U.S. Department of Justice Peter F. Neronha United States Attorney District othode Island 50 Kennedy Piaza. Fioor (401) 709?5000 Providence, Rhode Island 02903 FAX (401) 709-500i August 31, 2015 Jessica Jewell, Esq. Neal McNamara, Esq. Nixon Peabody LLP One Citizens Plaza, Suite 500 Providence, RI 02903-1345 RE: Eil v. Civ. No. 15?cv-99 Dear Jessica and Neal: Enclosed please ?nd documents hates?stamped DEA-03813 in the above- referenced matter. Also enclosed is a disc containing DEA-03814, which is a video recording. As we have discussed, these documents are being produced in response to your client?s February 1-, 2012 request for documents under the Freedom of Information Act 5 U.S.C. 552, which requests exhibits admitted into evidence in the matter of United States v. Paul H. Volkman. This production includes the remaining documents in the Defendant?s possession that are being released in response to your client?s request, subject to the redactions described below. Thus, this is the ?nal production of documents in this matter. In keeping with our previous communication, our understanding is that this production will obviate the need for any further litigation. As with the previous production, the enclosed documents contain redactions to protect the privacy of third party individuals, which is exempt from disclosure under FOIA Exemptions and and under the Privacy Act, 5 U.S.C. 552a. Speci?caliy, these redactions were made to remove identifying information for third parties, which includes, for example, names, social security numbers, addresses, telephone numbers, dates of birth or death, medical and tax record numbers, insurance information, employment information, and particularly unique and sensitive personal and medical information that couid be used to identify an individual. in a few instances, the information redacted includes the identifying information of those assisting with a criminal investigation, which, in addition to raising general privacy concerns, also raises issues of individual safety under Exemption Finally, DEA numbers are not disclosed under Exemption The redactions made in these documents are accompanied by a notation indicating which speci?c exemption applies to that redaction, which appears either within or next to the redaction box. If there is confusion regarding which notations apply to which redactions, feel free to contact. me. The following admitted exhibits are being released, subject to the above redactions, in this production: Exhibits 20, 44a, 45, 48a?l, 49a?j, 51, 52, 53, 54, 56a, 57a-c, 66a, 67a, 69c, 71/102, 72, 73, '75a, 75g, 78, 80, 83a-e, 89a-b, 90a-b, 91b-d, 94, 96a?b, 97a-explained in our earlier correspondence, there are certain exhibits in the possession of the Defendant that are responsive to the above-referenced OIA request that contain the medical records of an individual who is named in the transcript of the trial of United. States v. Paul H. Volkman such that the individual could be associated with that speci?c exhibit. These exhibits consist entirely of the individuals? medical records. In these instances, redactions cannot protect the privacy interests of the individual, as they are already identi?ed in the trial transcript. As such, these exhibits are being withheld from production pursuant to FOIA Exemptions and as well as the Privacy Act. One such exhibit is a video recording of a medical visit by a patient. Relatedly, several exhibits pertain to individuals who have passed away, including detailed autopsy and toxicology reports, reports of post-mortem exams, and photographs of the deceased. These specific items are also being Withheld in their entirety to protect the continuing privacy interests of the deceased as well as their relatives under the same statutory requirements. Finally, at least one exhibit contains tax records of an individual, which cannot be disclosed pursuant to Exemption The exhibit list accompanying the Complaint ?led in this matter, as well as the publicly?available trial transcript, should provide any additional detail that is needed regarding the contents of these documents. The following exhibits, which consist of 4,927 pages, are being withheld for the reasons described: Exhibits 17b, 44b-g, 55, 56b, 58a?c, 59a~c, 60a~b, 61awd, 6Za-c, 63b, 64a, 64c-d, 65a- d, 66b?c, 66e-f, 67b~d, 67f, 67h, 68d, 69a-b, 69d, 75b, 75e, 84a~c, 85, 86a~d, 87a-c, 88c, 890, 91a, 91g, 92a?b, 93, and 95. Finally, as we have discussed, the docketed trial exhibit list in the criminal matter appears to include certain exhibits that were admitted into evidence but that are not in the possession of the Defendant. These exhibits appear to include Exhibits 75h, 77, 82, 89d, 99, 100, 103, 106, 107, 108, 109, 110AA, BB, CC, DD, and, As stated above, it is our understanding that this production removes the need for any further litigation in this matter, making the withdrawal of the Complaint appropriate at this time. If you have any questions or concerns regarding this matter, please feel free to contact me. Sincerely, new,? My ?s?iethany N. Wong Assistant US. Attorney Enclosures uuHquHGI-s IG'aiLu Reg? Dm' VITAL STAT{s'ncs 32$; REQ- Dist No. - CERTIFICATE OF DEATH Siate Fife N6. FDR ODH Regisfrar?s No. TYPE 0R pRm'T BLACK WK A - .. 1 Decedenis Name rFirsr Middre. _2.Sex 52..Dateorneatnmm,p.,,ym Yes No DEATH unwraan 1H5T1TUTION.GWE aEsgna-JCE BEFORE :03. Method ofDisposition 20b. Pace of isioa ere cemetery. Cmmalwy 20c. Location ci: awn, Ste Ea Burial' Cl Cremation t) Removal from 5mg 20? We 0' D?sm'?m _?La=v *6 "mar :23.aand eta ty (1m Gigs:ng 3Ralph F. Scott Funeral Home, Inc. - - -- . - 1422 Lincoln Street 2 25' ?0 Portsmouth, OH 45662~3619 "563. Signature of Persnn issan Permit .5 22b 'r foibcen' 26b. Dist No! '27. Date Parfait issued 233- (Czar One) CI Certifying Physician To the best my knmdadga. death Damned' at the ?lm, dale, and pbca; and due in the causa?} and manner as stamd? . Coroner On 1119 basis of examination andJor in my death owned a! 1116 lune: claim and place: and due to the pmmats) and manner as stated 28b. Time of Death' . bunce Dam Year} 28d. as Case Referred to Coroner? . - - .Yes rs; No 2f License Number 289. ate x. maximum immli ?awed Onset Ind Damn 30,Pan?. 3. Eur Iha aim, or complicalmns Inst :2qu me death Do nix emer the mode of such as cardiac or wast. shock. or hen-?1 fn?mm List eniy nne cause on such line. Type or print In permanent blackink. 5 ran 7L I .vquem ?y . . ?ua 0 max; 8' H?sequen .6 2% lmmadiah Cans-a 3 a. (Final disease ormnd?ion ramming death cause" EnlarUndud 1 Cause I mmsequence of): evenls rasuftmg :21 deathConsequenbe of): CALI SE 8? EEATH Part 21. Other Signi?cant Conditions contributing to deaih bu: not in ihe undenying cause given in Part 31a.Was in mm Ware Amang Fumes I Performed? Anni-Ebb Print Tn cur-mam 55E ENSTRUCTIDNS - - or Clus- nr Dun? DNREVERSESIDE a" . Ms No ?Y/es No 32. MannarOfDeam ?33. Date of?n'nry 33b.Time of ?njuw' 33c. iniury atWork? 33d. Describe How injury Damned i 0 5.323% . rm No; .3fo 1mg. Demude 33- (Specify)? x, .. HCA 271? SUNS Dalarmnned - 5152.05 Homicide DEA-02034 7 lerk, Scioto County Coroner, do hereby certify and attest th aad certi?cate to be a true and accurate copy of the death certi?cate on ?le in the Scioto County Coroner?s Of?ce of the following deceased: Date STATE OF OHIO) of Scioto 7) f" I?w On this day of . 2006, before me personally appeared the above? named individual, to me known to be the person described in and who executed the foregoing instrument and aclmowledged that he executed the same a his own ?ee act and deed; In testimony whereof I have hereunto subscribed my name at Portsmouth, Ohio, this day. My commission expires 0 My 4,2010 DEA-02037 Um>-omowm ?imtw .3. WW KW (jut-Sivth -7 The Boorum Pease? Quality Guarantee The materials and craftsmanship that went into this product are of the finest quality. The page: . . Ire thread sewn. meaning they are bound to stay bound. The inls are moisture resistant and will . i not smear. And the uniform quality of the paper mores consistent rulings, excellent writing surface and erasability. II any time during normal use. this product does not perform to your expectations, we will replace it free of charge. Simply write to us: Boorum Pm Company 48 S. Service Road. Suite 400, Melville. NY 11747-2340 3? I i 't Attn: Marketing Services - a Any correspondence should include the book title stamped at the bottom of the spineOne Good Book Deserves Many Others. Look for the complete line of Boot-um a; Pease? Columnar. Journal, and Record hooks. Custom- designed books also available by special order. For more information about our Customized Book Program. contact your office products dealer. See back cover for other books in this series. Made in Canada 3930703 - DEA-02039 - 0-5 ?lmmak- Page 0?..H DEA-02040 - .t .5 150 . 0?4. "g i 0mm Fan Vitoth ES .- - iv] The Boorum 8i Pease? Quality Guarantee :1 The materials and cransmanship that went into this product are of the ?nest quality. The pages are thread sewn, meaning they are bound to stay bound. The inks are moisture resistant and will not smear. And the uniform quality of the paper assures consistent rulings, excellent writing surface and if. at any time during normal use, this product does not perform to your expectations, we will replace it free of charge. Simply write to us: Boomm Peas: Company ?8 S. Service Road" Suite 400. Melville, NY 11747-2340 Attn: Marketing Services Any correspondence should include the book title stamped at the bottom of the spine. \n i One Good Book Deserves Many Others. Look for the complete line of Room 8: Peasem Coinmnar. Journal, and Record books. Custom- deslgned books Ibo available by special order. For more information about our Customized Book Program. contact your of?ce products dealer. See back cover for other books in this series Made in Canada 8030703 go. 1% . 'L1.b .. - 4 ?t?lant..- - 0932043 wo?Mr-A .w 4, Ct: . DEA-02045 9.. '33" - ?$3374 DEA-02046 ?zrrz?lh ?1 a The Boorum 85 Pease? Quality Guarantee The materials and craftsmanship that went into this product are of the ?nest quality. The pages are thread sewn. meaning they are bound to stay bound. The inks are moisture resistant and will not smear. And the uniform quality of the paper assures consistent ruling. excellent writing surface and erasahility. ii?, at any time during normal use, this product does not perlonn to your expectations, We will replace it free of charge. Simply write to us: Boorum Pease Company 48 S. Service Road, Suite 400I Melville. NY ?747-2340 Attn: Marketing Services Any correspondence should include the book title stamped at the bottom of the spine. . . . - . One Good Book Deserves Many Others. Look for the complete line of Boorum 8: Pease" Columnar. Journal, and Record books. Custom- designed books also available by special order. 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Hum Juan Dq 4-31 11-31] 3:3 I I I 4'31 I am 5:12DEA-02049 rm. (:30 mm; I: 3 {fanswemdal' ?when 0233, m. i?mgsO DEA-02051 I .. . 0 .29.: run .110. DEA-02052 w? .J?y mo? .2 . DEA-02053 PM (?er Mini? The Boorum 8C Pease? Quality Guarantee The materials and craftsmanship that went into this product are of the ?nal quality. The pages are thread sewn, meaning they are bound to stay bound. The inks are moisture resistant and will no! smear. And the uniform quality of the paper assures consistent rulings, excellent writing surface and If. at any time during normal use. this product dos not perform to your expectations, we will replace it free or charge. Simply write to us: Boomm 8: Pease Company 48 S. Service Road" Suite 400. Melville. NY ?747-234. Attn: Marketing Services Any correspondence should include the book title stamped at the bottom of the spine. One Good Book Deserves Many Others. Look for the complete line of Room 8: Pease? Columnar. Journal, and Record books. Custom- designed books also available by special order. For more information about our Customized Book Prop-Inn, contact your office products dealer. See back cover for other books in this series. Made in Canada 8030703 ..- . . I .. LA. if DEA-02054 Ti? DEA-02055 Um>uowomm -.- ?t-v The Boorum 8c Pease? Quality Guarantee The materials and craftsmanship that went into this product are of the ?nest quality. The pages are thread sewn, meaning they are hound to stay bound. The Inks are moisture resistant and will not smear. And the uniform quality of the paper assures consistent rulings. excellent writing surface and erasahility. II. at any time during normal use. this product does not perform to your expectations. We will replace it free of charge. Simply write to us: Boorum Fuse Company 48 S. Service Road" Suite 400, Melville. NY 11747-2340 Alta: Marketing Services Any compomlenee should include the book title stamped at the bottom of the spine. One Good Book Deserves Many Others. 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Qq 30 0?1. 190' 30%_ ??24 NL ?at-aw? 9Q 33, :1 co 91:35 'l I 9791:214:34; 30 30. f3). .33. 1 13:13 oq 2341 m, 3?17 0? 43* 09?. 34] oq 2'10?. .. ,5 5 P.8- DEA-02073 I DEA-02074 Lg: r. WE- Lee-:2 .L- LEE i .519. -5: I I 5 7. 2 n_u A . "?111 'I?mv a: . .Jovwm Ps-trm? :n WM "3/5750 ?3 kmme Widgets The Boorum Pease? Quality Guarantee The materials and cra?smanship that went into this product are of the ?nest quality. The pages are thread sewn. meaning they are bound to stay bound. The inks are moisture resistant and will not smear. And the uniform quality at the paper assures consistent rulings. excellent writing surface and erasability. If, at any time during normal use, this product does not perl'onn to your expectations. We will replace it free of charge. Simply write to us: Boorum 8: Peas: Company 48 S. Service Road" Suite 400, Melville. NY Min: Marketing Services Any correspondence simuld include the book title stamped at the bottom of the spineOne Good Book Deserves Many Others. Look for the complete line of Boorum 8: Pease? Columnar. Journal. and Record books. Custom- designed books also available by special order. For more inl'orrnation about our Customized Book Program. contact your oilice products dealer. See back cover for other books in this series. Made In Canada 3030703 I. 7.4a?? 9.3- . . nA -- ,Onwup?'br? 31% silk-M. kl. nw. Page DEA-02078 5? (IL _lolsan Lag_p/m 1:20 we . 5991'? Jillian..? "Dkaa a .. i oLroAb .. at! I 5 . (fl/5oz? {0/1239 vii DEA-02079 pi. 9 DEA-02081 . - any?. DEA-02083 4 . v. - ?r?nvu'i'u - The Boorum Pease? Quality Guarantee The materials and craftsmanship that went into this product are of the ?nest quality. The pages are thread sewn. meaning they are bound to stay bound. The inks are moisture resistant and will not smear. 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E5 Emuk_ .aarhk? To.? 3.. a: .PI- 7w? ELIE . kl 1&5 I . . 9.x? 1* am 2. Fi I DEA-02085 5&1- - [3?DEA-02056 1* Wu :1 "c . I .. {Lia .- . :elmkm- Qt?mnmm low I "f ?y gages/1A0 L133 LILUH (?iwg?hf ESL Lia ligm i?mr The Boorum Pease? Quality Guarantee - The materials and that went into this product are of the timer quality. The page: are thread sewn, meaning they are bound to stay bound. The Inks are moisture resistant and will not smear. And the uniform quality of the paper assures consistent rulings, excellent writing surface and erasabitity. it, at any time during normal use, this product does not perform to your . expectations. we will replace it free of diarge. Simply write to us: Boorum I: Pease Company - 40 8. Service Road? Suite 400, Melville, NY 11147-2340 Ann: Marketing Services Any eon-espondence should Include the book title stunped at the bottom of the spineOne Good Book Deserves Many Others. Look for the complete line of Boornm Peon. Colnmnar. Journal, and Record books. 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DEA-02104 DEA-02105 mowmoimo . . k?fbom?o knit} The Boorum Pease? Quality Guarantee The materials and craftsmanship that went into this product are of the finest quality. The pages are thread sewn. meaning they are bound to stay bound. The Inks are moisture resistant and will not smear. And the uniform quality or the paper assures consistent rulings, excellent writing surface and erasability. If. at any lime during normal use, this product does not perform to your expectations, we will replace it free of charge. Simply write to us: Boorum Pease Company r. WV. w?av?w . 48 a Service Road. Suite 409. Melville. NY 111474340 Attn: Marketing Services 5 Any correspondence should include the book title stamped at the bottom of the spine. '1 l, One Good Book Deserves Many Others. Look for the complete line of Boorum Gt Pease? Columnor. Journal. and Record books. Custom- designed books also available by special order. For more information about our Custom'ued Book Program. contact your o?'lce products dealer. See back cover for other books in this series. Made In Canada 3030103 r? .. . I maul-vera- ?mwmv . . Page n?o??v?rDEA-02108 DEA-02109 0.. PNOLQMO Log. song Wm; a. Two-v - om?. The Boorum Pease? Quality Guarantee I. - The materials and cra?smanship that went into this product are of the ?nest quality. The pages are thread sewn. meaning they are bound to stay bound. The inks are moisture resistant and will not smear. And the uniionn quality oi the paper assures consistent rulings, excellent writing surface and erasability. If, at any time during normal use. this product does not perform to your . expectations. we will replace it free of charge. Simply write to us: Boorum 8: Pease Company 48 S. Service Road" Suite 400, NY ?747-2340 . Attn: Marketing Services Any correspondence should include the book title stamped at the bottom of the spine. 'v?e amnmm cram?w One Good Book Deserves Many Others. 1' Look for the complete line of Boorum l?easeo Coiurnnar. Journal, and Record books. Custom i daigned books also available by special order. For more information about our Customized Book Program. contact your of?ce products dealer. See back cover for other books In this series. Made in Canada 3030103 a. DEA-02111 7 1 A DEA-02 F?x _x 3 1 1 2 0 A [Illi- I. 3, FNonFrorn: >Reply-To: >To: "paul volkman" >Subject: Re: chronic pain treatment, southern ohio >Date: Wed, 29 Oct 2003 07:47:29 -0500 >MIME-Version: 1.0 >Received: from mail14.atl.registeredsite.com by mc7- Q6.hotmail.com with Microsoft ed, 29 Oct 2003 04:48:01 -0800 >Received: fro mail l4.atl.re isteredsitecom >X-Message-Info: >Message-Id. >X-Sender: >X-Mailer: >Remm~Pathzw >X-OriginalAmva Time: 29 Oct 2003 12:48:02.0297 (UTC) 9E1 >Dear Dr. Volkman, >Thanl< you for sending me a copy of your letter illuninating the corrupt economics and politics of pain treatment in your town. I hope you can publicize yoUr experience, which in microcosm captures the perversion of politics both domestic and international. >I'm somewhat mysti?ed as to how you are surviving in the setting you describe. What measures are on takin to enhance your personal security? Feel free to e-mail me or to call me M, if that's more convenient. >With warm regards, -- Original Messa >From: "paul volkman" >Date: Sun, 26 Oct 2003 - >1 left you a phone message today, but maybe you will get this ?rst. I am a >physician working in a chronic pain treatment clinic in Portsmouth, southern >Ohio. I read your article of Oct 23 and wholeheartedly agree with your >major points. I am about to write a long and detailed report of my >experiences in the clinic since my arrival in april, but I would love to >talk to you to gain additional exposure and publicity for the plight of DEA-02197 >chronic pain patients and the doctors who attempt to treat them. >Southem Ohio is a deeply depressed area with essentially no functioning >industry and few jobs except for service sector. Lots of car repair shops >and fast food. Lots of drugs, prostitution, corruption, violence and >despair. Several doctors in the area have recentl been convicted of >selling narcotic prescriptions >and there are levels upon leve corrupt 1013 0 were pai off to >look the other way. There have been murders in broad daylight seen by half >the town which remain mysteriously unsolved; reports of cut up bodies found >in the new bridge foundations on route 23. It is common knowledge that >there are several clinics where narcotic prescriptions are freely dispensed >to anyone who can pay the $250 "of?ce visit" (no doctor ever sees these >"patients"). The New Boston, Ohio police get $50 for everyone who 063 >throug?h the doors. The only honest policeman in the department >(who now works for us as a security guard) has been hounded off duty with >bogus charges; he is now suing the town and the police department for $5.7 >million. Many pharmacists are much more interested in selling their >narcotics out the back door than in ?lling legitimate scripts; if >threatened with an inspection they are hit by unfortunate "robberies"- >Our clinic, Tri-State Health Care, was started several years ago a brilliant, tough matriarch who essentially . iters, construction workers, truck drivers, carpet layers >who have been mined by years of hard work and various wrecks, but who >eagerly return to working 60 to 80 hours a week when given enough pain >medicine so they can walk. >Starting about a month after I arrived at the clinic, local pharmacists >began callin each other (we think at the instigation of some of the crooked >ones and/orhand his business associates) and spreading transparent >lies that they a used as covers for not ?lling my prescriptions, like I >was under investigation, I did not have a license, I was working for etc. etc. Soon, there were no pharmacies in the area which would 1 my pain medicine scripts, and my patients were driving to Columbus, >Cinn, and Huntington to try to get their medicine. At that poin nd DEA-02198 2* >1 realized that the only way to continue was to start our own pharmacy and >dispense all the scripts that I wrote. Several months later, we are >starting to get it right so we have the needed meds on hand, but it has been >a struggle. Throu hout we have been harrassed by the Portsmouth police, came to the of?ce clearly looking for payoff >money. ave een arrassed by the Kentucky Pharmacy Board who has >intimidated pharmacies from ?lling our scripts. Our patients have been >harrassed by Ohio Pharmacy Board investigators who have accused people of >being drug dealers. In several instances, our patients who went to Columbus >to get their meds were handcuffed and dragged out of the stores by security >who called the Columbus police (lawsuits are in preparation!). Until we >started ?lling our own scripts some patients who went to were ripped >off and extorted by pharmacists, charged $300 for scripts that were formerly The Portsmouth police have sent at least one individual into our >of?ce wearing a wire; we found out and dismissed him for violating the >narcotics agreement which stated that no person can come into the of?ce >posing as a patient and obtain scripts unless for treatment of legitimate >pain. Pharmacists have routinely refused to ?ll my scripts, telling the >patients that am under investi ation am about to lose my license, am >about to be thrown in jail lik and they should go to another >doctor" We have a number of these defamatory diatribes on tape. When I >repeatedly call the Ohio Medical Board to ?nd out if in fact I am under >investigation, they think it amusing, and tell me there is no investigation, >but do nothing about the questionable activites of the Ohio Pharmacy Board >investigators, who are nothing but apologists for the crooked druggists. >All of this experience is consistent with deep and wide prejudice against >chronic pain patients and the doctors who treat them, even among family >members and friends and even the patients themselves (they think they should >be able to bear the pain without complaining and without meds, otherwise >they are weak or somehow immoral for needing narcotics). When widespread >drug abuse is mixed into the situation, you can see how hard it is for an >honest doctor and clinic to take care of' real patients who are suffering >needlessly. hepe have not lost you half way through. If you are interested in >continuing your investigations, I hope you contact me. >Paul H. Volkman, MD, >Surf and talk on the phone at the same time with broadband Internet access. >Get high-speed for as low as $29.95/month (depending on the local service >providers in your area). . DEA-02199 VV just told me about your listserv. I would be happy to receive any support as well as publicity. My situation, in brief, is that I was a medical pain management doctor in southern Ohio, when I was shut down by the DEA Feb 10, 2006. tied out office, emptied out my bank account (and that aim, and suspended my DEA certificate. They did not fi crimina 5 against me, over 18 months after the investigation started. I am perhaps the ideal poster boy for a pain doc unlawfully and inappropriately attacked by the DEA. I am certified by the Amer Acad of Pain Management, I have a in Pharmacology and extensive experience in CliniCal Pharmacology, 25 years experience in Emergency Medicine, Family Practice and Pediatrics. I was always been extraordinarily careful to monitor my patients with frequent office and hospital drug tests, demanded that my patients keep their medicine in a safe and dismissed them if their medicine was "stolen". At present, my "expedited" DEA hearing on my certificate suspension is underway, 11 months after the suspension. The hearing is an obvious farce, with the DEA "judge" bowing and scraping before the DEA attorney, who is a complete moron without a clue of how to present witnesses or evidence. All of the "evidence" presented is rank hearsay of drug addicts or attributed to drug addicts, which if true helps me out as it shows that the individuals obtained medicine by deception and then took it in an unauthorized manner. The DEA attorney is so clueless that he did not even object when my attorney 1 DEA-02200 got the head DEA agent on my case to admit that he completely left out all exculpatory evidence in writing up the affidavits presented to the magistrate judge to obtain the search warrants, the asset seizure warrants and the DEA suspension- As such the agent incriminated himself by admitting reckless disregard of the truth and deceiving the magistrate judge for the purpose of obtaining illegal warrants. He thus admitted everything needed for me to win a section 1983 civil rights suit as well as a malicious prosecution suit. P5 soon as the Kangaroo Kourt concludes I plan to file an immediate 706(1) appeal with the 6th circuit court of without waiting for the ALJ's ruling, which when she ever issues it, will of course be against me. The transcript will show such eggregious violations of Due Process and my assorted constitutional rights, that my attorney expects that the DEA will have their institutional ass handed to it. Then the way is wide open for me to resume my practice of pain management while I file a whole flock of high profile lawsuits against the DEA. There is a separate federal case against my assets, a so called Forfeiture in Rem case. My attorney has filed a 1236 motion to dismiss, which has a very high probability of success. Then I will sue the US attorneys involved in that case. I honestly think that one crushing defeat of the DEA in a case such as mine could have a vast impact, even triggering Congressional investigations of the DEA and the possible appointment of a Special Prosecutor. I would welcome media attention, but realistically no one is interested until I post a big victory in court, showing that I am not just another hapless doc caught with his drug screens down. V'v M.D. Yahoo! Mail . Yahoo! My Yahoo? Mail ml MI mm. germ? mum-Harmon: 5:51 1.: a Sign up today for only SEES/month oer. Moll Check Mail I Compme I I Search mu I amoun- Well I Ml? um mm ?ue-Io: rm: WI Duet-I um I rum-rd I ep-ml I messageis mum] [m an] s..qu Fmedate ortv hug. am: Mon, 11 Apr 2005 14:12:57 43400 Chan Iron? TM II: M11) tam] 1M Dear ur- Volkman. "'deu? Dane} Thanks for your interest at the pain management department of the Cleveland Clinic. He would like to schedule an interview for you during IVSJhuu's the month of Hay. Please send me th ya of your visit and us will arrange for some meetings with the department's chair and some of our staff. us: Thanks whats mama (Wm roman-m - 1nalor ?nd Gil-Wald: ?hr FIv?GeIVuuslo-I Here you are! From: Paul Volkman {medium Sen - - 2 PM To: SubJect: - ate of cv I have been working in southern ohio tor the past 2 years in Portsmouth, at Tristate Healtheare. I have enjoyed the practice. consisting at medical pain management and learned a lot about the care of chronic pain patients, most of Whom are poor This past December we began much more intensive monitoring of the patients including frequent drug screens with Mayo clinic confirmations. This program revealed that about hall at our patients were selling their pills instead of taking them. and they were summarily dismissed. Unfortunately. that leaves me with about a half time job. I am writing to explore any opportunities for me as a medical pain management specialist at the Cleveland clinic or one of its outreach centers. Thank you for your consideration. Note: forwarded message attached. Do You Yahoo!7 Tired of spam? Yahoo! Mail has the beat spam protection around http-lluail yah DEA-02202 3 of 4 DEA-02203 ?Lergotriie in the treatment of Parkinson's disease.? H. Klawans. c. Goetz. P. Volkman. P. Nausieda. W. Heiner. Neurology ZBITI: 699?102, 1973 comparison of the vascular dopamine receptor with other dopamine receptors." L. Goldberg. P. Volkman. a. Kohli. Ann. Rev. Pharmacol. Toxicoi. 18. 51-19. 1975. "Characteristics of the vascular dopamine receptor: comparison with other receptors.? L. Goldberg, J. Kohli. A. Rotate. P. Volknan. Fed. Prat. 31(103: 239s-402- 1978 'N.N-Di-n-propy1 dopamine: a qualitatively different dopamine vascular agonist." J. Knhli, L. Goldberg, P. Volknan. J. Cannon. J. Pharnmcol. Exp. Ther 207ill. 16-22- 1970. 1917?1979 An animal model for nyoclonic seizures lepiiepayi and the study of the effect of various drugs on nyoclonic seizures. myoclonua in guinea pigs: a model for the study of central serotonin-dopamine interactions.? P. Volkman. 5. Lorena, G. Kindel, J. Ginos. Neuropharoacoiogy 947-55. 1918. ?Use of dopamine for shock in neonates [letterl.' P. Voiknan. J. Pediatrics 9415): 052-3. 1979. 1979-1981 Director of Clinical Research, Department or Anesthesiology. Michael Reese Hospital. Chicago. Illinois. Basic Research: study of various therapeutic modalities in the treatment of subarrachnoid hemorrhage [stroke from bleeding aneurysm). Clinical Studies: use or nitroglycerin during coronary bypass surgery: use oi aneiotensin and nitroprueside in stroke patients with subarrachnOid hemorihage. Private Practice?Family Medicine and Pediatrics. 1991? Board Certifications: American ?oald of Pediatrics. 1981 American Board of Emergency Medicine. 1903 and 1994 Hospital Experience as Attending Emergency Physician; St. James. Chicago Heights, IL, 1975-1978 Hurty- Chicago. IL, 1971-1919 Holy Family, Des Plainos. IL. 1979-1983 5t- Catherine, E. Chicago. in. 1969 1990 St. Therese, Haukegan. IL. 1990-1992 Locum tenens positions. 1992-1995; 1990?2000 St. Joseph, Fort Kayne, IN. 1995-1997 St. Francis. Milwaukee, wl. 1997-1998 Sinai Samaritan, Milwaukee, 31. 1999?2000 university. Cleveland. OH. 2000-2001 Northiake. Gary. IN. 3/2001-8/2002 Staff physician. Wisconsin Parkinson Association/Milwaukee Nuutol go; Movement and Sleep Disorders, 8/2002 to 3/2003 with Evaluation. treatment and continuing care or 1?00 Parkinson] Alzheimer patients using sophisticated combinations of drugs including carbidopalievodopa. Mirapex. Requip. Permax. Botigatine. Contan. Eldepryl, Eftexor. Seroquel. Remeron. Paxil, Prozac. clozarii, Zoloit. Len-pro. Renanyi and Aricept combined with paliidotooy and deep brain stimulation. Teaching and Resident Supervision Chiei Bes.den;. Peliatrics. Loyal. Heuical center. Haywood. IL, 1978-9 Sinai Samaritan. Hilwuukee. WI, 1999-2000 University Hospital. Cleveland, OH, 2000-2001 Attending Pediatrician. Children?s Memorial Hospital. i981 - Conferences and Seminars Advances in Neuropharmacology. Portsmouth. U.K.. 1976 Pediatrics Update. Port St. Lucie. FL. 1982 4/20/2005 8:36 PM 2 of 4 DEA-02204 DIN: 2 Apr 2004 15:07:04 40400 home WhmIVMk?nn' Tm Plain Text Attachmenu Paul H. Volkman. H.D.. CURRICULUM VITAE office Address: 6913 Archer Avenue Chicago. Illinois 60633 713/255-4125 Home Mum" Washington, D.C- Education: Calvin Coolidge High School. Washington. D.C. Valedictorian. 1964 University of Rochester. Rochester, New York A3 with honors. 1968 University of Chicago, Chicago, Illinois Medical Science Training Program Ph.D.-Neuropharmacology. 1972 M.D.-1974 Internship: Pediatrics. 1914-1975 Duke University Medical Center. Durham. North Carolina Fellowship: Committee on Clinical Pharmacology. 1975-1977 University of Chicago, Chicago. Illinois Residency: Pediatrics, 1977-1979 Research Associate. Department of Pharmacology Loyola Univeraity Hedical Center. Haywood. Illinois Research/Laboratory Experience: 1910-1972 Neuroendocrine pharmacology; pituitary and pineal gland studies. "Pineal N-acetyl transferase activity: effect of sympathetic stimularian.' Voikman, A. Heller. Science 171l999): 039?540. 1971 ?Neuronal control of monoaminas in brain and melatonin-forming systems in the pineal." A. ?eller, P. Volkman. and Browning. Prog- ?roln nes- 35: 257?250- 1973- 1915v1977 Basic studies or effects or drugs on renal blood flow. Clinical evaluations on new agents in the therapy of Parkinson's disease. "Similarities and difiarencea of depamine receptor: in the renal vascular bed and elsewhere.? L. Goldberg. P. Volknan. Kohli. at al. Adv. Biochem. 16: 251-6, 1971. ?Coniormational requirements for dopamine?induced vaeodiiation." P. Volkman. J. Kohli. L. Goldberg, I. Cannon. T. Lee. Proo. Nat'l. Acad. Sou. USA 14(9): 3602?6. 1977 4/20/2005 8:36 PM .30! Mail I wilderness Medicine. Lake Tahoe. NV. 1934 Children's Hospitai Grand Rounds, Chicago. IL. 1981 - Drug Policy Foundation. Chicago, IL, 1990 Policy Foundation, ?ashinqton. D.C a 1992 Drugs and the Law Drugs, Medicine and Health ACEP Board Review Course. 