Document 7Q0eqaJQjv4kdG7pRB1gOOdB

CAM-399 State of Rhode Island and Providence Plantations PR0vmEN Sc WORKMENS COMPENSATION COMMISSION madeIn the above entitled cause it is agreed that the following entry be .A.D.19. ..- .- .- -.....-.-.....- ..- .-4- Petitioners Attoey Respondents Attorney wccl1 10 CAMC-Abeyta-002757 March 1979 State of Rhode Island and Providence Plantations PROVIDENCE Sc WORKMENS COMPENSATION COMMISSION TfiONAS..TFALL vs .UNTOYALr...J.LNC No....782S1.Q... NOTICE OF HEARING The above matter will be in order for bearing before the Workmens Compensation Commission on the 27th day of April 19 79. at 930 A.M If reached on the above date pre-trial conference will be held prior to proceeding with hearing cc Thomas Westfall Rappoport Esq Mark Mandell Esq Argentierl Esq Clerk READ CAREFULLY You are directed to be present at the offices of this Commission 25 Canal Street Providence on the above date together with your witnesses and your attorey if you are represented by counsel at 930 in The Commission will be ready to hear your case on that date WILL NOT BE GRANTED EXCEPT FOR AN URGENT REASON REQUEST FOR POSTPONEMENT THEREYou are advised that if your petition is not heard on the above date MAY BE CONSIDERABLE DELAY BEFORE IT IS AGAIN REACHED FOR HEARING wcx // CAMC-Abeyta-002758 U- It VV\ Rhode Island 02809 401 253-8880 CAMC-Abeyta-002759 March 1979 State of Rhode Island and Providence Plantations PROVIDENCE Sc WORKMENS COMPENSATION COMMISSION THDMAS_WES.TFALT.._ 1AL VS _.. ........ No 7.8-2510 .. NOTICE OF HEARING The above matter will be in order for hearing before the Workmens Compensation Commission on the 8th.... day of March 1979 atcOcM p.m If reached on the above date pre-trial conference will be held prior to proceeding with hearing cc Thomas Westfall Stephen Rappoport Esq Mark Mandell Esq Robert Argentleri Esq READ CAREFULLY You are directed to be present at the offices of this Commission 25 Canal Street Providence on the above datetogether with your witnesses and your attorney if you are represented by counsel at 930 The Commission will be ready to hear your case on that date WILL NOT BE GRANTED EXCEPT FOR AN URGENT REASON REQUEST FOR POSTPONEMENT You are advised that if your petition is not heard on the above date THERE MAY BE CONSIDERABLE DELAY BEFORE IT IS AGAIN REACHED FOR HEARING wcx CAMC-Abeyta-002760 State of Rhode Island and Providence Plantations PRovcE sc THOMAS WESTFALL vs TJNIROYALIN WORKMENS COMPENSATION COMMISSION AD.191 madeIn the above entifled cause it is agreed that the following entry be hereby enter my appearance as co-counsel on behalf of the Petitioner --. -.-...- -.---.-...- STE PHEN RAPPOPORT _.. ._ Petitioners Attorney Respondents Attorr /1.1 1rrr 11 CAMC-Abeyta-002761 State of Rhode Island and Providence Plantations PROVIDEcz Sc TWflT TITTP1T.T TTNTPCYAT vs TN WORKMENS COMPENSATION COMMISSION cc no.78 -251o November A.D madeIn the above entitled cause it is agreed that the following entry be ..I here byen ter my appe ar beh ofhe re matter an deny all th all ega them in Detitionerts Detition contained h .- ...- .4 ...... wccll to CAMC-Abeyta-002762 en 25 TO one of the and in is and Add to to SENDER Complete iteml your addicas reverse RETURN apace The following service Show whom requested check date delivered Show Show and to whom date address DIVERY whom date delivered delivery RESTRICTED DELIVERY and to Show whom date acMress delivery in Fees shown fees are to addition postage charges and of 85 45c1 $1.05 other TO ARTICLE ADDRESSED cc -n -1 li NO NO ARTICLE DESCRIPTION REGISTERED CERTIFIED INSURED NO or of the Always obtain slgnaturs address. ag.nt ijave received SIGNATURE article described above Addressee Authorized agent DATE OUfJ.JV LJt1f27797g -DDRESS Compl.t only r.qusst.d PorMARIc UNABLE DELIVER BECAUSE CLERKS lO-203-4te GOP If TO CAMC-Abeyta-002763 Oct 26 1978 State of Rhode Island and Providence Plantations PROVIDENCE Sc WORKMENS COMPENSATION COMMISSION IEALL1--- vs 78-2S10 NOTICE OF HEARING The above matter will be in order for hearing before fD ecemb er the Workmens Compensation Commission on the at 930 A.M If reached on the above date pre.trial conference will be held prior to proceeding with hearing Thomas Westfall Mark Mandell Esq Uniroyal Inc Prentice Hall corp System READ CAREFULLY You are directed to be present at the offices of this Commission 25 Canal Street on the above date together with your witnesses and your attorney if you are represented Providence by counsel at 930 WILL The Commission will NOT BE GRANTED be ready to hear your case on that date EXCEPT FOR AN URGENT REASON REQUEST FOR POSTPONEMENT You are advised that if your petition is not heard on the DELAY BEFORE IT IS AGAIN REACHED FOR HEARING above date THERE MAY BE CONSIDERABLE In on on the the the event above date otdfhaettheeatttfehirnesdtipngehteitoiaorrnienexgramstihnheinagldl apfteuhryntshiisecihaanttotecnathdrmeinogCt oaomprpmeeiasxrsaimonining physician will be available to testify wcc CAMC-Abeyta-002764 tatr 11nh 1ntan an rnuth.rntg tantattrni WORKMENS COMPENSATION COMMISSION 23 Canal Street Providence Rhode Island 02903 EMPLOYEES PETITION FOR COMPENSATION BENEFITS NAME OF INJURED EMPLOYEE Petitioner Thomas Westfall NoHOME ADDRESS Street City or Town State NAME OF EMPLOYER Respondent UNIROYAL INC NoBUSINESS ADDRESS Street City or Town State 17 Hendricks Street Providence RI 02908 DESCRWflON OF EMPLOYEES JOB Machine operator manueneralNATURE OF EMPLOYERS BUSINESS facturer of Rubberized Products Middlebury CONN 06749 7a NAME OF AGENT FOR SERVICE OF PROCESS Prentice Hall Corp System lb ADDRESS OF AGENT FOR SERVICE OF PROCESS 1125 Hospital Trust Tower NAME OF EMPLOYERS INSURANCE CARRIER ON DATE OF ALLEGED INJURY UNIROYAL INC DATE OF ALLEGED INJURY Month Day Year TIME injuries occurred over long period of 11 IF NOT ON EMPLOYERS PREMISES STATE WHERE INJURY OCCURRED N/A time 10 DID INJURY OCCUR ON EMPLOYERS PREMISES XX Yes No 12 NAMES AND ADDRESSES OF WITNESSES TO INJURY No single injury occurred Petitioner was exposed to thesepowders 29 year period 13 HOW DID INJURY OCCUR Petitioner worked with talc and mica powders on the job 14 NATURE OF INJURY AND PARTS OF BODY AFFECTED BY INJURY mesothelioma cancer IS NAMES OF PHYSICIANS AND HOSPITALS WHO HAVE RENDERED SERVICES Dr Denis Baillargeon Rhode Island Group Health Miriam Hospital St Josephs Hospital Association over 16 WEEKLY WAGES AT TIME OF INJURY Last wage $4.75/hr plus overtime Base Pay FIRST DAY OF LOST TIME Uniroyal closed i.ts Providence plant on 6/28/75 18 DID YOU RECEIVE WAGES FROM YOUR EMPLOYER WHILE ABSENT FROM WORK IF SO TO WHAT DATE Yes No DATE 19.a DID YOU RETURN TO WORK FOLLOWING THE INJURY WHEN Yes No DATE 20 FOR WHOM DID YOU RETURN TO WORK Give Name and Address AT WHAT WEEKLY WAGE N/A 21 NAME AND TITLE OF PERSON IN EMPLOY OF YOUR EMPLOYER WHOM you OR WHO HAD KNOWLEDGE OF YOUR INJURY did not find out about the mesothelioma until 1977 after my plant closed 22 DID YOU RECEIVE WORKMENS COMPENSATION BENEFITS FROM YOUR EMPLOYER FOR THE ABOVE INJURY Yes JNo DATE -- 23 WAS PRELIMINARY AGREEMENT CONCERNING COMPENSATION 24 WASTr NON-PREJUDICIAL BENEFITS ENTERED INTO WITH YOUR EMPLOYER X1Yes No Yes N/A TO WHAT DATE AGREI4ENT No 25 CHECK BELOW THE BENEFITS YOU ARE SEEKING dowr XXJ TOTAL DISABILITY COMPENSATION FROM 11/1/7 to date PARTIAL DISABILiTY COMPENSATION XXJ MEDICAL BENEFITS XXX DEPENDENCY BENEFITS SEE SEC 28-33-17 NAME OF WHOLLY DEPENDENT WIFE OR PHYSICALLY INCAPACITATED HUSBAND NAMES AND AGES OF DEPENDENT