FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 PM
`NYSCEF DOC. NO. 89
`
`INDEX NO. 605898/2020
`
`RECEIVED NYSCEF: 05/10/2022
`
`EX NO.
`
` NYSCI
`
`605898/2020
`
` EF’:
`
`05/10/2022
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 P
`NYSCI EF DOC. NO. 89
`
`IND
`
`
`
` EIVE iD
`
`Exhibit “O” — Part 3
`
`
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 PM
`NYSCEF DOC. NO. 89
`
`INDEX NO. 605898/2020
`
`RECEIVED NYSCEF: 05/10/2022
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 P
`NYSCI EF DOC. NO.
`89
`
`IND
`
`
`
` EIVE iD
`
`EX NO.
`
` NYSCI
`
`605898/2020
`
` EF’:
`
`05/10/2022
`
`
`
`Si, Joseph Ho
`
`At the heart af health
`
`
`ST. JOSEPH HOSPITAL
`4295 Hempstead Tpke
`Bethpage NY 11714
`
`Conti, Michael J
`MRN: E3180479, DOS:
`Adm: 3/26/2019, DIC: Bf
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`001
`
`
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 PM
`NYSCEF DOC. NO. 89
`
`INDEX NO. 605898/2020
`
`RECEIVED NYSCEF: 05/10/2022
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 P
`NYSCEF DOC. NO. 89
`
`
`INDEX NO. 605898/2020
`
`
`
`
`RECEIVED NYSCEF: 05/10/2022
`
`A
`ag. St Josep Hospita
`
`ites
`
`At the heart
`af health
`
`|
`
`Conti, Michael J
`ST. JOSEPH HOSPITAL
`MRN: E3180479, DOB:|
`4295 Hempstead Tpke
`
`Adm: 3/26/2019, D/C: 3.
`. Bethpage NY 11714.
`Hospital Record
`
`
`
`Patient identifiers
`“CSN: "3015007555
`EPIC Number: E3180479
`STAR Account Number: 1908500393
`
`Admission information
`
`
`LONG ISLAND SERVICE AREA
`
`(rong)
`
`Medical as of 2/36/2679
`
`a : oe
` PastMedical Histary
`
`“Diagnosi
`SAE
`es PSS : “Source
`
`Diabetes mellitus(HCC) co
`TT nace ni caving Provider
`DVT (deep venous thrombosis) (HCC) —
`leftleg 2 weeks aga
`Provider
`
`surgicalas of 3/26/26
`"~~Surgicat last reviewed by Perry, Margaret M,"RN on3/26/2049
`
`“None*™*
`
`
`Familyasof 3/26/20 nt
`Family lastreviewed byPePerry,Margaret M, RN on 3/26/2019
`**None**
`
`
`FamilyStatusasof$/26/2013
`Family Status last reviewed by Perry, Margaret M, RN on 3/26/2019
`“*None**
`
`—— a
`
`
`
`TobaccoUseas ofSEMZROISppt acneneennn
`Tobacco Use last reviewed by Perry, Margaret M, RN on3/26/2019
`_ SmokingStatus.
`“Smoking Start Date “Smoking Quit Date...Packs/day. ....Years Used -
`Never Smoker
`—_
`~
`—
`‘
`~~
`EOE OE, 8BE ek Se sags AEG asf SeeCateeg “ESPROKeIeRSS MS
`ae
`oe
`Co Smokeless:Tobacco Tobacco Quit.
`Types2eSGomments 0 oO Status Date Soe 'Sguree es
`~
`NeverUsed
`Provider
`
` noha Uae latnebyBory.MfiargaretryBNonBBSne
`
`002
`
`
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 PM
`NYSCEF DOC. NO. 89
`
`INDEX NO. 605898/2020
`
`RECEIVED NYSCEF: 05/10/2022
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 P
`NYSCEF DOC. NO. 89
`
`
`INDEX NO. 605898/2020
`
`
`
`
`RECEIVED NYSCEF: 05/10/2022
`
`
`
`
`
`
`
`ZEsSu
`Ce OGmments:0! Se
`13(contntinued)
`
`:Alcohol/Wee
`
`
`
`
`—
`~~
`—
`Provider.
`
`3ST. JOSEPH HOSPITAL
`4295 Hempstead Tpke
`Bethpage NY 11714.
`Hospital Record
`
`Conti, Michael J
`MRN: E3180479, DOB
`Adm: 3/26/2019, D/C
`
`DrugUse as of HeGlauig
`
`eeEOeeeeetintintttegarnishennneypaneererantether
`
`DrugtUsefastreviewed Py Perry MargaretM, RN on 3/26/2019
`
`
`
`“DrugUse
`:
`y.> Commenis. 9"
`
`
`oe
`a
`"Provider
`
`
`ee.
`SexualActivity as of 2/26/2019
`SexualActivity last reviewed by Perry, Margaret M, RN on 3/26/2019
`
`= Sexually
`ican
`'
`ee ERED cutg te eM ES
`
`__.
`
`_
`
`Activities of Daily Living as of3/26/2019
`“None
`
`
`SeciaiDocumentationasof3/26/2679_
`oasceirnsnanermateeterARenkhAaAnhypewoeshaieeetikemabiietinrneninsmn
`None
`
`Oocunational;asof328/264
`memsesemucennatnrinenSnitiitnasnamartiatmhtrerNernstinnimeemcereus,
`“None
`
`Socigeca: omic as of 26/2049
`
`Preferred:
`
`ahStatus.
