EXHIBIT(S) - T (Motion #2) Montefiore Medical Center chart (1 through 413 of 6973 pages) Redacted per 22 NYCRR - Montefiore Medical Center chart (1 through 413 of 6973 pages) Redacted December 22, 2022 (2024)

 
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 > INDEX NO. 56387/2020NYSCEF DOC. NO. 196 RECEIVED NYSCEF: 12/22/2022EXHIBIT “T”INDEX NO. 56387/2020NPager cbed73 NO. 196 TORRES, Angel luis -RECEIVED NYSCEF: 12/22/2022Mame, TORRES -onus Name, ;accta7 MsMontefioreFORGOING LIFE-SUSTAINING TREATMENT INCLUDING DNROS Pe Ta aMARiPTAs Le eR Ls SLAM Gd Se RCM Cs Res otADDRESSOGRAPHYI, Order to Forgo Life-Sustaining Treatment including DNRThis is an order for the following: (Check appropriate):‘opsent to a Do-Not-Resuscitate Orderonsen to a Do-Not-intubate OrderMeonsent to heteneerTIL Determination of IncapacityVe -gustgining treatment(s}:A. To be completed by the Attending Physician| have determined to a reasonable degree of medical certainty that this patient lacks capacity to make this decision to forgo life-sustaining treatment.The patient tacks capacity due to: halobdls EvtapdeleyNote:“If the patient lacks decision making capacity because of mental illness (excluding dementia) one of the physiciansdetermining capacity must be board certified or eligible in psychiatry or neurology.* If the patient lacks decision making capacity because of mental retardation or developmental disability, special rules apply tothe determination. Contact Office of Legal Affairs.The duration of incapacity is expected tobe: Temporary 1 Prolonged PremarenEch Rend we | rol22| ICPrint Name/CREDENTIALS ‘Sidwardne/CAEDENTIALS Dare/TiMeB, To be completed ty the Concurring Attending Physician| have independently determined to a reasonable dforgo life-sustaining treatment.medical certainty that jhig patient lacks capacity to make,this decision toThe patient lacks capacity due to:city is expected tobe: L) Temporary _[ Prolonged Bee anento> yA _ Maley1T AME/CREDENTIALS ‘Sianaj NTIALS. Date/Time.MMC-ONRO2 (08111) Page tof 3TORRES, Angel luis - ES - Vic -INDEX NO. 56387/2020RECEIVED NYSCEF: 12/22/2022NYSOBP 56873 NO. 196MONTEFIORE . | .FORGOING LIFE-SUSTANING TREATMENT INCLUDING DNR FORM 2 ~ADULT PATIENT WITHOUT CAPACITY, WITH AHEALTH CARE PROXY _: acctName; TORRES, ANGEL LU.C. Notification (Must choose one} on 7 SecM Ty:T| « “ 150ct15 MOSES K7 K735-A. O The patient has been informed that he or she has been determined to lack capacity and Adm:SONY, DEEPTHI s. MEM| that his/her Health Care Agent is authorized to make health care decisions for hinvher; Att:SONY, DESPTHI Ss. cAOR ULPatient has NOT been informed of the above, because there is no indication that the patient can comprehend the information.TIL. Identity the patient's Health Care Agent .Health Care Proxy document is in (Check one) (Chart erefectronic medical recordName of Health Care Agent MANas ms Toresy(PRINT CLEARLY)TV, Decision by Health Care Agent to Forge Life-Sustaining Treatment. The health care agent may give oral OR writtenconsent,A. Written DecisionTo be completed by the Health Care Agent:"1. The doctors have told me about the patient's illness and chances of getting better, and explained to me the risks and benefitsof treatment and other options. | had a chance te ask questions and have them answered to my satisfaction.2. 1am deciding based on the patient's wishes, inclusing his/her religious and moral beliefs. if | don’t know and can't tind out thepatient's wishes, | wil! decide based on the patient's best interests. Those interests include the dignity and uniqueness of thePatient; the possibility of saving the patient's life or health; and the relief of the patient's suffering.3. I consent to the following treatment decisions \@ Name of Health\Care Agent (PRINT CLEARLY) yf Health Care AgentAD “Decision por ‘escrito 1Debe ser completad por 6 agente de atenctén médica:1. Los médicos me. han informado acerca de, fa énfermedad dal paciente y sus probabilidades de recuperacién, y me"‘explicaron los riesgos y benéficios del tratamiento y las demas opciones. He tenido la oportunidad de formular Preguntas_:que fueron respondidas satistactoriarnante.-2. Estoy tomands esta decision sobre ia base de'los deseos det paciente, incluidas sus creencias religiosas y morales. Si noconozco cudles,son jos deseos del paciente y'no puedo averiguarlos, tomaré la decision sobre la base de lo que considero“que,es mejor para el paciente. Esto incluye su dignidad y su cualidad de ser Unico; la posibilidad ue salvar su vida o.suSalud; y el alivio.de su sufrimiento.3, Doy consentimiento alas siguientes decisiones de tratamientos:Nombre del agente de atencién médica: - .Fima del agente de atencién médica Fecha/hora»: (ESCRIBA CLARAMENTE EN’LETRA DE IMPRENTA) : .B. Oral DecisionIf the health care agent expresses his or her decision orally, the Attending Physician shall document the consent below:To be completed by the Atteriding Physician:The health care agent expressed the decision described above orally to me.PRINT NAME/CREDENTIALS SIGNATURE/CREDENTIALS Dare/TIMEInterpreter (if required)@ Name of interpreter (PRINT CLEARLY) Signature of Interpreter Date/TimeInterpreter number (if telephone interpreter) or addressMac-DNRO2 (04/11)Page 203TORRES, Angel luis - [: cc -INDEX NO. 56387/2020RECEIVED NYSCEF: 12/22/2022‘MONTEFIOREFORGOING LIFE-SUSTAINING TREATMENT INCLUDING DNR FORM 2—ADULT PATIENT WITHOUT CAPACITY, WITH A shamesHEALTH CARE PROXYMs acctANGEL Limicy gene Ty:T“A1s0ctl5 MOSES K7 738Adm:SONY, DEEPTHI S$. uti PTHI S.C: Witness Signature to the Decision of the Health Care Agent (oral or written), Att: SONY, DEE{ have witnessed the written or oral decision of the patient's health case agent to withhold or r withdraw life-sustaining treatment. | am18 years of age or older and an ote of Montefiore Medical~ laskn SA <Name of Witness (PRINT ClAddress of Witness:PhilsDate/TimeV.. Attending Physician Signature| made all the determinations ht ascribed to the Attending PhyExelyn A kncl nelPrint Name (Credentials)The Atlending Physician must:‘* Place this form into the patient's medical record.