1994 current issues in Genitourinary Tract Infections. 1996 Ortho/HcNeil Pharmaceuticals Institute of Medicine. Chicago, 1L Ethics in Health Care Institutions. 199? Seminars on ethics; managed care: medical history: medical education: state Hedica1d provisions: changing physician practice and innovations in rehabilitation technology and long?term care. Scientific Assembly. 2001 Northieke Hospital Grand Rounds: Natriuretic Peptide in CHF, 7/2002 Chicago Institute for Conference on Freud, 3/2002 Addendum- Hedicai director, Tristate Health Care and Pain Management, 4/03 to present. Do you Yahoo!? Yahoo! Small Business Ieb Design Giveaway ~uns - D?dmmr nefi'y? 1 2 3 4 5 Prescxiption is void if mare than is wrnten per bsank m. - A i 9? ma- 4.. Imm-A?rz?' "Mu-n mm"? n1" . 22-1 my (m . 1 State Lic? PAUL MD. 1:19 Findlay Street - Ponsmouth. OH 45652 (740) 355-6949 Fax: (740) 35545946 Name Address - I I 'Date ?ij If 7 El 2549 [350-74. '75?100 .i 1 101.4559 '1 Land-ever Prescription is void if more than (1) prescription is written per blank DEA-02239 . 4State Lic. #35070722-v PAUL MD. 1219 Findlay Street Portsmouth, OH 45662 (740) 35545949 Fax: (740) 355-6946 Name . . . I Address - y??j 3.13-24' :3 25?? {k D?isolm 75-100 1 >1p1f150? '1'51 and over Prescription is wait! if more than. (1.) prescription is written per biank 1)" rm~wu??_ 5. H. Stale Lic. 5. PAUL "1219 ch??ay Street Portsmouth, OH 45552 (740) 3555949 Fax: (740) 355-6946 Name Address - . Date . Q: 1424 7/4] 2549 VD 5044.42 75-100 1101-150 l?15'1varlrd bv?JPrescriptEon is void if more than (1) prescription is written per blank mm {7 - ?S?kma 2 HeleNH12 3 4 ?5 . DEA-02241 Stale Lic, PAUL VOLKMAN, M.D. 1219 - Portsmouth. OH 45662 (740) 355?6949 Fax: (740) 355-6946 Name I Address \g . ?a . I. 2549 ngi 3% 4 '3 1" 5 I 50-74 a 75?100 3 [3 101450 7 ?4 . I .2 151 and over nemgNPrescripl?on is vo?d if more than (1) prescription is written per blank. I. - {7 Ply: EXMWm/tiow y-w I Diasto?cW. Weigh Mark in appropriate space in coiumn at ieft, if finangs are abnormal on examination and describe in space bezow. Check 1/ if ?nings are no: a?er examination I ?Eruption . .u ?Texture ?Modules ?Pigment . ?Other ?Petechiae . I i 71 W) HEAD EYES - 7 WConjunct?va mFields __Sc!era ?Comea __Lid~lag WMuvement WTension ?5 A ?Mystagmus ?Ophthalmoscopic i thher - EARS _Drums __Mastoid ?Hearing mOischarge NOSE mAirways w_Sinus Tenderness m5ep?um Wmhet MOUTH g? Wareth Ducts WTeeth "Gums . k? THROAT D?p WPharynx . *Pafate mOthEr NECK WMasses wTrachea ?Omar NODES ?Cervica! Minguinai "Epirrochlear ?Supraclavicular ?Axillary CHEST __Shape wHespira?ons 92W BFIEAST ?Masses ?Discharge morher HEART ?Sounds I tmpulse A2 P2 Third _Murmurs WShock WGaHop __Rale _Friction . - - WOIher LUNGS 3- wFrerniMs WSpoken Voice MPercussion Voice Saunds momer WAdventi?ous Sounds {:ver! .. I .. 2);me mars Medical AM a-aoo-Jza-zws Staie Lic. PAUL VOLKMAN, MD. 1219 Findiay Street - Emismouth, OH 45662 (740) 355-6949 Fax: (740) 355?6946 Name Address [1 75-100 6/ f? _7 101.150 A I 7 151 vand over Ref'w??n12345 . - lit/l. - - -: g/L. Prescr?ption is void if more than (1) prescription is written per blank EA-O 2244 -- ind Slate Lic. P5UL VOLKMAN, MD. 1219 Findiay Street OH 45662 (740) 355-5949 Fax: (7'40) 355-6948 Name 9/ Address . [1 L24 2549 i jay 3 Dim-74 {j 75400 101459 ?1'51 and aver ?4,561 Prescription is void ii more than (1) prescription is written per biank Slate Lia P5UL VOLKMAN, MD. 1219 Findiay Street - Eoctsmouth, OH 45562 (740) 355-6949 Fax: (740) 355-6946 a. DEA uwa . -um. 57.- - - ?cmg/ n? a a 7 13:; @p ?522-; ?Refih?fx?l? 5 "D'isi'ahd?kler Prescription is void if more than (1) prescription is written per biank Slate ch. PAUL 1219 Findiay Street Eo?rtsmouth, OH 45552 (740) 35545949 Fax: (740) 355-5945 v1 DEA Name v? "7/67 L24 25-49 75-100 101 ~150 A151 and 6v?r Address Date Re?l Prescription is void if more than (1) prescription is written per blank after examination Check if ?ndings are normal Mark in appropriaze space in column a! ieft, if findings are abnormal on examination and describe in space beiow. ?Eril?ti'on ?Moisture mNodulas _Hair HEAD EYES ?Conjunct?va mPtosis __Comea mEXOphthalmos mPupiS WMovement ?Tension EARS mDrums __Mas$oid ?Hearing WOther WDischarge NOSE __S?nus Tendemess ?Mucosa mTransi?uminazion WSeptum __O?her MOUTH __Brea:h mLips __Salivary Ducts mTeath __01her THROAT WPosi-nasa? Drip WPharynx *Palate ?Other NECK mVasseis WMasses ?Traci-?ea mOther NODES WCervical ?inguinai ~_,__Epitrochh2ar WSupraclavicuiar _Other ?Axillary CHEST __Shape ?Symmetry WOIher BREAST ?Masses *Nipplas WDischarge ?Other HEART WApicai ?Sounds M1 impulse A2 P2 __Thril Third WPuisa?iOn MShock mGalEop w?aw w?hy?thm WOIher LUNGS Fremitus Voice Percu55ion ?Whispered Voice Sounds WAdventitious Sounds (over) DEA-02247 MCQM 020379 - Medical Nb Press 16003284175 State Lic. 33507-072241 PAUL VOLKMAN, MD. 1219 Findiay Street - Portsmouth, OH 45662 (740) 355-6949 Fax: (740) 355-6946 0: 1! A [11?24 >0 9 D22: i (I 770 33213;, a) 64 A an over ?iiliNFHzazasg fa) E?i151 4 Prescription is void if more than (1) prescription is mitten per biank 6? $15" State Llc. 935-07-0722-V PAUL VOLKMAN, MD. 1219 Findfay Street - Portsmouth, OH 45662 (740) 355-6949 Fax: (740) 355-6946 Name Address - I Date 1-24 TV 2549 i ?50-74 75400 101?159 kin/NI) 151 and bver Refitt'lgSCI/mew" L69 Prescription is void if more than (1) prescription is written per blank A. Slate Lit: PAUL VOLKMAN, M.D. (v if; 101-150 /i 151 and over I V?wa He?lib?a 1 2 3 4 5 Prescription is void if more?than (1) prescription is written per blank - mm m0~ .u State Lic. . PAUL 1219 Findlay Street Portsmouth, OH 45662 (740) 355-6949 Fax: (740) 355-6946 Name. Address Date 1-24 ram ((60 0 25-49 . x/ 77 Ag 75-100 I . 101?150 151andover Hernan 1 2 3 4 5 Prescription is void if more than (1) prescription is written per biank \kl DEA-02251 Stale Llc. I PAUL VOLKMAN, MD. 1219 Findlay Street - Portsmouth, OH 45662 (740) 355-6949 Fax: (740) 355-6946 age"? 9 I 1:24. "'73 6 f0 2549 2?96)! 75-100 5. $101450 \2 I53 151 and over Fle?li?m? 1 2 3 4 5 Prescription is-void ii more than (1) prescription is wrinen per blank State Uc. ., PAUL VOLKMAN, MD. 1219 Findlay Street Portsmouth, OH 45652 (740) 355-6949 Fax: (740) 355-6946 ?s >8 1-24 2549 5044 75-100 101 ?150 151 and over gunman He@2345 Prescription is void if more than (1) prescription is written per blank MEDICAL A A 2201 Lexington Avenue Ashland KY 41101 Tel: 606-327?4601 Fax: 606-327-4738 Location: OPT Room: Bed: Att. physician: VOLKMAN, PAUL Req. physician: VOLKHAN Surg.date: COMMENTS: 740 355 6946 I . . RESULT AB UNITS TOEICOLOGY COLLECTED 02/28/05 14:48 LXJ PCP NEGATIVE NEGATIVE BENZODIAZEPINES POSITIVE AB NEGATIVE CONFIRMED BY ALTERNATE METHOD COCAINE NEGATIVE NEGATIVE AMPHETAMINE NEGATIVE NEGATIVE CANNABINOIDS NEGATIVE NEGATIVE OPIATES POSITIVE AE NEGATIVE CONFIRMED BY ALTERNATE METHOD BARBITURATES NEGATIVE NEGATIVE TRICYCLIC NEGATIVE NEGATIVE COMMENTS: FAX 740 355 6946 I TESTMNAME . RESULT AB UNITS TOEICOLOGY COLLECTED 02/28/05 15:10 ETHANOL (1163 mg/dl done at cabell w? 0 Location: OPT Room: Bed: Att.physician: VOLKMAN, PAUL KEY FOR ABNORMAL COLUMN: H-HIGH, AB-ABNORMAL, P-PANIC, X-ABSURD 37 of 121, 114 of 266 PRINTED 03/01/2005 04:05 Page: 1 of 1 DEA-02254 l, 930010(01/00) 9 are I MEDICAL . .0 ?a .Fayti ABORATORY 2201 Lexington Avenue Ashland KY 41101 Tel: 606-327m4601 Fax: 505w327~4738 Location: OPT Room: Bed: Att. physician: VOLKMAN, PAUL Req. physician: VOLKMAN Adm.date: 02/28/05 Surg.date: i MAYO MEDICAL LAHBOEATWORIEASE 7 RESULT AB NRML-RANGE UNITS 7?NH?Clonazepam?by Negative ng/mL EXPECTED VALUES -- Cutoff: 100 7?NH?Flunitrazepam-by Negative ng/mL EXPECTED VALUES Cutoff: 50 Alpha OH~Alprazolamwby Negative ng/mL -- EXPECTED VALUES ?w Cutoff: 100 Alpha OH?Triazolamvby Negative ng/mL -- EXPECTED VALUES Cutoff: 100 Interpretation Positive This report is intended for use in clinical monitoring and management of patients. It is not intended for use in employment?related drug testing. Test Performed by: Mayo Medical Laboratories 200 First Street SW, Rochester, MN 55905 Laboratory Director: Curtis A. Hanson, M.D. OPIATES SEE BELOW HI Expected Test Result LO Units values Opiates, Laboratory Control No. C2423 Immunoassay Screen Positive EXPECTED VALUES Cutoff: 300 Codeine-by Negative ng/mL Location: OPT Room: Bed: Att.?hysician: VOLKMAN, PAUL KEY FDR ABNORMAL COLUMN: L?Low, H-HIGH, AB-ABNORMAL, PMPANIC, 49 of 139, 151 of 239 PRINTED 03/03/2005 04:05 Page: 2 Of 3 . 930010(01/00y I It MEDICAL I y? .5 - EX R.11 2201 Lexington Avenue Ashland KY 41101 DAUGHTERS Tel: 606?327?4501 Fax: 609?327?4738 at gist-n- ii a .3 Location: OPT Room: Bed: Att. physician: VOLKMAN, PAUL Req. physician: VOLKHAN Surg.date121E RESULT AB NRML-RARGE UNITS EXPECTED VALUES Cutoff: 100 Hydrocodone?by EXPECTED VALUES Cutoff: 100 ng/mL Hydromorphone-by 1571 ng/mL w? EXPECTED VALUES Cutoff: 100 Morphinewby'GC/MS Negative ng/mL ww EXPECTED VALUES Cutoff: 100 Oxycodonewby Gc/Ms 17000 ng/mL EXPECTED VALUES Cutoff: 100 Interpretation Positive This report is intended for use in clinical monitoring and management of patients. It is not intended for use in employmentwrelated drug testing. Test Performed by: Mayo Medical Laboratories 200 First Street SW, Rochester, MN 55905 Laboratory Director: Curtis A. Hanson, M.D. Location: OPT Room: Bed: PAUL KEY FOR ABNORMAL COLUMN: LWLOW, H-HIGH, RIB-ABNORMAL. x?masmu) 50 of 139, 152 of 289 PRINTED 03/03f2005 04:05 P396: 3 Of 3 9 a MEDICAL CESR #7 (30R.ZX C311 2201 Lexington Avenue Ashland KY 41101 Tel: 606?327-4601 Fax: 606*327-4738 Location: OPT Room: Bed: Att. physician: VOLKMAN, PAUL Req. physician: VOLKMAH Surg.date: COMMENTS: 740 355 6946 H.11 C) I) I (I.A It (J C) 1113 AB UNITS REFERENCE LAB COLLECTED 02/28/05 14:47 BENZODIAZEPINES SEE BELOW HI Expected Test Result L0 Units Values Benzodiazepine Confirmation, Laboratory Control No. C2423 Immunoassay Screen Positive EXPECTED VALUES ?m Cutoff: 200 Lorazepam?by Negative ng/mL EXPECTED VALUES Cutoff: 100 Nordiazepam?by 7320 ng/mL ww EXPECTED VALUES -- Cutoff: 100 Oxazepam-by 11900 ng/mL EXPECTED VALUES w? Cutoff: 100 Temazepamuby -.7784 ng/mL EXPECTED VALUES -- Cutoff: 100 Negative ng/mL EXPECTED VALUES Cutoff: 100 Location: OPT Room: Bed: Att.ph?sician: VOLKMAN, PAUL KEY FOR ABNORMAL COLUMN: L-LOW, H-HIGH, IKE-ABNORMAL, P-PANIC, I-RESURD 43 of 139. 150 of 239 PRINTED 03/03/2005 04:05 Page: 1 Of 3 93001 0 (01/00) I I:wa Patient Last Name 4 Check it findings are normal after examination DATE . e: Systoiici Diastoiic Mark in appropriate space in coiumn a: Eef?l, if ?ndings are abnormai on examination and describe in space beiow. __Coior mEruprion ?Moisture _Nai!s mNoduies wPigmenl ?Pezecmae HEAD EY ES __Conjunctiva ??elds *Ptusis ?Cornea ?Maven-ran: mTensEon "Nyssagmus ?OphMImoscnpiC WAG-lily meme: EARS _Masmid HHearing _Discharge 03 ?Sinus Tenderness MMucosa ?Transinuminat?cn WSemum WOmer MOUTH marealh ?Tongue wSaiivary Duas mTeezh THROAT ?Tonsil: mPusz-nasai Drip ?Pharynx WPalaze Meme: NECK MSt?i??ness ?Vesseis ?Masses ?Other LY ODE WOCCipita? mEpilrochtear ?Axi?ary HE ST ?Shape w_Other BREAST ?Masses ?Discharge "Caner ?Apical ?Sounds M3 Empe!se A2 P2 anrm Third ~Pu$saiion WMurmurs WShock wGaihp ?Other LU NGS ?Fremitus Voice "WI-Espered Voice Sounds __Omer __Adventit?ous Sounds (over) [20379 - Magma Ans Pug, I few [gimme 1? N- ma-;n ?vim DEA Slate Lic. .53.. PAUL 1219 Findlay Street - Portsmouth. OH 45662 (740) 355?6949 Fax (740) 35543946 . mie?m. Izzy)? a Date [1 1-24 [1 25-49 5074 [1 75-100 101?150 151 and over Prescription is void if more than (1) prescription is written per blank I 1219 Findlay Stre?t Portsm?i?h?H 45662 (740)355-6949 Fair: (740) 355?5946 Slate Llc. PAUL VOLKMAN, M.D. [j L24 a} 2549 75?100 9 101450 Fl 151 and over 1 2 3 4 5 Prescription is void if more than (1) prescription is written per biank A SIate Lic. PAUL VOLKMAN, MD. 1219 Fundan Street 4 Portsmouth, OH 45662 (740) 35546949 Fax: (740) 355-6945 Name Address 75100 ., $101450 El 151 and over i 76/79 x/ I I Re?if?wi 1 2 3 t1 5 Prescription is void if more than (1) prescription is ertten per biank ?1 5 1? I I I fig/SW - Wm Pa?GEERL: A . . ssure: Systolic ,Diastoli 3 ?fe norma Mark in space in column a? left, if ?ndings are abnormal after examination on examination and describe in space below. SKSN . __Co!or mEruptSon ?5 I ?Muiszure ?Nails a mTexture ?Hair . ?a - __Petechiae .. HEAD - EYES - ?Conjunctiva ?Selma mPtosis mComaa _Pupil ?Lid?lag mMovemen! WTension ?Ophthalmoscopic wACuiTy EARS WMasloid ?Hearing ?Other mDischarge NOSE Tenderness mMucosa WOther MOUTH ?Breath mLips __Salivary Ducts __Teeih MOther ?Gums THROAT ?Tonsils ?Post-nasai Drip tharynx #Uvula mPalate MOther NECK mSiiffness WVessels mMasses ?Thyroid ?Other NODES minguinal mOccipital ?Epizrochiear ?Supraclavicular WOther mAxiiIary CHEST BREAST ?Masses w?Nippies. MOther HEART __Apicai __Sounds M3 impulse A2 P2 ?3mg! Third mPulsation MMurmurs ?Shock mRate Hon-gar LUNGS mFremitus Voice ?Percussion mWhispered Voice MBreath Sounds *Adveniitious Sounds (cue!) ~75 '33 ?20379 - Medical NT: PM: 1-800-323-2179 {625% {0/1 0 Mag/M 90(3sz 357%) Ur (5 am 59:27 QC ?6 6/4, {4f 7 1 - DEF 3. 1 State PAUL VOLKMAN, Mp. 1219 Findlay Street Portsmouth. OH 45662 ((740) 355-6949 Fax: (740) 355-6946 Name 7 Address - - - Dale {ff/l 1?24 I: ?t v29 a - [150?74 75400 47 101-150 A 151 and over MW Prescription is void if more than (1) prescription is written per blank 1? DEA-02264 Stan; Lic. PAUL VOLKMAN, MD. 1219 Findtay Street Portsmouth. OH 45662 (740) 355-6949 Fax: U40) 355-6946 1~24 r; a 25-49 1/ @g 75400 m] 1 101-150! [j 151 and oiler a" . ,1 L. Prescription is void ?f more than (1) prescription is written per blank DEA-02266 Stale Lic. PAUL VOLKMAN, M.D. 1219 Findlay?Slreet Portsmouth, OH 45662 (740) 355-6949 Fax: (740) 355-6946 Name Address 1?34 a a a . :1 A?kj? lifj? L1 50?74 I 1] 75-100 [3 1017159 J. 2 151;,andiover HefiliNrR)12345 . {it if Prescription is void if more than (1) prescription is written per biank Stale Lic. PAUL 1219?Findzay 45662 (740}35543949 DEA Name Address 1-24 . I I .2549 - 6.3 4 7E1 50-74 I 4 75,100 .. I 101-150 I 1"51'andoVer I Rem?? 1 2 3 4 5 Prescription is void if n'fore than (1) prescription is written per blank State Lic. PAUL VOLKMAN, MD. 1219 Findlay Street - Portsmouth,'OH 45662 (740) 3556949 Fax: (740) 3556946 Name Address @owwr -: 50-74 6/ 6 75100 . 101-150 a onQLr?fL i v, - 151 and ov?r RefiliPrescription is void if more than (1) prescription is written per blank State Lic. ?335?07-072?2-v PAUL VOLKMAN, MD. 1219 Findiay Street OH 45562 (740) 355-6949 Fax: (740) DEA Name Address a It - I 1) a 1-24 TV . 1 2549 O) (A K, F7 13-5074 if r? A. 75?100 S?nf' [3/21. 101-150 I Wand-aver 2 3 4 5 Prescription is void if more than (1) prescription is writter'i? p?er biar'fk mam-m! mm mu?: -. HWB: ?Israte #350755? PAUL VOLKMAN, M.D. 1219 Findan Street - Portsmouth, OH 45662 (740) 355-6949 Fax: (7405 355-6946 Name . Address 1-24 (72% 2549 . 5074 75-100 if) I 101-150 (I 151 and over Barium/?it? Presuription is void if more than (1) prescription is written ?er bla?k PAUL VOLKMAN, M.D. . I I A 1219 Findtay Street Portsmouth, OH 45662 (740) 3?55-5945? Fax: (740) 3556946 Name Address If. [2 75-100 101?150 151 and over [Aw Prescription is void if more than (1) prescription is wr?tten per blank ne?iwn 1 2 3 4 5 0mm FROH- r-nsa palm MM THE 1155 mm mm mm FEDICN. CENTER BRIE 1 BHJD Inn!? inn-4:3 mums? mm: 33.7mm mam: ?25# E319 TEST REFERENEE mm .3 ll? HEIDI. .Bf TBIICULHEV. WINES IEERTIUE LEIQES 8%!me Emmi i 2 NEH REFEREE BREE *?alues less than 13 :3qu are cunsid'sred nagitive. This aethnd {rarities only a LII-elicier manila-11??: result. A :an specific alternative nethud shuuln be used to cnnfirn a pusitive result. Regains results indicate that !ithB? tha urine sample dues not contain drugs in that class ar that the ?ru? :?men?h?i?m is halos-i the cutoff levei p-aur 54:08?? FROM-50MB RECORDS MAYO Hm Whom Mayo Ciinic Up: of Lab Med and Pathology 200 First Street SW 095 Rochester, MN 55905 740-355-5219 T-BM P.03f65 Laboratory Service Report Mayo Medicai Laboratories New Engiand 265 Baliardvale Street Wilmington. 01887 1-800-533-1710 1-300-533-1 T1 0 CUM 24D0404292 2200072372 Lab Director: Cums A. Hanson, MD. . Lab Director: Cherie; .L MD. MA Med Rec GENDER QRDERING PHYSICIAN EFAULT I . Ohio Med: COLLECTION DATE a. Time REPORT NOTE rm: Selma La #312005 10:55 PM 3.18 1805 27th Street OH 45662 Benzndiazepine Con?rmation. RECEIVED: 114/2005 1:43 AM REPORTED: 11712005 4:36 AM Results Units, Expected Values Laboratory Control No. [32015 lmmnoassay Screen Positive Cutoff: 200 Lorazepam-by GGIMS Negative ngImL Cutoff: 100 NDrdiazepam?by 534 nQ/mL Cuto?: ?aO? Oxazeparn-?by GCIMS >2500 Cum?: 100 Temazepam-by GCIMS 1145 :1me Cum?t 10:1 OH-E?wI-Flurazepamhy GCIMS Negat?ve Cutoff: 100 7-NH-Cionazapam-by GCIMS Negativ Cutoff; 100 TvNH-Flunitrazapam-by GCIMS Negative ng/mL Cuto?: 50 Alpha OHwAiprazoiam-by GCIMS Negative Cutoff: 100 Alpha OH-Triazolam-vby GCIMS Negative Cutoff: 100 Enterpra?atian Pasitive Procedure Nam: NAME ORDER STATUS PRINT DATE 5mg; saga-M DEA-02273 Page 1 of2 04:09?? FROM-SOME RECORDS MAYO 0 Mayo Clinic of Lab Med and Palhofogy 200 Street SW Rochester, MN 55905 mmsaa-mo cum 2400404292 [fog Lab Director: Curtis A. Hanson, NAME -- FAULT . Ohm Medic! Scion: m; Scion: Lab 3805 27th Street onsmomh OH 45662 COLLECTION DATE TIME 1132005 10:55 PM 740-356-5219 T-EDI F-155 Laboratory Service Report Mayo Medical Laboraiories New Eng?and 265 Ballardvale Street MA 01837 1-800-533-1?10 2200072372 Lab Director: Charies J. MD. Continued This report is: intended for use in clinical monitoring and management of patients. It is not intended for use in employment'relaced drug testing. amen STATUS FINAL NAME PRINT DATE TIME 9110712095 Ems-w Page 2 of2 r, FEB-H45 MIIOHJ FROM-SIM: LEDICAL ECORDS T-BUI I Laboratory Service Mayo Clinic Up: of Lab Med and Pathology Mayo Medicai Laboratories New Eng!and 200 First Street SW 265 Baiiardvale Street Rochester, MN 55905 Wiirningtom MA 01887 1-800-533-1710 14005334710 CUM 2400404292 2200072372 Lab Dire-clan Curtis A. Hanson, MD, Lab Directo: Chanes J. MD. mam NAME RDER DOB AGE GENDER u? a PHYSICEAN CLIENT ORDER FAULT Ohio Mcdicai - 360m L3 505 gm Sweat onsmeuth OH 45652 COLLECTICN DATE 8. TIME 1/3/200511z10 PM 2mm NOTE Meprobarnate. RECEIVED: 114E005 3:26 AM REPORTED: 1172005 4:36 AM Results Units Expected Values Meprobamake. 6.6 ungL See Notes Expected Values: :10 (Therapeutic concentration) or a :00 (Toxic concentration} ORDER STATUS PRINT DATE 8: TIME . 5:36'3f ?st? Page 1 of 1' FEB-H-US MEDICAL RECORDS ran-3554219 T-rgu was m?muwu Laboratory service Report Mayo Clinic. Up! of Lab Med and Patna!on Mayo Medical Laboralcw?as New Engiand 200 First Sweat SW 265 Baxlardvale Street Rochester, MN 55905 L) Wilmington. MA 01837 1-300-533-1710 1-800-533-1710 CUM HUN-04292 Lab Director: Curtis A. Hanson, Lat: Director: Charles J. MD. gamma ORDERING PHYSICIAN EFAULT a . Ohio Mesiical om nu; Scion Lab; 1-- 805 27th Sweet 21"ortsmoath OH 45662 CO DATE 8. TIME 1312005 10:55 PM OPS BJS Benzadiazapine 11412005 1:43 AM REPORTED: 1 mzoos 4:36 AM Results Units Expected Values Labnratory Contra! No, C2015 mm. ?mm. 44mg; 39;; '534 "an; 100 Oxazepam?byIQCI-MS >2500 nme 100 .-.., .w .112: .. unm?um??um?? .F- Alpha OH-Alprazdgm~by (30st Negative Cutoff: 100 Alpha OH-T?azoiam?y GCIMS Nega?Ve Cutoff: 100 p?rgmdu.?- mm .p?an mum-?mp? snterpretatjon Positive Procedure Note; NAME oassa sums mm a. men: . . {Emma?a Page 1 of 2 022055! FROM-SOLIS LEDICAL RECORDS Mil-35545219 T-YBZ mm 7 Laboratory Service Report Mayo Clinic Up: of Lab Med and Pamctogy Mayo Medical Laboratories New England 200 First Street SW 265 Ba?ardvala Street Rochester, MN 55905 Wiimington. MA 01887 1400533471 0 2400404292 22DO0T2372 Lab Director: Curtis A. Hanson, NLD. Lab Director: Chane: J, Frzyiamski, MD. yaw-rum FAULT Ohio Medical em Scion-.1 COLLECTION DATE 5 TIME m1: Scion La 11312005 11:1 0 PM 1805 27:11 ommou?i OH 45662 "Rama? NOTE Meprubamata, RECEIVED: 1.6412005 3:23 AM REPORTED: 1172005 4:35 AM ReBuIts Unib Expected Values Maprobamate, 6.6 ugme See Notes Expected Values: <10 {Therapeutic concentration) or 100 (Toxic concentration) ORDER STATUS PRINT DATE 5 TIME Firm A. {31 1mm 5 gm 1553 I Page 17011 DEA-02277 FROM-SOMC MEDICAL RECORDS T40-355-5219 T-BDI F-EES 0 . . SOUTHERN OHIO MEDICAL 1805 27TH ST. PORTSMOUTH, OHIO PRINTED OQJANDS TIME 2235 ADMITTED 03JAN05 PAGE 1 DR: mama. - . {ms-ms" mau??g OBJANGE 2254 NEGATIVE CANERBINOIDS NEGATIVE COCAINE META NEGATIVE OPIATES POSITIVE EARBITURATES NEGATIVE BENZDDIAZEPI POSITIVE OJJANOS 2310 . ALCOHOL .0-10.D .0 geesaahag ABNORMAL, footnotia URINE DRU SCREEN This methgd prevides an1 a preliminary a lytical test result- A more specific lternative me od should be use confirm a positive result. Negative esults indica that either the 'rina sample does rm: contain drugs in 1: class or the Cirug cons gtzraticn is below the Cutoff level and there are not date: ed. AI NOTE NEW FERENCE HANG (le24/02) END OF CHART ourmrm REPORT a Pig/:sz 15wa Patient st DATEW Check :1 if find?ngs are nonnal after examination Mark ?n appropriafe space in cotumn a: left, if ?ndings are abnonna! on examination and describe in space beiow. SKIN MN ails meture ._Pigment ?Hair HEAD EYES ?Conjunctiva ?Sclera WElophzhaEmos WPupii ~Lidw?ag WTension __Acu%ty mower EARS WHean?ng __Discharge OSE Tenderness WMucosa WTrans?iIumina?on ?Other MOUTH ?Breath ?Tongue W,Lips ?Salivary Ducts ?Teeth ?Other WGU ms THROAT ?Tonsils Drip WPharynx mUuula ?Pataie EC ssels WMasses WTrachea _Thyraid momg LY PH NOD ES ?Cervical WOccipita? ?Epitrochlear _m0mer mAxiHary CHEST WShape ?Respirations ?Symmetry BREAST ?Masses mNipptes WDischarge ?Other EA RT mApical M3 Impulse A2 P2 Third WPutsaaion __Murmurs *Ga?op W?aie ?Friction ?Other LUNGS ?Fremitus Voice wPercussion wWhispered Voice ?Breath Sounds dAdVBn?iiOus Sounds (over) 79 Ply/5M Mm L/?wiu/ 2/20 7275p 5:371? 7,729 120379 Michal M5 Frau 7'9 DEA-02280 Stale Lic~ 9350743722? PAUL VOLKMAN, MD. 1219 Findiay Street - Portsmouth, OH 45662 (740) 355-6949 Fax: (740) 355-6946 Name Addfess' - - I Data 1-24 [1 2549 50-74 . 75100 101-150 f?E NR 1 2 Rail 3 4?5 Prescription is void if more than (1) prescription is written per biank 151 and over' th?a-n Address Smle Lic. PAUL MD. 1219 Findiay Street Portsmoum, OH 45662 (740) 355-6949 Faxi (740) 355-6946: Name {1:36 t3 WK??7~cef/ 3 6577 (EM ?33 M) 6 M7, 3:23; 124 25-49 [3 5074 151 and bver Re?ll?l?12345 Prescription is void if more than (1) prescription is written per biank 993742-; PAUL MD. 1219 Street - Portsmouth, OH 45652 (740) 35543949 Fax: (740)355-5945 Name - Addr?ss Date I 1224 25-49 50-74 75-100 101-150 a I 131 and ?ver - (71,14 [tva?t??c/l amalgam 2 3 4 5 Lg {9 Prescription is void if more than (1) prescription is written per blank - 1 PAUL VOLKMAN, 1219 Findlay Street Portsmouth, OH 45662 I (740) 355-6949 Fax: (740) 355-6946 Name . Address Date I . a f, .. ??24 .1 I 3 a 75-100 1017150 C?h (9 [3151 ?nd over Ref?il(@ 2 3 4 5 i Prescription is void if more than (1) prescription is written per blank .v Siam 1135034172211 . x? PAUL 1219 Findtay Street - Portsmooth, OH 45662 (740) 355-6949 Fax: (740) 355-6945 Name Address . -. Date 1 ?24 1 2549 50-74 2L 13 75400 101-150 Am?al-E [3(131 and over RefiilNE1 2 3 4 5 . VHKM Prescription is void if more than (1) prescription is writien per b?ank a. amt?omu 1..- mmk; Hun-??4? .mwMAwW .. ?9.1?1.4 a Consent for Chronic Opioid Therapy A consent form from the American Academy of Pain Medicine Dr. ?sprese' pio" medicin -, some 'rnes fora dia osis of ,i ?310 OLD 0 Will This decision was rii?ide because my condition is serious or other treatments have not helped my pain. I am aware that the use of such medicine has certain risks associated with it, including, but not limited to: sleepiness or drowsiness, constipation, nausea, itching, vomiting, dizziness, allergic reaction, slowing of breathing rate, slowing of reflexes or reaction time, physical dependence, tolerance to analgesia, addiction and possibility that the medicine will not provide complete pain relief. I am aware about the possible risks and bene?ts of other types of treatments that do not involve the use of opioids. The other treatments di cussed melded: . - . 74;" 2 3 ?f .1 Cit- I will tell my doctor about all other medicines and treatments that I am receiving. I will not be involved in any activity that may be dangerous to me or someone else if I feel drowsy or am not thinking clearly. I am aware that even if I do not notice it, my re?exes and reaction time might still be slowed. Such activities include, but are not limited to: using heavy equipment or a motor vehicie, working in unprotected heights or being responsible for another individual who is unable toi?care for himself or herself. I am aware that certain other medicines such as nalbuphine (Nubain TM), p?ntazocine (Talwinm), buprenorphine (BuprenexT-M), and butorphanol (Stadolm), may reverse the action of the medicine I am using for pain control. Taking any of these other medicines while I am taking my pain medicines can cause like a bad calleda withdrawal I agree not to take any of these medicines and to tell any other doctors that I am taking an opioid as my pain medicine and cannot take any of the medicines listed above. i am aware that addiction is defined a the use of a medicine even if it causes hm, having cravings for a drug, feeling the need to use a drug and?a decreased quality of Iife. I am aware that the chance of becoming addicted to my pain medicine is very low. I am aware that the development of addiction has been reported rarely in medical journals and is much more common in a person who has a family or personal history of addiction. I agree to tell my doctor my complete and honest personal drug history and that of my family to the best of my knowledge. - w. urn-3n I understand that physical dependence is a normal, expected result of using these medicines for a long time. I understand that physical dependence is not the same as addiction. I am aware physical dependence means that if my pain medicine use is markedly decreased, stopped or reversed by some of the agents mentioned above, I will experience a withdrawal This means I may have any or all of the following: runny nose, yawning, large pupils, goose bumps, abdominal pain and cramping, diarrhea, irritability, aches throughout my body and a flu~like feeling. I am aware that opioid withdrawal is uncomfortable but not life threatening. I am aware that tolerance to analgesia means that I may require more medicine to get the same amount of pain relief; I am aware that tolerance to anaigesia does not seem to be a big problem for most patients with chronic pain, however, it has been seen and may occur to me. If it occurs, increasing doses may not always help and may cause unacceptabie side effects. Toierance or failure to respond well to opioids may cause my doctor to choose another form of treatment. (Males only) I am aware that chronic opioid use has been associated with low testosterone Ievels in males. This may affect my mood, stamina, sexual desire and physical and sexual performance. I understand that my doctor may check my blood to see if my testosterone level is normal. (Females Only) If I plan to become pregnant or believe that I have fome pregnant while taking this pain medicine, I will immwiately call my obstetric doctor and this office to inform them. I am aware that, should I carry a baby to delivery while taking these medicines,,the baby will be physically dependent upon opioids. I am aware that the use of Opioids is not generally associated with a risk of birth defects. However, birth defects can occur whether or not the mother is on medicines and there is always the possibility that my child will have a birth defect while I am taking an Opioid. I have read this form or have it read to me. I understand all of it. I have had a chance to have all of my questions regarding this treatment answered to my satisfaction. By signing this form voluntarily, I give my consent for the tr Date ?0 4 13-. {-4034 Patient signature Witness to above Approved by the AAPM Executive Committee on January 14, 1999. 4700 W. Lake Avenue Glenview, IL 60025-1485 847/375-4731 - Fax 877/734-8750 n. Email aapm@amctec.com ?1.th . .-- Check if findings are normai after examination SKEN @Emp?on . . ?Texture .__F'igment WHair MWOther ?Petechiae HEAD - EYES WConjunctiva mSciera ?Haggis mComea #Exophthalmos WPupii ?Lid-lag - WTension mAcuity ?Other EARS __Dnirns HMastoid *Hean'ng ?Discharge NOSE WA?rways . __Sinu5 Tendemess mMucosa wTransmumination . I mother MOUTH WBreath @Tong'ue, __Lips wSaGEvary Duds WTeezh ?mower mGums THROAT __Posi-nasai Drip MPharynx WUvula ?Palate ?Other NECK MSti?ness #Vesseis mMasses NODES WCervica! mlnguinai moccipnat ?Epitrochiear ?Supraclavicuiar Homer WAxmary CHEST _Shape WRespiI-a?ons homer BREAST ?Masses WNipples ;_Other HEART ?Apicai ?Sounds M1 Impulse A2 P2 WThn'll Third MPuEsation __Murmurs _Shock ?Gallop WHate ?friction ?Other LUNGS WFremitus W?poken Voice? ?Percussion Voice __Breath Sounds "Omar WAdveniitiOus Sounds (?ver) Mark in appropriate space in coiumn at Ieft, if ?ndings are abnormal on examination and describe in space bemw. 129379 um Arts amaze-2% 79 Sula Lic. 335-07-0722-V PAUL VOLKMAN, M.D. 1219 Findlay Street Portsmouth, OH 45662 (740) 355-6949 Fax: (740) 355-6946 1.15/4? 1 [3 1-24 (2 2549 g! 50-74 [1 75-100 1015150 Prescription is void if more than (1) prescription is written per blank i DEA-02289 State Lie. #3507072? 1 . . PAUL 1219 Findiay Street - Portsmouth, OH 45552 (740) 355-6949 Eax10401355-5946 Address i \f 5M4 [3 75-100 .gmga 7 I 5e: Prescription is void if more than (1) prescr?ption is written per blank 4 State Lic. 335074372? VOLKMAN, MD. 1219 Findlay Ster - Portsmouth, OH 45652 (740) 355-6949 Fax (740) 355-6946 Name Address i [3 1?24 La 0 Mr I?m x3]. 50-74 5 75-100 7 101-150 (J . 151 and pver Refill/912345 I i A Prescription is void if more than (1) prescription is written per blank State Lie. 33507-07224: . 1% PAUL VOLKMAN, M.D. 1219 Findlay Street - Portsmouth, OH 45662 (7 40) 355-6949 Fax: (740) 355-6946 My? a I - 1~24 5 2549 Q??yb ELI-J 6M 5 50-74 I, 75-100 0 101-150 Av? 151 and over RamaPresc 1p i void Ef more than (1) prescription is written per Hank a DEA-02291 Slate Lit; 595?01972? PAUL VOLKMAN, MD. 1219 Findtay Street - Ponsmoum, OH 45662 .(740) 355-6949 Fax: (740) 355-6946 Name I?V/f?f/ 7 Address w. . (MAX 31 ?1 25?49 . PM 7 6329 a, A (I 754001..? (/60 f? 6: W7 6 a" 151 and oye{ 3 4 . 3f I PrescripIiOn is void if more than (1) pre?cription is written per biank Check 1/ it findings are norma! a?er examination __Eruption MMoisiure ?Nails mNodules __Petechiae HEAD EYES ?Coniuncliva WFields mSciera _Ptosis ?Cornea mExophmaimos mPupil mMovemen: ?Tension ?Mystagmus WOphmaimscopic ?Acuity ?Other EARS "Hearing WO?ther MDischarge NOSE WSinus Tendemess WMucosa wTransinuminaL?ron mSeptum MOUTH ?Breath WTongue WLips Duds __,Teeth __Other ?Gums WROAT WTonsiis WPast-nasai Dn?p __Uvuia ?Patata mOthar NECK mszi?ness ?Vessels ?Thyroid ?Other NODES mingt?nal WOccipitai MEpitrochiear WSupraCMVicular _Other ?Axillary CH EST PShape w?espira?ans ?Symmetry _0ther BREAST mNipples WDischarge ?Other HEART "Apicz? "Sounds M1 Impuisa A2 P2 MThriH Third mPuisation "Murmurs __Ga??op ?Rate LUNGS WFremiius ?Spoken Voice ?Whispered Voice ?Breath Sounds ?Other SOUnds Invnr?. Mark in appropriate space in autumn at ieft, if findings are abnormal on examination and describe in space below. ure: Systolicm Diastolic 2 Zvreigh W??m Eva?W; QM 020379 - Medical An: Pres; 79 DEA State Lic. #35?07-07224/ PAUL MD. 1219 Findsay Street - Portsmouth, OH 45652 (740) 355-6949 355-6946 Name . Address Date . - 11:11-24 WV 2549 VTFK I {7 50-74 ?Fiji?- 5 I a? I 1 1375?100 . C: IE1 101-150 . A: K, ?1 Ii] 151 and over 0121111!Pr?scription is void ?1 more than 'pr?'scrilption is whiten-per biank State Lic. PAUL VOLKMAN, M.D. 1219 Fi?ndiay Street - Portsmouth, OH 45662 (740) 35576949 Fax: (740) 355-6946 Name Address Date ,\ifwx 50*74 - jg 75-100 VMW 7% 101-150 151 and overv . RePrescr?ption is void if more than (1) prescription is written pef blank Stale Lic? PAUL VOLKMAN, MD. 1219 Findlay Street - Portsmouth, OH 45662 (740) 355-6949 Fax: (740) 3556946 45/ ., Address I Prescription is void if niore tha? (1) ?res??ption is Mitten per blank .. a 1?~24 {?ia?x ow" 7 ?3 i'1' .. Kw/I'k this 50 74? [j ?5-10'o Cl 101450 151 andover Re?imj?12345 - Slate Lie; PAUL VOLKMAN, MD. 1219 Findlay Street - Portsmouth, OH 45552 (740): 355-5949 Fax; 040) 355-6945. 9 .5. .A ulj 1?24 7Z 6377 - - 3:2; (fl/Wu? 4? Refin 1 2 3 4 5 7 .151 and over . Pres?cription is void if more than (.1) prescription is written per blank AH?q?m.? . ., Siat? A PAUL VOLKMAN, M.D. 1219 Findiay Street - Portsmouth,_ OH 45652 (740) 355?6949 Fax: (740) 355-6946 Name ?Addr?'s's ~47? MW 303:: 2 - 4 E11 75306 - . - 101-150 . 151 and over ne?aPrescription is void if more than (1) ?rescription iswritten bef biank en! Last Check 1/ if findings are norrnai after examination {Diastoiic Mark in appropriate space in coiumn at left, if findings are abnormai on examination and describe in space below. i DEAio?zss SKEN Color _._Emption Moiszure WNajis Texture __Nodules Pigment _Hair ?Other Petechiae HEAD - EYES angunctiva M?elds Sclera __Ptosis Cornea WExephthaJmcs Pupil #Lid-iag Movement __Tension Nystagmus ?Ophthalmosoopic Acuity Homer EARS Drums WMastoid Hearing __Other Discharge NOSE Ainvays Wsinus Tendemess Mucusa #Transi?wnination Septum WOther MOUTH Bream ?Tongue Lips "Saiivary Ducts Teeth _Cnher Gums THROAT Tonsiis mPos?l-nasal Drip Pharan mUvula Palate #Oiher NECK Stiffness mVesseEs Masses Thyroid _Other NODES Cervical winguinai Occipital MEpitrochlear Supraclavicuiar Axillary CHEST Shape WFiespirations ?Symmeiry M01th BREAST Masses JiNippies- Discharge wmher HEART Apicai WSOunds M1 impuise A2 P2 Thrill: Third Puisation _Murrnurs Shock Rate mOiher LUNGS mFremitus ?Spoken Voice 'Percussion Voice Breath Sounds WO?iher Adventitious Sounds (over) #3379 Medea: Aris Press 1-630-326?2i79 r- i . . State Lic. 53507-0722-v PAUL VOLKMAN, M.D. 1219 Findiay Street - Portsmouth. OH 45662 (740) 355-6949 Fax: (740) 355-6946 25-49 5074 El 75-100 101450 . 