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URL 22024 c ISLAM. I'CSi'ITAH PASSAIC, r-V\i .IV.l'SV.Y * Pi::-RT STAY RECOUP Room Lo: ' h.-u.w : t A. tli-tui re i t.a I t:<: H.P'iA Doctor: DU. u;; Date of Adi t: 6 -O-SA Rate of THnc'n: (>-(>-EY THIS FORM TO BI USED FOR OUT PATIENT SURGERY AND 0:;f. DAY STAY CASES (Deaths excluded) FINAL DIAGNOSIS: ANGIOSARCOMA OF THE LIVER. HISTORY: 65 year old male with the above mentioned diagnosis is readmitted for chemotherapy. Ever since he was diagnosed in March 1984, he has been treated with Adrianiycin which was escalated slowly as his total bilirubin was decreasing gradually. He feels less anorectic and less weakness but over the last three weeks duration, he noted increasing size of tha abdomen. PHYSICAL: The patient is well developed hut chronically ill appearing emaciated male not in acute distress, fully alert. Skin, dry and dehdrnted and he had papillary eruptions in the right forearm as described before. No change in size or numbers. The largest one 2.5 x 2.5 cm. HEEMT, Sclcrac not icteric. Conjunctivas pale. Funduscopic examination did not disclose papill&dcma or hemorrhage. Tongue papillated and no mucositis in the oral cavity. I'cck supple, no palpable lymph nodes. Heart, RSR normal. Normal SI S2. Ko murmurs or gallops. Lungs are clear to F and A. Abdomen, markedly distended. Thu abdominal circumference around the umbilicus 119 ecu Because of this ascites, I cannot appreciate tha size of the liver vrell but it is 7 cm. below the right costal margin. Extremities, no peripheral edema, no bony tenderness. Hcuro, all within normal limits. w:w;kk;;k and :;h?-;maky Obtained Ct'C all accept ah 1 u level lor con l I non i <i> > clu-n.ot L< ropy mid n*> r. i gn l f i can!; inroirval. rbnngo:: for KfX and 1 increased the Adri.'u.iy<:ln up to 75 mp.. pur meter uquarc. For hi:; artheitiu, I gave him Aldner.onc. I obtained CT scan of the abdomen and showed rumors iu the liver showing v.uch decrease in the size but he developed ascitcis which was not present 5u the past and als;o had some collection of fluid in the right pleural, space virh mild degree of atelectasis in the right loiter lobe of Che lung. The patient will he followed as an outpatient. U1E-1 b i.. UiuT >unPT STAY...SHORT STAY ... SHOUT STAY. .SHOUT STAY. .SHOUT STAY...SHOUT // 1^1 ,YAewv;i.e. . J -4n<ia ...".....7..\*.Z...... P*R5TNAM . r~ J.W6 RHONE brtrj^r - .... . SOCULSC._* 7T71J.: -v 6^f ^<L'Ki^rS` _______ ^Cjs5c-si. B>TH6ATC71/:;*U.':':_y''4.' 7-^r*SEX~" TT'ACc Cjb* y^i r;TTAfCs.r'.:. rel EMERGENCY CONTACT / --o^'V*'e- W\^vY\vca- GL'ASAAT '**" o LAST NAME VO ^ ' OOC'Cn s NAME V-A-V\. W\ IV.2 A^TNE 5-^ w VAP - r . \ j DvSsGnc RELAT70MSHIO TO PATIENT' 'vTf' co;G= RELATIONS*!** TCT.PATTENr*, TTtT ACpRESS EMPLOYER OP GUARANTOR AC -- PCSC INSURANCE COMPANIES'~ V .. _ . .. r- aw 1 jfOu'AVpAT^:Aco|r^j7PE7p|-A`*' ' tf/srSB*?N>AraTfT5w?f vyQsos.r jt; 77; 'O'-ICY fJUY.iC. .....- . . SRCurNQ....... i.;EUgSCRSR'Xr:-^r^2 iv'OL`2 OP .k*'RIVAL' '';.'`>7",;**77^ pptjce``T^^towk^- . DyesD; \ 3Z03- r;:~c:rj:'.'-TmrsasnsssEssaa ALLcRGica. .4. .T VoiA'JAClONa. L=5 CL&RX r~ c c CONDITION ON ARRIVAL EMERGENT OuRGEST G NOM-iis*G5' jLE'/tLS O'- iNSc.Uuw''iP.S3 (CalE^ G:TO*.1a*OSS G SEMJ-CCMArQSS OoRIENTATlON NURSING ASSESSMENT ------- ^ -- Y'Ttts&fi'st-/C&kr.-'&//<*# f/t/c-ST' ./>7 : `---T .; ----- r--- A--* ~ --- `4; .-T-.''*- ' ' ` ,'-r-------.'r.7:'': . r. ---- --------....................................... . - .......... ..............--;* .* " - VITAL SIGNS"' *jZ' . -1^ __ _-_^i - - -------- R ` '."^7 f [, :"7" ' """" ' '"*' ^-vVilS'^TC'V r.:. PHYSICAL EXAM * TREATMENTS - LAST ,.. \ TETANUS 8P .. 0OCT0K`S-O0RS k 'A 1 Time - - rs !' ' TC fs- Nj ri_on c kamienLi funeral homes, in MAIN OFFICE: 106 LOCUST AVENUE WALLINCTOM, M. J. 07057 PAUL- J. KAM1ENSK1. P ft 51PSNt-hanaGEH Phone (201) 779-1967-b 207 RAY STREET GARFIELD. N. J. 07026 2 ESSEX STREET PASSAIC. N. J. 07053 SI 9 - 2 tar AVENUE PATERSON, N. J. 07313 File No. . . 'F.Z... ' . " Name of Deceased JF. ..... Address F.Vr. Dale of Death ........................... ZVM Dale . ZW.Z.S.Iti. {!?.?. f. ...................................... ..............J- . f.AAP.'f/A. J. A/: CASH DISBURSEMENTS Cemetery Plot ........... .. 2 V- - ............................ ....................\. Grave Opening /Jf? {{>'.......................... . ..... V ' i Crematory............................ ..................................................................................................................................... ' Church Offering............... 7.-.... f?f?............ fit:.................................5................ Organist ............. ................................................................................................................................................. .. Clergy Honorarium............................ ............................................................................................................ Pallbearers............... ..., .6C. @ $ J?.*?. *............. ............................................................................ V*** Newspaper Notices (Estimated) ... Transcripts and Burial Permit .... ... f.^A. .Y. /?'!?.'*?...................................... &\Q.......... .................. .......................................................... !.?............. .../ Gratuities (Day of Funeral}......................................... ............................................................. h*. .................... Telephone, Telegrams .......................... ...................................................................................... .. Tolls....................................................................................................................................................... .. Out of Town Shipping Charges....................................................................................................................... .. : Out of Town Funeral Director Charges.................. ................................................................................................. Catering (Estimated)........................................................................................................... ..................................... Refreshments and Hall (Estimated)....................................................................................................................... TOTAL CASH DISBURSEMENTS....................$. % cp The foregoing statement has been read by (to) me and I hereby acknowledge receipt of a copy of same and agree to pay the above funeral account'cash disbursements on of before ............................3 AteJf.... A?.................................... 190.^. The liability hereby assumed is in addition to the liability imposed by law upon the estate and others, and shall not constitute a release tnhereorf. . T2-*. By . ............. Ordered By KAMIENSKI FUNERAL HOMES, INC. L.S. U.U.../JL L.S. . f/AAAA.AAA)&ress cimienski O' unera. onies; iae locust avenuV e WALUNGTON. H. J. 07087 PAUL J, KAMfENSKl. PRESIDENT.MANAGER PHONE (201) 779.1967-S 207 RAY STREET GARFIELD. N. J. 07026 Z ESSEX STREET PASSAIC. N. J. 07033 nc. 818 1UT AVENUE PATERSON. N. J. 07813 Pnt-H July 3, 1984 TO Mrs, Lottie Memice_____________________________________ _ ___________ 54 Rutgers PI., Passaic, N.J. 07055. For Professional Services As Arranged And Merchandise As Selected For the Funeral Of: Joseph Memice PROFESSIONAL SERVICES___________ ___________ USE OF FUNERAL HOME FACILITIES--,_______ TRANSPORTATION Removal Frnm Beth Israel Hospital Hearse---- Limousine____L_____@ $8.CL.0.Q Flower Car 1--@ ?7CLQ0 Clergy Car_____ ____________________________________ Other_______________________________ -------------------- MERCHANDISE Casket as SpUnt-M . Schuvlkillhaven, Oxford Outer Rprpptflrfe__ . Cenien.t .Vault____ __ _ Clothing_________________ _________________________ $______________ 85a. 00. 525.00 65.00 90.00 sslsxl 70.00 50.00 Total 3~. 1.050.00 435.00 355.00 *c3r oA) Register, Memorial and Acknowledgement Cards and Religious Artifacts_____ ________________ Inc. Total $__________l,4g5AQ.Q. NET 30 days. Legal Rate of Interest__ __________Charged Thereafter. tOTAL 3,219.40 URL 22028 East Ridgelawn Cemetery i. (V V . J.' N? 40544 EAST RIDGELAWN CEMETERY 255 MAIN AVENUE CLIFTON, NEW JERSEY 07014 To__________ Kamienski Funeral Hnma______________ Date. Garfield, N.J 7-3-34 136 50 Nn. Nn OrnvM Pnw Nn. T ,nf Nn Sq. Ft. Rlnrk Nn. Vanlf k x Crews rvprK'eg'-ilar Nom/- Joseoh Merrn nn ArMn. 54 Rutgers Place Passaic, N.J. Mnmnlrnm Service Charon Blanker Charge* Foundation Charges Other Charges Crypr Total Amount One Amount PaidBalance Duc_ Reccivcd by__ ' r*1111 t L . -V_ f. - I.. .V. A-.f.i;X f. 380 00 1748 50 .Amount. c( 0 Hiellinii PLEASE DETACH AMO RETURN THIS 5TUQ WITH TOUR REMITTANCE. OATE URL 22030 A SILLINC CHARGE OF SI .00 WILL OE AOOEO TO ACCOUNTS NOT PAlO IN 30 OATS.