746:24 reported (3) 59: 17;60:7,13,18,23; 4:17 selected (2)

references (5) 10:5;80:8;90:10 61 :4,9,11;64:11;65:9,10 rule (5) 6:21,2345:5;56:5;64:23; reporter (2) ribs (21) 7:20;16:6;70:14,23; sense (I)66:21;71:16 4:16;5:3 12:15,16,20;13:8,14, 74:8 16:21

referencing (2) Reporting (1) 24;14:3,4,8,13,18;15:8, run (I) sentence (3)28:5;53:15 4:17 9,16,18;53:11;60:16; 17:24 68:20;77:25;79:25

referral (1) reports (1) 63:15;64: 18,23;65:1 running (1) separate (2)25:11 61:15 right (94) 18:3 15:8,22

referrals (I) represent (2) 8:14;11:9,23;12:2,12; September (3)25:5 34:7;35:17 15:21,21,24;16:2;18:5, S 89: 13,17;90:25

referred (1) request (I) 10;20:7;21 :9;22:24; serial (I)25:7 54:3 23:25;25:3,23,25;27:14, sac (1) 63:7

referring (1) requested (2) 24;28:5;30:8;32:12; 69:25 set (2)86:8 44:15;58:1 34:17;35:9;36:12,14; sadly (I) 43:15;84:11

refractory (1) require (6) 37:14;38: 13,16;40:24; 31:12 seventh (1)17:1 12:6;23:15;32:24; 41: 1,15;43:11;44:20; safe (1) 60:16

refresh (I) 33:21 ;61 :5;62:3 45: 18;46:24;47:4;49:23; 31:8 several (1)58:8 required (2) 50:5,21 ;51 :3,4,13,19,24; same (18) 23:8

regard (1) 24:21,22 52: 1,25;53:6;55:1,12,14; 8:14;14:25;19:25; severe (13)38:13 requirements (I) 56:1,19;59:4;64:4,11; 28:21 ;32:16,18;33:23; 77:10;86:5,15,18,22;

regarding (3) 31:11 65:23;66: 14,16,21;67:2, 37:4,13;38:13,15;46:8, 87:1,17,20;88:19,24;25:12;58:8,24 requires (2) 10,14;68:24;69:5,9; 23;47:2;52:3;54:6,8; 91:2;94:7,8

regards (3) 23:18;33:10 70: 13,20,22,24;72:2,7, 94:8 severity (1)35:25;36:12;41 :22 residency (6) 18,22;74:4,7;75:3,9,14; sandwich (2) 16:21

reiterating (I) 5: 18,21 ;6: 17,18,23; 76: 12;78:5;79:18;81:13; 70:2,3 S-H-A (1)80:8 7:5 85:11,13,19;86:13; Saran (I) 51:25

relate (2) resident (2) 89:21 ;90:2;92: 17;93:16; 16:16 shallow (I)

~I

records - shallow (10) Verbatim Reporting, Limited(608) 255.7700

Powers, et al. v.,. American Family Mutual Ins., et al.

Video Deposition of GINA A. UTRIE, M.D.August 30,2011

20:9 similar (1) 26:21 ;28:7;46:13; 4:7,19;5: 1;7:6;16:9; suddenly (1)share (1) 15:14 52: 13;62:24;70:18 33:13 38:6

84:24 simply (1) sort (10) stated (3) suffers (1)shared (1) 31:11 12: 12;29:11 ;32:9; 33:5;67:2;95:4 20:14

34:8 sit (2) 34:9;39:22;41 :21 ;69:20; statement (8) suggestive (1)shift (1) 20: 11 ;52: 11 71:9;74:2;81:14 32:2;59:12;69:4; 41:11

44:2 site (1) sought (1) 87: 14,1 5;88:10;90:6,18 summarize (1)short (3) 24:23 38:11 states (16) 79:7

71:15;84:4;85:5 sites (1) sounds (2) 53: 17;61: 15;62:23; summary (4)shortness (2) 23:11 65:20;84:17 63:5,18;69: 16;72: 19,20; 34:9;53:8,12,16

56:11,17 sits (4) South (1) 73: 10;74:14;75: 15;79:3, superimposed (1)shoulder (62) 20: 11 ;69:22,24;70: 1 4:6 9,25;90: 1;94: 18 93:17

11 :24;12:1,2;17:22, sitting (2) space (3) static (1) suppose (1)23;18:4,6,8;19:14,16,17, 13:21;39:20 69:23;70:4;88:7 29:14 51:2419,20,20;20:8,9;21:13; situation (1) spaces (1) status (1) supposed (1)22:20;26: 10;36:12,14, 82:15 94:7 62:22 46:1019;37: 14;38:2,13,17; situations (1) specialist (1) stay (2) supraspinatus (1)41:23,25;42:1;45:6; 21:2 10:9 32:16,18 70:1146:25;51:4,19;52:2; six (2) specific (1) steroid (1) Sure (12)65:23,25;67: 10,14;68:5, 91:24;92:9 60:18 26:8 27: 1;33:8;34:2;61:19;21,23,25;69:5,9,21; sixth (1) specifically (7) sticking (2) 62:2;63:22;70:20;73:5,70:14,21,22,24;71:9,11; 60:16 10:2;32:20;41 :22; 51:12;76:14 21 ;81 :8;86:25;87:2372:2;73:22;74:1,4,8; skin (1) 61 :9,10,23;64:17 stiffness (1) surface (1)89:7;90:15,18;92:5; 29:12 spectrum (2) 61:16 90:993:3,22 sleep (2) 13: 1,6 still (3) surgeon (6)

shoulders (6) 13:23;91:15 speculation (1) 21 :2;76:24;93:13 21 :22;25: 13,15,19,23;22:9;31 :7;45:12; sleeping (1) 63:23 stimulates (1) 42:2553:19;61:16;66:14 14: 1 spinal (1) 29:11 surgeons (1)

show (6) slid (1) 63:6 Stitgen (2) 25:1017:19;59:3,3;85:3; 9:11 spine (11) 25:7,13 surgery (3)89:10;94:2 slight (1) 55:22;56:23;58: 13; stop (2) 21: 18;22:3;75:12

showed (1) 75:22 60:11;63:1,7,13;64:21; 57:20;59:18 surgical (2)68:10 small (3) 68: 10;77:22;85: 15 Stoughton (2) 7:21;25:15

showing (1) 24: 19;33: 19;42:4 spot (1) 4:6;8:5 surprise (1)94:7 small-town (1) 32:10 straight (1) 80:10

shown (1) II:17 squished (1) 45:15 surprised (4)58:23 sneezes (1) 70:8 strap (1) 46:2,7,16,23

shows (4) 14:4 stabilized (1) 30:9 surprising (1)79:11;91:3;94:5,11 soft (4) 24:4 Street (1) 91:19

shy (1) 15:12;70:2,6;80:23 stable (1) 4:18 suspect (2)84:15 sold (1) 33:18 strike (3) 60:24;68:25

sic (1) 31:24 stage (1) 10:4;66:7;75: I sustain (4)55:21 somebody (6) 46:11 stronger (1) 13: 17;58: 12;65:8;

side (7) 10:5;13:12;14: 1,3,8; stamp (2) 19:2 92:248:5;11:23;18:4;24:8, 80:12 44:19;58:25 structures (2) sustained (7)13;41:23;79:18 somebody's (1) stamped (4) 70:3,6 11: 18;25: 16;58: I 6;

signal (1) 17:7 43:11;49:2;51:13;76:2 studies (2) 60: 13,23;65: 10;83:429:16 someone (5) standard (3) 23:20;24: 12 swear (1)

signed (4) 13:11;30:15;42:10; 5: 19;37: 1;54:8 study (2) 5:366:2,3,4,9 74:23;82: 14 standpoint (4) 39:14;59:16 sweet (1)

significance (1) sometime (2) 21:24;37:11;87:13,14 subacromial (1) 32:1010:8 65:5;82:5 stands (2) 26:4 Swenson (89)

significant (15) sometimes (13) 63:2;71:6 subjective (5) 4:21 ;7: 14;8: 15,21,24;10: I 0;13:16;16:7,23; 16:8,9;18:21 ;26:6; start (5) 55:8;64: 10;72: 10,12; 9: 15,17,24;10:2;1 1:13;19:6;39:5,18;40:17,19; 29:9;39: 12,18,19,20; 12: 15;13: 19;27: 12; 74:13 12:6,23;15:3,25;16:22;52:21;68:4;74:15;77: I 0; 68: 1;80:11 ;86:21 ;91:15 59:19;92:14 subsequent (1) 18:11,23;19:6;21 :3,18;86:18,22 somewhere (1) started (8) 41:2 24:21 ;26: 16;29:3,20;

significantly (1) 36:6 7:9;16:11;18:24; subsequently (1) 30:16;34: 10;35: 19,21;31:5 soon (1) 35:21 ;36:8;37:9;67:13; 40:16 36:6,23;37:19;38:8,10;

signs (1) 90:4 84:18 substantial (1) 41 :7,22;42:2,14,22;69:16 sooner (2) starts (1) 68:2 44:22;46: 17;47:24;48:4,

silence (1) 92:14,15 18: 1 subtle (1) 15,24;50:3,15;53: 14,24;48:21 sorry (6) State (6) 61:7 54:14;55:20;57: 15;

\lill-L-Scrip ti: Verbatim Reporting, Limited(608) 255.7700

(11) share - Swenson

'"I

~I

Powers, et at. "v.American Family Mutual Ins., .et a1. '4

Video Deposition of GINA A. UTRIE, M.D.August 30 2011,

58:11,15;60:8,13,23; tear (29) 60:11;64:21;68:9;76:19 18:8,10;19:7;20:1;61:1,11,14,17;63:20; 12:1 ;18:16;20:3,15, though (3) 21:11;22:22;28:22; U65:8,16,23;66:8,25;67:9, 20;21:16;22:18;27:11; 20: 18;24:19;56:17 73:11,21,24;79:19;13;68:15;69:5;72:1,16, 39:8;40:12,24;41:2,11, thought (3) 80:24;90:17 ultimately (1)22,25;75:3,7;76:11; 15;57:3,6;69:17;70:10; 46: I;82:8;90:20 trauma (10) 48:1177:6;81 :3,10,18;82: 11 ; 71 :18,22;75:13;79:12; threatening (1) 16:13;39:21;42:25; unclear (1)83:16;84:8;88: 17;89:2, 80: 11 ;81 :4,11 ;82:23; 6:14 43:1;54:4,9;81: 15; 22:212;91:18,22 83:3;88:6,12 three (11) 88:12,13;91:6 uncomfortable (4)

Swenson's (28) tears (3) 5:17;6:7,23;12:18; traumatic (5) 13:22;14:5,7;16:249:20;14:11;28:19; 18:16;20:18,24 13:14;14:3,8,13;51:2; 62:23,25;67:21,23; uncovertebral (1)35:24;36:11;37:8,13; technical (1) 52: 15;84:15 71:23 77:1239:25;40:9;41:15;43:6, 21:24 Tight (1) travel (1) under (11)9;44:2;50:9;54:11; tells (1) 45:6 28:23 44:25;55:3;56:4;57:21;58:24;59:12; 10:12 tightness (1) treat (4) 64: 10;66:17;69:12;61 :24;62:7;66:14;69:8; temporarily (1) 45:12 7:25;18:23;82:20; 72:10;75:20;77:1;78:21;77:5;78:23;80:16;82:22; 27:5 timeline (1) 92:16 86:483:19;90:8 tend (1) 91:25 treated (7) undergraduate (1)

sworn (2) 14:20 times (2) 8:21;10:3;25:3;36:6; 5:155:6;9:20 tenderness (2) 24:9;30:25 42:2;47:21 ;50: 18 underlying (3)

symptom (1) 55:21;65:16 Timothy (1) treater (1) 16:10;91 :17;93:378:16 tendon (7) 25:21 84:18 underneath (1)

symptomatic (13) 20:20,22,23,24;26:11; tingling (2) treating (1) 26:1112:20;16:8;39:23; 69:24;70:10 78:4,10 37:10 understood (2)68:15;70:17;77:24;80:9; tends (1) tip (2) treatment (18) 12:10;34:2281 :16;87:14,18,22; 20:20 69:20;71:9 7:25;9:15;12:6,20; undersurface (1)91:14;93:14 TENS (5) tissue (6) 24:20;27:15,16;28:17; 69:18

symptoms (29) 29:6,8,20,22;30:3 20: 18,22;70:2,6; 32:19;34:9,12,23,25; underwent (2)7:25;10:5;12:7;15:14; terms (15) 79: 17;80:23 37:19;38:11;47:25; 76:15,1818:12;24:10;27:5;31:15; 13:1;28:17;37:21; tissues (1) 50:14;72:25 undoubtedly (1)32:7;39:11;40:15;41 :17, 39:7;40:6;53:15;57:2; 15:12 treatments (2) 13:1218,19,20,21;44:25;45:5, 60: 19;69:15;71 :7;72: 13; today (7) 9:17;84:25 unfortunate (1)11 ;48: 12;75:19;79:21; 73:19;75:16;78:8;79:8 4:22;8:8;44:10;52:11; tries (1) 65:480:2,11,18,20;82:22; terrible (1) 57:24;58:6;88:2 16:14 unit (5)83:2;89:23 34:16 today's (2) trouble (2) 29:6,8,20,22;30:3

syndrome (1) terribly (1) 82:4,5 14:1;39:17 University (1)78:6 15:2 together (3) true (11) 5:16

territory (1) 23:3;28:23;70:8 14:22;15:17;87:14; Unknown (1)T 21:21 told (2) 88:10,11;89:4,5;90:4; 55:24

testified (8) 9:10;63:22 91:12,20,21 unless (1)TI2 (1) 5:6;35:19;48:14,17; took (1) try (9) 8:17

68:11 50:15;59:17;70:16;75:5 75:24 20:4;29:23;34:17; Unlikely (2)talk (4) testimony (4) top (8) 37:3,4;62:15;82:20; 14:10;81:15

7:13;11:12;13:10; 8:7;9:20;46:1;50:9 10:22;18:7;20:10; 84:3;85:5 unremarkable (1)27:18 Thanks (4) 45:15;49:5;55:3;68:19; trying (3) 67:7

talked (4) 8:20;28:15;35:9;95:8 69:22 48: 11 ;65:20;86: 16 unsure (1)15:5,22;19:14;54:11 theory (1) torn (2) tunnel (2) 46:10

talker (1) 29:16 74:4,9 78:6,15 unusual (2)85:10 therapies (1) torso (1) turn (4) 87:21 ;88:23

talking (9) 23:19 15:11 16:24;44:19;45:9;53:5 up (21)8:15,17;10: 1; 17: 16; therapist (1) tough (1) Two (19) 8: 1;13:3,21 ;20: 13;41:21;43:4,5;60:7;64:22 29:10 19:5 4: 18;16:2,19;19: 11; 30:18;39:22;40: 11 ;45: I,

talks (2) therapists (1) towards (3) 38:4;44:13;56:2;57:15; 15;46:4,18;47:1;59:3,3;86:3,5 30:10 13:7;74:12;78:22 70:1,2,7;71 :13;84:19,20; 62:3;63:22;68:7;80: 12,

tape (4) therapy (13) training (1) 86:7,9;89:19;90:10;91:3 13;84:11;91:357:9;59:19,21 ;60:4 18:20;19:3;27:7,10; 51:23 two-day (1) upon (1)

tasks (1) 28:19;29:2;32:25;33:22; translated (1) 7:5 8:932:5 75:8;91 :23;92:4,8,12 51:7 two-year (1) upper (18)

T-bone (1) thinking (2) transport (1) 38:17 15:11;18:3;43:11;9:12 24:17;75:24 24:23 type (3) 44:20,23;50:21 ;51 :3,13;

teaching (1) third (1) transported (1) 13:20;39:21 ;79:12 53:6;55:1,12,14;56:1,19;6:25 62:21 42:15 types (1) 64:4;65: 17;66:16;72:7

team (1) thoracic (8) trapezius (17) 18:22 use (7)42:25 51 :3;54: 17,23;55:21; 11:25;15:23;17:17,25; 29:10,22;40:19;51 :8;

Swenson's - use (12) Verbatim Reporting, Limited(608) 255.7700

~,"


60:21 ;65:4;86:21 11:20;15:5,10,19; words (2)used (I) 21:7;38:2;66:11;68:4 19:5;88:6

24:1 Waupun (I) work (5)useful (2) 42:5 14:i5,20;29:25;31:10;

26:7;29:18 way (10) 82:7uses (3) 8:14;13:3;19:25;46:4, working (1)

51 :6;52:1;86:15 25;59: 12;60: 15;65:3; 30:25usual (2) 83:20;85: 12 work-up (2)

17:1,5 ways (I) 42:21;61:13Utrie (15) 23:8 worse (10)

4:4,13;5:4,10,13;44:5; wear (14) 15: 16;32: 16;33: 18,21;59:22;60:5,7;64: 1,3; 39:8;40:12;57:3,6; 40:7,10;80: 11,16;87: 12;68:24;84:3;91 :22;95: 11 71 :18,22;79: 11 ;80: 10; 94:15

UW(14) 81 :4,11 ;82:23;83:2; worst (I)42: 15,22;49:4;53:21, 88:5,12 80:124;54:3;57:21 ;59:9; wears (1) worth (1)61:14,20;62:8;63:20; 88:8 22:174:14;76:11 week (6) wrap (2)

UW-Madison (1) 30:25;44: 13,14,14; 16:16,185:22 58:7;89:19 wrist (1)

weeks (5) 78:15V 13: 18,19;41 :6;44:13; write (1)

84:15 90:3variety (1) welcome (2) wrong (3)

88:25 83:15,25 18: 10;50: 1;91: 15various (1) weren't (1) wrote (1)

24:8 90:10 92:1vehicle (7) what's (14)

62:22;63:2;64:9; 16:4,15;26:4;32: 12; X66:12;69:1;77:8;79:11 39:24;44:4;50:20;53: 1;

Verbatim (1) 59:6;64:1;76:13;82:19; X-ray (27)4:17 83:22;85: 14 41 :10;43:9,20,24,25;

versus (2) whenever (1) 54:11,14,17;58:24,25;4:10;83:3 8:8 59:3;60:22,25;61:5;

vertebrae (1) When's (1) 67:6,7;68:24;69:8;70:6,54:24 58:5 9,14,2 I ,22;71: 1;74:8;

vertebral (1) whereas (1) 76:15,1963:1 78:13 X-rays (1)

VIDEOGRAPHER (9) whiplash (1) 81: 134:3,16;5:2;17: 10,14; 77:2357:8;59:20;60:3;95: 10 whole (1) Y

videotaped (1) 85:44:4 who's (1) year (7)

visit (13) 13:12 5: 19;6:24;14: 18;41: 10;64:9;66:5;69:6; who've (1) 55:20;83: 17;92:6, I 872:22;76: 11,24;89: 12, 91:10 years (22)16;90:4,23;92:2,4 win (1) 5:17;13:13;19:11;

visits (1) 34:16 30:16;35:20,25;36:7,22;23:16 Wisconsin (4) 37:9;38:4;39:23;50:4;

voiced (1) 4:8,12;5: 16;42:5 77:20;78:24;79:9;82:12,89:3 without (9) 18;84: 19,20,22;87:7;

voices (1) 54:21 ;70: 13,20,22; 88:891 :19 71: 1;73:5;74:7;76: 19; Year's (1)

voluntarily (2) 81:14 92:2544:16,18 witness (9) younger (1)

5:3,5;33:3,7,24;62: I 7; 14:16W 83:25;94:23;95:9

woman (1)wait (1) 88:23

94:1 word (8)waiting (1) 33:25;34:4;40: 19;

92:19 60:21 ;61 :23,23;65:4;wall (8) 87:10


\!in-t'-Srript ;! Verbatim Reporting, Limited(608) 255.7700

(13) used - younger

MEDICAL RECORDS CERTIFICATION

I, b~~vV- GOYj t:tY\ f11 ~lIto.. s-::,C.:...r , of(Name). '(Title) J

/1 l lie)/'. r r ('fr._.v.. /"\/) u),\c;Jo.&/ {jill e:- 0r~1'tlch?do hereby certify that the attached photocopies

(Provider)

of the medical record of J!.(flr i 6J1 ~K (We (OOB): W"p '7 ,(Name of Patient) 7

covering the period of '/!?pO to ft <rilL-r .consisting of ..2g'

pages has been compared with the original on file and that the attached photocopies

are a complete, legible and accurate duplicate of the said medical record, except for the

following:

P1

NAME, ADDRESS Be TELEPHONE NUMBER OF HEALTHCARE PROVIDER:

COpy

" "." "..I SWENSON, :MRS. WiNTON (HARION· ~.L F.-E. DATE 1-29-80 (5-28-75) CASE' 00148·i ~~~.NAME-'11#-. .... - .-.. WISCONSIN . 8O-1'1~STREET ,'BOX,]'7' - "CITV~'~·· - STATE ZlfI""- S3SB2 MAIU'rAJ:;: M •....~

':1- OCCUPATION J Housewife 50 BIRTN DAT.ll2'§l 9.-sTEL. 6Q",.hr4201 AGE,ur..:. . )'

REFERRED 8" :sel f PREVo D.C. T.R.Clinton, D.C. QB, Aller

SYMPTOMS L.B.P. MD. INTO-LEFT HIP 5 YRS., MORE ACUTE SINCE 10-5-79; TIGHT SHOULDERS SINe...r0-5-79 .

i

. SURGERY ". App; Ton;Hyst;B.ladder

'tUURY,Auto acc 1O-fj..;19

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Tele. 608-270-0710 Employer STAT! BANK OF CItOSS PQccupation ---:;;U=T_Ill=!D=- SO 7-26-29

Marital M 4 Referredby SELP. Prevo DC NON! Age::.:..75::.-..._

Initial Symptoms 1-21-91 LBP !AD "INTO L HIP I TIGHTNESS IN SHOULD!llS

SIMPTQHS 4-4-05 ! cP & ST1J!J!1i!SS 1 H!U, HAC, SEU L KH!1$ pAIN WB!H TN FI.OII»! 2 MONTHS At

Ace/lnJ AUTO ' 79

Medication NONE UPOllT!D

Surgery UP., TON., RIST.. BLAPDn

BP ---l_PP WI. Ht.__

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5

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DATE TREATMENT a.-SYMPTOMS f-FlNDlNGS OX-DIAGNOSIS ,e-PLAN(SUbJective) (ObJective) (Assessment)

,

DATEMO. OAY YA.

Cons.·X-r~st·Anal~s '$60.00 80-1-14475-5-1102

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c.:HG. CASE NO. \

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DATE DATE Las t fJ 1ms . '-29-80• DAY YR. MO. DAV YR. L.~.1'd (S":r//, r:L ..

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DATE X·RAYS CHG. CASE NO.

~IIPII'?ia:lress ..6J.J3aEngelhart Dro City "::lfadtiioit State WI Zip 53713 SSN: 399-26-7979

Tele. 608-270-071J!.Employer Bank.·~ ...9;oss PlaCiBupatlon--.!.~l~~""-,, -----80

Marital M-4 Referred by Non~ . Prevo DC ~No;;:;::ne=- Age: 61

Initial Symptoms LBP Rat'Hating into Lt. Hip. Tightness jn shoulders.':.-

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P18PRE-SERVICE !QB!: pst =Pre-seuice 1: levier patiellt records; PS2 =Pre-seuice 2: Bevier I-rays/previous diagDostic testa;PS3 =Pre-senice 3: COB1IJIicating lith staff/Preparatiolls for care.HOIB: fhis clinic follols the protocol of the GOlStead Chiropractic technique cliaical procedures. Bacb office lisit the patieDt~a cODsultation for respolle to prelloDs treataeat, curreat SJlptOIS, hrief history .piate,. paillatile or prolocatlle actilltles,eliliuatioD hy lisaa1 aualys!s, static iDd lotlol paJpatiol iDd apiaal heat 4iffereltlal for !nterlertebraJ joilt drsflDctioll.Orthopedic testa as appropriate.I.: Subjective ~: Objectire - lecordillg Is doue 01 a 0 to • paiDt .cale (0=10 flndhgs, 1=Jild, 2=104eote, 3=a04erate selere,I=.e,ere). m =Joiut d,.foction fiDdill!s reported as ..!.ll- Ihere a=loUol palpaUol, b=tendeneas, c:spiaaJ heat 4Uferea-thIs, d=paraaplaalIDse1e coatracUoll. b14 .1: AsseaOeAt l.: llil - en aud reapo..e reported as .I!... rhere e=adjastaeat respoue of 0=10 IOIUeut, l=Jesa thai appropriateIOvelot, 2:goo4 IOmeat, ]=oJer adjusted rr f=adjastwt 4iscolfortpoSt-SOfia: bn: 'oat-senlce 1: Prepare docueabUoll; l2n: Post-Senlce 2: Discus case lith staff/redo l1teratue.

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· P20PRE-SERVICE IORl: PSI =Pre-senice 1: Rerier patient records; PS2 =Pre-senice 2: leviel I-rays/previous diagnostic tests;PS3 =Pre-ser,ice 3: (olJUDicating lith staff/Preparations for care.lOrE: fhis clinic follors the protocol of the Constead Chiropractic technique clilical procedtres. Each office ,isit the patfenthas a consultat1ol for respoDse to pre,ioJs treatlent, currelt SJlptOIS, brief histolJ Ipdate,. pall1all,e or pro,ocati,e acti,!tie8,eJuinatfoD by visual ana1ys!s, staUc aDd IOUOI palpatiol and spinal heat dfffereatfal for iDtenertebral joiDt dysfancUon.Orthopedic tests as appropriate.1: SabjecU,e 2: Objecti,e - Recording is done 01 a 0 to 4 po1lt scale (O=no ffilligs, 1=af14, 2=lo4erate, 3=aoderate se'ere,4=seJere). m =JoiDt dpfuctfol findia,. reported as .!.l.£.. wbere a=lOtiol ,al,alfol, Il=teaderaess, c=spiD11 heat differu-tills, d=paraspiDalluscle contraction. III d .1: Issesslut I.: Plu - (If aDd respol.e reported II 1!... ,llere e=adjastleat respoase of 0=10 lO'eteat, 1=less tllu appropriateloveaent, 2=9004 lO,ea8lt, 3=Ofer adjlSted Ir f=a4jlstleat 4isCOlfortPOSf-BlJIlla: !21! =Post-senice 1: Prepare doeueabtfOli bn : Post-Senice 2: Discus we lith staff/redel literafue.

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iRE-SERVICE VORK: PSI =Pre-service 1: Reviel patient records; ~ =Pre-service 2: Be,ier I-rays/pre,ious diagDostic tests;PS3 =Pre-senice 3: COBunicating litll staff/Preparations for care.lOrE: fbis clinic follols the protocol of tJ1e Gonstead Cbiropractic feeW'lle clinical procedures. lam office dsit the patienthas a consultation for response to pre,ious treatleat, current SJlptOIS, brief bistory Ipdate,. palllati,e orpro'ocati'e acti,itieseluiaation' by· visual analysis, slatic aad IOtiOI palpatiol and spinal beat differential for intmertehral joint dfsfDJIctioa.Orthopedic tests as appropriate. .'I: SlIbjectiYe ~: Objective - lecordiag is dODe OD a 0 to 4 point scale ('=,DO fildilgs, 1=lild, 2=loderate, ]=Ioderate se'ere,4=8e,ere). ~ =Joint dysfDJIctioD fiadings reported as~ vhere a=lotiol palpation, h=tenderless, c=spinal heat differe!tials, d=paraspinal luscle contraction. hi d 0

1: Assesslut l.: Plan - W and respollse reported as 1!.. where e=adjustlut response of O=no JO'UeDt, 1=less thaD appropriatelovueat, 2=good loruent, ]=over adjl8ted Ir f=adjustlent disconDItPOSt-SBRVIg: PoSl =Post-seniCt 1: Prepare doeuentatiol; ~ ='ost-Senice 2: Discuss case lith staff/reliel literature.

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Medicare Health History Update. Dace1-#-&1

FullNune~1J~~ t_ ~J~hone#------- Date ofBitth _

P24

(Zip)(State)(City)

Address,__--:- _

(Residence and mailing)

Age__ Wt.__...Jlbs Blood Pressure--I~g

PmattCompbiat 6:n.P)-~.-L4.J=-----------------

When did this problem begin? _

Did your problan begin: ( ] imniediatdy after a ~ecific incident, [ ) unevendU1ly, [ ] gmduaIIy over timeIfyour problem began following a specific incident, please uplain?, _

Is your am:ent complaint associated with an old injw:yl Yt3 or NoWas your current complaintaggra~ by a recent incident1 Yes or No

Please describe the character ofyour amatt pain: (You may check one or mote answ"ea.)[ ) sIw:p/stabbing [ ] shatp/dull [ ] acht3 [ ] dull [ ] soreness( ] weakness [ ] numbness [ ] throbbing!gnawing [ ] shooting[ ] gripping!constricting

How otten are the complaints present? [] Constant [] 75% ofday [J 50% ofday [] 25% ofdayOthu _

Since your problem be;~ is the paiD: [ ] Increasing [ ] Decreasing [ ] Not Changing

Indicate how your symptoms are affected by physical activity:_ symptoms are unaffected by rest, exercise, etc.~ symptoms increase with, or are ~deworse by, exercise or physical activity._ symtJtomS increase with, or are made worse by, rest or inactivity.

• •••. f

Are your complaina affecting your ability to wode or otherwise be active?No effect

_ Some physical restrictions (able to do light duty work and household tasks.)_ Need limited assistance with common everyday tasks._ Need assistance often._ Have a significant inability to function without assistance._ Am totally disabled (impaired). Cannot care for sel£

.~ .

Please Jist all medications and/or vitainins you-are azrrencly taking:Type For ".: Type For _Type For ··TfPe For _

______~Date:....- _______--'Oate _

)lease list all surgeries:rype When:, _.ype When:. _

Accidents/ln;uries:. _

TypeType

P25

Present[ )I ).[ )

I JI ]( )[ J[ )I I[ ]

PackslOay_Per Week_

CupslDay_CsnslDay_

ConditionEmphysemaArthritisDrug orAlcohol DependencyDiabetesUlcerKidney StonesBladder InfectionOther ---'_Other _Other _

Check All.~t ApplyTobacCoAlcoholTranquilizers! Sedatives

LaxativesCoffeeSoft Drinks

Past Respiratory PresentI ] Shortness of Breath I ][ ) Chronic Pain ( ][ ] Chronic Cough [ )[ ) Chronic Sinusitis [ )

Past Gynecologic Present( ) Pain DuringMenslruation [ ]I ] Irregular Menstrual Row I ]( ) Spotting [][ ] Menopausal Symptoms I ]

Past Genlto-Urinary Present[ ) Painful Urination ( ]I ] Loss of Bladder Control [ ]I ) Frequent Urination [ ][ ) Urethral Discharge I )[ ) Impotence I ]

Past GI Tract Present[ ] AbcJomfnaJ Pain [ I[ ) Difficult 8waUoWing [ ][ ] Heartbuml Indigestion [ ItJ Constipation { )I ] Diarrhea ( ]

Past Skin Present( ) Rash I)[ ) Dermatitis or Eczema I ][ ] Persistent Itching [ )

Present[ )[ )[ J( I[ )

( )( ]( )[ )( )[ )

)

[ ))

Present[ I( 1[J[ I[ ][ ][ ]I )[ ]

I][ ]( 1.[ ][ I

PresentI ]( )

Past Cardiovascular[] Rapid heart Beat[) Chest Pains

Past Endocrine Present[) loss of Appetite [ ][) Abnormal Weight Gain I ).[1 Abnormal Weight Loss (. )

Please list any conditions you have currently or have had in the past.Past Condition Present PastI) Hemon1loids I ) I )[] Rh~maticHeart Disease [ ) [ )[J High BlOod Pressute [ ) [ ][] Angina I] [)I] Heart Attack [ ) [ )[J Stroke I) I)[] Asthma I ] [ )I] GaD Bladder [ ) [ )[J Cancer I] [)I] HIV Positive! AIDS [ J [ )

Past Her/ous System(] Depression[] Insomnia

[] Bed Wetting[] Fainting[) Conwlsions[) Dizziness[ ] . Headache(] Muscular In coordination[] Heating Loss

(] linnities (Ear Noises)[) Ear Pain() Impaired Vision[] eye Pain[J Paralysl$

. Below are listed conunon symptoms that may suggest the presence ofan ailment involving a particular body system.Ifyou have ever had a listed symptom in the past. please check that symptom in the left hand column. Ifyou arepresendy troUbled by a particular symptom, check that symptom in the right hand column.

Past Musculoskeletal[ ] Neck Pain[ ] Shoulder Pain[ ) Pain in Upper Arm or elbow[ ] Hand Pain( 1 Upper Back Pain

[ ] Low Back Pain[ ] Pain in Upper Leg or Hip[ ] Pain In lower Leg or Knee[ ) Pain in Ankle or Foot[ ] Jawpain( ] Swelling in Joints

(List Jolnts__----...J[ ) Stiffness ofJoints

(Ust Joints -J

P26SYMPTOM UPDATE QUESTIONAIRE

Date ofBirth: Z-j,(., - ).f Date: q- (~ -~ '(

Present Complaints: Please check all answers and fill in the blanks where appropriate. The information you proviassists your doctor in obtaining an early understanding ofyour condition.

did uns problem begin?~~~--;.~~..-..It:.=S-..ILt:.r.&d.~2S::::!:.---";!' _Have you had this problem before

Ifso when?~'~=--=-:--_-::-~--:-__--:-::--:---:-,:---:,,-:-__~~~~ _Did your problem begin: [ ] immediately after a specific incident, [ J.uneventfully [XI gradually developed over tiIfyour problembe~ following a specific incident, pleaseexplain? -------

Were you previously treated for this condition? [ ] Yes [ ] NoIf yes by: [ ] chiropractor [ JMD. [ ] Therapist [ ] other:. _

Please describe the chataCterofyour current~ (You may check one ~r'more answers.)· [] sharp/stabbing . [ 1shmp/dull .[b4.aches [ ] dull [ Jsoreness [ ] weakness [ Jnumbness

[ ] throbbing/gnawing [ ] shooting P<l gripping/constricting .How often'are the.complain:ts present? [ ] Constant, ~ hts. per day. _days per week. _days permonth.Since your problefil began. is the pain: pQ Increasing [1Decreasing [] Not changing.Ifyour eutrent complaints are asSociated With an old injury,an~ .wereaggravated (made worse) by a recent incident,please describe the incident and when it occurred: 'Date:. Discription:. _

Indicate how your symptoms are affected by physical activity:_symptoms ate unaffected byrest, exercise. etc.~symptoms increase with. or are made worse by. exercise or physical activity._symptoms increase with, or are made worse by. rest or inactiVity.

Are your complaints affecting your ability to work or otherwise be active?No effect . ~ /.J"'~

?:,,S"oniephysical restrictions (able to do light dutywork and household tasks.)l;~ 0--__Need Iitnited assistance with common everyday tasks. ,. . \\

Need assistance often.-Have a significant inability to function without assistance.

Am totally disabled (impaired). Cannot~ for self. •Please list any medications or vitamins you are currently taking: AAttu.- ~~ ~.. t 1« X ~

t4A:.:deC "'{'" ttl~ ~ tJ ~A.4"t:.-oD /It '(2 AP $'.- 3;;;- h'\. 1-------PI~e list anysurgeryyou~ .

)

the indicated codes.EXAMPLE

bee the ..v.rlty 01 ,aur pein .t In l ..stand .C'O.t..t tI... by. eIl.c:kln. tvo bo•••• onthe followln••cal••

Hark OD the picture' where you have had symptoms according toS =stiffness .A =AchingP =PainH =NumbnessT=Tingl~gB = Burning

P27LUMBAR SPINE

PAIN AGGRAV.BY: BEeR MINORS ADAMS- - ---CgLlghi ng 0 Rt 0:.sn~tnt..~. ..~EL/T~E .!'.ALK SL...!-!-t:-_~

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,l(pf12 11 11 :02a Arlington EMS 608~5-3924

MEDICAL RECORDS CERTIFICATION

p.1 01

~~ i.)iU;~~__=-.......;.._....:.=;...:...-_~ , of(Title)

I. fft:>5S"6'-L K06e1-S(Name)

..../lfUIu..;.......;..,.a9......;..,.7DtJ__t_"'_S do hereby certify that the attached photocopies(Provider)

of the medical record of (f/l1£.ltJAI s-;,~(Name of Patient)

covering the period of D?/"'/:J.otJ2 to o1ItJ-tj~, consisting Of __~_~__

pages has been compared with the onginal on file and that the attached photocopies

are a complete. legible and accurate duplicate of the said medical record. except for the

following:

(Date)

NAME, ADDRESS Be TELEPHONE NUMBER OF HEALTHCARE PROVIDER:

f.qJr 12 11 11 :08a Arlington EMS 608-635-3924 p.7 D13

Prehospital care Report

ARUNGTON EMERGENCY

MEDICAL SERVIa!215 IIre.a ST"

ARUNGTON, WI 53911

Name: Swenson, Marlon E. __ J9V_

e-lhn ........

WIlIgbtI 0 KGlUI

~ 1lIt*3S&*379S

o.o.B: 07/2N'1Rt~ISSNz

--~~.. "...Clll'YII..

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estItilllblL c.__ applied and Pt _ bImad IIId IIId CIIltD. '-'0 baIrII. SIDS~ 1III",1IIlI fit -1blIPIId ..... ID le.g IIoMI.~ IlaUrna ___

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to: SO 0710)/300'

Prf_,.,SyalpIlIIm

dlathln

_at.....