151 and over 2 3 4 5 I . (Garage Prescription is void ?rf more than (1) prescription is written per biank State Lic. 33507-07224! PAUL VOLKMAN, MD. 1219 Findlay Street Portsmouth, OH 45662 (740) 355-6949 Fax: (740) 355-6946 A {-24 2549 x4 4 [3 75-100 101450 Cl 151 and over .I - Prescription is void if more than (1) prescription is written per biank DEA-02302 Stale Lia PAUL 1219 Findlay Street.? Portsmouth OH 45662 (740) 35545949 Fax: (740) 355-6946 Date . - - I Name Address . . . 1-24 CI 25?49 n/ I I 5074 I 75-100 7? @x A . 51 and over mam-:Prescription is void if mbre than (1) prescription is written per biank Stale Lic? IPAUL VOLKMAN, MD. 1219 Findlay OH 45662 (74013555949 Fax: (740) 355-59461 11124 25-49 L1 L1 5074 1'3 El 1 75-100 101-150 D1 151 and over ne?11/Nn1234sf Prescription is void if more than (1) prescription is written per b?ank DATES. AMWW 'GENERAL: Ag. - - Blood Pressure: Systoiic iastolic Check if if findings are normal Mark in appropriate space in coiumn at $eft, if findings are abnormal a?er examination - on examination and describe in space beiow. SIGN - ?.Coior mMoisture WNaiis - . mTexture _Noduies ?Pigment mEcehymoses Pelechiaa HEAD EYES ?Conjunctiva ?071; WSciera WPtosis W_Comea mExophthalmcs ?Pupil ?Lidvlag I WMovemeni mTension mOphmalmoscopic ~Acuity __Other i} EARS 1 MDrums WMasioid ,r ?Hearing ?Other .. ?Discharge NOSE . I Tenderness meucosa WTransiiIum?na?on ?Oiher M55470 MOUTH mTongue . ?Lips Ducts mTeeth ?Other . -. ?Gums h?I a THROAT ?Postwnasai Drip MPharynx __Pala!r: meme: aw, NECK ?Ssi?ness mVessels ?Masses I mmher NODES mCenricaE ?inguinal 5 WOccipitaf WEpitrochiear ?Supraclavicuiar ?Axii?ary CHEST WFlesp?rations mower BREAST wMasses Werner HEART WApical wSounds M1 impuise A2 P2 mThrili Third wMurrnurs WShock ?Rate W?hyihm Moms: LU NGS Voice ?Percussion WWhispered Voice WEreath Sounds MOther mAdvenzitious Sounds ?m-~mmrm' imam 'm . Stal?Lic. 335417-07sz PAUL VOLKMAN, MD. 1219 Findlay Street .: Portsmouth, OH 4566251740) 355?6949 Fax: (740) 355-6946 Name 7 7 Address i M, A. 1724 A 2549 . . [j 1? a (I (ft/k . :54130 - I 101?150 (J I, a 151 and over Re?rg??Prescription is void if more than (1) prescription is written per biank '3 i? 5: 'StamLhaasFm-mzzw" PAUL VOLKMAN, M.D. 1219?F?ndxay Fax: (740) 355-6946 Name - Dale 1.24 .i 2549 50?74 754100 - I 3? A 4 101M150 6/ a ?4 151 and over_ Re?lt? 4 5 Q. x'v Prescription is void if?more than (1) prescrip?On is written pei biank A ?smteLic?as?ov-mzz-v PAUL VOLKMAN, M.D. 1219 Findlay street (740) 355.5949 Fax: (740) 355-6946 A . . .. .1 1-24 1 1 7. 25?49 um Gj?? 5074 a? r' . 75-100 101-150 . . 7/644 oygr 2 3 4 5 Prescription is void if more than (1) prescription is written per blank State Lic. 1335-0707224] PAUL VOLKMAN, MD. 1219 Firid?ay Sheet OH ?5662 (740) 355-6949 Fax: (740) - Name Address" [1 1-24, .3 I 25-49 101-150 7 and qver Re?nNh 1 2 3 4 5 gal/op r59 -- - Prescription is void if more than (1) prescription is written per biank DEA-02308 A r" . ?v . Anew -- I I - iood Pressure: Systoiic 2 Diastoiic?Weigm 1.2.- .. . {17? a ivy/i? yang-gar? -. i dame? Puise Respiratio Check 5! if ?ndings are normal Mark in appropriate space in coiumn at ie?, ii ?ndings are abnormai after examination on examination and describe in space below. 7 SKIN ?Cm - 7 ?Moisture WM 7? ?_Texture ?Pigment ?Hair 4? b? . . . HEAD -- EYES mConiunc?va wFIeids mSciera __Ptosis memea WExophthaimOS WPupii WUd?Iag . __Movement "Ophthaimoscopic MAcuity WOther . EARS wHean?ng Werner __Dischar 05E WAirways ?Sinus Tendermass mMucosa WTransiliumination ?Septum MOUTH Ware-am ?Salivary Ducts WTeem _Other WGums THROAT ?Tonsils WPost-nasai Drip WPharynx ?Uvula 3 WOther NECK Wsziffness WMasses ?Thyroid WOther NDDES MCervicat __inguinal Occipiiat mEpitrochiear :Supraciavicuiar mOther Axillary CHEST ?Shape mRespirations BREAST WNippies HEART i ?mica: ?Sounds M1 impulse A2 P2 512 Third Pulsaiion __Murmurs q? HI Mi [aw LUNGS Framitus ?Spoken Voice Percussion ?Whispered Voice Breath Sounds Adventitiuus Sounds Hi i (over) .- I2st Haml? Press moons-2:79 State Lic. #350m722-v 5 PAUL VOLKMAN, MD. 1219 Findlay Street Portsmouth, OH 45662' 35576949 Fax: (740) 355-6946 Name Address - Date .. . a 1:24 2549 ?i . 50?74 i Em :3 5 75300 101-150 1.51 and over aw 3'4 5J Prescription is void if more than prescription is written per biank a J. W71 W/v ?Ham? -.. .. . 1 . A State Lic. PAUL VOLKMAN, MD. 1219 Findtay Street? Portsmou?yOH45662 ~(ir403 355?5949 :Fax: (740) 355-6946 7- Name Address I 1-24 25?49 50-74 El A V. 4 ,3 101-150 a? I 151 andover 2 3?46 . - -. '1 k1 Prescription is void if more than (1) prescription is written per biank - Hal-M ?w?m-aa-A-hn. .4 . Mum?g? 2 DEA Stale Lic. PAUL MD. ,1219 Findiay Street Portsmouth, OH (5'40) 355?6949 . Fax: (740) 355-6946 ?1-24 2549 (If no (JOB .- [1 75-100 101450 151 and over Prescription is void if more than (1) prescription is written per blank Ret?ifr??i 2345 DEA-02313 Slate Lin. #350743722-v PAUL VOLKMAN, MD. 1219 Findlay (746)555?6949 Fax: (140)355-5946 Name Address 1-24 30 a 31213;? 7 .V 151 andover Luis/{AK Prescription is void if more than (1) prescription is written per blank ?mu-Mm. .MH khan. mm. mm? D. ?bulb-48? .aA-t?ur Check ij findings are normal after examination SKIN ?Color ?Emption __Maisture ?Ma?a mTextura mPigmenl WPetechiae HEAD - EYES ?Coniunctiva __Sciera *Ptosis WCamea mExophthaJrnus _Pupil Jag ?Movemen: WOphmaJmoscopic ?Acuity EARS WHearing Homer NOSE ?Airways Tenderness ?Mucosa WTransiilumina?on ?Septum mOlher MOUTH .._._Bream mum; ?Salivary Ducts WTeem ?Gums THROAT mTonsils - Drip ?Pharynx WUvula ?Palate __Other NECK ?Stiffness WTrachea NODES WCervical __0ccip?tal WEpitrochlear *Supradavicular ?Other _Axi?ary CHEST __Shape mnewimtims ?Symmetry BREAST wMasses ?Nipples _Discharge Mame-r HEART M1 Impulse A2 P2 Third "Pulsa?on _Munnurs _Sl1od< WGallop __Fiate LUNGS ?Frmitus mSpoken Voice #Perwssion _Whispe:ed Vo?ce _Breath Sounds ?Other "Adventilious Sounds (over) o??ogsm pd Pressure: Systolic /Diasto?ic Weigh Mark in appropriaze space in column at left, if findings are abnormai on examination and describe in space below. State Lic. PAUL VOLKMAN, MD. 1219 Fendan Street Portsmouth, OH 45662 (740) 355-6949 Fax (740) Address [3 1?24 2 . l] 2549 - 3 50-74 - a 2 . [1 75-100 L) 101?150; 151 and over Prescription is void if more than 1) prescription is written per biank . - rm- - Shta Lic. f35?07-0722?V PAUL VOLKMAN, MD. 1219 Findlay StreeL- Partsmoum, OH 45662 (740) 355-6949 Fax: (740) 355-6946 1-24 25-49 50?74 75-100 1 O1 ?1 50 Re 12345 (i Ram/s? Prescription is void if more than (1) prescription is written per blank DEA-02316 Stale Lic. 135-07-0722-v PAUL MD. .1219 Findiay Street Portsmouth, OH 45662 (740} 3536949 .Fax: (740) 3556945 Name Address Date A SQWAEFO OM 6 7 ,E/Izr?zgr: 1-24 25-49 50574 1 2 3 4 5 Prescription is void if more than (1) prescription is written per blank 1 DEA-0231 7 8 i .i r. PAUL vdeMAN, State Lic. MD. 1219 Findlay Street - Portsmouth, OH 45662 (740) 355-6949 Fax: (740) 3556948 Name Address (I Refil@ 4/ 1?24 25-49 5044 75-100 101-450 151 and over 1 2 3 4 5 Prescription is void if more than (1) prescription is written per biank a?ent st Name GENERAL: Age Check if findings are normai after examination _;=Eruption WMoistura WNodutes ?Other _Petechiae HEAD - EYES WCuniunc?va ?Fields ?Cornea ?Exophiha?mos ?Lid-Eng mMovemen! MTension ?Ophthalnmcopic WAcuity EARS ?Drums mHearing __Orher mDiScharge NOSE mAirways mSinus Tenderness mMucosa __Transil umination WSeptum ?Other MOUTH mBreath mTorugu ?Lips __Salivary Duczs mTeeth mOther _Gums TH OAT mTonsils Dn?p WPharynx *Paiate WOther NECK ass ?Vessais mMasses __Thyroid MGthar NODES ?Cervical WOccmitaJ ?Epitruchlear ?Supzaclavicuiar ?Other CHEST WRespirations ?Symmetry . BREAST ?Masses ?Nipptes WDischarge WOthar EART WApicai __Sounds M1 impulse A2 P2 thn?i; Third __Puisa?ion WShock mGallop ?Rate ?Friction _Ot.har LUNGS wFrem?zus WSpoken Voice ?Percussion Voice Waralh Sounds ?Other ?Advanu?ous Sounds z. 1 r. u- rr? I Brood Pressure: SystoiicMEasto?L?? Mark in appropriate space in column at Eeft, if findings are abnormai on examination and descr?be in space below. egg] ?ag m/iu mars Monica: Aru PM: moo?323.2179 Slate Lic. 335-07-0722N PAUL VOLKMAN, MD. 1219 Findlay Street - Portsmoum. OH 45562 (740) 355?6949 Fax: (740) 3556946 Name $2;wa Address Y-d? Data [3 1-24 2549 50?74 75-100 101-150 (?x/N0 C15 Refit??1 2 3 4 5 151 and over State Uc. l35-07-0722-V PAUL VOLKMAN, MD. 1219 Findiay Street Portsmouth, OH 45662 (740) 355?6949 Fax: (7 40) 355-6946 1 -24 ll El 2549 ?ka 5074 75?100 101450 151 and over Prescrip?onv is vb?d if more than (1) prescr?ption is wr?tlen per bfank J- . ?in?u? .. Erik/7 - @wl? 4n 0% 6/55: a sum Lb. K35070722-V PAUL VOLKMAN, MD. 1219 Findl?y Street - Portsmouth, OH 45662 (740) 355-8949 Fax: (740) 355-6946 . 3 Name Address 1?24 25?49 101450 151 and over ?39447 Hem/1,191 1 2 3 4 Prescription is void if more than (1) ?rescription is wri?en per blank I. .J-_nh ?w A. .. 1. . smug-:1; LJ .1- -t Stale Lic. PAUL VOLKMAN, MD. 1219 Fmdtay Street - Portsmouth, OH 45662 (740) 35545949 (740) 355-8945 101450 Name Address .Data 1-24 MW MW 2549 [3 5034 U, a/ I 75-100 2x3 UN151 and over Prescrip?on is void if more than (1) prescription is written per blank . A 9% mg?. A4 Check 1/ if ?ndings are norrnai after examination SKIN I - - I _CoidWMoisture MNaits I ?Texture __Noduies V, _Pigment wHair .- . WEcmymoses _Other i HEAD EYES wConiunctiva w?elds f1 __Sc!era ?x I "f __Comea WExophthaEmos . I A WLid-iag . ?Movement I WAcuity mOther EARS - mMastoid mozher NOSE WAirways WSinus Tenderness mMucosa . MOUTH WBreath ?Tongue Mu?ps mSalivary Ducts ?Diner ?Gums THROAT mTonsils WPosl-nasal Drip WFmate w__Other NECK ?Sti?ness MVessels ?Masses womer LYM PH NDDES "Cervicai mlngu?nal WOccipita! ?EpiUochlear mSupraclavicular Wom? ?Axillary CHEST ?Shape . BREAST wMasses mNipples WOther HEART _F_Apica? __Sounds M1 ?mpu338 A2 P2 MThn'Ei Third WMurrnurs WShock __GaHop MRale ?Friction m?hmm H?thss LUNGS dFremitus "Spoken Voice MPercussion WWhispered Voice ?Breath Sounds MAdven?tious Sounds (over) 'b?EA?o??z?f (3)379 Media! Press moons-2?79 Slate. Lin. MD. 12:19 Findlay Street OH 45562 (740)355?6949 Fax: (740) 355-6946 Name Addrass . 1-24 25-49 A8279 7% 0/ $39 a 7 75400? as 101450 Refil . LW?rmr Prescription is? void if more than (1) prescription is written per biank DEA-02326 Slate lJc. PAUL VOLKMAN, MD. 1219 Findlay Street - Portsmouth, OH 45662 (740) 355?6949 Fax; (740) 355-6946 Name - Addrass - - - - Date .. - 1-24. Ir (W 3% C) 25-49 L5 50?74 ?4 A 75-100? 4L3 101450 151 and over Re?ti 1233 4 5 Pres?ription is void if more than (1) prescription is written per biank Slam PAUL VOLKMAN, MD. 1219 Findan Street - Portsmouth, OH 45562 (740) 355-6949 Fax: (740) 355-6945 1?24 ?ww A a 5-49 :ngjj,? 5044 6/ 101450 151 andover 'Re? NH12345 Prescription is void if more than (1) prescription is written per biank DEA-02327 328 State Lic. 33507-07224! PAUL VOLKMAN, MD. 1219 Findlay Street Portsmouth. OH 45662 (740) 3556949 Fax: (740) 355-6946 Name . [1,124 2549 (/ij 50-74 321151 over 1% so Prescriptio? is void if more than (1) prescription is written per biank Address f7\ i7 GENERAL: Agp Check 1? if ?nc?ngs re noa! after examination SKIN ?Eruption ?Moisture W?Nails _..Tenum ?Modules ?Pigment _Hair ?Other ?Peiacniae HEAD - EYES WHOSE MCornea ?Pupil wuwlag ?Tension ?Nyszag mus ?Ophthatmoscopic ?01h er I gnnu Drums: mMasmid wHean??g _O!her NOSE _A;rways Tenderness WMucosa WTransiliummal?on wSeptum MOUTH ?Breath __Tongue mLips WSal?rvary Ducts __Other mGums THROAT mfonsiis WPost-nasm Drip _Pharynx ?Other NEC WSIEHHE ss ?Vessels "Masses mTrachea mT?hyI-oid ?Other LYM 0 mCewicat gu?naf ?Occ?p?tal mEpitrochiear WSupraclavicular thher CH EST #Shape ?Respirat?ons ?Symmazry ?Other EAST _:0ischarge EAHT ?Appeal ?Sounds M1 ImpuEse A2 P2 Third _Murmuf? __5hock MGalfap ?Rate Womer LUNGS ?Fromm: ?Spoken Voice ?Percussion _Whispered Voice Sounds moms: mmw?ms Sow'nds (over) -- Respiratibn h, Biood Pressme: Systoiic ':_Diaste? a Weight Mark in appropriate space in cofumn at ie?, if ?ndings are abnormal W4, fau- 1244/ ?y ?ail/wag 6 676/1 16% 644% I J. Lax-2 Luge; an? m?za ?Lib-"1; State Lic. PAUL VOLKMAN, M.D. 1219 Findlay Street Portsmouth, OH 45662 (7 40) 355-6949 Fax: (740) 355?6946 44:; r? .c L453f?x'?f?disp??m?z?f?E? a . . .rv -?xi _w way- P. .7 \3 . 3km." . an ans?3W aw.? J19 .- a, ?1 State Lic. 3 PAUL VOLKMAN, M.D. f} 1219 Findlay Street - ?Portsmouth, OH 45662 f? (740) 355?8949 Eax: (740) 355-6946 2: .1 Ev min?55 I135 6/562}, .. 41?waryurn.) A ?gm: smug?; 1" gumwm ?Wigwam. i State ch. PAUL VOLKMAN, MD. 1219 Findlay Street Portsmouth, OH 45662 (740) 355?6949 Fax: (740) 355?6946 A3323 1. :r $16.55 4? .0 "In: 5.195171 :5 .. Jr .- 0" .4-1 A. .31 w?pg??.31. i??hm??Hit: 3: .. . .l-Iy . 9 I . State L?c. #350M722-v jg PAUL VOLKMAN, M.D. 4 3; 1219 Findlay Street? Portsmouth, OH 45662 I (740) 355-6959 Fax: (740) 355?6946 . . . . m: 14': mm #31472'r11;: fig} A- .1 _W.M,hl ?pearl-?n. until.? - - . .-.. . . . an,? i: Ig?n?, mim~ a. -- mug? 54.95 L: A .5 51? ?1 .y-w 1/ "r DEA-02333 DEA-02334 "raw. . .4 fr; - f't?f?hf?Mum. ?if: . fay." .v.531 .l ?am-n. a. atm'33;qu 5:72am? 1v 4 7. State Lic. PAUL VOLKMAN. 1219 Findlay Street - Portsmouth, OH 45662 (740) 355?6949 Eax: (740) 355?6946 6234, (20.5046 1 ((vknM? (amass-Q . 5 chl?V?tekylaems-written per blank.? 7 Check 1/ if findings are normaf after examination SKIN ?Color WEruption ?Moisture WTexture MPigment WOIher *Petechiae HEAE EYES chniunc?va mFseids WSclera _Cornea w_Exophrhalirruns ?Pupil WLid?lag ?Movement WTension A Dohthaimoscopic mACl-Iify? EARS ?Drums WMastoid ?Hearing mOlher ?Discharge NOSE MAirways Tendamess ?Septum MOUTH _Breath MTongue WUps Ducts WHTeeth WOIher mGums THROAT Drip __Pharynx WPalaie mmher NECK mSti?ness WVesseIs mTrachea MODES WCervical __inguinat ?Oocipitai WSupracfavicular mower .Axi?ary CHEST ?Shape __Respirations WOIher BREAST WMasses mNippies ?Discharge mower EAFIT ?Sounds ME impulse A2 P2 ?Thrill Third ?Shock W?ate homer . LUNGS ?Spoken Voice Voice I zit?r: t: I . Bioad Pressure: Systolic?biasto?c Mark in appropriate space En coiumn at left, if ?ndings are abnormat on examination and describe in space befow. Maw 77/505: ?m cry?Mg 54%; 4% W4 ?52-4 6% WW Maw/M .W i??iza mm mm ?rm, unease"; Slate Lic. 33507-07224! 1? PAUL MD. 1219 Findlay Street Portsmouth. OH 45662 (740) 355-5949 Fax: (740) 355-6946 1 ?24 A I r117! Q??a 6/ 101-150 51 and over Ono?iquj . Pres?ription is void if inure than (1) prescription is-writtenper biank Slate Lic. PAUL VOLKMAN, MD. 1219 Findlay Street Portsmouth, OH 45652 (740) 355-6949 Fax: (740) 355-6946 Name eggw . El 1-24 . - 57f233W L??xme Prescription is void if more than (1-) pfesc?ption is written per blank Address Date State Lic. 33507-0722? PAUL VOLKMAN, MD. 1219 Findiay Street - Portsmouth, OH 45662 (740)355-6949 Fax: (740) 355-6946 Name Address . . i [3 1?75100 - .101-150 . . 151 and over Prescription is void if more than (1) presaription iswritten per blank State Lic. PAUL VOLKMAN, M.D. 1219 Findlay Street - Portsmouth, OH 45662 (740) 35545949 Fax: (740) 355-5946 AddreSS 151 and over Re?ll?Prescription is void if more than (1) prescription-is written per blank [1 1-24 M4 350 3:3: I . 754100 M, No 9:3217 6/75? DEA-02340 Slate Lic. PAUL VOLKMAN, MD. 1219 andiay Street - Portsmouth. OH 45662 (740) 355-6949 Fax: (740) 35545946 Name 3?17? Address 1 . [11?24 7? 5/ 07' $212: Heggf??'e 151 and Over Lgf? Prescription is voidjf more than 1) prescription is written per blank Tri?State Health Care Pain Management Paul 1219 Findlay street Portsmouth Ohio 45662 Phoe (740) 355-6949 Fax (740) 355-6876 NARCOTIC PAIN MEDICATION AGREEMENT To receive narcotic pain medication the patient must meet the following conditions: I. The patient has never been diagnosed with, treated for or arrested for substance dependence abuse. Patient has never attempted Suicide or has any Suicidal Ideations. TO RECEIVE NARCOTIC PAIN MEDICATION, THE PATIENT MUST CONSENT TO THE FOLLOWING TERMS: l. Theipatient agrees to supply Tri-S,tate Health Care the name, address and telephone number of the Pharmacy that is ?lling the prescription. 2. The patient agrees to all prescriptionsiprescribed by Oak 5 we Pharmacy, The patient must provide three(3) days written notice when changing his/her pharmacy under normal circumstances. In the event of an emergency requiring another physicians attention, the patient will immediately inform Tri?State Health Care?s Physician/Physicians?IStaff of such prescribing physician and dispensing pharmacy and provide all records of treatment for the patients chart for treating Physician/Physicians at: Tri-State Health Care. 3. The Patient agrees to allow Tri-State Health Care to send a copy ofthis agreement to the pharmacy, referring physicians/physicians and all other physicians involved in the patients care. The patient agrees to allow TriuState Health Care?s Physician/Physicians/Staff to discuss freely with other Physicians. 4. The patient agrees to take his/her medication only as prescribed by Tri-State Health Cares Physician/Physicians. The patient agrees that he/she Will Not Give 3 L: i Ian, - 1., is f- pt-"I i? i H?l \l'll i. 5. The patient understands that that no allowances will he made for lost or stolen medications or prescriptions under normal circumstances. Proper documentation, police reports or other ot?cialj reports~are required-before rP-hy-sicia consider any prescriptions. Lost or stolen may be grounds for dismissal from this clinic. lj.? in 6. The patient understands prescriptions will be dispensed only after scheduled of?ce visit and no prescriptions will be given over the phone under ormal circumstances. 9. The patient agrees to aiiow Tri-State Health Care?s to call other Pharmacies for polyudrug prescriptions and or usage. All Patients are 1:1. furl 'j jg: . g: .: . 10. The patient understands that the Physician/Physicians at Tri?State Health Care will stop treatment if any of the following occur: l. The Patient uderstancls that the Physician/Physicians at Tri-State Health Care will modify treatmentqu any of the following occur: fat.) 7 7, 12. The patient will adhere to the advise of the regarding operation ofa motor vehicle. If Tril?shtate Health Care?s Physician/Physicians witnesses or is unable to validate information of the patient driving under the in?uence, drugsor alcohol) the patient authorizes Tri~State Health Care or their Physician/Physicians/Stal'f to notify authorities and Tri?State Health Care or their PhysiciaanhysicianSIStaff shall not be held liable for any damages which may occur. Female Onlv l. The patient certi?es that she is not pregnant. This patient also certi?es that she will notify Tri-State Health Care?s Physiciaanhysicians if she is planning a pregnancy or believes she is pregnant. By signing this document, I agree that I have read all of the information in its entirety or that it has been read to me and that Fully Understand and Agree to the contents as written and by signing I fully agree to adhere to them. I give Tri-State Health Care, Physician/Physicians/Staff consent to contact and freely discuss/share Aini'ormation to any past or current Physicians, Doctor Of?ce, Clinic, Health Care Facilities, Mental Health Care Facilities, Pharmacies or Law Enforcement Agencies concerning my 'Past or Current History. Having no other questions pertaining to the above, I am signing this document on the date designated below. are?! Da tel Pharmacy Phone Number I: .- (I 4? l' .. . - Icodressure: Systolic Diasrofic Weig Cheek 14' If ?ndings are nonnaf Mark in appropriate space in cofumn at Salt. if ?ndings are abnorma! after examinauon . .on examinationnand-describe inspa?cfdb??iaw. SKIN ?Color bEmption i ?Moisture ?Naifs ?Tenure __Nodu!es 4 ?Pigment mHa?r ?Other Jamie? d/M?M/g WM mConjuncriva ?Fields iera __Ptos?s wComea WExophthalmos __Pupii WUd?lag ?Movement ?Tension WNy?agmus wcge??maawpg; 7_ ?Acuity ?other i J, 67 EARS I I I _Masrcid I 1- ?Hearing ?Other ?Discharge NOSE 1.. Tenderness WMucosa ?Tmnsiiluminarion . ?Septum Xi MOUTH M) ?Bream ?Tongue 6? WLips WSalivary Ducts ?Other Gums THROAT ?Transits ?Poshnasa! an mm /7 *Paiate NECK mMasses MTrachea I ?Thyroid ?Other I NODES ?Cervical ?Inguine? ?Occipital I - mSupracfavicuiar ?Other CHEST .1 ?Shape . - r-mome' BREAST u. U, wMasses ?N?ppfes "Discharge HEART . ?Agra! mScunds Mt Impuise A2 P2 mm mPulsation ?Rare __Frictr?on . w_0tner - 1 LUNGS D, ?Pram mSpoken Voice *Pamssion Voice . 5mm Saunas ?Other Sounds (Over) DEA-02345 DEA-02346 . 1.4 2 ~?yxk . Junngit?r'. 83:51: 1m 5: 9r} u. I {Ta?Vb. State Lic. PAUL VOLKMAN, MD. 1219 Findiay Street - Portsmouth, OH 45662 (740) 355?6949 Fax: (740) 355?6946 wk-?H?Jaw? .3 a. at.? r; .3 v5 wasState Lic. - PAUL VOLKMAN, MD. 1219 Findiay Street - Portsmouth, OH 45652 (740) 355?6949 Fax: (740) 355-6946 >?Minn std-if d-q?vr watp.19. R, 5 . . Mn?, z-I-i ?n-in-iie?-Lgav?auDEA-02347 ., z. 3- . 1 3? State Lic. a PAUL VOLKMAN, MD. xi 1219 Findlay Street - Portsmouth, OH 45662 (740) 355-6949 Fax: (740) 355-6946 . . . . . 12d 3" 5. f1QCV?snr-ra. 1.9..- n, Lum? 4?4b Aer did-?2 Java-?avn ?sues-1:412, ?a.th *4 Jim-751M}; 133$ DEA-02349 3; . ?aj'vfw?ef State Lic. - PAUL. VOLKMAN, NLD. 1219 Findtay Street Portsmouth, OH 45662 (740) 355-6949 Fax: (740) 355-6946 Ez$747 . 591-011 .r CH m?w?fv~437- "yru- r. - 1 vac? . 1?4? n-shod-A -- ?214 State Lic. #35-07?0722-v . AUL VOLKMAN, M.D. 1219 Findlay Street Portsmouth, OH 45662 (740) 355?6949 Fax: (740) 355-6946 of] 3"Ifbr' 'N?M'hil, . w'n Nun-A" f" . I 3'42- an. 1' i i 1x. -LA. wig-Aid. 3.1.. 3.3-5 . Check u' if ?ndings are normaBlood Pressure: Systoiicm Diastoiic? Mark in space in column at left. if ?ndings are abnormaWeigh '2 (over) after examination on examination and describe in space below. SIGN . . wEmprion __Mo?sture ?Naiis WTexture ?Modules __Hair . mm - HEAD EYES WScjera . __Exophthalmos ?Pup? mUd4ag ?Tension ?Mistagmus m?Awiw Aw I Am 367 EARS ?MDrums mMasiaid 3 . i i ?Discharge 1 6" . INOSE ?Airways Tenderness WTransilluminaziun ?Septum ?Other I MOUTH ?Breath mTongue WLips WSaiivary Ducts 7 ?Teeth a, ?Gums THROAT Drip M5 - WPharynx WUvuia NECK WSti?ness #Vessels LYMP NODES mtnguina: . #Supraciavicular ?Home: Mmatarv mm I I CHEST [d ?Shape WHespirations . - "Symmetry thher 4 BREAST. 3, DWI N53 349 ?Mass-es MDischarge HEART wApicai "Sounds Mi impulse 2.: l/ a? It Third _Murmurs ?Shock WGBHOP W?ate LUNGS w_Frelrnitt.l$ Voice MFercussion _Whispered Voice ?Bream Sounds wAdventi?ous Sounds DEA-02353 7, "If 52:2? v7 "r w" 3? Wx?. u? ?re-W3. tw-T?J?FState Lic. #35?07-0722-v PAUL VOLKMAN, M.D. 1219 Findtay Street - Portsmouth, OH 45662 Fax: (740) 355-6945 (740) 355-6949 ?Mvr: wry. . . umaf??9?32?in rim-w ni-nr-x-n?; Van-?H: . Mr .. \m - ?4&5 .- .1 .DEA A 'w PAUL VOLKMAN, MD. 1219 Findlay Street Portsmouth. OH 45662 (740) 355-6949 Fax: (740) 355-6946 .m?frar?Fist; 3:33.43. fry ammun51. wsm? Vt . "5?5 3 J-us?. a Lily .. Siate3.5V -, a. T- "13? ?2 ar?N.? .: it. 1- 4? I State? Lic. #35?07-oizz-v PAUL VOLKMAN, M.D. 1219 Findlay Street Portsmouth, OH 45662 (740) 3555949 Fax: (740)355-6946 '?:23? .113: V2 ?rum 4-44.4? M. Al DEA-02355 . n. . .- State Lic. PAUL VOLKMAN, MD. 1219 Findiay Street - Portsmouth. OH 45662 (740) 355-6949 Fax: (740) 355?6946 I ?dm' limbDEA-02356 ?4 ?iSu State Lic. ?if?reaper: '2 PAUL VOLKMAN, MD. in. .. (a 1219 Findiay Street - Portsmouth, OH 45662 (740) 355-6949 Fax: (740) 355-6946 3 {a Av.? mt Mar19; (?hug 4.593;, .quy k, A .H .,?in- "413mg; -7411" -7- .. . 733M SOUTHERN OHIO MEDICAL CENTER 1805 27TH ST. PORTSMOUTH OHIO PRINTED 14NOVO 3 TIME 2 2 3 4 ADMITTED 14NOV03 DR DEFAULT PAGE 1 DR: DR: ?13m- 14NOV03 1530 . . . . . . . .CHEHISTRY. .. . . . .. BILIRUBIN TO 0.1-l.0 0.3 . BILI DIRECT 0.00?0.30 0,14 ALK PHOS 50w140 77 SGPT 30?65 29 SGOT 00*50 16 TOTAL PROTEI 6.4?8.2 7.7 ALBUMIN 4.1 14NOV03 1522 I I I I NEGATIVE CANNABINOIDS NEGATIVE COCAINE META NEGATIVE . OPIATES POSITIVE BARBITURATES NEGATIV BENZODIAZEPI POSITIVE anotes r: ABNORMAL DEFAULT END OF CHART REPORT I 17-Nov-zaae 635$?? FROM- PRINTED 1730093 *mw TIME 1253 ADMITTED 1450933 .. OHIO HEDIERL CENTER FREE 1 ..-. DR: FEW UHID DH: ELECIRBLYIESIEREESIEHEHISTRY SFEEIHER DHTE TIE 0W 3.1 1.5 HEIDL 9.3 BILI MEET 8.813 - 9.3% PEIDL 6.14 RLK FREE 55 1#8 IUJL TT 553T [91.11 30 IUIL 29! 950T Ba 58 IUIL, lE TUTRL EH - 3.2 34-36 HWK 4d TDHITDXICOLDEY SPEEIHEN BRIE IGHUTEE L. TIE DW 1522 TEST REFERENCE RQNEE TESHTIUE NEGHTIUE EBERIHE NEEHTIUE 1V 935111in BHRBITLEWES WIVES BENZUJIHZEPIHES Fnutnotes i ?hnoraal DEFHULT EH3 SHEET DATF 94/3 Amway 17Vian . resure: Systolic Diaslotic 7( 2 Weight Biood aspirant) Check 1/ if findings are normai after examination Mark in appropriate spaca in coiumn at le?, if findings are abnormai on examination and describe in space beiow. mCoior WMois?ture wNaiis mTexture wNoduies thher mPetechiae HEAD EYES mConiunc?va _Sc?era WPtosis mExophthaimos #mLid-lag WTension _Ophmalmoscop$c _AcUity ?Other EARS #Dmms mMasioid mHean'ng mmher NOSE WA?rways mSinus Tenderness WMuoosa wTransiliuminaiion mSepium Womer MOUTH WBreath _Saiivary Duds MTeeth mower WGums THROAT WTonsils WPost-nasal Drip mPharynx mUvula mPaiate ?Other NECK mSii?ness MVesseis mMasses ?Trachea __Thyro%d WOiher NODES ?Cervical _inguinal WOccipital *Epilrochiear w__Supracia\ricular WAxiliary CHEST i __Shape mmOlher BREAST WMasses #4Nipplas Womer HEART __Apicai _Sounds M1 impulse A2 P2 Third MPuisation (?Shock wGaiiop ?Hate WFriciion WRhT?hm _Other LUNGS Mermiius __Spoken Voice ?Percussion WWhispered Voice _Breaih Sounds __Olher Sounds (over) i Maw-W 1% 6% 62 4/4? 1?54 7/2 ?74/m 3W3 State Lic. . PAUL VOLKMAN, MD. 1 4 i1 Portsmuuw?assz (740)3556949 ai DEA Iii?d.- i m- pw?: W??wne-a Wm?wwvw yer-w- ?raw-Y a -w .3 1 5am?: 1 I 5' . has. a u-e inc-MW r. win-1?? a: J?ecL-mwe-zw 361 .- ?StateL'icms-o' "?r-onzlv PAUL VOLKMAN, MD. - Po?smouth.OH 45662 9. 3? q" [a 713?" (740)355-6949 Fax - . r? "in. "Aura- - PM .1 ev- ?a @341 ?r 1 a . 4 aar- a a .- g??s?mmn "InnagJam" 35mm 3:25;: ?Cr: 2:53 "f??ff "aw State Lic. 4. PAUL 90mm,ch 45662 (740)355-6949 Fax (740)355-6946 r? v. L-. w? wm ,J-bm ?2,411. . vim nan-H A. a? ?hd?HNI??Mk?v?w?w?w?WW Vat:? - State Lic. #mvom-v PAUL VOLKMAN, MD. 1200 Ga} Street - 45652 (i4o)3556949 i 2 1 3 - State PAUL V12OOGaySheet - Portsmouth, OH 45662 (740)355-8949 .. W, w. 1 M. .g mam.? 4. NAME BIRTHDATE DATE Important: Please date and initial every entry. 0 numru? DEA-02366 DATF I m. At: ndi ise .. Relratro rse: Systolia Diastolic maig 1 Check 1/ ii ?ndings are normat Mark in appr?pnate space in column at left, if findings are abnormal after examination on examination and describe in Space below. ?Coior ?Eruption mMo?stu re _Na?ts _Texture mNodules .. -. ?MPigmeni WHair Mm WEod'Iymoses ?w mPetechiae HEAD EYES *Fieids _Sclera mPtosis WCnmea __Pup? *Movemem WTension 636 I WOiher EARS We __Drums __.Masloid WHean'ng WOIher . ?Discharge . NOSE 5 WAirways MS?:sz Tenderness HMucosa *Transillumination ?Other . MOUTH wTongue mSa?vaw Ducts WTeelh thher WGums THROAT _Tonsiis wPost?nasal Dn?p mPharynx MMUvuia w__Palate mDiher NECK ?Stiffness "Vesseis MMassas ?Trachea WOther NODES ?Cervicai ?inguinal __.Occipita? maping WSupraclav?cular _Olhe{ 7 0 Mg WAx?lary CHEST WRespirations mOther BREAST mMasses ?Nipples "Discharge WOther HEART WSounds M1 Impulse A2 P2 Mmrili Third ?Pulsation mMun?nurs ?Shock _Ga?op WRate wFtiction __Rhy1hm LUNGS _Fremi1us _Spoken Voice MPechSSion ?Whispered Voic Sounds #Other _Adven?tious Sounds (over) gnaw. HMWanw Jar #20679? Press 1-WEZB-2379 . nu?v.72? 1 FFR 333'}, 923? 354,w?h? State'uc. gas-07.41722? PAUL VOLKMANgamut?: 1.3.: ,7 32" .gszJ?-?N it?: 1.xt?wyl.wk?uw? a" a; . mu? - DEA-02368 c? wm'?I?L?h?gtf'Jingf in. k. 3: ., . avg: immua?.? an? 7 Ifsas-omm?V PAUL VOLKMAN. M.D. g3. 12msaysueet- Puttsmouth,0H 45662 (740)355-6949 $3 2: $963 Q. 0 :2 $5 A DEA-02369 4 waxm-wgw-s .7?4:6 .: . 4 . 3:317: T: ?rm .4?-7ng?lteq?gjfw?h?? -. . . Him;- wg-4-35. en's-1. a, grate Llc. PAUL VOLKMAN, M.D. ?1ZODGayStreet- (740)355-6949 DEA .. . m?a- ?arr Inn?- 9 Ft?? ?2812; a -. 317?" V. . . idi'a??Wmm?aw A..- - . '2 .H Q- 2? ., 91?? whim.- . a I .- Sign whammy PAUL VOLKMAN, "rm-?1?ijth?wwr?A?rt-?h in 21: a NJ K. wharf?" 4' 5 4 ?ink Aft-mg 1:1. . . 4mg. 1374 4?21; - - ?1,11ch M: State mm-onz?v {a I PAUL MD. 1200GayStreet~ Portsmoum.OH45662 (740)355?6949 w: 7 Allergy: I. 3" I I Current Medications(if knowledge. at they undersiand are comg Pirientlniriais: Patient agrees that infurmation pro" cd is true an (actual to have been given a copy. and understan our privacy poiicy pertaining to HIPAA regiyiatiuus. .- 3.34 ?x a? 61:? .w Diagnosis: . . Prescribed Medications/Treatment Pian: Patient has been advised and understands that they shonid not drink alcohol -- meditation. aiso patient agrees that they have fuliy disclosed alt ESE bed by any other Panent Immis: PAUL VOLKMAN, 12006?va (740)355?6949 Fac?40)355?6945 .3 .952?. ?crash?K?ti'nqigl- aim: (. ?m . - . Ir." In! I, 33"? . -- V, Up; as. .mm. . L.-. - ? . 4.2. . -i -25., E. a a 3.37?. 5.: (in. {iai?imState Us. PAUL VOLKMAN, MD. .. Jgriy;5?71;??; p? a. . m. . . aw?, . a (1?40) 355-6949 Fax: (740)3556946 ?guf??x I . - H?B'v'l?t?pf zy'x. 120063ysueet - 45662 eriv mam-om- . PAUL VOLKMANJULD. 12meay5teet~ 45662 (740)355-6949 Faca4o)355-6946 - . . 9 L's. . y: (7.339 . I ?3 A, .. f: .5242?: 3:3; - 311;?L13fi?zLEQa "mm PAUL VOLKMAN, MD. 1200wa - 45662 (740)3556949 Mommas-$946 '{491w! uh; 1-4 ua-"mavw?x? 43:11?! a. 13? 4.931.}: "3.34 ?ef?gy; aim?wv? 1 . ?*5?WMTE5?ntrh?i?E23? 3135' State Lic. #3547072? PAUL 12msayStreet? ~Portsmuih_ .0H45662 (740)355-6949 puma? . lar- ?State PAUL VOLKMAN, MD. 12DOGayStreet- Portsmouth,OH45662 (740)3556949 ch(740)3555946 . 1 2:44 myrq?iw.5: ?ml. .Aa. M. .L- ,4 <5,State Lic. mommy PAUL VOLKMAN, NLD. mosaysueehpoztsmumwmz (740)355-6949 z/X/c, C90 5 ?zcI?m-?r 4; A . 4A Vim", . imagi?m, a gagr? .?iL in 32 m! r, VHF, may,? Fr.? {Mi .r M. BIPrrent Medications: Side Effects: Current Mcdications "no. explain: rcmic lgrumu?ll?. 5.: that they Patient than? infurmariau provided is true and fauna! to lhrir That they understand are Patient initials; ?4 havc been given a copy. and our privacy policy pcmining HIE-L4. regulations. mm; {mm I a Physician Exam: . M. Diagnosis: Prescribed Medicationsn?reatmentPlan: gal? LB [(6-50 ail/J,? I I, Patient has been advised and understands that they should not drink a! ma:ng um hm ?my dimmed "Hi" mfdj??us nrmribcd by any other physicists: Patient Initials: I DEA-02381 State Lic. PAUL LVOLKMAN, M.D. TRIS-TATE 8: PAIN MANAGEMENT - .. . I I Name . Address ?di?Wm.? ?Wu am #4360 6/ 101450 .LEI?Jsundover Re?l?l??g12345 Presm'ption void if more than (1) prescription is written per blank State Lic. PAUL MD. TRI-STATE 8: PAIN MANAGEMENT 1.24 25-49 0 :9 CI 50-74 Mas-100 101-150 151andover Re?llQ12345 Prescription is void if more than (1) prasc?p?on is written per blank .- - - 2? my.? . mi State Lic. PAUL MOLKMAN, M.D. HEALTH CARE 8- PAIN MANAGEMENT $572 :?24 7&0 33?: 754(1) 101-150 074754 10 151W Prescriptim is void if more than (1) prescription is mitten per biank a a TRISTATE HEALTH 8- PAIN MANAGEMENT H. PAUL MD. #360 2 3 4 5 mm ifmgf?m?sc?p?m is mitten per blank CC Stale Lic. 25-49 50-74 75-1 on 1 01 4?50 m?f/Mww? 53/4; 352 Note: Mum xmze mm? 3 TQM ?905; 73?0 5: ?01 . @774 . ?0 m. 6/69 {Mood} . i i - -- m. . ix!ng .713?: . Stae Lic. PAUL VOLKMAN, NLD. TRI-STATE HEALTH CARE PAIN MANAGEMENT 1200Gay Street - "r?d Hmmw-Ip-r I. 2 a Address 5 ~o 1.24 El 2549 sot/4 75100 )g 1.01450 MW - - El 151 andover ?Ref@12345 Prescription is void if more than?) prescriptign is written per blank 5 0 2?3 315DEA-02388 .r a, a. ff 12008ay5trget Hg?mvl,mw?uruw uni-Vt5?. 1 Q) 151and?over 7 VG State Lic. PAUL VOLKMAN, M.D. TRI-STATE LTH CARE PAIN. ., :25? ?it/m 6? 101-150 Prescription is void if more than (1) prescription is written per blank DEA-02389 .0 9 State Lic. PAUL VOLKMAN, NLD. HEALTH CARE 8; PAIN MANAGEMENT 1200 Gay Street - Ports - Name Address . ?umv'f? ?-li1-24 #7 )0 5 a CI 25-49 1 5074 75100 :1 101-150 g4. 2/1151 and over 1?3: Prescriptionisvoidif more than (1)prescn'ptjon is written per biank n? ?ns-K . State ch. i PAUL VOLKMAN, M.D. TRI-STATE HEALTH PAIN MANAGEMENT 1200 GayStreet - Name . Address 5 Sbmg$? 37*? 5? .- 1?24 ?2549 I: 50-74 75100 101450 Re?@1 2 3 4 5 151 and over Prescription is void if more than (1) prescription is written per biank DEA-02390 State Lic. PAUL VOLKMAN, M.D. HEALTH CARE PAIN MANAGE NT 1200Gay5 - OH 45662 740 355-6949 Fax f? Name 7 Address 1 2 3 4 yrescription is void if more than (1) prescription is written per blank u. rhuL State Lic. #35070722?4 PAUL VOLKMAN, M.D. HEALTH CARE 8. PAIN MANAGEMENT Name Address 1-24 25-49 50-74 75-1 00 1 01450 151 and over Prescription is void if more than (1) prescription is written per blank ununbn '5 .a i PAUL VOLKMAN, M.D. HEALTH CARE PAIN MANAGEMENT 41;? ?g 5: j; El 2549 7 El 5074 "i [1 75.100 317 - 101 -150 ON 9; 151andover Prescn?ption is void if more than prescription is written per blank w' A '1 527' I 1, a. a . Maggy gm 72? g; gsgwirv <15. .. State Lic. #3507g72?v PAUL VOLKMAN, MD. TRI-STATE HEALTH CARE 8. PAIN MANAGEMENT 2OOGay$ - . . . . -m-Wm-v Ad?r?ss' 2 3,245 1 .V?w .a . Stateucj #3567g722-V?v. . 3 PAUL VOLKMAN, 1.200 63? Skeet Name 151 and over Prescn'ption is mid if more?th'a?n (1) prescription Is writlen per hm a I State Liami-om?v PAUL VOLKMAN, NLD. HEALTH-CARE 8.5PAIN MANAGEMENT . . . A Vex/5% :0 I E. a; [325-49 7 770 52:21; WW . 3.12123?- Remy/u} 12 3-45 ifmorethan (1) prescription iswritten per blank DEA-02398 -K ?t 2 Sim; 4 . VOLKMAN, .TRI-STATE HEALTH CARE PAIN .1r2OOGavS?me?t - - igName .. "?rgr 4 [r . . .7 .3jl?Vim,? Rig/91 2 34.5 - a: Js'esc?ip?o?is fppre per blankf' 3:3; w; . ?up-a. A- - ?qu? rrw< . .J ., - {Jar?Wan. .. . Wwv??mw - . . .I State mammwl 3, PAUL M. 101-150 .151ahdqver Re?? 3 4? 5K Prescriptidh is void if more than (1) prescription is her blank ?09 7D 30* 90 [411? A 1: zo/?m w. Z) DEA-02400 DEA-02401 . u_ State Lic. #35-07-0722?v 43*: CARE I (740)355-6946 Rake; 12 344? 