BIlL DREN PERMISSION TO HAVE MAJOR SURGERY PERFORMED NAMELY FROM Wife Betty Westfall SPECIFIC COMPENSATION CONCERNING THE FOLLOWING BODILY MEMBERS OR FUNCTIONS XXX COUNSEL WITNESS AND SHERIFFS FEES myhereby petition that rights to benefits under the Workmens Compensation Act may be determined and in support of this petition make the foregoing statement of facts further certify that both my employer and are subject to the provisions of the myWorkmens Compensation Act that my injury was not occasioned myby wilful intention to bring about the injury or death of myself or another and that said injury did not result from intoxication on duty have read the above statements and affirm that the same are true Name and Address of Attorney for Employee Mark Mandell 500 Howard Building Pii4snr PT fl29O P135 OA/1 Signature of Employee i./-1 Date i- CAMC-Abeyta-002765 PETITIONER THOMAS WESTFALL 17 Hendricks Street RIProvidence VS ATToRNEY FOR PETITIONER Mark Mandefl Esq 500 Howard Bldg Provi4erxce R.I 029031 782510 RESPONDENT UNIROYAL INC LI w.c.c CASE HisTORY 1578 pct 26 tL DecOriginal Petition riled and a8signed to 1978 2A4Q /1Z2 7- 4Q /7 Jm /1 7g iimate cs 4rldjtjon3l cbargc efund______ 1ua1 Cost rar3ciip4 .-- -.- W.C.C DocKET CAMC-Abeyta-002766 to JU 1976 MEDICINE PROGRESS JjhcLIL iJ IW ///u 00 29 PLAN 73i91976 Fl MU Jj // //7 i- ./ ov 51976-nc t_ -_g L4-rc- rrt 7_I WCCNo 1IIiiIII tw -- 1_ CAMC-Abeyta-002767 PROGRESS PLAN WESTFALL THOMAS 009426 /./76 Mr Westfall comes in for evaluation of two problems Ocie tinnitus in his left ear which has been going on for about year now he wakes up The It tngi.ng is usually worse seems to be little hit tin the morning WhTt better by nighLtue There is no associated loss of hearing no vertigo atta.ks He has had no headaches lIe has worked around loud machinrv all his life The other problem is lump which has occirrd in his left groin He first noticed thIs while taking shower about one year ago has increased in size and continues to take Regroton Over the past month he feels is painful when he walks He daily it PHYSICAL EXAMINATION HEENT NECK The tynipanic membranes are clear bi laterally His hearing appears gross- ly normal Webers is benign The temporal arteries are bilaterally The carotid arteries are wit no bruits bilateralLr CHEST The lungs are clear to percussion and ausul tat ion The heart is regular rhythm without any murmurs or gallops ABDOMINAL IMPRESSION 2cmThe abdomen shows no mflSSCS or organ omegaLy There is about rn mass just mediaa to the left femoral artery This was examined with Dr Perry The impression was poss femoral hernia be explored that it was which shoiiL Hypertension under good control with Regret on Tinnitus pro reprcsents nerve damage to the years of working around loud machiii cry Th patient wonders about medicatioo ef fect from Regroton Howcv-e-r the PDR mei tions deafness -as aside.effect of Regron but not tinnitus We will have tomograms done out of the tumor internal or other auditory ineatus to compressive lesion ru1 near the seventh nerve PhwoaeLfvAeNwtheillmThleeheteahfatetrunipnsaggrtrieoetlifinneeetsrwtbwyhiailmilnlDdl rbtoectooPmnsEenctNighrTnrreuaydmefupslrewdIfoeitfhvftahothlertuheaesxtliureoaRrnfgyetAigcraionaltOtreeenrxnnpaeloHl geraaatutdiioV- n RI ClIARI GAY.ZERRO 14.1 ps CAMC-Abeyta-002768 PROGRESS .-i4--- PLAN a-u 24 kQA i. L4 i----- tuIjl cLyk.___-__ I. t/4a .- ..i L-__ J-tc.- 71 a/- /..-.-- PR- D1C1IL WESTFALL THOMAS 009426 s$177 PROBLEM SUBJECTIVE seen EpigastriC pain The patient has had no further pain since 1t OBJECTIVE The lungs show Ileart has regular rhythm uppex raabdomen shows no tenderness occision.a.l expiratotY rhonchu without murmurs or gallop5 fhe masseS The I. showed active some deformity ulcer in the duodenal bulb but actual IMPRESSION Peptic gistritl.s PLAN Patient to continuC the rigel asked him to retufl in weeks for final tinus daily followup Richard Gazzerro D./pti CAMC-Abeyta-002769 PROGRESS PLAN ..I ... q7ED1NF /7Z WESTFALL THOMAS PROBLEM 1/1 Tinnitus OO9426A 12177 SUBJECTIVE tinnitus He The has patfent complains been evaluated by of three to four Dr Gazzerro for yeari this In the past The patient complains that the tinnitus has worse over the past few years rob1em gotten OBJECTIVE The patient has had multiple audiograrns here which are e8sentially within normal limits He has had -ravs nf his internal auditory canals which are also within normal limits ASSESSMENT The cause of the ringing in his ears is not cicar at the present time agree with Dr Gazzerros previous assessment that an ENT consultation would be useful at t1- present time PLAN The patient is to be referred to.ENTAssociates for thcir evaluation PROBLEM //2 Bilateral skin tags SUBJECTIVE The patient has small skin tags below each ailli He states that they become Irritated especially when he wears constricting clothing or during the summer when he perspires He complains that the one on the right side is currently Irritated and would like It taken off OBJECTIVE The patient has bilateral skin tags The one eu the right being irritated and inflamed mt the present time ASSESSMENT The patient should have the skin tags removd PLAN The skin tags will be removed by Jim Cahill this mcernonn Charles Cutler M.D /psi CAMC-Abeyta-002770 PROGRESS VI t. WESTFALL THOMAS 009426 PROBLEM Epigastric pain 42977 SUBJECTIVE OBJECTIVE IMPRESSION No further problem Heart lung and abdominal Gastritjs resolved benexam is PLAN Return p.r.n RICHARD GAZZERRO /psi /c7/-/ _it3_.2.L .6 It iil/L4.l 2i 4L-tt- WESTFALL THOMAS 009426 /1f77 Mr WesLfall comes for ren1LIation of his hy rtnLun Jhi1e be is here he complains that over the past fur wtk hihe has been ha1ng pain over left chest..hi.s sding type pain and occurswhen he lies on his left an aii worse when he takes deep breath He had been havy cJ.g ette smoker for about 20 years up until 10 years t.hcr switched to pipes He denies any cough hemoptysis sllcirt of breath _j7 --The pain is not brought on by exerc.Lse- Uc CAMC-Abeyta-002771 PROGRESS PLAN not remember any trauma to the area He has lost fivc pound recently without dieting but he attributes this to hot L.eaLh er On examination the neck shows no adenopathy The rnch is midline The lungs are clear The heart has rcguiar rhythm without murmurs or gallops The abdomen shows no hepto splenomegaly Examination of the rib cage shows some tendernss laterally over the 10th and 11th ribs IMPRESSION Chest wail pain rule out neoplastic disease Hopefully this Is muau1ose1ctl PLAN The patient will have se chest xray lb films CBC calcium alkaline phospha ThctrcrcrdTjram iTh nstructed him that if the pain is not gone in two weeks would like to see him again We will of course contact tii if any of these tests are abnormal lie is given prescripLin for Hydrocortisone creaLn .1% for seborrhelc dermatitis wliih he has Tic is to return in November or December for follow provided the tests are all negative RICHARD CAZZERO M.D./psl Zf L.4-T .1 .AjJ/I -c /i/ 12 .__.___ 7JofN LDT .oi- E... -. .ic i-O-- t.J.c _-Lt.1 -- f2D 1L -i--- .