* Enter an order into the patient's record.* Document in the medical record the discussion with the health care agent about the patient's diagnosis and prognosis, the rangeof available treatment options and/or resuscitation measures, the reasonably foreseeable risks and benefits of life-sustainingtreatment and/or cardiopulmonary resuscitation and the consequences of forgoing life-sustaining treatment and/or a ONR Order.i s altsjnature (Credentials)@ VL. House Officer StatementAhouse officer may enter a TEMPORARY order for DNR and/or DNI only. This section is to be completed by the treating House Officerwhen the Attending Physician is not on site and after discussion with the patient's Attending Physician. The House Officer may, afterdiscussion with the Attending Physician and the patient's health care agent, obtain the health care agent's consent for a DNR and/orDNI order. The Officer should complete the applicable consent sections above as well as the statement below.‘The Attending Physician must compléte the entire form as son as s/he has examined the patient and enter appropriate standingorders. This must be completed within 24 hours of the House Officer Statement.To ba completed by the House Officer:I have discussed the following order(s): ONR O0n weetfor Prne\ Lis Toes : (Patient's Name)with the ATTENDING PHYSICIAN Sy : Eglin Rseting \ (Name of Attending Physician)dhe has authorized me to enter a TEMPORARY order. The Atte; ter standing orders. ,acoso CZ at (ofri furs 6:00DATETIMEArnon 1E/CREDENTIALS ‘SIGNAFURE/CREDENTIALS* After completing the procedures for orders to forgo life-sustaining treafment, including DNR, applicable DNR and/or ONI orders mustbe ENTERED IN THE ELECTRONIC MEDICAL RECORD.© Inpatient orders to forgo life-sustaining treatment, including DNA, must be reviewed and renewed every 7 days. The review of theorder will be documented in the medical record by the attending physician.as the order in ELECTRONIC MEDICAL RECORD. This documentation form must remain in the medical record after the Attending _Physician draws an “X” across the whole first page, writes “REVOKED” across the first page and signs and dates the notation. Therevocation and reasons must be documented in the medical record and other members of the team must be notified.e » If an order to forgo life-sustaining treatment, including DNR, is REVOKED, the Attending ‘Physician must cancel this order, as wellMMC-DNRO? (08/11) . PogeSotaTORRES, Angel luis - J vc -INDEX NO. 56387/2020RECEIVED NYSCEF: 12/22/2022NY¥SGER dd6e73 NO. 196JNMSUMMARY SHEETMED REC #: MONTEFIORE MEDICAL CENTERACCT NO: MMC MOSES DIVISIONINPATIENTMT)|ADM DT & TIME: 10/17/2015 2:05am ADM STATUS: Emergency DIS DT &UNIT: K7 RM #: K735-A REAM: Y ADV DIR:PATIENT NAME: TORRES, Angel luis SSN #:C/O: THROGS NECK EXTENDED CARE CC AGE:ADDR: 707 THROGS NECK EXPRESSWAY MOTHER'S MAIDEN NAME:CITY: BRONX ST: NY ZIP: 10465 BIRTH PLACE:PHONE BUS: HOME: (718)430-0003 PCP: CLARK, ELIZABETHCell Phone: (347)256-6306x1E PCP PHONE: (866)633-8255RHIO CONSENT:Ask Patient for cons PREF LANG: EnglishSPOUSE NAME & EMPLOYER NEXT OF KIN EMERGENCYTORRES, ELIZABETH TORRES, Elizabeth. TORRES. Et izabeth1071 ELDER AVENUE 1071 ELDER AVENUEBRONX NY 10472 W BRONX NY 10472 W(718)378-2721 (718)378-2721SERVICE: MHM ADM SOURCE: EMERGENCY DEPARTMENT PREVIOUS HOSPITAL ADMISSIONATTEND MD: RONDINEL, EVELYN M. G/P/S: H DATE FROM: TO:ADMIT MD: MAZING. MARIA Y. HOSP NAME:ADMI! DIAG: SUBDURAL HEMATOMA ADDR:PATIENT OCCUPATION: PRIM INSUR: -EMPLOYER: RETIRED SEC INSUR: -ADDR TER INSUR: 999999 -ZIPDISCHARGE DISPOSITION:REGULAR AMA TRANSFERRED WHERE?EXPIRED SZ AUTOPSY? YES _ NO ye ME CASE?” YES 1GADTFACE Printed On; 10/24/2015 9:35amTORRES, Angel luis - - vic -INDEX NO. 56387/2020RECEIVED NYSCEF: 12/22/2022N¥SGEFODRG3 NO. 196 TORRES, Angel luis -DAIE FILED THE CITY OF NEW YORK - DEPARTMENT OF HEALTH AND MENTAL HYGIENECERTIFICATE OF DEATH =—Ceniicutu Noow NDECEDENTS LUIS A TORRESwey iat ie"ei aro oe Tne Tretang Te vo ian naase eB Rano Ta a sy ay ea5 ‘icone Satna ran nee| 2 cree Do Ovi #0 Drv Het aBs Gaowom ins ‘one ty ie, | mone ht Coa Ly oe cn| Se ie ie Ta oa |e [Eag BE October 24 2015 08:41 J Male to | ba | 2dtsSp ameca | BET ceatar teeay town censtto athe now amar ace Rain ard WD oon ny enone WaDRGI ry & SSionr@ TO NOT Bay ay Ema WORD.q Bj orrecbtdmenenrcutinnmnonsanno win Ct linge3 128 ane oro Evelyit M Rondinel MC. ou Edy i. AS eondoiel 0.ghar) [Be ee Pe Tiana Bacay Aan teatad? BT pains TILE 210th Street, Bronx, New York 10487 ae 00d av OCT-24:jac] eee Tone on reve TA ean TeasNew York Bronx Bronx 1071 Elder Avenue TE 19672 __|intven'sssne |5 © Deed TER ap Oman |S Aga BT re Ua — [STIS HetLe a. {ete om Le ea3 gage ee ee [oom a | eR —Za | A Bubetiiferdent worker Superintendent {Luis Angel Torres8 VW Gitnplace (Gir b Staiee Frege Coury) Thaw cr IN om tg ses fp ven et ho carpi Fo oh a wun. |z 3 Puerto Rico Foie lien gine ergona 3Jxucowamenre mtr aabaewuaiee Aaa "a ee. 2Hitgrsenad yan G0 UBarvereaugrn wg A M6 US NuWHSOiAluegeN 9g. mi BOE UNM KLE J,4 Se Tee ebs |i Malem ne Sake armas TF Easing Sonar Fate y Rave i we nae oer ist RamaANF es LNT4 3," Rewcrotes? {90 Matas 3 comme meng) 1D.a [ES ive eitne [FaShursaunment Sonerwne _ tegeoms |ekzaboth Pacitaa eet vnarevnrwtncmmar to Sa Was TG HRT OR ST3) gy Cristino Teres Casilda Lucianoq va ey owas Name 250 Relawonieup w Ducwonn | 06. Acdroas Sirevi and Hume Ap Ne Civ a Siar TP Coani 8 Elizabeth Torres Spouse 1071 Etder Avenue # 1E, Bronx, New York 3104728 ig water Dann FB Vacwel Bini aren or PRSa Mines Peierbon Fam «ACH Conegl Bis sere sinon St. Raymond's Cemeteryi SF Gaecaieaain ert Sava tome Com a Brea a aeEa “| Dsouneona Bronx, New York 10 26 20162 [Er Rien Caine IR Rane a aoe Se Tseow Porta Coeli $an German Funeral Home 1822 Westchestor Avenue, Bronx, New York 10472TORRES. ANGEL LUISFAC MMC MOSES DIVISTCNitalien K735-A008: iVIS:40/17/2015 2:05aL aTHE CITY OF NEW YORK — DEPARTMENT OF HEALIN AND MENTAL HYGIENECONFIDENTIAL MEDICAL REPORTwirvoitor ones [Ty bo tmedan by FONERAL DIRECTOR o- won 01 Cry nal by Purnoun c*ntticats NaTr Wcewer Goet oe besne‘[58 Haw ab ovina ay ha US Coie ech ore erean ‘oat wil Sc secngar gow ees nag renee Ea!