5 Pfescrip?on is void if more than?) prescripiidn is written per plank Date 7" 1-24 25-49 5074 75-100 101-150 151 and over lRefL16I112345 Slate Lie. 335.07.073.31 . a, a M.D. - j" a CARE "'12OOGayStfeeh Portsmouth it 1 -24 25?49 UM jay/w 151 andover ?Prescrip?on is void if mote _than (1)pfescrip?6n is writtgn per biank '3 5 ~k I 7-. (?Mun State Lic. ?gs-070mm - VOLKMAN. M.D. HEALTH CARE 1-24 2549 El 50-74 7 75-100 1014150 El 151 andover 1? Prescription! is void if more than (1) prescription is Written per blank . . . . ?m?$x?quM . Po. Box 754 .. ?Lm?g?thj-JOQF . ,1 mm.? . u; .. . AllerflesRe: 1553/" .. - Current Maids: ??iu '71?th .r Notes: i A a afmi. {2 m. 5w wmbm.25" W0 3-500 ?mm Qm?n\ f/l . un?t-1.. 4.. DEA-02404 #6 3.7. my .r?A?v any-r?. -?wvm "batik" a. . 5" a? Sr? Stale Lic, mv-omu PAUL VOLKMAN, MD. HEALTH CARE 1200Gay$treet - Pansth OH 45662 740 355-5949 2 Wf? 1-24 I 25-49 50-74 75-100 1014150 151 and over 4 Rei 12?34?5 - 33, 2m 54; ~15" a; - .. A . Presaiptiqn is void if morgthan (1)??Pre?cript?dn is miugn per bfank Lag}. .??ldhuu?nidhuTI-?L? may -t ?AJ-u-un "Irv-Van: 7? Datez3-13-03 Tri?State Health Care 835 Main Street South Shore, Ky 41175 Phone: (606) 93?.?2586 Fax: (606) 932-6837 Dear You have been scheduled to see Dr. MD. on March 27, 2003 at 9:30 am. This appointment will be for you to get the nerve conduction study of your Right leg. You will need to take your insurance information and a picture i.d. If you have any questions regarding this appointment feel free to call. a '4 I: Thank You, ?i I I P.O. BOX 754 FSC) TH I?v Et-?m Date: Allergse728,1 -- Notes: 0. I .1, r; 2,13 a? ?a bowl-w (3W {114,149,122 ?ll 914% . {Li {7/63 gm I . . 4?39?? 7- I If z??SVr'frf(?szp-3 (V State Lic. State Uc. Prescription is void DEA-02409 State Lic. Fax: 606-932-6837 Name Address . 1?24 1:1 50-74 ., 75-100 101-150 Re? 12345 Prescription is void DEA-02410 .. HEALTHCARE 1 7" R030 764 a I SOUTHSHO 3i (606) 932-2586 We: 7 ,LAllergies: - I 9- 1 I Ila-7M LIV 5/319 (,th #J/vLemfw g2 {/357st . QM Nib am? a? p; ?t 25% 2 State Lic. [1 124 C) 2549 3% [1 101?150 151 and over Prescr?ption is void if m0 blank QEA State Lic. i. 835 Main St. South Sh - Fax: 606-932-5837 Date ("Iii /7 4% 90 . 2549 4 7,3 i 75-100 over Prescription is void .f (In Of?ce Urine) Name? Results Read By: Date: Witness Initials: Time: . if Drug Screen Used Postive Negative i eJ . W'Alnphetamine :3 5 I Benzodiazapines Cocaine Methadone Morphine THC Tricyclie Antidepressants J?asf 52496 mi 11.5; D??a?mwj Luz?I DEA-02415 'l - w. .. yr I. TRI-STATE HEALTHCARE P.Notes: . DEA State ch. . 835 Main St South Fax: 606-932-6837 Datezglf/my/ i Name Address WK WW- "Jr/(w 32:5?. 7?4 ?at 21nd over M- Prescription is void if more than (1 prescription is written per blank DEA-0241 7 8 DEA State Lic. TATE HEALTH CARE 335 Main 51. - South Sho 606~9- - Fax: 66?;932?6Qg7 E1 1~24 3% 3 :49- f? 00 101-150 over IN 2345 Prescription is void if more than prescription is written per biank State Lic. TRI-STATE HEALTH CARE a 586 - Fax: Gama-SQ? Dale /chq/; ?24 @635th f/O [1 75-100 101-150 151 and over Refill NR 1 2 3 Prescription is void if more ank 9 . ?nd-Au.? L, (I: HEALTHCARE P.O. BOX 754 SOUTH SHORE, KY 41175 (606) 932-2586 Datei': Allergies: DEA HEALTH CARE State Lic. 835 Main St. 0 South Shore, KY 41175 0 Phone: 603932-2586 - Fax: 606-932?6837 . .an.? wrung, 345 111w "yfrfun? Prescription is void if more than (1) prescription is written per btank 71-3r?r, . EA-02421 DEA-02422 751v; 1 9:12"; ., pm a was! ?mgw ?hays-w; - .- . :3ng "7?1"an Vim 6- . 441:? .. ~15 a DEA Slaie Lic. FRI-STATE HEALTH CARE -586 - Fax: 606?932?6837 Date 12? [3 1~ 4 .. 34:49 [3 50-74 I 75100 101-150 1 and over PM 345 5? r. Prescr?ption is void if more than is wntt?? penblaqk z? r? hymn?Lyn: m?vu? W?4?w' wank?2'?! v" . HEALTHCARE SOUTH SHORE. KY 41175 .1 (606) 932-2586 i I it? (9 i '?fyy END ?mi/pap/pm 4.14 455,5. 52,4ng - p? ?75? ??m?wk i Olgyx MM 1129,; 5 $is: n?r- Wu - -6. {hm-3 Bu; (350 ?x?usea??s 3-24 25.49 50:14 75-100 101450 iandover Prescription is void if i DEA-02424 EA-02425 V: Emamm} '-m77 "de "v DEA State LJC. - J. 835 Main St. - South 5 - Fax: BOG-9326837 Name ate gt? Address Prescription is void if DEA-02426 State Lic. 335 Main St. - SW 51:; .. - Fax: 606-9326837 Name Address in? El 101-150 I 151 andover R12 3 4 5 Prescription is void if biank Date i HEALTHCARE no. sex 754 scum SHORE. KY 41175 (606) 932-2588 7b. We: ate, Allergies: {b32333 Pt. Name: 5? - BmJkugmm- Current Meds: AW y?Jv State Lic. HEALTH CARE 1-24 I Lx 3 25-49 Katya/c >z s~ we) 3 :21; I ?V?/bwlj 101450 ei 4 151 and over DEA State Lic. 6 I Fax: 606-932-6837 I 745/- 23* [j 1?24 [3 25-49 V4 75-100 over Prescription is void if I i i . i #1 HEALTHCARE ,1 6' P.O.BOX 754 . SOUTH SHORE. KY 41175 (606) 932-2586 Date: wlergies: I iM?ia??i?-i I . IL why. IL .1 W. 7; 1-4 ..-- 71% I, 5/Y/xgme%ma A . ?0?95: My 11 .: . 1/ 2.4 L/J?r?i/ [ff/jZ/m/y?: 5 f/S? ?r ll, . . W137: "-11 .JMf-w-u-L . I DEA-02430 State Lic. A .w . .. 3-4-24.? ., 9.34 MAMA: a ?y w; 62 $34; ya a 7229 Prescription is void if ??u?lvp-II EA-02431 hut nut read [by Physician! HEALTH CARE RO. Box 764 835 MAIN STREET SOUTH SHORE, KENTUCKY 41175 Voice: (606) 932-2586 or Fax: (606) 932?6837 Vitals: B.P. 90/68 P. 84 R. 17 Temp. 98.6 Re: Pt. complains of pain in neck and shoulder pain, muscle spasms, and night leg pain. I I . Lorcet 1 0/650 Diagnosis: Low back pain Neck and shoulder pain Muscle spasms Treatment Plan: Take medication as presm'bed and follow up in four weeks Lorcet 10/ 65% tr rdor l' otesThe use of narcotics for pain management has been explained to the patient and the patient fully understands all given I) DEA-02432 but nut read by Physician! HEALTH CARE P.O. Box 764 835 STREET SOUTH SHORE, KENTUCKY 41175 Voice: (606) 932-2586 or Fax: (606) 932-6837 Vitals: B.P. 110/72 P. 114 R. 17 Temp. 98.7 Comglaints: Re: Pt. complains of pain in. neck and shoulder pain, muscle spasms, and right leg pain. V'isteril 50 mg Locet 10/650 Diagnosis: Low back pain Neck and shoulder pain Muscle spasms Treatment Plan: Take medication as prescribed and follow up in four weeks RX: Lorcet 10/650 pain management has been explained to the patient and the patient fully understands all instructions ri?State Health Care - car fair poor improved ~same- worse eafood dye - others: List Carre?t M?edications: Last Visit - List I-erw 50 3L4 01W 101L431 Bad 4. Results - List 5. 6. . 7. 8. Physical Therapy Consult: yes Are you participating in home exercise program: yes no What type of exercise do you do? Consult.? yes I Do you attend any type stress reduction class? yes no Equipment Vital ns Does it reduce painList our pain areas and rate your pain level 1. 56K 0-10 Scale - 0 is no pain 3. 44510 10 is worse pain igl?? Improved a same worse (Follow-up visit Medication renewal . Return 2 . RN CNA HEALTHCARE PO. BOX 754 SOUTH SHORE, KY 41.175 (606) 932-9535 Initial Pain Assessment Tool Date I. {5:933 J. Location: Nurse marks dra IV. VI. VII. Intensity: Patienyt? the pain. Scale used Present; Worst pain gets: ?77 Best pain gets: Acceptable level of pain: pn? . ache, burn at What causes orincreases he pa 7 d4 ?g a alga . ?Effects of pain: (Note decreased function, decrea?dyality of life.) Accompanyin (eg. nausea) Sleep 4.. Appetite Physical Activrty j? Relationship with others irrita .. .. Emotions an suicidal, (Q Concentration ther Other comments: Plan: Signature: Progress Notes News: .. 9 mains-i .L pm? 1 . . 77! (gap/RM 1? be" z! 99??,qu '3 9:?er If) .. (f 7/ tag!? 46? ?3 1/ Doctors Signature: DEA-02436 DEA-02437 State Lic. i I. A, . mfg/WW 1-24 25-49 CI 50?74 M100 [j 101450 151 ahd over Re12345 Prescription is void if more ps per btank .wL?? ?with; Inn w; 3?31?! can: A "f Pig?, . . ,k Jli?f ,rL 4f 'fl?c 2 emu_z.A . 1.1.333Lhiygt 7 iv a i lat at?1'31. v?In? lull h? 45? Patient Name: Datezfz? Ass?ssrnem .M A of you), PamDragnousm de/C Contributory illness: Depression? Anxiety__ Cardiacw Complete history and physical, including pain history, are in chart_[ Current and past pain treatment treatments were reviewed History ofsubstance abuse was asked? Positive history Yesm Pain- related disability: Work? Activities ofdaily Treatment: ?lediCati0ti_Mj- Physical Therapyyk? Eyal: Yes? Where Goals of Treatment: Reduce PainJW/lmproye ability to participate in Daily Functioningy Reduce use ofmerlical system and emergency department \?isit?w/ 1? ie were reviewed with patientf: Risks: Bene?ts and appropriate dosing schedu Folloiv Plans 1 Weeks Consult Drag Testsg??i?d Of?ce visit followup-Jr-m' . . . it? . Date: r'con?Ip?llnu: V7 9 mm m, MW. gimmick W4 . Current Medication: Tests/Referrals: Did Patient Comply? Yes No No NIA Results Received? Yes s/v?rm? 7 I/tgw, 453)? {24 Doctors Orders: 9 2314 Diagnosisr- Oak Sg/h FBS: )thcr; Allergies: Meds: . 11.5? Exams: 8? "fig WT Eyes: Fundi WW Ears: Normal Red Retacted Fluid Throalchd Swoilcn Tonsiis Exudatcs Neck: Normal Abnormaf Chest: Clear Rates Wheczcs Rhonci Heart: Nonmi Murrnur 1* - Rubs 1- Anh?hmia- Abdomen:$o? Non-Tender No Misses Rebound Extra: De?cils Lumbar Spine: Normal Abnormal Thoracic: Normal Abnormai Cervical: Norma! Abnormal Other: Return: Charge: Telephone: 606-932-2586 DEA JO State HEALTH CARE 335 MAIN SOUTH SHOFIE, KY 41175 Name Date AddressW [3 1-24 a 25-49 0?74 [1.75400 101-150 51'and over Re?ltNR? a 4 5 Prescription is void if mere than (1) pre?pription is written per blank I a Telephone: 606-932-2585 DEA State HEALTH CARE 335 MAIN STREET, SOUTH SHORE, KY 41175 Name Address . . Date f? (55/0 1:24 5.3/23? is 754100: 101?150 1151? and over Re?li?fm 2 3 4 5 Prescription is void if more than (1) om?n- -. .mrv a HEALTHCARE no. BOX 764 I ?scum SHORE, KY 41 175 (606) 932?2586 Br. Pt. Nam D?te: Allergies: .115239 ??uni?m mas: mm 155 .- Xxx/w 5% I At{10? 7% ?g 41%} :1 ?gw? ML arch. M, Lads" ?p {gm gab: N49: L319 K's 1) 1 119 .5 Telephone: 606-932-2585 HEALTH i .. SREE 30. Name Date SD my. @0 25-49 @9337! 7" 75-100 101-150 151 and over Address A fii Prescription is void if more than prescription is written per biank Telephone: 6069322586 THE-STATE HEALTH ARE Name ., Address . [31?24 25 000% 1W I 75-100 101450 151 and over Prescription is void if more than (1) prescription is written per blank FRO J13 t. manna}. mi: Wu, mm BIOCHEMIERL PHBFILE MTE YEW TIME 1H5 T-AZE mm 17m nus 1243 HDIITTED 1753532 ma 2 TEST RM TUTRL 6.3: 3.3 WW. 3A 5.3 M. 3.9 MEIUH 8.5 - 13.5 9. BILIEIJBIN 3.1 1.9 HBIE. 6.3 RLK FIHBS SB ""149 11M. 68 551T 59 NHL 23 SEPT 33 65 Ill/L 34 mm 148 143 FEEJL 137* POTASSMH 3MERIL 193 {393 El 32 HEWL EB 70 - 119 EIDL EB Bib! 7 - IB IEIDL 19! CERTIHINE 3.6 - 1.3 mm 1.1 TESTS EJEEIHEN DQTE 1m TIRE 11W 1839 TEST "un?mm TSH .33 - 5.63 1.71. FMTE 2.6 33.! rant 1% BIZ 211 - 95m. 299?: FULHTE PINE NEH REFEREE RM UITHIIR 312 ME 5% RM Funtnuta: Rbnmal, - F-UBT . 0? 7-425 moi/nu: war mm mm . TIIE 12% u. 94311er 17551292 mum mm ma: 1 na: mm L. HEHHTULUSY I k, mm mm mm TIFE name: 1% TEST REFEREE cm. 4.: ?134.18 HEB 12.5 15.3 Sill 13.2 HIT 37.3 47.? it 39.5 #39 82.8 $2.8 FL 94.6!- NEH 29.8 - 31.8 pg um: 3.3.3 3m ems. 32.54 RDH 11.5 - 14.5 a: 12..HBC nmenamm $53 35.3 - 7m 53.3 LWTE as we 32.5 mm - 18aware Rum Ems - 16 mm DIFF - nu: w: - .V mm HYHICHM (H - WWIIE33 8.8 1.3 KiuL 69.1 Funknute: Ir Panama}. i DEA-02446 DH: DEFINED w? na$? FREE a. Viwpuu:; e: 1-w?iggagged .f axiai imagg-and a 1 be&-of inemeaSedrs?gnal in ?age n10 76 "3 ivi'dduj49'??f1sj131gQ?TELNEf 7 DEA-02447 Compose Num 3 Caps H?ld i .. . - E318 ,?dit. gonnectiun Setup Scrigt Vimd?w I I m-e3?. - im-- MR1 53%? ,nfarct, hemorrhage or a mass effect. g?ermal basilar and carotid flow vaids are noted. '?ild mucosal thickening is present in the left maxillary antrum. [Mild degenerative white matter change is suggested, as described. There is nag levidence of a cortical infarct or a focal enhancing lesion. Mild mucosal Lthickening is present in ghe left @axillary antrum without a fluid level. ?Status i: sing; print)" 1 401m; composeii Hum I Cap: Hold; DEA-02448 .: pizaii?'?'m g'4n7'i'i'E-m! I 1 '7 34 Compute Ii Mm 7: Caps Hold 5 WW 1. (3 i} I. . HER: a Ez?f ?ai? Extending "ta right arm. Wis study is, 2 were was a CT that gas ,on d? is d??69?bix??wa?% F1 TE sagittal ?maging and I 19-39%ng is done from. za ?fflis'?i?ht?ined bilaterally using the ,2 q??rmalm ??ght: ?ni?armal alignment amd fer-32513? Sbm? lm'p??nggment :on I r; .: ?Mt ~4th .p 7 m. ?-4?1?avtf?l: ?vai?izi??aiELa1?BJELNE?"" -. Ham! ?Elgt?iran 4 tsmam?w . Edit gonnectiun Setup Script ?indow ?ab ?El??ial ?ag?r??i??gala?.gg? . 3.3 I MRI CERUIC SPINE . d?gree of 315k bulging and/or posterior spurring} 'Impingement nated subarachngid space identified at the level that appears to be secondary to an element of disk bulging and/or- QwOsterior spurring. end-of report Status is Fiuat' (?F12F?2'scroli, ?2?E31T?7to print)? I 401% I ?172.1531?! via TELNET Compose Num 1 Cap: Hold i DEA-02451 *??i?isneapti?n .E?it. cmm' sag? WVWP (Rip. FRIES EBEER :93; staid-@2555: po?i?eficif thg?ant??ia? the beggawt?at A 4 DEA-02452 DEPARTHENT 0F RADIOLOGY SOUTHERN OHIO MEDICAL CENTER SCIOTO MEMORIAL HOSPITAL PORTSMOUTH, OHIO 45662 CHART Name: Uni DOB: Sex/Age: Trans: cr. Order Dr: . Nur Stat: ER Admit Dr: Room No. Radiolog: Pat Cl: Reason/exam BODY ACHING, DIFF BREATHING Admit Exam: CT CERV. SPINE CONTRAST Reqseq 8 104943 Date Done: 04-30?91 Reed: 04?30a91 TPD Date: Time: 1228 FINAL Exam: 3546 CT CERV. Side: DOS: 04/30/91 CERVICAL SPINE CT: Without contrast. The study shows mild disk bulging at C4. At C5 there is a suggestion of a soft tissue density posterolsterally on the right at the level of the foramen best seen on image #12 that could represent a lateral disk herniation at this level. It is better visualized just below the level of the main part of the disk and could be spurious. Given the patient's clinical findings of right sided one might consider HR study to aid in this assessment. The C6 and C7 disk levels show no abnormality. CONCLUSION: Soft tissue density is suggested just below the main level of the C5 disk that could represent a lateral disk protrusion into the right lateral foramen at this level. Because it is not visualized right at the level of the disk I Heuld suggest HR study to aid in this assessment. Signed by Dr. DEPARTMENT OF RADIOLOGY SOUTHERN OHIO MEDICAL CENTER PORTSMOUTH, OHIO 65662 CHART Name: DOB: Sex/Age: - Trans: 5838 Refer Dr: Nur Stat: 0? Attend Dr: Room No. Rudiolog: Pat C1: 0 2 . Reason/exam NECK PAIN Admit 1 Exam: AL SPINE Reqseq 213768 a Date 06w24u92 end: 06u25w92 TPD Date: 06?25-92 Time: 1047 a FINAL Exam: 5m. - mu: 'sade: nos: HR 0? THE LUHEAR SPINE The patient has a history of neck pain with radicular of the right arm. The study was performed to evaluate the cause of the patient's cervical radiculsr The HR study shows a prominent disc protrusion and some degenerative spurring posterolaterally on the right at It canses marked effacement of the ventral subarachnoid space and some mass effect on the ventral and ventral lateral cord a at this level. This was also suggested on a CT of Hild disc bulging is noted at 51 through CA and the C7 disc levels appear normal. ?4 CONCLUSIDN: A moderately large lateral disc protrusion is noted _at on the right. This is also suggested on?the CT of '4/30/91. Some associated degenerative spurring is also suggested on the HR study. There is SJme mass effect on the ventral cervical cord at this level. Hild disc bulging is noted at Signed by Dr. DEA-02 ?It .l M. 4 (Eig??mw . gag Edit gorllnection Segup Scrigf I Wow a ?g?g 9ATIEHT pkatgg?mga Status is?s:ngn report f! (am?.2 view link print) 1 405, i 172151.31 vi? TELNET Compose 1mm Hold ?le 1.9man Sew Scriat Hinddaccessing nae: HAME regaigngegg?? 06/20/%8_ Exam Shims SERIESEWI ?The alignment of the cervical column is normal. The vertebral bodies and *intervertebral disks appear well maintained without apparent fracture or :subluxation. There is some minimal posterior spurring at the level. The odontoid is intact, The neural foramina are bilaterally widely patent. cThere is only minimal posterior spurring at the level with the cervical fspine series otherwise unremarkable. Status is?F1aaLf print) 3 407,79 ?17215131 my: Num 1 Caps ?314} EA-02456 ,E?e?sctim 7? Ef?e *gdit gonnection Ea ?jjg? (RIP) egocenaee; 03:33 SPINE - ROUTINE, INCLUDING AP, UPSHOT, BOTH ?:93 LAJERAL The lateral projection of the lumbosacral is of technically poor quality. I so not see obvious fracture. The vertebral body heights are normally Nreserved as best I can tell as are the intervertebral disk spaces. No gseoliosis is seen. Ihe obliques show the component portions to be intact. Stu? link list, I 405.73 h' Compose 1; W?um Trap. Ham; Elle. E'th gunnegtiun Segup Scrip; ?indow ?elp I Rig L.T a Q_g I nee HQME peasgngagz' SPINE ROUTINE, INCLUDING AP, LATERAL, OPEN MOUTH, AND BOTH 308LIQUES ;'fThe vertebral body heights are normally preserved and no fracture is seen. iThe C5-C6 intervertebral dis? Space shows sbme mild narrowing. Bony Emineraliaatiom is nermal. The odontoad is intact. The CT cervical ribs are 'not present. Obliques show Ehe interveriebral foramina to be normally -patent. .20 fractare is See"- 's?atus is list;ax?E?ITEi?finti $5.78 w, compose i! Num Cap: Hold} DEA-02458 i Edit: ghnnectiun Se__tup Scrigt ?indow ?elp a! ?g - -i paTlgui wags . THORACIC SPINE . :21; .spao?s of the dorsal spine appear horm?l study. and of report WStatus is wa?il' a link from 73 {??Wimm ?112151.31. via TEL-NET Compose Hold i ?The patient?s history is motor vehicle accident. The study is performed to ?aid in this assessment. ?gThe stug?_shows n9 evidence of disk herniaxion 3-3 ages . EXAM osi22/01 TIME: 21 24 m?ild disk bulging is present at Otherwise negative study. ere is no evidence of disk herniation or canal stenosis. h??I OF THE DORSAL SPINE: 'Status iS'giset print) .9 I 407.73 I . Compose :1 "um 1 Caps Hula; DEA-02460 ?ag-93m 5i - items? ?e gunnec?un ?Segup Scrip}: I ?elp' eeTxeer eaME'. 03! 1 1:535 RI OF THE CERUICAL SPINE: Jihe'patien??s histery is meter vehicle accident and neck pain. The study is *performed to evaluate for possible herniated nucleus pulposus. Technique utilized is sagittal turbo spin-echo Tl?weighted imaging, sagittal turbo spin?echo T2?weighted imaging, sagittal gradient?echo T2-weighted imaging, and spin axial gradient-echo TZ?weighted imaging. I rya?g?o?dw? Q??he study shows mig? disk bulging at There is no evidence of risk herniation or central or foraminal stenosis. Status is Fzmea'k QeFi?ef?escrdi1,SELECiV?iew link listhEKPE?fi?-print) I 4017?8 i . Compose if Num I Caps Hold 1 :Eamzmw - - 31:3.de go?nectian Setup Sdigt Endow' help .. k? RIE.S I {gigjfw Hag, .parignf namg 1' s-E - EXAM 777 [egative MRI of the lumbosacnal spine. and of report Status I I rin) I 405,73 Compose 1: Num 1 Caps Hold; 3 Edit Lamination Setup 9% Scrigl: Mndow 94ioszo1 0F . The patient?s history is herniated disk, motor vehicle accident, low back pain: and right leg radiculopathy. Yhe study is done to include T1 and T2 sagittal imaging and T1 and T2 axial imaginga The axial images are done from L3 through 31. The vertebrae are of normal l?eight and normal alignment and demonstrate normal signal intensity, There isi 'no disk space narrowing identified and no evidence of impingement on the j?nteriqr'subarachnoid s-ace is noted. Tthe 15 no disk herniatign identifi?d?. Status'is IE-to print) 1 409,?9 1' Compose 1: Num 1 Cap: Hold 3 Edit annection Setup Scrigt ?indow lief]: I ELIE-10204 EN 36 USERNE RESULT a.y 3V3 3 gr? I a ageggszo?_n?g mama ?a mmExa? BEIE: .11/97/01 ?egeneratiue spurring. s?iwsLUSIo?: Lit straightening of the cervical spine is noted, which could be posit? to lig?amentous injuryr or splintin-g from pain. Otherwise, negative study end of report 'statUS is?finAL ii?? print) 1 384,?8 1 Compose 1; Num 1 Cap: Hold; 3% 'a $533 TI .ERUICAL SPINE ROUTINE, HQHE . Bfe; ?gait .Quhnection Se?up Scrigt Elf-Ida?! INCLUDING AP, LATERAL, OPEN MOUTH. AND BOTH INDICATIONS: Neck pain. MFINDINGS: istraightening of the cervical spine noted? disk stace narrowinn, 'fracture, 'Status isfFZ??y The preuertebral soft tissues are normal. There is some There?is no evidence of a or listhesis, There is no evidence of link 334.73 ?vw4umr?17215131veTELNET Compose "um I Cap: ?uid 3 i; 5 a gt?gsszauf??k 1? x. F: .. Qia??i?gmiato?fs den-$332133? L19 the? right The "mart, ., ii?eif?l??cgtion Eire unarema?cisabvle. 334:?3 3? 4 Compose Erwuum? gaps Hold 3 DEA-02466 - Edit gonnectian Segup Scrip; ?indo maria! mama alas'37? Pauggn?ags" .mmEx?mw??IE; end of report 'statug is brint) . 40138 Hum" i'ta'p? .Hold 7 Elk-?02468 to ?ght. ,I?Jopgjarvm (?stenlion. Nmfandet. Ham: SI, 82 mZSd?Nn mammal}. No masses. No There 5mm 'n the, @1Mm?xhami??sz?t, are Thane was no of lag. Hat gait was mwm, wumamm - tax-1;! Wm?mm1ha?m. *5 7 . ,a?m?ve se?ng maWufM.Wn-r at? mi 1h hpa?mt, and HE 3531:615th bashed 1-5 15mm; mrihites;mmyteeslm;?nlvvas mumm?uas ?vmeme - 1) Fm pail. 2: Winn. tohav n?mimia - I .. Daleofsmf ?4 Pa?a?lmbi Dbtatedby: [hsz ?Tramclbed by: 141,1 Pa?mtsemhw?m?mwim CHIEF WWJAM-mmalai?s. I'm: ?upa?er? is femdewho wives per Wmmp?aiimem'h marbersaysil ?sway-W W,Sheddre?se meal?: spasms. aim mom with lhafha?idll She WhiteMRI. She 'Ww . She aha sigma that that wm mind va?y. PAST MEDICAL HSTORY: She has 3 mm on herd'gm kng. ermth had a pa'?al hysterectomy. I. I I . lmrdown, she stated H??swasi 3mh?zea?m. mates: PILL. APR 162001 6 453* -, ?at-Q? . 4 . - Paga1'of3 mm: 64? 74 . Mm}? a-n?agsm "mom- . . . PAST WSIALLERGIESJSOC. ax: "rs, Mm' 5? ILA Additions/Deletiona' cousr: neg? .- HPl-feva-ch?l' simloss?weakness-malame; m? appe?len'otbe: . EYES: ENMT: - ~seel??I-mtlnou?heam exem? 'ataxis .: . . ., a - 3 I . RESP- seeHPl SOB sputum production .wlaeenng DOE, FMY Hx: cv: @oseeHPI-cbest Jun-?chopm-palpmuom- - em GI: neg-seen?! - neg-seeHPI-dysuria?urgency-?eq - discharge?vaginal bleeding HTN DM FPO: nag - see ?a palm-la polydipsia fe?wld intolerance Cancer ed and wereneganne I I I - i I ADDITIONAL PHYSICAL Constimtioa?l: Vitals (See Nurses Notes)? well developed52> 4fme ?pleasant, coopeta?ve .4 - -- m: Drophaxynx: tonsils; n1 enlarged erythematous a? ?7f-v? I 4! .11; - var? mu ,nosenl . ?moist mucous membranes ?pplez?ymssesm thyroid n1 ?nvtender gt 1% ?a . {?ab .4 'cal ad: .ar? no Gem ?apathy it a? 51 Chest: retractionsm non-tender Lungs: if - . . (location) 7? 1- . CV: irregular no murmurs/rubslgallops f? 4" (j-Iqup?g GI: Aw I sounds n] nl no masses 1 i [x on-tcnderw tender (site) . in? mv ?any . $4125} GU: Malezw no CVATW nl external genitalia - . I Scrum] tendexw enlarged . 1 Feamle: nl external genitaliam nl uterus/adnexia A . - motion purulent 0" 3'31!" ?gfk . Afilt n1 gait? no defoqu FROM sueogth/tone_ edema Am nl thought/judgement no homocidollsuicidal thoughts 5 hallucinations age~appr0pria?e behavlour 7? 7" SKIN: no no palpable lesions? MEDICAL DECISION {bum/tr? {344; (Dual INSURANCE - .-. TREA ENIRENOEREOIINJH 1 AR ETA-PHYSICIAN Paw?' TO, P'me CAREFULLY THE ON THIS 332151 nggu??ogms .YOU CONTINUE-TOME PRORLEMS OUR BASES-EN READ ON A PRELIMINARY OASIS. CONSULTATION ANS. SESIEMI MILL. SI: MARE-THE WE TRY TO TWO OR TRREE: SAYS 3F THERE 5? A ?b I T5: . DIAGNOSIQ: 2" ,f .- I OBSERVE WOUND FOR SIGNS OEINPEOTIONGNOREASEO. m?mu?Tm-gsg 2' I -v KEEP INJURED A >1 - .zICExzo a 7 .: I . AREA I . . {Ar . 1 APPLY HEAT TO INJURED AREA. I - REWRAP ACE BANDAGE IF TOO TIGHT- 1 I3 "Emma: mme PRESCRIPTION ASDIRECTED. a - - - - FORCE EMERGENCY ROOM - STOP AND is ABE. T0 RETURN TO WORK DO NOT DRIVE OH OPERATE HEAVY MACHINERY WHILE I . HI MAY RF BE WITH YO TAKING MED ON TO PERFORM THESE TASKS. (x ABEDREST FOR WW DAYS BE RELEASED TO MY - SCHOOL $3133? mm. ASSESSMENT: PAINSOALE1?35. n4 :7 IOISOHARGE INSTRUCTION SHEET: . - . AN APPOINTMENT TO BE SEEN BY YOUR PHYSICIAN IN DAYS FOR .r-Aa-uwxei- I I TAKE FILM WITH YOU TO YOUR FOLLOW-UP DH. APPOINTMENT. ..- RETURN EN . 1-0; SCIOTO MEMORIAL MERCY HEALTH WHEELERSBU EMERGENCY ROOM CARE CENTER URGENT CAR 3533??- 3OR FURTHER TREATMENT OH EVALUATION OF CONDITION REMOVAL OF SUTURES WOUND EVALUATION OR RETURN TO EMERGENCY ROOM IP ANYHFURTHER-PROBLEMS ARIAPR 1 6 29m 1 ADDITIONAL QUESTIONS AOORESSED. YOU CAN . . 3 hiPATIENT NUMBER - -- 3% '53? -- - . :iid.?.l - w? . 2'34 1,11-SOUTHE PHYSICIANYES NO NOTES 5. ASSESSMENT REVIEWED 9 Assam CAREPLANI ff: FOLLOWMPIRX CHESTPAMAT. [j KUB . maimme ?fgmne kit?s-Ems APR Mum SERVICE -- AMP- l-H 7' HI . . - . . .. . 3 a nut . ;y .131P4 a. .rvnkJill.ti ?in r. ?1 . ?wuwnwum?6.111 I .1. tn. . .. . laugh540mg? . 1:33?Wham.WHA .w fr: EA . .. lit-'3 ll I a CONST: negksaeHPI-fwu-?c?lh-mloas-?M- causal othu' amm- mg-mm-Mm?mwmhopm-pdpm?m- mamM?wlm-wlydipsf??" '9 - I Cons?mtional.? Vitals Nursa News) Mpg-{mated cam/nose mucous mbtanes . Neck; 4 4d supplem no masses? thyroid 111% ?emit: no cervical ad?nopathy n] cffon recreations mm 903% Lungs: ear rah: mad-(sitar - . -- 5mm enlarged INSURANCE .-2 o. .--.-.. V3saunougsz?nagw- mm. L, -. ,t .53?rim-3568.258: tag-z:- . . - -. QABE - .UP I 39-" msmw?fi? WW3 .. HAS {31% A 3335838.. FSMAL REVIEW 1113?. RE: mamas: F'mesm WE WELL TRY. TO YOU 7W3 0R DAYS E: THERE ARE ANY IDBWIQNAL SUI {351% 1F 1 wizagxaigg - . CLEANJAND DRY. - I ?i?r?k?i g. :g?s??c?dgsg 5 22.x r. . w? A HairMUGHAS - . EERTTREATE 35mm 10 WGRK 86305FLU1DS. .. WAS SEEN STOP SMOKING QN . THE EMERGENCY ROOM . . AND IS TURN TO ON - - I TAKING MAY YOUR TO PERFORM THESE TASKS. BEDBEST FOB DAYS A 7. 7 REC SED TOMY . SCHOOL 0R EMPLOYER: a f? PAIN-ASSESSMENT: PAIN SCALE: 0 3? 4354?s 7-513 9? 1:0 . ?u Assn"; TO PATIENT: 3+ Riki-Rm - (a 3 i . 1-MAKE AN APPOINTMENT To BESEEN . PICKUP YOUR THE TAKE WITH YOU TO YOUR PHYSICIANS OFFICE my IRETURN 1N TO: -EI scxom MEMORIAL EMERGENCY ROOM WHEEL a 086mm??~2991 FURTHER TREATMENT 0R EVALUATION OF CONDITION EVALUATION 'S?s?iuh 0.01MB. THESE IN venous; ucnl In Alf?l- - .. madame $539,qu YDE, RECORD PORTSMOUTH. - 7' 1. .- Li. Emsrm ?105? up MAM ?4,100ng {figKit. 1.: i.ng agy?yLLi t- i . >53 min OTHER HtsronYmAsqguRGEntES: a . . a, H12 SMOKER cameo mum. MASK 70mm: NURSES NOTES . .- [juemunes 1134mm?; -- . i PERSQNAL I i - FAMILY ITEMS. r- cusses . [j WMJET a . a" YES PPD Wong-Baker FACES Pain Rating Scale? 1o nun-tr mun num- unu-r mun: an?: LOCATION: Aaoommgj {gr pm; if; HEADACHED sac] AQTHEFIPHESSURECI .. - a ONSET: a . FREQUENCY: . *fv PAIMSCAAE: 1 2 3 4 gm?f SEJWIS impa'n severe 3 H11 . wig?a 7? <7 A (M 752%}; . at} Pam - Mfg/212956 . I ?Drum 1426?} Ari/4' a. 5 W-f OTHER SURGERQESI . 7? L, - 471?}, rm-ww 6? . . 6? maid yaw-ax. . .k?nwyrv.47" - I UMQN. MASK 02 Mus Damgw* PERSONAL . ., . -. - PAIN '3 V- . .. 1 - as, FACES Panama-Sosa LOCATION: ,?-rwoommgans BACKUH ?$1121..75ONSET: omen: 7 - FREQUENCY: -- -. nopain - .- 3 . a r9" . -, u. - - his-fastbno 45662 I: it? . .. -- -- imp?'fWAx_ i 1' a {13? ANDY P: ravni?zggf - :54 kiwi? I 1533:1113}? 02 NURSES NOTES oemunes [j JEWELRY WALLET PERSONAL GWEN To ITEMS: PAEN ASSESSMENT: YES LOCATION: ABDOENALEI BACKCJ HEADACHECI LEI OTHER: .. PRESSUHED . ONSET: HOUHSCI DAYSD OTHER: PAINSCALE: 4 1 2 napain Wong-Bake: FACES Pain Rating Scale? (1&9 Etf'w'? :m f! law. .3 . - :v ERNLOHIOMEDICAL 09451111ng posizivemm . I J) - CONST: negchius {:33 cm. .. I. I r. my}: -cpistaxis 1' RESP: CV: ?gL 4r in 7:41 i.h. NEUR: . ncg\ sec HPI - HA . seizures focal weakness - dizziness - numbness - ENDOS neg see - polyuria - polydipsia heat/mid intoierance All other systems reviewcd and were negative ?w PHYSICAL EXALI Constitutional: News I oped, wet! nomis - casant, (Ompharynx: t5 I enlarg?'d? . . . dline. IJRW bulging 1mm dull UR petif ted ammo amines? Alamo; membranes Neck: Wm no 4w thyroid mWnder no .WD 0_ cervical adenopathy - 3: "h Chest; non-tench I Lu? s: 7? clear roles rhorfchi who'ezcs . . d, - (locatmn) cv; - irregular_zl.O30 NEG 5.0 REQUIRED NONE NEGATIVE NONE OUTPATIENT REPORT 250 MODERATE TRACE POS TRACE 1~5 1-5 1w5 MODERATE INNACCURATE DUE i0 COLOR OF SPECIMEN TRI SOUTHERN PORTSMOUTH, OHIO PRINTED 2OMAR01 TIME 1103 ADMITTED 18MAR01 PAGE 1 DRUG NOT TESTED SUSCEPTIBLE NT 2 MS MODERATELY SUSCEPTIBLE NI DRUG IN INDICATED I 2 INTERMEDIATE BLANK a DATA NOT AVAILABLE, A.. RESISTANT OR DRUG NOT ADVISABLE CULTURE 01-078~0160 18MAR01 1515 CLEAN CATCH URINE 19MAR01 0713 19MAR01 0713 CULTURE 010320 1020 NO GROWTH AT 1,000 OR GREATER DEA-02496 EMERGENCY OHIO MEDICAL CENTER PORTSMOUTH, OH. 45662 REC A MEDICAL RECORD NO. REGISTRATION CONSULTANT OR FAMILY .1 ?aft; .I- JV .5 RACE PATIENT NAME PERMISSION TO TREAT PREVIOUS .PHYSICIAN YES No ADM YES NO TIME TIME DONE RSING NOTES ASSESSMENT REVIEWED DIAGNOSIS: DILANTIN OLD CHART AMYLAS DRUG SCREEN ASTHMA PROTOCOL .1 CAFIE OW-UP I Rx FOLL CHEST LAT. KUB ROUTINE 5 VIEW .2 PORT. CHEST G-SPINE ROUTINE a 5' A OTHER LAB REPORTS YES NO DISCHARGE ROOM NO. DISP. RHOME CI ADMITTED CI 23? OBSERVATION CI EXPIRED CI UNSTABLE .r ED Bed OHIO MEDICAL CENTER, NURSING ASSESSMENT availab! Yes PORTSMOUTH, OH. 45662 EMERGENCY RECORD ARENA TIME . ??cus?m READY CHARGETIMEIDATE TO THE-FLOOR TIME Jifs . -- SESSMENT- I w. Hbil?IGAs OTHER SUHGEFIIES: ?77? . c, 2 6:50?7 a HOME TRIAGE NUFISE BLOODY WT. ANOHEXIA COUGH FEVER WITH: SIGNIFICANT REACTION REACTION TEST: A HISTORY EXPOSURE TO 02 APPLIED . MASK NURSES NOTES [3 DENTURES JEWELRY PERSONAL GWEN TO FAMILY ITEMS: [j GLASSES E1 WALLET ASSESSMENT: NA WT HT. . PPD Wong-Baker FACES Pain Ratlng Scale? 65 49LOCATION: CHESTD ABDOMINALCI BACKEI HEADACHEEI EXTREMITYEI. LE1 OTHER: DUEATION: 5 DULLD PRESSURECI CONSTANTCI ONSET: MINUTESEI HOURSEI DAYSCI OTHER: FREQUENCY: PAIN SCALE: 01"2345678910 severe no pain Ita' EMERGENCY SOU OHIO MEDICAL DEPARTMENT RECORD PAST HX: AdditionsiDcletions: Review of Systems: (circle positive responses) CONST: neg wt loss weakness malaise - ppen'te - other EYES: neg Calm/weal; ENMT: see HPI - sore throat hearing loss tinnitus - emche - nasal drainag - epistaxis RESP: ee HPI - SOB - cough sputum production - wheezing - DOE see HPI chest pain PND orthopnea - palpitations - see HPI - rash - skin lesions lprm'itis - NEUR: see HPI - HA - seizures focal weakness . dizziness - numbness - paresthesia - ENDO: ne see HPI polyuria - polydipsia heat/cold intolerance Cancer f?m? All other systems reviewed and were negative Other PHYSICAL EXAM ADDITIONAL PHYSICAL FINDINGS: Constitutional: Vlixai/sgs? Nurses Notes) well oped, well nourished easant, cooperative HEENT: Oropharynx: tonsils: enlarged erythematous vula midline. red UR bulging dull purulent UR ated UR external earsinose n1 ecous membranes Neck: ?an?zm no ma thyroid n1 .L?me?nder no ND 0 cervical adenopathy Chest: retractionsmtaohypneam men-tender Lungs: ralesmrhonchimwheezes {iocation} CV: @irregular murmurs/rubs! allo m2+ tal pulses G13 1455:: sounds CK. I no masses ?non-tend index .. . - . .. GU: Male: nl "temal mtalia Scrotal Content nl__ tender enlarged Female: 34: n1 external genitalia n1 uterusladnexia Cervix: n1 motion tenderness purulent no deformity nontender n1 5 gth/tone_ edema ?ght/judgement no homocidaI/suicidal thoughts no ucinations age-appropriate behavio . SKIN: ?es ?ame lesions Mom}: MEDICAL DECISION DEA-02499 MEDECAL 1 . SOUTHERN MEDECAL CENTER MERCY HOSPITAL PORTSMOUTH, OHIO PRINTED TIME 2231 ADMITTED PAGE 1 0 1825 CBC..sa?a WBC 4.5m10.5 10.3 REC 4.00?6.00 4.13 HGB 12 5?15 0 1219 HCT 37.0m47.7 38.5 3 MCV 82.0?92.0 93.3 FL MCH 29 0-31 0 31.2 pg MCHC 33-0m37.0 33.5 RDW 11.5m14 5 13.4 PLT 140?440 300 MPV 7.4m10.4 7.9 FL SEGS 35.0?70.0 56.8 20.0V40.0 38.8 MONOCYTE 4.4 37__ EOSINOPHIL 0 0?10.0 0?0 Mk; BASOPHILS 0.0?1.5- 0.0 3 ATY AU BLASTS AUTO BANDS IG AUTO DIFF - NUC RBC ..ABSOLUTE DIFFERENTIAL. SEG 1 4m7 0 5,9 0.8?4.0 4.0 MONOS 0-0m1-0 0.5 305 0.0?1.0 0.0 - BASOS 0 0?1 0.0 ANISO MICROCYTES - MACROCYTES HYPOCHROME, . HYPERCHROME Footnotes ABNORMAL A. CONTINUED OUTPMIENT REPORT SOUTHERN CENTER MERCY HOSPITAL PORTSMOUTH, OHIO PRINTED TIME 2231 ADMITTED 1643 I I HOW OBTAINED CL CATCH COLOR YELLOW APPEARANCE CLEAR GLUCOSE . 0 NEG BILE NEG NEG KETONES NEG TRACE SPEC GRAVITY 1-030 1.025 BLOOD NEG NEG PH 5.0?8.0 6.0 PROTEIN NEG NEG UROBILINOGEN NITRITE NEG NEG LEUKOCYTE ES NEG NEG . . . MICROSCOPIC. - . MICROSCOPIC REQUIRED . 1?5 NONE EPITH 1~5 NONE URINE BACTER FEW NEGATIVE BUDDING YEAS NONE 1826 PREP..can-tus.u WP WBC NONE :5 WP BACT MANY WP YEAST NONE WP TRICH NONE WP CLUE NONE Footnotes CONTINUED OUTPATIENT REPORT DEA-02501 SOUTHERN OHEO MEBECAL CENTER MERCY HOSPITAL PORTSMOUTH, OHIO PRINTED TIME 2231 ADMITTED 1825 PROFILE.-. CALCIUM 8.8w10-5 9&3 SODIUM 140~l48 137 POTASSIUM 355~5.2 4.5 CHLORIDE 100?108 102 C02 21*32 24 GLUCOSE - 70-110 86 BUN 7*18 12 CREATININE 0.6?1.3 0.9 - c; Xgotes 1" f?J ABNORMAL OUTPATIENT REPORT PORTSMOUTH, OHIO PRINTED TIME 2233 ADMITTED PAGE 1 SUSCEPTIBLE NT 2 DRUG NOT TESTED MS MODERATELY SUSCEPTIBLE NI DRUG IN INDICATED I INTERMEDIATE BLANK DATA NOT AVAILABLE, 9 PESTQTENT OD DRUG NOT ADVISABLE DEA-02503 END OF CH2 PORTSMOUTH, OHIO PRINTED TIME ADMITTED PAGE DR DEFAULT 13MAR01 1104 1 SUSCEPTIBLE NT DRUG NOT TESTED MS 2 MODERATELY SUSCEPTIBLE NI DRUG IN INDICATED I INTERMEDIATE BLANK DATA NOT AVAILABLE, RESISTANT OR DRUG NOT ADVISABLE URINE CULTURE 01?071?0187 1300 CLEAN CATCH URINE 12MAR01 0733 12MAR01 0733 CULTURE 010313 1014 NO GROWTH AT 1,000 OR GREATER END OF DEA-02505 41.1w? E1 r. n; 2 drill; f. ?v .1 . Seethee?i ?hie iaedicet CeeterwSeio?to Cameos Patient Name: Date of Service: Patient lD No: Dictated by: Ditath on: Transcribed by: 171 3423 CHIEF Motor vehizie accident. OF PRESENT The patient is .. emote who was involved in a motor vehicle accident about 2 days ago. She continues to have too: back and nezk pain; also a tittle headache. She denied any loss of consciousness?or other iniuries during the moment. She was seen in the emergercy department at that time, but apparently no maps were done. RENEW SYSTEMS: Muscuiosireietal: Positive for pain in the neck and aiso the tower back; worse with movement- PAST Tubal ligation, partial hysterectomy, and uterine cancer. SuCl?tL Negative. She smokes i pacts per dayoi cigarettes. Vital Signs: Temperature 97.1, pulse respiratory rate 18, blood pressure 155,68. Head normocephalic. Footie equal, round, reactive to tight. Sclerae white. Neck: Supple without thyromegaly. Lungs: Clear to auscultation without retractions. Heart: Si, 82 without murmur or tub. Rate regular. Abdomen: Soft, contender. No masses. or organomegaty. Skin: Without cyanosis, edema, or rash. Neurologic: Alert and coherent. Moves atl extremities equally. Musculosketetal: Moves all ioints symmetrically without bony;r or ioint deformity. She did have some painful though fair range of motion of the neck and tower bmk. Negative straight ieg raising was done. General: femaie in no acute distress. X~rays of the combat spine and lumbosacral spine were unremarkable. assess Acute cervical tumbar strain. TREATMENT Rest, ?rm mattress, and Motrin. Page i of 2 Emma?? DMQ Caniermgti?m gamma Patient Na me: 5 Date 5f Service: Patient 2D Ditath by: A a Diciaiedhut nut read for errors f/ *7 1 $5 a r, - I SOUTHERN CENTER [h MEDICAL IMAGING DEPARTMENT . PORTSMOUTH, OHIO CURRENT DIAGNOSIS: MVC 3/5/01; C/o BACK CONSULT DR: DEFAULT CONSULT DR: ADMIT ORDER A I REASON FOR BACK PAIN REASON BACK DOS: 03/ 8/01 DOS: 03/ 8/01 CERVICAL SPINE ROUTINE LUMBOSACRAL SPINE COMPL CERVICAL SPINE ROUTINE, INCLUDING AP, LATERAL, OPEN MOUTH, AND BOTH OBLIQUES The vertebral body heights are normally preserved and no fracture is seen. The intervertebral disk space shows some mild narrowing. Bony mineralization is normal. The odontoid is intact. The C7 cervical ribs are not present. Obliques Show the intervertebral foramina to be normally patent. IMPRESSION: No fracture is seen. LUMBOSACRAL SPINE - ROUTINE, INCLUDING AP, UPSHOT, DOWNSHOT, BOTH OBLIQUES, AND LATERAL The lateral projection of the lumbosacral is of technically poor quality. -I. do not see obvious fracture. The vertebral body heights are normally preserved as best I can tell as are the intervertebral disk spaces. NO scoliosis is seen. The obliques Show the component portions to be intact. IMPRESSION: No definite fracture is seen. a Signed by: PDF 03/08/01 RAD CHART COPY END OF REPORT .4 4 CHEF ??Cili?v?iPL?xi?sT: 8?4: gain. amaie ?n winger aca?deni awning wiih Severe. he? $13-51: 9&5? Came-r 32.5mm} Inez?L15 iubmi i?g?iion, i313; b?tmd svgar. 