- CAMC-Abeyta-002772 PROGRESS WESTFALL THOMAS Ufl--942A rth.i 5- yea Dr Gazzerro fila Ii lit II being ig lie on err seen for evaluation oI an norma cli Ho Was jii hi US ua lie ii ii ma we go lie Ii ha ci oma cli rot em and he thou Ii ha was rr once ti mahi cli oh cm Lii lie grad Ia hu up owe cli Ga ze set in fur or II Ii ini to ii ii mci iii in tme ii er the It on Sc tt these symptoms and decided to wait out then to have them prodevaluated The discomfflitgraduaiiY increased over this of time and when he saw Dr Gazzerro September 1977 DmteppyomoeayrsacbteibrieendesGrnatw1tazopgz5itwnehotehrorurokTngheoentrdheooerarwndretiefeteoilnsrirdteewedfaiUainnslntoioRaftohnocfehyshaeyitinslsmalitcnlprcsbegtxiouanurmsscaileensaWyehseaiansnnwgdeHheiUitchiwh2ncewh6iRehansoashmyaoahntiowrnedlueevnadortofteloefvtwldoeudhcfdreanodwtedudrirewtesahnacoesoobsnuvitteEwtyhraiorsntvuwggtoelhiTrxthoe rpdlhsieuaaiadbsytsbiseeshtnamarttdhrotapkeedtnrdoiennihgteissieanmws_geoisaekatitnsntrgeyoslalinlstdstpleupenincpo itTefiilhbmceiyrtaeaerphlxsgpOpwhiroa.ooasspxrsutiarmeetxnoiaeopftonteosbfltuyesrreaveaesetabihrgtpeohpstnoteonsotyositeheelveaxuhereisooinsrwptttseiyogvsennriosThiieelnieHliee OBJECT1VE The patient HEENT arc unremarkable is afebrile Blood pressure is 16YO Tue neck exam reveals no adenopalhv and no thyromegaly Chesi exam reveals few rhonchi on fcrid cx- piration arid some decreased breath sounds at the left base The heart exam is norma The abdominal exam reveals no liejaLo splenomegaly and no misses and normal bowel sounds Extcinitics reveal no clubh ing no reveals that Lhe rihit edema and good pulses The rectal ean lobe of the prostate is little lt enlarged and occult blood no nodules levi ow .tI arc Id his chest The stool tests nega ti br eittxrayS reveal that 01 ber there was deftnitei.y dens LI-y in the left lower Lung region obliterating the cardiac silhouette somewhat sugy.csrive of ii ngul ar ptielimOr Li however the lateral vie here appears pneulflon in the tobe fluid wiihin the eft rnajor fissure ti.s On the Sep toniber 15 1977 films there is densi ty which 011 itcrtes the cardiac silhouette ni ease .is well as the phragin in the lct heInidapiira On the lateral view only one is visible presumably ihic right and there is an Inc rcas thickness of the major fissure had the patient come in last night for repeat xray which amount of fluid and lateral dectibitus there is the presence ol great deal of shows an 1ncrcas in film which confirms pleural effus ioi he thaI It CAMC-Abeyta-002773 PflOGRESi PLAN probably rep rusen ted pleural ef lus ion from the very beginning ArTtehShpaSisErteSsShmeMeanEyNthTares prtheuaUsdhenenrilctauptIeaoonrLsaIilteimvppeyleemutuarbaefrrocemuilfiunsjopinsiekiinnoiT-ihteetsistpaitniiet nthtmeaysapyasst cIIw asltpleural effusion the talc the rubber industry was an contains high proportjoii pleural malignancy either It- may r.present an tlia was indus trial used many grade of years talc ago in which of asbestos may represent primary mesotlcjoma or metastisi Of course it may also rcprccii metastjses to the pleura hronchog.njc carcinoma with dsfPl3oe0pLia0rfAatgNcnccemcoesllluTtdiohncaecfdoxrruppilpulnaasurttpirteryeounsrltlielcaliesfncwltte.iifcclilounajddttdilneiiotadhirowpaeyancpdsrseorronooxgubitIecstaaaistrnhici5ngso1errdawgcasecltuhanecTpttoehhessirnesfeioitsnertmfrhlpetuodriddionaAtyteiepnwirpnafcsortoohresxcstocjarimnllt Li.j pliment culture rheumatoid factor and approximately cytology acid fast smear and 150 cc sent for cell block pos tprocedurc chest size of the effusi on is to have P1D ray revealed marked decrease in the and no cvi dent pneumotliorax The pa Li int TUs planted today lie is to come bae Thursday to have it one week and have decubitus done just read repeal prior lie is chest to comce back ray PA and and see me in left lateral DENTS BAlLLAgcEN M.D /ps-i jj --- WESTFALL THOMAS 00 26 9/27/77 ibis gflt1emdfl 15 nLei hirL tol further followup of unilaceral leftsided SUBJECTIVE tesis caiii we did thor aching throughout his left c1ies breath ing ile en les vr or chills We got some samples Lll the Pleurde count was not idicative of tr1V relative lymphocytosis the protein iuu catedan xudae the cytology was nondiagnostic there wete 1. CAMC-Abeyta-002774 PROGRESS very atypical mesotheii.nl rIlS The cellblock was i1e ic nondiagnostic with very atypical mesot.helial cells 1ntriin1y though the sugar was very low low sugar is seen in emp\cfl which he does not have ma lignaticv which doubt because the negative physi cal exLminat ion and absence of mass Jes tu1 on chest Xray rheumaloid lung which doubt because of absence of rheumatoid arthritis or tuberculosis lie had strongly nosis of therapy positive PPD so things are pointing towards the diag tuberculous pleural effusion Before starting him on however.1 would like to do Pleural biopsy for whih he will be admit ted to IaL ima IOS1 it t1orrow In thc meaflt imc he is going to get platelet count P.T.A CBC and sei rate DENIS 1A1LLARGEON M.D./psi CLL -- 1.\A \.4f \\ k\O LQ kc CAMC-Abeyta-002775 PROGRESS __________________________________ ... ....__...._ PLAN ..... g1j -\ --.. -r- L. r.j -.-.____ -tkLW-.. r---------- ii__.._ --------.--..---.--....-- r- ---------- -.- -.---.-... i..-.-- 1. -..---- .- .L..._ CAMC-Abeyta-002776 PflOGFtSS ______BJuitL tc __ _c __----r ________ ________fMiLVJ ---f------------ IIIiIIIII --. ___ 1ii_- 6i2wj WESTFALL THOMAS 009426 10/20/77 The patient stating that he has he cannot lie down at night and Last night he didnt sleep very taking every four hours without had increased che6t pain so has to try to sleep nitting well at all Percodan he much relief of his pain that up BLOOD PRESSURE 150/Th TEMPERATURE 99.6 LUNGS There Is dullne8s 2/3 of the way up the left chest Patient was referred to the Miriam Emergency Room for inothcr xray and consideration of admission EDWARD GAUTHIER N.D.Ipf/h CAMC-Abeyta-002777 PflOGRES 7r7/--- PLAN WESTFALL ThOMAS O09426A 10/28/77 Thhadcde-ahiheInldsslivedysesolnlqtoabogauprsetxofeitetnndretgbacl.oevharnymiiiesalaelibrpnteunimtpdleeihuuassbeormiienirfnoeysoegonnanntiutdthcewitnshrtrceieiithn1veh0aigs0indtdgmyaahdeuyiyeeedtnsrgtcearleseahwWetafgoheasorynwosrtiesattvohtftuehupitresornmttihgoeplptehhaaaetr1stt0Piie2efapeonnnnrldhetdlitglaseouhprsgwresthrameotueeuahampelsfidntTpeihhnereahgrsShaavhitipneusetaclroeneeutral biopsy could then have mimicked mesotheliQina Therefnrr am going to give this patient few more days of antibiotic therapy with going to have rythromycin 250 mg four times day arid an him come back to see me on Tuesday afternoon We are going to get repeat chest xray including left lateral decubitus at-that time We- may then bronchocope h-Lm on Wednesday morning or we may admit lilm to Miriam Hospital for insertion of test tube and institution of Thitepa therapy DENIS BAILLAItCEON M.D./psi/eb t7 IIIf III II.I II WESTFALL THOMAS 009426 1.1/1/77 TSbhiinoisceticgehsnistlemlHaeasnthasvisisbieetenntehretainrkeginghheerhehisasfotermnaTfiupnrettarhaineteurdrefohalinlnodworiuta-pl haasnii1-rn stgoing up to night when approximatelY 100 to 100.5 degrees he remaiied completely afebrile all until day and au iirlnight last night fle is still significant of the left His chest xray today lung with elevation of sore but ii.tLng s-bows some volurn ions the left hemi diaphr.igii and mcst r-safifmwtfsnrrohuieemiiiferntrheeehtedhcibilcniecrftfaeiolryholsusumnrnoiocdittondhohtrioehhcelgaoawl.nsrOahtarynwmemdetcthsahosteihmahidtsoaiilpustlvieelseaeptifhteltwptaeheaetlltoYpfieLeolapiarnelreelcttnecxeNtcluehdrlesuraaaiveadsdesslreeeeTeuvihansddetaLsgphlenetoceehcphCeuielasw.tTbddehimciesttetpnhixshirSogloetearChuetuptamtfairrsiaaccaeulamuitmlilfrnYrlnnonyotuIsmOs.hcncufaielceannitlvrvlritcIo.kddtpafnecrsoegnelinuytechaiLcnenodnaonltinhde CAMC-Abeyta-002778 PROGRESS PLAN WESTFALL THOMAS 00942A 102577 This 55yearold man is entering here for fur ther fo lOW UI Since his last visit with me the pal ient it lie was moving some heavy furii Lure fl hen ci to ng se usa