‘i rapane naanesn Pawns (a1 we 22 etacs er can teareas Sven Berenir 61] 23 4 Ameren butanNaska sie‘Marve aterlnd o we 0)cape vatvine Some Best Bn oe aamininasn 85" CeSMEAR | ot ununcinan ange [SecoCae ee ee aeamame tunecome ae141 OMe! Pee ie arden Sonely LUIS _A_ TORREStose, 132 Dre Soeaty — | DECEDENT'S LEGAL NAME (tyea0 Pant)aca cat oe | | ea CoE TRmagma ibdural Homatoma eeeDEO GAS REISER OF[Brain Herniation days‘BOE TO On 15 AGNSECIENEE™ oe[DOF TS on AS WCONLOOENEE OF‘CTE SOR GANT CORTON CONT WT NE TO DEATH tral aaaig nite amnyrg cane pre HP Pei on aR‘Stroke,Coronary Ariery Disease, Hypertension, Atral FibrillationHe iisige [8 Baas parma Tre we pin rheaceegetltee Zo [14 bigeye sy damon [Jesuit sont ancwBe enon ange | ape TI aagwe nae saan [eo neeSHOR. [PSST EAS Scene |S SaCiNce sane _[o sidearm yy aan armen nein 4Bins Saveur Senn? ee rgnara a TH wd kms wTsquevena vinnie | ttle Tima wuni ME Gino sooness 113 210in Street, Bronx. New York 10487 ucenseno 238912SIGNEIUNE, Che vedTORRES, Angel luis SID: W AINDEX NO. 56387/2020WYSEEFoARAEs NO. 196YA15 Rev.) Caution te Physicians: Read Tais Entire Section Botore Signing‘Section S57) cl the Now York Ciy Chanér and Seclion 17-201 ol tho New Yorx Cy Agminisiraitve Gods pranee that tha death ul any person fram criminalwiolenco, by a casualty, by suicide, suddenty wher im apparect Neallh when unariended by » physician, i. Conectional facity oF in any Sussicious 21 unus\alrenner shal B@ teportad fortuvth to tne Ofice oF Chie! Medicei Examiner [OCME]. Only the Madicat Exarinar may iesue a death cerilicare’in sucit cases. InWis contans “unattended by 3 prysician” shal mean not vealed by a physician within trny-ane days immediately wececing deat. Furtrar, als injry af any Ser,‘hysicalo: chemical, causes or corintutes te dealh. 0 manner how hiar ine eorirbution the atalty msl be reparied to tee COME.Sections 208,09(a(2) and 205 05(a} of tho New York Cy Heath Code proviee that il a death rom natura! causes accure eisawhere thas in @naspia, ine deth‘rust be reported by the tconsed physician in aiendance of by his duly authorized medical associate, poWlded such aasociate reviews the merlca ecords of thedecedent and catfies nat he has found fc evidence of suspioaus of unusual cireumstances, When a dealh oecuts in @ Nossital, tha folojpng sha! sign theoath cemfizate: prysician in attendance er easatog, ete! medal ofleax of howpta, cs the gocior in charge 0! sevice where death occurredWany of these terms are Included in the events leading to death, contact he OCME al (212) 447-2080 before compieling fite certificate |ACCIDENT ‘CHOKE FIRE INGESTION POISORINGADVERSE REACTION CONTUSION FRACTURE nuuRY STINGASPHYXIA ‘CRUSHED Gunshot INTOXICATION SUFFOCATIONASPIRATION cut HEAT STROKE INTRAVENCUS ORUG SUICIOI,AT WORK ‘GROWNING HEMATOMA USE THERAPEUTICASSAULT ELECTROCUTION HEMORRNAGE LACERATION COMPLICATIONae EXPLOSION HOMICIDE MISADVENTURE TOxeNyBLUNT (PACT EXPOSURE HYPERTHERMIA NEGLECT TRAUNAUARS. Fat HYPOTHERMIA O¥EADOSE WOUNENotice to Physictans and Funeral Directors> The death certicate ig the paomanent ‘gga! record of tne fact of dealh of an individual and can be used Ia coun as evidence in, matters arising aut ot atdeat. Accutale medical inlarmalion is important, Dealh cenicete vata ace usec by the pubic newilh commusty lor ¢esearch chat evaluates and morovesite haa of all ciizens. tis crucial that she Intermalion suppl by Ine physician, Neath eare professional, hnesa! alrector, end instnuro be completo andaccurate.> Paper centicates must be compiated In black tine point nk, Aleraione, loids ot omissions are unaceuplable,> AKA (A’so Known As) is any oiner rieme used by decedent, fit is substantially diferent from ne decedent's legal name, AKA doss not rcwde nicknames,speting variations o! the lus! ot middle ngeres, presence of absence ot the midcie iis! of arosence cr absence of BuNCILation ms'ks cr yoaces. For#kampla, Matk Twain's tne AKA ol Same Clemens, but John Doe is nat tha AKA of Jonathan Doe,> This eevthcate must be accompanien by Ine Contizential Medical Rapo’. No parm for te disposel ct Ing body ean be granted tunilthe Contlienval MedicalRepart is filed. Dwulging the information contamed in the Contidenta) Medical Report, or delvery of that Report 1o anyone ether than, 3 licensed funeralrector, oF an oficial of the Otte of Vas! Flecords of the Deparment of Health ard Menial Hygiene designated to receive such ser oris, may resum inprosecution under the provisions of the Health Cada,Funerai Director's Certiticationwi is the| cerlly that tne undersignag has been employed {0 dispose of the remains byct te decedent and is the next of kin oF lagal representative. This statement mado to obiain. a disposition permRaina)Name ol estaplishrment adressier we, Gm, iat, ai ZiP CodedSignatureRoagistered Funeral (vectors NameFunesal Pwactor’s NY State Regisiraten No.NY Stale Business Registation No.Gi rceRTIFY THAT I HAVE IN MY POSSESSION AN AFFIDAVIT OF AUTHORIZATION FOR CREMATIONFOR OFFICIAL USE ONLY.‘Trials of Pane ote0 cenrwicate REJECTED ‘ME REFERRAL BY: ISSUANCE HISTORYav: — | Dvown C1 sunerat onecvon DATE No, COPIES’ intTiaLsTe: ME CASE - -pare: M8, NAME — -AEASONGS): CREMATION APPROVAL IE. + a -''Puwsician WusTRUCTIONS FOR COMPLETING THF CAUSE-OF-DEATH SEcTiON> Complete and accursie medical information is impatam, Daath ceriiicate data ace used by He pubic Iwallh community in evaluat and Improving the‘eallh of al eiizens,» The cause of dealh section on New York City’s death cenilcale is eanfidentia! to encourage full and accurate reporing. Cause of death it not avaitable tofamily members,The CAUSE-OF-2E4TH Sortion cansisis at tao parts.Pant Lis fer raporting a enaln of evass lading diegery 10 deain, working back tigre the mediate cause ot death (Ine final disease oF caunpication directlyCausing death) ta me underiiag cause of death [the disease tnat Inilated the cain of mortid everis that lc directly Io death}, Tre saaerlying cauce of- Seath must be eticlogicaly speciticamr tis tor ceporing all afer signiicant diseases or conditions that c*ntsibuled to death but did nat resul in the uncelving cause of death fs given in PaRT> THE CAUSE-OF-DEATH romano SOKO BF YOUR BEST MEDICAL OPWON, .