Inc. Date: 071aJ/2009Incldent'-:20090725103

Pallent Name: Swenson, Marlon Eo

Call_: 09-27-49

ARUNGTON EMERGENCY M2DlCAL

SElMCE Page: 1

oau: Printed: 07/27/2009 13:06

· 'UWHealthUniversity of WisconsinHospital and Clinics

March 14,2011

i)

600 N. Highland AvenueMadison, WI 53792

M1

I hereby certify that the attached TWO HUNDERED NINETY THREE pages are a truecopy of those records whose release has been properly authorized from the medical recordof:

SWENSON, MARION1675629

from the University ofWisconsin Hospital & Clinics. These records reflect the period oftime requested per the attached'request and/or authorization. The original record wascreated in the usual course of business and is maintained in the custody of HealthInformation Services.

Dawn Paulson, RHIAAssistant DirectorHealth Information Management

uwheallh.arg3CANNE:G

M96

All Notes (excluding Disch Medication Orders and RPh Medication Hx) (continued)

Scene Information: Passenger, Belted and High speed (>30 mph)

HPI: This patient presents as a Level II trauma, involved in a MVA. Pt was the restrained passenger in a MVA with herfriend driving, when they ran into a car that cut them off. Presents to ED via EMS on backboard and in C-collar. Pt deniesLOC, and only subjective complaint is chest and back pain. Denies ambulating at the scene. Presented to UWED withGCS 15.

PMH:HTNGERO

No past surgical history on file.

No family history on file.

HistorySocial History• Marital Status:

Spouse Name:Number of Children:

• Years of Education:Occupational History

• Not on file.Social History Main Topics

• Tobacco Use:• Alcohol Use:• Drug Use:• Sexually Active:

Other Topics• Not on file

Social History Narrative• No narrative on file

AllergiesAllergen

• Sulfa Drugs• Amoxicillin

WidowedN/AN/AN/A

ReactionsRASHRASH

NeverNot on fileNot on fileNot on file

Concern

Current outpatient prescriptionsMedication Sig

• PRILOSEC OTC 20 MG OR TBEC 1 TABLET DAILY• NIFEDIPINE 30 MG OR TB24 1 TABLET DAILY• ATENOLOL 50 MG OR TABS Take 1 tablet twice daily• BENAZEPRIL- 2 TABLETS IN THE AM

HYDROCHLOROTHIAZIDE 20-12.5 MGOR TABS :.

• ASPIRIN 81 MG OR TABS 1 TABLET DAILY

Page 29

SWENSON,MARION EMRN: 1675629Adm:07/03/2009Printed By SMH077 at 3/14/11 10:06 AM

Author Type: Registered Nurse

M102


Orthopedic A&P:Marion E Swenson a 79 year old with a mid thoracic tenderness and age indeterminate findings on CT ofland T spine. She has no neurologic deficits and other than some TTP at the mid thoracic level she has no back pain.She will be admitted to Gen Surgery Trauma team. She will be kept on C,T,l spine precautions until cleared. We willreview her films and attempt to determine acutiy of findings. If these are in fact new findings treatment will likely be with aTlSO brace non operatively.

.Handoff signed by Rachel Mullins, RN at 07/03/09 1704

Author: Rachel Mullins, RN Service: (none)Filed: 07/03/091704 Note Time: 07/03/091703

Nursing Admission Note

Admitted to F4/666 from Emergency Department for MVC with T & L fractures. Verbal SBAR report receivedfrom Melanie, RN at 1615. Oriented to unit and surroundings. Call light within reach. Patient encouraged tocall with any needs. Physician orders and Interdisciplinary Plan of Care initiated.

Submlned by: Rachel Mullins, RN- 7/3/2009 - 5:04 PM

H&P signed by Michael J Schurr, MD at 07/03/091712Author: Michael J Schurr, MD Servicel GENERAL SURGERYFiled: 07/03/091712 Note Time: 07/03/091506Related Related note by Benjamin l Hartshorn, MD at 07/03/091530Notes: J.

Original note by Benjamin l Hartshorn, MD at 07/03/09 1530

Trauma History & Physical

Trauma Level: level I!

Author Type: Physician

...

CC/lnJury Mechanism: motor vehicle crashLoss of Consciousness: noDazed/Amnestic: noScene Information: Passenger, Belted and High speed (>30 mph)

HPI: This patient presents as a Levell! trauma, involved in a MVA. Pt was the restrained passenger in a MVA with herfriend driving, when they ran into a car that cut them off. Presents to ED via EMS on backboard and in C-collar. Pt deniesLOC, and only subjective complaint is chest and back pain. Denies ambulating at the scene. Presented to UWED withGCS 15.

PMH:HTNGERO

No past surgical history on file.


HistorySocial History

• Marital Status:Spouse Name:

Page 35

: I

WidowedN/A

SWENSON,MARION EMRN: 1675629Adm:07/0312009Printed By SMH077 at 3/14/1110:06 AM

M116.,

All Notes (excluding Disch Medication Orders and RPh Medication Hx) (continued)ED Provider Notes signed by Thomas 0 Meyer, MO at 07/05/09 0654 (continued)

Author: Thomas 0 Meyer, MD Service; , (none) Author Type: PhysicianFiled: 07/05/090654 Note Time: 07/05/090624

Chief ComplaintPatient presents with

• MVA

HPI Comments: Coordination of care: This patient was seen directly by me as well as in consultation with thetrauma residents as a level 2 trauma evaluation. Therefore please also see written medical record.

History of present illness: This 79-year-old woman belted front seat passenger riding in a vehicle that T-boneanother auto at highway speeds. She had no head injury or loss of consciousness but did note sudden midback pain. She specifically denies other injuries. She was fully immobilized at the scene longboarcl cervicalcollar and CIOS device and brought directly to the ED for evaluation by EMS. At the time of arrival in the E. D.Patient denies headache, chest pain, abdominal pain or focal extremity weakness.

,"

Patient is a 79 year old female presenting with MVA.M)lAPertinent negatives include no chest paio', no abdominal pain. no loss of consciousness and no shortness ofbreath. '"''

.~

No past medical history on file.

AllergiesAllergen



HistorySocial History• Marital Status:

Spouse Name:Number of Children:

• Years of Education:Social History Main Topics

• Tobacco Use:• Alcohol Use:• Drug Use:• Sexually Active:

Other Topics• Not on file

Social History Narrative• No narrative on file

Page 49

.1

ReactionsRASHRASH

WidowedN/AN/AN/A

\

NeverNot on fileNot on fileNot on file

Concern


M120


Component

• HematocritValue42

Range34-46 (%)

Imaging:while imaging studies were obtained and reviewed with radiology.-CT scan of the cervical spine demonstrated multilevel degenerative disk disease but no evidence of acutefracture.-CT of the thoracic spine demonstrated chronic T12 compression fracture with multilevel degenerative diskdisease but no acute fracture-CT scan of the lumbar spine demonstrates chronic vertebrally body compression fracture involving 50% L1vertebral body at T12 vertebral bodies. There is also multilevel degenerative disk disease and facetarthropathy.

Medical Decision Making:this 79-year-old woman sustained for fever or body fractures and a high-speed motorvehicle accident. She appears entirely stable. She has been given opioid pain relief with some significantimprovement. She will be admitted to the trauma service observation overnight. She is entirely stable at thetime of admission

Diagnosis: Traumatic compression fractures, vertebral spine in an MVA

Filed:RelatedNotes:

Signed,Thomas D Meyer, MDClinical Assistant ProfessorEmergency Medicine SectionDepartment ofMedicineole Summaries signed by Shea N Lues, NP at 08/14/090919

Author: Shea N lues, NP Service~ TRAUMA SURGERY-ADULT

08/14/090919 Note Time: 08/14/090918Cosigned by James A Orr, MD at 08/17/09 0902

Author Type: Nurse Practitioner

Note Status: Revised

Addendum by James A Orr, Moral 08/17/090902

Trayma Short Stay plscharge Summary

Dear Dr. No Pcp No Pcp, we =had the pleasure of recently taking care of your patient Marion ESwenson. The following is a summary of her stay at the University of Wisconsin - Hospital and Clinics. Wethank you for the opportunity to care for your patient and look forward to working with you in the future.Should you have any questions about her recent hospitalization, please do not hesitate to contact us throughthe UW Access Center at (608) 263-3260.

Admit Date: 7/3/2009

Discharge Date: 7/5/2009

Hospital Diagnoses: sip MVC with no traumatic injury

Procedures I Management: trauma evaluation

Consults: Ortho Spine

Page 53

II:SWENSON,MARION EMRN: 1675629Adm:07/0312009Printed By SMH077 at 3/14/11 10:06 AM

M121


Complications: None

Hospital Course: Marion E Swenson is a 80 year old female who presented to the University of WisconsinHospital and Clinics as a Level 2 Trauma on 7/3/2009. She was admitted for observation, spinal clearanceand serial examination. After her spines were cleared, the diet was advanced, pain medications wereconverted to oral. and they were able to ambulate without difficulty. She was discharged home on 7/5/2009.

.1}

AllergiesAllergen


,.

ReactionsRASHRASH

Discharge Medications:

~ P~~~1i1iii%iJ?i~~_iacetaMINOPHEN (TYLENOL) 325 MG TABS

2 Tab PO EVERY 4 HOURS PRNOty: 60 Refills: 010

hydrocodone-acetaMINOPHEN (NORCO) 5-325 MG TABS1-2 tab PO 04 hrs/PRN painOty: 60 Refills: % "

senna-docusate (SENOKOT S) 8.6.:00 MG TABS2 Tab PO 2 X DAILYOty: 30 Refills: 0/0

CONTINUE these medications which have NOT CHANGED.jl~$~~£~~ii~~~&~ri~·;~til@j~~~~~·~·" >~~~:w.~':

furosemide (LASIX) 20 MG TABS20mg by mouth daily

PRILOSEC OTC 20 MG OR TBEC1 TABLET DAILYQty: 90 Refills: 3/3

Comments: 3 month rx

NIFEDIPINE 30 MG OR TB241 TABLET DAILYQty: 90 Refills: 3/3

ATENOLOL 50 MG OR TABSTake 1 tablet twice dailyQty: 180 Refills: 1 year

Page 54

-,.~

SWENSON,MARION EMRN: 1675629Adm:07/03/2009Printed By SMH077 at 3/14/1110:06 AM

M137

CT (continued)

Results (continued)Resulted: 07/03/09 1651

5772128 - CT T SPINE W/O IV CONTRAST Performed at UWHCCurrent Diagnosis:Resident/Fellow: Staff: MICHAEL TUITE 104126Report Dictated on Jul 3 2009 Transcribed By: PSC on Jul 3 20094:48PM

Ordered by: Benjamin L Hartshorn, MD 07/03/091122Date Taken 07/03/091217Addenda:Narrative:

Resulted by:

Signed: by

Page 70

CURRENT Ox/SIGNS AND SYMPTOMS QUESTION: traumaCURRENT Ox/SIGNS AND SYMPTOMS COMMENTS:REASON FOR EXAM QUESTION: eval fxIdlslocxREASON FOR EXAM COMMENTS:PAST HISTORY QUESTION: mvaPAST HISTORY COMMENTS:ADDITIONAL COMMENTS:

Report Dlctated:Jul 3 2009 Last Update: Jul 3 2009 4:48PM by PSCResident or Fellow:

STUDY(S):CT T SPINE W/O IV CONTRAST, DATED 07/03/09 AT 12:17

REPORT: CT thoracic spine without contrast:

Correlation with cervical imd lumbar spine performed on the same day.Impression comparison'iV

Technique: Thin section axial imaging through the thoracic spine wasobtained. Coronal and sagittal reformats performed.

Findings: Age indetermi~te, probably chronic compression fracture at T12is likely chronic with approximately 50% loss of vertebral body height atthe superior endplate. N~ acute fracture. Multilevel degenerative diskdisease with vacuum dl~~ phenomenon In the lower thoracic spine. Nearcomplete loss of disk height at T11-T12 with vacuum disk phenomena. Bonedemineralization. Bone bridges the posterior fifth, sixth, and seventhribs, and Is likely posttraumatic.Calcified granuloma in the right lowerlobe. Associated passive atelectasis in both lower lobes. No prostaticcalcifications and tortuous aorta. Large hiatal hernia.IMPRESSION: 1. Chronic T12 compression fracture.2. Multilevel degenerative disk disease.3. Calcified granuloma in the right lower lobe.4. Posterior matter changes in the right posterior fifth, sixth, andseventh ribs.5. Large hernia.

dAs the teaching physician, I personally examined the radiologic study,

",SWENSON,MARION EMRN: 1675629Adm:07/0312009Printed By SMH077 at 3/14/11 10:06 AM

,.

M138".II

CT (continued)

Results (continued)reviewed the findings with Dr. and arrived at this interpretation.Ordering Provider: 002762 - BENJAMIN HARTSHORNHL Authorizing Provider: THOMAS MEYERDictation Date: 07/03/2009 Staff: MICHAEL TUITEAccession #: 9963418Electronically Signed By: MICHAEL TUITE, M.D. on Jul 3 2009 4:48PM

CT LUMBAR SPINE WI 0 IV CONTRAST [48553567}Resulted: 07/03/091651 ''!

Final result

5872131 - CT L SPINE W/O IV CONT Performed at UWHC .Current Diagnosis:Resident/Fellow: Staff: MICHAEL TUITE 104126Report Dictated on Jul ~2009 Transcribed By: PSC on Jul 3 20094:48PM ".

Ordered by: Benjamin L Hartshorn, MD 07/03/09 1122Date Taken 07/03/091221Addenda:Narrative:

Resulted by:

Signed: by

"CURRENT Ox/SIGNS AND SYMPTOMS QUESTION: traumaCURRENT Ox/SIGNS AND SYMPTOMS COMMENTS:REASON FOR EXAM QUESTION: eval fxIdisloxREASON FOR EXAM COMMENTS:PAST HISTORY QUESTION: mvaPAST HISTORY COMMENTS:ADDITIONAL COMMENTS:

Report Dictated:Jul 32009 Last Update: Jul 32009 4:48PM by.PSCResident or Fellow:

STUDY(S): l'

CT L SPINE WIO IV CONT, DATED 07/03/09 AT 12:21

REPORT: CT lumbar spine without IV contrast:...

Comparison: No prior study for comparison.

Indication: Trauma.

Technique: Multiplanar thin section imaging of the lumbar spine wasobtained without the administration of IV contrast. Coronal and sagittalreformats performed.

Findings: Age indeterminate, probably acute vertebral compressionfracture involving approximately 50% loss of vertebral body height in themid L1 and T12 vertebral bodies. No acute fracture. No retropulsion offracture fragments. Circumferential disk bulge causes severe centralcanal stenosis at L3-L4 and L4-L5. Endplate spur causes moderatebilateral neural foraminal narrowing at L4-L5 and L5-S1. Vacuum diskphenomena at T11-T12, T12-L1, L4-L5 and L5-51. Atheroscleroticnondilated abdominal aorta. Lower lumbar facet arthropathy.

Page 71"


M 1.:S~

cr (continued)

Results (continued)IMPRESSION: Impression:1. Age indeterminate, probably chronic vertebral compression fractureinvolving approximately 50% loss of vertebral body height in the mid L1and T12 vertebral bodies.2. Multilevel degenerative disk disease and circumferential disk bulges.3. Multilevel facet arthropathy.

As the teaching physician, I personally examined the radiologic studyI

reviewed the findings with Dr. and arrived at this Interpretation.Ordering Provider: 002762 - BENJAMIN HARTSHORNHL Authorizing Provider: THOMAS MEYERDictation Date: 07/03/2009 Staff: MICHAEL TUITEAccession #: 9963419 'Electronically Signed By: MICHAEL TUITE, M.D. on Jul 3 2009 4:48PM

CT CERVICAL SPINE WI 0 IV CONTRAST (48553565]Resulted: 07/03/091652

Final result

5172125 - CT C SPINE WIO IV CONTRAST Performed at UWHCCurrent Diagnosis:Resident/Fellow: Staff: MICHAEL TUITE 104126Report Dictated on Jul 3 2009 Transcribed By: PSC on Jul 3 20094:48PM

"

Ordered by: Benjamin L Hartshorn, IV'D 07/03/09 1122Date Taken 07/03/091207Addenda:Narrative:

Resulted by:

Signed: by

CURRENT Ox/SIGNS AND SYMPTOMS QUESTION: traumaCURRENT Ox/SIGNS AND SYMPTOMS COMMENTS:REASON FOR EXAM QUESTION: eval fx. dislocREASON FOR EXAM COMMENTS:PAST HISTORY QUESi;ON: mvaPAST HISTORY COMM¥.:NTS:ADDITIONAL COMMENTS:

Report Dictated:Jul 32009 Last Update: Jul 32009 4:48PM by PSCResident or Fellow:

STUDY(S): IlCT C SPINE WIO IV CC;nRAST, DATED 07/03/09 AT 12:07

REPORT: CT cervical spine without contrast:

Correlation with the thoracic and lumbar spine from the same day.

Indication: History of trauma.

Technique: Thin section axial imaging obtained through the cervicalspine. Coronal and sagittal reformatting performed.

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CT (continued)

Results (continued)

Findings: No fracture or·~slocation. No prevertebral soft tissueswelling. Odontoid is intc!ct. Lateral masses are aligned. Severemultilevel degenerative disk disease with complete loss of disk height atC5-C6 and C6-C7. Uncovertebral hypertrophic degenerative changes andfacet hypertrophy cause moderate bilateral neural frontal narrowing atC4-C5, C5-C6, and C6-C7.No paraspinous mass.IMPRESSION: 1. No fracture.2. Degenerative disease is detailed above.

As the teaching physician. I personally examined the radiologic study,reviewed the findings with Dr. and arrived at this interpretation.Ordering Provider: 002762 - BENJAMIN HARTSHORNHL Authorizing Provider:· THOMAS MEYERDictation Date: 07/0312009 Staff: MICHAEL TUITEAccession #: 9963417Electronically Signed By: MICHAEL TUITE. M.D. on Jul 32009 4:48PM

GML LABORATORYALCOHOL (48553558] Resulted: 07/03/09 1Ntt6 Final result

Resulted by:

Signed: byComment labThis result should be used for MAlmedical purposes only. N

FlagRef Range0.00 - 0.00 g/dL

ValueRESULT BELOW METHODDETECTION LIMITS

Ordered by: Benjamin L Hartshorn, MD 07/03/091120Date Taken Blood 07/03/09 1122 •Addenda:ComponentAlcohol

Testing Performed ByValid Date Range10/30/07 1405 - Present

Director AddressTeresa Darcy MD, 600 Highland Ave.Med Dir Madison WI

NameUWHCTRANSFUSIONSERVICES .....-=__........- --=....,...,....~-__.,.._ ' ~~=~ _=---UWHC CSC i Teresa Darcy MD, 600 Highland Ave. 05/07/070929 - PresentLABORATORY')' Med Dir Madison WI

lab - Abbreviation902 -BB

908 -MAIN

""..I

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Progress Note InfoAuthorKimberly K Arndt, MD

Note StatusSigned

Last Update UserKimberly K Arndt. MD

Last Update DatelTime1/19/11 05:14 PM

Authorization InformationSigned by Kimberly K Arndt, MD at 1/19/2011 5:14 PM

Progress note is dictated.

Progress Note InfoAuthorKevin L Brown, MA

Note StatusSigned

Last Update UserKevin L Brown, MA

Last Update DatelTime1/19/1102:34 PM

Authorization InformationSigned by Kevin l Brown, MA at 1/19/2011 2:34 PM

Marion E Swenson is a 81 year old female here for flu neck pain, medication check.

Progress Note InfoAuthorKimberly KArndt, MD

Note StatusSigned

Last Update UserKimberly K Arndt, MD


Authorization InformationAuthenticated by Kimberly KArndt, MD on 01131/11 at 1718This document replaces document DCT4196375

SERVICE: PAIN - EAST SWENSON·, MARION ESEX: FUWH#: 1675629 OOB:07/26/19290ATE OF SERVICE: 01/19/2011

CHIEF COMPLAINT: Neck pain.

HISTORY OF PRESENT ILLNESS: Marion Swenson is an 81-year-old female whopresents to the Pain Clinic today for a followup appointment. She was lastseen by Megan Feil, PAC, on October 12, 2010. She was last seen by me onAugust 4, 2010.

Ms. Swenson had onset of right-sided neck pain on July 3,2009, after amotor vehicle accident. She has sev~re multilevel degenerative changes withcomplete loss of disk height at C5-C6 and C6-C7, uncovertebral hypertrophyand facet hypertrophy, and moderate bilateral neuroforaminal narrowing atC4-C5, C5-C6, and C6-C7. She was asymptomatic prior to her a(,~ident, but

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Telephone Contact Summary (continued)

she suffers pain since that time.

She continues to have right-sided neck pain that radiates into thetrapezius region. She denies any radicular symptoms or paresthesias. Shedenies weakness in the extremities. She denies any bowel or bladderdysfunction. Overall, she has had no ~hange in her symptoms since her lastappointment. ;

','Since she was last seen Ms. Swenson was hospitalized for complications offlu, She has been out of the hospital for approximately 2 weeks, bout shehas been feeling "miserable" for mar1¥ weeks now. She had an increase inneck pain over the past few months for an unknown reason. She does not feelthat it is related to weather.

Treatment for her neck pain has included hydrocodone/acetaminophen 5/325 mgtablets. She is taking 2-1/2 tablets of hydrocodone daily at this time. Shetakes 1 tablet in the morning when she gets up, 1 tablet around lunchtime,and 1/2 tablet at bedtime. Occasionally, she does not require the bedtimedosage. This dosage of hydrocodone is keeping her fairly comfortable. Shealso uses ice packs, which are very effective for her pain. She has alsobeen using a TENS unit with some benefit and doing some massage for themuscular pain around her neck and upper shoulder. She had tried lidocaineointment, which previously had been helpful, but now she does not feel thatit is beneficial.

Overall, she is sleeping well. She gets 7 hours of sleep per night, butthere are times she does not feel rested afterwards.

Currently pain rating is 8/10 on a 0-to-10 pain scale. On average, her painis 8/10. Pain diagram demonstrates ~harp pain over the back of the neck,mainly on the right side extending int~ the right trapezius. .

CURRENT MEDICATIONS:1. Acetaminophen p.r.n.2. Aspirin 81 mg p.o. daily.3. Atenolol 50 mg p.o. b.i.d.4. Benazepril/hydrochlorothiazide 20/12.5 mg 1 tablet p.o. b.Ld.5. Hydrocodone/acetaminophen 5/325 mg 1/2 to 1 tablet p.o. t.i.d. p.r.n.6. Nifedipine 30 mg p.o. daily.7. Prilosec 20 mg p.o. daily.

ALLERGIES:1. SULFA, which causes rash.2. AMOXICILLlN, which causes rash.3. TAPE (ADHESIVE), which causes rash.

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I


PHYSICAL EXAM: In general, Ms. Swenson is pleasant, cooperative, in noacute distress. Vital signs include blood pressure 116nO, pulse 68, andweight 128 pounds. Height is 5 feet 1 inch. Pain rating is 8/10 on a0-to-10 pain scale with pain located in the neck. She is alert and orientedx3. Mood and affect are normal. Gait is normal. Further examination isdeferred in favor of discussion.

ASSESSMENT: Marion Swenson is an 81-year-old female with right-sided neckpain that developed after a motor vehicle accident in July 2009. She hassevere multilevel degenerative changes with loss of disk height at C5-C6and C6-C7, uncovertebral hypertrophy and facet hypertrophy causing moderatebilateral neural foraminal narrowing at C4-C5, C5-C6, and C6-C7. She hasmyofascial pain in the right cervical paraspinals and right trapeziuomuscle. ,~.

Symptoms have been stable for many months now. She has an increase in neckpain, which has been fairly well controlled with a slight increase in herhydrocodone dosage. She is taking 2:1/2 tablets of hydrocodone daily. Shedoes not wish to try any new medications at this time and feels that withthe hydrocodone and other modalities she is managing fairly well.

PLAN:1. Continue hydrocodone/acetaminophen 5/325 mg 1/2 to 1 tablet p.o. t.i.d.p.r.n. She was given 90 tablets with 1 refill.2. She may continue to use lidocaine 5% ointment topically t.i.d. p.r.n. ifshe feels it is effective.3. Future medication trials could include muscle relaxant or scheduledNSAID if kidney function and GI symRtoms allow.4. She is not interested in additional \gterventional procedures at thispoint and will contact us if she is inte\~sted in any injections.5. Continue use of a TENS unit, massage, and traction as needed.6. Continue use of ice modalities at home. .. ,7. We will have Ms. Swenson to follow up in the Pain Clinic on an as-neededbasis. We will be in contact with Dr. Otrie, her primary care prOViderregarding taking over prescribing of her hydrocodone, since her symptomshave been fairly stable and we are n~t making any major changes to hertreatment plan. '.

Of this 15-minute followup appointment, greater than 50% of the time wasspent in counseling and coordination of care regarding the issues outlinedabove.

Kimberly K Arndt, MDAssistant Professor CHSOrthopedics and Rehabilitation Medicine

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· , M218

Telephone Contact Summary (continl.,:)~d)

DICTATED BY:Kimberly K Arndt, MDAssistant Professor CHSKKAleavD: 01/19/201116:06:11T: 01/20/2011 09:01 :58Doc#: 4196375A :Revised:01120/2011 09:01 :58Job #: 46425820: ESAcc:Gina A Utne, MD

Electronically signed by Kimberly K Arndt, MD on 01/31/2011 17:18:20

,.

Last Update DatefTime10/1211012:37 PM

Last Update UserMegan L Feil, PA

I~Note StatusSigned

AuthorMegan L Feil, PA

Progress Note Info

Authorization InformationSigned by Megan L Feil, PA at 10/1212010 12:37 PM


Progress Note InfoAuthorKimberly A Wells-Moe, MA

Note Status'Signed .'

Last Update User Last Update DatelTimeKimberly A Wells-Moe, MA 10/12110 12:04 PM

Authorization InformationSigned by Kimberly A Wells-Moe, MA at 10/12/2010 12:04 PM

Marion E Swenson is a 81 year old female here for neck and head pain.~

Progress Note InfoAuthorMegan L Feil, PA

Note StatusSigned



Authorization InformationAuthenticated by Megan L Feil, PAC on 10/15/10 at 1505

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Telephone Contact Summary (continup.d)

',.,:.

(I


Note StatusSigned


Last Update DalelTime8/5/10 10:38 PM

Authorization InformationSigned by Kimberly K Amdt, MD at 8/51201010:38 PM


Progress Note InfoAuthorKevin L Brown, MA

Note StatusSigned

Last Update UserKevin L Brown, MA

Last Update DatelTime8/4/10 11:30 AM

Authorization Information I.

Signed by Kevin L Brown, MA at 8/412010-11 :30 AM

Marion E Swenson is a 81 year old female here for flu neck pain, medication check.


Note StatusSigned



Authorization InformationAuthenticated by Kimberly K Arndt, MD on 08/09/10 at 1648This document replaces document DCT4021715

SERVICE: PAIN EAST SWENSON, i~ARION ESEX: FUWH#: 1675629008: 07/26/19290ATEOF SERVICE: 08/04/2010


HISTORY OF PRESENT ILLNESS: Marion Swenson is an 81-year-old female whopresents to the Pain Clinic today for § follow-up appointment. She was lastseen in clinic by Megan Feil, PAC, on June 15, 2010. I last saw her in

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clinic on May 4, 2010.

Ms. Swenson had onset of right-side~neck pain on July 3, 2009, after amotor vehicle accident. She has severe multilevel degenerative changes withcomplete loss of disk height at C5-C6 and C6-C7, uncovertebral hypertrophyand facet hypertrophy, and moderate bilateral neural foraminal narrowing atC4-5, C5-6, and C6-7. She was asymptomatic prior to her accident, but shehas had persistent pain since that time.

She continues to have pain in the rig~t side of the neck that radiatesalong the right trapezius. Her symptoms have been stable, but her paincontrol has improved with the changes in medications made at her lastappointment.

Ms. Swenson was started on hydrocodone/acetaminophen 5/325 mg tablets. Sheinitially was taking 1 tablet b.Ld., and this gave her good relief of herpain and allowed her to be more functional during the day. To make hermedication last to this appointment, she has decreased the medication to 1tablet in the morning. She notes that she does feel somewhat tired withthis medication, but it gives her pain relief that lasts approximately 4hours. She would not be interested in taking anymore of this medication.She has never done a trial of an ext~ded release opiate.

Ms. Swenson denies any new symptoms. She did have a right 3rd occipitalnerve block on June 1, 2010. This injection did help her pain for the first1 to 2 days. Based on these results, Qr. Sehgal was willing to do a rightcervical medial branch block with local anesthetics and steroids. "had along discussion with Ms. Swenson today, and she is not sure if she iswilling to go through an injection pro~dure due to the risks associatedwith that injection. !

She has continued to use heat and ice as needed. Heat seems to be the mosthelpful. She continues to use traction which has also been beneficial. Sheis wondering whether acupuncture would be a treatment to try. She hascontinued to take acetaminophen which has also been helpful for herheadaches and neck pain,

Pain diagram today demonstrates sharp pain along the right side of theneck.

CURRENT MEDICATIONS: •1. Acetaminophen 325 mg, 2 tablets:.h.o. every 4 hours p.r.n.2. Aspirin 81 mg p.o. daily.3. Atenolol 50 mg p.o. b.i.d. .4. Benazepril/hydrochlorothiazide 20£12.5 mg, 2 tablets p.o. daily.'5. Furosemide 20 mg p.o. daily. .

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6. Hydrocodone/acetaminophen 5/325 mg, 1 tablet p.O. b.i.d.7. Nifedipine 30 mg p.O. daily.8. Prilosec OTC 20 mg p.o. daily.

ALLERGIES: ~

1. SULFA, which causes rash.2. AMOXICILLIN. which causes rash.

,.PHYSICAL EXAM: In general, Ms. S~enson is pleasant, cooperative. in noacute distress. Vital signs at today's visit include blood pressure 108/60.pulse 80. and weight 132 pounds. Pai!1 range today is 8/10 on a 0 to 10 painscale with pain located in the neck. She is alert and oriented x3. Mood andaffect are normal. Gait is normal. Further examination was deferred infavor of discussion.

ASSESSMENT: Marion Swenson is an 81-year-old female with right-sided neckpain that developed after motor vehicle accident in July 2009. She hassevere multilevel degenerative changes with loss of disk height at C5-C6and C6-C7, uncovertebral hypertrophy and facet hypertrophy causing moderatebilateral neural foraminal narrowing at C4-C5, C5-C6, and C6-C7. She hasmyofascial pain in the right cervical paraspinals and right trapezius.

Her symptoms have been stable but somewhat improved with the medicationchanges. After a long discussion abo~t potential spinal injection therapy,she has decided that at this time she is not interested in pursuingadditional injections due to the risk of stroke and other problems with theinjections.

PLAN:1. Continue hydrocodone/acetamin08hen 5/325 mg tablets, 1 tablet p.o.bJ.d. She was given a prescription fcir60 tablets with 2 refills.2. Consideration of an extended release opiate could be considered;however. at this time if her pain is cofitrolled on hydrocodone, I wouldcontinue this medication at this time. Any extended release opiates thatshe is given would be a significant increase in opiate dosage, and Ms.Swenson is not interested in an extended release medication at this timegiven that there would be more side effects and a higher dosage ofmedication.3. Continue anti-inflammatory medications such as naproxen.4. Continue acetaminophen p.r.n.5. Trial of lidocaine 5% ointment, apply topically ti.d. p.r.n. She wasgiven 1 tube with 5 refills. Lidocaine p.atches were not covered byinsurance, but she would like to try a1topical medication.6. Continue use of heat and ice as n~eded.7. Continue cervical traction for symptom management.8. Continue home exercise program from physical therapy.

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9. Consideration of muscle relaxants such as tizanidine or baclofen couldbe considered to address the myofascial component of her pain. At thistime. she would not like to add in any additional new medications.10. She will consider doing a trial of acupuncture. There are nocontraindications to this type of treatment.11. If she does change her mind and would like a spinal injection. she willcontact the clinic. and we would be h;ilppy to order that.12. We discussed how to do deep tis~ue massage using a tennis ball. amassager. and she was shown how to obtain Thera Cane if she is interestedin that piece of equipment to help witb deep tissue massage at home.13. I would like to see Ms. Swenson back in followup in the Pain Clinic inapproximately 2 months.

Of this 25-minute follow-up appointm~nt. greater than 50% of the time wasspent in counseling and coordination of care regarding the issues outlinedabove. .

Kimberly K Arndt, MDAssistant Professor CHSOrthopedics and Rehabilitation MedicineDICTATED BY:Kimberly K Arndt, MDAssistant Professor CHS ,KKAlsehD: 08/05/2010 22:37:56T: 0~06/2010 14:37:55Doc#: 4021715A :Revised:08/06/2010 14:37:55Job #: 4451913l?: ESAcc:Gina A Utrie, MD '.

.,".'"Electronically signed by Kimberly K Arndt, MD on 08/09/2010 16:48:05

Progress Note InfoAuthorMegan l Feil, PA

Note StatusSigned

Last Update UserMegan l Feil, PA


Authorization InformationSigned by Megan l Feil, PA at 6/15/2010 .4:18 PM

~

.....~.~'/I

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Mll~



Progress Note InfoAuthorMegan L Feil, PA

Note StatusSigned


Last Update OatelTime6/23/10 11:48 AM

Authorization Information ~

Authenticated by Megan L Feil, PAC on 00"123/10 at 1148This document replaces document DCT3965739

SERVICE: PAIN EAST SWENSON, MARION ESEX: FUWH#: 1675629 DOB: 07/26/1929DATEOF SERVICE: 06/15/2010

CHIEF COMPLAINT: Patient returns for a recheck following a right 3rdoccipital nerve block that was done with 2% lidocaine on June 1.

HPI: Ms. Swenson is an 80-year-old female with chronic right-sided neckpain. This onset was shortly after a motor vehicle accident that happenedin July of 2009. A CT scan is significant for severe multileveldegenerative changes, facet hypertrophy, and foraminal narrowing throughoutC4-C5, C5-C6, C6-C7. She was referred for a C2-C3 facet block andunfortunately due to her anatomy the needle was not able to get into thejoint space and a 3rd occipital block was done instead.

Patient reported pain at 8-9 prior to the injection. The day of theinjection she states that her pain wa~.:significantly decreased. Shenoticed that she felt a lot better and V7as able to move her head more. Shestates the pain never got lower than a6, but in her perception this was asignificant decrease. Unfortunately, it did not last long.

" .She is accompanied by her daughter today, who is inquiring about options tohelp treat her mother's pain. The patient, herself, has been using hot andcold packs. She does her exercises J3gularly and uses traction.

She was given nabumetone at her last appointment. She states she did okayon it for a few days, but then ended up with a massive bladder infection.It was treated with antibiotics. She did not want to return to using themedication. In its place, she has been using Aleve in the morning andfeels that it is modestly helpful.

In the past after the accident, patient was taking hydrocodone. She didreport relief of her pain symptoms, but she thought maybe it did make herfeel a little groggy. Patient's daughter points out that she was not doing

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Telephone Contact Summary (continL'ed)

much other activity at that time.

Patient and her daughter both have concerns over pain management as well asif there are any other interventional injections that would be beneficial.Neither patient nor her daughter would like to pursue any surgicalintervention, and I do not think it is warranted given her multilevelsevere disease'and her age.

No other change in her history.

CURRENT MEDICATIONS INCLUDE:1. Tylenol as needed.2. Aspirin daily.3. Atenolol.4. Benazepril with hydrochlorothiazide daily.5. Lasix daily.6. Aleve daily.7. Nifedipine.8. Prilosec. .:f

PHYSICAL EXAM: Patient's weight today is 135, blood pressure is 126/72,pulse 76. She is alert and oriented, in no acute distress. She is verypleasant and conversant. She sits with a slight head forward posture withher head tipped slightly to the right. Range of motion of the cervicalspine is significantly decreased, especially with extension-basedmaneuvers. She is able to achieve a little bit more flexion based. Shehas very limited lateral flexion as well as rotation bilaterally, whichincreases pain. She has some tenderness in the suboccipital region,particularly on the right. She has more tenderness over the facets roughlystarting at about C3-C4-, C4-C5 and C5-C6. This reproduces much of herpain. She has significant tight and ten'der upper trap on the right sidewith no distinct trigger points noted, but instead a very tight muscle.Sternocleidomastoids are minimally painful. Anterior scalenes also areminimally painfUl. She maintains goo~ strength in the upper extremities.There is no sensitivity to light touch tfiroughout the posterior neck, sideof the face, into the head, and/or into the arms.

IMPRESSION: Ms. Swenson does report about a day of relief following aright 3rd occipital nerve block that was done with 2%. Pain went from a 9to a 6 with improved range of motion.. She has a significant myofascialcomponent as well with underlying severe degenerative disk disease.

PLAN:1. I have agreed to talk with Dr. Sehgal, an interventionalist, aboutproceeding with any type of other block. She may benefit from medialbranch blocks; however, I do not think she is a candidate for

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radiofrequency neurotomy given her ~ifficult anatomy. Patient and herdaughter understand this. They were.mquiring about whether or not asteroid injection could be performed ~o that she has longer lasting relief,and I certainly will ask. ADDENDUM: Discussed with Dr. Sehgal. She iswilling to do right cervical MBB with local and steroids. Information wasconveyed to Karla, patient's daughter and they will contact us if they wantto pursue. .2. We will begin a cautious trial of hydrocodone. In the past, patient didtolerate this medication and we will see if she can tolerate it again if itimproves pain control. She will start with just taking a half a tab dailyas needed. A prescription was provided today. Depending on how she doeson this medication, we could revisit trialing a longer acting medicationsuch as extended-release morphine, but we will just see how she does withthe hydrocodone. If this medication will be continued, next month we willput the patient on contract with us, anti they are in agreement.3. Continue with her stretching exercises.4. She will return to the clinic as scheduled.5. .6. Thirty minutes was spent today with Ms. Swenson and her daughter. Halfof this was in counseling and education. Additional time was spentreviewing the CT images and her an~omy.