`seh
`ao
`Je
`- Language ~Ethnicity.
`= Race scl:
`
`
`
`Divorced —
`—_
`—
`English
`Not Hispanic or White or
`—_
`
`Latino
`
`Caucasian
`
`
`ith asof3/26/2079
`“**None**
`
`
`
`SiniireisiarcleneintioestatletehlocindatinbnniveeeonsGensletesabUhCedeNaimanodeeddebitaindwinndavenmninvinbooedratoNeneem nnn
`
`ae: Aleryies
`
` Aller ies as of N26/2019
`Prior Te Admission Medication as Re orted B Patient
`
`Tsonutinnesrneetet
`puri
`saieniesnoeey
`Tanoeteaa
`solaniinitiatesataninestieNR centre RealeakertnmathenatoasaereinabaneinimgtonerabaondonantereteeeeaOeaaa
`
`Prior to Admiission Meds AfterReconciliation
`
` “painint
`
`©
`
`ED Chief Com taint
`
`003
`
`
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 PM
`NYSCEF DOC. NO. 89
`
`INDEX NO. 605898/2020
`
`RECEIVED NYSCEF: 05/10/2022
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 P
`NYSCEF DOC. NO. 89
`
`
`INDEX NO. 605898/2020
`
`
`
`
`RECEIVED NYSCEF: 05/10/2022
`
`ST. JOSEPH HOSPITAL
`
`Adm. 3/26/2019, D/C: 3
`
`Sex: M
`
`Cont, Michael J
`
`St.Joseph Hospital
`4295 Hempstead Tpke
`MRN: E3180479, DOS:
`Bethpage NY 11714
`At the heart of health
`Hospital Record
`
`
` Ep Chief Comptai
`
`
` Margaret M, AM
`
`
`RN
`
` Final diagnosis
`Right leg pain
`Dream, Andrew, MID
`26/2018
`Attending
`4.50 PM
`Provider
` US DUP EXTM YENOUS RT LOW
`
`
`“O5/26/79 0936.
`~ Bat
`VEL
`BERRY, MARGARET M
`032879 6939
`_ Trage Stared oo.
`PERRY, MARGARET M
`
`03/26/19 oeds
`istProvider at Bedside
`_
`_ MUSHTAG, KULSOOM
`O326/19 1429
`Patient discharged
`SCOTT, DEBORAH
`
`O3/26/19 1429
`ED Tracking End
`SCOTT. DEBORAH
`ED Disposition
`
`|
`
`Orears, Andrew, MD
`
`Michael J Conti discharge to Home o
`
`Condition al discharge: Good
`
`S$ stem Generated Tire Stam Ss
`
`Senetat 312612019aes
`
`BHAASAMARIAABAADDAWASOABNOMIDRDSRAMESAIANAERSCRAIARIANOpiedsete
`
`
`7 EmergoneyDepartment
`“MTS
`Emergency
`
`¥
`H2G/2019 G46 AM
`Ecdes Pery. Margacst M4, RN (Registered Nurse}
`
`Pt A&OX4 calf soft neg homans sign place in w/c pt states took one dose of coumadin today
`
`Perry, Margaret M, RN
`03/26/49 0948
`
` tf Ghose) by Peary:
`
`ah
`
` usglered MusSe
`
`15 WO? AE
`
`
` Seat, Detorah, RN (Requsterad Nurse?
`
`PA at bedside. Patient presented with complaint of pain In right calf area radiating up to mid thigh area for
`past three days to a week. Pain increases on palpation. Pain level varies depending on activity; 3 to 10.
`Presently 3 without movement. Right foot cald, toes mobile. Pedal pulse faintly palpable. Left foot warm,
`pedal pulse palpable. States had previous nerve damageto left leg. Lower legs assymmetrical. Patientin
`no acute distress., breathing easy and even. Verbalizes freely, speech clear, responses appropriate.
`
`004
`
`
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 PM
`NYSCEF DOC. NO. 89
`
`INDEX NO. 605898/2020
`
`RECEIVED NYSCEF: 05/10/2022
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 P
`NYSCIEF DOC. NO.
`89
`
`
`INDEX NO. 605898/2020
`
`
`
`
`RECEIVED NYSCEF: 05/10/2022
`
`
`
`.
`St. Joseph Hospital
`Seviets
`
`ST. JOSEPH HOSPITAL
`4295 Hempstead Tpke
`Bethpage NY 11714
`Hospital Record
`
`
`Conti, Michael J
`MRN: 3180479, DOB:
`Adm: 3/26/2019, DIC: 3/26/2019
`
` Sex: M
`
` ‘EficounterNotes(continued)’
`
`Version 1 of 4
`ED Notes by Scott, Deborah, RN at 3/26/2019 10:08 AM (continued)
`03/26/19 1017
`
`
`
` nally signed by Gent, De
`
`
`
`ysician Assistant
`
`: BQBZ018 10:14 AM
`
`Aiested
` :
`Mushiag, Kulsoom, PA (Physician Assistant
`en Dream, andrew, MO at S/eG2018 631 PM
`
`Attestation signedby Dream, Andrew, MD at 3/26/2049 9:31 PM
`| have personally seen, evaluated and participatedin this patient’s services and find this patient's history
`and physical examination are consistent with the Physician Assistant's documentation.