> Jcompleting the CAUSE-OF-OEATH Section:Aaport cach Disease, ABWORUALr, or CoNOrTiDN that YOU Baliove adversely aflacied the cecerenl, A conduion cari be ksted af "Deen delinitively diagnosedfobabye ever ilit has wotExauces OF Propency Compreren CAUSES OF DEATH Exaweces oF iupnorenty COMPLETED CAUSES OF NEATHa congestave heart feiture 2 Daye a eestiB uung metastases © Monens by Decubseus wicers© Breart canear 3 yeare ©. paraplessaFanti Atherosclerotic hurt tisease, enterocoliris WHONG-Parapiegia ic nal wilogicaly spect: requires wysanyng ciseOperavaniniormason. eluding Procetwo Lxptes scery Luparoserssnd Major Fodings Gangzanous bewe) . 3 septicemiaWACNS -nsuticaca lormanon;requinre Hnierying caust (=)2. beczeraal proumonse 1 Howehb Heningsers 3 vente a. Mecapcotie cancer to© Acquired tmynaceiiciency syndrome 2 Years WRONG Primary sta nol stuteeIRpiagrar vutin one you of deals owtcorne ol Prognaucy Live Bistn,ana dae 03-15-2003@ Mosenter:e thrombosis 1 WeekPont wColectouy for cancer of eignoida. Cardiac arrest ranedinteb. actric nenorznage 7 naysPant e'Gagerie uieer2 Brenchopnenmensa 7 weaks> Congestive seare fertwe ater© mitral stenosis 2 veareyeetive meart feitureJc ness! dugease© cancer of breassWRONG-Ineonsistanl soquence .2 PrenscurityWRONG lesulhevent sarmalon; requires underying cAusy()a, cardiopatrenacy arrertb_mypecensienWACNG-Hygaten sions not mpoingteally specie, esauires uaceriyg exss6TORRES, Angel luis SS - VcRECEIVED NYSCEF: 12/22/2022TORRES, ANGEL LUIS.Fic DIVISION7 K735-AWWINDEX NO. 56387/2020RECEIVED NYSCEF: 12/22/2022NPSGer dd6g7.3 NO. 196 TORRES, Angel luis -“DISsUMM ontefor Name: TORRES, ANGEL LUISTHE UNIVERSITY HOSPITAL FOR men:ALBERT EINSTEIN COLLEGE OF MEDICINE DOB: EXP_MAcct#/Fac/Room: v1dCreated by ANTHONY PACIONE PA, PA at 240ct2015 10:13 AMStatus: Signed by ANTHONY PACIONE PA, PA at 240ct2015 10:23 AM...Discharge Summary oo...Signed by: ANTHONY PACIONE PA, PA240ct2015 10:23 AMDates OF ospia Taton cesmmnsnnsntnntnntnnentenanvenentansansninivansiinisnisnnneneeeseAdmit Date: 170ct2015Discharge Date: 240ct2015 (EXPIRED)Piesenthg H Story _The patient is’a 77'Y old Male ‘with a history of Cerebral vascular accident ©; Coronary artery disease ; Hypertension ; Hyperlipidemia ; Non ST elevationacute myocardial infarc ; Severe mitral regurgitation ; Abdominal aorticaneurysm, ruptured AAA repair ; Abdominal abscess ; Fistula ; Cabg ;Nephrostomy, urinoma with indwelling foley s/p prosthetic MV ring; afib oncoumadin, ASA and Plavix who developed AMS x 2 days pta_ at the NH, wasconfused on Thursday, unresponsive on Friday, was seen in weiler ER, SDH withmidline shift and subfalcine herniation was dx by CT, pt was transferred toMoses for NS consultation, received plt, PRBC, K centra, IV Vit K. Wasintubated for airway protection and seen by NS who felt that his prognosis isgrim and would not change with surgery. Pt's daughter Milagros was initiallyinterested in DNR/DNI and palliative care, but then decided on full codestatus and continuation of aggressive care. Now requested repeat CT head tohelp with decision making on Goc.Pt is vented, comatose, unable to contribute to hx.per family pt fell 2 weeks ago at the NH, but was caught by the PT and did notit his head. No c/o HA.ress ; appears acutelyill and pale; is thin.Eye Exam: L pupil4 mm, R 2 mm, + corneal reflexOral Exam: mmm, intubatedRespiratory Exam: vented, was overbreathing the vent this am, but not anymore, lungs clearCardiac Exam: The heart rate is normal. The rhythm is normal. $1 is normal. S2 is normal.Gastrointestinal Exam: The abdomen is not distended. softExtremities Exam: There is no peripheral edema.Neurological Exam: There is inability to follow commands. does not respond to painful stimuli, +Prnted by ANTHONY PAC DNE PA,PA 240 ct2015 1023 AM 1/5TORRES, Angel luis - - vic -INDEX NO. 56387/2020RECEIVED NYSCEF: 12/22/2022NY¥SGEB dd6e73 NO. 196DISSUMM ontefor Name: TORRES, ANGEL LUISTHE UNIVERSITY HOSPITAL FOR vRN:ALBERT EINSTEIN COLLEGE OF MEDICINE Dos: EXP_MAcct#/Fac/Room: ‘ttCreated by ANTHONY PACIONE PA, PA at 240ct2015 10:13 AMStatus: Signed by ANTHONY PACIONE PA, PA at 240ct2015 10:23 AMupgoing bilat, not overbreathing the vent nowPerthentLabs and D jagnosttrsRoutine Lab ResultsResults (recorded as of 24Oct2015 10:15 AM for past 10 days)Chemistry Panels-Name Result Date/Time RemarksSODIUM 146 MEQ/L 210ct15 09:11POTASSIUM 3.3 MEQ/L 210ct15 09:11CHLORIDE 114 MEQ/L 210ct15 09:11co2 17 MEQ/L 210ct15 09:11GLUCOSE 102 MG/DL 210ct15 09:11UREA NITROGEN. 000 25MG/DL oo UOC 08 nunsCREATININE 1.30 MG/DL 210ct15 09:11CALCIUM 8.6 MG/DL 210ct15 09:11PHOSPHORUS 2.6 MG/DL 200ct15 09:45ALBUMIN 3.4 G/DL 150ct15 10:58TOTAL PROTEIN 6.7 G/DL 150ct15 10:58BILIRUBIN TOTAL 0.6 MG/DL 150ct15 10:58BILIRUBIN DIRECT 0.2 MG/DL. 150ct15 10:58ALKALINE PHOS 67 U/L 150ct15 10:58SGOT 12 U/L 150ct15 10:58SEPT eee AW coe enennen BOGS 1058CBC/Diff-Name Result Date/Time RemarksRBC 2.60 MIL/UL 210ct15 08:51HEMOGLOBIN 7.5 G/DL 210ct15 08:51HEMATOCRIT 23.6 % 210ct15 08:51MCV 90,8 FL 210ct15 08:51MCH 28.8 PG 210ct15 08:51Prnted by ANTHONY PAC DNE PA,PA 240 ct2015 1023 AM 2/5TORRES, Angel luis - - vic -INDEX NO. 56387/2020RECEIVED NYSCEF: 12/22/2022NY¥SGEB dd6e73 NO. 196DISSUMM ontefor Name: TORRES, ANGEL LUISTHE UNIVERSITY HOSPITAL FOR vRN:ALBERT EINSTEIN COLLEGE OF MEDICINE Dos: EXP_MAcct#/Fac/Room: ‘ttCreated by ANTHONY PACIONE PA, PA at 240ct2015 10:13 AMStatus: Signed by ANTHONY PACIONE PA, PA at 240ct2015 10:23 AM_Discharge Summary |.Name Result Date/Time RemarksMCHC 31.8 G/DL 210ct15 08:51MPV 9.2 FL 210ct15 08:51RDW 16.1 % 210ct15 08:51PLATELET-COUNT 240 K/UL 210ct15 08:51NRBC (ABS) 0.00 _K/UL 210ct15 08:51NRBC (%) 0.0 /100 WBC 210ct15 08:51WBC 12.1 K/UL 210ct15 08:51GRAN % 79% 210ct15 08:51GRAN COUNT. 