1* i a 1? .335 .333. . :75 Emma a {Gd-:3 pa? any. gun: i8 1 I um: 3543;: ?3?11? it a? ianHIEfi?JJ?. :11 In 4'1? A 'r 2? 1 BF hTm?dS: b?g?imal? far aha pasn in {he ?an we remainer 35 the Byeiarma war? wee-?E negaiiya. Via! E?Efif Emma? iim?is. Gena?: i: a we??dave?cga? ?v W. . - 9.5rema?a: aha gauges mm same ag??i bii??s?bb. rtth: . :mammai are mica Pup-9.: mini?: $3 in?: $sz. Hi} fa?g? EEG-HG: S. 18;: {125? .. maist. is 5325:. ?53. 92in ?hymmegay. Can?zs?z?vae are gink. Cardgazzt 3231233;- rrjr?e and Na aa??gas a? mils-3.. Lungs: Siear, w?th Quad air nmvemeni and aha-e? waif ?bd?man: Bowei gaun?s are presmt. GU: isium?sskefai She has rm c?uihing, vans-$33, a? e?ema- She ?ari ssm? ?end'emesg w?ih pamsg?nawi marat?es: 13 3pm: Sins has some mine? ?13 paipa??un 9F ibi- . -L . F-nz?? 1 0" ., mama: an aha mcuider an the. gum, mhszema unraacz?xa a. skin. shim and Wham ?61293! 1b. i?Jeum?g: Erma! zierwa are iris}? :3 exanmaim?z ?3 imam. Mania; S?aiusr 35%: re: aigenzea? .13 with if: apgmp?aiax affai 3?A-dra Siauidx ijiu. g; ?3 bird!? in am: 3am. Vacuum-5n it: :3 bf?uuma. a rumor venue; midem aiari he? an S?s-shiri?n, ?endin and Fiaxarii, g??sr?arm-2:13: am :2 if: {he aapmin :rf'zi. E: @331rt: 5-1 5-H. u: I- j? 5 :hurz a?e imam: up m; g; Hanan 5:31pmgc?gn $.11 day; aha Ln 3 - 1?1? ii?- 3:31:15 ?33? Ll DEA-02509 . .1. 1 Iranscribe? by: :3 :1 3135 Patient seen ?n :anjur?sciion a Far"- My .V ads-?: 2 mam; mama Uj?iiSiGr?i. famafs ?aha was i; :13 resiram'a?? m: gniseai cariha! She pmsentsioim um air tam: ?ning:- any She: zixrzes misiameri any injuriea. PAST i?femuntribumry. if}? ether are :?ev?ew-ed ?rst: are nega?ye. .: rvHi?tnbma. :?ti :L-uijm, acme d?fr: mammal. Exf'ij??ik??m?t Fi?-a? ?Si 33 respirafians T23, binod pressure $853 Generi: we?qmurisha? emala. She is alert frien?y, and m?pes?a?ve. am mum} anzi reaciwe is ?g 11 Neck: 31.12936! d?syiays fuii range 9? {nation a mad?i. aging; C?aar in ?aggiia?sn. Haas: Reguiar; m} mumwre Gr 35:. E13. 1. E3 {11 1:bainma?. a? zgndew 5.335 amasga?agaiy pd?pcbie 371333.33. Bates?E amm?: re amber? 'u a and Exir-?zm? es: AB mam ggcr?anenugiv. ?=ieumicgti Cran?ai aeweg. 5i ?xmug? SEE. intact??nes :st magi Jami 5:3; San. Pm warm. and arDECIQEQN Emause ihg pai?ani seemed a ?ii?e anxinus, we! her same daa?ned i??eai. $513 axial?: it; ??mwarge Esme wiih adyte in fake gr 'Ts FM merges. Le: a?y sm? . six?Sm 321152.655 shat ie 253%} lika?y ma? .9: gammy A: up u; L: {.13 :13 rag-SI mam? var?:ng 3&3 anna'ent min?Lm-Wd?n 9 "i I .. )5 .., a: '5 {1513:: was ?n =5 Lian; ?533n-m- ma a. if 2 ?217za?if.? ?can. .3 .42; 1:14 ?u 21:08 ROUTINE RECORD Vent. rate 66 BPM SINUS WITH SINUS . P?sirgervgl 13(8) m8 LOW VOLTAGE-LIMB LEAEE Romnz8 382/400 ABNORMAL, ECG axes 59 48 65 MEDSZ NONE 3 BP 94/69 WHEN COMPARED WITH ECG 0F 14:59, PREMATURE ATRIAL COMPLEXES ARE NO LONGER PRESENT . NONSPECIFIC WAVE ABNORMALITY NO LONGER EVIDENT IN Referred by: I ..ABSOLUT *5 .ABNORMAL SOUTHERN OHIO MEDHCAL CENTER SCIOTO MEMORIAL HOSPITAL PORTSMOUTH, OHIO PRINTED TIME 0049 ADMITTED 12DECOO PAGE 120EC00 2109 OMATED WBC 4.5410.5 10.1 RBC 4 4.09 HGB 12.5?15.0 13.1 HCT 37-0w47.7 38.2 MCV 82 0?92 0 93.2 FL MCH 29.0~31.0 31.9 pg MCHC 33.0~37.0 34.2 RDW 11.5~14.5 12.4 PLT 140?440 334 MPV 7.4410.4 7.6 FL SEGS 35.0?70.0 50.6 20.0440 0 41.3 MONOCYTE 0.0?10.0 6.4 EOSINOPHIL 0 0?10.0 1.3 BASOPHILS 0.0?1.5 0?4 ATY AU BLASTS AUTO BANDS IG AUTO DIFF NUC RBC DIFFERENTIAL. SEG 1.4?7.0 5.1 0.8?4.0 4.2 MONOS 0.0?10.1 BASOS 0.0?1.0 0.0 ANISO MICROCYTES MACROCYTES - HYPOCHROME HYPERCHROME CONTINUED OUTPATIENT REPORT 1.4 E- g' _i .1KBIOC oqtnotes ah?. 2143 HOW OBTAINED COLOR APPEARANCE GLUCOSE BILE KETONES SPEC GRAVITY BLOOD PH PROTEIN UROBILINOGEN NITRITE LEUKOCYTE ES MICROSCOPIC EPITH URINE BACTER BUDDING YEAS TRICHOMONAS 12DECOO 2109 HEMICAL CALCIUM SODIUM POTASSIUM CHLORIDE CO2 GLUCOSE BUN CREATININE 5 SOUTHERN OHIO MEDICAL CENTER SCIOTO MEMORIAL HOSPITAL PORTSMOUTH, OHIO NEG NEG 1.030 NEG 5.0?8.0 NEG ES NEG 8.8?10.5 140wl48 100-108 21m32 70w110. 7?18 CL CATCH YELLOW CLEAR NEG NEG NEG 1.010 6.0 NEG NEG NEG REQUIRED NONE NONE NEGATIVE NONE NONE MPATIENT REPORT TRACE 0049 CELLS CELLS CONTINUED SOUTHERN OHIO MEDICAL CENTER - SCIOTO MEMORIAL HOSPITAL PORTSMOUTH, OHIO 2109 TROPONIN ?00?.60 .04 12DECOO 2109 DIAGNOSTIC.-.., CPK 20?215 38 0~5.0 CKMB INDEX NOT DONE NORMAL, footnoie TROPONIN NORMAL 0.0 0.6 BORDERLIEE 0.7 1.4 MYOCARDIPL DAMAGE >l.5 c: INDEX Reference Range CKMB 5 Possible Myocardial Damage: CKMB 5 5 AMI 6 ou-rm-rmm" REPORT PRINTED TIME ADMITTED PAGE NOT DONE 10 and CKMB CKMB 0049 3 EMERGENCY OHIO MEDICAL _7 DEPARTMENT nEconD I 5n to?- PORTSMOUTH, OH. 45662 REGISTRATION TIME CONSULTANT OR FAMILY ?7 AGE PERMISSION TO TREAT PSEWOUS YES NO YES NO CONTACTED :25 TIME TIME pm TROPONIN I CBC URINE CULT BLOOD CULT Na CL STOOL CULT THEO SGOT DILANTEN OLD CHART DRUG SCREEN AEROSOL ASTHMA PROTOCOL CARE FOLLOW-UP RX CHEST PA LAT. KUB f] ROUTINE 5 VIEW [3 PORT. CHEST X-FIAY ROUTINE 3 VIEW . OTHER av SEE DESCHARGE PVT. ROOM REQUESTED YES NO ?7 a ROOM 23 OBSERVATION NO. FOR DISCHARGE EXPIRED med OHIO MEDICAL CENTEI: NURSING ASSESSMENT $3103 EMERGENCY DEPT. RECORD. I :?tA?aMf/j READY FOR DISCHANGE EQUATE TO -- A: 9 . a. NEON. 2&5 E: Mm 944. if ?3 mu ng OTHER 3"ng a?/Z bu 0mm - HOME gaffALLERGIES HEART DIABETES Ta SCREEN: 2. 2 WEEKS BLOODY WT. ANOREXLA COUGH FEVER REACTION REACTION T0 TB SKIN 02 APPLIED TB: HISTORY OF EXPOSURE TO DENTURES JEWELRY LAST TET PERSONAL GWEN TO FAMILY HT ITEMS: GLASSES WALLET WW SMOKER NO w?er i SOUTHERN OHIO MEDICAL EMERGENCY . ENTER RECORD DEPARTMENT PAGE 2 Review of Systems: (circle positive responses) CONST: neg - see HPI Weh?ls - wt loss - weakness malaise normal appetite other EYES: neg - see HPI acuity change - diplopia - photophobia ENMT: neg see HPI sore throat hearing loss tinnitus ear-ache nasal drainage epistaxis RESPWaiting - diarrhea pain - meiena - hematochezia - hematemesis? GU: neg - see dysuria . 3 my - frequency hematuria - discharge vaginal bleeding neg~seeHPI-rash~' s?prun'tis- NEURENDS: neg see 3 - poiydipsia hearicoid intolerance ROS Details: as @?ve or . .1 PHYSICAL EXAM Constitutional: Vitals (See Nurses Notes) Al developed, well nourished @n-tonc 4_/pleasant. cooperative other (see below) Eyes: ERRL OMI discs fundl normal "Ads, eonjunctivae other (see below) oropharynx; n1? erythematous tonsilsm enlarged uvula midline URlboth n1 UR nl external ears/nosemhearing grossly intactmsinus (see below) Neck: 4: thyroid ni non?tender 7130 JV no cervical adenopathy other (see?below) memesp: ,{ni effonm renactionsm Lungs .earmraleswrhonchiwwheezes CV: 74Rka irregular munnurslrubsfgallops or . A 45% 2+ distal other (see below) (I797 (non?tender tender (specify site) rm weI sounds ?ver/spleen [if no rectal, heme 1. ?g other (see below) GU: no external genitalia scrotal contents_nl_tenderweniarged 4% cervix: Wmotion tendernes urulent dfc?terus/adnexa nlwother (see below) MUSC: n1 gait extremitieszwno deforrnitymnontendeerROanl stren tone__other NEURO: II-XII intac/IAotor 515. ?yawning: sensation grosst dpeech?ar - intact ?s til/symmean (see below) n] homocidallsuicidal thougth no behavior other. (see below) SKIN: no rashes no membranes moistmother 9 u?nii?BmNG nus FORM WITH YOU. AND ARRIVE AT LEAST 20 MINUTESPRIOR TO THE EXAMINATION TIME. dzqg/ tins;1 King?s Daughters Diagnostic Center 2201 Lexingt0n Ave. 0 Ashtand, KY 606.329.8100 1?800?633?3896 fax 606.329.0402 Authorization number?7777. .7..77::7777 7'7'7 77 :7 7777 7.7. 7.7 .7777. 77.77.777.777 7. 77777 .7 777777177 7 .7.777.77 77 77777 1. Pacemaker (if yes, patient cannot have an MRIYES 2.Vascuiarclip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cochlear impiant or middle ear prosthesis . . . . . . . . . . . . Meta! or steel worker (history of metal fragments in eyesYES- 5. Claustrophobic: traditional scanner open scanner . . . . . . . . . . . . . . . . . . YES {if using a sedative. piease bring supply prescription and exact dosage?must be filled before coming to facility) 6.Pregnant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Past surgeries if . 8. Previous heart valve surgery . . Previous MRI: when where . . 10. History of impaired renal function . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . . . . . 11. H55t0f? . date $115he?gh Exam Requested MRI Extremities Shoulder (right or left) knee (right or left) tower extremity [area upper extremity (area MR: Brain/Head without (contrast if necessary) with and without contrast pituitary w/contrast iAC's w/contraSt orbits w/contrast head carot?ds lill i i on; cervicat without (contrast if necessary) chest pelvis iumbar without (contraSt if necessary) abdomen renai arteries thoracic without (contraSt if necessary} extremities cervicai with and without contrast iumbar with and without contrast MRI - Other thoracic with and without contrast pelvis abdomeh MRI Cardiac breast (right or Eeft) other morphology without (contrast if necessaer morphology with contrast 1 TRI-STATE HEALTHCARE function with and without morphology (complete study) PO. BOX 764 function with and without morphology {limited study) SOUTH SHORE, KY 41 175 (606 932-2586 veiocity flow mapping 731 7 7 i . Us. bale For Fest-time PW signature: DEA-02521 Phom {506932-2535 Fax: {6425;932? 2 m-s'rA'n-z HEALTH CARE - 120.301: 764 335 MAIN STREET Souk Sam. Kcumdcy 41175 Date: Your appoin nt 1135 been schodt?ed for you at: 7 I Datg: Ag? Time: 3Q gm lfyou an: unable to keep your scheduled appointment please call us at {606} 932-2586 a . ?it/h 4/ ?x WED 13:54 FAX 30632747156 EED. REC. KDHC 002 tit? RAD RESULTS a 5? 06/07/00 11:02 IBIS RESULT WILL BE A PRELIHINARI UNTIL SIGNED COPY IS DELIVERED 5108 MRI CERVICAL SPIKE FULL INDICATIONS: Humbness in bath arms. TECHNIQUE: T1 and T2 weighted sagittal and E2 weighted axial sequences were obtained. FINDINGS: Disc bulging and/or spur formation at the c5/6 and combined with posterior ligamentaua thickening to gauge mild spinal stanusia without cord No other significant abnormalities are appreciated, IMPRESSIOH: Mild spinal stenoaia at C6. READING DR: DATE TRAKBCRIBED: READING DATE: (617/00 END RAD RESULTS WED 13:55 FAX 60632747156 MED. REC. ICDHC 003 *if RAD RESULTS 5112 M31 LUHBAR SPIKE (an) THIS RESULT WILL BE A PRELIMINARY UNTIL a SIGNED COP: Is DELIVERED <83} 5112 MRI LUMBRR SPIHE FULL INDICATIONS: Numbness and pain in right leg. TECEEIQUE: T1 and T2 weighted :agittal and axial sequences were'obtained- FINDINGS: There is no disc herniation, spinal stenasis, or other significant abnormality appreciated. A tiny vertebral hemangioma is suspected in tha laft posterolateral L3 vertebral body . IMPEESSION: No significant abnormalities. READING DR: DATE TRANSCRIBED: READING DATE: END RAD RESULTS DEA-02523 01:11 05/03/2002 1131) 13:51 FAX 60632747156 MED. RECKing?s Dayghters? Modical Center 2201 Lexington Avenue 1 Ashiand, KY 411111 Medical Records? Fax (606) 327-7273 Date: Number Of pages (Including cover sheet): Comments: Please notify! @(oosi 327-4681 if there is a problem with the transmission of this fax. CONFIDENTIALEY NOTICE Tho'inionnation in this facsimile is mended oniy forms use of the individual or en?iy named above. This information may be priviieged or con?dential. ii you are notgtha intended recipient. be aware that any disclosure. copying. distribution or use of the contents is strictly prohibited. . abo' vs number to arrange for destruction or return of the transmission at our expense. Kings Daughters? Medical Center m" 3. 4., rig-:5 a. ?an .c its": 3 7 I emu: A- A: erritin e' titis, GGTP ~s 4 GTT hr . Giucose. 29;: Coag ma?on Lipid Bieeding Time 'Tri' lycerides Phosohorus 7 PSA FSP Progesterone LDL I Pro?me/?NR Profaciin . T586. . 1 Metabolic 7 3607? AST -- Eiectrohorsis Bleed Gases Sod?um 7 C02 Calc?um Calcium. Ionized Lactaie . Magnesium Fi?dememogiobin WI iUrinalysis w/Micro I i - Potassium 7 Uric Acid . i i Urine . Phos?hems Ret?c Count Sec! Rate Toxscoigg)?. I Tthoid - Acetaminoghen Free T4 Ethane (Medical) TSH Tn?cv?css {serum} Sa??c?iate {Serum} Urine Drug Screen Prenatal Serolog Thyroid g! .54 A30 ANA ghee T4 CMOSffidium Screen A30 TFTER TSH 3: 3: 8 _cec comp .08 . . . E: g: .cmse Toxicolggy "worm 8. Pre 31" 8 Hepauns 8 Surface AG Co?d Agg Acetaminophen . FTA !Erhano {Madman Rclovir?s 3 3 g: Rubena - HN . {Serum} 'nsv FA Gammon a P1: Unnalysas Mono Test . Sancymie {Serum} Viral Cuiture Agcwezocrczem PKU . Serum Drug Screen RA Test RPR iRubeHa Datengavmw&w I Tri?State Health Care Treatment Attestation for Pain Management Services seeking healthcare services for the treatInen [understand that my accuracy, compieteness and truthfutness in reporting my history and will directiy contribute to the developement of my treatment plan and the improvement in painful condition. I acknowiedge that I intend to provide all necessary releases for healthcare information 50 Paul H. Volkman, MD, may receive my preious healthcare records from other clinicians. I liner: that if I am not accurate, complete and truthfu! in providing my hiStOS?f and Paul H. ?v?olkman, MD, cannot safely treat me for my painfui condition. intend to disclose the names of all prior treating practitioners and to inform Paul Hw Volkman, MD. l'hd ofall current prescribers of controtled substances. I do not intend to seek medications for any purposes other than my personal medica! needs. I will not deliberately misrepresent my histon?. prevent Paul H. Volkman, MD, from obtaining my previous medical records, fail to inform Paul H. Vlkman, MI), about the existence ofother sources ofprescrip?tion medication, or allow anyone other than myseifto take medications prescribed to me I understand that obtaining controlled substances (prescription medications) through fats: representations is a crime and that I will be reported to law enforcement officials for attempting to fr?audulentiy obtain these medications for non-temputic purposes. I am seeking treatment for the purpose of reducing or relieving my pain. I am not appearing to Seek care from Paul H. Volkman, as a part ofan ongoing investigation of Paul H. Volkman, MD, Phd. I am a iegitimate patient voluntarily seeking healthcare services for - In most cases, you have the right to look at and to get a copy of your medical records and billing records that we maintain. when you submit a written request. If you request copies, we may charge a fee for the cost of copying, mailing the copies, and/or providing a summary of your records. If we deny your request to review or to obtain a copy ofyour medical or billing records, you may submit a written request for a review ofthat decisiou. [fyou believe that information in your medical or billing records is incorrect or if important information is missing, you have a right to request that we correct the records, by submitting a request in writing that provides your reason for requesting the amendment. We could deny your request for amendment ifthe information was not created by us;ifit is not part ofthe information maintained about you by us; or ifwe determine the record is accurate. You have a right to a list ofthose instances where we have disclosed medical information about you. You have the right to request that the medical information about you be communicated to you in a con?dential manner. You have the right to request that we do not use or disclose medicai information about you for treatment, payment or healthcare operations or to persons involved in your care except when Speci?cally authorized by you. when required by law. or in an emergency. We will consider your request but we are not legally ?25; you :four decision ofy'cur reauest. v? a IcLiUhCu u} law [u at. mm. Complaints: Ifyou are concerened that your privacy rights have been violated. or you disagree with a decision we made about access to your records you may send a written complaint to the US Department ot?Heaith and Human Services Of?ce ofCiyil Rights. Under no circumstances will you penalized or retaliated against for filing a complaint. All written appeals or requests should be submitted to the Office Manager at the address below: Tri-State Health Care IZOD Gay Street Portsmouth, Ohio 45662 opy ol'this notice. also that they agree +02 The following patient agrees that they understand and have with our privacy po Patient Signatur. Tri-State Health Care Notice of Privacy Practices Effective Date: 4/14/03 comply with legat requirements. This notice applies to ail ofthe by clinic sta ff or the doctor. We are required by law to - Keep medical information about you private - Give you this notice of our legal duties and privacy practices with re5pect to medicai in formation about you. . - Fotlow the terms ofthe notice that is currentiy in effect ??ho will follow the terms ol'this noticeLear, jwu at this clinic - Any heatth care profession - Ali empioy ecs. staffer voiunteers ofour chnic - Any associate with whom we share health information Chances to this notice: We may change all Our poticies at anytime. Changes may apply to medical information we already hold, as weil as any new in Formation after a change occurs. Before we make a signi?cant change to our policies, we wiil post the new norice in the waiting area ant treating rooms. You Witt be offered a copy ofthe new notice each time you come to our clinic. You will atso be asked to acknowledge in writing your receipt ofthis notices How we mav Me and disctose medical information about you; - We may use and disclose medicai information about you for treatment (such as sending medica! information about you to a specialist as part ofa referral): to obtain payment for treatment such as sending hitting information to your insurance company or medicare); and to support our heaith care operations such as comparing patient data to improve treatment methods). tion about you without your prior consent for severai other We may us: or disclose medicaf informs. reasons. These reasons inc?ude3 When required by law. - When we beiiey?e you maybe a victim ofabuse or negiect - For heaith oversight activities Forjudicialand administrative proceedingm1 - For law enforcement purposes - So that coroners, medical etaminers. and funeral directors can carry out their duties - To avert serious threat to heatth or safety - For military activities a For national security and inteiligence activities - For the information of correctional institutions or other law enforcement custodians - Far workers compensation purposes We may discfose medical information about you to a friend Or family who is iny?oived in your medicai ca re, SOUTHERN MEDICAL CENTER MEDICAL DEPARTMENT PORTSMOUTH, OHIO INS. 556E: I CURRENT DIAGNOSIS: NECK PAIN, LOW BACK PAIN ADMIT DR., CONSULT DR: ORDER DR: DEFAULT CONSULT DR: A I REASON FOR BACK PAIN REASON FOR BACK PAIN DOS: 12/05/02 DOS: l2/06/02 MRI CERVICAL SPINE MRI LUMBAR SPINE MRI OF THE CERVICAL SPINE Comparison is made to March 22, 2001. There is normal vertebral body height and alignment. The cord signal intensity is normal. At the level, there is again mild disk bulging at that is eccentric to the right. This does not result in cord impingement. The neural foramina are patent bilaterally. At the C6-C7 level, there is ligamentum flavum laxity resulting in mild central canal stenosis, but no neural foraminal narrowing. There is no other significant disk herniation. IMPRESSION: 1. Mild disk bulging at C5-C6 eccentric to the right without cord impingement. 2. Ligamentum flavum laxity at resulting in mild central canal stenosis. TSA/ksc MRI OF THE LUMBAR SPINE TECHNIQUE: Sagittal and axial Tl-weighted and T2?weighted sequences are obtained. COMPARISON: Comparison is made to the April 5, 2001, MRI evaluation. RAD DOCTOR COPY PAGE 1 RAD DOCTOR COPY A I REASON FOR BACK PAIN REASON FOR BACK PAIN DOS: 12/06/02 DOS: 12/06/02 MRI CERVICAL SPINE MRI LUMBAR SPINE FINDINGS: The vertebral body heights and disk spaces are well maintained. No bone marrow signal abnormality is seen. The conus medullaris ends at an appropriate level- There is no evidence of a focal disk protrusion or high?grade spinal canal stenosis. The neural foramina appear to be patent with epidural fat surrounding the exiting nerve roots. Many of the images are significantly degraded due to motion artifact introduced by the patient during scanning. IMPRESSION: Normal MRI of the lumbar spine. Signed by: ectronic Signature) END OF REPORT NARCOTIC PAIN MEDICATION AGREEMENT Page 2 of 2 16. The patient understands that the at HEALTH CARE will stop treatment if any of the following occur: A: The patient gives, sells or miss-uses the pain medications. B: The patient faits to keep scheduled appointments. C: The patient attempts to obtain pain medication from any other physicians without notifying Tri~State Health Care 17. The patient understands that the physician at HEALTH CARE witl modify treatment if any of the lotiowing occur: A: The patient develops a rapid tolerance or toss of effect from the pain medication. B: The patient deveiops side effects from the pain medication. C: The patients? functional activity level decreases. 18. The patient wit! adhere to the advice of the Physidaanhysicians regarding operation of a motor vehicle. if Tle STATE HEALTH CARE witnesses or is unable to validate information of the patient driving underthe in?uence, drugs or alcohol) the patient authorizes HEALTH CARE to notify the authorities and STATE HEALTH CARE ortheir shalt not be held iiabie for any damages which may occur. FEMALE ONLY This patient certi?es that she is not pregnant. This patient also certifies that she will notify HEALTH CARE, Physician! Physicians/Staff if she is planning a pregnancy or believes that she may be pregnant. 1. By signing this document, lagree that! have read all of the information on these two pages in its entirety, or that it has been read to me and that i understand the contents as written and will adhere to them. lgive Iii-State Health Care - Staff/Physician/Physician?se consent to contale discuss/share information to any past or current treating physicians, doctor office, health care facilities, mental health care facilities, pharmacies or law enforcement agencies concernin mypast or current history. Having no other questions on the date designated below. 94 a? Date Pharmacy Address Phone Number . an?" -- I . 4-1.1- I . 15. HEALTH CARE 1200 Gay Street PHONE (740) 355-8949 FAX (740) 355-6946 Portsmouth, Ohio 45662 NARCOTIC PAIN MEDICATION AGREEMENT TO RECEIVE NARCOTIC PAIN MEDICATION, THE PATIENT MUST MEET THE CONDITIONS: The patient has never been diagnosed with, treated for or arrested for substance dependence abuse. TO RECEIVE NARCOTIC PAIN MEDICATION, THE PATIENT MUST CONSENTTO THE FOLLOWING The patient agrees to supply to HEALTH CARE the Name, Address and Teiephone number of the Pharmacy that is ?tting the prescription. The patient agrees to have alt prescriptions prescribed ?lled by onig one pharmacy. The patient must provide three (3) days written notice when changing hisr?her pharmacy under normal circumstances. in the event of an emergency requiring another physician?s attention, the patient will immediately inform HEALTH Physician/PhysiciansIStaff of such prescribing physician and dispensing pharmacy. The patient agrees to ailow HEALTH CARE to Send a copy of this agreement to the pharmacy, referring physician(s) and ail other physician?s involved in the patient?s care. The patient agrees to allow STATE HEALTH CARE to discuss his/her care freety with other physicians. The patient agrees to take the medication oniy as prescribed by HEALTH PhysicianIPhysicians. The patient agrees helshe will not share or give medications to other individuals under any circumstances. The patient understands that each prescription is for a speci?c number of pills, designated to East a certain amotintoftlme. The patient understands that No Re?iis wit! be given if the prescription does not last untii the next scheduied of?ce visit under normal circumstances. The patient understands that No Allowances will be made for lost or stolen prescriptions or pills, or those destroyed by Acts of God. (ie: ?re, ?ood, etc.) Proper documentation, poiice reports or other official reports are required before Physician considers prescribing! replacing prescriptions. x! The patient undemands PrE-?SCrilJtions wilt be dispensed only after a scheduled of?ce visit'under normal cirCUmstances. The patient understands that No Prescriptions for pain medicrrtion will be given Over the Phone under normal circumstances. The patient agrees that helshe will not seek pain medications at night, on weekends, holidays or prior to the next scheduled of?ce visit under norrnai circumstances. The patient agrees not to obtain narcotic pain medications trorn any other physician without HEALTH CARES Knowiedge. The patient agrees to keep all scheduled appointments with HEALTH CARE. if the patient is unable to keep an appointment, hefshe must give at least 24?hours advance notice. The patient agrees to the care of the Physiciaanhysicians at HEALTH CARE if the physician feels it is necessary to change the patient's medication or dosage. if the physician feels the patient is not fotlowing his orders when asked to cease use of a controlled substance, the patient permits HEALTH CARE. Physiciaanhysicians to pursue remedies, which will disabte the patients driving privileges. The patient agrees to aiiow HEALTH CARE Staft. Physidaanhysicians to Gail other pharmacies for poly-drug prescriptions and/or usage. All Patien A - 2v .5: The patient agrees that any alterations of prescribed medications will be made at the discretion of the physician. P.0.Box 764 Phone# (606) 932? 2535 Fart: (606) 932-6837 335 MAIN ST. SOUTH soon, KY. 41175 5. THIS ORDER MUST qt: TAKEN T0 THE DAY 05.112511?: AQDIOLOGY . A Today?s Date: {Date} At: 0 may Mm olf?' i a RAY EXAMS Medical ?ecessuty 9 Code 9Code ?hest and Lateral Galtblodder -'Gl Aorta mall Bowel Carotid Duplex ?olon Kidneys ir Contrast Colon Pelvis s'P Abdomen oiding Cystogrnm Venous Doppler muses Other -sp ~sp Nuclear Medicine (8333780) -5p lammogram Liver Scan lnmmogram {W/ultm sound} Bone Scan 3 Phase Limited ideo Fluoro ther Stress Drug Induced f7?\ end - . spine; spine umb'. :Circle} left right nee left right \tremit} EXAMS end :ck nest :ine Lumbar odomen - piek up prep in x?ray his - pick up prep in x?ray stremity her Muga Rest Stress Hepntobilinry (HIDA) Thyroid Sc;1n& Renal Ejection Fraction Other Reason for Exam Comments 0116 egg Ma; 6am: [gt/21.1.1.1 Duplicate Copy to Dr. .. SGUTHERN QHHQ MEDHCAL CENTER SCIOTO MEMORIAL HOSPITAL . PORTSMOUTH OHIO PRINTED TIME 2237 ADMITTED 1009 WBC 4.5-10.5 8.8 . RBC 4.00?6.00 4.18 HGB 12.5m15.0 13.0 HCT 37.0?47.7 39.6 MCV 82.0w92.0 94.6 FL MCH 29.0?31.0 31.1 pg MCHC 33.0w37.0 32.9 RDW 12.6 PLT 140m440 34S MPV 7.4-10.4 8.8 FL SEGS 35.0870.0 58.0 20.0?40.0 32.5 MONOCYTE 0.0m10.0 7.2 . EOSINOPHIL 0.0-10.0 1.6? BASOPHILS 0.0m1.5 0.7 ATY AU 8 BLASTS AUTO - BANDS IG AUTO DIFF NUC REC ..ABSOLUTE DIFFERENTIAL. SEG 1 4m7.0 5.1 0 8?4.0 2.9 MONOS 0 0~1.0 0.6 EOS 0 0?1.0 0.1 BASOS 0 0~1.0 0.1 .RBC MORPHOLOGY. - a a . ANISO MICROCYTES MACROCYTES a HYPOCHROME - HYPERCHROME Footnotes DR: DEFAULT CONTINUED DUTPATIENT REFORT DEA-02534 SQUTHERN MEHCAL CENTER SCIOTO MEMORIAL HOSPITAL . PORTSMOUTH, OHIO PRINTED 17SEP02 TIME 2237 3 ADMITTED 17SEP02 DR: DEFAULT PAGE 2 17SEP02 1009 PROFILE.MQ TOTAL PROTEI 6.4m8,2 6.7 . ALEUMIN 3.4?5.0 3.9 CALCIUM 8.8w10.5 9.0 BILIRUBIN To 0 1?1.0 0.3 ALK PHOS 50?140 62 SGOT 00?50 23 SGPT 30-65 34 SODIUM 140?148 137 POTASSIUM 3 6?5.2 4.4 CHLORIDE 100~108 100 C02 21m32 26 GLUCOSE 70?110 88 BUN 7?18 19 . CREATININE 0 . 6W1 . 3 1.1 17SEP02 1009 TSH .30~5 00 1.74 miU/L EOLATE 2.6?20.0 7.9 VITAMIN 312 211?911 209 *f Footnote? 2: ABNORMAL, footnote F0 ATE NOTE NEW REFERENCE RANGE VQMIN 1312 NOTE NEW REFERENCE RANGE: DEFAULT END OF CHART OUTPATIENT REPORT DEPARTHENT OF RADIOLOGY SOUTHERN OHIO MEDICAL CENTER SCIOTO MEMORIAL HOSPITAL PORTSMOUTH. OHIO 45662 CHART Sex/Age: Trans: CRD Order Dr Nur stat: ER Admit Dr: Room No. Radiolog: Pat Cl: Reason/exam BODY ACHING, BREATHING Admit I Exam: SHOULDER: ROUTINE Reqseq i 10d889 Date Done: 04?30?91 Read: 04-30?91 TPD Date: 04-30?9l Time: 1052 FINAL Exam: 0190 SHOULDER: R0 DOS: 04/30/91 CERVICAL SPINE FIVE VIEW STUDY: Obliques demonstrate no bony inter- vartabral foramlna impingement. Vertebral body heights and 1ntar~ vartebral disc spaces are normally preserved and no fracture is seen. Bony mineralization and alignment are normal. CONCLUSION: Normal study. RIGHT SHOULDER: Three views. Bony structures, joint spaces, and sof tissues are normal. Signed by Dr. ?mm-w? q. . Eff-arr; . I . TRI-STATE HEALTH CARE 4 - - . .1 Poaox 64 I I 335 TREET South Shelf. Kcnzucky 4 175 Phonc i606}932~2536 m: :606:931-6337 HEALTH CARE Date: Dear Sir or Your [65! has been scheduled for you at: Date: 1 [t Time: ?51an ifyou are unab?e to keep your scheduied appointment please tail us at {606} 9322586 uk (am [021/ MM dig) MU Jag/081M [mg/w; jd?g? 3w Wig air?a?M/U? (20/2 r?huj 502.0 a/J?mdu/a 4/5950; Wu my amt- uzw/ ow Jazz Dom/mm? 772,67 gm; Wu (Mali (fsz Mg 1219 FINDLAY ST PORTSMOUTH PD SEARCH WARRANT DEA-02538 DEA-02539 a PATIENT SHEET Insurance Coverage (List Name And Address Carriers) Address; Address; ?dmf: Medicare LD. 3: Worker's Compensndon Number (5): Date/Injury (its): Emptoyer History Of Injury (ies): Motor \?ehicie Accident Hiswry Of Injury (its): Phase Indicate ?An; Member 01' cur Fwd!) HJs The {Mme-rm Imam f6 ?Sui. Please list AH musicians ?horn "You Hme Been Treated: Ph?ician??g Ph}s?c53n Address Address Putin For Au!? Fury)th iniun' (?Gm?enutism Our Of?ce Does 50: um l-ur Setdemcn: On Litiguiun Cu-ex. .\ur ?in ?c arker'a 94: ithou: Proper Authoriznciun From Agency . A a. . . Pa'tient?Hist?pryQuestionnaire Historyof eriousphildhood illnesses YesgNoiw IFYes?f?ix'pszn F16ng Bb?e/U gi?s 7' . es Ewes, 14/722283 4. Han many iix-e: uiri". 23hoax r311? - r- . - a D-\.ixsman :3 ,3 . 1 wa?. 325m 500 {argw ?he: 1m.- rofin Hands-13;? When 'ion' How fang tent hm Ce? b'ex? {-37.32% When Dan-on Ham {0.15% \?a'hersm Dan-oci Han Whenm Talwin Tate.ng Haw Fiorcet? How TylmoGZ Terno?x Tyla no! When?g Fiomal with How longm When Soma wfcodeine How long \R?henmm Empcrim?codeinef Whan 2% 3 4 Tri-State Health Care I. I Irreahpent Attestationfor Pain hianagemem Sen-ices am seeking healthcare services for the [understand that my . accuracy. compieteness and truthfulness in reporting my hisrory and samptoms wit: direCti}; 3 contribute to the deveiopement ofmy treatment pian and the improvement in painful condition. I acknowledge that I intend to provide a? necessary releases for healthcare information so Paul H. V'olkman, MD, may reccr'v: my pre?ous healthcare records From other clinicians. I know that if! am not accurate. co mpieze and truthfu! in providing my history and Paul H. Voikman, MD. cannot safe?) treat formy painful condition. I intend to dis: os: the names ofazl prior treazing praCLizioners and to harm Paul H. \?oikman, MD, of at; current prescrioers ofcontrolied subszarces, I do not intend to sees medications for any purposes other than my personai medical needs. I not delfo randy misrepresent my histor}. prevent Pau! H. MD, PM from obtaining my previous medica! records. fail to infou?n Paui H. kaan, MD, about the extsience ofocher so was 0 ofprescription medicazion. or aHow anyone otner than myselfto take medicazions prescribed to ?w'i .. r?afaA-L?w' m: 1:11- 0:11ng con-as net.- (preserspuon meuzca {Cub} orcch fafsc representations is a crime and tha: 1 be reported to raw enforcement o: reiais to: azzempaEng to 'frauduien?y obtafn these medicazions for rtcn-terapuric purposes ta 0: - a. a a [ant seating (seat ?era for the ?er0:: or reducmg or re?t?cum I an: not appearing to seek care from Putt} H. Voikman. as a part or'an ongoing investigation 0! Pan! MD. i am a icgitintaie patient R'Oiuntaril} seeking heafzhear: Semiees For, for Chronic Opioid Therapy . vs consentformfrom the American Academy of Pain Medicine a. lit Well if is pWr??ioid medicine, sometimes called narcotic analgesics, to me for a diagnosis of t- . This decision was made because my condition is serious or Other treatments have not helped my pain. 1 am aware that the use of such medicine has certain risks associated with it, including, but not limited to: sleepiness or drowsiness, constipation, nausea, itching, vomiting. dizziness, allergic reaction, slowing of breathing rate, slowing of reflexes or reaction time, physical dependence, tolerance to analgesia, addiction and possibility that the medicine will net pr0vide complete pain relief. am aware about the possible risks and benefits of other types of treatments that do not involve the use ?f?lf1?himm7lt anon slid/Intends J. {will tell my doctor about all other medicines and treatments that lam receiving. 