~'

Megan Feil, PACDICTATED BY:Megan Feil, PACPhysician AssistantMF~bsD: 06/15/2010 13:47:12T: 06/16/2010 13:35:02Doc#: 3965739A :Revised:06/16/2010 13:35:02Job #: 43912410: ESAcc:Gina A Utne, MD

Electronically signed by Megan Feil, .~AC on 06/23/2010 11 :48:11

:it


Authorization Information

Page 160

Note StatusSigned


Last Update DatelTime5/5/1008:52 AM

SWENSON,MARION EMRN: 1675629Ene:5/4/1 0Printed By SMHOn at 3/14/11 10:06 AM

f'I",

Telephone Contact S'ummary (continued)Authorization Information

Signed by Kimberly K Arndt, MD at 5/5/2010 8:52 AM


M228

Progress Note InfoAuthorKim K Zinkel, MA

Note StatusSigned

Last Update UserKim K Zinkel, MA

Last Update DatelTime5/4/10 11:19 AM

Authorization InformationSigned by Kim K Zinkel, MA at 5/4/201011:19 AM

Marion E Swenson is a 80 year old fem'1.1e is here for neck pain.


Note Statu~

SignedLast Update UserKimberly K Arndt, MD

Last Update DatelTime5n/10 11:05AM

Authorization InformationAuthenticated by Kimberly KAmdt, MD on 05/07/10 at 1105This document replaces document DCT3919993

SERVICE: PAIN EAST SWENSON, MARION ESEX: FUWH#: 1675629 DOB: 07/26/1929DATEOF SERVICE: 05/04/2010


HISTORY OF PRESENT ILLNESS: Mary Swenson is an 80-year-old female whopresents to the Pain Clinic today for a followup appointment. She was lastseen on March 2, 2010. Ms. SwensoJ;'l had onset of right neck pain on July 3,2009, after a motor vehicle accident.I'She did not have a fracture at thetime of the accident, but imaging was significant for severe multi-leveldegenerative changes with complete loss of disk height at C5-6 and C6-7,uncovertebral hypertrophy and facet hypertrophy, and moderate bilateralneural foraminal narrowing at C4-5, C5-6, and C6-7. Obviously thedegenerative changes have been there for many years, but she wasasymptomatic prior to her accident. .

Ms. Swenson states that her symptoms have been persistent despite hertreatment program. She continues to have right-sided neck pain and painalong the length of the right trapezius muscle. She also has a component


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Telephone Contact Summary (continu~d)t

of myofascial pain in the right cervical paraspinals, trapezius and levatorscapulae. She denies radicular pain in the extremities. She denies any.numbness, tingling or weakness in tht! bilateral upper or lower extremities.She denies any bowel or bladder dysfunction. She does have a rQtator cuffinjury in the right shoulder, which causes weakness with shoulder movement.

Ms. Swenson participated in physical therapy. She is now doing mainly ahome program. She was given an ov~r-the-door traction unit, which she usesevery morning. This does provide some relief. She is doing a stretchingprogram regularly. She is also using heat, which is very helpfUl.

Her worst time of day is morning. It takes her 3-4 hours to feel like shecan get moving in the morning. Most of her treatments, including heat,traction and stretching, is done in the morning. By afternoon or evening,her symptoms have improved. Her neck pain increases with any kind ofmovement or with vibration, such as riding in a car. Rotation and flexionand extension are most painful. Side~bending causes muscular pulling inthe trapeZius and lateral neck.

r·0'• I

She has been using Aleve 1 tablet in ,the morning and occasionally 1 tabletat night. The Aleve does make her somewhat groggy. She notes that she hasimprovement in pain for about 4 hours after she takes the medication. Sheis also using acetaminophen as nee~pd but in limited amounts. t •

.'

She is complaining of numbness and tingling in her hands when reading thepaper in the morning. She denie~ al1~', symptoms overnight. She has nevertried any wrist splinting. She denies any history of diabetes. She is notcurrently taking any anticoagulation. She has never had spinal injections.

MEDICATIONS:1. Acetaminophen 325 mg 2 tablets p.o. every 4 hours p.r.n.2. Aspirin 81 mg p.o. daily.3. Atenolol 50 mg p.o. b.i.d.4. Benazepril/hydrochlorothiazide 20/12.5 mg 2 tablets p.o. every morning.5. Furosemide 20 mg p.o. daily.6. Nabumetone 500 mg p.o. b.i.d.7. Naproxen 1 tablet p.r.n.8. Nifedipine 30 mg p.o. daily.9. Omeprazole 20 mg p.o. daily.10. Prilosec OTC 20 mg p.o. daily.

ALLERGIES:1. SULFA, which causes rash.2. AMOXICILLlN, which causes rash.

PHYSICAL EXAM: In general, Ms. SWenson is pleasant, cooperative, in noF


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:;.•• 1

M230


acute distress. Vital signs at today's visit include blood pressure128/82, pulse 68, weight 134 pounds; Pain rating today is 5/10 on a 0-10pain scale with pain located in the right neck. She is alert and orientedx 3. Mood and affect are normal. Gait is normal.

I

Focused examination of the cervical ~pine demonstrates tenderness topalpation over the midcervical spine extending from approximately C3-C6.She has significant tenderness over the right cervical paraspinals andright trapezius as well. She has decrer~sed range of motion in alldirections, but this seems most significant in extension and bilateralrotation. In side bending, she has a P"'Jlling sensation over the lateralneck and trapezius. She has 515 strength with bilateral elbow flexion andextension, wrist flexion and extension, finger rasp and finger abduction.She has decreased strength over on the right shoulder with flexion andabduction due to rotator cuff injury. On the left, shoulder abduction is515. She has intact sensation to light touch for the bilateral upperextremities. There is negative Hoffmann sign. There is no clonus present.

ASSESSMENT: Marion Swenson is an 80-year-old female with right-sided neckpain that developed after a motor vehicle accident in July 2009. She hassevere multi-level degenerative changes with complete loss of disk heightat C5-6 and C6-7, and uncovertebrar~,ypertrophy and facet hypertrophycausing moderate bilateral neural for~minal narrowing at C4-5, C5-6 andC6-7. She also has myofascial pain in the right cervical paraspinals andtrapezius.

"

Overall, her symptoms have been pe'rsistent and she has continued to havedifficulty. Mornings are the worst timE!. which is consistent withosteoarthritic symptoms. She has irnp,'rovement with use of traction, heat,and stretching exercises. She is takiritl Aleve with good response, butotherwise is not taking any other medications for pain. She would beinterested in doing a trial of injections to see if we could decrease hersymptoms.

PLAN:1. Start nabumetone 500 mg p.o. b.i.d. She was given a prescription for 60tablets with 1 refill. I am hopefUl that the prescription strengthanti-inflammatory may be more effective than over-the-counter Aleve. Wewill need to monitor her creatinine and GFR while taking this medication.I would like her to take this twice daily for at least a few weeks, butthen she could change it back to morr of an as needed medication or oncedaily medication. ,.2. Continue acetaminophen in addition to the nabumetone for painmanagement. We discussed with her that she may take both medicationsconcurrently, as too much medicatiortuse is concern of hers.3. Schedule facet injections to decre!3se pain. I would like them to

Page 163

..'..r..t l..

SWENSON,MARION EMRN: 1675629Enc:312110Printed By SMH077 at 3/14/11 10:06 AM

M2~1


palpate under fluoroscopy to determine the most painful level to target.4. Continue home treatments of treat, traction, stretching, and some lighttissue massage. .5. At her next appointment, we could ..consider additional topicalmedications such as lidocaine patch$ or diclofenac gel.6. I would like Ms. Swenson to follow ·up in the Pain Clinic with a midlevel provider in 6 weeks and then fonow up with me in 3-4 months.

Of this 25-minute followup appointme:lt, greater than 50% of the time wasspent in counseling and coordinationiof care regarding the issues outlinedabove.

Kimberly K Arndt. MOAssistant Professor CHSOrthopedics and Rehabilitation MedicineDICTATED BY:Kimberly K Arndt. MOAssistant Professor CHSKKAltlsO: 05/05/2010 08:50:35T: 05/05/2010 20:26:3500C#: 3919993A :Revised:05/05/2010 20:26:35Job #: 43421730: ESAcc:Gina A Utne, MD

.,.;~...

Electronically signed by Kimberly K Arndt, MO on 05/07/2010 11 :05:47

ir


Note StatusSigned


Last Update DateITime3/4/10 08:42 AM

Authorization InformationSigned by Kimberly K Arndt, MD at 3/412010 8:42 AM

Chief Complaint: Neck pain.

History of Present Illness:Marion Swenson is a 80 year old female who presents to the Pain Clinic for evaluation of neck pain. She wasreferred by her primary care provider, Dr. Gina Utrie, for evaluation and pain management recommendations.

Page 164

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M232


Right-sided neck pain began 7/3/2009 after MVA. She was the belted passenger. Cervical CT scan wasnegative for fracture but CT did demonstrate significant degenerative changes. She underwent chest x-ray,thoracic CT scan, and lumbar CT scan without any fractures identified, but there were significant degenerativechanges in the thoracic and lumbar spine including a chronic compression fracture at T12. The neck andshoulder pain is described as constant aching with occasional sharp pain. Denies pain radiation into bilateralupper extremity, denies numbness/tingling in the upper extremities, except NIT in right hand while reading thenewspaper. Pain and weakness noted with shoulder abductionlflexion. There has not been any painradiation, numbness, tingling, or weakness into the legs, and no loss of bladder or bowel control. She deniesmuscle spasms. Pain radiates Into postpiior head but she denies headaches. Ms. Swenson has a tom rotatorcuff in the right shoulder, but this pain is .different than her previous shoulder pain. Her shoulder pain hasimproved over time.

The neck pain is worse with neck movement, especially right-sided neck rotation. Pain is bad in the morning,feels stiff. Has tried different types of pillows w/o improvement. Pain improves by the afternoon since neckfeels loosened up. Pain improves when being active. She has had to limit household chores. There is not ahistory of prior back surgery.

Current doing a course of physical therapy. Trial of traction last week was helpful, especially for rotation. Feltsignificantly better the rest of the day after traction. Doing HEP daily, multiple times per day. Pain medsmade her "goofy", mainly hydrocodone. Extra-strength Tylenol worked better than pain meds. Only takingAleve in the morning. She was prescribed lidocaine patches but the pharmacist told her that there were manyside effects so she did not fill the prescription. Uses heat multiple times per day, using heat with stretchingexercises. Feels that her symptoms are Improving slOWly. Saw chiropractor in August 2009 but caused anincrease in symptoms, not planning to return. Her daughter massages her shoulder and this improves hersymptoms as well.

The patient has difficulty with sleep disturbance. She awakens in the middle of the night and therefore feelsfatigued much of the time. She does not take a sleeping medication. She describes her emotional health ashopeless and frustrated. She has not hfJ:i diffiCUlty with anxiety and depression in the past and does not feelthat she is currently depressed. :.

."

Pain diagram demonstrates aching pain over the right posterior neck, upper back, right shOUlder, and rightupper arm. She indicates sharp stabbing pain over the right posterior nack.

'1

Past Medical History:Patient Active Problem List:

UNSPECIFIED ESSENTIAL HYPERTENSION [401.9]NEOPLASM OF UNCERTAIN BEHAVl.OR OF SUBMANDIBULAR GLAND [235.00)

Past Surgical History:Past Surgical HistoryProcedure• Hx hysterectomy• Hx ovarian cyst removal

x2• Hx appendectomy

Page 165

Date19651948, 1955

1948

SWENSON,MARION EMRN: 1675629

I- Enc:312110Printed By SMH077 at 3/14/11 10:06 AM

MLjj

1Telephone Contact Summary (continued)

Medications:

Current outpatient prescriptionsMedication

• acetaMINOPHEN (TYLENOL) 325 MG TABS• ASPIRIN 81 MG OR TABS• ATENOLOL 50 MG OR TABS• BENAZEPRIL-HYDROCHLOROTHIAZIDE 20-12.5 MG OR

TABS• furosemide (LASIX) 20 MG TABS "• Naproxen Sodium (ALEVE PO)• NIFEDIPINE 30 MG OR TB24• Omeprazole 20 MG TBEC• PRILOSEC OTC 20 MG OR TBEC

Sig2 Tab PO EVERY 4 HOURS PRN1 TABLET DAILYTake 1 tablet twice daily2 TABLETS IN THE AM

20mg by mouth daily1 tab as needed1 TABLET DAILY1 tab daily1 TABLET DAILY

Oit6C

HH

9C

9C

Allergies:AllergiesAllergen


ReactionsRASHRASH

Social History:Occupation: Retired bank teller. She retired in June 2007. She spends her days reading, watching TV,doing light housework, cooking, and dancing. She used to dance frequently, but has had difficulty doing thissince her injury last summer.Marital status: widowed. She lives alone.

Tobacco use: No _Alcohol use: Yes, occasionally she has a drink before dinner.Illicit drug use: NoCaffeine use: Yes, 2 cups of coffee each morning, "Prior history of drug or alcohol abuse or addiction: No

Family History:Family HistoryProblem Relation• Coronary Heart Disease/MI Father• Cancer Other Sister

1 w/pancreatic cancer, 1 w/lung cancer

There are no musculoskeletal, rheumatologic, or neurologic disorders that run in her family.

Review of Systems:A complete 12 point review of systems was obtained and was negative with the exception-of those items listed


Page 166 Printed By SMH077 at 3/14/11 10:06 AM

a

M234

Telephone Contact Summary (continv'!d)

in the history of present illness, as well as eye or vision problems, poor wound healing. arthritis symptoms,varicose veins, heartburn. and anemia.

Physical Exam:BP 130n61 Pulse 80 IWt 1361b (61.689 kg) ILMP PostmenopausalGeneral: Patient is pleasant, cooperative. and in no acute distress. She is alert and oriented x3. Mood andaffect are normal.Gait: Normal.

Focused exam of the cervical and thora~ic spine is performed. There is no erythema, ecchymosis, edema, orwarmth. There is no asymmetry or scoliosis noted. Range of motion is relatively normal in flexion. but limitedextension and decreased right side-bending and rotation compared to the left side. She had pain withextension and right-sided rotation. There is tenderness to palpation over the cervical paraspinal muscles, rightgreater than left, and over the right trapezius and levator scapulae. There Is no tenderness to palpation overthe spinous processes, rhomboids, or scalenes. There is mild hypertonicity in the right cervical paraspinalsand right trapezius.

There is 5/5 strength throughout the bilateral upper extremities, with shoulder abduction, elbow flexion andextension. wrist flexion and extension, finger abduction. and finger grasp. There is 5/5 strength throughout thebilateral lower extremities, with hip f1exicm, knee flexion and extension. ankle dorsiflexion and plantarflexion.and great toe extension. There is weak.,~ss with shoulder internal and external rotation and pain with endrange shoulder flexion and abduction. Tnere is intact sensation to light touch throughout the bilateral upperand lower extremities. OTRs are unable to be elicited at the biceps, triceps, brachioradialis. patellar andAchilles tendons bilaterally. There is no clonus present. Hoffman sign is negative. Tinel's and Phalen's testsare negative. Spurling's maneuver is negative for reproduction of right upper extremity pain.

Imaging:Cervical CT scan was obtained in July 2009 after the MVA. Findings include no fracture or dislocation. Thereis severe multilevel degenerative disk disease with complete loss of disk height at C5-C6 and C6-C7.Uncovertebral hypertrophic degenerative changes and facet hypertrophy cause moderate bilateralneuroforaminal narrowing at C4-C5, C5-9S. and C6-C7.

.Ii'

Assessment: .Marion Swenson is a 80 year old female VJho developed neck pain after motor vehicle accident in JUly 2009.She did not have any fractures at the time of the accident, but imaging was significant for severe multileveldegenerative changes with complete los,,:: of disc height at CS-6 and CS-7, as well as uncovertebralhypertrophy and facet hypertrophy causil;l9 moderate bilateral neuroforaminal narrowing at C4-C5. CS-CS, andCS-C7.

.,nThe degenerative changes have been present for many years. but she was asymptomatic prior to theaccident. It is likely that after the accident she had changes in cervical spine mechanics or a Whiplash injurythat caused her degenerative changes to now be symptomatic. There are no concerning neurological findingson exam and it is unlikely that there is any radiculopathy present. She has known a rotator cuff injury in theright shoulder, which is contributing to weakness around the right shoulder as well as pain over the shoulderand lateral deltoid. She has intermittent numbness and tingling in the right hand while reading the newspaper,which is more consistent with carpal tunnel syndrome than radiculopathy,

Ms. Swenson has significant myofascial pain at this time. including the right cervical paraspinal muscles,

Page 167.'


M235'.

Telephone Contact Summary (contimi~d)."

trapezius, and levator scapulae. She has been participating in physical therapy with improvement insymptoms. She did a trial of traction las,.:week and this improved her symptoms for the rest of the day. She isplanning to continue a trial of traction in-physical therapy. Her pain has been fairly well controlled with extrastrength Tylenol. She did not like the we.y the pain medications made her feel and does not wish to take thistype of medication.

Plan:1. Medications: Continue acetaminophen and naproxen for pain management. Ms. Swanson is only taking

one tablet of naproxen every morning. I did discuss with her that it would be acceptable to increase thedosage of naproxen, especially if she is having more symptoms. We discussed the lidocaine of patches.After our discussion, Ms. Swenson was willing to try the patches. She states that she has a prescriptionwaiting at the pharmacy and declined the need for a prescription today.

2. physical therapy: Continue physical therapy. They will continue the trial of traction, as well as stretchingand cervical and scapular stabilizatio~. We discussed the importance of doing a home exercise programas directed. She has been very compliant with her home exercise program.

3. Regular exercise: I encouraged her to get regular exercise as tolerated.4. Activjty pacing: Principles of activity pacing were discussed, including taking rest breaks and changing

positions dUring activities that typically increase pain. oft

5. Modalities: She should continue to u~J! heat and deep tissue massage for symptom relief. She willcontinue to use heat prior to stretchmg exercises as this will increase the benefit of the stretches.

6. Injections: There are injections that could be considered should her symptoms be persistent, inclUdingtrigger point injections and facet joint injections or medial branch blocks. She wished to proceed withphysical therapy at this time and hola:off on injection therapy.

7. Stydiesllmagjng: No imaging is reqUired at this time.8. Follow-up: 2 months.

Thank you for allOWing me to participate in the care of your patient. If you have any questions or concerns,please do not hesitate to contact me.

Of this 60 minute appointment, greater than 50% time was spent in counseling and coordination of careregarding the issues outlined above.

Progress Note InfoAuthorAubrey Leiendecker, MA

Note Sta~Signed

Last Update User Last Update Date/TimeAubrey Leiendecker. MA 3/2/10 12:40 PM

Authorization Information •;),Signed by Aubrey Leiendecker, MA at 3/21201012:40 PM

Marion E Swenson is a 80 year old fem~e here for right shoulder pain post MVA. Pain extends up neck andside and back of head. .-

.1

Telephone Encounter InfoAuthor

Page 168

Note Status Last Update User Last Update Date/Time

SWENSON.MARION EMRN: 1675629Enc:3/2/10Printed By SMH077 at 3/14/11 10:06 AM

.~

N1-

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Ct1eat S bpIeaeumtive

~ 3-~-U---

.. SCANNEr

Swenson. Marion E (MR # 00706887) DOB: 07/26/1929

Results

Result IIIlYIInformation Anal result (1/112011 1:45 PM)

Entry Date 1/112011

Result CT scan of the head type A 1/1/11.Narrative

CT BRAIN WO CONTRAST (Order 59024188)

proYlder StatUIOpen

N40

HISTORY: Headache, dizziness and vomiting after fall.

FINDINGS: Axial images were obtained without contrast. There is mildprominence of the ventricles and cortical sulci consistent with mild diffusecerebral atrophy. There is no eVidence of mass, acute CVA or intracranialhemorrhage. Multiple tiny radiopacities project in the scalp over theconvexity of uncertain etiology. Bone windows are otherwise unremarkable.

Result IMPRESSION: No acute intracranial abnormality.Impression

Results were faxed to the emergency department at the time of the exaudnation.

Reading Radiologist- Mitby. HO, JulieReleasing Rad10logist- Mitby, HO, JulieDictation Date Time- 01/01/2011 12:02:15Transcriptionist- Doble. Amy

ResuIts SCan on 114flO11 8:52 PM by stanley. 81zabeth C: PR!lminary

C~=c::: CT BRAIN WJ CONTRAST (Order #59(24188) on 1/1/2011 - Lab and Collection Infonnation

Result History CT BRAIN V\O CONTRAST (Q'derl159024188) on 1/1/11 - Order Resun History Reoa1.

PACSlmagesShow images for CT BRAIN we CONTRAST

Order Providers Authorizing Provider

Sharpswaln. Russell D, DOEncounter Provider

Mlryala, Indira, MDBllnng Provider

Milby, Julie, MD

Order CT BRAIN WO CONTRAST[UdG181 (Custom})_____________________{Ae~ij1GG7126UOrder59024188l

Provider InformationOrdering User Ordering ProviderWoodhouse, Todd J, PA-C Woodhouse, Todd J, PA-C

Attending Provider(s) Admitting Provider PCPWoodhouse, Todd J, PA·C Eckelberg, Todd M, MD Utrie. Gina A. MD

Order PrOViders

Authorizing ProviderSharpswain. Russell 0, DO

Billing ProviderMilby, Julie, MD

AuthoriZing ProviderSharpswain. Russell 0, DO

Encounter ProviderMiryaJa. Indira, MD

Billing ProviderMilby. Julie, MD


Order InformationOrder DatelTime1111201110:21 AM

Contact Information

N41

Date & Time1/112011 9:57 AM

Acknowledgement Info

ProviderIndira Miryala. MD

Department Encounter #8mh 5sw Med Intem Cr 55879837

For AtPlacing Order 01/01/111021

Priority and Order DetailsPriority ClassSTAT Hospital

Performed

Associated DiagnosesFALL [E888.9Cl

Scheduling Instructions

Acknowledged ByKunze. Angela V. RN

Acknowledged- On- _01/01/111021

To make an appointment for a CT, call one of the numbers below: Please inform theschedulers if you need the study urgently and they will arrange it at one of thesites below.

DEAN CLINIC- Fish Hatchery1313 Fish Hatchery RoadPhone 608-252-7445 (tie line 543)Mon- Fri 8:00 am - 5:00 pm

DEAN CLINIC - East1821 S. Stoughton Rd.Phone 608-260-6210 (tie line 564)Mon - Fri 8:00 am - 5:00 pmGo to First Floor Reception Desk to schedule.

DEAN CLINIC - Riverview580 N. Washington St., JanesvillePhone 755-3586 (tie line 570)Mon - Fri 7:00 am - 5:00 pm

STOUGHTON HOSPITAL 900 Ridge StreetPhone 873-2299 (tie line 5741Mon - Fri 7:30 am - 5 pm

ST. CLARE'S HOSPITAL 707 Fourteenth St., BarabooPhone 356-1460 (tie line 522)Same day 608-356-1434Mon - Fri 8:30 am - 3 pm

BEAVER DAM COMMUNITY HOSPITALPhone 920-887-4006Fax 920-887-4084

Click toView Parent Encounter

!!'.... ..........--~

Swenson, Marion E (MR # 00706887) DOB: 07126/1929

QuestionnaireOrder Entry

N42

Question1.Date for Exam2.What is the Reason for this Exam?

3.Expected Exam Time4.When did patient last eat?

End ExamSSMW RIS XR END EXAMQuestion1. Is the patient pregnant?2. Patient shielded?3. Additional Information

Answer1/112011fall with NN riointercranial injury

AnswerNoNo

Comment

CPT Code Information

CPT Code 70450

Electronically Authorized by SHARPSWAIN, RUSSELL 0Date: sat Jan 1,201111:15 AM

Results

Result !il!1!mInformation Final result (11112011 1:57 PM)

Entry Date 1/112011

Result CT scan of the cervical spine 1/1/2011.Narrative

HISTORY: Neck pain after fall.

CT CERVICAL SPINE (Order 59024191)

proylder StatusOpen

FINDINGS: Contiguous aXlal images were obtained from the skull base throughTI-T2 wlthout contrast. Refocnatted saglttal and coronal lmages were alsoacquired. The patient is positloned asymmetrically making interpretationdifficult. There is very advanced multilevel degeneratlve change withnarrowing of the disc spaces at essentially all levels, but most severelyinvolVing CS-C6 and C6-C7. There is mlnor anterolisthesls of C7 on Tl andthere is a very advanced degenerative facet arthropathy at multiple levels. Nodeflnite acute fracture or dislocatlon is demonstrated. The prevertebral softtlssues are within normal limlts.

Result IMPRESSION: Advanced multilevel degeneratlve change. No definite evidence ofImpression acute fracture or dislocation.

The results were faxed to the emergency department at the time of theexaminatlon.

Readlng RadiologiSt- Mitby, MD, JUll~

Releaslng Radiologist- Hitby, MD, Julie


Dictatlon Date Time- 01/01/2011 11:59:54Transcrlption1st- Doble, Amy

Results Scan on 1/4/20118:52 PM by Stanley. Eljzabeth C; Pre!lminary

co~:C:~~ CT CERViCAl SPINE IOrder #59024191) en 1/112011- Lab and CoIlecllon Infonnation

Result History CT CERVICAL SPINE (Onter1l59024191) on 111111- Order Resu" HIstcry Repro.

Radport Decision Support Details

PACSlmagesShow images for CT CERVICAL SPINE

N43

Order Providers Authorizing proylder

Sharpswain, Russell D, DOEncounter providerMlryala, Indira. MD

Billing providerMilby, Julie, MD

Order CT CERVICAL SPINE prdG201 (Custom))____________________(Ac~~16G712n.J0rd.S902~191l

ProVider Information• : Ordeting:User .: ::: .: OrderingProYider:: :::::':.:::

Woodhouse, Todd J. PA-C Woodhouse, Todd J. PA-C

: Attending Provider(s) . : Admitting Provider . PCP· .Woodhouse, Todd J, PA-C Eckelberg, Todd M. MD Ulrie, Gina A. MD

Order Providers

AuthoriZing Provider: : : : ...Sharpswain, Russell D. DO

. Billing ProviderMilby. Julie, MD

Authorizing Provider ..Sharpswain, Russell 0, DO

Order Information.. Order DatelTime

1/11201110:21 AM

Contact Information. Date & Time

11112011 9:57 AM

Encounter Provider'Miryala, Indira, MD

ProviderIndira Miryala, MD

. Billing ProviderMilby, Julie, MD

:Department Encounter #Smh 5sw Med Intern Cr 55879837

Acknowledgement InfoFor AtPlacing Order 01101/11 1021

Priority and Order DetailsPriority ClassSTAT Hospital

Performed

Associated DiagnosesFALL [E888.9C]

Acknowledged ByKunze, Angela V, RN

Acknowledged On01/01/111021

Swenson~ Marion E (MR # 00706887) DOB: 07126/1929

Scheduling InstructionsTo make an appointment for a CT, call one of the numbers below: Please inform theschedulers if you need the study urgently and they will arrange it at one of the3i tes below.

DEAN CLINIC- Fish Hatchery1313 Fish Hatchery RoadPhone 608-252-7445 (tie line 543)Mon- Fri 8:00 am - 5:00 pm

DEAN CLINIC - East1821 S. Stoughton Rd.Phone 608-260-6210 (tie line 564)Mon - Fri 8:00 am - 5:00 pmGo to First Floor Reception Desk to schedule.

DEAN CLINIC - Riverview580 N. Washington St., JanesvillePhone 755-3586 (tie line 570)Han - Fri 7:00 am - 5:00 pm

STOUGHTON HOSPITAL 900 Ridge StreetPhone 873-2299 (tie line 574)Man - Fri 7:30 am - 5 pm

ST. CLARE'S HOSPITAL 707 Fourteenth St., BarabooPhone 356-1460 (tie line 522)Same day 608-356-1434Man - Fri 8:30 am - 3 pm

BEAVER DAM COMMUNITY HOSPITALPhone 920-887-4006Fax 920-887-4084


Questionnaire

N44

Order Entryauestion1.Date for Exam2.What is the Reason for this Exam?

3.Expected Exam Time4.When did patient last eat?

End ExamSSMW RIS XR END EXAMauestion1. Is the patient pregnant?2. Patient shielded?3. Additional Information

Answer·11112011fall with pain over L1112rio fracture

AnswerNoNo

Comment

History of chronic neckpain from MVA


CPT Code 72125

Electronically Authorized by SHARPSWAIN. RUSSELL DDate: sat Jan 1. 201111:15AM

Swenson, Marion E (MR # 00706887) DOB: 07/26/1929 N45

Order HistoryDatelTime01101/11135701/01/11 1346011011111115

Action TakenResult ..ResultReleaseResult

UserBridges, f:'acs ResultsBridges, Pacs ResultsPressentin. Kim, RTPressentin, Kim

Additional InformationRnalPreliminaryFrom Order: 59023466In process

Inpatient

Results

Result StatusInformation Anal result (8I3l2OO9 11:03 AM)

XR SHOULDER RIGHT 2WI OR MORE (Order 38339032)

Provider StatusReviewed

Entry Date 8I3f2()OO

Result ORDERING PROVIDER lSI : AMUNDSON, DARCEY PNarrative -

08/03/2009 XR SHOULDER RIGHT 2VW OR MORE

H1story; pain

FINDINGS: Three views were obtained.

There is superior subluxation of the head of the humerus and it articulateswith the undersurface of the acromion process. This 1S indirect evidence ofa rotator cuff tear. No traumatic or destructive bone changes are seen.There is a large inferior spur on the distal clavicle and diffuse degenerat1vebony hypertrophy of the AC joint.

IMPRESSION:

1. INDIRECT SIGNS OF A ROTATOR CUFF TEAR WITH THE HEAD OF THE HUMERUSARTICULATING WITH THE UNDERSURFACE OF THE ACROMION PROCESS.2. DEGENERATIVE CHANGES OF THE AC JOINT.

James Olson, M. D. RadiologyJO/klk 12164740-0 DD: 08/03/2009

co'::C:~: XR SHOULDER RIGHT 'NW OR MORE (Order 1138339032) on 8I3l2OO9 - Lab and Collection Infonnation

Result History XR SHOULDER RIGHT 'NW OR MORE IOrdertl38339032l 00 8/3,1)9 - Order Result History Repcrt,


PACS ImagesShow images for XR SHOULDER RIGHT 2VW OR MORE

Reviewed byList

Reviewed ByWEINSTOCK PCA. ANDREA J CJ'I Man Aug 3. 2009 11:18 AMAMUNDSON, DARCEY P CJ'I Moo Aug 3. 2009 12:43 PMWEBER LPN, KATHLEEN on Moo Aug 3. 2009 4:26 PM

Order Providers Authorizing Provider Encounter Provider BIlling Provider


Amundson. Darcey P, PA-C De.MiRm1 elson, James G. MD

Order

Result Notes Noles recorded by Darcey P Amundson on 0810312009 aI12:43 PMXR shoulder shows "indlrecr evidence d ro1ator cuff tear. Please anange ortho consun (ORler~

XR SHOULDER RIGHT2VW OR r.l0RE [U.lG84__________________(CtlStom)UAc.c.#1226407EUOrder 383390321.

Provider InformationOrdering'UserAmundson, Darcey P, PA·C

Attending Provider(s)Amundson, Darcey P, PA·C

PCPUtrie, Gina A, MD

AuthoriZing ProviderAmundson, Darcey P, PA-C

. Billing ProviderOlson, James G, MD

Order Providers. . AUthorizing Provider

Amundson, Darcey P, PA·C

Order Information. : Ortler DatelTime

8J3I2009 9:58 AM

Contact InformationDeite g Tirne8131200910:15 AM

Priority and Order Details

.. EncounterProviderDe, MiRm1

Provider: : . DepartmentMedical Imaging RM1 DE Dc East Mi

. Billing ProviderOlson. James G, MD

Encouriterl#· .44760858

Priority .:. . Class Modifier': .Routine Dean Imaging RIGHT SIDE

Associated DiagnosesSHOULDER PAIN [719.41J]

CommentsSHOULDER Right (AP, Lat, Grashey) XR (STANDARD)

Additional Appointment InformationVisit Type Appointment Made ByXR SPENCER, SUNNI A


QuestionnaireOrder Entry

Appointment Made On81312009

Question1.Clinical History

2.Which views are required?3.lf injury or illness, what is the date of onset?

Answer Commentright shoulder pain sipMVA 713109

Swenson. Marion E (MR #- 00706887) DOB: 07/26/1929

4.Patient Disposition5. Report Disposition

End Exam

N47

DHS RIS ONSITE PROVIDERQuestion1. Scheduled Radiologist:DHS RIS XR END EXAM QUESnONNAIREQuestion1. Was the patient shielded?2. Comments:


CPT Code 73030

Electronically Authorized by AMUNDSON, DARCEY PDate: Mon Aug 3,200910:10AM

AnswerOLSON, JAMES G [2430]

AnswerNot Applicable

Results

Result ~Information Anal result (7I3l2OO9)

SCAN ONLY HIS MEDICAL IMAGING (Order 37764008)

Provider StatusReviewed

Entry Date 7131Z.0oo

Results Scan on 7/1612009 9: 12 AM by Brumer. Jodi : LUMBAR SPINE UW HOSPITAL AND Q.INIC 2PGS

Reviewed by Reviewed ByList lAMKEN SA RRT, MARY G on Thu Ju 16, 2009 4:35 PM

Order Providers Authorizing proylder

None

Order


Provider InformationOrdering UserBrunner, Jodi

PCPUtrie, Gina A, MD

Encounter providerscan, Dean

SCAN ONLY HIS MEDICAL IMAGING [SCANMI(Customt,U0rder 3n64008l

Authorizing Provider(none)

Swenson. Marion E (MR # 00706887) DaB: 07126/1929 N74

11/16/2009 9:32 AM

Reason for callCough since 11/1612009

Call Documentation

Phone (Incoming) Swenson, Marion E (Self) 608-358-3795 (H)

Clark Rn t Patricia 11/16/0909:32 AM AddendedPatient calls states she was sick all weekend with a cough with green/yellow phlegm, no knownfever, had chills on Friday, no shortness of breath, no unusual neck pain.She is taking robitussin which helps for a couple hours.Wants to be seen around 11am because she has a ride at that time.Scheduled with Darcey.

Previous version

Historical Meds Added to ListHyperlink Historical Meds Added

Meds Removed To Update ListHyperllnk Meds Removed

Patient InstructionHyperllnk patient Instruction

Encounter MessagesNo messages in this encounter

Release of Protected Health Information Malion E Swenson (MR# 00706887)

912212009 1:30 PM

Patient InformationPatient NameSwenson. Marion E(00706887)

Reason for VisitFollow-up

Diagnoses

Provider DepartmentTimothy J Docter, MD Dc Fish Hatch Ortho

Sex ·DOBFemale 7/26/1929

ree rt shoulder

Encounter#·45120683

Phone608-358-3795

Rotator Cuff Syndrome [726.10C] - Primary

Visit Diagnoses and Associated OrdersRotator Cuff Syndrome [726.10C] - Primary

TranscriptionTypeProgress Note

Document Text

DIAGNOSIS: Rotator tear.

1012283817

Author

The patient feels therapy has made a major improvement. She feels pain reliefhas been dramatic, and she notes slight improvement in tunction.

Swenson. Marion E (MR # 00706887) DaB: 07/26/1929

Utrie, Gina At MD 918109 02:54 PM Signed

Subjective: Marion is an 80-year-old woman seen today for evaluation of neck pain. She was thebelted passenger in a motor vehicle accident July 03,2009. She suffered some broken ribs andwhen I last saw her about a month ago she had quite a bit of chest wall pain. She was notcomplaining of neck pain at the time. She had a cervical spine CT during her hospitalization thedemonstrated no evidence of fracture. She describes the pain mostly over the trapezius bilaterally.Has had decreased range of motion of her neck over the last 4 weeks with no new injury. Noradicular pain. No weakness numbness or tingling. .She also has been found to have a torn rotatorcuff in the right shoulder. She is using one hydrocodone every 4 hours with good pain control butshe is disturbed by the lack of range of motion In her neck especially when she tries to drive. CT ofher neck from the UW demonstrated significant arthritis but no other abnormality. Occasionally thepain does radiate from her neck up over the scalp into her occipital region.

She also complains of a lesion on her right neck. She tells me that she had some cream in the pastthat is taking care of this. She thinks that some kind of sulfa cream and she also used for anulceration on her leg. I can see no prescription for any such thing in her previous med fist She doeshave some triamcinolone cream on her list but she is unsure what she has used this for her. She didnot think it was for this particular lesion.

Past medical history, medications, allergies are reviewed and updated

Physical exam: General: Well-appearing adult woman in no apparent distress. Blood pressure118/74. Pulse 88. No tenderness over the cervical spinous processes or the occipital ridge.Minimal tenderness over the cervical parasplnous muscles. She is most tender over the trapeziusbilaterally. She has normal flexion but virtually no extension. She is approximately 20· of rotation toeither side. Left upper extremity with 5 over 5 deltoid, biceps, triceps, and grip. The right side isprobably 5 minus out of 5 in all of these but her exam Is compromised by her significant shoulderpain. She is arefJexic at the biceps, triceps, and brachial radialis bilaterally. On the lateral right neckthere is an approximate 1 em circular lesion with raised edges and some mild erythema.

Assessment and plan:

1. Neck pain: Without radiculopathy. Largely myofascial and DJD. Symptoms really did not appearuntil a month after her car accident and a cervical spine CT at the time of car accident wasunremarkable so do not think additional imaging is necessary. Recommend the addition of Aleve onetwice daily with food. Continue when necessary hydrocodone. Physical therapy. Return if notimproving or if new or worsening symptoms.