`- Andrew Dream, MD
`
`Version tof t
`
`
`
`
`R calf x1 week hx DVT in same leg 06/18 tx with blood thinners
`
`Michael J Conti is a 56 y.o. male With PMHx DVT (Right Leg x 1 year) and DM, who presents to the ED
`complaining of an acute onset of 5/10 sharp, constant right Lower leg pain, worse with movement. Patient
`states he had a DVT 1 year prior in the right leg s/p Right leg surgery which was treated on Coumadin and
`finished the course. Patient states the pain is worse when he moveshis leg or walks. He denies any fevers,
`chills, headache, dizziness, chest pain, palpitations, shorinessof breath,difficully breathing, nausea, vomiting,
`abdominal pain, dysuria, or hematuria. Patient states his brother also has a Hx of blood clots but states they
`were after surgeries as well. Patient denies any recenttravel, recent surgeries, prolonged immobilization, or
`hemoptysis. Admits to smoking x 40 years but states he has decreased smoking to 4 cigarettes per day.
`
`History re
`
`
`
`
`“+ Diabetes mellitus (HCC)
`* DVT (deep venous thrombasis) (HCC)
`left leg 2 weeks ago
`
`
`
`» Marital status:
`Spouse name:
`* Number of children:
`* Years of education:
`
`
`
`.
`
`. Divorced
`N/A
`N/A
`NIA
`
`005
`
`
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 PM
`NYSCEF DOC. NO. 89
`
`INDEX NO. 605898/2020
`
`RECEIVED NYSCEF: 05/10/2022
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 P
`EF DOC. NO. 89
`
`
`INDEX NO. 605898/2020
`
`
`
`
`RECEIVED NYSCEF: 05/10/2022
`
`
`
`.
`St. Joseph Hospital
`
`Catholic
`Me
`res
`At the heart af
`
`
`ST. JOSEPH HOSPITAL
`4995 Hempstead Tpke
`Bethpage NY 11714
`Hospital Record
`
`Conti, MichaelJ
`MRN: £3180479, DOB
`
`Adm: 3/26/2019, DIC: 3:
`
`Sex: WM
`
`
`EncounterNotes(continued)
`
`ED Provider Notes by Mushtag, Kulsoom, PA at 3/26/2019 10:14 AM {continued
`
`
`-Smoking status:
`Never Smoker
`Never Used
`* Smokeless tobacco:
`* Alcohol use
`No
`» Drug use:
`No
`* Sexualactivity:
`Not on file
`
`
`
`
`
`*Not onfil
`
`Social History Narrative.
`+ No narrative on file
`
`
`
`18
`() 87.2 PF (36.2 °C}
`
`Review of Systems- all other pertinent system negative except as stated above
`PHYSICAL EXAM
`
`CONSTITUTIONAL: Well-appearing; well-nourished: in no apparent distress:
`HEAD: Normocephaiic, atraumatic:
`EYES: EOMintact, conjunctiva clear, and sclera White: No evidence of racoon eyes:
`CARD: Regular rate and Rhythm; No murmurs, rubs, or gallops appreciated on exam
`RESP: Equal and regular chest excursion with respiration; breath sounds clear to Auscultation bilaterally
`;No wheezes, rhonchi, or rales appreciated on exam
`EXT/MS: Normai ROMin all four extremities; Right LE tender to palpation posterior Mid-calf to right upper
`thigh; Full ROMin right leg; Right leg slightly swollen; No erythema noted on right leg: No bakers cyst or
`popliteal cyst palpated on exam; Right foat cold to touch; DP pulse 2 on Right Foot, 2+ on Left foot;
`SKIN: Normalfor age and race: warm; dry; good turgor; No apparent lesions. rashes, or exudates: Brisk
`Capillary Refill in UE bilaterally;
`NEURO: Awake,alert, oriented x 3, no gross deficits, CN {I-X!l grossly intact: Sensation to touch and pressure
`intact in LE bilaterally; Strength 4+/5 in LE - feet bilaterally; 2 point discriminationintact bilaterally; Babinski
`Norma Bilaterally: Conversational and appropriate
`
`006
`
`
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 PM
`NYSCEF DOC. NO. 89
`
`INDEX NO. 605898/2020
`
`RECEIVED NYSCEF: 05/10/2022
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 P
`EF DOC. NO. 89
`
`
`INDEX NO. 605898/2020
`
`
`
`
`RECEIVED NYSCEF: 05/10/2022
`
`ST. JOSEPH HOSPITAL
`.
`4995 Hempstead Tpke
`_ St. Joseph Hospital
`Bethpage NY 11714
`:
`Aces
`
`e heart af health Hospital Record
`
`
`
`
`ncounterNotes(continued)
`
`ED Provider Notes by Mushta . Kulsoom, PA at 3/26/2019 10:14 AM (continued)
`
`
`Conti, Michael J
`MBN: E3180479, DOB:
`Sex: M
`
`Ado: 3/26/2019, D/C: 3/26
`
`Patient has a Hx of DVT - treated with Coumadinlast year
`Patient currently not on AC
`No SOB, CP, No pleuritic CP: Pulse 68 No indication for PE.
`
`Wells Criteria for DVT: 3 - High Risk
`US RLE doppler r/o DVT
`No indication for labs atthis time - will re-assess pending US
`Patient seen and examined by ED Attending, agrees with plan.
`
`Patient refusing pain medication atthis time - states no pain with movement
`
`Us Duplex Extremity Venous Rt Low
`
`Result Date: 3/26/2019
`Facility: St Joseph Hospital Indication: Lower extremity pain There is no evidence of deep vein thrombosis.
`Submitted compression and augmentation views demonstrate no discrete abnormality. Conclusion: No
`evidence of deep venous thrombosis.