ion ef increase in his pain lie felt that it was has had time OctOlCr 1/ and clues wi ma ed raw fl.iH every tiiile came have he in took on the deep breath in that rca of his chest 16th or nome day to be sccn and was marked increased iii the amouui of his pleural He ioteI to ci 1u jOt He was given prescription for Tyl end help at all ILe came in the following prescription for Percodan lie then the 23rd because fever and very //3 which did noL day and was given came in on Thu rdny loose sounding cough increaRnflthaleuiegspiedthaftteSavunnceddhraeysftiettovoHnrexearrcaEweayrsnysHttehevsrseohiwrsofyalwsYeCwudaanisfdcl mothdbmeietotfcenoapderuteasrebstloeiTusoetfeunptcnheaettiileopnfhtethoristsshwipesaitstmeanloscrtenaoivrneotgerld when lie says that the fever broke Ery titromycin mi Ii upset his stomach but it has not Today lie since he has is afcbrile been taking it wi tl meals repeat chest xray done last Sunday showed marked increase in the pleural ef ins on which went all the way up to the apices of the lung on the lateral aspects Today jim shows decrease i.n the si zc ii the effusion The patient was told Lo cout inue his Ery Litremyc ii for the rest of the week He was to that from here on in we are going to have to play it by ear If he persists in htving they effusion we may have to put him in the hospital for insert ion of chest tube with chest tube drainage and possible intracavitary insertion of Tliiotepa. IENIS.BAITLARCEON M.D./psi/kmin Thhltiihobioeoserpnteiricoltsoapr1ti1esciznehcdeLbeiriCopfuoweceprhrasOtaissricoettnsohponyoriwonwuiglrhhulaienvnicwnoignoIlSlrigekuafpdeitnhVveiaSenLCrdor1imshpokeotrorsosowwsfiiLblolmlpeoshrnuahpvpaecireenntonLiiLcne1rrhfaeel c antibiotics DENTS BAILLARGEON M.I- /ps i./cl CAMC-Abeyta-002779 PROGRESS 1i t.iI.7 1/ WESTFALL THOMAS OO9426A 11277 This 55yearold man is entering here this morning for fiberoptic pr.ocedure is of the lung bronchoscoPy The reason we are doing this because we want to rule out an adenocarcinoma metastatiC to the pleura which may rarely mimic mesothel ioma which we have di agnosel on this patient by pleural biopsy intercurrent pneumonitiS and have an endobronchial lesion Also we want which the patient has had an to make surehe doesnt could cause this P4TTwtptat%hohRrhnreieaeOdothycCXcthhEeppmyeDemdr2laooo%UauovtcRciepvreaEeeedXondidnystuTenltohrneoeeTwcTorrhhaadimreesoimetnrralaeian1lLfvclialypheeoblyrhearweceneawasrdrfrwdoliyootcinhtpawtahxahnbtpderyiprcdenaepinnuaoabhsdsrabrlogoptearsrnnrodliaaatcarnhlhsaptceioonoohhtsxpinoonciyohvCsOgricoancmeaPcoranyealnpalndlYealxnwitdawwctshwwoaeehmserawrdeasruaeonsssicdnnepfaidtuaawtrfrosounnrienrstdererteheeahtusbddhertcuolerievwculridtattizghrssaaahruaonntozvianuesueniiegndlsotstihoasztunhotSewhtneuhadeittIetthiishtzeilezei eidId wweTatinvththhaxnisoieessaetdhnrummaitlaslnehea2lpiueine%fzplfbdttnteersoaXdgrdwalTuymeonuhdpiiwdtoeechpacefednelatddranrrl5aeipnowpflealrotoenmwipbnabeperaareeuaenladptrdonepdadeeantnTnrtxhhdhdoaieneermlnmtoraaoibonabrlllreesdleirlmgooudfnthcatopchethfalfrrdronouoodSbppimutcrpesgooeivrPnhnriwteshtocswoaeuheualsogsaithambwtliLlhinaeezaeegsnelfstTttsdorhltweeheTaleeowhfsaetnewbnexdwrraeoeoammwlrbnisnaiitacntavphilghenoiqpidnodusbeurseeualabacidwcraroaeoknnpldfinldoaezyfcnrreohdadmunds cbahnryoedtnoclthoheoegfscyOppuroCpcpeedwrbuarrusesohbtheLteenngarnwdwwinaistnahltdedsroodanwe ntibiTinnhuenitdthepteerndtcconfonnt grtinuctuloayolrteuosrslaoetggesymudcetnttihoTnehoefing procedure well FNimIoNpAerLevisdsIeMinoPcnReESisSoIf0aNawnay itisenngidcoathhrelolfylCrfehlsi0aulrltmslesoitfornaccyhttoehLorb9bigrgoYhnOcUhital treeFinal PbtriwhneeLeeeasAnceNwchruitfolliolnosUrnpltaihtthtealeooenlfnglffacaololusrknytisdlpiadttaWehtirOrnwiesegndhtepwiamtaayaitlsglilefeonnwarattesdnmrtrhaieoiadtmvbSieahaihoitiomnitnouisoClndfSoanerhtfeehedeibnSgrrtatehoritpoleuypailndldecamwrusteihhtraieachshehle.pmdhhaaatsistpeoantin some rolein leviatiflg pain DENTS BA1LLARGJ1 M.D./psi-/krnm CAMC-Abeyta-002780 PROGRESS PLAN WESTFALL THOMAS 0O9426A 1118-77 his rnpijllThis gentleman is entering here for further follow up of Since his last visit things fairly Status quo He doeS say however thit in the last couple df days he has felt bet ter than he has in about month or so He takes an occasional Percodan for pain oiTs stiTT7and he Now he is told has to long beware history ofduodena1 about this iii vle ulcer probJems which .1 got the feeling is bothering him Percodan wi iii milk and takes an occasional He takes tli DiCel as we His chest xray today reveals no significant change There is no reaccumulation of fluid and there is stil1 the left lower lobe pleural density consistent with the mcsotheliorna PLAN We are going to get an upper CI series to check on the status of his Stomach and the patient is advised to take very frequent DiCel The patient also is takin Rogro ton which contains Thiazides as well as Reserpine for his blood roingpressure which is good at 142/80 So before his next visit to get another CBC sedimentation rate and potassium level i-Ic also ought to have repeat chest xray before his next visit with mein one month DENISBAILLARCEON M.D./psi/kmm -77 CAMC-Abeyta-002781 Ste530 Norlh Main Pt cvtrlern 401331-3000 02904 RADIOLOGY CONSULTATION ORDER FOfl .v P2/E1rld liEOUESTING PHYSICIAN _Ll--- PREVIOUS X-RAYS THIS FACI7Y YESO YR DATE OF REQUEST ii 7.1 DATE OF EXAM _____ X-RAY PUMDER OSHASSUCK WARWICK 4\ fi S/ .j S. AREA TO BE EXAMINED RIGHA 3.C MEDiCARE PLAN 65 WELFARE OThER INS.D _____________ NO INSURANCE Carrier WORKMANS CO.P AUTOi CClDEfTD EGNANT YES NO POSSIBLY LAST MENSTRUAL PERIOD DATE RAU.A YES NOLocation .LINIcAL OUE5TIOOF of susDected t/ fracture // 112277 UPPER G.I.SERIES Examination of the eosphagus failed to reveal ciflY alnoc1a1ity The stomach appeared normal in sizeshape and position The gastric mucoa appeared intact throughout There was no delay in gastric emptying The duodenal bulb and loop and few proximal loops of jejunum appeared normal Incidentally noted is evidence of left sided pleural effusion IMPPESSION NO EVIDENCE OF UPPER G.I.PATHOLOGY Thank you for referring this patient NDI/pv .Iannuccilli M.D Radiist MEDICAL FECORT f/i CAMC-Abeyta-002782 ___________ LII VLI 7-7.T1 DE-X __--IDOVO rz fl.JA_------ Y5- MCr Ft RD ATK iO --- \rDRCMtD oDD -- MuD M0ATE HAV ENC0CECM cms Ccucus ______ SSNT yS0 4- ocAvOA GCSiS ATiA/ -.G CLASS Iu CIAS3 iv --7 -- -- .- -- c- uJ/7 dr-f1 5Jfr1LLLL socs ._ _._______ MA UPA -- Li BiLL LII -- -- ___-- cs c-v-i .- i- ___O_c_- L_0ct -j ----- ---v 0k D---- __J_ -- __ ----- .-- CAMC-Abeyta-002783 TT -- REPORT ACEA -- 3C MID MCD MIW DERTE CC1S SLL sr ELLPE1T ______ NO PVI3US CTOLOGY OTHER FC OCICAL Cats CL ct5 IC CY CCL-S JJ BILL -- ------ c- _h CAMC-Abeyta-002784 JITED 3Y- %IjL- --...-...-- ._ -- ....-.