1 will not be involved in any activity that may be dangertms to me or SOmeone else ifl feel drowsy or am not thinking clearly. i am aware that even it? I do not notice it, my reflexes and reaction time might still be slowed. Such activities include, but are not limited to: using heavy equipment or a motor vehicle, working in unprotected heights or being responsible for another individual who is unable to care for himself or 'hgrseli'. lam aware that certain other medicines such as nalbuphine (Nubain pentazocine (TalwinTt?), buprenorphine (BuprenexTM), and butorphanol (Stadolm), may reverse the action ofthe medicine 1 am using for pain control. Taking any ofthese other medicines while I am taking my pain medicines can cause like a bad flu, called a withdrawal agree not to take any ofthese medicines and to tell any other doctors that I am taking an opioid as my pain medicine and cannot take any ofthe medicines listed above. I am aware that addiction is de?ned as the use ofa medicine even ifit causes harm, having cravings for a drug, feeling the need to use a drug and a decreased quality oflife, I am aware that the chance ofbecomlng addicted to my pain medicine is very low. I am aware that the develoPment ofaddiction has been reported rarely in medicaljournals and is much more common in a person who has a family or personal history of addiction. agree to tell my doctor my complete and honest personal drug history and that of my family to the best of my knowledge. I undei'stand that'physical dependence is a normal, expected result of using these medicines for a long time. I understand that physical dependence is not the same as addiction. I am aware physical dependence means that if my pain medicine use is markedly decreased, stopped or revers?d by some of the agents mentioned abOt'e, I will experience a withdrawal This means I may have any or all ofthe following: ninny nose, yawning, large pupils, goose bumps, abdominal pain and cramping, diarrhea, irritability, aches throughout my body and a flu-like feeling. lam aware that opioid withdrawal is uncomfortable but not life threatening. . I am aware that tolerance to analgesia means that I may require more medicine to get the same amount of pain relief. lam aware that tolerance to analgesia does not seem to be a big problem for most patients with chronic pain, however, it has been seen and may occur to me. If it Occurs, increasing doses may not always help and may cause unacceptable side effects. Tolerance or failure to respond well to opioids may?cause my doctor to choose another form of treatment. (Males only) I am aware that chronic opioid use has been associated with low te5tosterone levels in males. This may affect my mood, stamina, sexual desire and physical and sexual performance. 1 understand that my doctor may check my blood to see ifmy testosterone level is normal. (Females Only) Ifl plan to become pregnant or belie ye that I have 1"come pregnant while taking this pain medicine, I will immediately call my obstetric doctor and this office to tnform them. I am aware that, . should I carry a baby to delivery while taking these medicines, the baby will be physically dependent upon opioids. I am aware that the use of opioids is not generally associated with a risk of birth defects. However, birth defecrs can occur whether or not the mother is on medicines and there is always the possibility that my child will have a birth defect while I am taking an opioid, have read this form or have it read to me. I understand all ofit. have had a chance to have all of my quesrions regarding this treatment answered to my satisfaction. By signing this form voluntarily, I give my consent for the cmes. i ?5?6 Date 7 5 Patient signature Witness to abor Appmved by the AAPM Executive Committee on January 1999. $1394.57 4700 W. Lake Avenue Glenview, IL 600254485 847/375?4731 . Fax. 877/734?8750 a. - E-mail aaprnt?r?amcteccom -Jt- . 1 Part encounters with pain?sl injury or illness can influence your sensitivity to pain. Pain can come in many Forms such as: sharp,? - jabbing, throbbing, burning, Stinging, tingling, nagging, dull, and aching. Pain can also range from mild to severe. Severe pain gets your attention qtiiclter because it generally produces a greater? physical and emotional response than mild pain. Memories onast pain experiences. and your upbringing and attitude also all-ect how - 7 UNDERSTANDING CHRONIC PAIN able to go shopping, or?teturning to work. Some things that can be?tried first are behavior modi?cation, rehabilitation therapy, nonsreroidal anti?in?ammatory medicine, Over-the-counter pain medicine, or exercise programs to improve quality ol'life. More advanced pain treatment options can include opioids, tricyclic antidepressants, or anticonvulsants depending on the type ofpnin. IFchoosing opioids For the treatment olchtonic pain, morphinc is you interpret pain manages and tolerate pain. When pain persists beyond the time expected for an injury to heal or an illness to end. . it can become a chronic condition. ohen the ?rsr choice for moderate to severe pain. Extended release Formulations may be preferred for long?tetm therapy due to advantages, such as convenient dosing, susrained pain relief, and uninterrupted sleep. DETERMING CAUSES o?r PAIN Your docror will examine you to determine the reasons or causes For pain. Your doctor at ig it ask you queStions like these in Table 1 to better undetStand your pain. TO EXPECT FROM Legal, FDA-approved opioid medicine that is prescribed by your doctor for pain relief, is safe and only in rare leads to addiction. \?(hen properly used, these medicines rarely cause a feeling oibeing ?high?. they give relief. Opioids allow many to resume their normal lives nor make all oFyour pain Table 'l Pallialive' larlars/ Pravaraiive" latiars Quality What makes the pain beller?/ What makes the pain worse? disappear, but it will help you to Funcrion in your normal daily D95?le the Palm activities with less pain. Many people Fear that morphine will nor Radiation Where is the pain? allow them to work, but when taken correctly and as told by your severity How does the Pain compare with do'cror, people can go to work. school, etc. as they normally would. other Pain you have experienced? Do nor drive. operate heasy machinery, or participate in any other possibly dangerous activities until you know how yori reacr to this medicine. Cosmigzan make you drowsy at Temporal ladars Does the inlensiiy al the pain i change with lime? 'Palliative means provides temporary relierut is nor a cure. ADVERSE EFFECTS OF mood changes drowsiness. inability to concentrate nausea, vomiting ?Provocative means makes the ain worse. REATM ENT GOALS The ideal'ireatment for pain is to remoye the cause. but in chrOnic pain this?is nor always possible. The goal oi treatment for chronic . . 1 . A . . pain ts to provide people with enough pain relieFto allow them to go about their normal day-to?day acrivities. Pain reliefis usually achieved by treating the Pain management can include medicine, nerve Stimulation treatment. and therapies decreased breathing rate constipation - decreased urination tolerance/dependence with prolonged use (a physical need for the drug) such as relaxation training, controlled mental imagery, or hypnosis. Because chronic painis physically and emotionally challenging. depression can be common with chronic pain. This should be discussed with your docror. Pain is nor something you must accept no matter how mild or intense the pain is. By working with your docror. you should be abie to reduce your pain. 1? t? ,t LIL {R?Qh?h +5.1 l\ TREATMENT OPTIONS An important part of treatment is to lirsr identify specific and tealisric goals For therapy. such as getting a good night's sleep, being . 1'7 MEN only I Chm; Cl Appe?te poor - Cl BieedSng gums - 5553-5: El"an I Depression . U?Bioa?ng - . El Euned vision (5335? :5'33: - Dizziness - - Bowel changes Crossed eyes Lump in testicta; . Fainting Constipazion Cl d553haf Fever Dianhea -- Doubie vision Forgetfulness ?Cl Ex:essive'hunge: Earezhe Headache Exsessfve thirst Ea: discharge .ILOSS or Sgeep Gas Hay Eve: oniy LOSS Of weight Hoarsaness 3- - 'e on penis v.3. nlnb' . I w. Nervousness inc?gestfon Ci Loss of hearing 5-5535?? F-I-rie.bambness CI heree ?355355-35 lam; :Sweats Ll Hectai bizedmg :1 Pas s?en: cough Extreme pg'n S?emem pe in 933 am; :13: .?Zeshes . Vomiting? {1 gm 5 r; dis-:rta-z-z- - r- - - an, weakness, numbness W. - 5.235155 Fa A-ms Cl Hips 3:7 mac: He'cs :2 Ye: irate . - Barf-t 531933 Otre? .- I . I rag: Can: pan C53 He.de 1/ headers 1m; bzocd $333555 :3 5.3. 5.35 ?rst: 3% tea 3:3 Hues 5'53? 5? ?35: t?;ng 37.3353?5 1-31-13?: "47-33. Blood in urine x' Poor circufezicn 01535;: r; 5; He re: Frequent u:inat?on LJ Rec-Ed hear: tea: *2 9.3.52? ?i?rsg?em rm 1 O: Cent's? gift-,5 a 51:3.3 pfeg?aff? Pa?n:ut urination 1; Varicose veins 3: 53:5 232? :7 i=2: 5??351'11?3'5?? II I 9?47.? 5 nr-A'I? 4 - l. - . (3-33.15; re i3?; 1:51;: we :53? yea ABS 1 Anemia H3 (.1 {it1111 I 3:327 5 Arc-'31? we?xssw 2: my 3 seese *I?w?difs in} E??ees'es Af?fiisi :3 excome *3 Mc?e'ne Heezezz AS'hma i?qf .. -- e1- Ste-zine; Dzsarde-s 2.1 Gators?32 Cf 5:333: Luf-?p 1-1 3: ?f-fche Sziercs Sascha-'5 Hee". sees; 4 .?Js?ps aw'mia/ He:et?:?s iCance.? Heine iCatsrazts 1.: Peres 3 Pei: List rte: ceases a'e Coveniv 13122:; ?S?s/7w 35& mg 7% 5mm mow {02275; 1? gaggmg S?d ?fe 72g- - 1?76 ??xf?f $601792 1am: :y Neme?e?ir?i?e Pncne 5 776:: More . . u- _u In (Larcet - Lamb) Hydrocodbn'e 2:5 How Iongw When; Hydrocodone 5mg How longw When; Hydrocodone 7.5mg How longm Whenm' Hydrocodone 10mg How long? (Percocet - Percodan) Oxycodone 2.5mg How Iong? Whenm Oxycodone 5mg \V'henm Oxycodone 75mg How iongW When Oxycodone 10 mg. HOW iongm \K?henW (Oxycontin) HOW Iong? \V'henm How long? ?'henw How longm When? How Iongm WhenW Oxycodone time released 20mg Oxycodone time reieased 20 mg Oxycodone time released 40 mg time reieased 80 mg,? MS Haw Iongm When 75mg How JongW Whenw Duragesic Patch 35mg 50m Difaudid 2mg; Dilaudid 4mg Dilaudid 8mg ?How long? Onher?xk?cwame 30? m? 7758 W}sz Where 8. Previous Pain Mangemem? Who Hou. Kong. Prex'?ous Chiropraaic Care" Where When How. long When Han iong Previous PT/"Rehab" Where Da te: ?6 05009 YALE: PHONE: Etow DID YOUR cmm?ox REASON-TOR mm; {tam/?DATE: INJURY OR ACCIDENT WAS CAUSED FROM {we YOU BEEN PREVIOUSLY TREATED FOR Tms-commox?e was Awe m7 . {we 0.: HOSPITALS, ETC. axowxxm PHONE: AME: 3.07?? 559$? FEEOXK: .U-fi: KNOWN): ELECT IMAGENG OR TEST rem :1 05 BODY PERI-03350 3? WW YES may)? ?at ?I?Es?xo A. $15.4. SSCAN >50 max xniw/ Uii?d?? 501m \u h?i?'mp) BER YD: 12 PA A (2: 15:? [0221\?01? RC: F. YES OR oasxi?mx?n 5" MISC 3mm FORWARD ma; DOWN KLKING ozsmx?cr w: 1'05;on mm; mu: VF. YOU HAD Pm'srcuz. mm; I HAVE YOU BEEN PREVIOUSLY FOR YES NO 01:0 10 of Over'theCounter Pain'Medication BEEF history you began taking over the counter medica?ons To help control pa?n - 1, Tylenol ?How many tErn-cs a day M'har szrength How lone -u a: 2. Aspirin How many tEx \X'ha: szrengzh How. l: mtg?~? 3. Advil How many tEra-zs a day What Strengzh Hau- lorg 4. Ibuprofen How many [3:135 a \k'ha: Sirens-tn Hoax long . Aleve Ho's. man} that; a C13 \?(hat H32: long 'Ji others: Please bring a pharmacy print out olall your previou5 led appointment. prescription medications at your next sehedu Patient Signatu Da 03101 1 Attention: We do random drug screens/You have the right to refuse. Ifyou do refuse you will be dismissed as a patient. NO We alSO do random ?pill counts?. You have the right i to refuse, if so you will also be dismissed as a patient. NO All patients must provide correct address and phone numbers to be reached. All change ofaddress/phone numbers must be reported to office within 24 hours. If we are unable to reach you in a reasonable amount of time you will be dismissed. Tri~State Staff DOW Wing ?ctle ($00 . 2 0134312 .0iziinas; Dif?cuhy Swallowing W?slh whom do you live? Ara ihere any substance abuse issues mt If yes. plea?e explain Are you abi??to take car-3 of yourseif? not, prease enter name of caregiye; rem Vomiting A. Dfanfjea Un'nary Problems Rashes Swolien Joints Chronic Fatigue na hOusehold? No Yes Work ism/y Years x-xorked Why did you 1-3379? nich of the foiiowing drugs or subs-?ance- . many packs do (did) you smoke a day? be dup?cahd far usa.? Fluff"- r? pa,- Hpu - I J. .2397 af! {:qaan?l? i ?r nHC'u?wz/ to ea?h_ d'L?g 0" ?Ag {"185 302: v: cucied, mdcahz yo: usa: 3:0nafi/( (am: or a '0 9 Fjlcogfof harem ?m?uyzmaz- :?a?qua?a an. MW 3 0.71:: v.tn- t320'r'1'? {515' 3 ea: - .3 ins5313'? 30" be": *5 >09 was or cont:nuous?y( L.) A .L-fi . ca "awe :3 - (30:2 5.3. 3" . Pm?hatamnas {.Safijuana Other 051.33: 0.31:. Mum?m (53531? ,gu presenhy smoxe weeks: or use {abazco in any form? Yes ?a did YOU C?gafe?es or use t-Jbaccd in any form? Yes H: For how many yea:s? ,jfc) r. critics: a :t:ce. ll.? PAIN MEDICATION AGREEMENT . yum?.m- To r?ceive'narcotie pain medication the patient mus. meet the following conditions: mm, 1. The patient has never been diagnosed with, treated for or arrested for substance dependence abuse. Patient has never attempted Suicide or has an_v Suicndal Ideations': TO RECEIVE NARCOTIC PAIN MEDICATION. THE PATIENT ?s CONSENT TO THE 1. The patient agrees to supply Tri-Siate Health Care the name, address and telephone number of the Pharmacy that is filling the prescription. 2. The patient agrees all prescriptionsprescribed by Onlv One Pharmaex. The patient uLlSl?. provide three(3) dass written notice when changing his?ber pharmacy under normal circumstances. In the event of an. emergent;- requmng another physicians attention, the patient villi immediately inform Tri-State Health Care's prescribing physician and dispensing pharmacy and provide all records oftreatment for the patients chart for treating Physiciaanhvsieians at Tri-State Health Care. 3. The Patient agrees to allow Tri-State Health Ca re to send a copy of this agreement to the pharmacy, referring ph' sicians?physicians and all other physicians involved in the patients care. The patient agrees to allow. Tri?State Health Care's to discuss {reel} with other Physicians. 4. The patient agrees to take his?her medication only as prescribed by Tri-State ?Edith Cares Physician?Phs patient agrees that hefs'ae Will Not Give . Share or Sell?anv Medications prescribed hv P'nvsieian'thsicians to 3L otheli' Individuals under anv circumstances. You mas be prescribed high doses of ?ew-edul medicines for the relief ofvour severe intractable chronic stain. The medicines are safe when taken properlv. How ever. if vour meds are lost or stolen and taken in an unauthorized manner or bv anvone. else thev mav cause serious iniurv or death.Therefore vou are responsible for the securing voor medications in a safe. The loss or theft of our medications mav result in the dismissal from this clinic. Never take extra medications Or double doses of medications for :nv reason without contactineTri-State's thsiciaanhvsicians for further Tri-State Health Care Paul H. Volkman, MD. 1219 Findlay Street Portsmouth, OH 45662 T: 74045556949 F: 7403556946 033014 ., - . - a ., Ems-Yea new co It new ales: 5. The patient understands that that-p0 allowance-sail] be made for lost or stolen medications or prescriptions under normal circumstances. Proper documentation, police reports breth er of?cial reports are required before Physician/Physicians consider any prescriptions. Lost or stolen medieations!prescriptions may be grounds for dismissal from this clinic. 6. The patient understands prescriptions will be dispensed only after scheduled of?ce visit and no prescriptions will be given over the phone under normal circumstances. 7. The patient agrees He/She will not seek Narcotic Pain Medications or Anr medications from other thsician/thsicians without Tri-State's thsician/thsieians Knowledge. 8. Thepatientagrees the He/She must advise the thsiciaanhvsicians/Staffat Tri- State Health Care ofgpv medications tirescribed from an other thsician and of Am? Os'er the Counter Medications. Anv Diet Medications Over the Counter or Prescribed. lncludina Nutritional Sunnlements. Vitamins or Anv Herbal Pre?mtions. Teast Etc. beina taken bv the indent. 9. The patient agrees to allow Tri~State Health'Care?s call other Pharmacies for poly-drug prescriptions and or usage. All Patients are rectuired to Consent to Random Drug Screens and Random Pill Counts. Correct Phone Numbers Charted. New Phone Numbers Must be Reported to Staff within 2-1 hours. You mar be dismissed from this Clinic if?i?ou cannot be contacted for a Random Piil Count and Drug Screen. I 10. The patient understands that the Physician?Physieians at Tri.State Health Care will stop treatment ifany of the following occur: A. The Patient Gives. Sells or misseuses'am? medication B. The Patient to Obtain Narcotic Pain Medications from Anv other, thsiciaus without Noti?'ing Tri?State Health Care?s thsiciarL?thsicians/Staif. C. The Patient Fails to come in for Random Pill Counts. Drua Screens and Sup?lv Phone Numbers for Contacting the Patient. D. The Patient Fails to Advise the thsician/thsicians ofanv Over The Counter Medica?ons or Medications Prescribed by gm: other thsician While being treated 1 bv the vasiciaanhvsiciansat Tri~State Health Care. an 11. The Patient understands that the Phy?siciaanhy'sicians at Tri~State Health Care .3 OFWO 15 'will'modify treatment if any of the following occur: 2, ., .9 5 Medication 12. The patient will adhere to the regarding Operation of a motor vehicle. If Tri?State Health Care?s Phy'siciaanhysicians 'witnesses or is unable to validate information ofthe patient driving under the in?uence, drugs or alcohol) the patient authorizes Tri-State Health Care or their Physician/Physicians/Staffto notify authorities and Tri-State Health Care or their not be held liable for any damages which may occur. vel Female Only 1. The patient certifies that she is not pregnantt This patient also certi?es that she will notify Tri?State Health Care?s Physiciaanhysicians ifshe is planning a pregnancy or believes she is pregnant. By signing this document, I agree that I have read all orthe information in its entirety or that it has been read to me and that I Fully Understand and Agree to the contents as written and by signing I fully agree to adhere to them. I give Tri-State Health Care, Physiciaanhysicians/Staii consent to contact and freely discuss/share information to any past or current Physicians, Doctor Of?ce, Clinic, Health Care Facilities, Mental Health Care Facilities, Pharmacies or Law Enforcement Agencies concerning my Past or Current History. Having no other questions pertaining to the above, I am signing this document on the date designated below. 7,5?05 ?Date Pharmacy PhOne Number We: DEA-02553 1" The pursteb?fthis?Agreement is to prevent misunderstandings about certain medicines you be ?king {Oman management Tnis ?5 help both You and Your doctOr to comply with the law pharmaceuticais. . . the: lhis?c?g?t'ti?el?i?lent is essentia?? to the trust and con?dence necessafy in a doctor/patient rezationship and that my doctor undertakes to treat me based on this Agreement. i understand that ir'tbreak this Agreement, my doctor wit stop these pahmmror medicines. . in this case. my tic-:tart-gii taper off the med-?cine over a pascd Guevara; days! as necessary to award A550, 2 drug-dependence treatment pr gram. may 5, recommended [Win Communicafi' f3?? With my doctor about the cha'51" Me- av'id hOw weft the medicine is hefpihd t3 tne 0a.. not use substances inciudma ma-{Jsuaqa 00-535. [Wm n0: Share ?5:9 my medica?on anyone [will not attempt t3 cc-ta-?n any con-trotted megs-35,3 inch St?mwams' or 57337" '35! medicines from any otherdosgart wilt safeguard my car: medicine from toss or the-F: Lost or state": medcines not be repiaced tagree that ra?its {of pa n. med-ens; ce maze cafy a? 'the a? as of?ce ViStt or duan NC) refit; v, b3- 2 .31355-3 gym:- Cr. Weekends . 1 I Egress to U55 Mg?i?l?f additive! 9:337:33faca?ecf 8- 7 . A 7' ST )g?Ehwaa?,? 01 A, I {asaphone numb: Mn: prescriptzans for at! of my pain messing: lai.? ,iq4 I aummze the doc; "21d my pha?mal?i? to cooperate futiy with any city. 5-1.: 0. - ea. ta enforcement agency, inciuding this state's Baard of Phafmazy, in the invest?gatsd of any possible misuse, 0' other divei'sion of my Da?n mas-dicing my dcdar [73 provide a copy of this Agreement t3 my phan. acy. i agree to any app?cabge mfg?gg of ?gm of privacy or con?dent?atiry with respect to these authonza?ons DEA-02554 0 0 00 iv Tri-State Health Care Initiationwof Therapy for Chronic Pain Patient Nam Salts: 3 stem a WM 4 . I 2 Omaha Dam -LW Contributor}; illness: . 1 . . . Obesuyw Resptratorym Complete history .aad physical. including pain history, are in chan/ Current and past pain treatment treatments were reviewed Histo?'lofsubs?tanee abuse was asked. Pdsitive historx' Yes No - Pain~ related disability: Work; Activities ofdaily lit'ingw Let?surew Treatment: Medication 0/ mutt:ch Dani?. 500/ kw Howl Physical Therapy Et'al: Yes? No? Where Goals ofTrentment: 1? Reduce ability to panicipate in Daily FitnCIlOllt?gWI/ Reduce use ofmed?cal system and emergency department Risks, Bene?ts and appropriate closingr schedule were reviewed with patient/ Follow Plans Of?ce visit follow-up Weeks Consult Ding. Tests Ac.- 1? Attendin' si .7 ?1 .1 Biood Pressure: Syszolic?mastoii Mark in appropriate space in coiumn at ie?, if ?ndings are? abnormal ?3 Weig 7 Check if findings are normai - after Examination on examination and describe in space below. 3 ?Moisture 5 wTeniture WNodu?es mPigment mHair 3 ?Peiechiae 5 HEAD EYES _Coniunc?iva __Reids WSciera ?Come-3. ?Exophihaimos WPupii WLid?iag mMovameni mTension .m ?Ophthalmoscopic WAcuity womer I i . w?Hearing WOther mDischarge i 2 NOSE .2 ?Airways WSinus Tenderness wMucosa ?Transi?umination WSePtum MOiher . MOUTH 1m 0; ?f mBreath . __Tongue mLips ?Salivary Ducts WTeeih *Oiher ?Gums . . I THROAT r_ - - I mTansils mF?osimasai Drip m" Mi, ?Pharynx WPaiate __Oiher QECK WSiiffness WVesseis mMasses mTrachea ?Thyroid *Oiher NODES MCervical __inguinai Occipitai mEpisrochiear SupracEavicuiiar 6 . mShape mfFiespirations _Symmeiry . we 61 ?Masses ?Discharge 5 ?Other mApicai mSounds M1 lmpuise A2 2 P2 WThn'ii Third ?Shock i _Gai$op a - WRate WFriction 3 3 quuos MFremitus Voice ?1 mPercussron mWhispered Voice mBreath Sounds #Othar __Adventitious ?5 Sounds (over) 1 5 l20379 - Mm A113 PM 1-300328A2179 DEA-02558 State Lic- PAUL. VOLKMAN, MD. 1219 Findlay Street a Portsmouth, 01445662 (740) 355-5949 355-6946 Name ?1 ?a m? Address if; a! :?91 "24 . {?fw *549 (0 I, CI 50-74 3? If 1?7 75100 l/ . i - (3.152., r? (j cg?" 0 101-150 (V 151 and over Prescription is void if more than (1) prescription is written per blank DEA-02559 mm awnState Lic. PAUL VOLKMAIEI3 MD. 1219 chuay Street PortsmoutthH 45662 (740) 355-6949 355-5945 DEA 1-24 25?75-100 3/13,? 101450 #59151 and over Prescr?p on is void if more than (1) prescription is written per biank Maw?m? M7- ?v?w nummav, State Lic. PAUL MD. . . 1219 Findlay Street - Portsmouth, OH 45662 (740) 355-8949 Fax: (740) 355-6946 DEA Address - Date {1 1-24 3 3 2549 i it?, i] 5044 l, 1 kp/vr 101?150 in 1?1and?ouer Prescription is void if more than (1) prescription is written per blank DEA-02560 01023 a 5+ ?v?mmw . a. v? A a, ?5 7R1 (A05 yummy 0mg8u State Lic. PAUL VOLKMAN, MD. I 1219 Findlay Street - Ponsmouth, 45662 (740) 355-5949 Fax-(740) 3556946 p0,; 1-24 :4 xi/ 25-49 ?ll/csr/w (Am ,4 I if Ci 50'74 (Q [3 75-100 .J VJ I 101150 - 151 and over Refii?j1 2 304 50 I, Prescription is void i1 more than (1) prescription is written per biank Sta?a Lic. PAUL VOLKMAN, MD. 1219 Findiay sneer - Portsmouth?H 45662 (740) 355-69451 355?6946 DEA M9) 4? ([21 :1 if 1124 It: wg? f, (j if Mr 2549 f- lk?IL/j/qu 1' a? 1 'Ij 50-f/101-150 UL- :f ?tag?L- 151 and over Prescription is void if more than (1) prescrip?on is written per blank 01:027 State Lic, PAUL VOLKMAN, MD. 1219 Findtay Street Portsmouth, OH 45662 (740) 355-6949 35545946 Kin If Addregig 50.74 ~44! - ff" if ?75400 t? . I (If r, a (/51 7 2 [j 101 150 \Aut Vd?f If {m?land'over Hawaii/Hg 2 3 4 5 Prescrip?on is void if more than (1) prescription is written per biank 01:02.8 Slate Lic. PAUL MD. a i 1219 Findlay Street - Portsmouth, OH 45662 (740) 355?6949 35545946 Name Address i 13 1-24 . 7 f/ ,1 L) 25-49 . :3 7 50.74 i :4 75-100 a [.224 g? 101L150 jg? {if ?(dam H151 and Sayer. 1 2 3 4 ?f?v f" (V i i '6 .Prescription is void if more than (1) prescription is written per biank DEA-02566 Tri-Stdte Health Care Initiationpf Therapy for Pain I Date: 8? 9'03 Patient Name: Assessmentowwgg :35 . . Pain Diagnosis??w ?m?vsim?u? Nag . \p z; Contripiitoa' iliness: Obesity?. Depression?g??nxiety?ardiacm Respirator}; Otherw Complete historjr' and physical, including pain history, are in chart Current and past pain treatment treatments were reviewed l/ rice abiuse was asked. Positive history Yes No . - Pain~ reiated disability: Vk?orkm Activities ofdaily livingw Leisurem i 3 History: ofsubsta Treatment: 331/ tits?(is: its/i7 (mam/t .6 ?0 Physicai Therapy Eval: No__ Where Goals ofTrentment: I Reduce Piaianm/prove ability t0 participate in Daily Functioning/ Reduce use of medical system and emergency department \?isitsm/ Risks, Bene?ts and apprOpriate dosing schedule were reviewed with patient/ Follow -- Plans Of?ce visit follow-up H4 Weeks Consult Ding. Tests DEA-02567 Check 1/ are normal aflei' examination __.Color ?Erup?on MMolszure WNodules ?Hal: ?Eochymosas ?Pazachlaa HEAD EYES ?Fields __Sclera mPtosls WCornea wExophlhalmos ?Lid-Lag __Movamen: mTension ?Ophthalmoscoplc mOther EARS wDrurns mMaslold mHearin ?Dine: NOSE WAlrways _Slnu5 Tenderness MMucosa __.Sepzum WOther MOUTH ?Breath WUps mSal?vary Ducts __Gum5 THROAT ?PosE?nasal Drip WPharynx *Pa?ate a: NECK ?Mas i WTrachea 3 NODES Wearvlcal WOccipllal ?Supraclavlcular ?Other ?Axiliary CHEST _S?ape ?Symmetry w?Dina: BREAST wMasses mNipples ?Discharge EAHT ?Apical ?Sounds M1 Impulse A2 P2 "f mnma mMurrnurs Wsnock ?Flats WOlhar LUNGS mFremilus ?Spoken Voice WPercusslon "Whispered Voice Sounds ?Adven?tious Sounds (ow? DEA-02568 f. at . l' DATE Mark in appropriate space in column at left, if findings are abnormal on examination and describe in space below. My M2 l: ?nu?W AmgsM.? 3 DEA-02569 State Llc. #3507572'2?v PAUL VOLKMAN, MD. 1919 Findlay Street Portsmouth. OH 45662 (740) 355-6949 Fax: (740) 355-6946 ?46? A [3 1-24 - 77:9 wuw m? 33 Emma Kai? 75100 161.450 Np {/14 151 and over Prescription is void if more than (1) prescription is written per wank . Stale Lic. #3507672? PAUL VOLKMAN, M.D. 1219 Findlay Street - OH 45662 (740} 355-6949 Fax: (740) 355-6946 Maxi 1-24 25-49 50-74 75-100 101?150 7151 and over . M: I3 Prescription is void if more than (1) pfescription is wriiten per biank DEA-02570 Stale Lb. #35417 PAUL VOLKMAN, MD. 1219 Fmday Street - Portsmouth. OH 45662 (740) 3553949 Fax: (740) 355-6946 k. 2 scriptuon is void if more than (1) prescription is written per blank 1'24 5: - {3 25-49 H, m, . .. Ci 50?74 "?aw in"; . a a 101?150 1Q 151andover 1 2 3 4 5 0111034 .. . Mm W's. Maw DEA-02572 upr- .rvw? Uc. K35070722-V SIate PAUL VOLKMAN, M. 1?19nnd1ay81reez-Portsmoum, OH45662 (740)355-6949 He? 12345 I 50-74 151? and over 1~24 7 c??jL/O 573': 2549 [3 75-10;} 101-150 Prescription is void if more than prescription is written per blank ?rmqwu?mM, a State Lic. . . PAUL 1219 Fmdlay Street Portsmouth, OH 45562 (740) 355-6949 Fax: (740) 35543946 1:24 25-49 50-74 75-100 101 -150 151 and over Prescription is void if more lhan.(1) prescription is-written per blank .f-Sq. DEA-02573 Tri-State Health Care Initiation?of Therapy for Chronic Pain Date: ?2/5/05 Assessment Pain Diagnoska3 a UK Contributory illness: Obesityw Respiratory? Other? Complete hEstc-n' and physical, including pain history, are in chart/ .- and past pain treatment treatments were reviewed Histoh'YOFsubstarice abuse was asked. Positive historx' Yes No 1/ ?l Pain? related disability: Work; Activities ofdaily living; Leisurew i Treatment: tasty a: jlo/l gait/g Physical Therapy Ex?al: Yes? Now Where Goals ofTrejtt/ment: Reduce Pain? Improve ability to participate in Daily Functioning/ Reduce use oftnedical system and emergency department Risks, Bene?ts and appropriate dosing schedule were reviewed with patient/ Follow - Plans Of?ce visit follow-up in Weeks Consult Diagt Tests 01037 . A I I a W7L 640W Pracan ?rm) 19/9155ch Frienuasmama . I. . . pm: . I Attending Physiciap i Respiration??!- Blood Pressure: Systolic Diastol?c Werg . . . Check 1/ if are normal Mark appropriate space in coiumn at ie?, 1f are abnormal after examination . on examinakion and describe in space below. 5) 3 . mMoisture mNails I m/ ?Tamra mNodmes mPigment "Hair _Pe:echiae HEAD EYES WFrelde __Sclera thos?rs __Comea ?Pupil ?Lid-rag 4' mMovemem ?Tension Mc?' ?Nystagmus "Ophmaimoscoplc ?Acuity Homer . EARS momma ?Other __Discharge [40525 Tm .. TI uBreath Moujjmgue MW wSalivary Ducts Tenoxr I 33712132; :Ei?i'ama'm'p ?pa/?mz 1. W) 594 .4 5443* 2 ?Other I I ?Masses mTrachea StE'?ness NECKVessels :1 9 at? mkqu 30 1 #Thygeid "Other Nboes 2 i 1 ?033?; 1 M??i?imem 65a I 9 AD ?Supraciavculer thher 7" ?Puri?er? a CHEST A 00 7 __._Shapa m?espirai?cns . i 7 C3 BREAST I i mMasses WDischarge __.Orher ??aw HEAEsoundsg-g A 1 M5 Jam?? 6? Ck :23: . WW Lugs? r?W EPW W217, ?Breath Sounds 2" [0 1t) 5x200 ?hogaz?, ng DEA-02575 mSpoken Voice mPalcussbn __Whispered Voice 020379 W?m Press 1MZIT9 ,Chenkjl if ?ndinng an: normal i Mark in annropriam snares: in pm . wk. aft-9r grammar-1m?. . ?w A on examine?. . describe spate t?uow. ?5 BLOOD VESSELS ?Puises M?Vassel Walls 1 ?Ouafrty .. ., i ABDOMEN ?Contour muver ?Parisiaisis mScars mSpleen WSpasm mmgid?h' *Masses momer wFluid ENDOCFHNE mWeigi-rt ?Temp Intel. Whimt mVoioe Changes MHair ALLERGICJIMMUNOLOGIG ?Altergies ?Other GENETOURINARY - MALE WScars/Lesions mVas ?Penis WTasiis mScroium ?01118: #Epididymis FEMALE mEx?Iemal WAdnaxa a __D?scharge MUrethra _Biadder ?Cervix WOther ?Uterus RECTAL WProstate ?Fuseuia Vesicies ?Sphincter w__Mas:ses BONES JOINTS MUSCLES WDefon-nitses WTendemess ?Limit 0! Motion MOIher EXTREMITEES WCoior mUEcers WEdema WVaricos?ties ?Tfemor WCIUbbing Nerves ?Motor merafory WCoordination WHomberg ?Re?exes ?Other to time. place. parson and remote memory WMood and affeci Mower NEEDED - PLAN FOLLOW UP NEEDS Weeks Months PRN Physician Signature WMD. Date a DEA-02576 . . Slate Lic. PAUL VOLKMAN, MD. 1219 Findfay Street - OH 45662 (740) 355-6949 Fax: (740) 355-6946 Adm. . me #24 I, 2549 - 7 '3 - 3J7) 133:3; j101~150 Re?nPrescription is void if more than (.1) prescription is written per blank . j. -- MW .N m? WW, .. w. State UC. - PAUL VOLKMAN, MD. (740) 355-6949 Fax:(740) 355-6946 1219 Findiay Skeet - Ponsmo A 7 [1 1-24 ., 2549 2 75400 -- [3 101450 - 9 5? Flemore than (1) prescription is written per blank PresCription ?3 void if 011.041 State VOLKMAN, MD. 1219 Findlay Street Portsmoutl'l. OH 45662 (740) 355-6949 Fax: (740) 355-6946 A 7 22.303 124 2549 50?74 75-100 101-150 ?,91/151 and over Prescription is void if more than (1 )?prescription is written per blank E. State Uc. VPAUL VOLKMAN, MD. 1219 ?ndan Street- Portsmouth, OH 45662 (740) 3556949 Fax: (740) 355-6946 Date State Lie. PAUL VOLKMAN, MD. 1 219 Findan Street - Portsmouth, OH 45662 (7 40) 355-6949 Fax: (740) 355-6946 7n?74?5 1 ~24 2549 gran 50-74 75-100 -0 A9 ""450 151 and over Prescription is void if more than (1) prescription is written per blank 3. W..-HW-3.1? .- . DEAM02581 01:044 King?s Daughters Medical Center RADIOLOGY RESULTS 2201 Lexington Avenue Ashland, KY 4110] Printed: 07/5/2005 14:28:24 Patient Namei DOB: Admission No: er 0. Med. Rec. No: Pt NS/Room: - Ordering Dr: Referring Dr: PAUL VOLKMANMD. - N. - DATE OF EXAM: Jul 15 2005 MAM 1001 - BQNE CPT: 76075 Technologist: CLINICAL HISTORY: DEXA. FULL RESULT: The T?Score is ?2.7 for the lumbar spine. The T~Score for the left femoral neck is 2.6. The right femoral neck is IMPRESSION: Findings are compatible with osteoporosis of the lumbar spine and bilateral hips. The patient is at increased risk for fracture. Clinical correlation is advised. Transcriptionist: Transcrii Read by Reading Date/Time: Jul 15 2005 This document has been electronically Signed On: Jul 15 2005 4232? DEA-02582 0123045 Slate 035-07-0722-V PAUL VOLKMAN, MD. 1219 Findla 0 2 5569 Fax: I 3553-6946 - 9 05 ?7 472549 335:4: in, I, . . 5074 75-100 ff t? a If 101-150 37?? (LIE-L, :51 and over Re?r?l/l/ x?f i .. Prescription is void if more than (1) prescription is written per blank 2 0113946 Kings Daughters Medical Ctr. 2201 Lexington Avenue Ashland, Ky 4401 Patient: Facility ID: Birth Date: Physician: VOLKMAN, PAUL Height Weight: Measured: 7/15/2005 1:33:41 PM (6.80) Sex] Ethnic: Female Analyzed: 7/15/2005 1:34:34 PM (6.80) AP Sin Bone Dens I i, Reference: 12 BMD (g/cmz) YA T?Score L1 1.100 Age (years) L4 1 2 3 BMD Young-Adult Age-Matched Region (glan') T-Soore 2-Score L1 0.768 '3.0 -1.6 L2 0.767 3-6 ?22 L3 0.922 -2.3 -0.9 L4 0.944 '2.1 -0.7 *1 0.862 COMMENTS: 7 Image not for diagnosis Printed: 7/ 15/2005 1:34:46 PM (6.80) 76:3.00:50.00:12.0 0.00:10.02 0.60x1.05 0.00:0.00 000 00 ?iename -. - we. . 