2. Possible granuloma annulare: Trial of topical triamcinolone twice daily for up to 2 weeks.Dermatology if not resolving.

DatelTime Note Was Signed

DateJTime Note Was SignedTueSep8, 2009 2:54 PM COTTue Sep 8, 2009 12:46 PM COT

N79

MedicationsOutpatient Encounter Meds: End Of Enc - 918/2009

Disp Refills start End


Rotator Cuff Syndrome [726.10C]

Visit Diagnoses and Associated OrdersPain In Joint, Shoulder Region [719.41] - Primary

PT EVAL AND TREAT [pt4 Custom)

Rotator Cuff Syndrome [726.10C]

N87

TranscriptionTypeProgress Note

Document Text

Shoulder pain.

1012215038

Author

This pleasant patient is seen courtesy Darcey Amundson following a motorvehicle accident July 3. She did not feel she had any problems with hershoulder previous to that. At the time had numerous injuries and as otherareas of pain began to decrease, she noted significant shoulder pain. This hasimproved to some degree, but she still has a fair amount of shoulder painsuperiorly with radiation into the deltoid and somewhat into the biceps. Shedenies any numbness, tingling or instability.

Examination reveals definite pain in the subacromial area with palpation onimpingement testing. This patient has very poor resistance to abduction inflexion, but interesting can actively rise to approximately 140 degrees. Thereis definite pain at the AC joint to palpation as well. The bicipital groove isasymptoma tic.

X-rays were reviewed in which there is AC arthritis and an acromial hook with ahigh-riding humeral head. The MRI is consistent for a large rotator tear.

The findings were discussed. This patient has a large rotator tear and at manyinstances this would demand a repair. Given her age, she may get by withoutsurgery if she continues to recover and has compensatory strength. At thisstage she would prefer trying one more month of a home therapy program andactivity progression based on comfort and I will see her back at that time. Ifshe is significantly better, nothing further would be required. If she ishaving difficulties, we may start to discuss a rotator repair as a potentialoption. She and her daughter are very comfortable with this and will call orreturn at their discretion. Otherwise, I will see her back in 1 month.

Timothy J. Docter, MDTJD/mmm 12215038-0

EC

Encounter Note

Orthopedic SurgeryDO: 08/21/2009

DCOR

Docter, Timothy J. MD 8/21/0908:21 PM SignedDocumentation for this visit has been dictated on 8121/2009 by Timothy J Docter, MD.Documentation for this visit has been dictated on 8121/2009 by Timothy J Docter. MD.


DateJTime Note Was Signed

Swenson, Marion E (MR # 00706887) DOB: 07/26/1929

Patient History

Code Status Information

N90

Code statusFull Code

Surgical History as of 81312009ProcedureTOTAL ABDOM HYSTERECTOMY

Hysterectomy, Total Abdominal has "113" of Rovary

Family Medical History as of 81312009

Comments(none)

Date

Problem RelationDiabetes MotherCoronary Artery Disease FathercanCer ' Sister

Substances and Sexuality as of 81312009Smo~iflg'Status AmourytNever Smoker N/A

Smokeless Tobacco StatusUnknown

Age of Onset

MI at 74 (fatal)pancreas

Alcohol.UseYes

couple per week

Drug:UseNot Asked

Sexually ActiveYes

AmountN/A

FrequencyN/A

PartnersMale

Allergi~s as of 8121/2009

,.'

Sulfa DrugsAmoxlcillin

Family and Education as of 81312009Marital statusWidowed

Social Narrative as of 813/2009

N't d' ' .... ,:: oe· ::' .. :;',',:'212112007212112007

Date Reviewed: 813/2009,: .Reactions :,:,

RashRash

Goes dancing twice per weekWidowed (husband deceased cva) but has gentleman friend since 2005Retired but works for state on temp basis

Visit NotesJANE ELMER CMA Fri Aug 21,2009 12:05 PM.~V~Q.n 7-3-09 a!}d h~Q. shoulde.Lpail}~!D.9~~in wi~b._mot!.Q~. C'!!!~treaE.~,- _

Questionnaire

DHS AMB PAnENTVERIFICAnON

i:)wenson. Manon h (MK 11 UU7U6~~7) DOB: 07/26/1929

Release of Protected Health Information r.huion E Swenson (r.1R# 00706887)

N92

81312009 9:40 AM

Patient InformationPatient NameSWenson. Marion E(00706887)

Reason for Visit

Provider DepartmentDarcey PAmundson, Dc East 1mPA-C

Sex 008Female 7/26/1929

Encounter #44758149

Phone608-358-3795

Follow-up

Diagnoses

Post MVA on 7-3-09. Right upper chest & shoulder sitU hurting,burning, worse at end of the day.

Chest Wall Pain [786.520] - Primarysiioiiider·Pain-·fff9~4·fjr"··-·······_··················· - .

Visit Diagnoses and Associated OrdersChest Wall Pain [786.520] - Primary

Shoulder Pain [719.41J]XR SHOULDER RIGHT 2VW OR MORE [IMG84 Custom] - Future Order

Vitals. Last Recorded8P11Sn2

Encounter Note

Pulse80

Amundson, Darcey P, PA-e 8/3/0911:11 AM SignedMarion is an 80-year-old patient of Dr. Utrie's who presents today for followup of a motor vehicleaccident that occurred on 07/0312009. She is here today with her daughter. She was the beltedpassenger in a friend's car when they T-boned another car that slid into their lane on 07/0312009.She did have immediate onset of right chest and back pain. She was seen at UW hospital and spentthe night for observation. CT of the thoracic and lumbar spine showed old compression fractures atT12 and L1 as well as some new posterior rib fractures at #5-7. Chest x-ray and pelVis x-ray wereunremarkable. Labs were on remarkable. She was sent home on Vicodin. She saw Dr. Utrie infollowup on 07/1312009. At that time she was complaining of ongoing chest wall and back painwithout shortness of breath. When Dr. Utrie saw her she was specifically tender on the left upperchest where the seat belt would've been. We discussed using Aleve twice daily with Prilosec andVicodin when necessary for pain control. The patient states that Dr. Utrie said to give this at least 2months to completely resolve. She reports that she is still haVing the right upper chest wall pain andnow some right upper back and shoulder discomfort. She is having a hard time reaching her arm upover her head. She is haVing no shooting pains down her arm, no numbness or tingling. She doesnot feel weak on that side.

EXAM: Elderly woman in no apparent distress. Lungs are clear to auscultation bilaterally, heart isregular with no murmur. She has no chest pain with inspiration. Extremities with no edema. Chestwall is diffusely tender, particularly on the right side. She also has some right upper back/trapeziustenderness. Some tenderness noted over the deltoid and scapUlar region. She has full range ofmotion of her bilateral upper extremities with equal strength noted bilaterally and normal sensation tolight touch. Reflexes are equal at the elbow bilaterally

ASSESSMENT AND PLAN: Chest wall. upper back and right shoulder discomfort. The shoulder


wasn't bothering her when she saw Dr. Utrie last We'll check a x-ray of the right shoulder out ofcompleteness. I suspect this is all related to her motor vehicle accident. She will continue to use theAleve twice daily with Prilosec. I did refill her hydrocodone which she states she is only using oneevery 4 hours. Also discussed heating pad. She did not think physical therapy was necessary. Sheis an appointment with Dr. Utrie in one month. We'll reassess at that time, sooner if needed.

Darcey P Amundson, PA-C


OateITime Note was SignedMon Aug 3. 2009 11 :11 AM COT

Medications

Outpatient Encounter Meds: End Of Enc ·81312009. . , Disp : Refills . start End

acetaminophen (TYLENOL) 325 MG tablet UNKNOVVN 0 7/612009Sig: Take 1 Tab by mouth every 4 hours as needed for Pain. Maximum allowable Acetaminophen amount =4 Grams /24 hours. OTC- DO NOT TAKE WITH NORCOClass: Historical MedicationRoute: Oral

._ ...• _._. , •••••__••_ ••• _._. ••• ._,,_•••••• , .. ,... .,,~ ••• • •• ' ~, '0',. "'" .•• _••••

ASPIRJN 81 MG PO TABSSig: 1 TABLET DAILYClass: OTCRoute: Oral........ " . , - _.. - - .

atenolol (TENORMIN) 50 MG tablet 180 3 3/5/2009Sig: Take 1 Tab by mouth 2 times daily.Class: FaxRoute: Oralbe·iiazeprii.:jiydrociiioroiiiiazide···················1·S0····· ···.·.·..·.r···············.·····1oisii.ooa --..· .

(LOTENSIN HCT) 20-12.5 MG tabletSig: 2 TABLETS DAILYClass: FaxRoute: Oral

fUrosemide (LAsixfio' MG tablet 90 3 101Bf20013Sig: 1 TABLET DAILY TO LOWER BLOOD PRESSURE AND RID BODY OF EXCESS FLUIDClass: FaxRoute: Oral

hydrocodone-acetaminophen (NORCO) 5·100 0 81312009325 MG tablet

Sig: Take 1-2 Tabs by mouth every 4 hours as needed for Pain. MAX OF 12 TABLETS PER DAYClass: PrintRoute: Oral

hydrocodone-acetaminophen (NORCO) 5- UNKNOWN 0 7/612009325 MG tablet

Sig: Take 1-2 Tabs by mouth every 4 hours as needed for Pain. MAX OF 12 TABLETS PER DAYClass: Historical MedicationRoute: Oral

lidocaine '(LiOODERM") 5%patch 1 bOx 3 '7/15f2009Sig: Apply 1 Patch to skin daily. On 12 hours. off 12hoursClass: ePrescribeRoute: Transdermal. .. .

NIFEdlpine 30 MG (OSM) TB24 90 4 10/612008

N93


Chest Wall Pain [786.520] • Primary

Rash [782.1R)CSC NO DIFFERENTIAL [85027 Custom]

MVA (Motor Vehicle Accident) [E819.9AA)

Vitals - Last Recorded

N97

BP98/58

Encounter Note

Pulse72

Wt140 Ib (63.504 kg)

Ubie, Gina A, MD 7/17/0910:43AM SignedSubjective: Marion is a 79-year.old woman seen today in the company of her daughter for followup ofa motor vehicle accident that occurred July 03, 2009. She was the belted passenger in a friend's cartraveling approximately 65 miles per hour without line when they T-boned another car that slid intotheir lane. She had immediate onset of chest and back pain. She was transported to UW hospital instable condition. No loss of consciousness. CT scan of the cervical thoracic and lumbar spinedemonstrated probably old compression fractures of T12 and L1 as well as some new posterior rightrib fractures #5-7. Chest x-ray and pelvis x-ray were unremarkable. She was monitored overnightand her blood counts were stable. She was discharged on Vicodin. She reports ongoing chest walland back pain but no shortness of breath. He Is using 1-2 hydrocodone about every 4 hours.Senokot is managing her constipation. Vicodin is very helpful for about 2 hours and then wears off.She's not haVing any pelvic or extremity pain. Eating and drinking well. Appetite is good. Bowelsare moving normally. No headaches or neurologic symptoms. She did not have a head CT in theER as it was thought not to be indicated.

Her complaint Is a rash on her posterior lower extremities. Started on the left calf and she was In thehospital and now has moved to the right for the last 3 days. The left is significantly better. Nopruritus.

Past medical history, medications, and allergies are reviewed and updated

Physical exam Gen. doesn't elderly woman in no apparent distress. Moves cautiously to the examtable but is able to do so under her own power and get up on the table. Blood pressure 90/58. Pulse72. Weight 140 pounds. Heart regular rate and rhythm with no murmur or gallop. Lungs are clear toauscultation bilaterally. Abdomen is soft and nontender. She has trace peripheral edema. On theposterior calf on the right there are a few blanching erythematous confluent papules. Same on theleft but much less extensive. A few on both sides are nonblanching. Chest wall is diffusely tenderpartiCUlarly over her left upper chest where her seatbelt would've been.

Assessment and plan:1. Chest wall and back pain: Secondary to recent motor vehicle accident. Improving. Trial of Aleveone twice daily with her Prilosec and when necessary Vicodin for pain control. Lengthy discussionabout potential side effects of Aleve but I think in the short term the benefit outweighs the risk.Watch for GI upset. She has normal kidney function. No known history of peptic ulcer disease. I donot think in the short-term I will have a significant impact on her blood pressure. Also given Lidodermto be used when necessary. She understands 12 hours on 12 hours off. Consider long-acting opiateif this is ineffective I doubt that'll be necessary .

2: Rash: etiology unclear. Suspect that this was due to something she came in contact with butinteresting that it does not itch. It is improving spontaneously so no intervention. We'll monitor. Shewill call if it does not resolve. Doubt is medication related as it precedes the onset of herhydrocodone usage his only new medication. Since a few of them are nonblanching will check aCBC.

Swenson. Marion E (MR # 00706887) DaB: 07/26/1929

Reason for VisitBlood Pressure

DiagnosesHTN (HYPERTENSION) (401.9AF] • PrimaryFatigue [780.79B].~~..-tt~Q:~~9i..·..·..·.: .-. . .- ~.~ :.~.-..~.- .- .- .-. ~'- .- .-..:.: .. .-..- .- ~ .- .-..~ ~ .Otalgia [388.70M]

Visit Diagnoses and Associated OrdersHTN (HYPERTENSION) (401.9AF] • Primary

BASIC METABOLIC PANEL NONFAST [80048 Custom]

Fatigue (780.79B]cae NO DIFFERENTIAL [85027 Custom]UA W/MIC CULTURE IF POSITIVE [UMCPOS CPT(R)]THYROID PROFllE(W1T4 FREE REFLEX) [84443 Custom]URINALYSIS. AUTO, W/SCOPE [81001 CPT(R)]

Dizzy (780.4BO]CBC NO DIFFERENTIAL [85027 Custom]UA W/MIC CULTURE IF POSITIVE [UMCPOS CPT(R)]THYROID PROFllE(W1T4 FREE REFLEX) [84443 custom]URINALYSIS. AUTO, WISCOPE [81001 CPT(R»

otalgia [388.70M]

Vitals· Last Recorded

Nl02

BP128nO

Transcription

. Pulse68

'M.144 Ib (65.318 kg)

. Type: : ID AuthorProgress Note 11764582

Final version approved by Jarrett, Jennifer l, PA-C on 02124/09 at 1357

Document Text

CHIEF COMPLAINT: Blood pressure recheck.

SUBJECTIVE: Patient is a pleasant 79-year-old patient of Dr. Utrie who presentsto Internal Medicine today for evaluation of blood pressure.

She is currently taking for management of blood pressure:atenolol 50 mg b.i.d.benazepril/hydrochlorothiazide 20/12.5 two tablets dailyfurosemide 20 mg dailynifedipine 30 mg daily

Blood pressure reading today is 128/70. The patient states she checks her bloodpressure once a week at Wal-Mart. She is typically getting readings in the 1205to 130s over 70s to 80s. On 02/21 she started feeling more fatigued than usual,dizzy and just overall not feeling well. Denies diarrhea, constipation, nausea,vomiting, fevers, chills, night sweats. No change in appetite. She has hadchronic increasing urinary frequency and this is essentially unchanged. Deniesdysuria, hematuria.


The patient has switched from white bread to whole wheat bread and is down 6pounds from October of 2008. Otherwise she has not been actively trying to loseweight.

Has intermittent pain in her left ear and she would like this evaluated todayas well.

Her current medications and allergies are reviewed and updated.

OBJECTIVE: Patient is pleasant, seated, well-groomed, well-nourished in noapparent distress. Orthostatic blood pressure readings: Supine blood pressure130/88 pulse 76, seated blood pressure 130/86 pulse 76, standing blood pressure130/90 pulse 84. Eyes without injection or icterus. Ears with minimal cerumenon the left, scant cerumen on the right. TMs without injection, erythema oreffusion. No tragal tenderness bilaterally. Nose patent bilaterally, clearrhinorrhea. Oropharynx is clear. Neck without lymphadenopathy, thyromegaly orcarotid bruits. Lungs clear to auscultation bilaterally. No wheezes, cracklesor rhonchi. Heart regular rate and rhythm SI, 52. Abdomen is soft, nontender,nondistended. Positive bowel sounds. No masses, bruits, rebound or guarding.She has chronic peripheral edema which is trace bilaterally.

DIAGNOSIS:1. Hypertension, under optimal control.2. Acute onset of dizziness, fatigue.3. Left ear pain with minimal cerumen impaction.

MEDICAL TREATMENT PLAN:1. Patient is sent to the lab for a basic metabolic panel, CBC, UA, TSH. Shemay have an underlying viral illness causing her symptoms. She has had nochanges in her blood pressure medications in over 6 months and she is complianttaking them as directed. There is no evidence of orthostatic hypotension onexamination today. Her appetite is good. Will rule out other etiology andcontinue to monitor symptoms. She is leaving for vacation on 02/26 and wouldlike to know if there is something that needs to be addressed prior to that.She is concerned that she may have a low potassium level.2. She did have a left ear wash today and feels that she is hearing better outof her left ear.3. At this point patient will await blood test and urine test results todetermine if further management is indicated. Otherwise will give us an updateon her symptoms and follow up with any worsening or failure to improve.

Nl03

Jennifer Billmann, PA-CJB/mam 11764582-0

TE

Encounter Note

Internal MedicineDO: 02/23/2009

DEIM

wt144 Ib (65.318 kg)150 Ib (68.04 kg)146 Ib (66.225 kg)147 Ib (66.679 kg)149 Ib (67.586 kg)

Jarrett, Jennifer L, PA-C 2123/09 01:10PM SignedLast 5 Encounter Wt Readings:~:

02123/200910/08/200810/011200809124/200809/19/2008

Documentation for this office visit has been dictated on 2/23/2009 by Jennifer L Billmann, PA-e.

~wenson. Manon 1£ (MK # 00706887) DOB: 07126/1929

Patient Information

N176

Patient NameSwenson, Marion E(00706887)

Reason for Visit

SexFemale

DOB7/26/1929

Phone608-358-3795

Follow-up car accident 07/03109

Diagnoses

~.~ !~~-,g~..J?~.~:.1l.~ ..~~~~!Y. _ " _ .Slurred Speech [784.59AJ..m'(Hypertenslon)"[401.9AF] ....

Visit Diagnoses and Associated Orderscervicalgia [723.1J - Primary

Slurred Speech [784.59AJCONSULT TO NEUROLOGY [9019 Custom]CT BRAIN WO CONTRAST [IMG181 Custom] - Future Order

HTN (Hypertension) [401.9AF]BASIC METABOLIC PANEL NONFAST (80048 Custom]

Vitals· Last Recorded. SF?:

102/64

Encounter Note

..Pulse72

.Wr. .134lb (60.782 kg)

Utrie, Gina A, MD 213/1005:51 PM Signed

Subjective: 80-year-old woman seen today for these issues:

1. Right neck pain: She was the belted passenger in a motor vehicle accident in July of 2009. Shehas been SUffering from right neck pain ever since. CT scan of her cervical spine at the time of theinjury was unremarkable. She has been taking Alave one twice daily and participating in physicaltherapy for the last month and Is doing considerably better. She tells me her range of motion ismuch improved and she's had at least a 40% decrease in her pain. She has not tried a L1doderm.She did not pursue the MRI we discussed at her last visit. No pain radiating into her arm. Noweakness, numbness, or tingling.

2. Slurred speech: Please see the December 15, 2009 note for initial details. She believes thisbegan after her motor vehicle accident last summer. She has not noticed any other neurologicdeficits. Anything it is slightly better. She has not had any brain imaging. She decided not toschedule the MRI because of her concerns about claustrophobia.

3. Hypertension: Upset blood pressure is 109/66 and 118/74. No chest pain, shortness of breath,orthopnea, PND, leg swelling, TIA symptoms, claudication, or distal paresthesias.


Physical exam: Gen.: Well-appearing adult in no apparent distress. Blood pressure 102/64. Pulse

~wenson~ Manon t, (MK '" UU'/Ub~~7)!JUB: 07/26/1929 N177

72. Weight 134 pounds. Still decreased flexion and extension of her neck. She has about 30D ofrotation in either direction which is an improvement. Diffusely tender over the trapezius and cervicalparaspinous muscles bilaterally right greater than left. 5 out of 5 deltoid, triceps, biceps, and gripbilaterally. 5 out of 5 knee flexors and extensors and dorsi and plantar flexion bilaterally. Cranialnerves II through XII are intact other than slight left facial droop that she tells me has been presentfor decades and possibly asymmetric elevation of her palate. She does seem to have some milddysarthria.


1. Neck pain: Largely myofascial. Considerably improved with physical therapy and antiinflammatory. Continue. She has plans to see to be pain clinic and I welcome their opinion as well.No changes in her treatment at this point since she is improving.

2. Dysarthria/slurred speech: Even with Valium she is not enthusiastic about pursuing MRI. HeadCT. Neuro consult.

3. Hypertension: Very well-controJled. She is due for her annual metabolic panel.

Followup if not improving.

DateJTime Note Was Signed

:DateITime Note Was Signed: ..Wed Feb 3, 2010 5:51 PM CST

Medicationsoutpatient Encounter Meds: End Of Enc - 21312010

End .

213/2010

3/512009

. - _-- - ----..- - _..-_._.-1/1112010

3

3

o

180

180

. . .' Oisp: .. . 'Refills' Start .acetaminophen (TYLENOL) 325 MG tablet UNKNOWN 0 71612009

Sig: Take 1 Tab by mouth every 4 hours as needed for Pain. Maximum allowable Acetaminophen amount =4 Grams 124 hours. OTC· 00 NOT TAKE WITH NORCOClass: Historical MedicationRoute: Oral

AspiRiN'i~fMG'PO'TABS-"-'-""""""""""""'" -._- - -..-- - ---- .Sig: 1 TABLET DAILYClass: OTCRoute: Oral- _ _. _.~ .......•.._ _ __ _ _ _.A .__ ._ _ _ _ _ _

atenolol (TENORMIN) 50 MG tablet 180 3 213/2010Sig: Take 1 Tab by mouth 2 times daily.Class: ePrescribeRoute: Oral

atenolol rrENORM IN) 50 MG tabletSig: Take 1 Tab by mouth 2 times daily.Class: FaxRoute: Oral

benazepril-hydrochlorothiazide(LOTENSIN HCT) 20-12.5 MG tablet

Sig: Take 2 Tabs by mouth daily.Class: ePrescribeRoute: Oral

b8nazeprii:;;ydroctiiorothiazide····· ·········18Cj" .

~wenson, Manon t. (MK Tl UU'/U()~~'I) JJUH: U7/26/1~2~

Maintains with TMC cream•••••.••• ,_ ._. _0' _ _ ••• _ _. __ ••• __ ._._ _ _ ••

OSTEOARTHRmS 7/1712007Overview

feet.........a. __ • .- - __ • - _ 0- ' __ •• ,-_. _. _._ •• .• u- .. ' _ ~. • ..

Therapy Services Episode ReportTherapy Services Episode Report

Questionnaire

DHS AMB PA11ENTVERIFICA110N

N196

Question ..Verify patienfs full name is correct\;er1f.Y.~p.a.t!~nr~ ~a.~e..Of~j~h is' ~rrect" ..... ...

Referring ProviderGina A Utrle. MD

CCHlstoryHvoerlink to CC History

Level of ServiceHvperlink level of Service

Offlce VIsit

Answer'YesYes

MRrlon E Swenson (ltlRN 0010(887)

. . ...1/61201011:00 AM

Patient Information

. '~rovjder: '. :Department·zachary MBarber, PT Dc East Pt

Encounter# ..47515128

. Patient Name. : :Swenson, Marion E(00706887)

Reason for VisitPain Neck

Diagnoses

.. Sex.:Female

:. :DOB .. ·7126/1929

Phorie608·358·3795

Cervicalgla [723.1] • Primary

Encounter NoteBarber, Zachary M, PT 1/6/1001:58 PM SignedPHYSICAL THERAPY CERVICAL THORACIC SPINE EVALUATION

Marion E Swenson is a 80 year old femaleDiagnosis: 723.1 Neck PainNo past medical history on file.Past Surgical HistoryProcedure . . . Date

• Total abdom hysterectomyHysterectomy, Total Abdominal has "113" ofR ovary

Treatment for same problem in the past: Chiropractor. exercise and stretching, medication

SUBJECTIVE

~wenson, Manon t: (MK # UU7U6~~7) DaB: 07/26/1929

Pain/symptom location: Patient says she was in a MVA July 3rd, 2009 and has had neck pain eversince. She spent one day and night at UW Hospital and was in severe pain. She also had brokenribs, a rotator cuff tear and chest pain because of the seat belt. She says neck pain got much worsein August and over the last two months there has been no change. She also went to theChiropractor which did not help. She does nto want to get an MRI because she feels uncomfortableabout being in a small space for a long time.Onset cause: MVA 7/3/09Pain scale 0-10: 9-10 out of 10Symptom frequency: 100% of the day, mornings are the worstSymptoms aggravated by: AM, driving, compressionSymptoms improved by: exercise. medication, position. iceHeadaches: NoneOccupation: RetiredPhysical demands of daily activities: Independent in all daily activities except driving. painfullifting due to right shoulder pain.

OBJECTIVE

GaitITransfers: Patient rises from sit to stand with use of upper extremities. She ambulates withinnormal limits but has obvious upper trapezius hiking on the right and rotates her entire trunk right andleft when turning.Sitting Posture: Kyphotic and both shouders are elevatedROM Cervical Spine:Flexion 22Extension 25rotation right 14rotation left 18sidebending right 8sidebending left 15MMT Upper Extremities: Right shoulder is weak and painful in all motionsROM Upper Extremities: Not testedFlexibility: Decreased length for sUboccipitals, upper traps, levator seap and rhomboids R > LSpecial Tests:Transverse Ligament: NTCompression: +Distraction: +Spurlings: NTSharp-Pursor: NTULTI: NTJPA: Patient shows significant hypomobility in thoracic spine with central pressures and tendernessto palpation at the levator scap, upper trapezius, rhomboids and suboccipitals

TODAY'S TREATMENTTreatment today: Physical Therapy Evaluation and Soft tissue mobilization 15 min to right uppertrapezius and levator scapUla insertion.Total time spent: 45 minutes with 15 minutes spent in timed codes.

HEP: Heat and light AROM into rotation

Instructions were provided on all of the above exercises.

ASSESSMENT

Patient is a 80 year old female with severe neck pain due to MVA. Problem list includeshypomobility, flexibmty, ROM, weakness and pain. These impairments are limiting patients functional

N197

L)wensoo, Manon t-lMK 1F UU IUblSlS I} UUtt UII'1.blJn~

ability to tum her head and Iirt her right arm for functional activities.

Short Term Goals:1) Display normal, symmetrical tissue tension of upper trapezius by 4 weeks2) Demonstrate improved postural alignment by 4 weeks

long Term Goals to be met by discharge include:1) Display ROM of within normal limits by discharge to allow for head and neck rotation without pain2) Report 85 % decrease in symptoms by discharge

Rehab potential is good for the above goals.

Patient was educated and is aware of the therapy diagnosis and prognosis and agrees with thetreatment plan and goals.

Treatment plan: The patient is to be seen 1-2 time(s) perweek, for 6-12 weekes) to progress towardshort and long term goals.. Physical Therapy interventions may include:Therapuetic exerciseManual therapyModalities (ultrasound, electrical stimulation, mechanical traction)

Zachary M Barber, PT

Gina AUtrie, MD

Medicare patient: Yes - Supplier Standards issued 1/612010 by Zachary M Barber, PT.

I concur with the above treatment plan. Patient does not require social services(Both statements above are valid with physician signature unless one of the boxes below is checked)I certify that the patient listed above is in my care and in need of therapy.

Please check the following only if they apply._ I do not concur with the attached treatment plan._ Patient does require social services.

N198

Physician Signature _

Previous Version


DateITime Note was SignedWed Jan 6.2010 1:58 PM CST

Chart Electronically Signed ByTrow, Erica on 1/8/1011:23 AM

All Flowsheet Templates (all recorded)None

Orders & Results

Date _

~wenson. Manon t, tMK ;; UU IUbZSZS I) UUJ::S: U·/!'l.tJ/lny

Order SummaryPHYS THERAPY EVALUATION [97001 CPTCRUMANUAL THER TECH. 1+REGIONS.EA 15 MIN [97140 CPTlRU

Follow-up and DispositionRetum for 2 xper week 3 weeks, zach.

Routing History Recorded

Patient Instruction

N199

Hyperlink Patient Instruction

Problem Ust as of 1/612010 Never Reviewed

----_•._--

.NotedABNORMAL LEFTSUBMANDIBULAR GLAND 712612007

OverviewCT 10106 (outside facDity) with irreg L submandibular gland and pharyngoepiglottic fold.11/06 ENT eval at UW. Enlarged/firm L submandibular gland. CT with pass mass. FNArecommended and she declined.

8/07 readdressed when she established with 1M. She again declines further intervention."GE'ii:ftGa5troesoiiililgea"i'Reflux·O·isease)···.. ··..··· · ·..· ·· 711612007' · · .Wilf(Hypertensionj· ·.-··.·· ···.· ·.· ·····.······-························-······················7;16i2007····-···-····················.LECftii..CEif-· · 111712007· · . .

Overview. ; Medial R ankle since 2001. 8130 required hospitalization for IV abx. Did not require grafting

1 Maintains with TMC creamOSTEOARTHRITiS -..__ - -..-..---.-........ . -.- ····..·..·..·..·..·..·..······il1"7iifiJ't..·------··..·..·..·· .

Overview! feet

Visit NotesERICA TROW Fri Jan 8, 2010 11 :23 AM

MD signature on file in patient's medical record.

Therapy Services Episode ReportTherapy Services Episode Report

QuestionnaireDHS AMB PATIENT VERIFICAnON• Question. . Answery~~i!~.R~.~i~n.r~ ~_"..~C!".l~ .i~ ~~~~ ,.!~.~__ . _ _ _ _ _._. .Verify.patiellt'~ d~tl~ of birth is correct Yes

Referring ProviderGina A Utrle. MD

CC HistoryHyperlink to CC History

Level of ServiceHvoerlink Level of Service

Marton E SWenson12/18.:20092:36 pr,l Telel)honer.1RH: 00706887

Description: 80 y8ill' old feoudeProvider: Gina A Utrie. f,lD

Department: Dc. East 1m

Swenson, Marion E (MR # 00706887) DOB: 07126/1929

No messages in this encounter

N218

Release of Protected Health Information Malion E Swenson (MR# 00706887)

1/512011 8:30 AM

Patient InformationPatient NameSWenson, Marion E(00706887)

Reason for VisitFollow-up

Diagnoses

ProviderGina A Utrie. MO

SexFemale

DepartmentDc East 1m

OOB7126/1929

hospital

Encounter #55927675

Phone608-358-3795

.~nt(!,yp.~~.'.I~I~'.ItJ4Q.1. ~~AF.l.:..p..~!J.l~~. . . . .. . .Microscopic hematuria [599.72]

.~~~!~~1!~1?'?~jN~===~================~========~~===:~~.=============~_~============~..~~~.!.~~.~ ~?~:~~.]_...................... . . .. . . . . ..~!~~...P..;a~.r.- l?f.~; !.~J. _ _ _ .Rash [782.1 R]

Visit Diagnoses and Associated OrdersHTN (hypertension) [401.9AF] - Primary

BASIC METABOLIC PANEL [80048 Custom] - Future OrderBASIC METABOLIC PANEL [80048 Custom] - Future Order

Microscopic hematuria [599.72]UA W/MIC CULTURE IF POSITIVE IUMCPOS CPT(R)] - Future Order

Hyponatremia [276.1N]

Hypokalemia [276.8A]

Neck pain [723.1 B)

Rash [782.1R]

Vitals· Last RecordedBP160/88

Encounter Note

WI. .

128 Ib (58.06 kg)

Utrie. Gina At MO 1/5/11 09:03 AM Signed

Subjective: 81-year-old woman seen today in hospital followup. She was hospitaDzed January 1through the third with nausea and vomiting that resulted in hyponatremia, hypokalemia, andgeneralized weakness. She had a viral gastroenteritis with recurrent vomiting. She had generalizedasthenia and when getting up out of bed the night of admission and had a falling. This was not asyncopal episode. She struck her left neck and shoulder on the night stand. She did not hit herhead. Upon admission her sodium was 122 and her potassium 2.9. CT of her head and neck wereunremarkable. She was admitted and rehydrated. Her benazepril, furosemide, andhydrochlorothiazide were held. Potassium was replaced. With these medication changes andhydration her electrolytes returns to normal. She had some blood pressure lability was ultimatelydischarged on benazepril 20 mg (decreased from her baseline dose of 40 mg), her baseline dose of


nifedipine and her baseline dose of atenolol. Her 25 mg of hydrochlorothiazide and 20 mg offurosemide were held. Since returning home she has had no further nausea and vomiting and istolerating oral well. She feels generally weak but is slowly improving each day. Gets some problemswith headache in the hospital which is improved but not completely gone. If she takes ahydrocodone and put ice on her forehead the headache will go away for a period of time. Her neckpain is at its baseline. Her only new problem is a pruritic erythematous rash In the antecubital fossawhere she had her IV tape to. No other blood pressures since last seen. No shortness of breath.No edema.


Physical exam: Gen.: Well-appearing adult in no apparent distress. Blood pressure 137/78 and onmy repeat in the left arm I get 160188. 2+ carotid without bruit. Heart regular rate and rhythm.Lungs are clear the patient bilaterally. Abdomen is soft and nontender. Trace peripheral edema.She has blanching erythematous macules in the right antecubital fossa and to the right fifth finger.

Assessment and plan:1. Hypertension: Suboptimal control after recent adjustment of her medication. Recheck metabolicpanel today. If normal consider either Increasing her benazepril or adding back 12.5 ofhydrochlorothiazide. She would prefer to go back to benazepril 20 mg and hydrochlorothiazide 12.5mg and she just paid for a three-month supply of this medication. She is preViously tolerated thisdose of hydrochlorothiazide well for years I don't think it was the medication in and of itself thatcaused her hyponatremia but rather the use of this medication in the context of significantdehydration from her vomiting. Recheck blood pressure and metabolic panel again on Friday.

2. Hyponatremia and hypokalemia: secondary to profuse vomiting and the context ofhydrochlorothiazide and furosemide. Essentially resolved

3. Nausea and vomiting: Resolved.

4. Headache: Improved. This resolved with hydrocodone and Ice.

5. Microscopic hematuria: On her admission urinalysis. Repeat.

6. Contact dermatitis: from tape. Topical triamcinolone as needed. Over-the-counter antihistamineas needed

Flu as above

DatefTime Note Was Signed

DatefTime Note Was SignedWed Jan 5, 2011 9:07 AM CSTWed Jan 5. 2011 8:42 AM CST

MedicationsOutpatient Encounter Meds: End Of Ene -115/2011

Disp Refills Start Endacetaminophen (TYLENOL) 325 MG tablet UNKNOWN 0 7/612009

Sig: Take 1 Tab by mouth every 4 hours as needed for Pain. Maximum allowable Acetaminophen amount =4 Grams /24 haulS. OTC- DO NOT TAKE WITH NORCOClass: Historical MedicationRoute: Oral- .. , •.. -- , " _ _.. - __ ~ - -..- .