`
`Pain mostlikely MSK
`Robaxin and Naproxen prescribed for Pain
`
`ReturnPrecautionsDiscussedWithPatient
`vithpatient
`lowupwithPCPwithin2-3daystoensureimprovement
`
`dagreeswithplan
`
`Mushtaq, Kulsoom, PA
`03/26/19 2130
`
` cally signed by Dream, Andrew, Rit
`
`
`
`Seon, Deborah, RN (Registered Nurse}
`
`
`
`Version ‘tof 7
`
`OTF to US
`
`Scott, Deborah. RN
`03/26/49 1306
`
`
`
`ED Notes by Scott, Deborah,RN at 3/26/2019 1:36 PM
`RN
`PAM
`
`
`
`SQ2019 1G0 PM
`
`007
`
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 PM
`NYSCEF DOC. NO. 89
`
`INDEX NO. 605898/2020
`
`RECEIVED NYSCEF: 05/10/2022
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 P
`NYSCEF DOC. NO. 89
`
`
`INDEX NO. 605898/2020
`
`
`
`
`RECEIVED NYSCEF: 05/10/2022
`
`
`Conti, Michael J
` EDNotes 2 Scott, Deborah, RN at 3/26/2019 4:36 PM continued)
`
`st. Joseph Hospital
`M the heart alj health
`
`zeanoeeneecss
`mayest
`‘Returnedto ED‘bed
`
`ST. JOSEPH HOSPITAL
`
`4295 Hempstead Tpke
`Bethpage NY 11714
`Hospital Record
`
`MRN: E3180479, DOS
`
`Adm. 3/26/2019, D/C: 3
`
`Scoit, Deborah, RN
`03/26/49 1336
`
` t
`
`istered Muse
`Addendum
`
`Condition stable.
`In no distress. Denies any sain presently. Discharge instructions reviewed and
`explained, copy provided. Ambulatory from ED, gait steady. Companionin attendance
`
`Scoit, Deborah, RN
`03/26/49 1428
`
`Scott, Deborah, RN
`03/26/49 1430
`
`fan, ASbon 2202070 Boao PAS
`
`
`
` 1 26/2079 2:27 PM
`Deborah. RN (Registered Nurse)
`
`
`fas: Addendumby Sach, Oeborah, RN (Ragisterad Nurse) fled al 36/2019 2:20 PM
`
`In no distress. Denies any pain presently. Discharge instructions reviewed and
`Condition stable.
`explained, copy provided. Ambulatory from ED. Companion in attendance
`
`Scoit, Deborah, RN
`03/26/19 1428
`
`
`
`“Completed|
`
`Questionnaire
`
` oft
`
`008
`
`
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 PM
`NYSCEF DOC. NO. 89
`
`INDEX NO. 605898/2020
`
`RECEIVED NYSCEF: 05/10/2022
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 P
`NYSCEF DOC. NO. 89
`
`
`INDEX NO. 605898/2020
`
`
`
`
`
`RECEIVED NYSCEF: 05/10/2022
`
`Cont, Michael J
`
`MRN: E3180479, DOB
`Adm: 3/26/2019, DIC: 3/
`
`
`
`St. Joseph Hospital
`a
`cas
`Al the heart af health
`
`ST, JOSEPH HOSPITAL
`4295 Hempstead Tpke
`Bethpage NY 11714
`Hospital Record
`
` “Dream, Andrew,"MDon0826/1
`
`: Bream, Andrew, MD 03/26/19 4351
`: Dream, Ancrow, MO
`
` . Dream, Andrew, MD
`
`
`Dream, Andrew, MO o 03261ry1351
`
`Expired
`
`Dream, Andrew, MD 03/26/19 435
`
`Dream, Andrew, MO
`
`BID With Food 03/26/19 - 10 Days
`
` 03/2619 1265g-.*OODEr9 1328
`
`. STAR RAD
`
`Facitty: St Joseph Hospital
`
`indication Lower extremity pain
`
`
`There is no evidence of deep vein thrombosis. Submitted compression and augmentation views demons
`
` role no discrete abnormality,
`
`Conclusion: No evidence of deep vanous thrombosis.
`
`STAR RAG
`
`9- STAR Rad
`
`PRseoRRSGFLEDDRAHATRR
`All Meds and Administr: tlons
`
`BRASARASANODANSSRISDISSIKEABRNBIERAREASOCARRISAISDDSOSADEINRAICOSASADOMENTINTUoOELARISAOEDSoraneaMARERRGE
`OBIEchoeSahAIREDDEREDDSIORNLEODNDSVRSOARRCBUAEETOBIE
` Borg
`vig encountert
`
`(There are no med or
`
`
`tientEducation
`Primar Learner Assessment
`
`None
`
`
`
`Title: Acute Mi CHSU {Active}
`
`
`
`
`
`
`
` Co-Learner Assessment weedULbawayEbayruddsboae FTaU yasTaSbTSuE LETTbeeEALEHET
`
`009
`
`
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 PM
`NYSCEF DOC. NO. 89
`
`INDEX NO. 605898/2020
`
`RECEIVED NYSCEF: 05/10/2022
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 P
`NYSCEF DOC. NO. 89
`
`
`INDEX NO. 605898/2020
`
`
`
`
`RECEIVED NYSCEF: 05/10/2022
`
`
`.