597:5 Scan Mode: Standa at or above -1.0 Osteopenia T-Score between- . an -2.5 Osteoporosis T?Scere at 0r beiow -2.5 SD GE Medical Systems igv ILUNAH . DEA-02584 Kings Daughters Medical Ctr. 2201 Lexington Avenue Ashland, Ky 4401 Patient: Facility ID: Birth Date: Physician: VOLKMAN, PAUL Height Weight: Measured: 7/15/2005 1:33:41 PM (6.80) Sex I Ethnic: Female Analyzed: 7/15/2005 1:34:34 PM (6.80) ANCILLARY RESULTS Spine] BMD 1 Young-Adult 2 Age?Matched 3 ENG Area Width Height Region (We) T?Soore Z-Soore (crn) (cm) T12 0.802 - - - 3.6 4.5 3.5 1.29 L1 0.768 68 -3.0 80 ?1.6 8.2 10.7 3.7 2.91 L2 0.767 64 -3.6 75 ?2.2 9.6 12.4 3.6 3.4-7 L3 0.922 77 -2.3 90 ~09 12.8 13.9 4.0 3.49 L4 0.944 79 -2.1 92 ?0.7 15.5 16.4 4.6 3.54 L1-L2 0.768 67 ?3.2 79 ?1.7 17.8 23.2 3.6 6.37 0.825 71 ?2.9 83 ?1.4 30.6 37.0 3.7 9.87 0.862 73 ~27 86 ?1.2 46.1 53.4 4.0 13.40 L2-L3 0.849 71 -2.9 83 ?1.5 22.3 26.3 3.8 6.96 L2-L4 0.885 74 -2.6 86 ?1.2 37.8 42.7 4.1 10.49 0.934 78 -2.2 91 ?0.8 28.3 30.3 4.3 7.03 T~5core for Vertebral Height (L2-L4) Compared to young adult CT?Score): 0.19 Adjusted for stature (T ?Score): 0.61 1 ~Sl3tjsn'aaliv 68% of repeat scans ?ll within 1 2 AP Spine a. (anz for AP Spine GE Medical Systems Prodigy LUNAH Kings Daughters Medical Ctr. 2201 Lexington Avenue Ashland, Ky 4401 Patient: Facility ID: Birth Date: Physician: VOLKMAN, PAUL Height 1 Weight: . Measured: 7/15/2005 1:37:31 PM (6.80) Sex Ethnic: Female Analyzed: 7/15/2005 1:37:33 PM (6.80) DualFemur Bone Density Image not for diagnosis 1,6 2,7 3 Reference: Total BMD Young-?Adult Age?Matched BMD (glcm?) YA T?Score Region (g/cmz) 1am IwScore - ?2 Neck 1.13 1 Left 0.647 -2.8 -1.5 1.017 - 0 Right 0.648 ~2.8 -1.4 - 4 Mean 0.647 -2.8 ?1.4 g, 2 Difference 0.002 0.0 0.0 Total 5 -3 Left 0.679 -2.6 -1.5 3?4 Right 0.658 ~2.8 ~1.7 (133 Mean 0.669 ?2.7 -1100 Difference 0.021 0.2 0.2 Age (years) COMMENTS: 1 - Statisticain 63% of repeat scans fa?l within g/crn1 for DualFemur Total Mean) 2- - 3 - Matched for Age, Weight 6 Standardized BMD forTo as - - {1111, Total Left is 634 mg/cml. 7 - DualFemur Tout T-Score difference is 0.2. Asymme ne. 11 - WHO De?nition of Osteoporosis and Osteopenla 13:: (62,1 omen: Normal T?Smte at or above ?1.0 We a T?Scere between 4.0 and .25 meepere?s at or below -2.5 SD Printed: 7/15/2005 1:37:51 PM Filename Neck Angle (deg)= 53; Sca (deg): 57:5Gn Mode: Standard; F?ename: GE Medical Systems Prodigy LUNAR 5 86 011949 Kings Daughters Medical Ctr. 2201 Lexington Avenue Ashland, Ky 4401 . Patient: Facility ID: Birth Date: Physician: VOLKMAN, PAUL Height Weight: Measured: 7/15/2005 1:37:31 PM (6.80) Sex I Ethnic: Female Analyzed: 7/15/2005 1:37:33 PM (6.80) ANCILLARY RESULTS [DualFemur] 1,6 2,7 3 END Young-Adult Age-Matched BMC Area REGION (95) TM I?m (9) Neck Left 0.647 66 -2.8 79 -1.5 3.0 4.7 Neck Right 0.648 66 -2.8 79 -1.4 3.1 4.7 Neck Mean 0.647 66 ?2.8 79 ~1.4 3.0 4.7 Neck Diff. 0.002 0 0.0 0 0.0 0.0 0.1 Wards Left 0.503 55 ?3.1 74 ~1.4 1.2 2.4 Wards Right 0.504 55 -3.1 74 -1.3 1.3 2.5 Wards Mean 0.503 55 -3.1 74 -1.4 1.2 2.5 Wards Diff. 0.001 0 0.0 0 0.0 0.0 0.1 Troch Left 0.566 72 -2.0 81 ?1.2 7.0 12.3 Troch Right 0.552 70 ~22 79 -1.4 7.6 13.7 Troch Mean 0.559 71 ~21 80- ?1.3 7.3 13.0 Troch Diff. 0.013 2 0.1 2 0.1 0.6 1.4 Shaft Left 0.787 - - - 11.3 14.4 Shaft Right 0.763 - - - 11.0 14.4 Shaft Mean 0.775 - 11.1 14.4 Shaft Diff. 0.024 - 0.4 0.1 Totai Left 0.679 67 -2.6 78 -1.5 21.3 31.4 Total Right 0.658 65 -2.8 76 -1.7 21.6 32.8 Total Mean 0.669 66 -2.7 77 "1.6 21.5 32.1 Total Diff. 0.021 Statistically 68% of repeat scans falE within :1 0:11ch for DualFemur Total Mean) 2 - USNNHANES, Femur Ref {b33513 3 - Matched for Age, Weight *1 ac 6 Siandardlzed BMD for Total Right is 614 rug/aria Totai Left is 634 7 - DualFemur Total T~Scure difference $5 0.2. Asymmetry is None. Filename GE Medical Systems Prodigy LUNAH OFWOSO King?s Daughters Medical Center RADIOLOGY RESULTS 2201 Lexington Avenue Ashiand, KY 41101 Printed: 07/15/2005 14:23:24 Patient Name: DOB: Admission No: Order No 90002 Med. Rec. No: Pt NS/Room: - Ordering Dr: PAUL VOLKMAN MD. Referring Dr: PAUL VOLKMAN M.D. DATE OF EXAM: Jul 15 2005 MAM 1001 CPT: 76075 Technologist: CLINICAL HISTORY: DEXA. FULL RESULT: The T~Score is ~27 for the lumbar spine. The TuScore for the left femoral neck is The right femoral neck is -2.8. IMPRESSION: Findings are compatible with osteOporosis of the lumbar spine and bilateral hips. The patient is at increased risk for fracture. Clinical correlation is advised. Transcriptionist: . Transcrib it Reading Date/Time: Jul 15 2005 19P This document has been electronically On: Jul 15 2005 Imaging Services Consultation Pge: 1 orwos 1 Trl-StateHeatthCare Paul H._Volkman, r; WW, #7 . 1219 ?ndlasmet .ch Paramoum. 45662 ?ng I, 7m! - y- F: 740355-69MUST-BE TAKEN T0 Taxman THE on or 112511110 RADIOLOGY .- Today?s Date: . 6?15?? 3 Name - Rm) H: Your Appointment Fo- Testing Is Scheduled Time: {Date} For: {Ctr} 0 AM. 1(22 RM. 7} EXAMS Medical Necessity 9 Code ULTRASOUND ICU 9Code Chest and Lateral Gallbladder UGI Aorta Small Bowel Carotid Duplex Colon 7 - 5 Kidneys Air Contrast Colon Pelvis Abdomen Voiding Cysto'gram Venous Doppler Sinuses Other C-sp Nuclear Medicine (833-3780) e1 4 Mammogram Liver Scan . Mammogram {W/ultra sound} Bone gcan Tomograms 3 Phase Limited Video?il?luoro 'l'hallium Other Stress Drug Induced Muga Rest Stress MRI Hepatobiliary (HIDA) Thyroid Scan Uptake Head Renal Neck HID Ejectin Fraction spine,T spine, Lumbar {Circle} . .- Shoulder left right Knee left right Reason for Exam Extremity Clinical Information And Comments cr EXAMS 7 by: {Rite-13 Ca Head 3 Neck Chest Spine Lumber A Abdomen - pick up prep in x-ray Pelvis pick up'prep in x-ray Extremity Biopsyr Referrin' 01:052 SMH REGISTRAR SOUTHERN OHIO MEDICAL CENTER .Smoker: HEDICAL RECORD NUMBER 5V6 i? EOOM NUMBER DISCHARGE DATE I TIME I ADEIT DATE I TIME 06/21/05 14:57 32 I ELATIORSHE: ADDRESS HOME PHONE I ADHITIINC PHYSICIAN I . PHYSICIAN .1111 Inc. 7 PL CARRIER rm: POLICY - AM COHHENTS ADMITTING DIAGNOSIS: CODES PAIN RIGHT RIB AREA CONSULTATIONS: DRQ DISFOSITIOR ON DH TO HOME DO TO ANOTHER TYPE OF FACILITY [j [3 DG TO SHORT TERM GENERAL HOSPITAL DU TO HOME UNDER CARE OF HHC CORONER DS TO SEE LA LEFT AMA DI TO ICF EI EXPIRED ATTENDING DEA-02590 0113053 Southern Ohio Medical Center - Main Campus Tri Category Medic? iT__?jage D??femm?e" Hmong-em Dao??ITtme'; {Exan?tm Dat??ITime i 52:51:19 2:44:07 PMH i i i 14:51} ioniity?jislcta?? Transported by Mode Non-Staff VOLKMAN PAUL MD. Setf Walked rPolice Dept Se? i Custody Noti?cation mow- 1, . La I ma RIGHT SIDED an . A 7:39- . Peggnem?istoqx . PT STRUCKREGHT RIB ON COUCH 3 DAYS AGO co PAIN EFFORT AND MOVEMENT - Oral 96.9 i -- Rectat I Additionai NECKAND BACK PROBLEM CHRONIC PAH I No Signi?cant LUNG COLLAPSED Tympani :3 W5 Ci CAD {it Cancer Cardiac [3 CHF 13 CVA ?he Zoe: QMDM HTN Rena! Seizures El Substance Abus Right Len 1 ds 97 IE Respirations '20 i UTD Blood Pressure Penici?ln: TB PPD Pos or Infectious Exposures? No ?7!er Mammals-0mm . 106/59 precaution: Putse Ox ,?la-i . 96% i Alert Oriented LNMP weight (Kg) $3 6 Ab Miscar . a? n-MwE Head Clear ircumferenee Dimimish Read . - Wheeze Find Pm?! I Pin 3 Rates Conslrici Manual '5 Rhone; Ditatad Temp Normal Retreat [51 Cataract El Moist Nonnat meme Vie - - - -- - - - 4 at wafer? incesxh'teani . Are you being hurt by someone you iive . Norma; with or who takes care of you? Prlmary Language Engl?Sh Assessed Disability No Disability Eati? Messy;th Yesmo Mandatory compteuon of Communication Barrier Recent History of Fan Domestic ?033nm Referrai- . Language Transtator Wuae?wat Eti?eianei Daily Living Independent Mouvauon Laval High - - Knowledge Levei High 11 1 ?'51 - Living Conditions Family . I Triage Nurse comprehenSIGn Going Home with caretaker Triage El, it! W88 W53 LWBS LW Comptete Etoped AMA AMA Refused Patient Rights and and Guide to Pain Management given to Patient. Famiiy. and/or Caretaker DEA-02591 Patient Name Medical Record Number Date Southern Ohio Medical Center - Main Campus Discr?arge '"Stwc?mns Emeligency Department Discharge Datel'l?im 6I2112005 4:36:34 PM Diagnoses Additionai instructions on these condition Rib Pain 78652 LEI Abdominal Pain Neck Strain chest wal; injury Allergic Reaction Nose Bleed Asthma IE Middle Ear Infection Strain (Back) 347.9100-9 Back Pain PIDISTD Chest Pain Sore ThroatfPharyngitis Conjunctivitis Threatened Abortio Cornea! AbrasionlEye Injury Toothache I IE Fever Upper Respiratory infection You have been evaluated today by an independent physician practicing Emergency Medicine. In most cases folIow?up care is recommended with Head Iniury Vaginal Bieedin your regular Doctor. HMO or Clinic. High Blood Pressure Vomiting/Dianne Within 2 days Doctor HMO Clinic IE Kidney Stone wound Carejsutures Call for appointment as soon as possible. IDENITIFY Your Self as an ER Patient. If you don?t have a doctor or need a specialist foIIow up with: Other PhysidaniSpecialist - Address Restriction: Phone You may return to today. Additional instructions: You may not return to until: If the worsen or new develop return to the Emergency Department(ED) immediatety. can the ED for additional questions? If you had x-rays or biood tests, piease note that these don?t always show what's wrong. Sometimes Hays don?t show broken bones. After review by a speciaiist you witl be noti?ed it Return if increasing pain fever, cough shortness breath weakness there is an abnormality. You may not drive or operate heavy machinery because the medicines you have may make you sleepy. Nurse Signature: Patient Signature Southern Ohio Medical Center - Main Campus Date 512112005 Emergency Department Patient Name Phone: 140.355.3240 Prescriptions OI V0 VOID. VOI VOID VOID VOID VOID V0 . OI VOE Rx: P12) DID pm pain ?bo?wenlty) IRPefins 2ero V932 VOID VOID VOID VOED VOID VOID VOID VOID VOIQ VOID VOIQ .VOI This Prescription is VOID if submitted to a Pharmacy 48 hours after the Date and Time listed above. :5-55 UBSTITUTION PERMISSIBLE-EN ORDER FOR BRANDNAME TO BE DISPENSED THE PRESCRIBER MUST HANDWRITE-BRAND MEDICALLY NECESSARY ON PRESCREPTION Physician (Print) DEA-02592 Patienti Medical Record Date 6121I2005 Southern Ohio? Medical Center - Main Campus Emergency Department Record Acooun: History of Present lilness w" emale Patient Presents with Rib Pain Side for 3 Day(s). The Onset is Bending SIP. The are Moderate, sharp, Constant. Additional or Pertinent History also involve None. Furthermore, the Patient/Family Denies NauSea, Vomiting, Diarrhea; ShortneSs of Breath; Abdominal Pain; ,urinary Patient states exacerbating Factors that occur are Movement; Deep inspiration. Radiating inciude Chest. Revlew of Systems and Signs not covered in the HPI) GU Neg Neuro Neg ENT Nag Resp Nag Muscuioskeletal Neg Neg Skin Neg Neg Heart Neg Gt Neg Endocrine Neg Altergicr'immunoiogic Neg other ROS negative Constitutional st Neg Eyes Neg Vital Signsn?n?age Note Hx unobtainable due to Tx Additionat information from Old Medical Reviewed urgency or poor historian(s) Police, Ambuiance. NH or Records Past Medical History No Relevant PMH [j CAD Cancer [3 CHF [3 CVA Other mex Diabetes HTN Renal [j Seizures NECK AND BACK PROBLEM CHRONEC PAH CA UTERUES WITH OR, LUNG COLLAPSED Sociai History Pg] No RetevantSon ETOH Drugs Smoking Additionai Sx Family History ?me Physical Exam Exam Ema WA General Appearance Awake HEENT PERRL Moist Mucous Membranes No lcterus Chest No Lungs CTA No Ret Rib Tender Anterior Abdomen No Pulsating Masses Emits Tendemess-None GU Extremities Throughout ali extremities Appearance Normal CBR 2 sec Active Tendemess-None Neuro Major Muscle Groups 515 Gross Sensory intact Gait Normai Skin No pailorl rashes warm 8: dry Back Lumbar tender paraspinai decreased ROM Neck NT Full ROM No JVD Repeat or Additional Exams Notes Time dtr's 2+l4 symmetric neg cionus 15:24 Pt improving. No Sx(s) or Objective ?ndings that are life or limb 15:25 threatening. Medicaiiy Screened and Stable for disposition(Transfer) from the ED. improved but notes muscle spasms in lower back 15:29 DEA-02593 Medical Record Number Date 6121/2005 Discharge Instructions Southern Ohio Medical Center - Main Campus Emergency Department Discharge [)3th 612112005 4:35:33 PM Diagnoses Additional instructions on these condition Rib Pain 73552 ?059 [El Abdominal Pain Neck Strain chest we? injury Allergic Reaction Nose Bleed 0 Asthma Middle Ear infection Strain (Back) 847.9 Back Pain El Chest Pain Sore Throat/Pharyngitis [El Conjunctivitis IE Threatened Abortio Corneal Abrasioanye injury Toothache I @l Fever Upper Respiratory infection You have been evaluated today by an independent physician practicing FraGtUFB/Sprain/Strain UTI/Kidney '"feC?O Emergency Medicine. in most cases follow-up care is recommended with Head injury Vaginal Bleedin your regular Doctors HMO or High Blood Pressure Vomiting/Dianne Within 2 days Doctor HMO Clinic Kidney Slime Wound CarelSutures Catt for appointment as soon as possible. Your Seif as an ER Patient. if you don?t have a doctor or need a Speciaiist foliow up with: omer PhysicianlSpeciaiist Address Work/School Restriction: Phone I You may retum to work/school today. Additional instructions: If the worsen or new develop return to the Emergency DepartmentlED) immediately. You may not return to untili if you had x?rays or biood tests, please note that these don't can the ED for additional questions? aEways show what's wrong. Sometimes x-rays don't show broken bones. After review by a specialist you m?ii be noti?ed if Return if increasing pain fever. cough . shortness breath weakness there is an abnorrnaiity. You may not drive or operate heavy machinery because the medicines you have may make you sleepy. Patient Signature Southern Ohio Medical Center - Main Campus Date Emergency Department Patient Name Phone: 740-355-8240 Prescriptions Oi V0 VOID. I VOI VOID VOID V0 Oi Rx: PIE) EPD pain ?bo?wenty) ifs?ills 2ero VOEQ VQJD V039 VOED VOIQ XIng V939 VOID VOID VQIO V01 This Prescription is VOID it submitted to a Pharmacy 48 hours after the Date and Time iisted above. ORDER FOR BRANDNAME TO BE as. THE MUST HANDWRETE-BRAND MEDECALLY NECESSARY ON PRESCRIPTEON Physician (Print) DEA-02594 2 I I A I (RIP) ACCESSION NBR: PATIENT NAME PROCEDURE: LUMBOSACRAL SPINE COMPL I HAD: EXAM DATE: 06/30/03 EXAM TIME: 18:12 RIGHT HIE AND COMPLETE 0F PELVIS The study shows no evidence of a fracture or dislocation. IMPRESSION: 'Normal study. LUMBGSACRAL SPINE - ROUTINE, INCLUDING AP, UPSHOT, BOTH OBLIGUES, AND LATERAL Status is FINAL (PF1lPF2-scroll,SELECT-view link list,EXPEDITE-print) vi?" I I A I (RIP) ACCESSION PATIENT NAME PROCEDURE: LUMBOSACRAL SPINE COMPL RAD: EXAM DATE: 06/30/03 EXAM TIME: 18:12 Vertebral body heights and intervertebral disk spaces are normally preserved. Bony mineralization and alignment are normal. Posterior elements are normal and the sacroiliac joints are unremarkable. IMPRESSION: Normal lumbosacral spine. and of report Status is FINAL (PF1IPerscroll,SELECT?view link list,EXPEDITE-print) I ran I 0 I A I (RIP) ACCESSION NBR: PATIENT NAME PROCEDURE: MRI LUMBAR SPINE 1 RAD: EXAM DATE: 12/06/02 EXAM TIME: 12:23 MRI OF THE CERVICAL SPINE Comparison is made to March 22, 2001. There is normal vertebral body height and alignment. The cord signal intensity is normal. At the 05?06 level, there is again mild disk bulging at 05-06 that is eccentric t0 the right. This does not result in cord impingement. The neural foramina are patent bilaterally. At the 05?07 level, there is ligamentum flavum laxity resulting in eild Status is FINAL link list,EXPEDITE-print) a! 1n?? I I A I (RIP) ACCESSION NBR: PATIENT NAME PROCEDURE: MRI SPINE 1 RAD: EXAM DATE: 12/06/02 EXAM TIME: 12:23 central canal stenosis, but no neural foraminal narrowing. There is no other significant disk herniation. IMPRESSION: 1: Mild disk bulging at 05?06 eccentric to the right without cord impingement. 2. Ligamentum flavum laxity at 06-07 resulting in mild central canal stenosis. TSAjksc Status is FINAL link list,EXPEDITE?print) :3 DEA-02598 1 ENV2306 USEHNAME2RESULT I I A I (RIP) ACCESSION NBR: PATIENT NAME PROCEDURE: MRI LUMBAR SPINE NIO EXAM DATE: 12/06/02 EXAM TIME: 12:23 MRI OF THE LUMBAH SPINE TECHNIQUE: Sagittal and axial T1?ueighted and T2-weighted sequences are obtained. COMPARISON: Comparison is made to the April 5, 2001, MRI evaluation. FINDINGS: The vertebral body heights and disk spaces are well maintained. No bone marrow signal abnormality is seen. The conus medullaris ends at an appropriate level. Status is FINAL link list,EXPEDITE-print) 05062 ENV1306 I I A I (RIP) ACCESSION NBR PATIENT NAME PROCEDURE: MRI LUMBAR SPINE EXAM DATE: 12/06/02 EXAM TIME: 12:23 There isano evidence of a focal disk protrusion or high-grade spinal canal stenosis. The neural foramina appear to be patent with epidural fat surrounding the exiting nerve roots. Many of the images are significantly degraded due to motion artifact introduced by the patient during scanning. IMPRESSION: Normal MRI of the lumbar spine. end of report Status is FINAL (PF1lPF2-scroll,SELECT-view link list,EXPEDITE~print) r3? USERNAME1RESULT I I A I (RIP) ACCESSION NBR PATIENT NAME . PROCEDURE: CERVICAL SPINE ROUTINE I BAD: EXAM DATE: 11/07/01 EXAM TIME: 19:05. PA AND LATERAL CHEST 0N 11/07f01 AT 1903 HOURS INDICATIONS: Chest pain. COMPARISON: Chest film dated April 26, 2001! FINDINGS: Small granulomatous density is present in the right midlung. The heart, lungs, and pleural reflections are otherwise unremarkable. CONCLUSION: There is no evidence of acute lung disease or intermin change from April 26, Status is FINAL link list,EXPEDITE-print) DEA-02601 NODEIBLAISE-0234 USERNAMEIRESULT I I A I (RIP) ACCESSION NBR PATIENT NAME PROCEDURE: CERVICAL SPINE ROUTINE ?h RAD: EXAM DATE: 11/07/01 EXAM TIME: 19:05 2001. CERVICAL SPINE - ROUTINE, INCLUDING AP, LATERAL, OPEN MOUTH, AND BOTH OBLIQUES INDICATIONS: Neck pain. FINDINGS: The prevertebral soft tissues are normal. There is some straightening of the cervical spine noted. There is no evidence of a fracture, disk space narrowing, or listhesis. There is no evidence of Status is FINAL (PF1lPF2-scroll,SELECT-view link list,EXPEDITE~print) 2 01065 I 0 I A I (RIP) ACCESSION NBR: PATIENT NAME PROCEDURE: CERVICAL SPINE ROUTINE 1 EXAM DATE: 11/07/01 EXAM TIME: 19:05 degenerative spurring. CONCLUSION: Some straightening of the cervical spine is noted, which could be positional due to ligamentous injury or splinting from pain. Otherwise, negative study. end of report Status is FINAL link list,EXPEDITE-print) DEA-02603 I I A I (RIP) ACCESSION NBR: PATIENT NAME . PROCEDURE: MRI LUMBAR SPINE EXAM DATE: 04/05/01 EXAM TIME: 17:20 .. MRI OF LUMBAR SPINE The patient's history is herniated disk, motor vehicle accident, low back pain and right leg radiculopathy. The study is done to include T1 and T2 sagittal imaging and T1 and T2 axial imaging. The axial images are done from L3 through 81. The vertebrae are of normal height and normal alignment and demonstrate normal signal intensity. There is no disk space narrowing identified and no evidence of impingement on the anterior subarachnoid space is noted. There is no disk herniation identified. Status is FINAL (PF1/PF2~scroll, print) 2 01:06? NODEIBLAISE-0234 I I A I (RIP) A ACCESSION NBR: PATIENT NAME PROCEDURE: MRI LUMBAR SPINE EXAM DATE: 04/05/01 EXAM TIME: 17:20 OPINION: Negative MRI of the lumbosacral spine. end of report Status is FINAL print) .9 f9 DEA-02605 I 0 I A I (RIP) ACCESSION NBH: PATIENT NAME PROCEDURE: MRI THORACIC SPINE EXAM DATE: 03/22/01 EXAM TIME: 21:24 spaces of the dorsal spine appear normal study. CONCLUSION: Normal study. and of report Status is FINAL link list,EXPEDITE?print) 1:57 7 DATF ?3 w; PulseJQL Respiration . Btood Pressure18ysioiic LE 5 Diastolic?wmgh Check 1/ if findings are normal Mark in appropriate space in coiumn at ieft, if findings are abnormai a?er examination on examination and describe in space beiow. jazz? Wad MAJ WNoduies . . i __Pigment __Hair . I i I ?Diner HEAD - EYES __Conjunctiva ?Sciera ?Ptosis ?Cornea _Exophihaimos WPupii _L?d?iag mMovement WTension _Ophthaimosoopic ?Acuity WOlher EARS wDrums wHearing __O!her _Discharge NOSE . L, WSinusTendemass g- a I ?Transiliuminaiion ?Other MOUTH ?Breath WTongue Ups Ducis Teeth ?Other Gums THROAT . MTonsils ?Post?nasal Drip . 5w WOiher I Jr 3 Wde 9?09 3mg?? as rach ,0 30 NODES a wCervicai minguinai WOccipitai - __Supraclavicuiar WOIher A waiilary a CHEST m% . 3 WShape ?Respiralions 9 - BREAST mMasses WDischarge mOther HEART WSounds M1 M) . impulse A2 P2 a I . . *Puisau?on ?Murmurs ?Shock 7 ?Rate 3 m?hy'ihm LUNGS . mFremiius WSpoken Vo?ce WFercussion Vofca i A ?Breath Sounds WOther Sounds a um. Ann Stale Lic. PAUL VOLKMAN, MD. 1219 Find?ay Street Portsmouth. OH 45662 (740) 355-5949 Fax: (T40) 355-6946 DEA SE23 Llc. PAULLVOLKMAN, M.D. 1219 Finale Skeet 1* Po 5m. Name Name Address . . fly" Address Date 1?24 1-24 . . - of, [1 2549 I - 5M4 . 75?100 101-1500 ,r ,1 151 andmoyer 1 2 3 43 . 2, 25-49 50?1'01 '1 50 $51 and over i 1 1 ?aw-L ref3m? if], . .. I - 1 131112345 .1- Regigi? ?ak? 1 1s vo1d 11? more than (1) prescnpilon 15 written per bienk rescnp Eon is vow ff more ha? (1) prescr'pmn '5 wrmen per wank - - 5.- . - ,memym. ?bur-1 SZate Lie. PAUL VOLKMAN, MD. 1219 F1r1d1ay sweet - Portsmouth, OH 45552 (740) 355?6949 Fax: (740) 355-6946 State Lie PAUL VOLKMAN, MD. a r, I A. 1219 Findiay Sireei Portsmoulh, OH 435662 {740) 355-6949 Fax: (740) 355-6946 DEA Name Name . A) (Zr ?1.2 1? Address . - . Date .45 was Address 1-24 :f 1-24 ?1 if :1 2549 F3 ?x T1 [12549 3 fr! 50.74 m1 50.74 m- 751-100 75400 101450 151 and over 3" 123/1014 50 "i [j 151 and over 73nemmfl ?41" ?w . ?vw? Prescription is void 11 more than ?5 Mme? mar)? Prescription is void if more than (1) prescription is written per blank Check 1/ if findings are normal after examination SKIN WCoior wEmp?on @Moisture wNaiis __Pigment wHair WOther "Petechiae HEAD EYES *Coniunctiva MSciera -Ptosis WCornea wExophihalmos WPupii _Lio?~iag - __Movement ?Tension ?Opnzhahmscop?c WAcuity WOihar EARS _,,Drums _Discharge NOSE Tenderness MMuoosa mSepturn WOiher MOUTH ?Breath __Tongue . ?Lips Ducis WTeeth mower THROAT WTonsiis ?Pat-nasal Drip mPhaJ'ynx ?Palate NECK mSti?ness ?Masses ?Trachea WO?iher NODES ?Epiirochiear ?Other CHEST mFiespirations BREAST __Ma5535 __N?ppies WDischarge mOiher HEART ?Apicai ~__.Souncis M1 Impuis A2 P2 WThn?i? Third mPuisazion m, Murmurs __Rate LUNGS mSpoken Vo?ce ?Percussior: __Whispered Voice mBreaih Sounds Sounds (over) DEA-02612 Mark in appropriate space in coiumn at left, if findings are abnormal on examination and describe in space beiow. State Lic. #35-07o722-v State Ltc. ,9 I PAUL VOLKMAN, - 1219 Findlay Street Portsmouth, OH 45662 (740) 355-6949 Fax: (740) 355-6946 DEA 1219 Findlay Street - Portsmouth, OH 45652 {740) 355-6949 Fax: (740) 3556946 Name l? Address Name Address I . I I - . Date 25-49 i 75400 . f. a I [3 75-100 ?rm?1,50: ?363,495? . Zfa?is?iand a 1 1 1 1 1 ?5?ahq?OV9i 1 Heritt'?? 1 2 3 4 5 imxv? 52.3.2! 1 ?I?u-Prescription is void it morethantm prescriptionis-written per blank- Prescription is void if more than prescription is written per biank m- We .9.. .. MM .. ~45. A - . .?uzm'mm ?W??Yvui by? . . Mm?, .M he. t. .. State Lic. a . PAUL VOLKMAN, M.D. PAUL 1219 Findlay Street Portsmouth, OH 45662 (740) 355-6949 Fax: (740) 355-6946 1219 Findley Street Portsmouth, OH 45662 (740) 355-6949 Faxi (740) 355-6946 Name Address f1?" [1 2549 [315064 i [j 75~100_ 1.31. 10.13159. ?1?1?5'1'endotrer Error-reo- 4 Ij?151 and over r" Retiil neriuNH 't 2 3 4 5 ?we. .5. a - .- - ?xer-r Prescription is void it more than (1) prescription is written per biank 3 SEate Lic. 335-0 PAUL VOLKMAN, D. 1219 Findlay Street - Portsmouth, OH 45862 740) 355-6949 Fax: (74013556946 ?1-24 25-49 - ?50-74 7540 [1 101456 I I r; [j 151andov?r Re?si?N? 1 2 3 4 5 Prescription is vo?d if more than escription is written per blank DEA-02614 Pelient?Last'Nam GENERAL: Ag Blood Pressure: Systolicw U?astolicm Weigh {go Mark in appropriate space in column at left, if are abnormal on examinazion and describe in space below. Check 1/ it findings are normal after examinallon SKEN _Erup?lon WMolslure xture ?Modules. MPigrnent _Other wPetechiae . HEAD - EYES ?Conjunctiva ?Fields MSclera wComea WmPupil mMovemenl moahlhalmescop?c ?Other EARS mDrums mMastoid WHearfng WOIher NOSE WAirways Tenderness mMucosa _Sep?urn Wozher MOUTH wBrealh mTongue WLips mSal?vary Ducts ?__Teeth "Other THROAT mTonsEls ?Post-nasal an MPharynx WUvula MPalale leher NECK MSliHness "Vessels WMasses WTrachea _Thyroid ?Other LY MPH NODES _Cervica1 minguinal WOccipital prilrochlear wSupraClavicular ?Other CHEST __Shape ?Respiration WOther BREAST mMasses mNippies lescharge HEART mApScal ?#Sounds Ml Impulse A2 P2 mThriil Third "Murmurs MShock WGallop __Raie LUNGS _WFrern?tus ?Spoken Voice ?Percussion Voice Sounds Sounds {?vef- DEA-02615 w? Zm 7% 5% 72W 4/122 7/3 ?fe-QM m? 62? State Lit. DEA Staie Lic. PAUL VOLKMAN, M.D. PQUL VOLKMAN, MD. 1219 Findlay Street Portsmouth, OH 45552 (740) 355-5949 Fax: (740) 355-5946 1219 Findlay Street - Fmsmouth, OH 45652 {740) 355-6949 Fax11740) 35545946 Name Name Address Address Data 3 rad?{?24 2549 I I 25?49 jw 51150-74 [1 75-100 5 ,3 13 75-100 1] 101-150 :1 101-150 . 1; .. 151 and over I 151 and over semis/131 1 2 3 4 5 Prescription is void if rnore than prescription is written per blank I i 31329 no Siaie Lie. 11135-070792? I 1 1219 Findia?y Street ~f?0?rismouth, OH 45662 (740) 355.6949 Fax: (740) 355.5945 1219 Findiay Street - Eadsmouth, OH 45652 (740) 355-6949 Fax: (740} 355?6946 Name mum. . Name W. Address Address . 1-24 2549 1:50-74 75-100 101-150. ":22151 and over ?m 104 2549 . . [1150,74 75-100 101-150 3 . A 1 - 1' 151 and over 1. 2 rm Resigns 1'2 3 4 5 ,1 .- .?r?mti 2 Prescription Prescription is void if more than (1) prescription is writtenper biank. 6 DATE . - 'Respiration Biood Pressure: Systo?iiclm - - iastoiic Mark in appropriate space in column at ieftpif findings are abnormai Werght Check :1 if'findings are normal I I . . after examination on examinatxon and describe in space below. a - __Color WEmp?on ?7 ?Nails __Nodu[es~ I _P%gment ?Hair wome? *Feiechiae HEAD - EYES . "Conjunctiva mFieids __'__Sciera ?Ptosis wean-ma WExephmaimos ?Lid-lag I . mMovemsn! Rd?" . KM *Other 7 . -- I, EARS I ?Drums WMastoid . I mHearing mOlher ?Discharge 3" NOSE a mAirways __Sinus Tenderness WTransitEumination d?Septum MDther 1 MOUTH Wareath ?Tongue _Lip5 mSalivary Ducts HTeeth mother THROAT WTonsils WPost-nasa] Drip mUqua ?Other NECK WSti?nasa ?Vessels WTrachea WOIher MODES wwmguina! ?Occipitai __Epilrochiear "Supraciavicular ?Other WAxillary CHEST ?Shape BREAST WMasses __Nippies wDischarga HEART ?Sounds M1 lrnpuise A2 P2 Third wMurmurs __Shock ?Gairop __Friction #Rhy'thm ?Other LUNGS mFremiius ?Spoken Voice MFercussion ?Whispered Voice ?Breath Sounds ?Other Sounds {over} .. . (. Kiw?g?i? aw" . DEA-02617 (140)1355~5949 Fax': . II . I a stage ?cLaeabovIwOT?zV I PAUL (7440) 5355169149 355-5946" . Name an Name Address II Gage m. .9?dr?ss - 'y I 9" . "1.II 25-49 .. - 7 I I 75409 I . I I Cit-754001 A [3 101450 .. I .101-150 IIJII 9 5? ~1?51ahdove'r -I - 1?3! . A "15145nd50YBr.II. I Law" I, rm f\ Preaoripyon is?ymd 1f morp? thIaan) biank-Ja iIswoid'if marexh?n ??m'ank '5 - 2353- State LICIsismqu??j?asi-m-wm-v' MD: 1219 Findlay Street:- ta, sa . mmSeptum, ?Otter .1 MOUTH 'MTongue QLips WSaIivary Ducts . ., "Homer -. Drip 4Pharynx' ?Pa-late . gother a ~8ti?ness ?Masses . - _f_m_-Thyroid @Cervi?a?l goecipltalc .7 . ~_A_Sup.raclampulair? mower - ifgc?eext? A A g?espiratjo'ns' WMassesu Z, ?Nipmes' QDischarge ?Otheri WApica!' gm I impulse A2 - - P2 ThriH . 7 Third ?;u__Pulsation - . @Frictjon HFremitue' #390an Voice ?Percussion Voice Sounds ?Other Soupds (cve? ~f 9a: my J77 @643?, 16/4; I. DEA-02623 01:086 ?State Lid. #as-orwer?-v PAUL VOLKMAN, M.D. 1219 Findiay Street - Portsmouth. OH 415662 (740) 355-15949 Fax: (74013556946 Slate Lio. #3507072?2-v? DEA 1 PAUL VOLKMAN, MD. 1219 Findiay Street Portsmouth, OH 456-82 (740) 355-6949 Fax: (740?; 355-5946 Name Name Wm Address 1 I Date. Address . . [3315? .. ,3 1 . 1-24 1-24 25-49 5 [3 2549 1 [3 50174 -5o~74 75-100 75400 1 101-150 A - 1 101450 i 1?97?" 3'3 .3- 1 151 and over 1151' and-over SUBBED . 2 3 4~5 r- ?w HemPrescription is void if more than (1) prescription is written pror biank Prescription is void if more than (1) prescription is written per blank . o. . .- . AA State Lic. State Lic. 113507437224! -c 1219 Findtay street; Portsmouth, OH 45662 (740) 355-6949 - Fax: (740) 35545945 DEA 1219 Findlay Street - Portsmouth,?CiH 45662 (740) 3556949 Fax: (740) 35543945 I Name .- Name . .uu. Address Date A Addr?{pm-H 1 mum?? xx 1?24 1 1' 25-49 at: ,x 50~hum-Ma; I -7 4 75400 fl: - v' [1 75-100 1017150 I A 1] 101-150 151 and-over UDUUDQ . '151 and ov?r 5* I: . ?3 A HeftligNFt mm," Prescription is void 11 more than (1) prescription is written per blank - Stale Lic. 113507072247 - DEA 31mg Lac. 113507?0729} PAUL VOLKMAN, M.D. PAUL VOLKMAN, MD. 1219 Find!.ay szree: Portsmouth, OH 45602 {740) 055-5949 Fax: (740) 355?6946 1219 Findlay Street - Ponsmouih. OH ?55662 (740) 355-5949 Fax: (740) 355?6940 DEA Name Name Address Date Address 1?24 25-49 50-74 1' 75-100 101-150 "151 ?nd?o?er la 1-24 25-49 75-100 .- I 101450 A ?3 . 151 and over .I ?1 7'1, 7? I I: 214711,.? . -, - w; Refili NB 1.2 3 4 5 Rafiu-vw 5. A I LAW- ,a 1. PAUL VOLKMAN, v' i 1. 7 APAUF. 1219 Find?ay Stre?'! - Portsmouth. OH 45662 (740135545949 355-6945 Shier ch. #3507-0722?v 1219 Findlay Street - Portsmouth, OH 45562 (740) 355-6949 Fax: (740} 355*5946 Name Name Address Address :24 - 1 r177" 25-49 jg if.? f: 1 J3 A 5074 75100 I. (A V. [1 75-100 ?1 . 1? iv A .. ?Wm r~m?w~ ;m QWWQ, I V. f. 151and?over Banana 151i aind Iovver Hemm? 1 2 3 4 5 Prescription is void if more than prescription is written per blank Pig/Jim Exam?rmtiow Patient Last Nam a. Check if findings ewe normaE after examination 1:47 Attend . E. 1? ressure: Weight Mark in appropriate space in column at ieft, if findings are abnormal on examination and describe in space below. DATE SKIN __Cc?or WMoEsture WNaiEs mTexlu re WNodules ?Pigment __Hair mOther mPetechiae HEAD EYES __Fiefcis deefa ?Ptosis FComea mPupii mLid-?ag MMove-?nen: mTension mOphihalmoscopic wAcuity er EARS WDrums mMastoid _Hearing ?Dischazge NOSE ?Airways Tenderness mMucosa WSeptum _the OUTH ?Tongue mLips Ducts WTeeth mower WGums TH 0 AT W?Tonsris mPost?nasal Dn?p mP?nar?ynx ?Uvuia WP aiale MDther EC WSt?h'ness WVesseis ?Masses mTrachea ?Other LYM PH ES WCervicai minguinai mOccipitai MEpsZrocmear ?Supradavicmar ?Other wailiary CH ST ?Shane mHespira?ons ?Symmexry "Other REAST MMasses WNippies kascharge EA RT ?Apical mScunds M1 Impuise A2 P2 mThn'T? Third "Pufsazion MMurmurs __Shock WGa?op WHERE "Friction mo?her LUNGS __F{e_mitus ?Spoken Voice #Percussion Vo?ce Sounds WGther wwluj?vent?iious Sounds (gum) Mam Wag/u am" gig?W43 231%.? - Madmai M5 Pia? ?300-3281 3 T9 State Lic. #35?07-0722?1! PAUL VOLKMAN, MD. 1219 Findiay Street - Portsmouth, OH 45662 (740) 355-6949 Fax: (740) 355-6946 DEA Name Address 124 25-49 50-74 75-100 101:150 5 151 and over Refili ?1 2 3 4 5 I. 1,5. GUIDE Presor?ption is void if more than (1) prescription is written per bienk State Llc. #3507-072?2-v PAUL VOLKMAN, MD. 1219 Findlay Street - Portsmouth, OH 45662 {740) 1355-6949 Fax: {740) 355-6946 DEA Name Address Date 1-24 25-49 50-?4 751 00 101 ~150 151 and over DECIDED Helm NR 1 2 3 4 3' Prescription is void if more than prescription is written per blank . .. 5 .7: - a? PAUL VOLKMAN, MD. 1219 Find1ay Street - Podsmouth, OH 45652 (740) 3555949. Fax: (740) 355?6946 DEA Name Address 124 2549 4 [3 5044 [3 75-100 101-150? El; 151 and over u? Qua-red;1355710523: 1" PAUL VOLKMAN, mm 1219 andiay Street - Portsmouth. OH 45662 3556949 Fax: (740) 355-6946 DEA Name Address 1?24 25?49 50-74- 75*100 101.150 151 and over . . Mu.? 5 I 1 RefiilDEBUTD mu- \K'j mm Prescription is vo?d 11 more than (1) prescription is written per blank A . 4i En cm .2, 53536 9: 90E 90> mw cozamommi Lm>0 .UCN cm For Oonh ?Wow 91mm VNL. 9&9329: m8? 5.53:. nZdazv?JO" 434n? 95m . .. *z 5w .i w/j Check 1/ if findings are normai Mark in appropriate space in coiumn at left, if findings are abnormal after examination on examination and describe in space beiow. SKIN 5, WCoior #Moisture mTexiure ?Modules mPigment .. - I - I MPetechiae - - HEAD EYES WConiunctiva WFieids WComea __Exophthaimos WPupi! Mud-Eat; WMovement mTension WOphiha?moscopic WOther EARS mDrums __Mastoid WHean?ng Home: ?Discharge NOSE WAirways ?Sinus Tenderness mMucosa _Other MOUTH WBreath __Tongue mLips __Saiivary Ducis ?Teeth ?Other WGums THROAT mTonsiis Winner-nasal Drip ?Uvula WPaEate _Other NECK WStih?ness WMasses thJ'rachea ?Thyroid mOther NODES WCervicai minguinai __Occ?pitai WEpitrochiear __Supraclavicular Nome: CHEST "Shape ?Respirations WOther BREAST mMasses WNippies mD?scharge mozher HEART _Apicai mSounds M1 impulse A2 P2 Th?rd ?Puisation mMurrnurs m?aie . WFric?on mFihy'thrn WD?ther LUNGS ?Remiius mSpoiE-n Voice #Percussion Voice Sounds ?orher WAdveniitiou? Sounds . (?ver) l20?379 Medical Ana Press Lamaze-2179 DEA State Llc. PAUL VOLKMAN, MD. 1219 Findiay Street - Portsmouth, OH 45662 (740) 355-6949 Fax: (740) 355?6946 Name Address mm A . j. . 1-50-74 75-100 I i 101-150 I I 1. 1 . W?pr-m' Refill NFifi ,2 3 4 5 g! Prescription is void if more than (1) prescription is written per biank State Ltc. PAUL VOLKMAN, Mio. 1219 Findtay Street Portsmouth, OH 45662 (7'40) 355-6949 Fax; (740) 355-6946 Name Address and!? 124 2549 5034 75-100 101-150 ?v 151 and over 1.. (I, it"; \?kkuwfw-f? i 1?1 r? yal "a Prescription is void if more than (1) prescription is written per biank ?r .- Mm! ?1 [j 151 and DEA State Lic. PAUL VOLKMAN, MD. 1219 Findiay Street Portsmouth, OH (15662 (740) 355-6949 (740) 35545945 has? . . Name l' 34" . i? Address - 1 1~24 2549 50-74 75-100 101-150 1:13; 151 and over El i if} f2 1 19? ff'a?h 2 1:5 a: I ResarfyPrescription is voidif more than (1) prescription is written per blank of? 1. ?40 i u. . ?41?5, State Lie. PAUL VOLKMAN, MD. 1219 Findlay Street - Portsmouth. OH 45662 (740) 355-6949 Fax; (740) 35543946 Namew? Address 25-49 A 50-74 Ll} [Ix If" if} 75-100 ?4 1 . 101-150 151 and over a? uh if": ?3 1' - Prescription iS'void it more than prescription is written per blank wmwmoa.w~58mmu u: 35w P/ysimj? Ewa Eci (33159,;ng I are: Systoiic ?2 Diasmiic 2 va?igh I Check if findings are normal Mark in appropriate spgce in coiumn at ieft, if ?ndings are abnorma after examination on examination and describe in space beiow. Patient Last am SKIN a __Eruption ?Texture wNoduleS i WHah? WOther . "Petachiaa' 7 HEAD EYES . MCOniunctiva ??elds WSciera WComea ?Exophthaimcs MP UPE WMovemenl ?Acuity ?Owe: EARS MDrums mMastoid mHearing Womer -A- 5 I 0 I A Eva??