ASPIRIN 81 MG PO TABS

N219

OW~II:»UII. Manon ~ tMK It UU IUblSlS I) UUJ:S: U'lrJ.bl J'J2') N220

1/512011

21312010

11312011

1/512011

1/512011

4

3

o

4

o

180 Tab

180

30 Tab

Sig: 1 TABLET DAilYClass: OTCRoute: Oral

atenolol (TENORMIN) 50 MG tabletSig: Take 1 Tab by mouth 2 times daily.Class: ePrescribeRoute: Oral

, - -.. . ."

atenolol (TENORMIN) 50 MG tabletSlg: Take 1 Tab by mouth 2 times daily.Class: ePrescribeRoute: Oral.... "" -.- .. , ' -.- .

benazepril (LOTENSIN) 20 MG tabletSig: Take 1 Tab by mouth daily.Class: PrintRoute: OralCosign: Accepted by Indira Miryala, MD on 1/3/11 06:42 PM

hYcirocOdone4cetlmi"nophen'WiCO'oiN)·"30Tab' tj"" , , ······1Oi1"3i201tf5-500 MG tablet

Slg: Take by mouth. 1 in the AM and 112 in the PM.RX IS PRESCRIBED BY PAIN CLINIC AT UW.Class: Historical MedicationRoute: Oral

.NiFEdlplne CR osmotiC 24hr-~-"---9(rfab'-'-'-4----1'/5Ji01T-'--'-------"-

(PROCARDIA-XL) 30 MG (OSM) tabletSlg: Take 1 Tab by mouth daily.Class: ePrescribeRoute: Oral

·NiFEdiplne·CR·oS-moUc·24·hr························90·····················3··················..···2i3i2ofrj····· .(PROCARDIA-XL) 30 MG (OSM) tablet

Sig: Take 1 Tab by mouth daily.Class: ePrescribeRoute: Oral

., _ - - - , -.._.._- _ _.- - '.,." .,' . , ,.. -..omeprazole (PRILOSEC) 20 MG capsule 90 Cap

Sig: Take 1 cap by mouth daily.Class: ePrescribeRoute: Oral

'-Omeprazofe (PRILOSEC)20 MG capsuli"-OO'''~''~-''-4-'''~''-12J2jji2609'''-'''''-'-''-''---'

Sig: Take 1 cap by mouth daily.Class: ePrescribeRoute: OraliiiversiiiiAoiAiiNEf(s"i[VADENE)TOlo······..·······..··········.--- -.-- - -.

creamSig: Apply daily. To leg ulcerClass: Historical MedicationRCJLJ!e: !.0Jli~1 ... . .. ....

triamcinolone acetonide (KENALOG) 0.1 30 g% cream

Sig: Apply 2 times daily. FOR RASHClass: ePrescribeRoute: Topical

OrderedDisp Refills

atenolol (TENORMIN) 50 MG tablet (Discontinued) 180 Tab 4Sig· Route: Take 1 Tab by mouth 2 times daily. - OralClass: ePrescribe

start1/512011

End2/1812011

....... 1i5Ji011' 2i1siioH

Swenson, Marion E (MR # 00706887) DaB: 07126/1929

NIFEdipine CR osmotic 24hr (PROCARDIA-XL) 30 90 Tab 4MG (OSM) tablet (Discontinued)

Sig • Route: Take 1 Tab by mouth daily.• OralClass: ePrescribe

omeprazole (PRILOSEC) 20 MG 90 Cap 4capsule (Discontinued)

Sig - Route: Take 1 cap by mouth daily. - OralClass: ePrescribe

triamclnoiOiie acetoriide'(KENALCO) 0.1'%' .... "'30 gO 00... '0cream (Discontinued)

Sig· Route: Apply 2 times daily. FOR RASH - TopicalClass: ePrescribe

Discontinued Medications

1/512011

1/512011

211812011

2/1812011

N221

Reason for Discontinueatenolol (TENORMIN) 50 MG tablet Reorder

~~~~~jjJj!ii1·e·~~~.~~~~~~~~n!~~~~~:~~I·~f.~~.!~~.~I~~!!f.~~~~!~~.~.::.~:.o~:~:~~~'-.'-.~~~·~.·.:~~·.~·~:.:.~~~..:..-. __omeprazole (PRILOSEC) 20 MG capsule Reorder

Outpatient Medication List Prior to this Encounter 11512011acetaminophen (TYLENOL) 325 MG tablet Take 1 Tab by mouth every 4 hours as needed for Pain.

Maximum allowable Acetaminophen amount =4 Grams /24hours. OTC-DO NOT TAKE WITH NORCO.AspiRfN i1'"M'o'PC)'yABS..·· ·ffAS'LET'"tlAiIY··..·..·..··· .

.__ _-_ _-_ _--- ..----_ -..-._-_ -_ __ _._--_ _------------_.._---------_ __ _-----_._.__._.._ -'l~~~~~..(TI;~~~!~t~.O'.~~ ..!!I.!?..~L__.. __ .!~.~~ ~._!.~~ ..~Y._~.~~!~ ..?.~.~~~.~~!Iy.: ..benazepril (LOTENSIN) 20 MG tablet Take 1 Tab by mouth daily.hYdrocOdone4cetailiinophen·(\iiC·O'[)iNj··--Take··by·moutti...·fin·the·AM·and"172·in'the·P~f··"···· _ .5-500 MG tablet RX IS PRESCRIBED BY PAIN CLINIC AT UW.·NiFEdipine·cirosiiiOiic·24hr····..·················-Take·ffab"iiymoiiiil·daUy:···············_········..·········• .(PROCARDIA-XL) 30 MG (OSM) tablet

~~~~p~~~~~~~(~~~Q.~~9.j~~~~~.~~~~P.~~J~~=~!~~~}~g~P.~~Y.~~p~i~~~ni~==~====~==========~=========.sliver sulfADIAZINE (SILVADENE) 1 % Apply daily. To leg ulcercream

Orders & Results

Order SummaryFuture Orders: : : Expected By . Expires.BASIC METABOLIC PANEL (80048 1/5/11 2119/11Custom] Order #: 59179590.BASIC-MvETABOliCPAN·Eilio04s·-···-.. 177711'··----· -._..~ -v. ~2i19i1i-· " , __..Custom] Order#: 59180002·UA'W;M·ic·CULTU;i"li·iii·posirivE·· ·1i5;1T·· "2i1'gi1'1' .-.-..-. --- - ..[UMCPOS CPT(R)] Order #: 59180689

Medicationsatenolol (TENORMIN) 50 MG tablet Order#: 59177908NIFEdiplne CR osmotic 24hr (PROCARDIA-XL) 30 MG (OSM) tablet Order#: 59177909omeprazole (PRILOSEC) 20 MG capSUle Order#: 59177910triamcinolone acetonide (KENALOG) 0.1 % cream Order #: 59179589

Patient Instructions available as separate attachment.

Problem List Reviewed: 121912010 10:45 AM by Komaus. Mark A. 00Noted

Neck pain [723.1B] 211812011


Overview Addended Fri Feb 18,201112:00 PM by Utrie, Gina A, MDHydrocodone 5/325 2 per dayDr Ulne prescribes as of 211812010

Previous Version.... -, .

Secol1dary catara~t 1366,50A] 1/1812011

:~~6:~('ii;l~J::~DfBULAR GLAND (229~OD]· ';h~~:j~ .Overview Addended Mon Aug 13, 2007 12:00 AM by Utrie, Gina A, MD

CT 10/06 (outside facDity) with irreg L submandibular gland and pharyngoepiglottic fold.11/06 ENT eval at UW. Enlarged/firm L submandibular gland, CT wilh poss mass. FNArecommended and she declined.

. .J~/Q?.r.~~.~~~~s~.~d..Y'.h~f.:I~.h.4:).l!,stabJ~hl!,~.w.ith.I~.~ ..~.~4:) ..;sg~i.n..d.e.~lin.!;?.f.~~~E!.r...if.:l~e.ryl!,J:ltI~.I1~ .. .. ' ' , .. ,- - ,.,. -. , -." ,_.-., , '. ' , - _ " " •...... ' .. -, . .

LEG ULCER (707.100] 7/17(2007Overview Addended Tue JUl17, 2007 12:00 AM by Utrie, Gina A, MD; Medial R ankle since 2001. 8130 required hospitalization for IV abx. Did not require grafting; Maintains with TMC cream

OSTEOARTHRifi~fti·"5ioANr············· _ ······ji17i200t···· - .

Overview Addended Tue Jul17, 200712:00AM by Utrie, Gina A, MD; feet

Patient History

Code Status Information

Date

•comments(none)

'COde Status. .Full Code

Surgical History as of 1/5/2011procedure: .TOTAL ABDOM HYSTERECTOMY.._!iY.l3!~~~'!IX'..T.C?t~.I. ,6.~~!!!~f!~L~~~ ..'~.!~~' ..~! R .C?vc,tO' __..REMV CATARACT EXTRACAP.INSERTLENS""2003

Bilateral-Cataract Extracapsular Removal, Insert Lens

Family Medical History as of 1/512011Age of Onset. Problem . : : :Relation .

Diabetes' Mottier

:gQ!Q~~~~~~rY.J?j~~~~:~~:~:~:::~:~~:f~!E~!~:~~:::::::~:::::::::::~~:::~:::::::::::::::: :~I:~!I{F.~~~i>'.:::::::::::~::::::::::::::::~::::::::::Cancer Sister pancreas

Substances and Sexuality as of 1/5/2011Smoking Status AmountFormer Smoker (QUit 0 packs/day for 50 yearsDate: 12/112003)

Smokeless Tobacco StatusNever Used

Tobacco CommentPatienfs husband was at least a pack/day smoker, she lived with him for 50 years.

Alcohol Use Amount

Swenson~ Marion E (MR # 00706887) DOB: 07/26/1929 N223

1.0 oz per week. 2 Shots of liquor per weekYes(Xmple per week

Drug UseNo

Sexually ActiveYes

FrequencyN/A

Types

PartnersMale

Date Reviewed: 115/2011TypeAllergy

·.. :Noted· .212112007Sulfa Drugs

: ReactioFis· :: .Rash, PT STATESTHAT SHE CAN USETHE SALVE..Amoxiciiiin· 2121iiOCii '.0 Aii.ergy". .. .. ···Rash .

'pYri'iiiilm (PhenazopYrldine·HClf - ·..····10if3i2010···· Slde·Effectiadverse···Nalisea·andiiirvoni~ing

Reactionlintolerance·Adhesive··SensWvliY········..······_········..·· .._ ·'·1ifi2cfH ···············Side·Effecuadve-rse··si<fn-Reactlons··· .Reactionlintolerance

Allergies as of 11512011

Family and Education as of 1/512011. : :MaritSll Status: : : . . . . . . .

Widowed

I

Social Narrative as of 1/512011Goes dancing twice per weekwidowed (husband deceased cva) but has gentleman friend since 2005Retired but works for state on temp basis

Questionnaire

DHS AMB PATlENTVERIFICAnON

: qu~stion :: .. An~er:Verify patient's full name is correct YES

~Y.~t~P.~!!~~t~~~~!~~~t~~~J~~~ij.r.t~~!'._.·~·~~·.·~·.·~~:·_~.:..·.~~~.·:·.~:·.:.Y~~·~· ..·~::.·__..__ _..:.:·.::.~.~~.~ ..~.~ ~~:_.~.:.~~~.~:: ~~ :.::._~:.~ ..~.~.~~ ..:.:::.::Marlon E Swenson1:'3:"20119:56 AM Te1t!'honeMRt-I: 00706887

Description: 61 ye.lr old femaleProvider: GimlA Utrle, MD

Department: Dc East 1m

Outgoing Call. Date & Time

1131201111:04 AMProvider·Gina A Utrie, MD

Department.Dc East 1m

Encounter #55894927

Contacts

01103/2011 11:04 AMType . ContactPhone (Outgoing) SWenson, Marion E (Self)

Phone608-358-3795 (H)

Reason for CallScheduling since 113/2011 hospital fu

Call DocumentationScanlon Rn, Darlene 1/3/11 11 :05 AM SignedShe is scheduled 1/7/11 for Hospital FU

Swenson, Marion E (MR # 00706887) DaB: 07/2611929

Utrie, Gina A, MD 1/3/11 09:57 AM Signedpis call (afternoon 1/3 or later). Pt leaving hosp today. Put her in at 8:30 this wed for hosp flu please

Historical Meds Added to ListHvperlink Historical Meds Added

Meds Removed To Update ListHvoerlink Meds Removed

Patient Instruction

N224

Hyperlink Patient Instruction

Dean Routing History

113111 09:57 AMFrom'Utrie, Gina A, MD

fu ~~.

P EAST 1M CARE TEAM B-ROOMERJRN RoutinePOOL

Encounter Messages

No messages in this encounter

Release of Protected Health Information Morion E Swenson (MR# 00706887)

11112011 8:50 AM. 'ProVider: Department

Leslie E Bernstein, MD Dc East Uc: Encounter ##

55879631

Patient Information.. Patient Name

Swenson, Marion E(00706887)

Reason for VisitViral Syndrome

Diagnoses

sexFemale

OOB ..7/26/1929

Phone'608-358-3795

Head injury [959.01A] - Primary~Nii.ii~e~:,~-,!o~T~~nijjr.8!"Q"1.Br························· _ ..~~~...~.g;t.~~s.! ~~J'!.c.~ .. J;~.~.:1~) ... ......Multiple contusions [924.9AJ]

Visit Diagnoses and Associated OrdersHead injury [959.01A] - Primary

Nausea & vomiting [787.01 H)ONDANSETRON HYDROCHlORIDE,8MG.ORAl [00179 HCPCS]

Fall against object [E888.1A]

MUltiple contusions [924.9AJ]

Vitals· Last RecordedBP144/68

Encounter NoteBernstein, Leslie E, MD 1/1111 09:38 AM SignedCHIEF COMPLAINT: Chief Com plaint

Pulse80


Patient presents with• Viral Syndrome

HISTORY OF PRESENT ILLNESS: Marion E Swenson is a 81 year old who presents to UrgentCare with nausea. vomiting and head injury. Patient relates that when she woke up yesterdaymorning at 8 AM she was feeling nauseous. She went back to sleep and then got up againaround 9 AM. When she got up then she felt off balance and fell hitting the left side of her jawand neck,against the nightstand and falling to the ground. She did not lose consciousness.She was able to get herself back up. She relates that since that time she has been nauseous andvomits everything that she eats or drinks. She also has a headache. She has chronic neck painbut no increase of the neck pain since the fall.

PERTINENT HISTORY:HypertensionChronic neck pain for which she takes hydrocodone related to a motor vehicle accident that occurredJuly of 2009Social history: She lives part of the time with her male friend who is here with her today. She livespart of the time with her daughter and her family. She does not live alone.

REVIEW OF SYSTEMS:General: Denies feverHead: Denies loss of consciousness. Notes headacheENT: Denies bleeding from her ears and nose. Denies any change of her bite or loose or brokenteethNeck: Tenderness over the bruised areas and along the trapezius muscles but no new midline necktendernessChest/Lungs: Bruising over the left breast otherwise no chest injuryNeuro: Continues to feel off balance. No numbness or weakness of her extremities.Back: Denies back injuryExtremities: Denies injury of her extremities.GU: She did note some mild burning with urination earlier today.

PHYSICAL EXAM:Flied Vitals:

N225

BP:Pulse:Temp:TempSrc:Resp:

,::,Q11(l1.lZP1:t~S:Q2:AM :>

144/688098.2 OF (36.8 °C)Oral16

GENERAL: Alert woman in no acute distress.SKIN: Bruising and swelling is noted over the jaw on the left, the left anterior portion of the neck, theleft humerus proximally and laterally over the left breast.HEAD: No bruising or swelling. No palpable bony deformity. No tenderness.FACE: Bruising and swelling over the mandible on the leftEYES: No hyphema present. Globes intact.EARS: Right: normal auricle, canal and drum. No blood behind the drum, no leaking fluid.

Left: normal auricle, canal and drum. No blood behind the drum, no leaking fluid.NOSE: Nose is midline without deformity. No blood or fluid from the nose.OROPHARYNX: No trauma of the mouth. No loose, tender or fractured teeth. Normal dentalocclusion. No trismus.

Swenson, Manon t; (MR # UU7U6HH7) DOB: 07126/1929 N226

NECK: No midline bony tenderness.LUNGS: Breath sounds normal and symmetric. No rales or wheezes.CHEST WALL: No tenderness to palpation. Bruising over the lateral chest wall on the left side. Nocrepitus.HEART: Regular rhythm, normal 51 and 52, without murmurs, rubs or gallopsNEUROLOGICAL: Alert appropriate. Pupil are round and reactive. EOMJ. Facial movement issymmetric. Tongue protrudes midline. Normal grip. Normal gait.EXTREMITIES: Full and easy range of motion of all 4 extremities

DIAGNOSIS/MEDICAL DECISION MAKING:Nausea followed by a fall and now headache and recurrent vomiting. It is diffICult to tell if herheadache and vomiting are from the initial illness causing the nausea or from her facelhead injury.As such I think it is best that she be further evaluated at the emergency department withconsideration of having a CT scan of the head performed.

TREATMENT PLAN:Transfer to 5t MarYs emergency Department 5he has a normal neurological exam at this time andis quite alert and conversive. As such I feel it is reasonable for her to go to emergency Departmentvia private car. I did contact the emergency department physician.Patient treated in urgent care with ondansetron 4 mg ODT. .Because of the patient's urinary symptoms I did help to get a UA while she was here but she wasunable to produce one and said she would try at the emergency department.

DateITime Note Was Signed

.OStelTirtle NoteWas Signed :sat Jan 1, 2011 1:09 PM CST

MedicationsOutpatient Encounter Meds: End Of Enc -1/1/2011

End

21312010

21312010

3

3

180

180

. . . .. . . .. .. . DisJ). . :Refills: . . . :start

acetaminophen (TYLENOL) 325 MG tablet UNKNOWN 0 71612009Sig: Take 1 Tab by mouth every 4 hours as needed for Pain. Maximum allowable Acetaminophen amount =4 Grams 124 hours. OTC· 00 NOT TAKE WITH NORCOClass: Historical Medication

.. _~~l:I!~~ ...9.@!. . . .. . . . . .. . . . . . . . .. . .. " _. . . .. ".ASPIRIN 81 MG PO TABS

Sig: 1 TABLET DAILYClass: OTCRoute: Oral

ate"noial ttENO'RMIN) 50MG tabletSig: Take 1Tab by mouth 2 times daily"Class: ePrescribeRoute: Oral

benazepril-hydrochlorothiazide(LOTENSIN HeT) 20-12.5 MG tablet

Sig: Take 2 Tabs by mouth daily.Class: ePrescribeRoute: Oral

._._ • _._ ••_ .• _•• - _.. .0 •••••••• '0 • _ • _ •.••

furosemide (LASIX) 20 MG tablet

Swenson. Marion E (MR # 00706887) DOB: 07126/1929 N227

21312010

10/1312010

9/812009

3

o

o

90

Sig: Take 1 Tab by mouth daily.Class; ePrescribeRoute: Oral

hydrocodone-acetamlnophen (VICODIN) 30 Tab5-500 MG tablet

Sig: Take by mouth. 1 in the AM and 112 in the PM.RX IS PRESCRIBED BY PAIN CLINIC AT uw.Class: Historical MedicationRoute: Oral

NIFEdipine CR osmotic 24hr(PROCARDIA-XL) 30 MG (OSM) tablet

Sig: Take 1 Tab by mouth daily.Class: ePrescribeRoute: Oralomepraz(;ie'(PRi[o'SECf2"o'MCfcapsuie"'-gO"""""""'"---:r.-.----..··.· 1"2i2ai2cioo·······.······.·.· .Sig: Take 1 Cap by mouth daily.Class: ePrescribeRoute: Oral

oniiiinsetroii~·di·siiitegraiiiig~·(ZOFRAN·····-1·;=ab········-·····-·O-·····················1·Hfio1·1············----···- .ODT) 4 MG tablet

Sig: Take 1 Tab by mouth once.Class: No PrintRoute: Oral

siiversuifADIAZiNffCs·iL.VADENEffi·--···-scfg···········-··---·O--·················-···10;1·3i20-1lj""·-·-··-····· .cream

Sig: Apply 2 times daily.Class: ClinicAdminRC?~~: .. Topical.......... . .

triamcinolone acetonlde (KENALOG) 0.1 15GM% cream

Sig: Apply 2 times .daily. For up to 2 weeksClass: ePrescribeRoute: Topical

OrderedDisp

ondansetron, disintegrating, (ZOFRAN ODn 4 MG 1 Tabtablet (Discontinued)

Sig - Route: Take 1 Tab by mouth once. - OralClass: No Print

Discontinued Medications

.Refills·o

:sti:lrt .1/112011

:End :."1/112011

Reason. for Discontinuetriamcinolone acetonlde (KENALOG) 0.1 % cream Discontinued preViously

Outpatient Medication List Prior to this Encounter 11112011acetaminophen (TYLENOL) 325 MG tablet Take 1 Tab by mouth every 4 hours as needed for Pain.

Maximum allowable Acetaminophen amount = 4 Grams /24hours. OTC- 00 NOT TAKE WITH NORCOASPIRIN'S1 MG PO TABS" .. - "ftABLET O;&:I[Y-''''-' - -' - --- -- -- .

ate'noioifrENoRNiiN)5'OMG·taiiiei-------------Take·1·'tab·by·moutti-ftiiiies·dally.·-· .-- --------------.- - -.benazeprll-hydrochlorothlazlde Take 2 Tabs by mouth daily.(LOTENSIN ,HCT) 20-12.5 MG tabletfurosemide (LASIX) 20 MG tablet Take 1 Tab by mouth daily.hYcirococfoiie'~cet8'riijiiophen-rj'lcoDiN)"-Take'-by"mouiii:·finttieAM-iriej'·1iiin·Hie·PM:········ ..· .....- ..-......5-500 MG tablet RX IS PRESCRIBED BY PAIN CLINIC AT Uw.NIFEdipine'CR'Dsmotic'24hr . - - . Ta·ke·1 Tahby mou'tti dally: .. -. ..... -... .... . ..


(PROCARDIA.XL) 30 MG (OSM) tabletomepiizoie-(PRiLOsEcfio MG'capsuie .. -Take-{Cap by 'moUth-daiiy," .,.- .-sliver sulfADIAZINE (SILVADENE) 1 % Apply 2 times daily.creamtriamcinolone acetonlde (KENALOG) 0.1 Apply 2 times daily:' For up to 2 weeks% cream

Orders & ResultsOrder Summary

ONDANSETRON HYDROCHLORIDE.8MG.ORAL [Q0179 HCPCSJ Order#: 59022967

Medicationsondansetron, disintegrating, (ZOFRAN ODT) 4 MG tablet Order #: 59022876

N228

ProblemUst Reviewed: 121912010 10:45 AM by Komaus, Mark A, 00

Neck pain [723.18]OVerview Addended Fri Feb 18, 2011 12:00 PM by Ulrie, Gina A, MD

Hydrocodone 5/325 2 per day~ Dr Utrie prescribes as of 211812010

: . 'Noted: .211812011

~~!ql;l_s Version _.

~~~~~n~~~~~!~~~!~~~;'~Aj=======~==:~===~=======~==~~~==~======~1L~~f[Qf!==~=~~~=========.Basal cell cancer [173.9BE] 11/1712010"ABNORi\;-ACL'EFfSUBi\"ANDiBuiAR'G'LANifi229~oDj ii2si2Ofii·· ..·..·· ..·.. ·· ·..·· ..

. OVerview Addended Mon Aug 13,200712:00 AM by Utrie. Gina A, MD, CT 10/06 (outside facility) with irreg L submandibular gland and pharyngoepiglottic fold.i 11/06 ENT eval at UW. Enlarged/firm L submandibular gland, CT with poss mass. FNA: recommended and she declined.

;....~Q!..r.~.!~~r~~~~~ __~J)~_~_~~~_~~~~~J!~h~~.~!~JM ~h~.~_9~!~.~~~!!~~~ .f~r.t!I.~~.!~~~r.Y~.~~!C?~: __.__.._'LEG·ULCEFf[707~10·Gf -··..-oo -.- --.- -..-.-=;ifii2Cif,." .OVerview Addended Tue Jul17, 200712:00AM by Utrie, Gina A, MD: Medial R ankle since 2001. 8130 required hospitalization for IV abx. Did not require grafting: Maintains with TMC cream

·Os·fEoARTHRiTis"[71s:!ioANf·--···--·-· ··....---------·····-···--··-···---·---··----··--··--------·'7iWfioo7...---------.---.------..---..OVerview Addended Tue Jul 17, 2007 12:00 AM by Utrie, Gina A. MD

feete.' •••• , .•••• · ••••••••••••• ·••• -w., , _... • __ '.' .. '.' , , _ "'" _. _ ••_.'.".' ' ,. ,e.· '. _._•••

HTN(~ypertt!.~s.~~n)J~01~~F] 711612007GERD (Gastroesophageal Reflux Disease) [530.81SJ i/16i2bo7

Patient HistoryCode Status Information

Code Status CommentsFull Code (none)

Surgical History as of 1/112011Proc~ure OmeTOTAL ABDOM HYSTERECTOMY

Hysterectomy, Total Abdominal has "113" of R ovaryREMV CATARACT EXTRACAP.INSERT LENS 2003

Bilateral-Cataract Extracapsular Removal, Insert lens

~wenson. Manon E (MR # 00706887) DOB: 07/26/1929 N229

Family Medical History as of 1/1/2011Problem RelationDiabetes MotherCOJt)nary Artery Disease Fathercancer Sister

Substances and Sexuality as of 1/112011

Age of Onset

MI at 74 (fatal)pancreas

Smoking'Status AmountFormer Smoker (Quit 0 packs/day for 50 yearsDate: 1211fl003)

. Smokeless Tobacco.StatusNever Used

TobaCco·CommentPatient's husband was at least a pack/day smoker, she lived with him for 50 years.

Alcohol Use Amount .Yes .. 1:0 oz per week 2 Shots of iiquor per week

couple per week

: : Drug Use . : . ' . , Frequency . Types .No N~

. sexuallyActiveYes

Partners .Male

Date RevieWed: 11112011::Type.:,.· ':Allergy

:.·NOled·:,2121f2007

2121i2oo7'.""'-"--'--"'-' -..... ,. ' ....

10/1312010

Sulfa Drugs

Amoxicillin....__.._.- ' - - -----.- -- ..Pyridlum (Phenazopyrldine Hcl)

'. :Reactioiit;:·. :: :. :::.' '. :Rash. PT STATESTHAT SHE CAN USETHE SALVE.....Allergy" _.. ,.. " "Rash"··.. ·· .

Side EffediadVerse' .Nausea andior\/omitingReactionlintolerance

·Adh-esive·sensitiviiY·················_···················i/ii'2tHr············_···side·Eiiecuadverse··si<iii·ReaCiicins···············Reactionlintolerance

.. --.,., ., .. , . . .

Allergies as of 111fl011

Family and Education as of 1/1fl011. Marital status·: ..

Widowed

Social Narrative as of 1/112011Goes dancing twice per weekWidowed (husband deceased eva) but has gentleman friend since 2005Retired but works for state on temp basis

Visit NotesCHERI TEPPO RN Sat Jan 1. 2011 9:43 AM....~~~_~pf.~.':l.~.~~.QQ! ..l;I~~~.P.~~C?!..~C?~.~~i.~~~.!~~y_i.~JJ_!~r.§.~ .~~!t~.~~ .

CHERI TEPPO RN Sat Jan 1,2011 9:06 AMPatient clo nausea that started yesterday.She was off balance and fell hitting the end table with the leftside of her neck and shoulder.Large ecchymosis present.She vomited most of yesterday and again onarising today.WeakSkin cancer with removal done 1week ago on the right side of her neck. _

Letter available as separate attachmentLetter Information

.;)wcml:iun, Manon ~ tMK"" UU/UblSlSl) JJUI:i: U"/I1.blJl)2':)

StatusBERNSTEIN. LESLIE E on 111/2011 Sent

Questionnaire

CHS AMB PATIENT VERIFICATIONauestion AnswerVerify patienfs full name is correct YES

Y.~~~.P.~!!~~t~.~~~~.~tb..r~.~.!~.~.~~~ """" !.~~ _ .

N230

Release of Protected Health Information Marlon E SwellSon (MR# 00706887)

1212112010 9:00 AM

Patient Information. . Pcnient Name· :. .

Swenson, Marion E(00706887)

Reason for VisitMohs

Diagnoses

.Provider Department.Theresa L Behrs, MD Dc Fish Hatch Derm

. . . 'Sex ·DOBFemale 7126/1929

Encounter#55051626

.Phone .608·358-3795

other malignant neoplasm of scalp and skin of neck [173.4) Primary

Visit Diagnoses and Associated Ordersother malignant neoplasm of scalp and skin of neck [173.4) • Primary

CHMSRG MOHS MG TO HJNIHIF/G 1ST STAG 5 BLOC [17311 CPT(R»)CHMSRG MOHS MG TO HJNIHIF/G EA ADDL STAG (17312 CPT(R»)INTMD WND REPAIR REST BODY 2.6-7.5 [12042 CPT(R)]

Encounter NoteMaly Ma, Courtney 12121/1008:36 AM SignedMOHS PRE-oP EVALUATION

Last Dermatology visit: 11/15/10Last seen by today's provider: NEW

HISTORY:81 year old female referred by Jennifer Durocher APNP for evaluation and treatment of Bee on Rlateral neck.Biopsy: done When: 11/15/10

REVIEW OF SYSTEMSConstitutional: feeling wellSkin: no other skin complaintsAntibiotic Prophylaxis: NoPacemaker/Defibrillator: no

D/c'd ASA x 1 weej agiConsent form reviewed and signed

,!

M139

CT (continued)

Results (continued)IMPRESSION: Impression:1. Age indeterminate, probably chronic vertebral compression fractureinvolving approximately 50% loss of vertebral body height in the mid l1and T12 vertebral bodies.2. Multilevel degenerative disk disease and circumferential disk bulges.3. Multilevel facet arthropathy.

As the teaching physician, I personally examined the radiologic study,reviewed the findings with Dr. and arrived at this interpretation.Ordering Provider: 002762 - BENJAMIN HARTSHORNHl Authorizing Provider: THOMAS MEYERDictation Date: 07/0312009 Staff: MICHAEL TUITEAccession #: 9963419 .Electronically Signed By: MICHAEL TUITE, M.D. on Jul 3 2009 4:48PM

CT CERVICAL SPINE WI 0 IV CONTRAST (48553565]Resulted: 07/03/091652

Final result

5172125 • CT C SPINE W/O IV CONTRAST Performed at UWHCCurrent Diagnosis:Resident/Fellow: Staff: MICHAEL TUITE 104126Report Dictated on Jul 3 2009 Transcribed By: PSC on Jul 3 20094:48PM

Ordered by: Benjamin l Hartshorn, PJD 07/031091122Date Taken 07/031091207Addenda:Narrative:

Resulted by:

Signed: by

CURRENT Ox/SIGNS AND SYMPTOMS QUESTION: traumaCURRENT Ox/SIGNS AND SYMPTOMS COMMENTS:REASON FOR EXAM QUESTION: eval lx, dislocREASON FOR EXAM COMMENTS:PAST HISTORY QUESi~ON: mvaPAST HISTORY COMW!NTS:ADDITIONAL COMMENTS:

Report Dlctated:Jul 3 2009 last Update: Jul 3 2009 4:48l"M by PSCResident or Fellow:

STUDY(S): IlCT C SPINE W/O IV CC.nRAST, DATED 07/03/09 AT 12:07

REPORT: CT cervical spine without contrast:

Correlation with the thoracic and lumbar spine from the same day.

Indication: History of trauma.

Technique: Thin section axial imaging obtained through the cervicalspine. Coronal and sagittal reformatting performed.

Page 72 ...--

SWENSON 001096


!

M14C..CT (continued)

Results (continued)

Findings: No fracture or·il/slocation. No prevertebral soft tissueswelflng. Odontoid is int~d. Lateral masses are aligned. Severemultilevel degenerative disk disease with complete loss of disk height atC5-ce and C6-e7. Uncovertebral hypertrophic degenerative changes andfacet hypertrophy cause moderate bilateral neural frontal narrowing atC4-c5. C5-C6, and C6-C7.No paraspinous mass.IMPRESSION: 1. No fracture.2. Degenerative disease Is detailed above.

As the teaching physician, I personally examined the radiologic study,reviewed the findings with Dr. and arrived at this interpretation.Ordering Provider: 002762 - BENJAMIN HARTSHORNHL Authorizing Provider:-THOMAS MEYERDictation Date: 07/0312009 Staff: MICHAEL TUITEAccession #: 9963417Electronically Signed By: MICHAEL TUITE, M.D. on Jul 32009 4:48PM

GML LABORATORY

ALCOHOL (48553558] Resulted: 07/03/09 1~e Final resultResulted by:

Signed: byComment LabThis result should be used for MAlmedical purposes only. N

FlagRef Range0.00 - 0.00 gldL

ValueRESULT BELOW METHODDETECTION LIMITS

Ordered by: Benjamin L Hartshorn, MD 07/031091120Date Taken Blood 07/03/09 1122 ~Addenda:ComponentAlcohol

Testing Performed ByValid Date Range10/30/071405 - Present

Director AddressTeresa Darcy MD, 600 Highland Ave.Med Dir Madison WI

NameUWHCTRANSFUSIONSERViCeS __..1-' - -- -. ------- ...,........~:_=_ --UWHC CSC ... Teresa Darcy MD. 600 Highland Ave. 05/07/070929 - PresentLABORATORY')' Med Dir Madison WI

908 - MAIN

Lab - Abbreviation902 -BS

.,

Page 73

SWENSON,MARION eMRN: 1675629

SWENSON 001097 Adm:07/03l2009Printed By SMH077 at 3114/11 10:06 AM

Swenson. Marion E (MR # 00706887) DOB: 07;26i1929

Utriet Gina At MD 9/8109 02:54 PM Signed

SUbjective: Marion is an 80-year-old woman seen today for evaluation of neck pain. She was thebelted passenger in a motor vehicle accident July 03. 2009. She suffered some broken ribs andwhen I last saw her about a month ago she had quite a bit of chest wall pain. She was notcomplaining of neck pain at the time. She had a cervical spine CT during her hospitalization thedemonstrated no evidence of fracture. She describes the pain mostly over the trapezius bilaterally.Has had decreased range of motion of her neck over the last 4 weeks with no new injury. Noradicular pain. No weakness numbness or tingBng. She also has been found to have a tom rotatorcuff in the right shoulder. She is using one hydrocodone every 4 hours with good pain control butshe is disturbed by the lack of range of motion in her neck especially when she tries to drive. CT ofher neck from the UW demonstrated significant arthritis but no other abnormality. Occasionally thepain does radiate from her neck up over the scalp into her occipital region.

She also complains of a lesion on her right neck. She tells me that she had some cream in the pastthat is taking care of this. She thinks that some kind of sulfa cream and she also used for anulceration on her leg. I can see no prescription for any such thing in her previous med Usl She doeshave some triamcinolone cream on her list but she is unsure what she has used this for her. She didnot think it was for this particular lesion.

Past medical history. medications, allergies are reviewed and updated

Physical exam: General: Well-appearing adult woman in no apparent distress. Blood pressure118/74. Pulse 88. No tendemess over the cervical spinous processes or the occipital ridge.Minimal tenderness over the cervical paraspinous muscles. She Is most tender over the trapeziusbilaterally. She has normal flexion but Virtually no extension. She is apprOXimately 20· of rotation toeither side. Left upper extremity with 5 over 5 deltoid. bleeps, triceps, and grip. The right side isprobably 5 minus out of 5 in all of these but her exam is compromised by her significant shoulderpain. She is areflexic at the biceps, triceps, and brachial radialis bilaterally. On the lateral right neckthere is an approximate 1 em circular lesion with raised edges and some mild erythema.


1. Neck pain: Without radiculopathy. Largely myofascial and DJO. Symptoms really did not appearuntil a month after her car accident and a cervical spine CT at the time of car accident wasunremarkable so do not think additional imaging Is necessary. Recommend the addition of Aleve onetwice daily with food. Continue when necessary hydrocodone. Physical therapy. Return if notimproving or if new or worsening symptoms.

2. Possible granuloma annulare: Trial of topical triamcinolone twice daily for up to 2 weeks.Dermatology if not resolving.

\

'"N79

OateJTime Note Was Signed

DateITime Note was Signedrue Sap 8. 2009 2:54 PM corrue Sep 8, 2009 12:46 PM cor

MedicationsOutpatient Encounter Meds: End Of Ene - 91812009

Disp Refills Start End

SWENSON 001330

S\V~nson. Marion E (MR # 00706887) 008: 07i26/1929

Questionnaire

N42

Order EntryQuestion1. Date for Exam2.What is the Reason for this Exam?

3.Expected Exam Time4.VVhen did patient last eat?

End ExamSSMW RIS XR END EXAMQuestion1. Is the patient pregnant?2. Patient shielded?3. Additional Information

Answer1/112011fall with NN riointercranial injUry

AnswerNoNo

Comment


CPT Code 70450

Electronically AuthoriZed by SHARPSWAIN. RUSSEll 0Date: sat Jan 1, 2011 11 :15 AM

Order History InpatientDatalTlme Action Taken User Additional Information

9j!Q11.i!I~~~~}i~~~C~~:::~~:::~:~~:~::~~:~§n~ij~~~~~~~~~~~:~~:~~:~~E!~~C~~~::::::::::~:::~::::::::::::::~:~::::~~:::::~~:~:::~::.Q.1m1!.11.1~~.._.~~l:'~~ ~.~~Q~~L.e!~.R~l:'~~ P.~!!rrltf)~!'y .01101/111115 Release Pressentin. Kim, RT From Order: 59023465...............m· • .._·Resuif ······..·..m ..···-P·resseniiii:i<im·············..··..·iii·processm

- ..

Results

Result matuInformauon FInal result (1/112011 1:57 PM)

Entry Data 1/112011

Result CT scan of the cervlcal splne 1/1/2011.Narrative

HISTORY: neck pa1n after fall.

CT CERVICAL SPINE (Order 89024191)

Provider statUIOpen

FWDIlIGS: Contlguous axul 1maqes were obtalned from the skull base throuqhTI-T2 wlthout contrast. Reformatted saQ1ttal and coronal 1maqes were also~cqulred. The pat lent 1S ~oslt10ned asymmetr1cally maklnq lnterpretat10nufflcult. ~here lS very advanced rnult11evel ceqenerat1ve chanqe w1thnarrcw1nq of the dlSC spaces at essent1ally all levels. but most severely1nvolvlnq CS-e6 and C6-C7. There 13 m1nor ~~terOl1sthesls of C7 on Tl 3nd~h,r, 19 a very advanced ceqenerat1ve facet arthropathy at mult1ple levels. :10jefln1:~ acute fracture or dls1ocatlon lS demonstrated. The prevertebral softr.1=sues are w1thln normal 11rn1ts.

Result IMPRESSICN: ,\dvanced mul tll evel deqenerat 1ve chanqe. tlo deflnlteImpression acute fracture or ·julocat10n.

Th, results were faxed to the emergency ~~par:ment at the t1~e of the·~~amlnatl·,n.

~.'!adlnq RadlOl,,<}ut- lhtby, :m. Jull'!:~'!I~aSlnq R3dlOl~11st- H1tby. :iD. Jul1e

SWENSON 001293

". ~.. ::' . : '.'.. ,'" ~- . '

':Or.<nnaAUtrie - _'-Dem M~dicalCeIlter1821So~th Stoughtori;Road

, _',Madifjoll, Wl:537i6-2257 "'.,.: ,:.":":,,,,.'> "~:'\'~'..,,~ .', ... ' .

June 6, 2011-

,',. "

.", ,

R~:_. Patient:'MarionS\Venson '~Date of-Birth: 07/26/1929

. _ Date'ofIncident: 07/03/2009_', OUr FileNo.: 248.01

"

Dear Dr.·Utrie:

',' _' :''otu."fi.rin:'r~esents Mariort$wensonin a personal inj~ litigation matter.Enclosedis,~.fuedical- ':;: -,:authcjrization form' exectit~d_by her. so thatyou may discuss her condition withus. -, ,- ~: ' ", ",

, " "'~I':' .••.. .' ~ . ,'.~ ""',, , .•• ' , ,.' , '. ' '. ~.';';, ."~ .,'. •

'Ms'- S~enson reports that you have been involved in the treatmentS related to her July~, 2009,automobile accident. Itwould be most helpful ifyou could provide a_briefresponse to thefollowingissues:

'r .. ,

. ~. ",' ,

: .~'. ~

. !.

;".

: ..,'.

JUI1ei6':;201',F "j:::':, '-, .. '.,'

·.:~:~'$.~~~%;:I~~~tei;~~Qbt~eJ~~~ther-~~tij&:SW~:~Y'~l··....•.. ~ .••.•.....,'. " " .. «:<:.Ii1<e.!Y:Un:d~go,andthe'}ikelY:es.tim"~ted·~costofthat.tre~(ment a:S ~iesultofhei: " " .

. :.'. _ '.': ..accideJlt ~lated injures? j ..........:L.MAA.u~ - A J'II ,I'\;.;~'~ . .f. -/ i JAAJd-U.//U, , .• ,.;." . . '. If/Ut.ltTy,fWn..t, 6- ,v..l.,er. hJ.)· ~. . I f,P'~ -: >-:--7 '---

. . /t/it(Al . " . '~".~.~ ~ r/lJ', ,'~ .~~'fij. ~.'fflJ?'~~'"u.~·

,'IS e elih~od that Marion Swenson wiIl·be vuhierable to further injury or.. ,~evelopadditional injuries or.similar CO~~itions as aresuit o.fhcr ~es'l '

. .~~!lr·k~ ~1 ~.~ 't!'e-. '- 1?

..'......•~~/~~~~~ .

:. , '7.' .What.sorts ofactMties or conditions Willlikely trigger or aggravateher symptoms in,: ' the fumre? ' . .

:..~ .... "

..~'~ Iren.u '/ /l~ff:4l'!~(-,M

.--./hUU,~

. 8. Are there any specific restrictions on activities you would recommend?

!.::i~M/ th1 I'a~ cUd/I44fL 'fI

9. Finally, ifthere is any other infonnation you feel would be helpfulin explainingthe impact the accident has had on Ms; Swenson, it would be most appreciated.

~ .4 u ~4t 1Jr4'-41~ ~~~t7;tP~ ~U?!1p.4 Av1 ft11/~ ,~ AJV .~~It

tlUftu-I'vhm;tIZL· ~PP1A ct- y(J.'lA.#1 h H-tw.Jt1eu~ .~ ~JI/ltL 41 :tltdl;l ,4" Al/lL Au dffU//MWJi-i--£.?/j:?<:-A4~~ ;Ah/l~ dk///f/LH'CMt4!J flnu,t:e'c(

Please undersi~~f th~rThe legafiJrofession app{eciat~s that phy§fcians do not have a crystal ball tohelp them predict the future. Therefore, the law accommodates the uncertainty·of the future.Something is your legally-acceptable opinion if it is more likely than not true. You need not beabsolutely sure ofany opinion. In the same way, any opinions concerning permanency need not beabsolute. Ifyou believe more likely than not that Marion Swenson has suffered some injury that willtrouble her for theforeseeable future, then under the law she has sustained a permanent injury.

:.: r

. ~ - .. . ", ,"-:: .

"'. . .:;c: .

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.. " yOu fOIYQliT:co~~Y.·· ' " , '. ,'

.Sincerely,"

i.'

~;211LCAndrew J. Parrish .'

·AJP/amr.. 'Enclosure

c

. "

MEDICAL I~FORMATION. ~LEASE

Dr. Gina A. Utrie ._________,:(Heallll Care Provider)

The undersigned.~ eS£...,.e~utes this medical infonnation release for the purpose ofauthorizingdisclosure ofmedical records. bills and opinions in aid oflegal investigation. The undersigned herebyauthorizes disclosure ofall medical records, bills. correspondence, opinionsor reports, and x-rays. in the possessionof doctors, psychiatrists, psychologists, chiropractors, osteopaths, hospitals, clinics, or stale agencies havingprovided the undersigned with health care services pertaining to physical andlor emotional assistance.

This authorization form also grants you permission to release any and all correspondence, notes, memos,and olher documentation of any kind which is in my file to Kasieta Legal Group. LLC, and Attorney Robert J.Kasiela.

This infonnalion is to be provided to the law flllD Kasietl Legal Group, LLC, or its agents, employees, ortepreSCDtalives. This release includes authority to inspect andlor copy all written records and bills of the typesdescribed above.

This authorization is not intended to grant permission for any health care provider to discuss theundersigned patient with any other attorney. Such permission is expressly withheld. However, I grant permissionfor any health care provider to discuss my medical information with Kasiet8 Legal Group, LLC, or its agents,employees, or representatives.

Kasiela Legal Group, LLC, recognizes that federal regulation (42 CFR Part 2) prohibits furtherdisclosureofthe psychiatric/psychological records, ifany, without the specific consent ofthe.undersigned, or as otherwisepennilled by federal regulations.

This authorization fonn also grants you permission to release any records or documents related toalcohol or drug treatment or evaluation; AIDS or AIDS related illnesses; HIV test results; any psychiatric

consultations or other services for mental illness.

This release shall be valid for a period oftwo years from the date of its signing. Medical records createdbefore/after the date ofthis release will be honored.

Aphotocopy of this authorization shall be considered as valid as the original.

The individual may revoke the Authorization in writing. However, revocation ofthis Authorization willnot affect any action taken in reliance of this authorization before receipt ofa written notice ofrevocation.

Protected Health Information released to another party may no longer be protected by federal privacylawsand maybe further used by the recipient ofthe information without the patient's consent.

Treatment, payment, enrollment or eligibility of benefits may not be conditioned on obtaining theindividuals authorization.

Dated this~day of bec. . ,2009.

c.f7DCL-~ e <.S~~SIGNATUREDate ofBirth : 1- ~ c.. - ,;. qSocial Security No.: s3 tf 2- :L Go - 7 1 7 ~

AIILJKGTOlfDINJRBBOARDpos.=

ARLINGTON, WI 53'11(CiOI)63,..,

I:, O4IIfIlOlORUNNUMBIR

swiHlOiftlWllOJlE.'1811NCJLB1WlTDR.MADISON. WI. 53713

11N39-1251025

PADIlm~!WuoMB.D!'lW.IIIlVICI:'~~i'iI·.~.:·· ..

, "'9QlMNMi23··10: UWIfOSlirrAL.. '. '

INVOICBSTA1VS:PA1lT. PAlO0.- ••0• ·0"

. : .• ":,·0

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0204OS

[A08) BASBRATBNR.[A0422J OXYOBN[M312JSUPPLIBS

[AD425)28.8 IG.08fmi

10TALDUB

ACCBPl'BDON A8SIGNMBNT 04II9fJ010

$

s

475.GO4SJIO25.00

asJlO

67.40

RBPBI.TO1NVOlCBNt1M8BR.wrrHPAYNBNT

PA.'1UNT: SWBNSON.MAlUONILDAD_SlRVICS: 071031JOO9'l'IIANSPOk1;dl:~.o '. .. 1IIOJII9OINMM 123'1'0 : uwllOSPrrAL

INVOICB STA11JS:' PAllY. PAID

------_..--- ----_._----------------------.,

I, the undersigned, being the duly authorized Custodian of Records or other qualified witness for Walgreen Co., andhaving the authority to certify the records declare the following: The copies of records for whieh this Affidavit Is made aretrue and correct copies of the original records; The original records were prepared In the ordinary course of business at ornear the time of the act, cond'ltion, or event by aperson with knowledge of the facts recorded; and That

A)

Paper print outs of information for our retail drug stores and mall order faeKRies electronically stored inWalgreen Co.'s Pharrn~stem responsive to the subpoena or authorization and reasonably accessibleare provided and total...:a:L page(s).

B) CERTIFICATI0tlOF NO RECORgJ.&

Athorough search of our files, carried out under my direction revealed no documents, records or other materialscalled for In the subpoena or authorization.

D All records for the time pertod In question have been destroyed in accordance wRh our document retentionpolicy.

D Athorough search of the requested date range to ------has been performed and, understanding that such records could exist underanother spelling, name, orother classification but with the Information furnished to our office and to the best of our knOWledge, nosuch records exist

I declare under penalty of pequry under the laws of the State of Illinois that the foregoing is true and correct.

05/1412010

Subscribed and swom to before me this 14 day of ~...u,..AooCW ........- __----, 2010

Executed on

__--:-:::-:'J;-ill-:-:Bos_Ch~--------Signature: -+--H~u....l~JI-tU~-"-----(Print Name)

Notary Public "OFFICIAL SEAL" 4

SHANNA R. DOGGETTNotary Public, State of illinois

My commtaelon exp'm 04/02/14

~ There's a way·Page 1 of 2

INSURANCE PROFILE07103/2009 ttuough 0511412010

CUSTODIAN OF RECORDS1801 EAST VOORHEES STREETDANIIIU.E. IL 61834

DATE PRINTED: 051'4120'0

Drug Mfr NDC C.... DaysSupply

'9111138-2879 HVDROCODONEI TAKE ONE OR 1WD WATSON 00591· C3APII' 5MGIS25MG TABlElS BY MOUTH 3202001TABS EVERY .. HOURS AS

NEEDED FOR PAIN

MARION SWENSON618 ENGElHART ORMADISON, WI 53713Patient Phone: (608) 27().()710Date of Birth: 0712811929 Gender: F

Rx-8tDre MedIcation Instructions

'319221-<&240 NITROFURANTOI TAKE ONE CAPSULE EONN MONOIMAC BY MOUTH TWICE1DOMOCAPS

1319229-<t240 PHENAZOPVRIDI TAKE ONE TABLET BY AKVMANE 20ClMG MOUTH THREE lIMES

DAIlY AFTER MEALS

00185- AX0'22001

65162- AX0520-10

7

2

5

Allergy Conditions: None on fileHealth None on file

Entered Fill Fin RPH PbrName DEAl Pbr Phone PlanDale Qty Nbr

1112612009 14 RSB IMJODINARD. BW5642'44 (601)260- DECMPTHOMAS 60'6 D

Total 1 Subtotal: 14

"I26l2OO9 6 RSS VlCODIIIIARD. BWS642'4.. (808)260- DECMPTHOMAS 60'6 D

Total 1 Subtotat: 6

07lO4l2OO9 60 MBG ORR, JAMES 809644774 (808)263- DECMP04'9 D

CustAmt

3.00

$3.00

2.2'

$2.21

3.00

Total 1 Subtotal: 60 $3.00

-ntIS REPORT CONTAINS PA11ENT HEALlH 1..0RIIA11QN WtICH IS LEGALLY PROTECTED UNDER H1PM LEOISLA110N-1HIS INFORllA1ION 18JST BE USED AND STORED IN ACCORDANCE WI1H HtPM POUCIES

1Ida.... lDgelIlIrWIIII""....1lMI1Il, II Intended • .., lie use of lhe In6kIUIlor..fty to lIHdlltla edlhlled. Itm-yClIIIIIIIIInfarmIIan lIllIIlI ClII'IlldentII ...pI'lI/IIIIlIId tam dIIcmul8. II W'DII1ftI nat lhe InlIndId 1lIdpIe.... you ant '*""

IIOlIlIId lIIII., cIIaelI*Iallon oraapwlng otll1la....,or.,.a.dlftWIIl1s IIlIclIy pnl/lIIlllCl.lfyou /lIVe reCllvld lIlIalder '"_ ......naUttlhellltgln.l--1mInlIdIIlllIr1Ild",aflhlslatlBr. Mont'llllll8llY all8dlmetltl. 1'IIalIkyclU.

CUSTODIAN OF RECORDS190' EAST VOORHEES StREET DANVILLE. IL 11834

Total Scrip1s: 3 Total Price:Using generics you saved a totalotUsing more generics you could have saved a totalYour Insurance saved you a total of:

Your cash quantity discount saved you a total

Page

$8.21$0.00$0.00

$79.76$0.00

2 of 2

r ••

~Kasieta

oil : I Legal...•Group, LLC

II UllIucd 1.illllll" Campall)'

Direct Line: 608-662-2307Direct Email: [email protected]

February25, 20II

Dean Business OfficeAtta: Bll1ing DeptJ808 W. BeitUne HipwayP.O. Box 259328Madison. WI 53725-9328

.,--::::::-~-...

Re:

......._-

To Whom It May Concern:

Please enclose your bill for the copying of your records, and we will see that the bill is paidpromptly. Thauk you.

Sincerely,KASIETA LEGAL GROUP, LLC

f:.{j;JJ~J~antaiahGiJI

MAR 04 20~tReceived and Reviewed by PatientAccount Services. It's okay toprocess the US request &om the PIFaccount. KS~'\..,?""

7818 Big Sky Drive. Suite 112 Madison. WI 53719·4983

~~\lJ\CU~608)662·9999 Fax (608) 662·9977

\."""'\.; www.kasiela.com

(i~.:~ \.c:c:a\-\ ,

IfEE\Kasieta

~~3~P.llCDirect Line: 608-662-2307

Direct Email: [email protected]

February2S. 2011

Dean BusiDessOf6ceAttn: BiDing Dept1808 W. Beltline HighwayP.O. Box 259328Madison, WI 53725-9328

--~~ ....Re:

To Whom It May Concern:

Please enclose your bill for the copying of your records. aDd we will see that the bill is paidpromptly. Thank you.

Sincerely.KASIETA LEGAL GROUP. LLC

~.{j;JJ~~~t

M,\R 04 20~\Received and Reviewed by PatientAccount Services. It's okay toprocess the US request from the PIF

account. KS~"'?~'

7818 Big Sky Drive. Suite 112 Madison. WI 53719-4983~~\X5\clJ~- (608) 662-9999 ~ax (608) 662-9977