`St. Joseph Hospital
`
`
`‘ees
`Patient Education (continued
`
`Sex: M
`
`ST. JOSEPH HOSPITAL
`4095 Hempstead Tpke
`Bethpage NY 11714 -
`Hospital Record
`
`Conti, Michael J
`MRN: E3180479, DOB
`Adm: 3/26/2019, D/C: 3
`
`Education continued
`
`asialah be
`Topic:
`BD: easeManagement- Acute Mi (Active)
`
`orbeinnaVowibwienawenine¥predCoedHebeSiaWainaBeeslyaaaoworatenesenaeeneNoTRHEE
`Point: rdiac Rehab
`
` as of carhac +
`roton fie,
`
` Surnmary: gaming progress
`
`Poin Emergency Planfor Heart Attack Symptoms (Active}
`
`Hon£Educate the oe m yearegiver on how ip :
`
`
`
`Emergency!Medical Service number. Reinforce that the patifant should net delay in obtaining heals.
`Summary: Leaming progress - not on file.
`
`
`HeRANGMDAao
`Pain Home Activity (Active)
`
`
`ft, Educate| @ paleef
`sliy/caregiver on home :
`suit with Cardiac
`Rehab stall, if agplicabte.
`Summary: Leaming progress - nat an fite.
`
`
`
` “ Educatet © pakentiac yicare
`owing‘tien
`ions io
`fy for B8 weeks after di
`
`
`a mak jug), no pushing of pulling motions with ihe arms (sweeping. vacuuming Or faking}. ne driving
`hanged afler talking lo fhe doctor), no bathing in very hot or very cold water.
`Summary: Learning progress - not on fhe.
`
`Point: Sexual Activity (Active)
` Summary: Learning progress- nol on fie.
`
`Title Diabetes CHSLILI(Acti
`Fopiesis Signs and Symptomsof hypoalyeemia yeerglycemia iAstive)
`/
`
`eineKnarenomenaeesed
`
`Point: Patient will be able todefine h
`oglycemia as bloodglucose < 70mg? dl and define hyperglycemia a
`
`
`sachaiSeanais
`
`Son or not enough food, partic
`OD.
`ifation: Hypedkycemia (low b
`Sugar can be caussed by too mi
`
`
`
`with a bleed glucese level above 70
`defned as any bleod glucose level < 70 mg/
`dl, however if patient
`nis and symptoms of hypogly
`
`
`
`mg éii Orwithout saeeen Bbload Glucese® reading, it must he laken seriously and you should treat the patient. Some symptoms af hypoglycemia
`
`ing.sudden moodiness, hunger, and pais skin color, Shaking, confusion. sweating, and
`ost common. Itis heiphul to ask your pafient what they experience when thay go low so you can be aferted to
`thypersiyoaria1s defined as anelevated
`blood glucose level, however your patient may nel experence any signs or symptoms until their blood glucose
`on is heloful for HOG re
`shift report, and nursing documentation.
`
`
`
`level is much higher. Causes of hyperglycemia Include: too much foodS (particulany carhohydrates). toolittle medication, tiness, strass, or dacraase in
`
`Some signs ang symptoms of hypergiycenva include:
`Extreme thirst
`Frequent urination
`
`S.
`
`
`
`Hunger
`You dG need a ssyelratesy t
`
`your gatlect’s spac
`
`
`
`ge should aba
`
`010
`
`
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 PM
`NYSCEF DOC. NO. 89
`
`INDEX NO. 605898/2020
`
`RECEIVED NYSCEF: 05/10/2022
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 P
`NYSCEF DOC. NO. 89
`
`
`INDEX NO. 605898/2020
`
`
`
`
`
`RECEIVED NYSCEF: 05/10/2022
`
`ST. JOSEPH HOSPITAL
`_ 4295 Hempstead Tpke
`’ Bethpage NY 11714
`
`Conti, Michael }
`MRN: E3180479, DOB
`Adm: 3/26/2019, B/C: 3/
`
`Hospital Record
`Subantn eaneartoedhatonesevvimmeooetoonoesbonorie
`
`Slow healing of wounds
`Summary: Learning progress - rot on fle.
`
`ipdsaoncangunienrmenteeaa
`
`
`Point: Patient will be able to list two treatments ee for hypoglycemia and h
`
`¢
`Descrintion:
`criticalyour pat rt underst nds|¥ypohearis andthata they mn
`to treat their SyMpioms irened
`aly wth 15 grams of
`ung carbohydrate and
`
`
`
`
`recheck their Liood glucose in 19 minules (the 16/ 16rule") to confirm theinitial treatment was sufficient and effective. The “15/15" nie musi be
`‘onlinved until the glucose is greater than roma!id}. In order to ensure timely and effective treatment, your patient should understand this and carry
`
`
`hair glucose meterwith them as well as carry treatment options with th
`such a8 four glucoselablets, four ouncesoffruit juiee (excent tomate juice),
`four ounces of reqular soda {not diet}, or eightOunces of mae milk (ore
`¥
`low Tat because fat siows the absorption.
`
`
`Hyperglycemia can be 2 serious problem, if nol treated. Treatmenis options for Hypergiyeemia : if your tices glucose level is consistently loo high, you
`
`should talk with your proveier about what you can do to Keen it in a more normal fange, The provider may suggest an adjustment of medication, a
`reviewof the meal plan and adjustmertif necessary. Regular oxercise and maintaining a healthy fevelot,activity can help you keep your glucose lovel
`in a normal range.
`
`if hyperglycemia is untreated, you can develop = condition called ketoacidosis that can lead to coma. Symptoms can include shortness of breath, fruty
`smeli on breath, nausea ancvoriling, a very dry mouth, mental status changes, confusion, fatigue, and abdominal pain.