9.6 K/UL 210ct15 08:51LYMPH % 9% 210ct15 08:51LYMPH COUNT LOK/UL 210ct15 08:51MONO % 5% 210ct15 08:51MONO COUNT 0.6 K/UL 210ct15 08:51EOS % 6% 210ct15 08:51FOS COUNT i OBL nnn PEOSEES.OBISD a cssnnnnssunnnnnnennieeBASO % 9% 210ct15 08:51BASO COUNT 0.04 K/UL 210ct15 08:51*CBC SEE NOTE 180ct15 09:52Urinalysis-Name Result Date/Time RemarksCOLOR, URINE **SEE TEXT. 17Oct15 06:36APPEARANCE, URINE TURBID 170ct15 06:36SPECIFIC GRAVITY 1.021 170ct15 06:36pH, URINE 5.5 PH 170ct15 06:36PROTEIN, URINE 100 MG/DL (170ct15 06:36GLUCOSE, URINE Negative 170ct15 06:36KETONE (ACETONE) 15 MG/DL 170ct15 06:36BILIRUBIN Negative 17Oct15 06:36OCCULT BLOOD LARGE 170ct15 06:36UROBILINOGEN: 1.0 EU/DL 170ct15 06:36NITRITE Negative 170ct15 06:36Prnted by ANTHONY PAC DNE PA,PA 240 ct2015 1023 AMTORRES, Angel luis - - vic -INDEX NO. 56387/2020RECEIVED NYSCEF: 12/22/2022NY¥SGEFOBOGI7NO. 196DISSUMM ontefor Name: TORRES, ANGEL LUISTHE UNIVERSITY HOSPITAL FOR vRN:ALBERT EINSTEIN COLLEGE OF MEDICINE Dos: EXP_MAcct#/Fac/Room: ‘ttCreated by ANTHONY PACIONE PA, PA at 240ct2015 10:13 AMStatus: Signed by ANTHONY PACIONE PA, PA at 240ct2015 10:23 AM_Discharge Summary |.Name Result Date/Time RemarksLEUCOCYTE LARGE 170ct15 06:36WBC, URINE >100 -170ct15 06:39RBC, URINE 4-10 17Oct15 06:45SQ EPITH. CELLS MANY 170ct15 06:39BACTERIA MANY 170ct15 06:39HYALINE CAST 236 /LPF 170ct15 06:39GRANULAR CAST 0-2 150ct15 14:18FINELY GRAN CASTS 2-5 170ct15 06:45Other Common Tests-Name Result Date/Time RemarksMAGNESIUM. 1.9 MG/DL 200ct15 09:45Chemistry, General-/Antibiotic Levels-Name Result Date/Time RemarksVANCOMYCIN RANDOM 19.6 UG/ML 210ct15 09:11Microbiology, General-/Bacteriology-Name Result Date/Time RemarksBLOOD CULTURE Partl 200ct15 09:47 NGRESPIRATORY CULTUR Final 190ct15 12:28 MRSAURINE CULTURE Final 150ct15 12:24 >100,000 CFU/mL 3or more organismspresent without apredominatingorganismName Result Date/Time RemarksPROTHROMBIN TIME 9.9 SECONDS 170ct15 09:29APTT. 23.1 SECONDS 170ct15 09:29INR: 1.0 RATIO 170ct15 09:29pubwed by ANTHO NY PACDNB PAPA b4ocBO18 BOSE ns wsTORRES, Angel luis - - vic -INDEX NO. 56387/2020RECEIVED NYSCEF: 12/22/2022NY¥SGEF1BOEI7NO. 196DISSUMM ontefor Name: TORRES, ANGEL LUISTHE UNIVERSITY HOSPITAL FOR vRN:ALBERT EINSTEIN COLLEGE OF MEDICINE Dos: EXP_MAcct#/Fac/Room: ‘ttCreated by ANTHONY PACIONE PA, PA at 240ct2015 10:13 AMStatus: Signed by ANTHONY PACIONE PA, PA at 240ct2015 10:23 AM...Discharge Summary oo...H ospialc ourseHospital Course77M transfered from Weiler with SDH w/brain herniation. CTH had worsened significantly on 10/17compared to 10/15, pt no longer withdrew to painful stimuli. Deemed to not be a surg candidate due tofutility per NS. Palliative care met with family. Decided on DNR/DNI, comfort care in light of the above.Compasionate extubation done 10/23/15 at 12:30PM. On 10/24/15 at 8:41 AM, Mr. Torres expired.D AgnosesPrincipal Diagnosis (presenting condition)SDH w/brain herniationSecondary DiagnosesCVACADHTNAfibD Bcharge PIO at oc snsuteumnsennstnnneeinteiineisinseienteasiresesiesesThe following Core Measures questions are related to performance measures on patients treatedfor Heart Failure or Myocardial Infarction during this admission. Please help us document yourexcellent care of these patients.Core MeasuresThis patient is not eligible for the following performance measures related to heart failure andmyocardial infarction because they expired.Condition on dischargeExpiredPrnted by ANTHONY PAC DNE PA,PA 240 ct2015 1023 AM 5/5TORRES, Angel luis - - vic -AN IMPORTANT MESSAGE FROM MEDICARE ABOUT YOUR, IGTMONTEFIOREN¥, DEEPTHI Seeatt: S0STEPS TO APPEAL YOUR DISCHARGE* STEP 1: You must contact the QIO no later than your pianned discharge date and before you leave thehospital. If you do this, you will not have to pay for the services you receive during the appeal (except forcharges like copays and deductibles).© Here is the contact information for the QIO:LIVANTA:1-866-815-5440 TTY:1-866-868-2289o You can file a request for an appeal any day of the week. Once you speak to someone or leavea message, your appeal has begun.o Ask the hospital if you need help contacting the QIO.0 The name of this hospital is Montefiore Medical Center_Provider ID# 330059 .* STEP 2: You will receive a detailed notice from the hospital or your Medicare Advantage or otherMedicare managed care plan (if you belong to one) that explains the reasons they thin’ ‘nu are ready tobe discharged.* STEP 3: The QIO will ask for your opinion. You or your representative need to be available to speak withthe QIO, if requested. You or your representative may give the QIO a written statement, but you are notrequired to do so.* STEP 4: The QIO will review your medical records and other important information about your case.* STEPS: The QIO will notify you of its decision within 1 day after it receives all necessary information.olf the QIO finds that you are not ready to be discharged, Medicare will continue to cover yourhospital services.o If the QIO finds you are ready to be discharged, Medicare will continue to cover your services untilnoon of the day after the QIO notifies you of its decision.IF YOU MISS THE DEADLINE TO APPEAL, YOU HAVE OTHER APPEAL RIGHTS:* You can still ask the QIO or your plan (if you belong to one) for a review of your case.o If you have Original Medicare: Call the QIO listed above.0 If you belong to a Medicare Advantage Plan or other Medicare managed care plan Call your plan.* — {f you stay in the hospital, the hospital may charge you for any services you receive after your planneddischarge date.For more information, call 1-800-MEDICARE (1-800-633-4227), or TTY: 1-877-486-2048.Additional Information:‘According to the Paperwork eduction Act of 1995. no persons are required to respond to a coltection of information unless it displays a valid OMB control number. Thevalid OMB control number for this information collaction is 0938-0692. Tha time required to complete this information collection is estimated to average 15 minutes perresponse, including the time to review instructions, search exisling data resources, gather the data needed, and complete and review tha information collection. Il you have‘comments conceming the accuracy of the time estimates) or suggestions for improving this form, please write to: CMS, 7500 Security Boulavard, Attn; PRA ReportsClaarance Officer, Mail Stop C4-26-05, Ballimore, Maryland 21244-1850.NR7961ME (08/14) Sido 2 of 2TORRES, Angel luis - - vic -INDEX NO. 56387/2020NgBSE Fs boGa7NO . 