~~~ \\~ www.Ica".'I.coDl

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MARION E SIBNSON618 BNGBLBAR.'l' DR

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MARION B SNSNSON618 BNGBLHART DR

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MADISON, WI 53713

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Please Pay:

Page 9

03/08/11

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..MARION B SWBNSON618 BNGBLBART DR

MADISON, WI 53713

DEAN MBDICAL CBNTBR1808 W BBLTLINB HKY

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MARION B SWBNSON618 BNGELHART DR

MADISON, WI 53713

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MARION B SWINSON618 BNGBLBART DR

MADISON, WI 53713

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MARICH E SWINSON618 BHGBLHART DR

MADISON, NI 53713

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MADISON, WI 53713

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MARION B SWINSON618 BNGBLHA1l'l' DR

MADISON, WI 53713

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Physicians7974 UW Health CourtMiddleton. WI 53562

CERTIFICATION OF BILLING STATEMENTS

608.833.6090608.833.5039 Fax

I, Carol Meuz, Special BllHna Servkes, of VW Health, bereby certify tbat the attached is atrue copy ofthe bl1UDg statements ofMarlon Swenson for hlslber treatment from 07/03/09 topreseat, and no,Y OD me in the offices of UW Health Physicians, 7974 UW Health Court,Middleton, Wisconsin 53562 •

In witness whereof, I have here unto set my hand March 12. 2010.

'~1Il----Special BlUingservl~VW Heahh Physicians

STATE OF WISCONSIN ))ss

COUNTY OF DANE )

Personally came before me OD !\farch 12,2010, the above named Carol Menz, known to me tobe the persoD who executed the forgoing Instrument and acknowledged the same.

uwhealth.org

PWllEAElURHTOP POR1IONIM'fHYCUR PAYMENT.PAYClllGAT...IPPAYING BYMASl'ERCARDORVI8Ao FlLLGUTIIS.OW.

C CIIItlCMIt_ .......-- IIP.DAtI

ITA1BIINTDATE ACCT.'03/12/2010 P-379443

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r,i;"IK" Uti Cr: l'r.Yiiil!.!: c. 1:j-I,1I1 10:

UW Health • PhysiciansPO Box 2978Milwaukee. WI 53201·2978

HARlON B SWENSON618 BNGBLBART DRMADISON, WI 53713-4744

D CtIICk bOI.....OIln1ut1no1l11ac:tllllgldad fIldICata cIlIJlp(l)on metU IldI.

Detail fol' 'atleat: IS08)30S1 IWlIOH B SWENSOH

01/04/2009 SU8S8QUIIII' HOSPrJ'AL CMB. LBVL II ORR 18C.00 0.00 0.00 0.00

c:P'I'l 99232 011 805.8. Blll.l

01/2712009 lIfSURAIICB PA'llIIIlNI'-'l'PL 184.00

01124/2009 llSUIWICB PAlIMINI'-orPL 0.00

01/03/2009 1lHIIRGDJC" DIlPI' VJsrt. L£VBL IV KBYIR 389.00 0.00 0.00

c:P'I'l 99284 OXI 80S.4. 80S.2. Bl12.1

01128/2009 INSUIlAHCIl PA1HIINI'-'l'PL 0.00

08/03/2009 JNSUIlANCB PAYHIIN'I'..,.,L 38'.00

0"03/2009 BLIlI:'I'IlOCAIIOGIWI RBPORT VArmBl AU 15.00 0.00 0.00cpr. '3010 DlEa 786.50

0712712009 INSURAICB PA'llIIIlNI'-'n'L 15.00

O'J/O)/ZOO' CIlBft X-RAY 1 VW tul'I'B 48.00 0.00 0.00cprl 71010 011 V71.4. 553.3

01l031Z00' lIISUltNI:B tAYHIIN'I'-nL 411.00

07104/2009 IlLEX:'lROCARDIOGIWI REPOR'J' VANDBI AU 75.00 0.00 0.00CPT. 93010 ox; '786.50

08/241200t INSURAHCB PA'llIIIlNI'-MBDICAJlB 6.8801/24/20ot Ie~ ALLClIfMI:B-MBDlc:ARB 66.4009/21/2009 INSUUHCB PAYICIDn'-DUNCAIlB 1.12

01103/2009 X-RAY PELVIS 1 VW 'fUITB 48.00 0.00 0.00CPT. 121'70 ox: V71.4

08124/200' lICSUaMl:a PAYICIDn'-MBDleAJtB 6.6201/24/2009 Ie COIft'IlACtuAL ALIAlII1lNCB-KBDlc:MB 39.1309/28/2009 IffSUJtAIlC'B PAYHIIN'I'-DUNCAIlB 1.65

01l0ll20ot c:T SCAlf CBIV sPIn TUITE 327.00 0.00 0.00

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D ." D SPClUIE1M CGmpany Name

IF YOU HAVE QUESTIONS ABOUT YOUR STATEMENT

GENERAL '"FORMAMNThis bUl is Corprofcssloaal scrvicc:s ofJ'CICd by the providers orUnlwrsity ofWisconsin Medical Foundation. Inc. (UWMF).UWMF isaDOJloffOfit corporation which SIIJIPOdS the cIiDlca1 practic:es ofthc faculty pb)'SiciaDS oflhe UIIMrsit:y oCW"JICODSiD.UW Hcallh·PIlysiCIDS is IIle name UWMF uIilizes when conductine1ts bllUne aad collection services. Jr)'Outpmider deliYCmlservices at a hospital orclinic, )'GU may also receive a separate bill from that facility Cor COSIS related to the buildin& supplies,equipment aDd support staf[ .

FINANCIAL PQUCYCharges ROt CO\'eI'Cd by iDsuram:e are due "ithin IS days ofn=cciving )'Our stalcmenL There will be a c:harge for payments that areraumcd as DOD-sumcfcnt fimds. Please keep in mind that)'Our insumnce co\"CI'3ge is a contract hetwccn you and )'OUI' inswancecamer. You are ultimately rcspoDSl'ble for payment ofall charges and WldersIandiDg )'Our policy benefits.

lC)'Ou are unable to make payment in filii, please call 829·5254 or 1-877·565-8855 as soon as you rccche this statement to cUscuss)'OUI' financial situation and Inakc payment 8II1IDgcmcnts on )'OUr account

DO YOU NEED HELP WITH YOUR MEDICAL B.u.s?UW Health's physicians. clinics. ami hospitals are committed 10 providing care 10 patients who arc unable to pay for the medicalservices they n:cciw. UW Heallh's Community Care program is designed to help these individuals. Unil1SUrcd patlen\S arc entltled.0a discount off'most senices and may be eligible for a greater discount through our Community Care program. .

PAllENI ACCOUNT QUESDONIIfyou haw any questions on your llClCOunt. please feel fRc to contact a Patient Accounts Representative at the number belo". Theyme available to assist )'OU from 8:00 AM to 5:00 PM, Monday through Friday.

Local (608) 829·5217

long DIstance (877) 565-0505

AddreSS/Insurance Changes email [email protected]

81 USICd ticuc algona prcgunta refercnte a su cuen'" 0 ncccsita cstablcccr un plan de palO. par tawr comunlquese al

(608) 829-5217 or 1-877-565-oS05.

Thank you for choosing UW Health for all your health care need8.

~ealth

PhysiciansUW MEDICAL FOUNDATION 7814 uw HEALTH COURT MIDDLETON, WI &35a

PLEASEFlE1UANTQPPOR11ClNWlTHYOURPAYMBfI'~PAYCNJNEAT

IF PAYING BY IIAS1IRCARD OR VISA. FlU.our BILOW.

0 CllnlOM..... MIOlIIf

...u. .......ITATllllNrDAtB ACCT.'

03/12/2010 P-379443

MARION B SWENSON618 ENGELHART DRMADISON, WI 53713-4744

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PhysiciansPA11INT1lU8lN!U82RY1CE8(ICII)-.at7 or(In)--

UW Health - PhysiciansPO Box 2978Milwaukee, WI 63201-2978

CP'J't 72125 OIt 959.09. 722.4

08/24/200' IIISllIWICI .AYllllNNalDICMIl 45.49

08/24/2009 II: CClH'l'ItACt'UA ALLOWANCB-MBDleAlUl 270. Ie

01l21/20ot IHSUMHCI 'A-.r-DBMICAIlB 11.37

07103/200' C'l' SOH DDUAL SPlIlI: 'nIU'1 327.00 0.00 0.00CP'J': 12128 OIt 805.2. 722.51. 515

01l2S/200' INSURANCE PAVHINJ'-IlIDJc:MB 45.49

01/2S/2009 II: C01ft'IW:'I'UAL ALLClWANC:B-HlDIc:MB 270.14

0!U21/2009 IIISIlRAHCB PAVHINJ'-DIWCMB 11.37

0710312009 C'l' SCAlI LUIIIWt SPIHI 'nIint 326.00 0.00 0.00CP'J'1 72131 011 805.4. 722.52. 721.3

08/U/2009 INSlllWCE PAYMINr-HIlDIeAR& 45.49

01/24/2009 IIC c:cmRJ\CTUAL ALtAlWMICB-HlDlc:MI 269.1409/2112009 IJISUIWIC8 'AYIIIINr-D&NiCARa 11.17

07103/2009 DIl'l'IAL HOSP1'1'AL CMB. LBVL I 24•• 00 0.00 0.00CPr I 99221 011 V71.4. 724.5. 786.50

01: ElU.l

10/22/2009 fNSUlWCB 'AYH8NI'-MBDlc:MI 69.4210/22/2009 II: CClN'I'MCI'UAIo AU.CWANCB-HlDlc:MI 161.2211/12/200t INSUIWCa PAYIIIINr-DIMCAIlB 17.]6

07l0C/2009 SUllSllIQUBNI' HOSPITAL CARB. LBVL II llC.OO 12.93 0.00CP'J'I 99232 011 80S ••• 8811.1

03/12/2010 IRSUIWCZ PAnlINI'-1IIDICARB 51.7403/1212010 II: CONI'IUlCrVAL ALLOIfANCE-HIlDlc:MI 119.33

0310212010 OFFJ:CE/C1J'I'P1' VISIT. HJl,W. LBVL V ]78.00 0.00 318.00 0.00CP'J': 99205 01: 123.1. 721.90. 722.4

011 729.1. 959.2

ACCl:UtT NO:P-379CU

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IIIIIUI8CI D NewInIurancec., a 8POUII D CtcILD D O'IKIIR D InIurInceaw.a.'._- IPIlGnI •

._,

._, or' -,

IF YOU HAVE QUISnONS ABOUT YOUR STATEMENT

GIMRALINFOBMADON1bis IIiIJ is Cor professioaal scmces otrered by the pmideIs orUnlvcrsityorWiscoDsin Medical FouudatiOD, Inc. (UWMF).UWMF is a~ corpcmdiDD whicb supporIs the diaical pl8Clices oflhe faculty physic:iaDs oflhc UDiwnity ofWiscoDsin.UW HealIJl.Ph)osicau is Ihename UWMF utilizes wIleD coaduCdnl i1s bilIiDI and coUeclioD services. 1f)'ClUl'providerdeIhaedseMccsata hospital ardiDic, yGU mayalso Ialeive aseparate biU ftam tIIat f'ac:iIi1y far COlIS raIaIcd to the buiIdiDg. supplies.equipment and support IIafr.

FINANCIAL poueyCharges not QMftlClby!aswaDce are due within 15 da)'! ofreceiving )'OW'SIItemeDt. There will be a cbarge for paymeD1S that 8ICretumed as noHUfllcfeot ftmds. Please keep in mind tbal )'OU1' illSUJlJlCC CO\'eI8ge is a CODUaCt betweeD you 8IId your iDsuraBcccarrier. You are ultimately n:spcmsiblc for paymentofall charges and UDdersIaDding your policy bcacfits.

Jlyou are unable to make payment iD ftdl. pleasecall 829-52'4 ar 1-877·565-8855 as soon as)'OU r=\'C Ibis statemcnl to discussyour filllllCiai situation aDd make pa)'IDeIll ammgemems on )'OW' 8CC'OUI1l

DO you NEED HELP WITH YOUR MEQlCAL au I 8 7UW Hallah's ph)'Sidans. clinics. and hospitals 8IC commilled 10 providiDg care 10 patiealS who are unable to pay for the medicalservices they lec:civc. UW Health's Conununity Cafe program is dcsiped_to help these iDdividuals. Uninsural patients are entitled'0 adiscount oI1mosa scnices and may be eligible tor agrater discount tIuuugh our Community Calc propam.

PAlJINT ACCOUNT QUEIDONIIfyou baWl any questlcms on ,our account. please feel flee 10 conlaCt a Patient AcccRmls Represenl8liw at die nmnber below. Theyare available 10 assist~ from8~ AM to 5:00 PM, MoDday throuah Friday.

I::astance I ~ 829-6217 I-Address/I------nsurance---Changes---Em-af-I- !!!!I!!!l!1olans=wIoc.edu

Si USled tieno alpna pregunta refcrcnte a su cuenl8, 0 neccsha CSl8b1cecr un plan de palO. por rawr comuniquesc al

(608) 829-'217 or 1-877-56S~S05.

Thank you for choosing UW Health for all your health care needa.

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Physiciansuw MFDlCAL FOUNDA11ON 7174 UWHEALTH COURT MIDDLETON. WI 83112

...... J-

lW~ealtb

UniversityofWISConsinHospital and Clinics

September 8,2010

Kasieta Legal Group7818 Big Sky Drive Ste 112Madison, WI 53719-4983

600 N. Highland AvenueMadIsCIn, WI 53792

TI lEem£ov~~-; SEP 13 2010 ..,

... ' ... ,," '..

RE: Swenson, MarionMR# 1675629

Dear Ms. Burkeland,

In response to your request of 9/2/10, ·enclosed are billing records for dates ofservice 5/4/10 through 8/4/10. Please let me know if you have any questions.Thank you.

Sincerely,

~~. \\rIo--'"",,""'",=-----

Robin J. WillsUWHealthUW Hospital Patient Accounts(608) 263-8583

UW1lalllb.arg

mHeallbUniversity ofWtSconsinHospital and Clinics

600 N. Highland AvenueMadIson. WI 53792

September 8. 2010

I hereby certify that the attached 5 page(s) is a true and complete copy of chargesfor:

SWENSON .MARION E1675629

from 05/04/10 to 08/04/10 from the University of Wisconsin Hospital and Clinics.The original bill was created in the usual course of business, and is maintained

in the custody of the hospital business 0 ALynn BaslerSupervisor Patient Accounts

Dated this 8 day of September ,2010 at Madison, Dane County. Wisconsin.

~1Add2D~¥)rdnAra Ostrander

NotaIy Public j JMy Commission Expires ) rQJ~}~ ..

seERRJW09

uwhealtll.arg

uvHeanhUniversityofWisconsinHosplta13nd Clinics

600 N. Hlahland AvenUiMadIson. WI 53792

INVOICE FOR ITEMIZAnON

DATE: 9/8/10

REQUESTED BY: Ms. Burkeland

LAW FIRM OR COMPANY: Kasieta Legal Group

PATIENT NAME: Swenson. Marion

MEDICAL RECORD NUMBER: 1675629

Pursuant to Section 908.03(6M) (C) 3 WI Statutes or 102.13(2) (B) for WorkersCompensation

Requested infonnation faxedCertified Copy X

Number ofPages 5Amount due) $19.05(1ncludes Postage &. Sales Tax)

Send Payments toHospital &. ClinicsDrawer 853

Milwaukee, WI 53278

PLEASE DO NOT SEND CHECKS TO 600 IUGHLAND AVENUE

Please return check with this invoice so that I maydocmnent it correetly

UW Hospital &. Clinics Tax id # 391835630Reference #GL 05-2218-05-998

Itemization Request635 Science Drive Ste 200Madison, WI 53705

Univer.~ty~f Wisconsin Hospital and ClinicsDrawer 1853Milwaukee, WI 53278(608) 262-2221

Page 1 of 2

'Patient: SWENSON, MARION BMRN: 1675629Hospital Account. Number: 538070

Guarantor Account Number: 379443Financial Class: CAREPrimary Payor: MEDICARB 164Primary Plan: MEDICARB A & B 408Patient Type: OUtpatientLocation: BAST CLINIC

SWENSON,MARION B618 BNGBI.llART DR~ISON, WI 53713-4744

Admission Date: 05/04/2010Discharge Date: 05/04/2010Print Date: 09/08/2010

Amount

This is an itemization of your hospital services.

Charges, ~------------------------------Service Qty Rev Description Procedure

Date Code Code

05/04/201005/04/201005/04/2010

1 998 HB-VISIT aNITS 16-45 MINUTES ROOM USAGE1 998 HB-VISIT UNITS NA/MA1 510 HB-CLINIC VISIT LEVEL 2 RETURN • T4

HBZ9902·HBZ9906

HBT4L29921Total

0.000.00

166.50166.50

Amount

Revenue Code Sununary _

Qty Rev DescriptionCode

1 OSlO CLINIC - GENERAL2 099S STATISTICAL

!fotal

166.500.00

166.50

Amountpayments, ~__:_------------------------------Post Date Description

06/01/201006/15/2010

INSURANCE PAYMENTINSURANCE PAYMENT

Total

-76.51-19.14·95.65

AmountAdjustments. ~-------------------------------Post Date Description

17niver&it~...pf wisconsin Hospital and clinicsDrawer #853Milwaukee, WI 53278(608) 262-2221

Page 2 of 2

·Patient: SWENSON,MARION BMRN: 1675629Hospital Account Number: 538070

06/01/2010 Me CON'rRACTOAL ALLOWANCE

Total-70.85-70.85

.... .... Page 1ofl

Transactl()n SummaryAccount SWENSON,MARION E [638070]

PrInted at 91B12010 12:30:00 PM for WILLS, ROBIN J.

..iii

PmrMEDICAREDEANCARE GOlD

8I!!mEfJ25708280B.Um

.' . ~. . ... . . " ... .:. ~ .. : ,'.' . .. ,-

Past DIlo CRDMcdDtfoll11 0MU12010 2Q95.MC CONTRACTUAL •

file:lIC:\Doeuments and Settings\A1I Users\Application Data\Epic\HYPERSPACE\V7.6\Ser... 9/812010

Univere~ty··~f Wisconsin Hospital and ClinicsDrawer #853Milwaukee, WI 53278(608) 262-2221

Page 1 of 2

Patient: SWENSON,MARION BMRN: 1675629Hospital Account Number: 652952

Guarantor Account Number: 379443Pinancial Class: CARE'Primary Payor: DBANCARE GOLD 553Primary Plan: DBANCARE GOLD 1501Patient Type: OUtpatientLocation: BAST CLINIC

SWBNSON,MARION B618 ENGBLHART DRMADISON, WI 53713-4744


Amount


Charges ~__:--------------------__:~--------Service Qty Rev Description Procedure

Date Code Code

06/15/201006/15/201006/15/2010

1 998 HB-VISIT UNITS 16-45 MINUTES ROOM USAGE1 998 HB-VISIT UNITS NA/MA .1 510 HB-CLINIC VISIT LEVEL 2 RETURN - T4

HBZ9902HBZ9906

HBT4L29921Total

0.000.00

166.50166.50

Amount

Revenue Code Summary _


1 0510 CLINIC -~2 0998 STATISTICAL

Total

166.500.00

166.50

Amountpayments -:-__~~------------------------------Post Date Description

07/19/2010 INSURANCE PAYMENTTotal

0.000.00

AmountAdjustments :::-_-:--:-:- _Post Date Description

07/01/2010 Me RBPLACEMENT (L) CONT Al.LOW -0.01

univere~ty pf WiscoDsin Hospital and ClinicsDrawer '853Milwaukee, WI 53278(608) 262-2221

Page 2 of 2

Patient: SWENSON,MARIOH BMRN: 1675629Hospital Account Number: 652952

Total -0.01

... ..

Transaction SummaryAccount: SWENSON.MARION E [862962]

Printedat 91812010 12:30:20 PM for WILLS, ROBIN J.

Page I of I

file:l/C:\Documents and Settings\All Users\Application Data\Epic\HYPERSPACE\V7.6\Ser... 9/812010

Univer~i~YGf wisconsin Hospital and ClinicsDrawer 1853Milwaukee, WI 53278(608) 262-2221

Page 1 of 1

Patient: SWENSON, MARION BMRN: 1675629Hospital Account Number: 787148

Guarantor Account Number: 379443?inancial Class: CAREPrimary Payor: DBANCARE GOLD 553Primary Plan: DBANCARB GOLD 1501Patient Type: OUtpatientLocation: BAST CLINIC

swBNSON,MARION B618 ENGELHART DRMADISON, WI 53713-4744


Amount


Charges -:-~~--------------------~--------Service Qty Rev Description Procedure

Date code Code

08/04/201008/04/201008/04/2010

1 998 HB-VISIT UNITS 16-45 MINUTES ROOM USAGE1 998 HB-VISIT UNITS HA/MA1 510 HB-CLINIC VISIT LEVEL 2 RETURN - T4

HBZ9902HBZ9906

HBT4L29921Total

0.000.00

166.50166.50

Amount



1 0510 CLINIC - GENERAL2 0998 STATISTICAL

Total

166.500.00

166.50

Amount

Payments o:---:- _

Post Date Description

Total 0.00

Adjustments ~-~_:_:__-----------------------------Post Date Description Amount

08/27/2010 MC REPLACEMENT (L) CONT AilLOW

Total-0.01-0.01

-- Page 10fl... a "

Transaction SummaryAccount: SWENSONtMARION E [787148]

PrIntedat 91B12010 12:30:43 PM for WILLS, ROBIN J.

file:l/C:\Documents and Settings\A1l Users\Application Data\Epic\HYPERSPACE\V7.6\Ser... 9/812010

~ealth

Physicians7974 UW HeatlJl CourtMiddleton. WI 53562


608.833.6090608.833.5039 Fax

I, Carol Menz. Speda' BUling Servleo, of UW Health, hereby eertlfy that the attached Is atrue eopy ofthe iDlIngstatements ofMarioD Swenson for hlslher treatment from 05/04/10 topresent, and now on me In the omces of UW Health Physicians. 7974 UW Health Court,Middleton, Wisconsin 53562 •

In witness whereof, I have here unto set my hand August 20, 2010.

'-""'lI~--o'l

Special BiUlDg Sel'Vll'·'eL'"

UW Health Physicians

STATE OF WISCONSIN ))ss

COUNTY OF DANE )

. PenoDally came before me on 4ugu,;t 20, 2010, the above named Carol Menz, known to me tobe the penon who executed the forgoing instrument and acknowledged the same.

~e== V1 . tid,$«)Rq~J!nne NelsonNotary.Publlc, State of WisconsinCounty ofDaneMy CommlssloD expires 12/0412011

u\'/health.org

PWS£REMIN tOP PamONWITH YOUR PAYMENTorPAY ON1.WEAT...I' PAYING BYMA81I!RCARD OR VIM, FlU.OUT BILOW.

[J ~~IIIItIlll:oW»CMD_ /IIIDMJ

SIQM1UIlI IllI'DATI

ITA1EMIN1'DA1E ACCT.'08/20/2010 P-379443

MARION E SWENSON618 ENGELHART DRMADISON, WI 53713-4744

POl

o

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PhysiciansPA1IINTBUllNI88 URVICIB(a)l8G11or(I77J__

UW Health - PhysiciansP080x2978Milwaukee. WI 53201-2978

ChIck IIGlC If lIdlIr8U 01 NurancI"'cNngedIIld !rldIcIft cIlIftgtCI) on IeVtllellde.