`Immediate hospital care is needed.
`Surynary: Learning progress - nol on file,
`
`
`Point: Patient will be abfe to list two steps to prevent hy roglyceniia and hyperglycem
` (Acti eo}
`iabeds nasedasa
`sisiatiAaNTRiRAERHARE TURRETaAeatenTER
`
`Descrintion: Praventing hypoglycemia is the key. Risk factors for
`
`
`HoGglycemia include: exorcise, foc much ¢ labetes meication. skipping or+ detsay7
`
`
`Meals. and Hot galing carbohydralos, Hore are same steps your ‘
`Sationt can take (© prevent low blood giuccsa episode:
`Know their symptoms
`Check their blood glucose feval often
`
`Carry fast acting carbohydrates with them
`
`at mea's consistently
`
`Make sure family members knew howlo administer glucagon(they can learnin any CHS Diabetic Self Management Education Center)
`Wier an}1beat
`Hypperglycemia prevent!on can include monitoring your blood qucose, monitoring your diat, and daily exerciee.
`Summary: Learning progress - sot on file.
`
`Topic: A-aaAdministrationof Medication {Active}
`Paint:
`
`Summary
`bamning progr :
`
`
`Point: Patient will be abie to exptain relevant side effects to watch for Active)
` saa
`ishaSEEAEAAGARINNGSTAINARAALANASADASAARTRANSodanAASSASS
`
`
`
`SinesdbieiaSabhaUBB pneteae “Canrouseiaie
`
`nat eat
`mia if nutritional support is withheld’ delayed or if the po
`Descrintion: Sutfonylureas (insulin secretagogues: Can cause hypoalyce
`(carbohydrates on the tray),
`
`ase the busal coverage by 25%
`insulin: Long acting insulin (Lantus) should not cause hypoglycemia if dose ig cormuet. His nol uncommente ¢
`when patiant is NPO to be on the safe side, Howeverif the dose is actually correct, it should not need fo be adjusted.
`Prandial insulin should be held if patient is NPO or does not eat their meal, Susplememtal insulin coverage should not be held asit
`is being
`administered to address @ blood glucose level independentof food.
`Metformin (Glucophage:2} should nol cause hypoglycemia, howeverif car cause gasliic upset suchas ges blosting and dianhee. Metionnin should not
`be acministerad the day of any procedure with contrast and held fer an additinaal 48 hours aher the proceaure io ensure ine dye has been completely
`
`ed. A serum crealisine is suggested to ensure Kidney function has nat heen compromised.
`
`Surmmaery: Learning progress - nat on fe.
`
` a
`
`ation ofPhyvypogiycetrr
`
`
`ul storach
`> Take with food an a
`
`
`notonfie.
`Summary: Leaming progress
`
`i
`:
`&
`3
`f
`
`
`Lt at room teamnerature and ciscarded per manufacturer's storag
`hould &be ke
`
`
`
`£8 - ot ov fits LEELA CESELDA Dede A LORESy CALNE TEENY DEHELL SADE AND pS HDEESnSbd) dgSEER YUPDESeaND heme bee
`
`
`fuctons,
`
`011
`
`
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 PM
`NYSCEF DOC. NO. 89
`
`INDEX NO. 605898/2020
`
`RECEIVED NYSCEF: 05/10/2022
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 P
`NYSCEF DOC. NO. 89
`
`
`INDEX NO. 605898/2020
`
`
`
`
`RECEIVED NYSCEF: 05/10/2022
`
`Si Joseph Hospital
` 4
`
`4295 Hempstead Tpke
`
`Bethpage NY 11714
`Hospital Record
`
`Conti, Michael J
`
`MRN: E3180479, DOB:
`
` ST. JOSEPH HOSPITAL
`
`Ady:3/26/2019, DIC: 3
`
`
`
`osulin fo te administered. With an aleanal weine, have your pationtdean & twordineoh wove on the aroa that they veil ba injecting into.
`They
`a then di
`in
`pe
`we
`periorm
`s
`ne the
`ne
`3
`ure
`patancy.
`ave patient dial th
`
`
`
`lngulin requires fal to be absorved. H they can pinch and inch, ilis a good ilace lo administer. Have calient demonstrate insulin administration into
`
`the provided
`tion port in the Lantus Solostar trainingkit.insulin pens are not used in the CHS System, Theyare anty to be used for education
`
`
`practice for cost discharge diabetes mangement, andareRO forjinpatiantuse.
`
`H patient will be using a traditional insulin sy
`the top of the insutin vial with alcohol wipe, Have them pull back air inte the
`syringe (same amount as the insulin they vill be adininisteringg). Put needle into the insulin vigi
`
` esired amount of insulin. Encouragethepatient to
`Push air into
`the insulin viai, Invert the Insulin viel and pull
`back on the syringe to withdraw¢
`
`
`withdraw slowly to prevent air bubbles in the syringes. Have your patient express any
`if bubbles from the syringge before administering to ensure the
`catreed are ‘ofanelia tebe adlministeered, Patient shouted pinch sar
`using @ dart ike moticn, have patient inject needle inte their
`
`
`
`
`
`id massaging the sie after withdrawing
`the needle as d wit
`potastiatethe Z ction &afin
`in. Renmember to provide your patient with diabetes education written materials for reinforcement.
`
`&- Gotan file.