--------- DATE -_.p- 4f$ __n__ JL -- LrI44I lI .IAI II4-1 rrC.T .III4Y --____ MIt IlINII-l III 1114 AUF 1/ -/ // ._ IIAOIOTHEI1APY i_i NI LI _______________ IVON IFI-It IIVIOUSSMEAR NI NO 441 PORT 11 lALi FIILI 104.101 GV410 Al YPI.AI_ CVTIII Ic 1- us YI.S IAN NO Ill/Ill III -lI- LA INrIINrs AITIANOTIFII 4CYIL ATYPICAL .VTLI 4101 lIc.cr 1./I 44 LIAI INANLY III ATYIICAt CYTOLOGY IrETEIlMIpjat IV ATYPICAL cyro tGV.iGIS1il UI- MAL UNANGY MALIGNANT CELLS alf Ni MATEIIAL INGI III ICE ui 11111 //7 _I .4 .714C.C4I IrFICT NIGH MI01I1A1 LOW IIFPlIITIlJll ---S -s 4.7 ______ -S 4. ir IL_JHJLLDR E3ILLPATIENT -- ACCOiTJI NO c_LM iv __LLt_Li 11 TURA ION INDEX PT AGE 1IT2/LMP ITT PMP YIOIO4 CA.t CILNLCAt HORANE Rx DATA____.. REPORT WBC4 MILD YES MOD NO RADIATION YES ---I- HEAVY 01 RBCY MILD NO MOD PREVIOUS CYTOLOGY NEG HEAVY OEHER r------------- BACTEUA MILD MODERATE CLASs NO MALIG CELLS 0__HEAjENDOCfRVICAL CELL5 PRESENT YES NO CLASS Ii ATYPIA BENIGN iurClASS SUSPICIOUS CLASSIV R/O MALIGNANCY LI CLASS MALIGNANT CElLS /7 Preparud Bioran Modical Lab at Somerville Hosp Mass COC License 201054 ___Ei REPOI1TED PR R..4O .tiV fi CAMC-Abeyta-002785 gEPORTI cTEgIA --- -- Oil tASI NAME _1 Rx WC MILD MOD MILD MODERATE SOURCE OF SPECIMEN CVOERTAVICIL1G7 EIRN/1A/ It BILL lW BILL PAT1T rAcE MATURATION INDEX REOUESTD NO RAOIA1ION YES NO PREVIOUS TOLOGY NEG OTHR HEAVY RBCt MILD HEA DI ENDOCE MO ICAL CELLS PRESENTi YES NO C.OtI II MALIGN1Ct prcpared Bioran MedCOI Lab at SomorViIIe Hosp Mass CDC LiceflW201O Ii pIMHIAY CP CAMC-Abeyta-002786 NOU1II .LJ UI IMk UNt 200 IUjH SEVCE AVENUL IOOVIDENCE R1$ODE ISLAND 02904 5ALVATOF1E fl ALLEOflA M.D JIhohIloChiCf PATRICK fl1ODERICK.M.D CiAsjojgt PtFIOIa9$t MOIISEN SrLTANI M.D AociIoP.l/IUIOgat LASZLO SOMLO co Auoeaf Pjholugs CELIA RAMOS M.D AuisIarI Pjlho/ogssl GLADYS COK.Ph McoIioogii it LOC lOll I_ Perry ___________________________________ CLINICAL DIAGNOSIS __________________________ SPECIMEN SUBMI ITEL I. .. _4 GROSS AND MICROSCOPIC bESCRIPTION enbpec1ten roceived In stcttre contziiing freth tate conits brIght y11ci aipoe thir tine iicturing Draggregate Fpre3efltatiVe act1ons are subitt.td c-1i Section shows mr.thranousy arranged fibroadipose multiple congested biood veses tissue It coti TISSUE COtSISTET WiTH HERNIAL SAC 1X3220 REPORT isi2t2_Z_Li Mohsen Soltani CAMC-Abeyta-002787 j4.L1 170 WASIIINGION STHEET TELEPHONE 617 429-4900 HOLL5TON MASSACHUSFTTS 01140 DEPT OF PATHOLOGY -- CLINICAL DATA PATIENT SURGEON DATE WESTFALL THOMAS Dr Cutler January 21 1977 AGE 54 SUnG LAB II 540954 SN77102 SSfms SPECIMEN suBMITTED ci BRIEF CLINICAL IIISTORY mci duration and rapidity of growth PREViOUS OPERATlONS OPERATIVE FINDINGS POST-OPERATIVE Dx- PRE-OP DX PATHOLOGICAL REPORT SPECIMEN CONSISTS OF an oval fragment of tissue gray 1irrn and.measuring mm Bisected and submitted in LoLo iIICROSCOPIC DIAGNOSIS BENIGN SQUAMOUS PAPILLOMA WITH SECONDARY INFLANMATION ACROCIJORDON Histologic processing and interpretatiOll performed at FruiliflJhafl1 Un ioi iIopi bal /7 tiI1i CAMC-Abeyta-002788 SUGL.i1 PATIENT NAME NAMEOF HOSPITAL/CUNIC PHYSICIAN WESTFi1LL THOMAS Bioran Medical Laboratory Dr Barilargeon SOURCE OF SPECIMEN CLINICAL HISTORY pleuraifluid AGE 5Ol5 DIAGNOSIS PLEASE SEE BELOW fliorn OrnorviUz C.DC Lkenn LW 034 SEX HOSPITAL NO SURGICAL PATHOLOGY NC S-77--2 842 DATE .9/22/77 GaOSS DESCRIPTION pieuralthidconistsofapproxjrnateay MICROSCOPIC DESCRIPTION THE CELL BLOCK SHOWS NUMEROUS CLUSTERS OF CELLS CONSISTENT ITH MESOTHELIAL CELLS SOME OF WHICH ARE MARKEDLY ATYPICAL WITH ABNORMAL NUCLEAR AND CYTOPLASMIC PATTERN THERE ARE FEt NITOSES NOTED THE CELLS ARE GLANDULAR PATTERN THERE IS INFILTRATION THE APPEARANCE IUFLJOROCCASIONALLY ARRANGED IN PAPIbLARY AND MINIMAL -ACUTE AND CHRONIC OF THE CELLS MIGHT EITHER RESINT NEOPLASTIC PROCESS OR MARKEDLY REACTIVE PATTERN CF THE flLSOTiiELI2 CELLS SECONDARY TO AN UNDERLYING LESION RECOMMENDS FOLLOWU AND FURTHER EVALUATION PERIPHERAL PULMONARY MALIGNANCY SHOULD ALSO BE RULED OUT SGND ----t ALMARIO BUCAL PATHOLOGISt CAMC-Abeyta-002789 UI- UN PEACE SIHEEr PflOVDENCE RHODE ISLAND 02901 SALVATORE ALLEGRA Pathologot n.chief MO PA HICK URODE flICK M.D Altocate Chof Pathologist MIIIISLNOLTANI .4ssoc..t Pathologist M.D LAZLO SOMLO M.D Auocat Pathologist CEL.IA RAMOS M.D Assistant Pathologist GLADYS CDX Ph.D Microbiologist N.II IIOI_1C1 l3aillargeon CLINICAL DIAGNOSIS SPICIMEN SUIIMITTI.O ri Suraical GROSS AND MICROSCOPIC DESCRIPTiON ietctSpecrn rcceivod dimmsiOn mostly Drof soft tissue in fonialin consi.Sts of live very wall crr flattened almost trnnparent tannish griy frugnnt Without sectioning entire speciten submitted .tti Section includes few small fragments of skeletal muscle as ell as f-broconnective tissue and piece of pipi11ary processes and iriteryening processes are lined with one to two tumor composed of rather compact fibroconnective strorna Te papflry layers of hobnaillike atypical mosothelial cells NOTE The pattern of staining conform to that mesotheliorna iLEURAL BIOPSY In PAPILLARY TUMOR CONSISTENT WITH MESOTHELIOMA REPORT Mohsen LA IIIOLO1IS Soltaii 1.t CAMC-Abeyta-002790 ACE SilliEr PflOvlD RHODE ISLAND fl29U1 AtVATOflE ALLEGRA M.D PlofvgsI.n.chI MOPATRICK I3RODE RICK nc. CI.ef PIhoIagist MISFN SOLTANI M.D Auorar Patholoa LASZLO SOMLO M.D AuocaIe PafhoJozt CELIA flAMOS M.D Auiflaot Parh.Iogsi LADYS COK Ph Mcrobioogisf NI.II IUCIOII _.Qi1i.l0 CLINICAL DIAGNOSIS SPECIMEN SuI1MIITEO -- .-.- EI4VICE 11 Bloc GROSS AND MICROSCOPIC DESCRIPTION cto lined with rather uniform to slightly pleornorphic atypical what appears to be mesothelial cells In part the papillary structures arc associated with intervening delicate fibroconnective strorna NOTE The papillary structures by special stairs display staliiinq characteristics of msothelioma CELL i3LOCK.SHOWING.AGGREGATES 1IESOThELI OP4A DEPAPILLARY STRUCTURES COMPATIBLE WITI REPORT ISSUE_77/j /1 TII Mohsen Soltani .D CAMC-Abeyta-002791 Rhode Island Group Health Association Denis Baillargeon M.D Department of Medicine Mark Mandell Esquire Pr210 High Scrvke Avenu North n. Rh 401331-3000 December 1977 CNo.7/a Pelitioner Exhj No/ Dear Mr Mandell Mr Thomas Westfall has been patient under my care since September 20 1977 He was referred to me by Dr Cazzerro for evaluation of an abnormal chest xray The patient has longstanding history of essential hyper tension which has been treated with Regroton He also has history of intermittent peptic ulcer disease In early August of 1977 the patient began complaining of leftsided chest pain worse when taking deep breath and when lying on his left side Thepatient had worked for Uniroyal Rubber Company since age 26 until approximately two years prior to his present illness He had been cigarette smoker in the past but lately only smoked pipes. chest xray was obtained on September 1977 which was interpreted as showing pneumonitic infiltrate in the lingu lar segment of the left lung The patient was started two days later on Erythromycin 250 mg four times day for two weeks chest xray done on September 15 1977 was interpreted as showing no change and the patient was referred to me at this point for further diagnosis and therapy When reviewed the xrays interpreted the findings to represent pleural effusion rather than pneumonitfs lateral de cubitus film was obtained which showed free fluid in the left pleural space With the past history of long standing positive tuberculin skin test the possibility of tuberculous pleural effusion was entertained Also strongly considered was the possibi1ity of an asbestopura1 effusion or mesothelioma in view of h-i.s longstanding history of working with industrialgrade talc which has high percentage of asbestos fibers The patient underwent thoracentesis on SeStember 20 and approximately 300 cc of thick yellowish fluid was obtained for analysis These studies of the fluid were consistent with an exudate with cytologies strongly suggestive of N.rth M.in lrolIn Rho.k l..I.n.l fl24 IHhS Po..i Roul Wnrwhk Rho.1i Ilnd flR46 i/i CAMC-Abeyta-002792 Mark Mandell Esquire 2-- December 1977 malignant process The pleural fluid glucose was low and the patient was admitted to Our Lady of Fatima Hospital where pleural biopsy was done on September 28 The pleural biopsy was interpreted by Dr Soltani as papillary tumor consistent with mesothelioma