[);, i t nrr~~HltJIL-H: r'nO'iIU[!i Cli,"dIC[:; CliCDITc; I ~ l~, U n/.. r~c f. P,\JIL~~f

IJ:IlJ,tICC' {};... Lf\f"CL

DecAll for Patient: '50833051 MARION B SWIlHSClH

OS/ot/2010 ornCSICJU'l'1l'I' VISI'r.IS'r.LBVL IV (25 IIIN) AIlHD'I' 194.00 0.00 0.00

CIT: 99214 ox: 123.1. 121.90. 122 ••ox: 129.1

05128/2010 lRSURANCB 'AYHIIIn'-DDNOU 10.94

OS/28/2010 ll1Wt COJJI'RAC'I'UAL AD,J.1I8MCARB 123.06

0"01/2010 ltu PMAVIR'I' , 3IIt err 1 LBV SIlHGAL 969.00 0.00 0.00CPT: 64.,0 ox: 338.21. 123.1. 722.4

ox: 124.8

07129/2010 INSURANCE 'AYIIIlNI'-DIAHC»tE 105.51

07129/2010 DIlNI c:oN'I'RAl:'rUA AD,J·DBMCAAB 863.49

06101/2010 MOD c:s BY SAMB PIlYS. 5 YJlS • SEHGAL 290.00 0.00 0.00CIT: 99144 ox: 338.21. 123.1. 722.4

01: 124.801/29/2010 IHSU1WICB 'AYIlBHf-DIfAICMB 25.98O"Jn9/2010 IlIWI~ 1DoJ-1lDII:AJtE 2'••02

06115/2010 Ol'FtCBIClU'rPl' VJSIT.8S'r.LBVL IV 125 IIIMI 'ElL 194.00 0.00 0.00CPr: 99214 ox: 722.4. 121.90. 723.1

01129/2010 INSURANCE PAYHmft'-DIWCCAItE '73.'730712912010 DIWf CO!ftRAC'IUAL AD,J-DIWlCARB 120.2'7

08104/2010 OrrICa/Olll'Pl' VlSIT.EST.LBVL IV (25 IIlN) AItMD'I' 194.00 0.00 194.00 0.00CPr: 99214 01: 723.1. 721.90. 722.4

ox: '729.1

~ CURRENT 300A'II toGA'll 110 GAYS OVER t.GAYS~

aMiM::E....37'443 ftiia

IftSUIWCEIMMCE 194.00 0.00 0.00 0.00 0.00

'AIII!N1' IALMCE 0.00 0.00 0.00 0.00 0.00 194.00 0.00

ADDRESS CHANGESIIeet Phone'

cayJStatt Z1pCOdll

INSURANCE COVERAcae CHANGEp to lnlIured aNew~

OSEl1 a IfICUSE a CtILD a 01IlER a Insurancelnscampanr Name IPhanel Polley HoldeII Name IBlrthdale

Ins CClrnpanr AGlIf8SS -, • ., Date

IF YOU HAVE QUESnONS ABOUT YOUR STATEMENT

GENERAL INFOBMA110NThis bill Is for professional scn;ccs olf'craI by the providers ofUni\'ersity ofWisconsin Medical Foundation. Inc. (UWMF).UWMF Is a non-proJit Q)rporatiOD wblch SUp~11S the clinical practices of the faculty physicians orthe Uniwrsity of \VISCODSin.UW Hcaltb-PhysteaDS is the name UWMF utilizes whcn conducting its bilUng and Q)llcctioD services. 1f)'OUI' providcr dcli\oen:dservices at a hospilal or dinie:. )'OU may also recciw: a separale bill from that facility for costs related to the building. supplies.equipment and suppon staf[

FINANCIAL POUCVCharges not Q)wrcd by Insurance are due within 15 days ofreceiving )'Our Slalcmcnl There 'viII be a charge for payments lbat arercwmed as nono5Uffic1ent funds. Please keep in mind that )'OW' insurance Q)wrBgC Is a contract between )'OU and your insurancecarrier. You arc ultimately responsible for payment orall charges and undemanding )'Our policy benefits.

If )'Ou are unable to malcc payment in full. please call 829·5254 or 1·877·~S-88" as soon as)'Ou receive Ibis stalement to discuss)'Qur financial situation and make payment arrangements on )'Our account.

DO YOU NEED HELP WITH YOUR MEDICAL BILLS?UW Health's ph)'Sicians. clinics, and hospilals arc committed 10 providing care 10 patients who are unable 10 pa)' for the medicalsenices IhC)' rccci\'C. UW Hallb's COlDDlunit)· Care program is designed 10 belp these indi\;duals. UnillSURd patients are entitled10 a discount 011'most sen;ces and may be eligible for a greater discountlhrough our Community Care program.

PADENT ACCOUNT QUESDONSlr)'Ou ha\'C any questions on )'OW" account. please feel free to Q)ntaet I Patient Accounts Represenlali\'e II the number below. ThC)'are .\-ailabte to assist )'QU from 8:00 AM to 5:00 PM. Monday through Friday.

Local

Distance

Address/Insurance Changes Email

Si ustcd ticnc algona prcgunla rcfcrcnte a 50 cuenla. 0 ncccsiia eslableccr un plan de pago, por fa\oor comunlqucsc al(608) 829·5217 or 1-877·~5-o,O'.

Thank you for choosing UW Health for III your health care needs.

~ealtb

PhysiciansUW MEDICAL FOUNDA'nON 7974 UW HEALTH COURT MIDDLETON, Wl53H2

P. DOl

NUMER 0911933NUftBER S"'S91

'AX Ho. 608 287 2178-~

DATE: SEPTENER .1010 PAGE. 1_llnation of Payments

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FAX TRANSMrITAL.Fa: ~og,,; - CJf'l(

CONFIDBli'J!ULl'rlNOTICEtILe c!oc"lIIIIItI~ fa ItIIlImiIlltan may CGIdIfa coddeada1 padqt bealth fDfbmIa1loD tlaal Isl,p1ly pzatlClld lIIUI TbIa IatbJIIII11aD ilIm",,,,,,, CID1y for ...cpaiatts tFaImtIlt. pl)DIII. ar bIIIlhcare opfIIdfcm use of the • or II1dtJ 1IIIIIId abow. Ue IUlbaaIzie4 ncipIaIt of dill ..._ IIpro1dbffIdhili dIJoIaIfaa ddI to trtIodI.arpatJ1III1_.....ea cia ao by lawGI'~ ad isI1lq1Ibd CD desrIoy the dvrkI awedm:cd _ beea tbIIIIled.1IIIIcu CJt1Imwke IUIC II I)' CD clnmzuatII'aImeDCofapadIal.

To:

S8lltBy::--I.A~~~--

PbODe: 608 Fax: .1.@!)o,:287:.:...;;-Zial1ZIlti:iB _

You are belDg fued a tal of !fpages, mclitdIDg this cover sheet. IfY01ldo Dot ncelve the D er olpages IDdlcatecl, or Ifthere are problems withthe qualityor legibili ofthis fa, please contact the above persoD at thephounumber listed a eve.

. Date: _ ......oOlII5oo---.lllljF--.-.,"--

If,au 118 DDt die 'DIac1cd JOU C8 baeby DDIified 1ha11llJ cUselolUle, copyiq. dIsIrlbudOD, ar ICIkmCIba fa reUwe OA ca or... doaImeILts IIl1rlcdyplOlllhirld.lfyw!law nceIwd dIilI iDtbrmatiGn faIIIOt. ...seader • IDll tbr tllentalll.or lIeIIazI:tiOllof..daC!l1!M!lll

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ChartNotesCoding DocumcOther(pBI)

Insunmce lDfonnation CIRefe!encc Material QPimmciallnfotmation 0

Billing DocumentsCoDtract lDfonnationOther (No PHI)

.,

CERITFICATION OF MEDICAL BILLS

PATIENT NAME: ~\(•. '{ :(.; \ ~~, tSll\"\...,

DATE OF BIRTH: 7/~ (., / I?,:) (I

DATE OF lNRJRY: 7/.~/ Llq

, custodian ofpatient records at

Gonstead Clinic ofChiropractic. Mount Horeb, Wisconsin, hereby certify

that the documents aDDexed hereto, and consisting of "L. pages constitute

an accurate, legible and complete duplicate ofthe medical bills for the dates

ofservice 7,I3/tlCJ to Pre S( ll+ .

J~ 1J,1·Dated at Mount Horeb, Wisconsin. this /1.0 day ofF~rdt 20" LQ.

CERITFICATION OF MEDICAL BILLS

r"PATIENT NAME: triel t' i () 'l'\~ 1'1. S t:rY'-

DATEOFBIRTH:7/~{P1/1~'1

DATBOFlNJURY: 7/.3/t;2tJOi

, custodian ofpatient records at

Gonstead Clinic ofChiropractic, Mount Horeb, Wiscons~ hereby certify

that the documents annexed hereto, and consisting of..t:z- pages constitute

an accurate, legible and complete duplicate ofthe medical bills for the dates

ofservice 7-3-09 to Yr-esiwt:./

Dated at Momt Horeb, Wisconsin, this

;Q~~Signature /

_KasietaLegal

.Group, LLCA Limited Liabllhy CompaD)'

MarcIJ 10.2010

Gcmstcad Clinic ofChiropracticAttn: MecIlcal Records and BUling Dept1505 Business 18 and isi NMount Horeb, WI 53572.Re: Patient: Marion Swenson

Dato ofBirtb: 07126/1929Date ofIncideilt: 07/0312009Court Case No.: NlAOur File No.: 248.01

To whom it may concern:

Direct Line: 608-662-2284Email: [email protected]

We arereprese:nting the above-referencedpartyin apendingpcrsonal injurymattcr. Wewould likeacomplete certified copy of your medical reeords from 01/0112006, to the preseat. It is notnecessary that any doctor prepare a special report for us. If in fact previous reports have beenprepared for otherparties or insurancecompanies, wedo Want copies thereofsincctheydo constitutepart ofyour records. We are also requesting copies ofany correspondence in your file.

In addition, please provide a complete certified eopy ofall bills from 07/0312009 to the present.

We are enclosing at this.time a medical consent properly signed by our client.

Please enclose your bill for the copying of your records, and.we will see that the bill is paidimmediately. My direct line is 608-662-2284. Thank you.

Sincerely,

KASIETA LEGAL GROUP, LLC

{lL'~~'~Abigail M. RebholzLegal Assistant

Enclosure

7818 Big Sky Drive. Suite 112 Madison. WI 53719-4983(608) 662-9999 Pax (608) 662·9977

www·kasieta.c:om .

MEDICAL INFORMAll0N RELEASE

bo~ (J.;,..\c. 0(:. CWVOB~~er)

The undeniped~'- S~ecutes this medical information release for the pwpose ofauthorizingdisclosureofmedic:al records. bUls and opioioas inaid oflepl investigation. 'Theuodersipcd herebyauthorizescUsclosure ofallmeclical rec«ds,biJIs,cOl'u:spOlld-=c. opiDionsorreports. and x-rays. in thepossessionof doctors, psychiatrists, psychologists, chiropractors. osteopaths, hospitats. c1in~ or state ageDcies havingplOVi4ec1 \heundemipcd with health care services pertaioios to physicalaodlor emotional assistance. .

Thisauthorizatioo loaalsoptayou permissioD to Jeleaseaoyand allcomsspond01lte. Dotes. memos,and othcnlocumcntation ofany Idnd which is in my file to Kasieta Legal Group, ILC, and AUomey Robert J.1Casicta.

This iDformaaion is to beprovided to the law firm KaaietaLeplGroup, u..c. or its agents, employees, orRpfCSClIltatives. 'Ibis release includes authority to iDspect lUid/or copy all wrium records and biUs ofthe typesdescribed above.

This authorization is not iDteDded to pt pcuDission for any health care provida' to discuss theundersigned patientwith anyotherattorney. Suchpermission isexpresslywitbheld. However, I grant permissionfiJr any beaIth care provider~ discuss my medical information with Kasieta Legal Group. LLC. or its agents,employees. orrepreseoIBtivcs

....__ -._._ ".-.'_0._".. _._- _. _._e.••._. •__._ _••_.. _. a. 0_'

Kasiera LepI0r0up,LLC, recopjzcs that federal regulatioD(42 CPRPart2)prohibita furIber ctisclosureofillop~hological~ ifany, without tho specific consent oftho undersigned, or as otherwisOpermitted by federal replati0D8.

This aUthorization form also grants 'you permission to release any records or documents related toalcohol ordrug trcatmeDtorevaluation; AIDS orAIDS related illnesses; mv test results; anypsychiatric

CODSUltatioDs or other services for meatal iUness.

1biarelease sbaIl be valid for aperiod oftwo yean tiom tho date ofitS signing. Medical records createdbefore/after the date ofthis m1ease will be honoml.

Aphotocopy ofIbis authorization sba1I be considered as valid as the origiDaJ.

Tho individual mayrevob the Authorization in writing. However. revocation ofthis AuthoriZation willDOt affect any action takco in reliance ofthis authorization befoJe receipt ofa written notice ofrevocation.

PmlededHealth InfoJDUition released to anotherPartYmayno longer be protected by federal privacy lawsand may be fUrther usedby the recipient ofthe iDformatjon without the patient's consent.

TreatmeDt, payment. enrollment or eligibility of bcocfits may Dot be conditioned on obtaining theindividuals authorization.

Dated thisItday of O.a.e... .2009.

flD~ e~~G-S1GNAnJRBDate ofBirth : 7 - 2.~ - 2. '1Social SecurityNo.: .3 Cf"- , k.. 7 't .., q

,.Name smSQP, vump M_ F..LDate 4-5-05 case No R;;,;:C _

AddI8I8 618 IRPP.BAlT pi city WISOR • slat• ..iL.Zlp 53713 SSN: -=3;&,'9-~2~6-...,j7W1'...7...9 _

Te". 608=270-0710 Employer STAn BAItK 0' ClOSS PDcclipallon UTIUD BD 7-26-29

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==================a=============================================================Date: 03-16-10Time: 15:29:14

GONSTEAD CLINIC OF CHIROPRACTICPatient History

Page: 1

Chart 112826SWENSON, MARION@*618 ENGELHART DR

MADISON, WI 53713Home-(608) 358-3795

SSN# 399267979DOB 07-26-29

From 07/03/09To 11/03/09

Office-(608) 000-0000

GONSTEAD CLINIC OF CHIROPRACTICPO BOX 461505 BUS HWY 18-151 EAST

MT HOREB, WI 53572-0046(608) 437-5594

T Date CodeCheck 1

Diagnosis Prov AmountR IB Paid Balance/ CarrSusp. Amt

====_==~===== ========a=========aaQ ============================ ====C 09-10-09 98940C 09-10-09 99211P 09-10-09 PPAT

3591C 09-14-09 98940P 09-14-09 PPAT

3593C 09-17-09 98940P 09-17-09 PPAT

3594C 09-22-09 98940P 09-22-09 PPAT

3595C 09-28-09 98940P 09-28-09 PPAT

3596P 09-29-09 PIPPP 09-29-09 PIDC 10-06-09 98940P 10-06-09 PPAT

3599P 10-09-09 PIPPC 10-12-09 98940P 10-12-09 PPAT

3604PIO-16-09 PIP1?P 10-16-09 PIPPC 10-20-09 98940P 10-20-09 PPAT

3606P 10-26-09 PIPPP 10-31-09 PDHCP 10-31-09 PIPPCA 10-31-09 CDHCC 11-03-09 98940P 11-03-09 PPAT

3608

739 1739 1

739 1

739 1

739 1

739 1

739 I

739 1

739 1

739 1

TRCTRCTRC

TRCTRC

TRCTRC

TRCTRC

TRCTRC

TRCTRCTRCTRC

TRCTRCTRC

TRC·TRCTRCTRC

TRCTRCTRCTRCTRCTRC

25.50N NY38.00N NY

-18.01N

25.50N NY-18.01N

25.50N .NY-18.01N

25.50N YY-18.0lN

25.50N NY-18.0IN

O.OONO.OON

25.50N NY-18.01N

O.OON25.50N NY

-18.01N

O.OONO.OON

25.50N NY-18.01N

O.OONO.OONO.OON

-45.49N25.50N YY

-18.01N

25.5038.0018.01

25.5018.01

25.5018.01

25.5018.01

25.5018.01

0.000.00

25.5018.01

0.0025.5018.01

'0.00·0.00

25.5018.01

0.000.000.000.00

25.5018.01

0.000.000.00 PATNT

0.000.00 PATNT

0.000.00 PATNT

0.00 DENOO0.00 PATNT

0.000.00 PATNT

0.00 MEDOO0.00 MEDOO0.000.00 PATNT

0.00 MEDOO0.000.00 PATNT

0.00 HEDOO0.00 MEDOa0.000.00 PATNT

0.00 MEDOO0.00 DENOO0.00 MEDOO0.000.00 DENOO0.00 PATNT

ChargesPatient: 162.09Insurance: 105.41

Receipts-162.09

0.00

Debits0.000.00

Credits0.00

-45.49

Balance-0.0059.92

TOTALS: 267.50 -162.09 0.00 -45.49 59.92

9494O-adjustment

98941-adJustment

99201-exam

99211-exam

99212-exam

7201o-xray

7207o-xray

72100-xray

~~~~~r2Q808-437-5585

1501 Bus Hwy 18-151, Po box 46, Mt Horeb, WI 53572

PATIENT HISTORY CODES

PPAT-patlentpayrnent

PIPP-insurance paid patient

PNR-no response

PINS-Insurance payment

PDHC-dean health payment

PINC-Insurance does not cover this service

PMINFO-more insurance info needed

PIT-Insurance terminated

PNMN-not a medical necessity

CDHC-credit dean health

CRMDA- credit medicare disallowed amount

this Is just a portion of the codes we use If there is a code that you don't understand please contact usat (608) 437-5585.

GONSTEADCLINIC OF CHIROPRACTIC

1505 Bus. Hwy 18-ISIE Mt. Horeb. WI 53572. (80s) 437·5585

Kasieta Legal Group,LLC7818 Big Sky Drive, Suite 112Madison, WI 53719-4983

March 16, 2010

STATEMffiNTOFACCOUNT

Medical Record CopyRE: Marion SwensonDOB: 07/').6/1929DOA: 07/0312009

,"

$20.00

TOTAL AMOUNT DUE UPON RECIEPT

PLEASE MAKE PAYABLE TOGonstead Clinic ofChiropracticPO Box 46Mt.Horeb, VVIS3S72

THANKYOUI

, , J

~Kasieta.

, Legal.Group, LLC

AU." LlablUt, Com,la,

Din=ct Line: 601-662·2284Direct Bmail: [email protected]

DeIIl B"siaessOJficeAlta: BiIliDIDept1808 W. BeII1ine HighwayP.O. Box259328Madison. WI S3725-9328

July IS, 2011

I' .•----.---'-~. " Ir :., t.;" ::. . .~ fj ", ..~ j.:":: r;:-,!~:)\ l.~ "~~~; i. • L \/ 1,;.::; I~'I. -- - ••..,I • l

~UG 3 2011 i~

,~tJ\..c.h..

1;0 Whom It May Concern:

As you may recall, we are [email protected]~jJlH)wftlD5~

matter. Please send us updated eCODCemiDg our client Please nsfer to

Please euclose your bill for the copying of your records, and we will see that the biD is paidpromptly. Thank you.

Sincerely,KASIETA LEGAL GROUP, LLC

OA-'~' Q~ •~--'~

Eaclosure

, .Received and Reviewed by PatientAccount Services. It's okay toprocess 1he VB request from the PIF

BCCOunt.KS /\.~\.''-

"""", 7818 Big Sky Drive. Suite 112 Madison. WI '3719-4983. ~~ 'J\J "c::l..t~~6(8) 662-9999 Fax (608) 662-9977

III~""ts.. \d::f~:SCf5J. . .......kasl.tl.com

, " r

(lKasietaLegal

_Group, LLC, A Umltd 1.tlblllly Co.,IDJ'

Direct Line: 60~2·2284Direct Bmail: er@kuieta,eom

De8D Business OfficeAttD: BiWagDept1808 w. Bc1t1ine HighwayP.o. Box 259328Medin. WI 53725-9328

"'Re:

July IS, 2011

. "

ro Whom It May Concern:

As you may recall, we are represe_==inpenc!klg p.!!§!!oa1 inim litigationmatter. Please send us updated~ edJealbD l!i02i2011, to Ch. praeail'ccmcemiag our client. Please I8rer to e iRed. •OD previously provided.

Please enclose your bill for the copying of your records, and we will see that the bHl is paidpromptly. Thank you.

Sincerely,KASIETA LEGAL GROUP, Ltc

ON·~- Q~ •~-'~

Encloswe

, .'

Received and Reviewed by PanentAccount Services. It's okay toprocess the VS request from 1he PIFaccount. KS /\.~'\.,,"-

~, 7S1S Big Sky Drive. Suite 112 Madison, WI 53719·4983.~ ..$-- '-J\.J "Clt~~6(8) 662-9999 Fax (60S) 662-9977

II~~~\'\~ . www.k..I....c.m

PATIENT NAME: m~V'on SwensonDATES OF TREATMENT:

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MARION B SWBNSONSi8 BNGBLHART DR.. .MADISON, WI 53713

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MARION E SWBHSOH6,18 ENGELHART DR.MAD~, WI 53713

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DBAN MEDICAL- CBNTBR1808 W.BBLTLINB HWY

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uvHealthUniversity of WisconsinHospital and Clinics

March 8, 2011

Kasieta Legal Group7818 Big Sky Drive Ste 112Madison, WI 53719-4983

RE: Swenson, MarionMR# 1675629

Dear Ms. Gill,


In response to your request of 3/4/11, enclosed are billing records for dates ofservice 10/12/10 through 1/19/11. Please let me know if you have any questions.Thank you.

Sincerely,

~L~~LRobin J. Wills '------UW HealthUW Hospital Patient Accounts(608) 263-8583

uwhllallb.arg

mHeallbUniversity ofWISconsinHospital and Clinics

March 8, 2011


I hereby certify that the attached 03 (page(s) are a true and complete copy ofcharges for:

Patient: Swenson, MarionUWHC MRN: 1675629

From 10112/10 through 1/19/11 lor the University of Wisconsin Hospitals and Clinics.The original bill was created in the usual course of business. and is maintained in thecustody ofthe hospital business office.

Dated this (08) day ofMarch, 2011 at Madison, Dane County, Wisconsin.

olary Public il 2,7JLMy Commission Expires /,

(£ .

uwheallh.org

Unive~sity of Wisconsin Hospital and ClinicsDrawer 1853Milwaukee, WI 53278(608) 262-2221

Page 1 of 2

Patient: SWENSON, MARION EMRN: 1675629Hospital Account Number: 976363

Guarantor Account Number: 379443Financial Class: CAREPrimary Payor: MEDICARE 164Primary Plan: MEDICARE A & B 408?atient Type: OutpatientLocation: EAST CLINIC

SWENSON, MARION E618 ENGELHART DR~ISON, WI 53713-4744


Amount


charges, _

Service Qty Rev Description ProcedureDate Code Code

10/12/201010/12/201010/12/2010

1 998 HB-VISIT UNITS 16-45 MINUTES ROOM USAGE1 998 HB-VISIT UNITS NA/MA1 510 HB-CLINIC VISIT LEVEL 2 RETURN - T4

HBZ9902HBZ9906

HBT4L29921Total

0.000.00

166.50166.50

Amount:

Revenue Code Summary _Qty Rev Description

Code


Total

166.500.00

166.50

Amount

Payments, _


11/23/201012/20/2010

INSURANCE PAYMENTINSURANCE PAYMENT

Total

-76.33-19.09-95.42

Amount

Adjustments, _


Uniy'~rsi~y of Wisconsin Hospital and ClinicsDrawer #853Milwaukee, WI 53278(608) 262-2221

Page 2 of 2

Patient: SWENSON,MARION EMRN: 1675629Hospital Account Number: 976363

11/23/2010 MC CONTRACTUAL ALLOWANCETotal

-71.08-71.08

· .. Page 1of 1

Transaction SummaryAccount: SWENSON,MARION E [976363]

Printed at 3181201110:11:05 AM for WILLS, ROBIN J.

file:/IC:\Documents and Settings\A1I Users\Applic,ation Data\Epic\HYPERSPACE\V7.6\Ser... 3/8/2011

Oniversitv of wisconsin Hospital and Clinics .Draw~#S~Milwaukee, WI 53278(608) 262-2221

Page 1 of 1

Patient: SWENSON, MARION EMRN: 1675629Hospital Account Number: 1249585

Guarantor Account Number: 379443Financial Class: CAREPrimary Payor: DEANCARE GOLD 553Primary Plan: DEANCARE GOLD 1501Patient Type: OutpatientLocation: EAST CLINIC

SWENSON, MARION E618 ENGELHART DRMADISON, WI 53713-4744



ChargesService Qty Rev Description Procedure

Date Code Code

01/19/2011 1 998 HB-VISIT UNITS 16-45 MINUTES ROOM USAGE HBZ990201/19/2011 1 998 HB-VISIT UNITS NA/MA HBZ990601/19/2011 1 510 HB-CLINIC VISIT LEVEL 2 RETURN - T4 HBT4L29921

Total

Amount

0.000.00

166.50166.50

Amount




Total

166.500.00

166.50

Amount

Payments _


02/24/2011 INSURANCE PAYMENTTotal

-166.50-166.50

AmountAdjustments ~~------------------------------_Post Date Description

Total 0.00

Page I of 1

Transaction SummaryAccount: SWENSON,MARION E [1249585]

Printed.' 3181201110:11:33 AM for WILLS, ROBIN J.

NA

file:IIC:\Documents and Settings\All Users\Application Data\Epic\HYPERSPACE\V7.6\Ser... 3/8/2011

uwHealthPhysicians

July 19, 2011

Kasieta Legal GroupAttn: Abigail7818 Big Sky DriveMadison, Wisconsin 53719

FE: Marion SwensonDOB 01/26/1929

Dear Abigail:

7974 UW Hea/lh CourtMiddleton, WI 53562

608.833.6090608.833.5039 Fax

A copy of your request regarding the above referenced patient isenclosed.

Our office does not have record of any charges for professionalservices by U. W Health Physicians, meeting the criteriarequested in your letter dated July 15, 2011.

I~ I can assist you further please do not hesitate to call.

Enclosure

Services

u\'Iheallh.org

:M:,"WUi

'.'

l'nin'rsil\'lIf ""i.~~'""'in ~'lodlall'lI\1nd:1liIlRF:ll1dl\' 0; 1I1l~ llninorsll\" IIr \VI.'iClIIl~lnSrhlllli of Ml'tlldll\' :md l'Uhlir 11\'31111

, "~: '-.

, ..... " ..,.,_., '", ,-

'.- ".... ,. -.

" .. '

;'Re: Patient: MarionSwenson'-......;: :iOate,ofBirth: 07/26i1929

..',.: ':Dale Jtin~ident::67i(j3/2009 .' .'Court·C~eNo.: 'NHt· 16 c.V ZSlo9'

. :. ',OUr:Fiie N6~:248.01 .;: .!' ...

.. 'C;: ":' ·T': \ ..<>.' .... ;':..'. "~:=Fo;\V:J1oin lIt- May Concern:

.. -; .... ~~ ':' ...:,. ,.:., -,. -' .

;',' .:':i,·k.\you~rriay,"'ec.al~~we~tepresenth~g Marion Swenson in pendingpersonal injury litigationmatter." PJease send' us up'dnted certified medical bills from 03/0212011, to the present, concerning our

.~;i}.kf{)j~f~%)";A~li~Ii~~.rl~~~.~terf~~:"q.CS:ro.~'~~·authorization ~ilcJosed. .'f·;~·'~\"':'~.1?":,,&\ir;~~m@:iikt""j!t''*'~~:~:Oll'·: IJ'~; '.' . ;"<:~. " ..., " . .' .. ,.. " .

~..-i-'" ,··.,-~_~·:~:.'~:.·",;.:~~.:t:7"~:·:.::-/~,,~:r":"~}';':J-._,_~_:-~.~~Y" _'<'~";" .---'-·~"'~_.'~.-:-·~':"__I_~~ ->", •• '. - ,

PJe~ encJos~.your bill, for the copying of your records, and W~ will see that the bill Js ?~id

,·prOll)ptJy.Th8llk you." .. ,: Sincerely,

KASIETA LEGAL GROUP, LLC

Abigail M. Rebholz-JonesLegal Assistant

. .... -

. '., '-,

"""; ..;._':- .

{,... _'. '~ " "':':):,1.... '- '

, ,'. •...".; ~ ,:--i-. . ~ ..... ~... -.- .....-,. En~os~~ ,- .

'.','

'78'18Big Sky.Drive. Suite 112 Madison, WI 53719-4983'(6OtH :662-99.99 Fax (608) 662-9977

. ~.ww~kasieta.com:-.'.

.....

- -.'~ .- .....

MEDICAL INFORMAnON RELEASE

U~e&iW fuA~Provider)

The undersigned1~ r. S~ecutes this medical information ·release for the purpose ofauthorizing disclosure ofmedical records, bills and opinions in aid oflegal investigation. The undersigned herebyauthorizes disclosure ofaU medical records, bills, correspondence, opinions orreports, and x-rays, in the possessionoE dqctois, psychiatrists. psychologists, chiropractors, osteopaths. hospitals. clinics, or state agencies havingp~'1d~ the undersigned with health·care services pertaining to physical and/or emotional assistance.

This authorization form also grants you permission lo release any and all correspondence. noles. memos,and other'documentation ofany kind which is in my file to Kasieta Legal Group, ltC, and Attorney Robert J.Kasieta.

- _ .......Ibis iafotIQariOJ1j~QXijre.d to Ule law firmJ<asJ.e~ Leg~l Group, LLC. or its agents, employees, orrepresentatives. This release includes authority to inspect"and/or copy aU written records aod biJIs oftbe 6Jpesdescribed above.

This authorization is not intended to grant permission for any health care provider to discuss theundersigned patientwith any oth~ attorney. Sucb permission is expressly withheld. However, I grant permissionfor any health care provider t~ discuss my medical information with Kasieta Legal Group, ll.C, or its agents.employees, or representatives.----------- .- --------------_ ...-.._-_..... ---_·_--------- 0-

Kasieta Legal Group. LLC. recognizes that federal regulation(42 CFRPart 2) prohibits furtlier disclosureofthe pS}'Chiatriclpsycbological records. ifany, without the specific·consent of the undersigned, or as otherwisepermitted by.federal regulations.

. . This authorization form also grants you permission lo release any records or documents related loalcohol or drug treatment or evaluation; AIDS or AIDS related illnesses; mv test results; anypsychiatric

consUltations or other services for menial illness.

This release shall be valid for aperiod of two years from the date ofits signing. Medical records createdbefore/after the date of this release will be honored.

Aphotocopy of this authorization shall \:Ie considered as valid as the original.

The individual may revoke the Authorization:n writing. However, revocation of this Authorization willnot affect any action taken in reliance of this authorization before receipt ofa written notice of revocation.

Protected Health Information released to another party may no longer be protected by federai privaey laws·and may be further used by the recipient of tbe information without the patient's consent.

Treatment, payment, enrollment or eligibility of benefits may not be conditioned on obtaining theindividuals authorization.

Dated this I r day of D..o.e-. ,2009.

~e.~4,~SlGNATIJREDate ofBirth : 7 - 2'- .. 29Social Security No.: ! 3 'T If - ;. (, - 7 Il 1 e;

LegalHIPAATeam

KasietaLegalAttn: SJrlMadam7818 Big Sky Drive SUite 112Madlson, WI 53719

Re: Marion Swensonstore: 2335

TearnConnect # 201G-27161

Date: October 1, 2010

"

Walmart :~~.: .'.SrIemoney. LIftbett....

702 SW 8th S1r8ltlBentonvllll, AR 72718-0215Phone 478.273.4505Fax 479.204,[email protected]

DearSlrlMadam,

Please find the enclosed prescription records requested via subpoena/authorized release serviced toWal-Mart Stores, Inc. Also enclosed fa a notarized Certification of Records that we produce in Deu ofthe various Record Affidavits that we receive.

Please be aware of the fact that we are not pharmacists, and therefore we are unable to determinethe use of prescription medicines. There may be prescriptions in the enclosed medical expensesummary that can be used to treat mentaJ and emotional conditions. HIV/AIDS, or sexuanytransmitted DISeases.

"you have any questions or need further assistance, please feel free to contact me.

Sincerely,

HIPAA Teamlitigation Support Group

Ene.

-D'~©~DV~~I" OCT - 9 20'01 l~

J'L\~.o'

Walmart ,~~ ,:<S.M.....,. LlHbett.,. ..

LegalHlPAATeam

TearnConnecI.2010-27151

TO: Kasieta LegalMadl8on. WI 53719

RE: Marlon SwensonStore: 2335 (Dates of Service: 713109-1011/10)

CEBDFlCADQtiOE.BECORDS

Enclosed are the prescription recotd8 of Marion swenson (5 page(8». We are producing the

records pUl8U8nt to a 8ubpoenalauthonzed release issued to Wal-Mart In the matter of Marion

swenson. Please accept this document 88 certification of the records produced hel8Wlth. The

records you have requested are malntaflled by lI'Ie Phannacy Division of Wal-Mart Stores, Inc. in•

various locations tJuoughout the company. Upon receipt of your subpoena/authorized release by the

WaJ.Mart Stores. Inc. Legal Department. we requested of the appropriate location of WBl-Mart

Pharmacy to provide aD documents In their possession responsive to your subpoena/authorized

release. The record8 produced herewith are accurate, complete, true and correct copies of all

records received or retrieved by Legal pursuant to your request I further certify that WaJ-Mart

Stores. Inc. is the custodian of record, that the records were kept in the regular course of business

and that this Is a regularly conducted business activity, that these records were made at or near the

time the adB. events, conditions. opinions, or diagnoses occurred or within a reasonable time

thereafter, that the charges were reasonable for similar services. necessary as payment for a

prescription fiDed by our phsnnacy pursuant to a dOctOr'8 orders and finally that these records were

made by, or from Infonnation transmitted by, a person with knowtedge of the acts, events,

conditions. opinions or diagnoses atated therein.

STATE OF ARKANSAS ))

COUNTY OF BENTON )

Shelby John ¥ery Specialist

wa"Mart Stores, Inc. Legal DepertmentBentonville, AR 72716-0215

SSe

The foregoJng Instrument was acknowledged before me October 1, 2010.

~~~JACKIE BRADLEY

NotaryPublic·State af A.rkansasBenton CountY

Commission '123!aOOOSMy CommlsllOn bplresAualilt n. ~016

Page 1ors

Store -: 2335COnnuUl Pharmacy SV*Im

Reoort Data: 10/01/2010 WaHWt PIwIuc:y 10-2315MedIcII ......summary

PatIent: SWINSON, MARION e618I!NGaHART DRMADISON WI-53713...... 7/ZfifI929

Below Is a list tJI your PhInnacy ani... for the dati range Of: 01/03/2«S 10 10/01/2010

Dale FIIIIId RIC. Drug Name PreIcIt1Ier Qty o.r- Dr....n.. .dent PaIdCUhPrlce

Date Wrltllln FfIIID NDC PbpI_.. DI!A :-,"1 SUpply AI Wrftlllil TPRef.

PbraldmNPI

WaJ-MlUt PhannIcy, 4118 JWtOOSA 1RAIL, HADJSGtI WI-51714NAB' NumlJen '123013 IDa BWS41ass HPJ Nalllben U84141210

07/0912009 4429196 HYDROCO/APAP 5-325MG WES,SHEAN 100 8 0 $3.00 DOtTAB $49.54

07109/2WJ 1695442 00406-0365-01 MLl099957 0 5I637SZt07D96G

1023072683

08/0412009 6784&42 FUROSEMIDE 20MG TAB UTR1E,GINA 90 90 0$6.00 DOt$10.00

10/C8/2008 1702931 00378·0208-93 BU7S29641 3 684011090804261730135377

ClII07/100t 4429503 HYDROCO/APAP 5-325MG AMUNDSON,DARCEY 100 15 0$3.00 DOt

TAB S49.54

08I03/20Qg 1704147 004lJ600365-01 MA0496338 0 69713659080776

1588691398

otI0II2009 6796145 AlENOlOl. SOMG TAB UTRIE,GINA 180 90 0$6.00 DOt$2CUO

03/05/2009 1712606 51079-0684-63 8U7529641 2 8OO1196909082G

1730135377

09/08/2009 6810821 lRJAMClNOLON 0.1" CRE UlRIE,GINA 15 14 0$2.75 DOt$4.00

09/08/2009 1712863 00168-0004-15 BU7529641 0 80386259090826

1730135377

09/2712_ 6784398 OMEPAAZOlE 20MG CAP UlRIf.GlNA 90 90 0$6.00 DOt$240.78

10/0612008 1718390 00781-2233-31 BU7529641 4 87107849092746

1730135377

1010412009 6784400 BeHAZEP/HCTZ la-12.STAB U1RIE,61NA 180 90 0$6.00 DOt$86.32

10106/2008 1720563 00378-4745-01 BU7529641 4 89741059100426

1730135377

10/0412009 6784399 NIFEDIPIN ER(Xl)3DMGTAB UTRIE,GlNA 90 90 0$6.00 DOt$99.62

10/06/2008 1720564 00378-3475-01 eU7529641 4 8974106910049G

1730135377

--CONFlDI!NI'IAL-1F YOU R!CIIVE THIS REPORT IN EARO__ PLI!AS! RI1URN TO WAL-MART PtfARMACY IMMEDIAT1!LY.WAL-MARTS1ORlI, INC.