196THN reDEPARTMENT OF HEALTH & HUMAN SERVICESCenters for Medicare & Medicald ServicesOMB Approval No, 0938-0692Patient inlormation LaboAN IMPORTANT MESSAGE FROM MEDICAREABOUT YOUR RIGHTSAS A HOSPITAL INPATIENT, YOU HAVE THE RIGHT TO:* Receive Medicare covered services. This includes medically necessary hospital services and services youmay need after you are discharged, if ordered by your doctor. You have a right to know about theseservices, who will pay for them, and where you can get them.* Be involved in any decisions about your hospital stay, and know who will pay for it.+ Report any concerns you have about the quality of care you receive to the Quality ImprovementOrganization(QIO) listed here LIVANTA:1-866-815-5440 TTY:1-866-868-2289YOUR MEDICARE DISCHARGE RIGHTSPlanning For Your Discharge: During your hospital stay, the hospital staff will be working with you toprepare for your safe discharge and arrange for services you may need after you leave the hospital. Whenyou no longer need inpatient hospital care, your doctor or the hospital staff will inform you of your planneddischarge date.If you think you are being discharged too soon:* You can talk to the hospital staff, your doctor and your managed care plan (if you belong to one) aboutyour concems.* You also have the right to an appeal, that is, a review of your case by a Quality ImprovementOrganization (QIO). The QIO is an outside reviewer hired by Medicare to look at your case to decidewhether you are ready to leave the hospital.© If you want to appeal, you must contact the QIO no later than your planned dischargedate and before you leave the hospital.© If you do this, you will not have to pay for the services you receive during the appeal (exceptfor charges like copays and deductibles).* If you do not appeal, but decide to stay in the hospital past your planned discharge date, you mayhave to pay for any services you receive after that date.* Step by step instructions for calling the QIO and filing an appeal are on page 2.To speak with someone at the hospital about this notice, call (914) 377-4420 Utilization ManagementDepartment.Please sign and date here to show you received this notice and understand your rights.feta of Patient or OSC (admission) DateSignature of Patient or Representative (within 2 days of discharge) DateNAZO6IME (08/14) CMS-R-199(0112) Side 1 of 2TORRES, Angel luis - - vic -INDEX NO. 56387/2020022INDEX NO. 56387/2020RECEIVED NYSCEF: 12/22/2022D: W HNYPSGEF4BDOEI7NO. 196 TORRES, Angel luis -“ye eet YN ad\on vey Eww Ly S DEPARTMENT OF HEALTH & HUMAN SERVICES~ Centers for Medicare & Medicaid ServicesOMB Approval No. 0938-0692TORRES. ANGEL LUISww PCA Pump — © Spina - OnoRate Voune FIO, Moan Posse res Support OnvV1) alal IZ) (A) Lalo} oe'1714) Mela laeie) A La \x OnandarPl AIr“Tima of Gonach LNG PhysiRMA Transoot Consul Onsceno OLMG Terminale Tse"ED Chen NumberBeen Edens ge~ MD Signatre o 9° ° O°cau} SS,Alninens 8) Saws Rig AmUsed Am Used «Ama? Ar Nasied Wile aslo /Wnaes Sepetne/ The OLMC Prion 50x Jere meg na 09 X [ oOGan? CS Ninneedsy Sumine fea AmiUunt AM Unni AMIWored | ATLWGRed PVE © was] Wiles Sinatra Tue OLN Prpiean 30i 1 ra LT |ve 8 3 oOaTho be?77celal, ar on A vent FT. fa °hients teers. el war we ten Loted pePeeteO olobh Cov ty _f= = 7Px ee DV ete te ans aa autres]CONCTONT CAT Tas Bay Ems Caw FA] 5 praccermoa Roven | BE Ca easano —] Rene© To Scene O To Paton O_ To Dustinition JO Request forMad. Re O NA O Felted] ALS Coorsinatoresc or pemmctscre| Sie So fos | |CI Ovo OweTransgot_Q Supine© shea FO SeriFowiesDnwoition-™O Transport He Unit Q) laritnal UnieVehie by: “O stecicher © Longboard _ Position: © Lefvight Lateral Recumbent © Seoted O no wonspat —_O_oinesFG WENBE 7 CO eMT PATENT Recenn AGENT cenjuanataentatnnn ane ere snusSIGNATURE: } L “@ emr-p| SIGNATURE: / RE:™~ other 1+ 7. f siete eteptec meee eeXY AE Xx (tf EEEPRINT NAME: ue 7 PRINT NAME: pias ——TORRES, Angel luis A - vcNYSCEF DOC. NO. 196CREW SAFETY EQUIPMENTCONDITIONS CAUSING DELAYINDEX NO.RECEIVED NYSCEF:RESCUE AIRWAY1 Bye Protection 01. Traffic 1. Combitube2. Helmet 02. Weather 2, King ut3, Personal Flotation Device 03. Scene Unsafe 3. Other4. Protective Clothing 04, Crowd 4, Unsuccessful5. Protective Gear 08. Extrication6. CARN 06. Elevator Mode Settings7, Safety Vest 07. Building Accoss 1. Control8. NOS Mask 08. Door Barrier 2. Assist Control09, Awaiting Escort 3 SIV.10. Difficult Location 4 ceapIv site 11. Distance to pt. 5, Bi-PAP1. Right External Jugular 12. Vehicle Mechanical 6. OtherRight Hand 13. Pt not Ready3. Right Forearm 14, Paper Work not Ready4, Right Arm 15, Security Check5. Right Leg 16. Awaiting Transport Unit6. Left External Jugular 10 Site Exposurearte Hen 1. Right Proximal Tibia Uneedie. Lett Forear 2, Left Proximal Tibia 2. Splashsorte 3. Right Medial Malleolus 3. Airborne9 4. Left Medial Malleolus 4. Other5. Sternal (Maryland Only)Zins; 13uO3s vuNWEL WAL [[eko aioss vwnvar wior1 | Saunapves nau nwnadd ° == SaunIDvus G3s01D awisTas : ieze SNON Suniog= SRLVELaNBROTeW. z —#9| mwas vwo>ts tesBONIW'] — saNNON N3AO =Zs NON. ¥ sietC BuvuadwaDaa/VNOD ° aNONi poveronn.so sno T Gruner= + maar Gp-g5 | 3UNSSI¥S GOOTEc Grwwos NYHA ssa z Sryuit S608 SNOLSASS31} aunssaud coo7e € Saou 68-94Le Shui 96-05[as [| __Huie 96-08 | SMOLSASer Byuni0s NYHA WaLVIUD. ’ Syuw 69 NYHA WalvaNDtC SIBVNIVINIVIWNA) @ 3NON= mavaninie awansny 7 Tnee TwuH0) sivete (Gai Be) 8 Oz NYHI S531 z NIE? | Awouvmiasae1 Geil wv-2z) 64 OO ais £ NWSE WHEL WaLv3uDze | Gai v9) OW OZ NYE waLvauD r NUAVEz-O1S10) TONY“ S3HUNSfuone>ipawvoneqnautsuossesduso> souuoneinuen 4sew GesU26kkouonejnuins ajnDeL ‘uonansCuluonisog ‘Cuiwieny ‘GuIKRE kere,ye]:BUODS MODSV1D TIOL‘BNONNOISNILX3 TWABONEYNoIxaia TWARONSY,Nive OL