The pathologic material including slides and cell block was sent to Dr Carl Teplitz at Rhode Island Hospital for second opinion His interpretation was that the atypicality papillary formation andfoca spindling leave little doubt as to the diagnosis of pleural inesothelioma The patient had several episodes of reaccumulation of pleural fluid following this procedure and developed left lower lobe pneumonitis which responded eventually to antibiotics At the present time he is left with chronic pleural changes in the left lower lung area with no evidence of free pleuraleffusion He continues to have constant leftsided chest pain requiring chronic therapy with Codeine On November 11 1977 the patient underwent fiberoptic bronchoscopy to rule out peripheral adenocarcinoma of the lung metastatic to the pleura The procedure was entirely negative Bronchial washings for cytology were negative Therefore this patient has clearcut pleural mesothelioma for which ther is no satisfactory treatmntexcept perhaps consideration in the future being given to radiation ther apy purely for palliation of the patients pain and possibly intrapleural insertion of alkylating agents should there be reaccumulation of free pleural fluid The prognosis is extremely poor with death certain out come from thismalignancy However the expected length of survival is unpredictable This is obviously permanent and no doubt progressive lesion The patient may very well eventually require additional treatment such as radiation and/or hospitalization for intra pleural insertion of alkylating agent.s Eventually also the patient may require longterm confinement for terminal care The predicted costs of these future treatments are indeterminate Yours very truly DRB/psi Denis Baillargeon th CAMC-Abeyta-002793 DEPARTMENT OF PAT IOLY RHODE ISLAND HOSPITAL Providence 02902 iv __ CONSULTATION C77-317 PATIENT WESTFALL Thomas Date 10/12/77 Age 55 Male XX Female Number of slides submitted Slide numbers FA7748434 FA7748444 Hospital St Josephs Hospital Consultation requested by Denis Bail.largeon M.D RIGHA 530 North Main Street Providence 02904 COMMENT FA774843 and FA774344 Despite the meager clinical evidence for mesotheliom at the present i.etime small nonprogressive effusion nonbloody with littje pleural fibrosis on xraythe histologic picture in this small biopsy and cell block certainly looks like bona fide mesothelioma The atypicality alternative then we wi 11 papillary formation and focal spindling leave little there_is no clinicalprqgression_int_hreeiojis r1uate the situation DIAGNOSIS SEE COMMENT ABOVE WE SEE LITTLE ALTERNATIVE TO THE DIAGNOSIS IN TillS SMALL BIOPSY MATERIAL OF PLEURAL MESOTIIELIOMA Copies to Dr Baillargeon RICHA%J St Josephs Hospital File Slides being returned with copyof report to Director Pathology St Josephs Hospital -p raCNo v4p.oner 772r CAMC-Abeyta-002794 h.ode island Group HaIth As3.UOn /J Mfl jAJ flYLc1tcc EXTERNAL REFERflJL FOAM TT7i .- rom ti Li1 .e 1\ THS REQUEST DOES NOT AUTHORIZE HOSPITALIZATION UGHA patients may not be hospitalized without the proper authorization of the lGHA Claims Department Call 401 331-3000 UGHA patients may only be seen by the above named consulting physician for the pectlied number of visits marked below Patient Telophonn DATE ii The above named RIGHA patient has been asked to mako an appointment with you by calling telephone This will confirm the appointment made on behalf of the above named RIGHA patient for Day of the Week Date _____al Var kM P.M ervice Requested Single Consultation Visit Check one _______ Consultation Treatment No of Authorized Visits Mark No of Authorized Visits up to maximum th- Reason for Referral Reports Enclosed 1iU i f- tkucLos cLt ck J/oJ yid OLF X-Rays cL Forwarded -kI- Ii ______ __ Ruested By ______ IS6LIL6u yI__ i_ M.D 1L /.i Date Li onsultants Findings Please return brief description of findings recommendations If necessary use back of sheet for Findings please 8CC copy mcLci- cy \y ccc._ ___.Licof RIB conii L1C \_ .- j__JJ Send this copy to PROVIDER privig-4r mtit return thj cony loClaims Dpw1mont for pnyrnrnt pro /11 CAMC-Abeyta-002795 TFALL.THOMAS HENDRICK ST CITY PROV RI 2421 I_ it au O29O 1H194/29/22 O.p W.VIRGINIA --hr .OUFA130N SELFEMPLOYED ROLLCRAFT MVi2i IAb I4LOYLR AU0flCS INC PROVR.i j-r.r-i t.tt O9/2t/77 12 q--- rrI LEFT PLEURAL EFFUSION GZii 112976 HOME RLFEcuINIPYSrCIANUO AN0.1i FR4 BAILLARGEON F4TILNTSW0L BETTY WESTFALL SAME BAILLARGEON ADOR3 MET JEWELRY WORKER T.SARDELLI THOMAS ht r14 tATLNT EFO 0.U .WL fl3ST4LEPH0NE FLWESTFALL17 HENDRICK FATI444 flRJHPLAC SONS IPROVRI STPROV R.1290S IMAOtNNAOFFItTItITSMO14EIt PAT4jT It afl10R flO CtCUPA1ION ANO EI.4FLOYER OF FA1PIFR HPA MiNOR .VDHLSS OXUPATl0N AND EMPtOYER OF M0TxC El _______ Dr4J.f CIIA THAN AHO _____ WESTFALL MDFjrS HENDRICI IN r.Or LMttttI4Y SAME .ii.s 99911OO9426 0/ O4p.LLafLOyUI AHi.TII Oy nun2.r.I r4046 40 AO Li2P_1 ST PRfV WIFE 11.14 Non FOhI4At MEIICAIIL I40 _ii -t 11 .4ui.l .t Cl.ts 1Afo1c ItOI.If0L.H0W.ORPOLICYNO NAI4i4$4JAN0 lOtUVAtC --ht jiTIFnCATI044NO LLON iFAU0A10tN1.AUIIITYIO4tMAfI04 ISOd4ALW0iiiIFfl0.IJNKIlWN -thc --- AOI1 ECOWXRY IAGOSISES II OMPLIGATIONS PTICSINORDER OF lMPORANCE I1 .1 L-uNSULTAIOJ I- /4 ATtENNG HYSCANS cor sIIt.- IIIr /1 CAMC-Abeyta-002796 530 North Main Street Providence Ri 401331-3000 02904 RMOLOGY CONSULTATION ORDER FORM REQUESTING PHYSICIAN 1l PREVIOUS X-RAYS THIS FACILITY YES YR DATE OF REQUEST ____It____T_I _________ X-RAY NUMBER DATE OF EXAM -______ Li MOSHASSUCK WARWiCK .2 i. pto .7/ /- AREA TO BE EXAMINED -- EGHAE B.C.- 6.S.D MEDICARE WELFARE PLAN 650 OTHER INS CarrIer NO INSURANCE WORKMANS COMP AUTO ACCIDENTO REGNANT YES NO POSSIBLY LAST MENSTRUAL PERIOD DATE AUcJiA YES NO LocatIon of suspected fracture LIN1CAL QUESTION OF IO.OF ILMS ..3 TECHNICIAN w.ccNo.7Y5/Q Petitioner NLExhibit Left Ribs There is no fracture or intrinsic abnormality PA Lateral Chest There is lung pneumonitic infiltrate in the lingular segment of the left Impression Pneumonia lingular segment of the left lung npc Joht Thorp .. .. .... MUICAI flECORD ftn CAMC-Abeyta-002797 ri c_ 4.- ... .i L4 530 North Main Street Providence AL 401 331-3000 02904 RADIOLOGY CONSULTATION ORDER FORM 1v C- REQUESTING PHYSICIAN _____ PREVIOUS X-RAYS THIS FACILITY YES .-DATE OF REQUEST 77 YR X-RAY NUMDER vJOSHASSUCK WARWICK .17 It Date fi AREA TO EXAMINED V7.1 /_- .--- RIGHAEJ B.C.-B.S.D MEDiCARE PLAN 65 WELFARE OTHER INS.D _____________ NO INSURANCE Carrier WORKMA.rS COP AUTO ACCIDENT EGNANT YES NO POSSiBLY LAST MENSTRUAL PERiOD DATE IAUMA YES NO Location of suspected fracture OF.INICAL QUESTION --- PA Lateral Che5t The leftsided pleural effusion seen on September creased somewhat in size since that time 1977 has in IC JohrThorp MEDICAL fltCORD CAMC-Abeyta-002798 L_ 530 North Main Street Providence RI 02904 401331-3000 FADOLOGY CONSULTATOJ ORDER FORM PHYS1ClANj3LL CA. PREVIOUS X-RAYS THIS DATE OF REOUEST_ X-RAY NUMUER Ii-FACILITY YESYR -______ DATE Ci ik- NO OF EXAM _____ MOSHASSUCK WARWICK -cfist 7io /jnj -/ if AREA TO BE EXAMINED pJ RIGHA B.S MEDICARE PLAN 650 WELFARE OTHER INS ___________ Carrer NO INSURANCE WORCMANS coc1w AUTO ACCiDENT pREGNANT YES NO POSSIBLY LAST MENSTRUAL PERIOD DATE TRAUMA YES NO Location CLiNiCAL QUESTION OF Lsupecte fracZure IIi1iP NO OF FILMS Tc ---- TECHNICIAN .