Page20fSStOre _I 2335 COnnaul Pbanucy sYstenIReport DlIte: 10/01/2010 ....MatPharma" 10-2335

Medfcallxpenlu IumnNIry

PatIenb SWENSON, MARION E618 ENGatfART DRMADISON WI-53713

Blfthcla. 7nfl19~

Below IS • lilt or your Pharmacy OnteIS ror the dale ranoe Of: 07/03/2009 to 10/01/2010

OIdIa FlJled ..- DragNa... PrIIcrIIIer QtJ Daya CIa,..... PIItIent PaIdcalbPrlcie

....WrItten FDI JD HOC Pltyalcllln DIA :-no s.pptv All Wrtltilft TP..,_'hplclan N'I

11102I2ClO9 6815376 FUROSEMIDE 20MG TAB UIlUE,GINA 90 90 0 $6.00 DCH$10.00

lJ/O2/2OO9 1729749 00378-0208'93 8U7529&41 0 IOHlml1025G1730135377

1I/1f12OO9 6816446 AZIlHROMYCN 2SOMG PAK AMUNDSON,DARCE't 6 5 0$3.00 DOt

TAB $31,46

11/1&{Z009 1733879 00781-1496·. MA0496338 0 15973199111656

1588691398

11/16/2009 4430553 CHERA1USSIN AC SYP AMUND5ON,DARCEY 180 6 0$9.62S9.62

11/1&/2009 1734100 C0603-1075-58 MA0496338 01588691398

12/WZ009 6796145 ATENOLOt. 50MG TAB UlRJE,GJNA 180 90 0$6.00 DOt$20.00

0310512009 1740259 51079-0684-63 BU7S29641 3 2352997912061G

1730135377

12/2812009 6819652 OMEPRAZOlE 20MG CAP UIlUI!,GlNA 90 90 0$6.00 DOl$172.36

12/28/2009 1746894 00781-2233·31 BU7529641 0 3164424912Z88G

1730135377

01/04/2010 6820112 NIFEDIPIM: ER 30MG TAB UTRlI!,GlNA 90 90 0$10.00 DOt$99.62

01/04/2010 1749016 54458-0950-10 BU7529641 0 34415080010400

1730135377

01/11/2010 6820723 BENAZEP/HCTZ 2O-IZ.5TAB UlRJE.GJNA 180 90 0$10.00 DOt$86.31

01/12/2010 1751214 00378-4745·01 BU7529641 0 3747688001116G

1730135377

02/16/2010 6815376 FUROSI!MIDE 20MG TAB UTRIE,GINA 90 90 0$6.79 001$10.00

11/02/2009 1762050 oo378-0Z08·93 BU7529641 1 52933380021600

1730135377

03/10/2010 6822678 ATENOlOL SOMG TAB UTIUE,GJNA 180 90 0$10.00 DOt$20.00

"CONPIDINIL\L-JP YOU Rlc:uva THIS RIPORT IN ERRO~ PU!ASII RETURN TO WAL-MART PHARMACY IMMEDIATELY.WAL-MART S1ORIS, INC.

Page 3of5

5tcn,: 2335 COnn8:lall lIb.rlDley SpbIm

Report Date: 10/01/2010 Waf-Mart ,hanucy 10-23SIMedfcal. EJrpaJIRtI Summa" ,

Patrenb SWENSON, HARlON I!618 eNGI!UfART DRMADISON WI-53713

1NItIlda. 7/26/1929

Below IS • lilt of yaur Phannacv orders ror the date range 01: 07/03/2«» to 10/01/2010

DltilfUIed Ax. DnIJI Name Prelcrn- Cltr Dar- Df...... Patfent,...CUll ...

Dde WrIIIIn FlU ID NDC ,byalclln DM :-u SuppIr AsW..... ,.W.,_.ldan HPI

02/03/2010 1"9110 5107900684-63 BU7529641 0 629351500310161730135377

0m8/2010 .19652 OMEPRAZOU! 2CIMG CAP unue,GJHA to 90 0 $10.a0 DOt$1'72.36

l2/2III2GGt 1774007 00781-2233-31 BU7529641 1 7013341003282G1730135377

04/05/2010 6822577 BENAZEP/HC1'Z 2D-12.STAB UTRIE,GINA 180 90 0$10.00 DOl-'32

Cl2/03I2010 177&190 00378...745001 8U7529641 0 732D9600040SOG

1730135377 #

04/05/2010 682267t NlfEDIPINE ER 30MG TAB UTRIE,GlNA 90 90 0$10.a0 DOt$99.62

02103/2010 1776189 54458-Ot50-IO 007529&41 0 7320879D04059G

1730135377

• 05/0412010 6830017 NABUMETONE SOONG TAB ARNOT,IClHBERLY 14 7 0SO.GO$15.58

0SI04/2010 1785707 00093-1015-01 a1073672622

05/0S/2010 6830017 NABUMETONe 500MG TAB ARNDT,IClMBERLY 46 23 0$5.00 DOt.51.20

05/04/2010 1785708 00093-1015·01 0 M&8777005059G

1073672622

05/l5f2010 6815376 FUROSS41DE 20MG TAB unue,GINA 90 90 0$3.30 DOt$10.00

1110112009 1788921 00378-0208-93 BU7529641 2 90621030051566

1730135377

0610512010 6822578 ATENOlOL 50MG TAB UTRIE,GfNA lBO 90 0$10.00 DOl,20.CO

02103/2010 1794913 51079-0684-63 BU7529641 1 99326090060SSG

1730135377

0&105/2010 6819652 OMEPRAZOLE 20MG CAP UTRIE,GINA 90 90 a $10.00 DOt$172.36

1212812009 1794914 00781-2233-31 BU7529641 2 993261100&OS2G

1730135377

eeCONFlDINlIAL-JF YOU RECUV111ItJS Rl!PORT IN ERROR. PU!AS1l RI1URN 10WALeMART PHARMACY IMMEDIATELY.WALeMARTSlORES, INC.

Page40fS

Stare -:2335 COnnaul 'harmKY SyItem

ReIlOlt Date: 10/01/2010 WaHlart ,1uI.ICY 11-2331MedIaII &pen..'_mlry

PatIefttI SWENSOH, MARION I!618 EHGB.HART DRMADISCN WI-53713

BbtbdatIIt 712f11929

8IIow Is. Ust fI yaur PIlIrTnacr onsets rar the date range 01: 07/03f20t1IJ to 1000InOl0

DaN. ... Drug"'" PrelcrlIIer Qtr De,. DI.,... PatiImt'aldCUll Pdce

DaIIt Wrtllen FlU ID NDC Phplclan DIA :emlSUppif AI W... 1P"'.

Phplclan HPI

0&I1SI2010 ....32772 HYDROCO/APAP 50325MG FEIL.MeGAN L 56 28 0 $5.00 DOlTAB $».84

0&I1SI2D10 1797847 00406-03&5001 MFll78347 0 1411378ClO6158G1659338390

01124/2010 6833'1'AZlTHRCMYCIN 250MG PAl< WALlHER,OAVJD P , 5 0 $5.00 DOlTAB "54

0I/24/Z010 UlOOSOO 110781-1496-68 AWI331'13 0 1804t&S006244G1S48299860

0fI2412010 ....32881 H'tDAOCX)/APAPS-SGOMG TAB WAL'lHER,DAVlD P 12 2 a $3.26 DOt$11.41

01/24/2010 1800501 ~S7-05 AWI33I'IJ 0 18049H00624IG

1548299860

015/29/2010 6833919AZITHROMYON ZSCMG PAl< WALTHER,DAVID P 6 5 0

$5.00 DOtTAB $28.54

06124/2010 1801774 110781-1496-68 AWI331913 1 198&5070062926

1548299860

07/0312010 6822677 BENAZEP/HCTZ 2O-12.5TAB U'1'RE.GINA 180 90 0$10.00 DOl$69154

02/0312010 1803060 ooJ7804745-01 BU1529641 1 21766440070370

1730135377

07/04/2010 6822679 NIFEOIPINE ER 30MG TAB UllUE,GINA 90 90 0$10.00 DOl$10Q.46

02/03/2010 1803176 54458-0950-10 BU7529641 1 2191219007047G

1730135377

0'1/1112010 ....33010 HYDROCO/APAP5-SOOMG TAB WAl.lHER,DAVlD P 12 2 0P.26 DOt'1t.46

07/09/2010 1805132 00406-0357-05 AW1331'13 0 2472684007117G

1548299860

08/04/2010 4433288HYDROCO/APAP 5-325MG AANDT,KIMBERlY K 60 30 0

S5.00 DCH

TAB $29.68

01104/2010 1812535 53746-0109-01 BA991U49 0 350238S008049G

1851325435

0BI04/2010 6836939 UDOCAINE S'll OIN AANDT,KIMBERLY 36 10 0$19.88 DOt$19.88

08/04/2010 1812433 001&8-0204-37 0 34892300080460

1073672622

"CONFlDINlUl.-1F YOU RECI!IVI! THIS RlPOR'r IN ERROR. PLEASE RlTURN TO WALeMAAT PHAltMACY IMMEDIATELY.WALeNART STORrS, INCo

,

Store .: 2335Repott Date: 10/01/2010

Page Sors

SWENSON, MARION e618 ENGBJfARTDRMADISON WI-53713

111tWIte1 7/26/1929

Below ... lilt 01 your PhannIcy Orders for the date range of: 07/03I20fS to 10/01/2010

De" Filled Rx. Drug Name ........, Qtv D.,. ---- ....utP.rdc..hPrb

..... WrIttu flUID NDC Plapldan DEA :-au SUp,., Aa..... TPRef.

Pllyslclan "PI

lI8f09/2010 6815376 fUROSEMIDE 20MG TAB UTRIE,GINA SO 90 0 $2.83 DOl'10-110

ll/02nOO9 1813649 0037800208-93 BU7529641 3 *790600809561730135377

0910612010 6822678 ATENOI.Ol. SOMG TAB UlJUE,GINA 180 to 0 $10-00 DOt$20.00

02103/2010 1821962 5107900684-63 BU7529&41 2 4828848ClC19G6OG1730135377

09/2412010 6819&52 OMEPRAZOI.! 20MG CAP unue.GINA 90 90 0 $10.00 DOt$172.36

12/2Il2OO9 1827342 00781-2233-31 1lU7529641 3 51502968009240G1730135377

Report Date: 10/01/2010Attested To By:

Note: '.' Due to a supply issue, thIs presaiptlon was only partially filled on this date.You were not charged nor was your Insurance company blUed on this date.

-.CGNFIDEN1JAL.JF YOU RECEIVE THIS REPORT IN ERRORr PLRASI! RETURN TO wa-MART PHARMACY IMMEDIATELY.WAL-MART 5lORES, INC-

~.anb

Physicians7974 UW Haa1ttI CourtMIddleton. WI 53562


6088336090608.83U039 Fax

J, Carol Meaz, Special BlUlDg Semas, ofUW Health, bereby certify that the attached is atrue copyofthe bllllDg statemeats ofMarloa SWeaBOD for hlslher treatment from 10/12110 topreseaft aDd DOW OD me In the omas of UW Health PhyslclaDs, 7974 OW Halth Court,MIddletoD, WIscoDsID S3Sfi2 •

ID wllDess wllereof', Illave here ante set my bmd March I 2011.

STATE OF WISCONSIN ))81

COUNTY OF DANE )

Penoaallycame before me OD Mareb 1,2011, tileabove Damed CarolMenz, mownto meto bethe penoD wllo executed the forgoing lastrument md aelmowledged the same.

"i/ _ I A~.J .

~ _/Yl. J'J~~~~.~:.N;:'.RoUDDe NeIsoD •~••, '••~ -.Notary PubUc, State ofWIseoDSID !~/~OTAFI~\~~Comly ofDaDe : : - : :My CommlliiOD expires 1210412011 ~~\ PUSL\C i ~ :

• ""f. ••• ••• ~ ••.. ~ , ~~ .••• OF wtS(; ••••

' .

PlEASEREJUllfTOPPORIlOHWIlHYOURPAYMENrcrPAYClNLfEAT1IIIWIFPAYlGIYIIAI1'ERCARD OR VIllA. FILL ourBaOW.

C-~c._

oWlIUlCI'

~ .......1TA18IINTDAtI ACCT••

03/01/2011 P-379443

MARION B SWBNSON618 B'NGBLIfAR'1' DR~XSON, ~ 53713-4744

PGl

o

~ealtb

PhysiciansPA.......EIIURVICD....".(Wi)--

UW Health - PhysiciansPO Box 2978Milwaukee, WI 53201-2978

Deull for btllnt I 'SOI33011 HMIOH B SRIISOJt

10/12/2010 omca CUIPI' ~ nIL 130.00 0.00 0.00CPrI 11213 Dli 123.1. 121.90. 122.4

DlI 129.111/04/2010 DISUIlUICB 'AYJIa'I-IlIINIl:AU 41.8603/0112011 DBMI CClIft'IACIUAL AD.J-DINCARB 82.14

01/1"2011 OWlca outPr~ 133.00 0.00 0.00CPrI 99213 DlI 123.1. 121.90. 122.4

DlI 129.102/1612011 DllUJtMCB,~ 41.5502/1612011 DUJf COII'IUoC'IUAL AD.J-DIWll:UB 85.45

0tIIeI' 'lTuuctlou

1012112010 IBII~'_ 32.54

03/01/2011 RBV Ie~ ALLCIfAICB 8'.32 0.00 0.00

10/2712010 II: COIIrItACtUAL ~·HBDJCARB 89.32

ACCOUNTNO:,..319443

IIUWlICEIWMCE en.540.00

aDDAYB

0.000.00

10DAYS

0.000.00

80DAYB

0.000.00

II. .-0 • ••• .... ." .:. . ..- ... tI~AD~" ~f:!~f -I. " : '. .. ~.",••~" .••• ~..,:.• ". • .

. ~·9~ ·· ··s.·( . ~ ,":o't:=o .••• : .•... - . . '. '.', '. " " .. PIIorie •

.....

. .g., a 01IeI

IF YOU HAVE QUES110N8 ABOUT YOUR STATEMENT

FINANCIAL poucyCIwps DOt covered~iasuraDce are due within 15 days ormceiYiDa)'01JJ' I18temenL Then will be a cbarge Cor paymentstbat lienlIDmed as nolHU8J eDt ftmds. Please keep in mind that JOUI'I~ CCMlI8JO Is acoDUact balweeIl )'aU aDd)Vur IDslIIancocarritr. Yaa lie ultimately IaJIODSible for pa,meat oraD chirps and undeISI8JIdIDI your policy1JcDefits.

1f)'Oll lieauable 10 make paymcIlt in fbII. please CII1l829-SZ54 or 1-817·565-8855 as soon as)'DB aa:dw dds statemeDI to discuss)'DOl' financial aItuatioa 8Dd make paymem ananprncnts an )'0111' account.

DO you Hem HELp WITH YOUR MEDICALII' , '?UW Health's~ cJInk:s. aDd hospitals liecommitted to~cue to patIeats who lie 1UI8b1e 10pay tor the medicalsemces dJey i'eceive. uwHeaJtb's Community Que pqram isdell I to help these iDdividua1s. UDiDsuIedpdieDls lie CDtided10a disaJUJII aJf'mosa ICR'ic:aand may be eligible for agreater discount tIuaugh our COIIUIlUDity Cuepsagram.

PAlIENt ACCQUNt9Ul!lD0NSIf,.baYe 8DY questions em )'OUI' BCCGUDt. please feel iRe 10 CODI8CI aP8ticDt AccouDts ReplaeDtatiw at the D1ID1Iler below. Theylie I\'8iIable to aaist)'08 ftom 8:00 AM to 5:GO PM. MoDday tbmuBh Friday.

Local 829-6217

DIstance 665-0505Addres8lJnaurance EmaIl [email protected]

51 usted tleac alJU118 pIe8UIda rcfacatca sa CU!IlIa. 0 occesi1a establccer un plan de paso. por favor c:omunlqucso al

(60B) 819-5217 or 1-817·565-0505.

'Ib8nk you for chao8lng UW Health for d your IIeaIth care nee""

~ealth

PhJSicians7174 UW1tEAL11tCOURT

~..ItbUniversity of \VISconsinHospital and Clinics

March 18,2010

Kasleta Legal Group7818 Big Sky Drive Ste 112Madison, WI 53719-4983

RE: Swenson, MarieMR#1675629

Dear Ms. Rebholz.

600 N. Hlohllnd AvenueMadIson. WI 53792

In response to your request of 3/11//10. enclosed are billing records for dates ofservice 7/3/09 through 3/2/10. Please let me know if you have any questions.Thank you.

Sincerely,

~b--~.~CL ,t_..Robin J. WfttsUWHealthUW Hospital Patient Accounts(608) 263-8583

~.anb

University ofWisconsinHospital and Clinics

600 N. Highland AVlI!lueMadison. WI 53792

March 18, 2010

I hereby certify that the attached 12 page$s) is a true and complete copy of chargesfor:

SWENSON ,MARION E1675629

from07/03/09 1003/02/10 from the University of Wisconsin Hospital and Clinics.The original bill was created in the usual course of business, and is maintained

in the custody of the bospilBlbus~. _I~~"'-

Lynn BaslerSupervisor Patient Accounts

.,2010 at Madison, Dane County, Wisconsin.

suna DelzerNotary PublicMy Commission Expires -++::n9.iFJliiii"!~

Dated this 18 day of March

SCERRJW09

uwbalUloOlQ

SBLBCTBD DETAIL DATA SVC PACI WOBO 03/17/10 0849

P'1' NOI 760824356 SWEHSOH ,HAlU:ON B MR HO: 1675629 ACCT 'l"YPBI BRBG: 07/03/09 DSCH: 07/04/09 PC: II P'l': V BXP Dm: ACCT BALI .00.------------••• -.------------------------------------------------ PAGB NO: 1

ACCT BAL 757 V X66 V G94 V PT BAL.00 .00 .pO .00 .00

sve POST sve CD INS CD-DBSCRIPTION/eOMMBlft'-RBF DAD070309 070309 18018069 01 CRI'l' CA 30-74 99291070309 070409 18018127 01 BR TRAUMA TBAM G0384070309 070409 15070014 11 VBNXPUHCTORB 36415070309 070409 15070014 11 VBHIPUHCTORB 36415070309 070409 15070014 11 VBNXPUHCTORB 36415070309 070409 15500093 11 BBHATOCRIT HON 85014070309 070409 15500093 11 BBHAT9CRXT HON 85014070309 070409 15500119 11 GLUCOSB 82947070309 070409 15500127 11 URSA NXTROGBN 84520070309 070409 15500135 11 CRBATIHXNB SKa 82565

AKOm1T2909.503313.70

14.7014.7014.1016.9516.9528.0828.2236.65

---------------------------------------------------------------------------._--

J989RJW09

Unive

SBLBCTBD DBTAXL DA'l'A

C· .

ave PAC: woao 03/17/10 0849

PT HO: 760824356 SWBHSOH ,MAJaON B HR NO: 1675629 ACCT TYPB: BISdl 07/03/09 DSCS: 07/04/09 PC: H PT: V BXP IRlh ACC'l' BAL: .00•••• -------------.-.--.-.------.-.------------------------._.----- PAGB HO. 2

ACCT SAL 757 V X66 V S9. V PI' SAL.00 .00 .00 .00 .00

avc POST SVC CD INS CD-DBSCRIP'l'ION/COMHBHT-RBP DATIl070309 070409 15500275 11 ALCOHOL (BTBAR 82055070309 070409 15500432 11 BLBCTROLYTB PA 80051070309 070409 15501216 11 BASIC MBTABLXC 80048070309 070409 15503519 11 APTT 85730070309 070409 15503519 11 APTT 85730070309 070409 15503675 11 P~ER TI 85610070309 070409 15503675 11 P~ER TI 85610070309 070409 15503691 11 URXHALYSIS AUT 81001070309 070409 15508724 11 BHSRV aPLT AUT 85027070309 070409 15508724 11 BMSRVoaPL'l' AUT 85027

DOUNT77.32

100.36121.12

42.9242.9228.1328.1322.6946.3046.30

._----------------------------------------------------------------------_ .

J989RJW09

SBLBC'l'BD DBTAIL DATA SVC PAC I WOBO 03/17/10 0849

PT NOI 760824355 S_SOH ,KAlU:ON B MR NO. 1675629 ACCT 'l'YPB. BDGa 07/03/09 DScsa 07/04/09 PCI H PTa V BXP INDI AceT BALa .00

.--------------.-------------------------------------------------- PAGB ROa 3ACCT BAL 757 V X66 V G94 V PT SAL.00 .00 .00 .00 .00

94564930059300593005

00002TAB

eve POST SVC CD070309 010509 15660152070309 070509 15655011070309 070509 15665029070309 070409 12120671070309 070409 12120705070309 070409 35010941070309 070409 14100028070309 070409 18011551070309 070509 18011551070309 070409 13650015

IRS CD-DBSCRIPTION/COHIIBNT-RBP DATB11 AlrnBODY SClUf 8685011 ABO TYPINGLAB* 315555003 8690011 RB TYPING LAB* B15665003 8590112 BLOOD PUS lION12 VBNODYNBS (SCD)22 CONSULT/TRAIN23 BKG ROUTINB '1'R23 BKG ROUTINB '1'R23 BltG ROUTINB '1'R28 88DDa-QocuBate (

AHOm1'l'66.7919.6019.60

.00.00

50.8097.2097.20

-97.205.03

-------------------------------------p-----------------------------------------

J989RJW09

SBLBCTBD DBTAIL DATA

o s

SVC PACI WOBO 03/17/10 0849

PT NOI 760824356 SWBNSON ,MAJtJ:OH J 1m NOa 1675629 ACCT TYPBa BRIGa 07/03/09 DSCHa 07/04/09 PCI H PTI V BXP XNDI ACCT BALI .00

------------------------------------------------------------------ PAGB NOI 4ACCT SAL 757 V X66 V S94 V PT BAL.00 .00 .00 .00 .00

evc POST SVC CD IRS CD-DBSCRIPTIOB/COIIMBNT-RBF DAD070309 070409 13650015 28 atenolol (TBRORK 00050KS070309 070509 13650015 28 88DD&-docusate ( 00002TAB070309 070409 13650023 28 MORPB~. injecti OOOOtMG070309 070409 13650023 28 prochlor,perazine 00010KG070309 070409 13650023 28 MORPHine inject! OOOOtMG070309 070409 13650023 28 labetalol (BORNO 00010HG070309 070409 13650023 28 MORPHine injecti OOOOtMG070309 070409 13650023 28 HORPHine injecti OOOO~S070309 070409 13650023 28 HORPHine injecti OOOO~G

070309 070409 13650114 28 PHARHACY PBB

AKOtJNT5.02

-5.0334.1525.4634.1530.5834.1534.1534.1549.50

------------------------------------------------------------------------_ .

J989RJW09

u a

SBLBCTBD DETAIL DATA avc PAC, WOBO 03/17/10 0849

H HOa 760824356 SWBHSON ,HARION B IIR HOa 1675629 ACCT TYPBa BREG: 07/03/09 DSCHa 07/04/09 PCa II PTa V BXP Dma ACCT BALa .00

-------------------------------------~----------------------------IAGB HOI 5ACCT BAL 757 V X66 V G94 V PT SAL.00 .00 .00 .00 .00

ave POS'!' ave CD ms CD-DBSCRIPTION/COJOlBNT-RBP DA'l'B070309 010409 13110029 28 HORPH%HB SULPATB 00002HG010309 010409 13651203 30 sodium chlo:ide 01000HL070309 010409 13651203 30 sodium chloride 01000HL070309 070409 13651203 30 sodium chloride 01000HL010309 070409 18011866 87 PRXHARY ZNJBCT 96314010309 010409 12127551 99 IV PUMP HODULB070309 010409 12127551 99 IV PUMP HODULB070309 070409 12127569 99 IV PUMP PROGRM010309 070509 15665003 99 ABO/RH TlPB PANEL .p070309 070409 35011170 99 STAT RBSPONSB

AHOtDr1'34.1552.3852.3852.3834.80

.00.00.00.00.00

------------------------------------------------------------------------------.

J9S9RJW09

u

SBLBCTBD DBTAIL DATA SVC I'AC: WOBO 03/17/10 0849

P'1' HO: 760824356 SWBNSON ,HARIOH B HR HO: 1675629 ACC,", TYPB: BDO: 07/03/09 DSCH: 07/04/09 pc: II PTa V BXP Dm: ACC'l' BAL: .00

----------------••------------------------------------------------ PAGB HOI 6ACC'l' SAL 757 V X66 V G94 V " BAL.00 .00 .bo .00 .00

avc POST avc CD070309 070309 80205107070309 070309 80200892010309 070309 80224520010309 010309 80224595070309 010309 80224751070309 070409 93669158070409 070509 15070014070409 070509 15500093070409 070509 12120671070409 010509 12120105

INS CD-DBSCRIPTXOH/COIIMBNT-RBP DA'l'BS5 CBBST XR 1 VW 7101079 PBLVIS XR 1-2V 7211089 C1' C-SPR WO CH 7212589 C'l' L-SPR WO CH 7213189 CT T-SPH WO CN 72128V ROOM 1'4/6-66 V

11 V1DTIPiJHCTtJRB 3641511 BBU.TOCRXT NOH 8501412 BLOOD PUS IIOH12 VBHODDBS (SCD)

AHOUHT109.30321.00

1979.001921..901921.902431.30

14.1016.95

.00

.00

-------------------------------------------------------------------------------

J989RJW09

SBLBCTBD DBTAIL DATA SVC PACI WOBO 03/17/10 0849

P'l HOI 760824356 SWBNSON ,HARION B HR HOI 1675629 ACC'l' TYPBI BREGI 07/03/09 DICH, 01/04/09 PCI II PTI V BXP Dml ACCT BALI .00--------------.-.------------------------------------------------- PAGB HOa 7

ACCT BAL 157 V X66 V Q94 V PT BAL.00 .00 .00 .00 .00

SVC POST SVC CD IRS CD-DBSCRIPTION/COMMJlN'r-RBJ' DATB070409 010609 12224366 12 SLBBVB SCD 1HB1219200070409 010509 88065834 20 ~ BVAL 97003GO070409 010509 14100028 23 BEG ROUTXHB T.R 93005070409 070509 13650015 28 atenolol (TBNORK 00050KG070409 070509 13650015 28 senna-docusate ( 00002TAB010409 070509 13650015 28 seDDa-docusate ( 00002TAB010409 010509 13650015 28 atenolol (TBRORK 00050HQ070409 010509 13650015 28 nifedipine 24br 00030llG070409 010509 13650015 28 seana-docusate ( 00002TAB070409 010509 13650015 28 aspirin BC tab 8 00081MG

AlComrr46.30

372.3091.20

5.025.03

-S.03-5.026.145.034.98

------------------_._._--------------------------------------------_._ --

JI81RJW09

SBLBCTBD DBTAIL DATA avc PAC a W080 03/17/10 0849

P'l' HOa 760824356 SWBNSON ,HARION B KR HOa 1675629 ACC'l' TYPBa BRBQI 07/03/09 DSCHa 07/04/09 PCa H PTa V BXP %RDI ACCT BALI .00------.----.------------------------------------------------------ PAGB HOI 8

ACCT BAL 757 V X66 V G94 V PT SAL.00 .00 .00 .00 .00

8VC POST avc CD ms CD-DBSCRIPTIOH/COMMBN'l'-RBP DA'l'B070409 070509 13650015 28 atenolol (T.BHOBK 00050HG070409 070509 13650015 28 pantoprazole (PR 00040Md070409 070509 13650015 28 benazepril (LOTS 00040KG070409 070509 13650015 28 hydrocblorotbiaz 00025MG070409 070509 13650023 28 MORPHine injecti OOOOtHQ070409 070509 13650023 28 MORPHine injecti 00001MQ070409 070509 13650023 28 MORPHine injecti 00001MQ070409 070509 13650023 28 MORPHine injecti OOOOtNG070409 070509 13650023 28 KORPHiDe injecti 00001KG070409 070509 13650023 28 MORPHine injecti 00001MG

AKOmrr5.028.715.165.02

34.1534.1534.1534.1534.1534.1S

-------------------------------------------------------------------------------

JI89RJW09

BBLBC'rBD DBTA%L DATA BVC PACa WOBO 03/17/10 0849

PT HOa 760824356 S_SOH ,MARION B HR HOa 1675629 ACCT TYPBa BBGa 07/03/09 DSCHa 07/04/09 PCa H PTa V BXP Dma ACCT BALI .00

-------------------------.---------------------------~------------ PAGB HOa 9ACCT SAL 757 V X66 V Q94 V P'l' BAL.00 .00 .00 .00 .00

ave POST IVC CD INS CD-DBS~P'1'ION/COMHBHT-RBPDAD070409 010609 13641162 30 SOLH .9\ RACL 9912107070401 070509 13651203 30 sodium chloride 01000KL070409 070509 88069000 86 RBRAB V%S%'l' ST070409 070509 12127551 99 IV PUMP MODULB070409 070509 12127551 99 IV POMP HODULB070409 070509 12127569 99 IV PUMP PROQRN070509 070609 13650015 28 a~enolol (TBRORM 00050MG070509 070609 13650015 28 paD~oprazole (PR 00040MG070509 070609 13650015 28 nife~piDe 24br 00030KG070509 070609 13650015 28 aspirin Be ~ab 8 00081MG

AHOlDft'50.9952.38

.00

.00.00.00

5.028.716.144.98

----------------------------_.- .._-_._.----------_._---------------------------

JIB9R.lW09

u·

SBLBC'rBD DBTAIL DATA

Cllnl'~C!

IVC PACa WOBO 03/17/10 0849

PT HOI 760824356 SWBHSOH ,HAUOH B 1m HOI 1675629 ACCT 'l'DBI BRBGI 07/03/09 DSCHI 07/04/09 PCa II PTa V UP UGh ACCT BALI .00--••--------------- •• --------------------------------------------- PAGB HOa 10

SVC POST BVC CD DS CD-DBSCRIPTION/COHMBNT-RBP DATS070509 0'0609 13650015 28 88DDa-docu8ate ( 00002TAB070509 070609 13650015 28 beDa.ep~il (LOTH 00040llG070509 070609 13650015 28 hydrocblo~othiaz 0002511G070509 070609 13650015 28 beDa.ep~il (LOTH 00040MG070509 070609 13650015 28 hydrocblorothiaz 00025MG070509 070609 13650015 28 ateao101 (TBNORH OOOSOMG010509 070609 13650015 28 DifedipiDe 24hr 00030llG070509 010609 13650015 28 pantop~azo1e (PR 00040MG070509 010609 13650015 28 8eDDa-docuaate ( 00002TAB070509 070609 13650015 28 a8pi~in BC tab 8 00081HG

ACCT SAL.00

757 V.00

X66 V.00

G94 V.00

PT BAL.00

AHOtJN'r5.035.165.02

-5.16-5.02-5.02·'.14-8.71-5.03-4.98_____________________________________ L • _

J9892&ni09

SBLBC'rBD DB'l'AIL DA'l'A SVC PAC: WOBO 03/17/10 0848

PT HO: 760824356 SWBRSOH .HARIOH B IIR HO: 1675629 ACC'l' TYPB: BUB: 07/03/09 DSCHa 07/04/09 pc: II PTa V BXP IND: ACCT BAL: .00

-----.------------------.-.--------------------------------------- PAGB HOI 11ACCT SAL 757 V X66 V G94 V PT SAL.00 .00 .00 .00 .00

avc POST072209 072209080509 080709080509 080709081309 081309082709 082709082709 082709

avc CD1594

999979991778

1560991133995746

INS CD-DBSCRXPTIOH/COHMBN'l'-RBP DAD00 SAPBCO AUTO IRS 75 17297.91o HOVBD·PROH 7608222281 BAnCO INS PH'1'

00 MBD PART A 0.002 MBDICARB C1JRR (BDX) PAYHBN'r2 MBDICARB DRG ADJ

Altomrr.00.00

..4304.00.00.00

-12993.91

.._-----------------------------------------------------------------------------

J989RJW09

.. Page 1 of 1

Patient: SWENSON,MARION BMIN: 1675629Hospital Account Number: 368610.Guarantor Account NUmber: 379443Pinancial Class: CAREPrimary Payor: DBANCARB GOLD 553Primary Plan: DBANCARE GOLD 1501Patient Type: OUtpatientLocation: BAST CLINIC

SWlNSON,MARION B618 BNGBLHART DRMADISON, WI 53113-4744


Amount

This is not a bill. This is an itemization of your h08pital services.

Cbarge8._~~~_~_~:---:- ----::-- _Service Qty Rev Description Procedure

Date Code Code

03/02/201003/02/201003/02/2010

1 998 lIB-VISIT UNITS 46+ MDIU'1'BS ROOM USAGB1 998 lIB-VISIT UNITS HA/MA1 510 lIB-CLINIC VISIT LBVBL 3 RB'l'URN - T4

HBZ9903HBZ9906

HBT4L39921Total

0.000.00

195.10195.10

Amount

Revenue Code SUlll1l\ilX'Y' _



Total

195.700.00

195.70

payments, ~

Post Date Description Amount

Total 0.00

Adjustmentsi ~~------------------------__:-__:~Post Date Description Amount

Total 0.00

Printed on 8/30/2011 04:58 PMPage 1 of 2

SWENSON,MARION E Scan on 7/16/2009 by Brunner, Jodi of THORACIC SPINE WO CONTRAST 2PGS

dll~~/~~~~ da;~~ aua-~a~-ooo~ uw r~u ~~~~

Swenson, Marion E (MR.# 1675629) DOB: 0712611929

~ealthF4IlI600 H1g111a11d AvMIIdlIoII, "'" 5:mr.zPhOne 283-1320

Page Jof2

Hospital Encounter

Result BfW>~w...DuJoInformation 713QOO9 4:81 PM

Result

Marton E Swenaon (ePIC MRN: 10833061, PPD MRH: 1145Z9S,UWHC MRN: 187S629~ DOB: 712811928, AGe at aos: 19 year

old,8EX:F

~Flnall'Osult

CT THORACIC SPINe WI 0 IV CONTRAST (Order 488831168)

RNuItNanatlve '72128 - CT T SPINS V/O IV COJlTIUS" "erfonood lit U'llHCcurrant ~1aqno.1.~

aesidont/Follow: Stat!: MICHAtL TUITE 104126Report Dictated on Jul 3 2009 T~anscr1bed ay: PSC on JUl 3 2009•• 48P!1

CUIUUW'l' DX/SIGNS NfO s'!MP1'OKS QU£8TION: traUlll&

CVIUWI'J' DX/SIGNS ANtl SnlPTClHS COMKBNTSI SCA~J TO EPICCAR CRV.9ON FOil ElOIIi QUr:S'flOU: evol fx/dislocx r lL.NlA8~ !'OR Ev.M Cl»lKSH'tS:PAST HISTORY 0018'10»: nV4PASt HIS1QRY COHHZNtSIADDITIONAL Cot01ltr.rS:

Report Dictated.Jul 3 2009 Last updato: Jul 3 2009 ~:48PM by PSCIle'ide~t ot Fellow:

STUDYIS):Cf T SPI~ "/0 IV CONTRAS~. OAttD 07/03/0' ~T 12:17

Correlatiee ~ith oerv1cal and lu~ar spine performed 00 the SAma day.I=presslon ca=parlscn.

Technique: Thin 4o~tion 4k~al i~~91nq throuqh tho thorec1c ~plne wasobtained. Coronal and sagittal :etormnta pe~to~~d.

Findings; Age indetQ~n8te. probably chronic compresaion fraoture at T1218 likely chronic with apPEo~iQQLaly ~D' loal of vertebral body hQ19h~ attho Duperior endplate. No Deute !ract~re. Multilevel dogenerRtivc di~k

disease with vacuum di~k phonomonon 1n tho lowor thcrac1c ~plna. Nearc~lcto 1008 ot disk helght At Tll~:lZ with vacu~~ disk phenomen~. Bonedomineralization. 80ne bridQRr. tbe post.r1o~ fifth. c1~th. and eeventhribs. and i8 likely pOBttraumatlc.Calcirl0d 9~anuloma in the r10h~ lowerlobe. Associated passive atelectasis 1n both lower lobet. No prostaticc&l~itication. and tortuous aorta. Larq, hiatal harn~a.

IMPRESSION: 1. Ch~on1c T12 compression trDctu~e.

2. Multilevel doqonerative disk d~scaae.

3. calcified oranuloma In the r1~bt lower lobR.4. Pcstarior matter changes in the right pOIt.erior fif~h. sixth. andScv<\Illth rlb~.

5. L~rge hOEn~o.

~. tbe teachinG pbysiciac. I percocally Qx~ed the radiOLOGic study,

Swenson, Marion E (MR # 1675629) Printed at 1/15/098:38 AM Page 1 of2

Printed on 8/3012011 04:58 PM Page 2 of 2

SWENSON,MARION E Scan on 7/16/2009 by Brunner, Jodi of THORACIC SPINE WO CONTRAST 2PGS

OIUQ-~g~-OOO~ UW'·~I~

Swenson, Marion B (MR '1# 1675629) DOB: 0712611929 Page 2 of2

Hospital Encounter Marlon E SWenson (EPIC MRN: 80833051, PPD MRN: &745293.UWHC MRN: 1678$29) DOB: 712811829, AGE at DOS: 79 year

ald,SEX: F

r.v~ewQd the findings with Dr. and arrived at this lnt~rprQt.t1on.

Or~ln9 'rovidors 002762 - BBNJAKIU HAlrSHCRNHL Authorizino rrovider: tHOHAS HlYlRDictation Date: 07/0J/~009 Stltfl K1c~e~ TOI~BAeCQIs1cn ,: '96341881ectronically S19n~d By: HICRAEL 'UIrB. H.D. on .lul 3 2009 4148~

Result History CiT~e.tNE WCO..nL~$:t.(Otde~~7J3I09 ~llJW1U:flstcllY Aepptf,.Lab Information UWHC NOVIUS RADIOLOGY

PACS'maglJ8

Padent ~tltnt Ham ~ DOBInformation swenson. Fem.1e 712811929

"'arlon E(1675628)--_. --_. ,----_ _._._---_ _ _--_...... . -.._- .. - .

-----_.._._-----_ _-_._- - _.,._ ..Original Order p.!!JJl!.tA..QD

{,.rl:bJ~. 2Q09j1:22B\4Prde~rUbHartGhom, Benjamin L, MD----_.__•.._._._----~------_.. . _.- _ .

order Questl!:lllQuectlons Lalit creollnlne value?

TrlII1$port Molhod

Why are you ordering I/lls 8l1l1m?

A1reldy known history?

CUrrent signs and symplcma?

~.~

No Cre,Unlna within'1.130 daY'

FloorDelermlnodlEnlel1ld

eval fxldlslocc

mV8

DebBed frjp~Il&Q~er.De~nll

information -----_ ..__...- _-- _._ - _._----_. - ~ .

-----_ __..__._-_..-_ - ..- _---_ _ __ .

Swenson, Marion E (MR# 1675629) Printed at 7115/09 8:38 AM Page2of2