SAAWEGHLIMHONOL OL SMVYOHLIANLN3W3AOW SNO3NVINOES TWAEON3NONNivd O1 SNVOWNivd O4 $3183‘Sans Savisuaava ‘SoOD,3NONNiva OLHoaads OLSNO3NVINOdSaSNOdsayHOLOWTefnfsicfeses|eled-asNods3uaWwaUan‘ONINadOBARsantwn | 3WLAWBAME] WILS383A713040# | yoavams | viNiDw | Auaninaa 60;NOLID3S SLN3WWOD NM IN3WINDOA ‘S31HIATIIA GO THY Houiasaoeavuns| YEoats ow oI | STEN] word winsrouts] Magawomrmanguona | Nguer | asuoasauen] AimavinnySines Sunes 5 hor2009 "SNe anos a3sareTana Tos)Deux -wwenon | wana wae | wouetcela|eo wano | oot monae Tuva suaapIudERLE MEFEL Pe eet lityOn - SE "1 10cu56387/202012/22/2022£269 30 2) eBeqINDEX NO. 56387/2020NPSGE Fs. BOk7aNO. 196LEASE ARSEEEFax: (718) 209-138)For Ambulance Transporation‘all (718) 251-9888RECEIVED NYSCEF: 12/22/2022094 aA416) Or ft a Soe es] bhp) Or i/E ed ls 4 CALL7 (NICS. Us uses © To desinaton © TeamCrow #1 LGA Crew #3 "|| ar 7‘ alel / ‘Qvae Oremes\O Jove ons: i ensCH E J aA WEa =aChiron CQ) sceme Osu @ orp © ovcine | |" matorectans Set Pay © HMOICeRmeRit Wor ReteeEe aTORRES, ANGEL ISShonenSee te4 Ta Rea© Frontacing _O| LC Seng vet _© oven ous _O Peer Due _O._ Fenengw SueTREASOW FOR AMSULANCE TRANSPORT —fay I tt spOREIMaieaia 5 1 pasels,‘Q Recent knee surgery/replacement RL© Generalized weakness caused by: __Q ParalysisiParesis affecting RI side dve tr,© Recenthipfx/surgery RL© Lower extremity elevation due tBilateral AKA “© One AKA and One BRAS rain located atue to:Contractures: © lower © upper enemies© raplgi © Comatose © Quel© Overal weakmess due to!peice eeePree rer)PeesDecubitus Ulcers (Bed sores)‘ Pt unable to self administer 02 O Heel (© Buttocks© suctioning, eke Q Sacrum Back© Other: S| © towerexvemityO Other:O MRSA © VRE © 16Gor O MeningitisO otherEni© Danger toself, © Danger toothers© Flight risk © Chemically Restrained© Physically RestrainedcoonfTreatment not available at sending hospitalQ Psych © Cardiac Specify,Trauma © Rehab© Surgical roca,© Amputation© batovors Diorder QDehyeratondizzinessPRESENTING PROBLEMSO cs. Q Environmental Cold Q Wattle Treuma_Q Poisoning Q Spinal injury © Vomiting 'Q Abdominal Pain Q Cardiac Arest © fiw. HazardousMaterakO Nasal flaring © PossDisiocation © STEMIQ Airway Obstruction © GediaRelated Potentiah © Environmental Heat — © Nausea OPossFracture — OStridorO alleegicReaction © Chest Pain O ETOH fPotentia) opGyK =O Rash O SubstanceQ Atered Menta status O Cough Q Fever ‘Q Obvious Death Respiratory arrest Abuse (Potential)Q BledingMerortage CO Diabetes Ponta)SeenGesvo-nteina Distress © OverdoseGeucalvesmaose Q PanParalysis© Penetting runs © Soft Tsui© Respiratory Distress Q SyncopeO seizure O TIAICVA possible}© Unconscious!ONLY TO BE COMPLETED BY MEDICAL FACILITY REQUIRED BY 42 CFR 91040 (0) FOR ALL NOW EMERGENCY TRANSPORTSIn my profesional opinion, tis patent requites vansont by Ambuance This Patient's medial contin necestatesENTFICUTION STATEMENT fesse sce ete eee a ee me cae(O This patient is currently bed. ie due to Medicare/CMs regulations.The patient is bed-confined secondary te:‘The definition of Bed-Continement is: The inability 10 get up from bed without assistance, ambulate, and sit in a chair, including a wheelchair.Can not be transported safely in a wheelchair van due to:‘© Unable to hold self in we due toPCS © attached © faxedPatient Requires Medical Monitoring:CContractures of the: © Upper RILQ Severe pain due to© Unatie to sit uration of transport due to ~QFirwayisuctioning —_Q=vant dependent© Overall wasting, tao weak to st up due to @ Seine prcations VineParalysis: © hemi O semi D quadriplegic © Unable to self administer necessary O:Fracture of the: © hip Orneck D spine © kee O leg © Other - ‘OrAltered level of consciousness© Lower RIL Extremity’) © Fight Risk © Neads Restraints© ‘solation Precautions© Abnormally stiff and rigid due to —Decubitus ulcers of the: © Sacrum© Lower Extremities © otter© Other: Describe type of monitoring & why:© Buttocks —O Cougyx 0 Hipsone fen{SShoeinieos olLoAG OLsugars core bd onmecca neces for Aro ance transportation The ecu ofthis document doesnot esse tat any ayes hal eae fr Series mane atinYGcull of is patient understand hs thin loan contained Neh be wed bye Deparment of et nd Hanan SeesaPrnane 1 TE MOPaCie One7 AN 7 DBCHPLANNER SgnatcieINDEX NO.RECEIVED NYSCEF:56387/202012/22/2022D: W HNY¥SGEFOBOGI7ZNO. 196FLOW CHART REFERENCE GUIDE:TREATENT 26 025 74 Promethazine HCI aK VENTRICULAR05 T2tead EKG 27-050 49, Proparacaine 45 50 42 FVC Couples08 3 Lead EKG 93 DSWSolution 15 Propofol 50 Topicaly 43 Run OF VTachAED 86 Decadron 16 Prostaglandin 444, Torsade de PointesAED Preval ALS 28 Diazepam 17 Racepineprine use# 41 Ventricular Bigeminy31 AED Preval BLS 29 itiazem 50 RingersLacate Solition 72. Autoinjet 40. Ventricular Tachycarcia28 AED Pre-Ariva Citizen 30 Diphenhydramine 18 Romazkon 65 KVO34 AED PreAvrival 78 Dobuiamine-Dobutiex St Sodium Bicarbonate 71 Over 1029 minutes Blocks,30 AED Pre-trival First Responder 31. Dopamine 83 Sodium ChorieScksion 0948) 70. Over 5-15 minutes 50 Second Degree Mobit2 Type 133 AED Pre-rival PO 96 Enalapril 87 Sodium Thiosufate 73 perheur 51 Second Degree Mobitz Type 218 Capnography 76 EpiPen 61 Succnyichovine 67 permin, 52 3rd Degree Complete) Block13 Pap 32 Epinepivine 110.000 62 Terbutaline 66 PRN $53 Sinus dhythrn vs tt degree block2 OPRGew 33 Epinephrine 1:1000 88 Tetracine Topical 60g minutz25 CPRPre-Astval ALS 13 Esmolot 52 Thiamine 63 q 1Orvnctes PACEMAKERS25 CPRMe-Artival LS 69 Etomidate 19 Foradol 61 25min nes 63. Avial Pacemaker23: CPRPre-AsrivalCizen 87 Fact Vilorik 83 Trail 62 qSminutes 60 Paced Rhythen with capture26 CPR P¢e-Autval FD 66 Fentanyl! 33 Vasopressin 68 Fapidpuh 61 Paced Rhythm, fake to capture24 CPRPre-Acrival First Responder 34 Furosemide A Vecureniams 68 Slow pus 62 Pacemaker Rhythm27 CPRPe-ArTval PO 14 Gentamycin 82 Verapamil 64 Wide open 64 Ventricular Pacemaker12 Gricotiyrotomy 35 Glucagon MEASURE 65. AV Sequential Pacemaker01 Defibriation 36 Glucose Paste yeas ‘CARDIAC REIVTIOM #20 ETsuction 68 Haldol 2S ARREST ARTIFACT09 ET 98 Heparin 12 cane 03. Agonal Mioventricular 70 Astifact70 77 tern 12 gin 0 Aspiot 1 oer6 20 tpratiopium Bromide 19 SS (04 Icioventricular 72. UTO (Reason in comments)15 MagiForcess 82 Label 7 ge 6 PAM Ta Montertaiee11 Neale Decompression 84 Levaltutero! 