- Chest PA Lateral Left Lateral Decubitus Since the last examination of September 15 1977 there has been slight decrease in the amount of leftsided pleural effusion On the lateral decubitus view the effusion layers along the lateral pleural gutter ----- /7 john Thorp npc MLDJCALWCOflD CAMC-Abeyta-002799 21 High Service Avenue North Povidenco Rhode Island 02904 401331-3000 RADiOLOGY CONSULTATION ORDER FORM REQUESTING PHYSICIAN //t4i-4_ yESRPREVIOUS X-RAYS THIS FAcfrLITY DATE OF REQUEST X-RAY NUMBER OF EXAM DATE 27 1-Z9-J WOSHASS CK WARWCK 40 3Th /y Da1c .__./ b./ AREA TO BE EXAMINED i9.//K. \-- RIGHALY B.C B.S.D MEDICARE PLAN 65 WELFARE OTHER INS Carrier NO INSURANCE WORKMANS COMP AUTO ACCIDENTO pREGNANT YES NO POSSIBLY LAST MENSTRUAL PERIOD DATE IRAUMA LtN1CAL YES NO Location QUESTION OFL of suspecjed fractu ___J__q___ PA Lateral Left Lateral DecubitUS Chest 1920Comparison is made with 1977 There has been costophreniC angle whith the previous examination of September slight re_accunhlflUlatiofl of effusion at the layers along the lateral pleural space on left the decubituS.VieWS. /Jhn Thorp N.D./ .npc MEDICAL RECORD I/lb CAMC-Abeyta-002800 210 High Service Avenue North Providence 401331-3000 Rhode Island 02904 RADOLOGV CONSULTATION ORDER FORM REaUESTINc PHYSICIAN PREVIOUS X-HAYS THIS FAc/VYER DATE OF REQUEST 2- X-RAY NUMI3ER /_2_f DATE OF EXAM 1/ MOSHASSUCK WARWICK NO.0 67 Dt AREA TO BE EXAMINED M-/2/71I- 1_ /4L7I// i RIGHAI B.C B.S.D MEDiCARE WELFARE OTHER INS PLAN 65 ________ NO INSURANCE Carrier WORKMANS COMP AUTO ACCiDENT REGNANT YES NO POSSIBLY LAST MENSTRUAL PERIOD RAUMA L1NICAL YES NO Location QUESTION OF of suspec ed fracture le /9 DATE est The chest examination was performed following thoracentesis according to clinical history The leftsided effusion has cleared by thoracenteSis with very tiny amount of fibrous organization in this region There is no pneutnOthorax orp //J npc MFDICAL F3ECOIID f/Jh CAMC-Abeyta-002801 __-_- L_ 530 North Man Street Provicienco RI 401331-3000 02904 RADIOLOGY CONSULTATION ORDR FORM _2 REQUESTING PHYSICIAN i/a f-To YESVRPREVIOUS X-RAYS ThIS FACILITY NO ___27O-JDATE OF REQUEST -777 OATEOFEXAM1 X-RAY NUMBER MOSHASSUCK WARWiCK 77 iJi1 Da1 AREA TO BE EXAMINED flLI4 AtilLA IEGNANT YES NO POSSIBLY RIGHA B.C.- E3.S.D MEDiCARE PLAN 650 WELFARE OTHER INS Carrier NO flURANCE WORKMANS COMP AUTOACCIDENTO LAST MENSTRUAL .PElOD DATE AUMA YES NO Location NICAL QUESTION OF //spected 1racuro /1 L._ Chest PA Lateral and Right Lateral Decubitus Views There has been slight decrease in the size of the left pleural effusion since the last examination 1977 Some of the ffsiniSlCulitedbUt on the lateral view of Septeniber does flow slightly superiorly psio1 Loculated but slightly decreased effusion at theleft coetophrenic angle John Thorp npc McDICAI flECORD CAMC-Abeyta-002802 ______ a. a..- s. 530 Not Ui Main Sli et Provdunce 401331-3000 RADIOLOGY CONSULTATION OFDER FORWZ 02904 cj 1_\ REQUESTING PHYSICIAN PREVIOUS X-RAYS THIS FACILITY YESO YR ________ NO DATE OF REQUEST DATE OF EXAM ______ X-RAY NUMSEfl ______ _i MOSHASSUCK WARWICK l7 -.r .1 /J/ Date 1C AREA TO SE EXAMINED Ii /1 c1JLI.J 14 FIIGHAD B.C MEDICARE WELFARE PLAN 65 OTHER INS.D ______ NO INSURANCE Cariler WORKVlANS COMP AUTO ACCIDENT PREGNANT JOYES POSSIBLY LAST MENSTRUAL PERIOD TRAUMA YES NO Location of suspected fracture CLINICAL QUESTION OF DATE -____________ T OF TECHNICIAN FILMS L/ lest PA Lateral Left Lateral Decubitus The previously noted effusion has decreased considerably in size on the decubitus view Some blunting of the costophrenic angle is still present alongwith organi zationand fibrosis of the residual effusion John Thorp m/ np M1ICAL RECORD CAMC-Abeyta-002803 _e 530 North Main Street Providence Ri 02904 401331-3000 RADOLOGV COSULTATlON ORDER FOUI1 -o pflEVIOUS X-RAYS THIS FACILITY Y1gYfl DATEOFREQUEST NOJJ/ DATEOFEXAM4417 X-RAY NUMSER 1MOSHASSUC1 WARV/ICK Date PflEGNANT AREA TO SE EXAMINED -S G/ -- c.-e YES NO POSSIBLY RIGHAD B.c.-B.S.D J7 MEDICARE PLAN 650 c- WELFARE OTHERLNS.D_ Carrier ___NO INSURANCE WORKMANS COMP AUTO ACCIDENT LAST MENSTRUAL PERIOD DATE TRAUMA YES NO Locationof suspcted fracture CLINICAL QUESTION OF 1- Chest Tdttdrhhhaeieaiecdcgurikeonbcegiohntruiasisasnnispggheinivpcgiaodoetfsdneitectvtuheiindeoesesninootlscietefhefset liToosabhfmmlaeosraanaeegsllbwaletlhTehshisocfeetthsoilarsdeiwpigesfpothdeuatldlrTasphlutebleenetougrcarcaabroil7selnctlshioeacionVsflfraetuaeSeascnCleiritoucmlnaewrwnTiatthahsselolirleefthhvferipidosuelmeecnunctlivoterneadairclioabuyls appears normal NlchC11i COICALflECOfl0 CAMC-Abeyta-002804 _i L___ 530 North Main Street Providence 401 331 -3000 02904 RADIOLOGY CONSULTATION ORDER FORM PREVIOUS X-RAYS THIS FACIUT JPDATE OF REQUEST _LL YESYR DATE OF EXAM NO LfL/7/ XRAYNUM5Efl OSHASSUCK WARWICK --s-- I__\/ PREGNANT AREA TO BE EXAMINED _- i1r14 YES NO POSSIBLY UGHAD s.c B.s MEDICARE PLAN 650 OTHER INS NO lNSUflACE Carrier WORIMANS COMP LAST MENSTRUAL PERIOD DATE tAUMA YES NO Location sypectOd fracture LlNlCAL QUESTION OF Chest There is involving There is is clear again noted evidence the left lower lobe evidence of elevation The heart is within of leftsided pleural effusion Changes appear to represent an inflammatory process of the left hentLdiaphraCI The right lung the limits of normal in size ressiOfl tliTaapghrreeeerveipgorrueiosssuupmncoahnbeelcsytolipnsflaiieclsmcatoisCnl dhaifripysrotaoctvoeryassilaanabmvlieuansfilltaawmboaullwmeldaaytsboeTrhybeehpefcriolnopcdnfeiusnsilgsds.r9da0tf the present course in thi Correlatio1With Nicholas a1nuccilli npc MDICAI RECOflI ..-.- ..- fi CAMC-Abeyta-002805 .1 ii L_. 530 North Main Street ProvidflCC 401331 3000 02904 RADIOLOGY CONSULTATION ORDER FOflM REQUESTING PHYSICIAN ______ PREVIOUS RAYS THIS FACILITY YESSrR DATE OF RCQUST ____________________ L1NO DATE OF EXAM RAY NUMSER MOSHASSUCK WARWICK 7J //J Dates //A/7// AREA TO SE EXAMINED i2 RIGHAD B.C B.S MEDICARE PLAN 650 \WELFARE OTHER INS Carrier NO INSURANCE WORKMANS COIP AUTO ACCIDENTO PREGNANT DYES NO POSSIBLY LAST MENSTRUAL PERIOD TRAUMA CUNICAL YES NO Location QUESTION OF ___ of suDpected II fracture DATE ____ Chest There has been decrease previous examination An lobe The right lung is in the amount of effusion on the left since infiltrate remains involving the left lower clear The mediastirium is midline The left the hemidiaphragm is elevated iV Nicholas uccilli npc JtCAL flECOfD CAMC-Abeyta-002806 _-__.J .h 530 North Main Street Providence Ri 02904 401331-3000 ADOLOGY CONSULTATION ORDER FORM REQUESTING PHYSICIAN -- PlEVlOUS X-RAYS THIS FACILITY YES YR DATE OF REQUEST ____________ NOD DATE OF EXAM ______ 7th f4- /%2L- X-RAY NUMBER MOSHASSUCK WARWICK AREA TO BE EXAMINED C/Li141 Date /%.j -U RIGHA B.C EL MEDICARE PLAN 650 WELFARE OTHER INS _________ NO INSURANCE Crr1er WOflKMNSCOMP AUTO ACCIDENT PREGNANT YES NO POSSIBLY LAST MENSTRUAL PERIOD DATE TRAUMA YES NO Location of suspected fracture CLINICAL QUEST1ON OF NOOF TECHNICIAN Chest TpThhleee urvraiigsl uhaet lfifzluuensdgionibsownycitlhestarcurhcatnugOrenessthseuapglpgeeeafsrttinngtohrecmrreranlsisolTidheeavitdomennecdeioafsotitfnhuemmleiosfdtemralotiedwleinrsiezleodbe There Is evidence of elevation of the left hemidiaphragm NIcholucci11 MC.OCAL RECORD i/i CAMC-Abeyta-002807 530 North Main Street Providence 02904 401331-3000 ODEFORRADIOLOGY CONSULTATION Ij EQUESTJNG PHYSICIAN IA 1/ ----------- YR-YPREVIOUS X-RAYS THIS FACILTY DATEOFREQUEST X-RAY NUQOER 77- 71 DATE OF EXAM kJvtOSt-IASSUcK WARWiCK NO iv 4.ci 3/ _____D_at_c __ AREA TO BE EXAMINED 1/ -4 EGNANT YES NO POSSIBLY RIG HA 8.C.