`Summary: Learning pregre
`
`
`
`>
`The
`improperdisposal otsayringes, lance
`6S pose a pole
`
`
`
`
`f athazaed ter any,
`ding laritymembers,
`ani
`
`
`workers, peopie in the community, hotel housekeeping staffs and schoo! personnel. T?
`nedisposal of syringes or reusable hypodermic needies is
`reguiated by siate law.
`
`
`Cispose of syringes, jancets, and insulin pen needles in a rigid container, cuch as a detergent/bleack container, with a screwtop ta prevent harmta
`
`
`ciners. AQ hosoitais must accept community sharps. All CHS Diabetes Education Centers wil accept sharps dropped off in the approps ake COMlginier,
`Summary: Learning progress-nol on fie,
`
`Point: Patient will Identify potential barriers which may impacthis or her ability to appropriately take medication and strategies for reducing
`these barriers (Active)
`-
`_
`_
`
`
`escristion:
`Exniore with pa janis the patentai
`leatlon &
`involve csw i necessary
`b.
`istrag
`wamary: Learning progress - qoloanfie.
`
`eae AneatenleFatehatheistniente
`viata
`inoeinintendnienchecinch
`iiSeaarnhinPb
`
`lucose level (Active)
`Topic: F--Fingerstick blood gglucose monitoring FSBGM: ability to safely and accurately seil-monitor blood
`
`
`
` z re patient is a dry hands6 Ore FBG,
`
`Power on: (most OTC meters are activatedbyputting the teststrip inte the appropriate port,
`
`
`Make sure patient can safely and accuratelyuse thelancing device.
`courage the patient to avoid using the middia- np of the finger. We encour.age
`
`
`the use ofthe side of thetip of the finger to dec,
`@ pain and mcrease capillary refi. Have patient dernonsivate test strin and lancel remoyal
`(Reinforce sale sharps disposat).
`Summary: Learning progress - not on fite.
`
`
`
`Poir f
`Patient will be able to describe how to care for monitoring supplies [Active}
`
`f Pini closed otailimes in-between use
`
`
`
`
`
`
`Patient shoutd carry personal biced glucose meter with themat af times.
`Summiary: Learning progress - nol onfife.
`
`BeSeencaNAaacBARRSCANGI
` Paint:Patient willbeable to statee hereonfargettateeeevalues (Active)
`promeal blocd glucose laveis >60 agit, and <
`~ to?2 hours after‘thcd siart of the meal| should be«ABOgnvdL. These targets should be adjusted to age and patient specific needs and
`
`glucose
`
`co-morbidities.
`a
`Summary: Learning progress - nat on file,
`
`
`Paint: Patient will discussthe importance of timing of FSBGM, insulin delivery and meat ced{Active}
`inion:
`FSEGM should 6be performs oO more than 30
`
`15 coimutes
`
`
`
`either
`before or 4 Her Sart of the meal.
`
`Complex carbohydrates (@.g., corn, peas, ce
`broccoli. dried beans.
`oats, apples) decrease giucoselevaly/insulin negds. reduce serum cholesterol
`levels, and pronynote satiation. Fo:O06 intake is scheduled according te specificins:
`isties [8.q.. peak effect) andi
`dual patient rasponse
`
`
`N
`ss
`}
`Hin io Dravent hypogiynemia
`Somogyi n
`during sivep and potenttal
`
`nat on file.
`
`Sunimary: Leaning progress
`
`
`iealed, Pro
`
`
`Hthods ava
`
`
`3.
`
`
`
`POH an he,
`
`012
`
`
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 PM
`NYSCEF DOC. NO. 89
`
`INDEX NO. 605898/2020
`
`RECEIVED NYSCEF: 05/10/2022
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 P
`NYSCEF DOC. NO. 89
`
`
`INDEX NO. 605898/2020
`
`
`
`
`RECEIVED NYSCEF: 05/10/2022
`
`si. Joseph Hospital
`
`Cath
`|
`Ab the heart af health
`
`ST. JOSEPH HOSPITAL
`4995 Hempstead Tpke
`Bethpage NY 11714
`
`Conti, Michael J
`MRN: E3180479, DOB:
`
`Adm: 3/26/2019, D/C: 3
`
`Hospital Record
`
`ewevavveyaomiemie
`Education continued
`
`
`
` “chack ‘with your doclor b iG any 2 program,
`
`
`
`
`
`Short waiksara a goad wayte bagin an exercise progdm.
`Stop i you experience any pain, shortness of breath, dizziness or leg cramps and report this cain to your doctor.
`
`Patients taking insulin of insulin secretagoques are atrisk for hypoglycemia#insulin dose or carbohydrate intake is not adjusted with exercise.
`Checking your blead sugar before doing any physical aaivily is important to prevant hypaglyceraia. Hf you oxparionce hypoglycemia during ar aftar
`exercise, tt must be ireated immediately.
`Summery: Leaming progress - not on fle,
`
`pnd
`opie: E. Continu
`ation of Diabetes Education after discharge and Emer
`
`
`Point: Provide contact information|for CHS Diabetes Self Management Education Centerclosest to home (Active)
`
`
`aaaaieichNABenTEteasdetBARGEROAASSASSINeISSNRLEaonabsencestechLSStt
`waeiain
`
`
`Descrigtion:
`Priovide gach na
`¢ with the contact information for the CHS
`
`ation Center closest to their home.
`Diabetes Self Management &:
`
`SSH. S16-820-22 44. SFH: 416.