2 joaes 05 Pulseless VTach14 NGTube 81 Levophed 20 ou 02 VFib 724EAD EVALUATION35 00 Delvery 237 Udowaine img £0 Normal clei ST Segment08 Pacing 38 Lorazepam sae sinus 1 ST Segment Elevation06 Quide Look Pads 39 Mag, Sulfate oe 10 NSA 82 ST Segment Depression08 Rescue Airway 75 Manitol 12 make 14 Sinus Ares19 Secondary ET verication 41 Mataproterenol— TO 11 Sinus Br adycarcia conpmon40 Suction 40 Methyprednisione 7 MRS. 19 Sinus yarciawith degre bck 00 No ChangeSynchronized Cardioversion 72 Metoprolol OF iails 13 Sis Oy rythmia 01 mprovedPostive Impact42. Midazolam 27 mal 53 Simscty hmu/ ttdegreeblock 02. Worsened/Negative impact,MED # 43 Morphine ae 18 SinusRhyGunwith mutifocl PVCS 03 Successul20 2AM 4a Narcan Te 15 Sinus thm wth PACS 04 Unsuccessul6) Activated Charcoal 89 Nipride See dunt 16 SinusRiahen wits21 Adenosine 55, Niro Paste 26 Tho 17. Sinus Rhythen with unifocal PVCS22 Alputero! ro Spray 12. Siws Techyearia5a Amiodarone 46 Witso Tab WIS0grain Route57 Antibiotic 85 Nious Oxide 43 ETT ATRIAL23 Atropine 47 Nownal Saline aim 20 Atrial ibrilation58 Benzocaine 80 Ondansetron St inva Nasal 21 Atrial Flutter78 Benzocaine-topical 99 Other 210 2BA Bretyium 90 Bumex 48 Osytecin 41 bos81 Calcium Chloride 65 Phenobarbital 40 IV dip JUNCTIONAL85. Captopril 7B Phenylephine 48 Nebulizer 431 Accele ‘ated Junetional Ahythmn12 Cefuroxime 97 Potassium 52. Ophthalcelly 30 Junctcnal Rhythm24 Chewable Aspiin 6 Pralidovime CL 45 PO 32 tunctionaiTachycarcia25 D190 75. Procainamide 49 Rectal53. VPUMPTORRES. ANGEL LUISTORRES, Angel luis - - vic -NWSGEf0 BOB73NO. 196MONTEFIORE Moses Emergency Department Patient: TORRES, Angel luis111 East 210th Street Triage Date: October 15, 2015Bronx, NY 10467 DOS: ay Sex: Male718.920.5734 Med Rec#: IN Age: 7 yrWU OT account: aPre-Hospital Care Initial VSIV. Site: time:MEDS: TT 7ST > O47}rT: T< 965 [JOxygen @Backboard: €Coltar: BP: SBP_< 90 [}Dressing/Spiints: _R RR > 22 {JFall Screen Needed (ves LINoSpecial ConsiderationsBarriers to Learning: P p> sf) |[1 Communications: {] Language {] Hearing [] SpeechProtocols | U) Interpreter [ ] Deat Talk Pulse’ ox Pox < 93 ()I] CEU |] Abuse/Neglect/Exploitation Screen: [] Neg fon [1 02[] RAI } Stroke [| Social Services to be Notified: |] Yes Mo1 Communicable Diseage Screen, [] Pos {Nee Peak Flow:[] Isolation {] Yes A/No Type:[] Suicidat [] Homicidal [ ) CO tnitiated Time: Best P.F.:Have you ever tried to end your life before? [] ¥ N [] SEPSISDo you feel Les now? []Y A N LtChieti Complaint (7 ER pet ff WiaAta >Assessment:RN Signature: Endorsed To:Past Med/Surg é } Va heacct —_ vat YTORRES. Angel luis.RELIG:CA DOB: (MBM REG. 10¢15/2015 1:25PM - teCARE OF: THROGS NECK EXTENDED CARE APT:AQDR:707 THROGS NECK EXPY BRONXNY 10465 TEL: (718)430-0003 SEX:M AGE:77 MS:MEC: TORRES, Elizabeth REL W }ADDR:1071 ELDER AVENUE BRONX rstNY 10472 TEL:SPOUSE: TORRES, ELIZABETHNOK: TORRES, Elizebeth . Allergies:FLAG: NONEPCP: CLARK, ELIZABETH M GER1250 WATERS PLACE BRONX Allergy Band: I] YesNY 10461 TEL: (866)633-8255 NON MMC: Limb Alen: () YesaT 002 PNAACC: Pain ScaleARRIVED: Ambulance Used Scale:PRI CARR:MO3 -SEC CARR: - [] Wong-BakerTER CARR: - {] DescriptiveACCID PLACE: {] Nea-VerbalACCID D/T:(See Patient Record)1 :i ETA willDU OUR NR CAML ANS AU A aN Ye a Printed 10/15/2016 at 18:31 - Page 1 of 2Nursing Notes -- Triage / Asses nent — Lynx Medical Systems, inc copyright 2006 TORRES, Angel luis (78 yr + M) Neurologic ProblemTORRES, Angel luis J - vcEMP: RETIREDINDEX NO. 56387/2020RECEIVED NYSCEF: 12/22/2022D: W A INDEX NO. 56387/2020NYBaE2 DAGIAO_196. TORRES, Angel luis | RECEIVED NYSCEF: 12/22/2022MONTEFIORE Moses Emergency Department Patient: TORRES, Anget luis111 East 210th Street Triage Date: October 15, 2015Bron 008: Sex: MaleMed Rec#: EE Age: 77 yrUIUC A Account:Nursing Notes -- Emergent Medication Record - ‘Assessment Date/Time: °EMERGENT MEDS PRIOR TO REGISTRATICNMEDICATION! Amount/Route/SiteResponse:Response:Response:=t[ima | Rene md [Saree [NoreLdLEC ACNE ess naNursing No -Triage/A essment — Lynx Medical Systems, inc copyright 2006 TORRES, Angel luis (75 yt + M) Neurologic ProblemTORRES, Angel luis - [ES vc -INDEX NO. 56387/2020NYSGER2 BOB73N0. 196TORRES, Angel luiRECEIVED NYSCEF: 12/22/2022MONTEFIORE Moses Emergency Department111 East 210th StreetPatient: TORRES, Angel luisB 467 Triage Date: October 15, 2015teocoeyat. ae :718.920.5731 DOB: Sex: Maled Rect: Age: 77UU SAS 0 LA Account: _Nursing ED Assessment FormDate: /p //S //S Time: NS 6 - ‘Advance Difectivés: [}None []ONR []ONI [] Health ProxyPrecautions: []Fall [] Seizure fuaaye. OnSocial History: [] Non-Smoker [ ] Smoker/ppd: [] Drugs 4[] ETOH/amount per day Last Drink:Initial Glucometer (Reference Range 70-115 mg/dL): See CIS Urine Hcg: — See CISSpiritual / Cultural Needs: Identified (}Yes [] No Addressed []Yes [] NoCrisisintervention: [] Yes []No_ Type:Respiratory Cardiovascular Neurological p ginali] Rhythm Alert [] Oriented Ke [] Distended , [ } Firm|[] Pacer [] AICD Confused [ ] Verbal { | Tender { ] Nontender,Cap Refil:[ ] <4 sec [] >4 sec|[ ] Lethargic [)KUnresponsive |{ ] Guardingwv0 11 ¥ KN Combative [ ] Bowel Sounds]Edema[]Y | Dizziness [] present [ absentIntegumentary Speech: lt] Nausea [ ] ¥omitingColor: g Diarrhea Lactation|) Accessory Muscle Use |[ ] WNL [] Pale [ } Flushed LMP. ] MenopausalI ] Nasal Flaring Mottled [] Cyanotic Grad: (} Para ~F{ ] Jaundice Bleeging [ } DischargeBreath Sounds: ‘Tem perature: Z []R {]Clear (VR Je ‘am, [] Cool []Hot |] Paralysis []R L{[] Dysuria [} FrequencyDiminished [JR [JL ry { ] Diaphoretic Mobility: [] Incontinence| } Last Void:Absent []R [] L |Skin integrity: [ }] Moves Ail Extremities Safety\Universal Precautions:Wheezing []R [JL ][] intact [JY [JN Gait: [ ] Steady [ ] UpSteady|[ ] Bed in Low PositionRhonchi []R [jl [Describ; [ ] Bed in Prominent AreaCrackles UR te al pee Tagan Injury I | 

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