- D.S.D MEDICAfE WELFARE PLAN 650 OTHER INS ________ NO INSURANCE Carrier WORKMAIS COU AUTO ACCIDENT LAST MENSTRUAL PERIOD DATE TAUMA YES NO Locatlo of UN1CAL QUESTION OF p9cted fracture Chest PA Left Lateral and Left Lateral Decubitus last examination 102577 Note is again made Comparison was made with of the leftsided pleural the ef fusion and density in theleft lowerlobe which is unchanged since the last examination MHIcAL fl1COFD CAMC-Abeyta-002808 530 North Main Street providence 401 331 -3000 02904 T1oYtRADIOLOGt CONSULTATION ORDER FORM PREVIOUS X-RAYS THIS FACILITY YR NO DATE OF REQUEST X-RAY NUMBER DATE OF EXAM ILL_E i7 LI1 MOSHASSUCK WARWICK 7ibj Is Da1e AREA TO BE EXAMINED RIGHA7t B.C.- B.S.D EDCARE PLAN 65 WELFARE OTHER INS CarrIer NO INSURANCE WORKMANS COMP AUTO ACCIDENT -- pREGNANT YES NO POSSIBLY LAST MENSTRUAL PER1OD TRAUMA YES NO LoCatiOflfUSPeCt0d fracture CUNICAL OUETION OF .- DATE Chest Tisnhtrisethaekstinuadgmyouawnloat ns goof -bthlteaeifntspeidldeeufdroalllopwsleuinurgfraaclebreoifnsfuchssoiotsicnllOPbYypreasptephnretorxeiamnhdaatessloYmbeee4ne0%ffusdieFocnirberaosstetiicll remains posteriorly Johop npc __ ..__ ..__ ._ ._ ._ ._ ._._ _. __._ .___ MtPICAL nECORD CAMC-Abeyta-002809 $CRENiNG ORJEflW U\ 250 500 1K 2K I- 4K IX I- Ii k4 .4 .--...- --------3- ________ 1/4 CAMC-Abeyta-002810 NOTE PLACE LABO DATE 1AY MONIN \i 1FS sL CCIJt - -- ci r._ -ci NJ CV MC //9 21 47 87 90 DFFRLNTA pti 5iA8 1Y.pPi-l /AC NC ..- 11 Cv L/ ii AIr .. CI -r -- L-1IlL IIT.11I_ riIt LC Ill TI -_ijt Ii 7iCi 1C f/h CAMC-Abeyta-002811 --- CAMC-Abeyta-002812 RHOL ISLAND GHOUP 210 Hiqh Service Avenue Providence P.1 401 331.3000 AOCA1 IOt ioi Post noi Warwick P.1 401 739.4900 1OLIED LW LI. Li iii Cm CAMC-Abeyta-002813 NOTE PLACE LABORATORY HEMATOLOGY REPORTS fl00 IN DATE oo r- i...iti uu HA in -v .1 I- PATE DAf 7/ dc w0C .4.810.8 RUC 106 Hh lfl Het VtL% MC MCH P149 MCHC 4.0-0.2 424 14-18 ___12-lb 4-.7 37.4/ 80-100 81100 21-31 37-36 Iv CI .1 ..-..--..-.... M\tt-I IhMA If 7I/7Ri .1I733 imfliHo ---fl .viI t- I-do .tI Li... hh .j1 34 -- II 71 I--- --T Q__1 -_t-_ Ji ...___.__.__ fCv II -- .Yfjfl -H MI 1r.. flMui .. J-i.i -- .. DAIL.Ojfi- .T -- .F 1M .L-4 --jS ---. h.v 114 -h -- CAMC-Abeyta-002814 iI \\1l.I GRtJI ui\iFH tU II/..lJT.tiR -CH YlTI IT II CH RESULT CH EMSTFW63 NORMAL TEST z- rn ox rnZ 65110mg% 10-20 mg% 05-ISrnq% 50-160 t174 SOIl flIl I.ll 744.444 fl04 6080440% -S w% IIJCOSF 141144 CRIA1ININFI C4101I.SIFROL 141101 yCI HIDE All111111 Al IIIIM III 11PI II 11111 IS II1IAI 444144 IN Al 434 14.1114 tO3 T3 01 0_us .t -o 01 0_ -on rlq% Dl OSmg% 1003444 101 fIll 1111111144 lIlIlICI 144 El In In El 20-450 AMYLAS 30-IfS Alk P1115 UP 10 40 SOUl UP 10 13 63 ACID 641011 l3S-l4Smi/t 3S-S0meg/L 98-IORInepL 20-28 ncg/L 35-45% 45-ll44ncq% 455-57 SODIUM POTASSIUM 34101601 02 TI 14 IT GLUCOSE TOLEHANCE OL000 URINE Lt .i 4344 POFILS 8PAII 42 fIll 44111 DATE //jf fill -- Ill j/LA NO TEC-I Ii CAMC-Abeyta-002815 rIflTL 01 AtC lAD rAT%I.% SEROLOGY MMUNOLOGV/2 PLACE TOP OF 4th REPORT HE PLACE TOP or Ii HF HE ... CAMC-Abeyta-002816 -- -- .Yr -.- iiRi Hospital bate Serology Lab APC-Bld fm 1140 phone 277.506i /- i_____________________ _____ bi Ii /cI1-3 USENOANTl.CAGULANTS 21238Febile Aggutirtation Series SalmonelIa _4/ Somatic Group _________________flagella _________________ GroupB ____________ ____________ GroupC _____________ _____________ Group _______________ ________________ Group _________________ eh __________________ Vi antigen 21972 Antibiotic Seru Level Predose Time indicate Antibiotic_____________ Post dose Time 21980 Serum lnhibcr Level Cidal Level Pie Dose ________________ Post dose _____________ 21881 MIC Level Organism vs Antibiotic 21956 Brucella Group AMS_______________ Organism 21261 Pasteurela Tutarensis 21956 Weji-felix Reaction ProtetS OX lE21873 CountercLent Bactera arts 1.Leve immurto electrophoresis ...f PeusOX-2_ Viral antgens Proteus OX-K ____________________ SUgest repeat in 7-14 days indicates significant or etevated titer Other Test Describe Date .i by f\ CAMC-Abeyta-002817 ___n_____ .-- --- .. .- .--- 5- -S -- I- CAMC-Abeyta-002818 -- IL CAMC-Abeyta-002819 BACTER1OLOGY/ BACTERIOLOGY ORGANISM CULTURE 0I Ii o-JJC -J.3 .U j.LLLCY ILl -L//LCL WIll IN 5111w -i 1.v4 nC-UJA COIUNY COUNT 611AM STAIN 11146115 CUI SINS HI SENSITIVITY ANTIIIIOIIC NlII III At_lIlt 11115 lIJI IN .11411111MII5 II FlAt 41 INI Iii Ico -I -D0 g.0 rq In DATE ITt T.AlII NI 11 1411141 II IIIAN II 1114 III 41115 lAl .1114 1/I III Ill III Ill 1.11115 II 1-11111111 11111 IINlttM1.Il lIlt 11111.4 YtCES IIVA Ill-i Vt 1IM 111.111 141111111 LAB NO TECN .1 14 CAMC-Abeyta-002820 RHODE ISLAND GROUP HEALTH AS NO 210 HiGH SERVICE AVENUE PROVIDENCE RHODE ISLAND 02 401 353-4700 RHODE ISLAND GROUP HEALTH ASSOCIATION 210 HIGH SERVICE AVENUE NO PROVIDENCE RI 02904 401353-4700 LUCOS DUN CREAIININE CMOLESFROI 1HIGLYCERI UF4IC ACID CALCIUM PiSPIl000tS TOTAL PROIEIN ALBuMIN AID lOT Bit 1RIJBIN DIRECT _________ B.t ID rng% cn 05 11 RESUL np50-lEO 25-80ng% 85.10S mi 2545 6080.jm iiiii2 I-I 01-OSmp TEST RESULT AUYLASE Al PIIOS 5011 5P1 ACID P1105 SODIUM POIASSILIM ChLORIDE 13 1.1 13S-l4mp/L 35-5 Oniijt Q8lfl6m.gL __71 711 45 I5ncc GLUCOSE TOLENANCI BLOOD URINE IASI hIP BLOOD h-Ill URINE I-Ill till RIOHA NO p4/ HI DATE -iS TCI4 .- --5.-- .-- --- -- ___ CAMC-Abeyta-002821 ...-- -- ._ ._ SECII.tl1 1_ iUiU O1IIE 1C__AI3D Ar.CS L1-4\ s1rlC ie1 Ct1flLUG .L NONE A1MFAR FOR AOD BAC FE 11 MANY PAl POSITIVE CULTUIE PUlRES MYCO \CTtRIA NOT FOUND ----ICO8ACI FOUND CA1 1i Ii WIEKS CONTAMINATED SPEcIMEN UNSTISFACTOR\ fOR CU1U \1KS FrOl CULTUPE cUuU InIrIW AS MYCOflA11 It LICULO OIliER .. CAMC-Abeyta-002822 -..- .1 . CI1v43m lI AAIi j-M o3 _y twq .ppv H1LflO L1fl 11 ON JWILdS Kk1 NWD3dS fAI Wfl1Tdd 3-tLO yvv- SNYtDIAHd WVN ONY snciov VJ tto3Yi-j V7Y ijSV OAIJ HrY SflOH $t4WildS 1Iw tJ AO1VOOV1 IVHLI/A PIOIID3flO gj Sflifl tON 1I V3W jtnno HU4M SMVtNO JAISd DNIQNJ IYflL1fl NOILVNWVXI cs3Usn 4.- Iflh1fl VI3iDVOAW ION QNflO VId31DVOAW ONflO sMs3IflOTh 8- OiVNIWYiNO N3WO3dS AO1YiSLtVSNfl fOI 3fflL1flD NOUYDIi1N31 S3Intm -c S3M woi 3flhifl C3fJIINXH WfltJ1DY9OAW SISO1flDfli 3I-1O toI IJ9Q iO O1YOV1 ..-. CAMC-Abeyta-002823 LL otvsioN LIOJ\ tO Alt itt Jf WJIIDING iROVlLCE 02903 Pletise Pnnt PInly With Soft Blcck Pencil or Pen PATIENT ADDRESS. Dateof Taking Specimen Vn/ Syphilis Seroogy Lab AGE./ .SEX /1. Specimen O1jmen .oo 1o iincouy Suspected Costs Treated Case Routine Physical Esom Pte.Muritaj treNatoj Remortis LABORATORY REPORT VDRI test perfoimtsd routinely on oil specimens Kolmer ABS on request only IPI.by speciol orrangement on oil reactives or upon request FTA Unsotisfoctory flrokrn Tube Hemolyi Other Dote Reported Dote Received Chief of LoLorotorios Any Physician who treats coce number to the State Deportment direct 23..fl. General laws of of Venereal of Health R.l Diseoe shall moire in such monner and reporf of such case by seporotn form as soid Deportment shall 2.09 174 CAMC-Abeyta-002824 Cc/._- _-p/1 77 ACE IiS_ tV -- -- LE- L- WI .u.r ..- _t _. .-.a -e ___________ t.r _________ I______ ---_..__ ---r ___ _______ I-i --.----- _____ -- ------ -- __- I_______ _.L --- _______C_-I __ .L -. -- -I -.-- -- __ _______ CAMC-Abeyta-002825 --v- // pAQGpE-.---....- ..- OT___ _AXS .- .- -- -- .r-- .- .6.._ ._- ... -... ..-- _4__ .----- -- -_._ _________ TTT -.-- ______________ _______________ __f __ r1i _._...__..__..___L__ i__ ---- __. ------r----- I----4-----------.--------------- .-.- ______ .__--____.I ____ LIi.i i. I.4 4_- mr- LI__-- .L_.__...I i.r../IL l--1 hi--T-t iziIIi__ __ __- __ .t-- --- ----- -------H__-jL----- ------ -- .- ._1__ CAMC-Abeyta-002826 PATIENTS IOENT$F$CATON -- ._/_ I--- INTPLTD icc 0A _______ -WAD .it /1 CAMC-Abeyta-002827