`29-2070; MMC: 516-705-2532; SCH: 631-474-6449
`(i has been shownthat i
`
` ood of themkeeping them. 7
`appocirimenis while patients are in the hospitel increeses ik
`
`part of "Meaningfid use 2").
`Summary: Learing progress - not on Be.
`
`Point: Patient able to verbalize to call MD or seek medical interventionfor patierns of low and high blood glucose levels as defined by the
`
`phys
`speci
`the patient'shealth status (Active)
`
`oi
`irnainalehanRAARCAARAocitaAASAWKMREDSacbaoahhdikindRndRbbaobabLiebdRisceinbbainedebhiandtbh
`MNsitaainiindbaiohimineatindutiibinclnplanieeadashoatace
`“Summary: L
`
`
`
`
`
` purpose of
`efficacy, and &symptoms tcfo "63port.
`Summarys Learning progress - aot on Me,
`
`
`Point: Insulin Lispre (Active)
`
`
`
`
`
`
`Description: Instrucl learners on name anddf purpose oofime
`
`
`appropriate, inchida feodidnug,‘nteractio
`
`
`38, Penariing of
`cations and possible sida effects.
`eticacy, and symptoms to report.
`Summary: Learning progress - not on fie.
`
`Pol
`
`
`
` efficacy, and symptoms to repert.
`Summary: Learning progress - ant on fie.
`
`Point: Atorvastatin Calcium{Active}
`Descrigtor
` propriate. include food
`
`efficacy,
`2id symptomsio regert.
`Summary: Learming progress - not an file.
`
`
` Sy iptoms to
`
`earning prouruss - not on fe.
`
`
`
`
` nate, inchihe
` onnate nck Tanpr
`
`013
`
`
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 PM
`NYSCEF DOC. NO. 89
`
`INDEX NO. 605898/2020
`
`RECEIVED NYSCEF: 05/10/2022
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 P
`NYSCEF DOC. NO. 89
`
`TNDEX NO.
`
`
`
`
`RECEIVED NYSCEF: 05/10/2022
`
`
`
`605898/2020
`
`
`
`
`
`si. Joseph Hospital
`
`
` OME PY 48
`Al the heart af health
`
`ST. JOSEPH HOSPITAL
`4295 Hempstead Tpke
`Bethpage NY 11714
`Hospital Record
`
`Conti, Michael J
`MRN: E3180479, DOB:
`— Adm: 3/26/2019, D/C: 3
`
` atientEducation(continu
`
`
`
`Tame and purpose of n
`
`
`efficacy. and symptoms te eapart,
`Summary: Learning progress - not onfite,
`
`
`Title: Interdisciptinary Patient/General Education Record CHSLI {Active}
`BEVELERRARTASESERERTALTARSEOEEESELMBUEAceUNAHUnSESEei FevELeHEWEebdesnnNesddabeSVb1euCblassiaetyclestoaetayNeseen SUVASSaEiaVERSEENGRTEUSSUEBAGbeaVENUEGEOUEUEEOSLSDSHANAARNEONaANEN idk4bChaSUL44UHwaiinandeandedtsawheselinaTacdadebavsiacesydes
`
`Topic: PationtsDischarged«onWarfarin(Active}aioieAVeateeBS8SaAESYDasHaTOLBSERISaLENovacaAEAUt
`
` aTeiSieEReaDTAa O68skSaSNBRAS eadaneaseCNRSEEN AE
`
`eaCDaehSaaadLosDakbasssadeaseeaadneusuataensaagockedepans
`
`
`
`
`Pat awas provided writitten documentat
`‘$} and Verbal ed cation on
`(
`
`
`é iatary advice, which include:
`Concurung a consistent amount offoods with Viamin K cather than avaiding them
`Avoiding maior Cranes|in dietary habits
`Contacting§your decter prior lo changing any dietary hapits
`Summary: Leaming progresHSS > nolan He.
`
`
`
`seepingbthatebsalied
`
`Point: Follow-Up Monitoring {Active} ee
`rite
`DennisobasaaRAHaiiNEMASSAI
`
`Doscrinian: Patient wa & provi ed written document
`STAYS) and yerba sues
`fan onfollow. ug monitoring for Warfarin Therapythat lachide follow
`
`
`
`r their Warlaria Therapy.
`up with gootor within t week post discharge to moni
`Summary: Learning proaress - aot on file.
`
`
`dingthepateniial tor interactio 2oneaeug roastiona,s,
` inctuding
`
`
`
`
`abont wag provided written decurnenintion (AVS) and varbal
`CHT TOK
`Howdiet and medication can affect the INR level
`Howthe patient should not lake or discontinue any medications, over -fhe-counter medi
`ations, vilamins, or herbal products except onthe edvice of
`their ductor or a pharmacist
`How Viarfarin increases the risk of bleeding andthe patient should call 6 doctor # theey exnerieries eymploms such ae unusual bruising or heading
`Summary: Learning pre
`§~nolon He,
`
`
`
` ator and back
`antontfie,
`
`oxygen cylinder systern.
`Summary: Leaming progress - not on fe.
`
`umimary @arningy
`
`proures
`
`oZs
`
`iP7
`
`pg
`
`s
`‘>3 fot<&
`ig
`
` ebdvabvendceabienavned eash eekyaeg ay cde oebevesnets SednaNTnaEte bbphy ebenugvadeshived sabcaiheeb ewesravesaronde
`
`
`
`
`014
`
`
`
`FILED: NASSAU COUNTY CLERK 05/10/2022 09:16 PM
`NYSCEF DOC. NO. 89
`
`IN