/ NOSE . I wAirways ?Sinus Tenderness ?Transillumination a - ?Septum __Other h? MOUTH - . WTongue MLips WSaiivary Ducts a ?Teeth _Other THROAT _Tonsiis mPost-nasai Drip 7? vaula - mOthe: 7 NECK . (2:4 ?Sti?nass "Vassals .w ?Masses WTrachea . WOther NODES ?Inguinai ?Occip?tal WEpitrochEear WSupra-clavicuiaz __Other wailiary CHEST mRespimtions ?Symmetry REAST MMasses WNipples WOther HEART HSounds M1 impuise A2 P2 _Thri?i Third mMurmurS MShock __Ga?lop WFriCtion Home: LUNGS ?Spoken Voice mWhispered Voice mare.?th Sounds mower *Adven?tious Sounds invar?: INSE?MedmlAns Press 1-800-325-2119 DEA State ch. #:1507-0724r DEA State ch. PAUL VOLKMAN, 1111.0. PAUL MD. 1219 Findlay Street OH 45562 (740) 355.5949 Fax: (740135543945 1219 Findlay Street - Portsmouth. OH 45562 (740) 35545949 Fax: (7403 355-3946 Name Nar?1:11-5M4 raft/r27 v3 1 1 3111' 1' it 101-150 .1 101450 1_ - 1? 1. 1 1, 151 and over . 151 and ever neglng ?1-: 1:24 1 25.49 I 50-74 754 00' Hrs? v.4? 2" 1?0" - {?He?ijNH Prescriptionjs void if more than (1) prescription is written per biank Sime DEA Staff; U6. MD PAUL VOLKMAN, MD. 1219 Findiay Street Ponsmoum,_QH 45652 (740) 35543949 Fax: (740) 3556945 DEA 1219 Findiay Sireet Portsmouth, OH 45662 (740) 3556949 3556946 Name 11 3:1; Name_ 5 Address Address - 1 02116: 124 25-49 50-74 751001 1011150 - 151and over 50~74 .- 1; 7540012,) 101150 2 ?(15?14and over - ff 1 1 j! I .. RefilgNR FlefiHNH '-mpm..-fi .W a, 1-24 1 1 I 2549 11f jig-X1": 17'1"? .1. magma . Prescritib 1 Prescription is void if more than (1) :9 written per blank - an ?5 mid Ff more ma? (-1) '5 written per biank 1 011096 Stale Lic. #35-07-0722 PAUL VOLKMAN, MD. 1219 Findlay Street - Portsmouth,.OH 45662 740 355?6949 Fax: (740) 355-6946 1-24 25-49 50-74 75-100 101-150 . - . 151 andover Check 1/ if findings are normai a?et examination SKIN wColor WEmplion __Mois:1:re wNails WNoduies _Pigment chohymoses mPeiechiae HEAD EYES WConjunciiva wFieIds ?Sclera WPtosis w?flames. ?Pupil WLidvlag mTensiorI ?Ophmaimusaopic ?Acuity ?Other EARS ?Dr?ums _Mastoi:d _Hearing _Olher __Discharge NOSE ?Aimays "Sinus Tendetness ?Transi?umination Wsepmm Momer MOUTH #Breath _T0ngue WSaiivary Duds mTeeth mower MGums THROAT mTonsils WPost~nasal Drip HhPharynx *Uvuia WPaiate WOlher NECK '~Sti?ness wVessels __Masses mTrachaa ?Other NODES wCervical ?Mwingu?na! mOccEpitai WEpitrochie-ar __Axi3iary CHEST ?Shape ?Respirations ?Other BREAST A mMasses __Nipp?es mDischarge HEART wApical wSc-unds M1 impuisa A2 P2 mThri? Third ?Pulsation __Gai!0p WRate __Fric1ion thy?thrn __Other LUNGS __F{emitus ?Spoken Voice mParwssion Voice WErea?-L Sounds WAdvemEtious Sounds (over) DATPssure: Systoiic I 19" Mark in space in co?umn at left, if findings are abnormai on examination and describe in space beiow. i #20379 Medical Arts Pres: 1-800-323-2179 011993 Stale Lic. - PAUL VOLKMAN, MD. 1219 Find?ay Streak - Portsmouth, OH 45662 (740) 355-6949 Fax: (740} 355-5946 DEA State LEC. .1 I PAUL VOLKMAN, M.D. 1219 Findlay Street OH 45562 (740) 355-6949 Fax: (740) 355~6946 Name Name Address Address 124 25-49 50?74 2549 50~74 . I 'i 75400 r? a" I 101?150 A ?u?"f?sqind over I '1 1,49%? Hf l! 37 151 and over H???15:1 i I 1 (Ru; 5 "1vnewState Lit; PAUL VOLKMAN, MD. 1219 Findlay Street - Portsmou?h, OH 45662 (740) 355-6949 Fax: (740) 3556946 DE 51am Lic. PAUL VOLKMAN, MD. 1219 Findlay Street Portsmouth, OH 45662 (740) 3556949 Fax: (740) 355-69453 .a 1 Name Address A - . Datg 1-24 2549 . 50-74 - :1 75-100 . . 1 1 I a I 1-24 25.49 L151 \50-74 2? 113.56,] 75?100 ,g 1 JD 10;?150 {1 ?mm i 151and over In?? . - 151 and over Hem: NFU1 Rafalrleiin L?r-L?rpw Prescripiion is void if more ihan (1) prescription is written per biank DEA-02636 a Check ??ndings are normal afterexamination SKIN __Color ?Moisxure ?Naiis mTexture WNodules Mpigmen! WHa?r ?Petacniae HEAD EYES mFieids WScle-ra __Ptosis MWComea ?Exophthalmos _F?upi? mLidwl'ag MTension _?_Ny5tagmus wOphzhaimos?copic MAcuily mOther EARS ?WHean?ng moms!? ?Disoharge NOSE m_Airways WSinus Tenderness #Mucosa MTtansil?umination mmSeptum m01her MOUTH mBreagh Ducts __Tee(h mOther __Gurns THROAT >M_Tonsils ?Postvnasaf Drip WOi?her NECK mS??ness WVesseis WMasses mTrachea _.__Thyroid ?Oihe: MODES mCervicai __ nguina? MMOCc?pftai __Epi rochlear wSupzaciaviculai MOiher WAxa'Hary CHEST ?Respirations Fl EAST ?Masses __Nippies ?Meme: HEART ?Apical WSounds M1 impuise A2 P2 Thad WPuisa?on __Murmurs mShock "Friction WOther LUNGS _Frem?ius __Spoken Voice wPercussion mWhispere-d Voice ?Breath Sounds mower ?Adventitiuus Sounds Is a. Respirahon (?Steed Prssure: Systolic?iaste?c Anethy . Mark in appropriate space in coiumn at left, if findings are abnormai an examination and describe in space beiow. ?u 114'sz 722555;" 120379 - Mad-=41 Arts Press 1-9004234179 DEA I PAUL VOLKMAN, M.D. Name State ch. 03507-07224; i 4 1219 Findtay Street - Portsmouth, OH 4?5662 (740) 35545949 Fax-z (740} 355-6946? Address . .5 Prescription is void if more than (1) prescription is written per blank DEA 7 PAUL VOLKMAN, M.D. Name 1-24. 25-49 50-74 75-160 101-150 7451 and qver State Lic. 1219 Findiay Street - OH 35662 (i440) 3556949 Fax: (7.40} 355-6946 Addres's HeiiElNl?i25-49 75?100 101-150 Prescription is void if more than prescription is written per biank ?3?151? and Dyer DEA smie' L?c. PAUL VOLKMAN, MD. .1219 Findlay Street-4 PartsmoUth, DH 4556i (NO) 3556949 Faxi (740) 355-6948 Name Address 50?74 [3 75?100 ?101459 iji' 151 and over . . State PAUL VOLKMAN, MD. 1219 Findlay (740)355-6949 Fax: (740)355-6946 - . W4 - 25-49 50?74 75400 101?150 151 and over '8 Patient Last Nam is? I Respiration? a me: Sysaoiic Diasto?c? ?MaH-c X?ih 'appropn?ate? space if findings are abnormal on exammation and describe in space beiow. Check i! ?ndirigs are normal . 3:29; examinaiian MW . 7% J?u?h "Moisture mles ?Naduias i mm. 2 HEAD - EYES Peiachiae WConguncliva WFields ?Sciara mPtosis ?Corr-lea ?F?upai _Lxd?}ag mTension - #Ophtha?moscopm ?Acuity _Olher EARS Z/fj/ WDfuu'dS WMBSID: WOther WD?scharge A NOSE 4 Tenderness __Mucosa WTransEiluminat?on ?Other MOUTH #Lips ?Salivary Ducts WGums THROAT ?Tamils an 4 mPharynx mUvula 11% mPak?gie "Other NECK ?64125 mVessels - h? ?AmMasses mTrachea ?Other NODES /g%5 MCerwcal ?inguinal 3 WOccip?tat ?Epitroch?ear mSupraciavicular __Olher . CHEST ?Shape mHespirations .. ~mOther BREAST #Masses ?Nippfes ?Other HEART - WApicai __Sounds M1 Impulse A2 __Thn'i? Third wPulsation WMurmurs WRate ?Friction _O1hez LUNGS Breath Sounds ?Other wAdventitious (e wShock mGallop mSpoken Voice WWhiSpered Vuice Sounds Ply/5W {over} I - .s ms: ar- IZOSTB Medicah??s Press 1-800-328-2179 BEA-02639 m? 0113102 DEA PAUL VOLKMAN, Siam Lic. MD. 1219 Findiay Street Portsmouth,_ OH 45662 (740) 5556949 Fax: (7,40) 355-6945 Name Address Prescription is void if more than prescription is written per 1-24 25-40 50-74 75-100? 101-150 Hun?V4 tank over DEA stale Uc. #3507?0722?v PAUL VOLKMAN, MD. 1219 Findiay Street Fonsmouim OH.45502 355-6949 :Fax: (740) 355-6946 jj_ Na?rrla I Address Date 1-24 25-49 50-74 75400 101-150 151 and (War ?i .v 2 3'41: . fl i DEA PAUL VOLKMAN, State Lic. M.D. 1219 Findlay Street Portsmouth, OH 45662 (7"40} 355.6949 . Fax; (740) 3556946 1). .Name W. Address [a A x} i? Regains 2 3 4 DEA-02640 5 2549 50?74 754 00 101-150 151 and over Prescription is void it more than (1) prescription is written per biank EA State He. VOLKMAN, MD. 1219 Findlay Street - Portsmouth, _Oi-i 45662? (740) 355-0949, Fax: (74013556946 Name Address 124 25-49 50-74 [3 75100 i Cl 101-150 I - - - t5} and over Refill vm?w?nv? Prescription is voici if more than prescription is written per biank 0.11103 min! 51 Name Sheck ?rf findings are normal. after examination DHTE Pressure: Systolic QyD?astolic Weigh Mark ?n appsc-priate space in coiumn at ie?, if ?ndings are abnormai on exammation and describe in space below. SKJN mColor ?Moisture WNaiis ?Pigment ?Hair WOIher ?Petech?ae HEAD EYES ?Conjunctiva MFEelds WPtosis chmea H_Excph?ha3mcs mPup?i MLid?lag MMovement wTension WOphihaEmuscopic _Other EARS _Drums WMastoid __Hearing mOther WDischarge NOSE mAirways ?Sinus Tenderness mMucosa ?Trans?lumination wSeptum WDther MOUTH WTongue WLips Ducts WTeeth WGums THROAT mTonsils _Post-nasal Drip mUvu?a mFaiate NECK MS??ness WMasses MTrachea WOther NODES mCervicaJ m0ccipita? WEpitrochlear WOther WAxi?ary CHEST WShape ?Respiration WOther BREAST WMasses __Nipples ?Discharge w?Other HEART ?Apical mSounds M1 Impu?se A2 P2 w__Tm?i? Third mPuEsation mShock WGaimp WRate __Fn?c?on mRhy?thm LUNGS mFrem?fus wSpoken Vo?ce ?Percussion __Wh?5pered Voice __,Breazh Sounds __Other WAdvent?rtious Sounds {ever} DEA-02641 MM 2775742? 23;? 42;, NT r/f . 4 ?aw affirm - f2? [la/44 in 4% XML lac/j l/[bjum l? [20379 - MadicalAns me: 1-800-328-2179 DEA Slate Lie. PAUL VOLKMAN, MD. 1219 Findiav Stra?atr Portsmouth, OH 1566? (740) 355-6949 Fax: (740) 355-6946 Slgia Llc. F3507-0722-V PAUL VOLKMAN, MD. 1219 Findiay Streat_- Portsmouth, OH 45662 (740) 355?6949 Fax: (740) 355-6946 iame Name . address Address . ?aw 1-24 rg 1-24 .1375" i ,7 ?25?49 53?? - ,m 25-49 i I- I Mr lvJa/q- i I 50-75?100 . 1? . .1 a ti 1 Qir? {21/7 fol-w. ?r - 151 and over HeIg-vf; . 50'74 I I Jr? 75-100 d? x" I 101M150 1112mm] . ,Ii? 151?a dimer Hetiu12345 Prescription is void if more than (1) prescription IS written per biank Prescription is void ii mare than prescription is per biank 1 1- Slate Liar PAUL MD. 1219 Findlay Street - qu?lsmnuth. OH 4.5662 (740) 355-6949 Fax: (740) 355-6946 5mm L3G. PAUL VOLKMAN, MD. 1219 Findlay Streei ?Portsmouth. OH 45662 (740) 355-6949 355-69411 tame Name 1ddress . I 4 Address 1 1 Date Kr 1~24 124 25-49 50?74 75400 101-150 I 1:1 A A a 25.49 .K fr 6 5974 El 75101,150 . 1?1. A 151and?p?yer? 1 If 111911111111 91311101151 and'ovar void if more than (1) prescription is written per biank L- - i N, kt?: A n. . a ,y PatientLast Nm GENERAL: A Check :1 if after examination "Color mErUption WNaiis I *Nodules WPigmant "Petechiae HEAD EYES WConiunctiva #Fieids WSclera ?Ptosis :mCornea ?Pupil ?Movement MTension "Ophthalmoscopic MOther EARS ?Masioid HHear?ng ?Qkher ?Discharge NOSE WAErways Tenderness WM ucosa _Transi2!uminat?on 'MmSeptum ?omen MOUTH WBrealh __?Lips __Sa?vary Ducts ?Teeth mOthar THROAT ?Tans?is Drip harynx ?Palate ?Other NECK "Stiffness wVessals MMassas merachea NODES WCaruicai __ nguinal ?Epitrochiear #Suamclavicmar "Other EST ?Shape _Respira!ions __O!her BREAST ?Masses wNippies ?Dischagga Mower EAHT MApicai M1 Impulse A2 P2 _Thriu Third _Pu?saz?on mShock ~Gaiiop mHate __Friction LUNGS __Fremitus __Spoken Voice ?Whispered Voice wwarmth Sounds ?Other MAdven??ous Sounds (overIn.? Kiri; Ame ood Pressure: Sys?ioiicMiastoch i Mark in appropna te space in column at 39ft, if findings are abnorma? on examination and describe En space be?ow. man - Medial Ari-I Pres! ?4800-328-2171 2 SL319 Lic. (13507-07224! PAUL VOLKMAN, MD. 1219 Findiay Street - Portsmouth, OH 45552 (740) 35536949 Fax: {740) 355-6946 Name Address [3 L24 I 2549 ~f 5 50-74 [3 75-100 101?150 1 151 and over as. 1 Retili 113Prescription is void if more than prescription is written per blank I r'k I 1 3 4 5 viiPrescription is Void if more than (1) prescription is written per btank Prescription is void if more than (1) prescription is written per blank 512 OF 120 Re: .. 1.. I Away @19 CuirrentMeds: Notes: W??mm ?7/0 70 90 L361: $617341 A . . A, mg?m DEA-02658 .. x: y? State Lia. HEALTH CARE 1200 Gay Street Pumamo-Mh OH DEA Name Address .1 001-91 69-52 El #31 3-. 7. 1m pus LSL 13"? .nm~e-n- .mu1'24 25-49 50-74 75-100 101-150 151 and over ra-?ng?-?u-rr??wmf: i (W HHVO Rama/NRPrescription is void if more than (1) preacripti?n is wr'rnen per b1ank i" F. aims-1m State L10. #35-01072g-V PAUL 1 . 9s CARE {12?99av?twer- wwmoA '1an :1qu :ad uanuM-sg 1) new emu; 1; pm 5; ?mi;an:53x! Rx! a 1 -24. 25-49 1 .m - ?7.41/0 332:1; a 2? 1014150 151 and over Refiil NR 1 2 3 4 5 Prescription is void if mom than (1)prescriptio:n is writlgh per Hank .4 DEA-02659 GENERAL: A Check 1/ if ?ndings are normal after examination WColor #Emplion mMoislure _Nails _Other __Petech?ae HEAD EYES wConiunctiva __Fields mSciera mPtosis WComea WExophzhalmos ?Mavemenl wTension ?Ophthalmoscapic mm_Acu?y EA RS ms UMWHeanng mAimays WSinus Tenderness WMucosa WTransiEiuminazion __Olher MO UTH n__1bngue ?Lips mSal?Nary Ducts vTeeth HwO'I?her meums TH ROAT ??wposbnasalD?p A__Uvma ?Parana ECK ?_wS??ness _?,Vessas ?__hdasses _?_jTachea MODES r. ?inguinal ?Occipiial WEp?trochlear WSupraclavicular WOlher 'WAinlary CHEST _?_Shape __?Respha?ons BREAST __Nipp?es ?Discharge HEART M1 impulse A2 P2 Third _Shock __Gallop Womer LUNGS WFremitus __Spoken Voice ?Permission #Whispered Voice Wareath Sounds WOIher mAdvenSitious Sounds {over} 6? a . . mg x?g?3?/33 W?g - My? 2% Blood Pressure: Systolic Diaskolic Weigh Mark in appropriate space in column at left, if ?ndings are abnormai on examination and describe in space below. zip/?y JM Mm [Mi mad/?! ?z?w 67/ @1235 Am 1136/" (522774, {1122/ M71 34/? Wm ?y 5/9 Jam, 5% fms. /1 55%? My Maw who: Der? mgr/1 4 5: 0m? WJMM Mg I 2 i7? 9ng Respiration ibu?se . 3'4?4. MN 3?1 State Lic, #35?07?0722wV PAUL VOLKMAN. MD. 1219 Findlay Street Portsmouth, OH 45662 (740) 355-6949 Fax: (740) 355?6946 State Lic. PAUL VOLKMAN, NLD. - 1219 Findtay Street - Portsmouth, OH 45662 (740)355-8949 Fax: (740)355?6946 DEA- State Lic. #35?0740722-v State Lic. #as-omvzz?V VOLKMAN. MAI). PAUL VOLKMAN, NLD. I . . 1219 Findiay Street - Portsmouth, OH 45662 1219 Findiay Street - Portsmouth, OH 45662 Fax: (740)355?6946 (740) 3556949 Fax: (740)355?6946 . Stat? L?c. #3541743 22v PAUL VOLKMAN, MD. 1219 Findiay Street Portsmouth, OH 45662 (740) 355-6949 Fax: (740) 355-6946 ?2.251195 2m Fallen-l Last Nar GENERAL: A Check r/ if findings are normal after examina?on #98 AKW??ian?-? . I I I I 7 Blood Pressure: Systolic Diastolic 7( 2 We?gh Mark in appropriate space in column at left, if findings are abnorma? DATE SHN *Culor WErupsion ?Mo?slure - wTexlure *Nodules mPigmem ?Hair WOther ?Pezechlae HEAD EYES ?Coniunctiva wFields WSclera WPiosis __Exophlhaimos c?_Fup? _~_Ud4ag MMovemenl MTension mAcuiiy Mather EARS ?Drums ?Masroid ?Other mDischarge NOSE mSinus Tenderness wMuoosa wTransElluminalion mSeptum ?Other MOUTH wErealh ?Tongue _Salivary Ducts ATeeth WOther THROAT WTonsils mPos?~na5a? Drip WPharynx __Uvu?a ?Other NECK mSti?ness __Vesseis mMasses ?Tracheal thher _Cervlcal Winguinal __Occ?pital WEpitrochlear _Supraclavicular ?Other CHEST wShape WRespirations WOther BREAST AAMasses WNipples mDischarge _Other HEART mSounds M1 Impulse A2 P2 Third wPulsaz'ron ?Gallop #Haze ?Friction LUNGS mFremitus mSpeken Vales __Percuss?on WWhispered Voice dBreath Sounds WOEher MAdven?iious Sounds (over) (/2921, 62? 1554/ QM 72? ?ake f? 15..- 57 r? $20379 - Medial An: Press. 1-800-328?21 3'9 Ui?i? l.in A-h so PAUL VOLKMAN, MD. b'tale PAUL MD. 1200 Ga'y auger - Fn?smoulh. OH 45662 (510)355-6949 a - {3 1200 GayStreet 45662 (740)355-6949 I 7 when amt-4:? My w?vwwv . 42a: . nay-mpg I . ?q ?a Lic?ss?omm-v PAUL 1200 Gay Street a ?Fansmauth?H 45662 (740) 355?6949 a [r Stale Lie; #35?07v0722-V PAUL NLD. _1200 Gay Street - Ponsmumn, OH ?45662 (340)355-6949 u:an .201: 128 (740) 355?5945 Fax State Llc. #35-07?0 22 N, DI (7.40) 3355-6949 Farts um. 6H 45562 A Stre?t 1mm DATE 3 xi??/Zx? r: Diastolic: Weigh Patient Les: Na r- 7 ,3 Rear GENERAL: Ag Check 1/ it ?ndings are normal Mark in appropriate Space En co!umn at le?. i? ?ndings are abnermai after examinaiien an examinazien and descr?be in sgace below. SKIN .. wErupxinn - M, *Taxlure ?Modules - - . . ?Pigment WHM 4% - wPeiechiae ?w I 3 HEAD EYES . mConiuncziva ?WFieids WSciera WPmsis mComea mF?npii ?Lidvlag ?Movemenl ?Tension r? ?Nys?agmus mOphThaimoscopic mAcuEiy _Olher EARS mDrums WMasioid - thher 1? l) mDischarge NOSE . 5 __Sinus Tenderness I ?Mucosa >wTranSiflum?naiion v. ?Septum ?Other MOUTH ?Breath. "Tongue ?Lips WSaiivary Ducts mTee?'r mmOther THROAT WTORSHS me?osbnasal Drip WPharynx ?Palefac- W- NECK ?Masses W_Trachea WTthoid wOiher 2 .7, LYIVIPH NODES - 9 Mac??X5 WCervicai M?nguinai a WOccip?ia? mEpith i ?Supraciavicuiar MOther we"! arr/m CHEST A MShape ?Resp?rra?ons . ?Other tr BREAST ,2 a *Masses ?n I mDischarlZ-Je A z? w? HEART mApicat MSounds M1 lmpuiee A2 P2 .A mThriiE Third 2 I i7 Pu?sat?on Murmurs aw ?i ML w?Shock WGanop . WRaie WFric?on .3 . LUNGS AFremitus Vo?ce wj??ermssien mWhispered Vo?ce MHBreaih Sounds _Oiher if 3' WAdventi?ous 1' Sounds (over) #20379 - Medical Press 1-310-623-2179 I Slate PAUL Slate Lic. PAUL VOLKMAN, M.D. 1200Gay Street 45552 (7402355594? - 1200 Gay Str?et'a Portsmouth?H 45662 (740)355-6949 State Llc. I State Lac. ?scram-v PAUL VOLKMAN, M.D. PAUL VOLKMAN, MD. - 1200 Gay Street 45652 (740) 355-6949 Fax: (740)355-6948 ta") (7 5-5- a i 2 WW I {rm.325 93 mg En. uwmbub?ac. ?is. ab his men 38 8% I PtclomTpiainUISyolptems; - /7 g. by 1] (41M ,4 Mg g; Cur-rent Medications; I 352- Mg 2%;ij a! I Side Effects: i Current Medications Controlling J24. Z) ?7 - mm .. Patient agrees Ihat all information pro 1 cd is true 2n factual to 14!? knowiedge, 1g.? they arc com in- 3: that the)? have given a copy. and uudcrsian Our privacy policy permining (u HIPAA Putirm initials: Physician ExamDiagnosis;- (Mrc?fj? aw Prescribed Plan}: 4. 1 . Cow?m {:47 mm I a ma . 773-: ,2 Msr-g {law/3%: gig/a? .. @544 do - on Iv. scioscd :li medication. also patient agree: that they luv: fully di Paricut has been advised and understands that {hey should not drink alcohol {h other medications proscribed by any other physicians. Paricut Initials: DEA-02670 . - A . .. tn -v . State Llc. PAUL VOLKMAN, MD. 1200 Gay Street 45662 (740) 355-6949 Fax (740)355-6946 PAU M.D. 120mm Street - Portsmouth, OH 456362 (740)355?6949 2PAUL VOLKMAN, M.D. 1200 Gay Street - Portsmouth, OH 45662 (74mm Fax: (740) 355-8946 I StaE Llc. -PAUL VOLKMAN, MD. 1ZOOGayStreet - Po?smm?h.OH45662 (740)355-6949 ?in-iv 7, -.- DEA-02671 Stain Lic. PAUL VOLKMAN, MD. 1200 Gay Street - Portsmouth. OH 45662 (740)355?6949 PAUL VOLKMAN, MD. 1200 Gay Siree! Portsmouth, OH 45662 (740) 355-6949 Fax (740) 355-6946 State Llc. #3507m22~v madness: an 33213 '1an 9969-999th 19:1 may Ho?umu'wsma - zaans?esoozl 7 I a. l' {fay/?jmylergies?: . #3 M. 38? 7543/5; Wm mL QWQ, - i I Cur-rentMeds: 5/ g5?) 0 he 5" @?xizz?vii my? ?59; 4 *1 33H 4:90:77?0 g: 6/47 4 {1/9 ?2 . 1 . 1 PAUL ww. fL ENT I TRI-STATE HEALTH CARE 3. PAIN MANAGEMENT 1200 G?gfg?g??. HEATH CAR MAMA EM 1200$aystraet~ Pun?. . 7.. . . .. Name Name A Address Address 1 :1 1-24 ii) . 2549 A 1 1~24 m? .r 1 El 2544a M, 12150.74 113:5" 13 75-100 13 101-150 V. k! 5;"ka 151 and over Frescn'ptian Ia votd 11 mare than (1) presarlption is written per btank 1:1 50.74 4?41 a 11315? 75?100 1 101-150 El 151 and over Refil I Prescription is void If more than (1) is written per blank . . . . . .. . 13;. .1 .114 . g??if?g?gwState ch. #35-07-07224/ 1. PAUL VOLKMAN, NLD. HEALTH CARE 84 PAIN MANAGEMENT 51 Gay; Street - - 4 - - (740) 35569146 State Lib. 43507-07224; KMAN, Mp. PAUL VOL 1200 Gay Street Portsm Name ?Name Address 4 Address . 1424 f) I 9 $243 25-49 ,5 it 25-4 C1 - if 50-74 I at? . A 75?100 4 1 A A 4' 21101.150 L) {:57 1 101.150 1 I 1 1 Nut 1516mm? El 151 and over C?zx? ., g? I?void if more than (1) prescn'ptton'ts written per blank 5034 75-1 00 i 11311611291 Prescription is void if more than (1) prescriptton is written per biank Allen-?e? W559 ,5 V??zw {rigid 1 . i CurrentMedanj . ,isz/zL ?2 Wes? Ag 1 cgdin?bq . i "7,72 9% 4? 4? dig? (Qua; 1 19 DEA-02675 }Stale . .A . VOLKMAN, NLD. I TRE-STAT-E HEALTH ?@384? in MANAGEMENT 4,1200 Gay'stregt 5~6946 ti. PAUL VOLKMAN, MD, HEALTH .PAENT MANAGEMENT TRHTATE I i .1200 Gay Sl?ljegt 9-. 1 .41" (xii/f- 144 25-49 505M 75-1 00 1 01?150 151 and over ?124 El 25-49 {>034 fil- Lg - ?ha75-100 . A 7mg? ,v El 151 and over EIEID I 713Prescription is void if more than (1) prescription ls written per blank %Re?llN/B- :2 3* l" 12345. ix, ?a 1? 1" ls (1) pr?scriptlon ls w?tten per blank 3M2: 1.x? I. EL. "u "lalv?q?. MamState . PAUL VOLKMAN, M.D. TRI-STATE HEALTH CARE 8- PAN MANAGEMENT 1200(3aysrra: - ?4 . . State uc. a . PAUL VOLKMAN.VM.D. HEALTH CARE MANAGEMENT 'l 1200 Gay Street Naing .- Name Address 1 -24 25-49 E1 . [3 25-49 [j i 3/ El 50~74 El E1 x. El? 50-74 A ?3 101450 2 . I L) . .151 and ovar 1 .1 . 9' 75-100 I 101-150 if x" 151 and over f? I Re?ll NR1 23:if.? . - Re?ll/NR1 2 3-4 5 max" 1' if "We than (1) Presan?m '5 ?man Per blank ls void if more lhan (1) is written per blank A NNQNOLQMQ a a . . .uar . 3 (.1331. ?an M. . ?ragged 875. 3.3 ?fr-u..yu. Emsmu. {5 23a :55: E525 POAllergies: MM 9'4 I, gig/2W ?/ng $74 Xwg? ng/zm W?w I. ?36" L, $0 a I Cs?rsw awn C7 WK \gxw 7/90 M74 ?76/il? Q4 I M?4?w . . . mmwmo?xma 5.5 was 2 Has a no: Emmi ?53 Lem 53:: suing 5% mg 8:2: 87E. Min ESEE .042 .ng?jo> ?Nno?b?mu .03 35m L.lv4 I: 19.6: 032*535 .. 5? 7 9. Nam Date= gig/93 Margie? ,ng'fifz Max/(1M pm. (Kym, [M?mj? . . :urrent M) ?ag Kim.va Wm?? 7729,: /mn_m ?g iotes= 43%;63 x:ng (j?wm 0 If +254 fw?) firr53?- 4 A, ?3 I '25? ?rWWgWer/ 4W (113% CL/b??j #1506) gg??f. - ,xf/ . A (9b 1/5?5/2/ ?s?w may?? . . .. 62:. 9 ?z07 1 ?f A 4 1,1 iffy/1"} If?? 1452/ (11' .713" .LJLF r. ,"75 - ?iv, 5074 1:754 00 635 Mai a SL South- Prescription is void State Lic 86 0 Fax: 606-932?6837 Address State Lic. - Fax 606?932-8337 714, Jana 3 ALL-24 q, MW, J, L, ., 25-49 . .1 a CI 50?74 7.) .51? [1 75-100 hf". z? 11.9 .. I 5* r- xi? 101450 I3 101450 TRI-STATE HEALTHCARE P.O.BO 764 A - SOUTH SHO .KY41175 ?ni - - (606) 932-2586 7 Notes . .f 2 Allergies: ?3 .mummvn baa. ?49. 9? 2? Lu 5:3 Date S?gn-in Sheet (Please Sign name and time of appointment) DR. ?jn/f?t?m?j .. Date {3/42: ign-in Sheet (Please sign name and time of appointment) DR. Date Sign-in Sheet (Please sign name and time of appointment) DR. 2?!ng aw Date g/?hya} ign-in Sheet (Please sign name and time afappointment) DEA-02812 DR. l/Zifgmam Date af??bw)? ign-in Sheer (Please sign name and time of appointment) 3 Date N34??e??ay ign-in 5/193! (Please Sign name and time of appointment) DEA-02814 $53? ?mi 5 DR. m&m? Date My Sign-in Sheet (Please sign name and time afappointment) I -. 1. Date Sign-in Sheet (Please sign name and time ofappointment) DEA-02817 8 on. if . um {52 A3 Sign-in Sh eet (Please sign name and time of appointm 3b ?gme?m 9 Date if? DR. Sign-in Sheet (Please sign name and time of appointment) a? 5' (7 I 2? 51-0/7 . 2:0 c2 1 3235/ c) I :2128. 29., 30. DR. . Date "?ns-03 Sign-in Sheet (Please sign name and time of appointment) DEA-02821 DR. V0 Date 94/4193 Sign-in Sheet (Please sign name and time of appointment) DEA-02822 DR. 0 9003.. Sign-in Sheet (Please 51ng name and time of appointmeno DEA-02823 g@?95? {3::30 ff?? 3 :33 a wig? i 6 z. I ?55: j? a 0?0 G?rh/ I appointment) 7 ft s2? ?aw? - r? If DR. [kn-in Sheet (Please sign name and time afappaintment) . I 32 5% 29%- "??xi/xz??rjf $535 gig gig-<3 . .- DR. Ef?? gm Date WE Sign-in Sheet (Please sign name and time af appointment) DR. \leL?/mr? Date Ce O3 Sign-in Sheet (Please sign name and time of appointment) 02:30 x55?? a? a is: DEA-02829 DR. KMQH Date a; Sign-in Sheet (Please sign name and ?rm: afappainhnena DR. Date ign?in Sheet (Please sign name and time of appaintmen? DR. 1/031 I Date . (25; fee? 52% gem Sign?in Sheer (Please sign name and time of appointment) 0 a DEA-02833 03- . Date ff? 'ntment) DEA-02834 DR. . Date Sign-in Sheet (Please sign name and time of appointment) . i Date [/13 (Whig); i ?y Sign-in Sheet (Please Sign name and time of appointment) r? 3 . . Date 0/35: Sign-in Sheet (Please sign name and time of appoiritmenr) DEA-02837 DR. . Date ?ag; 45% Sign-in Sheet (Please sign name and time of appointment) h"I k? DR. W1 Date. .. Sign?in Sheer (Please sign name and time of appointmena NAN-N DEA-02839 DR. . Date. {gm-in Sheet (Please sign name and time afappointmena DR- .. Date -- [q DEA-02841 m. Km a Date 53 Sign-in Sheet (Please Sign name and time of appointment) "g 7 f/i? 7 DR. 5% a? Date 1f Sheet (Please Sign name and time of appointment) am Date 4? DR. Jag! MBIU Date if? 0?3) Sign-in Sheet (Please sign name and time of appointment) DR. 5' Date Sign-in Sheet (Please sign name and time of appointment) DEA-02846 DR. Iggy/(mg? pate 1'4, may Sign-in Sheet (Please sign name and time of appointment) 5km DR. Date Sign-in Sheet (Please Sign name and time of appointment) 3a ONRSn?E-uroh . MN 55:5 DR. mew om Iii/?lf/mz Sign-in Sheet (Please 513:: name and time of appointment) DR. 7 Date 62?} Sign-in Sheet (Please sign name and time of appointmena 3?751417- 31-0 4.. if" Date W??rzw Sign-in Sheet (Please Sign name and time of appointment) DR. 59 OM mm M3 "k'30. DR. Date Sign-in Sheer (Please sign name and time of appointment) $5190 DEA-02853 DR. Date .. ?595 . Chg?? Sign-in Sheet (Please Sign name and time of appointment) 2' 93 475' e..~oo we} 19._ 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. DEA-02854 DR. V0 i-W?Zs?a Date ff '3 Sign-in Sheet (Please sign name and time of appointmenv Sign-in Sheet (Please sign name and time of appointment) pm ff- DR- 1 . Date aw Sign-in Sheet (Please sign name and time of appointment) DEA-02857 DR. Date .2 Sign-in Sheet (Please sign name and time of appointmena .7 j? Date ?f?g Sigmin Sheet (Please sign name and time of appointment) DR. v30) Date Sign-in Sheet (Please sign name and time of appointmeno DR. Date /0 ?53? ?3 Sign-in Sheet (Please sign name and time of appointmeny Date Sign-in Sheet (Please Sign name ?nd time of appointment) DR. 44L. DR. ?n?fa?azm. 7 Date 5 J) I if; Sign-in Sheer (Please sign name and time of appointment) Momma DEA-02863 DR. if? 7?2} Date 2?531/ 7:3 Sign-in Sheet (Please Sign name and time of appointment) DEA-02864 DR. Date Sign-in Sheer (Please Sign name and time afappointment) DR. ?fW . Date #393 Sign-in Sheer (Please Sign name and time of appointment) Am?? DR. ME) . Date 132:2; mm Sign-in Sheet (Please Sign name and time of appointment30. a - *3 DR. ?ag-1m . . Date i Sign-in Sheet (Please sign name and time ofappaintment) DEA-02868 DR. Oei?gww* Date ifMa WM. Sign-in Sheet (Please Sign name and time of appointment) Date Sign-in Sheet (Please sign name and time of appointmeno DEA-02870 I 9L1 Date I I Sign-in Sheet (Please sign name and time of appointment) E. 41 ?yiS 3.5x? 7? 3? a 3:3 DEA-02871 Date Ci DEA-02872 DR. Date 9- 11. 12.. 13. 14. 15. 16. 17. 18. 19. 21. 22. 23. 24. 25. 26. 27. 28. 29.. 30. DEA-02873 DR. Date xii/I? Sign-in Sheer (Please sign name and time of appointment) Date I {j a. Sigmin Sheet (Please Sign name and time of appointment) In '1 I glut "v.1 La $4 a?w?m-w 33?] 3 DEA-02875 Date ?g Sign-in Sheet (Please Sign name and fime of appointment) DR. Date 51/} Sign-in Sheet (Pleasersign name and time of appointment) DR. Date . Sign-in Sheer (Please sign name and time of appointment) f? DR. .. Date Sign-in Sheet (Please sign name and time of appointment) DR. Date 5* Sign-in Sheet (Please sign name and time of appointment) ri-State Health Care 835 Main Street South Shore, Kentucky DR. Date ?93 Sign-in Sheet (Please sign name and time of appointmentDEA-02881 Tri-State Health Care 835 Main Street South Shore, Kentucky ign-t'n Sheet (Please Sign name and time of appointmentDEA-02882 5, DR. gnaw Date" f? yww??gw Sign-in Sheet (Please sign name and time of appointment) DEA-02883 ri-State Health Care 335 Main Street South Shore, Kentucky DR. . Date (Q 5 6 Sign-in Sheet (Please Sign name and time of appointment) DEA-02884 ri-State Health Care 835 Maiiz Street auth Shore, Kentucky DR. Date Sign-in Sheet (Please Sign name and time of appointment) ri-State Health Care 835 Main Street South Shore, Kentucky DR. MEN Date ?93 Sign-in Sheet (Please sign name and time of appointment) DR. Ea Date @122 . Sign-in Sheet (Piease Sign name and time of appointmeno ?9 9? DR. Date 9; Sigmin Sheet (Please Sign name and time of appointment) DEA-02889 ri-State _Hedlth'_ Care Date igmin Sheet (Piease Sign name and time of appointment) 17+ Sign-in Sheet (Please Sign mane and time afappaintment) 7? 12.3.7 7m? 3% Date Sign-in Sheet (Please sign ?hd time of appointment) DEA-02893 ri-State ealth Care 835 Main" Street South Shore, Kentucky 'Date. 17/5 Signain Sheet (Please sign name and time of appointment) . 30. DEA-02894 ri?State Health Care 835 Main Street South Shore, Kentucky DR. gem/2M Sign-in Sheet (Please sign name and time of appointment) 25. 26. 27. 28.. . .. . 29. 30. ri-State Health Care 835 Main Street South Shore, Kentucky Sign?in Sheet (Please sign name and time of appointment ri-State Health Care 835 Main Street South Shore, Kentucky 2 7. 23. 29. 30. ri-State Health Care 835 Main Street South Shore, Kentucky DR. 77 . Date Egg 3 Sign-in Sheet (Please sign name and time of appoinanent) DEA-02900 gas 29% DEA-02901 Sign-in Sheet (Please sign name and time of appointment) DR. HEM Mb Date DR. Date I 5 ?43 Sign-in Sheet (Please sign name and time of appointment) NNM up?. 9? . Wk: 532? Sign-in Sheet (Please Sign name and time of appointmentDR. Date :9 3 Sign-in Sheet (Please Sign name and time of appointment) .- J. m. iL/g? \Dare. Sign-in Sheet (Please Sign name and time of appointment) DR. ?73 E: 1:5 $59.56} Date 5g. . Sign-in Sheet (Please sign name and time of appointment) ,qu 35:2?? ef?ggi 2 28. 29.. 3 0. ma. .L/a/?mm pm 7 ?3 Sign-in Sheet (Please sign name and time of appointment) v- wax 25?s?? 5 fig-?5?" 56$ fa igffif/g??) Date jQ - Sign-in Sheet (Please Sign name and (ime afappointmeut) it) g?f?kmimljgii Ewe-gees L096- Wd?a 53:51 Date Sign-in Sheer (Please sign name and fime of appointmentEggs- ?ik? aim i a fee-3s 5% ?46% 0 DR. {jg/:14? m; Date ?(93 Sign-in Sheet (Please sign name and {fine ofappointmem) 2 30. Eff?: Date f} ign-in Sheet (Please sign name and time of appointment) I- 5/5 DEA-02912 DR. Date Sign-in Sheet (Please sign name and time afappaintmem) DEA-02913 a. "i wa? um {a Sign-in Sheet (Please sign name and time of appointment) DEA-02914 DR. -- Date Sign-in Sheet (Please sign name and time ofappaintmena 5 If?? 1" a DR. Sign-in Sheet (Please sign name and time of appointment) i 5% ?gigxi?g?; {ig?g?w 6 Date _7 7,, "93502918 Daily Patient Sign In Sheet September 2005 dz?? 35 I No Further Appointments Will be taken today! a 1 1 1 1 {dz} 1 nitDEA-02919 Daily Patient Sign In Sheet Septem?er; 2005 35. No Further Appointments Will be taken today!? 0{ i p4 17/? AZ 2o - 55 Daily Patient, Sign In Sheet 2005 September 28. 29. 30. 31. 32. 33.. 34. 35. No Further Appointments Will be taken todayL Daily yPatien Sign In Shem 2005 No Further Appointments Will be taken today! DEA-02925 Daily Patient Sign In Sheet September 2005 ,Wm 30, 09 27. 28. No Further Appointments Will be taken today! Daily Patient Sign In Sheet September i 2005 No Further Appointments Will be taken today!_ mt an Wei/05"" DEA-02927 7?2 3 @31 $561+? Lana/213M [velar DEA-02929 Daily Patient Sign In Sheet 2005 September 35. 0 Further Appointments Will be taken today! Daily {Patient Sign In Sheet Orifc?ar 2005 No Further Appointments Will be taken today! W5 due/51? 3g ,4/1 Ply/5W Exww'natiow I DATE 51} 07? Patient Lasz Name . Firs; Name Attending Physician GENERAL: Age Temp. Puise Respiration Biood Pressure: Systoiic Diastolic Weight Check 1/ if findings are normai Mark in apprOpriate space in column at left, if findings are abnormal after examznation on examination and describe in space beiow. A I 11:8? 1% __Eruption WMo?sxure mNaiis mTexture mNodules ?Pigment mHair WOEher _Petech:'ae 7 HEAD EYES ZO I WConjunc?va mj??ields I i ?1 mSciera ?Cornea _Exopht?naimos 7 mPupiE WMovement ?Tension _Nyslagmus ?Ophthaimoscopic WAcuity WOther EARS (- f/ ~_Drurns 4? ?Hearing womer mDischarge mm fl} r' WSinus Tenderness WMucosa M_Trans?iumina2ion mSepium mOther i 3 If: MOUTH if WBreazh WTongue Ducts . mTeeth WOther ?Gums I M) THROAT MTonsiis WPostwnasai Drip WPharynx mUqua WPalate ?Other NECK WVStiffness wVessels A _Masses WMTrachea MOther . MODES r- - WOccip?al WEpitrochiear WSupraciavicuiar w" CHEST I ?m WShape wRespira?ons ?Symmetry ?Other BREAST WMasses WNipples mDischarge __Other 6 HEART #Apicai M1 impuise A2 P2 ?rm: Third ?Puisatz?on _Murmurs _Shock ?Gallop M__Rate LUNGS MFgem?ius Voice ?Percussion *Whispered Voice MBreath Sounds _Other WAdventitious Sounds (onlref) DEA-02933 - Medical Ans Press .. '1 PATIENT NAME BIRTHDATE PAGE DATE . impo?Bnt: Please date and initial every entry. . K, . DE Au02934 #20381??Medica5Ans Press' 1?800-325-2179 lo 3+5 20 [20 23q0 'to r34 ?.25 [20 (2/0 (20 (23 (lo 120 220 [20 120 IZQ )2/0 HO [0 ?20 P30 (20 (20 [20 Ill No. ET2-150L UPC 2411!) smead.com - Made in USA CY ?ha-?35; ?mm A: Ply/duct . @l?LrO? Patient Last Name . Firs: Name Attending Physician GENERAL: Age Temp. Pulse Heepiratz?on Blood Pressure: Systolic D?astolic Weighl Check ?f findings are normal Mark in appropriate Space in column at left, if findings are abnormal after examinallon on examination and describe in space below. A SKIN W_%Color WEruplion _Moisture M_Tex1ure WNodutes __Hair - WOlher WPezechiae HEAD EYES wConiunciiva ?Fields WSclera WHOSE ?Cornea mPupil ?Lid-lag _Movemeni WTension ?Ophthalmoscopic wAculty "WOlher EARS WHear?ing wOmer MDischarge an NOSE *WAinNays WSlnus Tenderness mMucosa #TransiEiumlnalion ?Saptum MOUTH WBreath WTongue __Lips ?Salivary Ducts ?Teeth WOther umGums THROAT ?Tonsils Drip MPharynx MUvula mC?her NECK WSt??ness __Vessels mMasses WTrachea wahyrold WOther NODES HCervicaE Mlngulna? chcmitai mEpizrochlear mSupraclavicular mOther __Axiilary CHEST ?mShape mHespira?ons ?WOther BREAST ?Nipples mOther HEART ?Apical WSounds ME lmpu?se A2 P2 Third WWMunnurs mShock #Gallop MFlale ?Friction W?hy?thm MOther LUNGS mFrernitus ?Spoken Voice WPercussion _Wh?spered Vote WBreath Sounds WOIher ?Advanli?cus Sounds (over) Pig/5W IZOSTQ - Medical Arts Press 38130-325299 g; 4'4 3 Emjres?n/?Jotwm - PATIENT NAME 4 PAGE El DATE . Import?int: Please date and initial every entry. Kim Ci if I #20351?0Med3camm Prass? 2-300-323-2179 (EAL m- 17/0 120 (w (7/0 {20 12A: l7/O (Lo 12/0 r20 120 '20 (2,0 12/0 (Lo [2/0 120 120 120 {20 ?20 (2/0 120 12,0 17/0 17/0 130 1?,0 ?20 L20 [30 no ?2?0 120 120 {7DEA-02940 {6 Ase bug f5}? 1 ill/ ?1 I If I I) kin Fi?/Va 2'7 r? bf rad; f? I w??ry Wm .41 70/? ?ig?i? {36/ ?aw/Ukuw?ud KW 2 {lac an] DEA-02942 State Licv M.D. . DEA 3 PAUL VOLKMAN i mass-6345 1-24 25-49 5004 75-100 101 -1 50 151 and over Prescription IS void if more than prescripiion is written per biank Stine Lie: PAUL VOLKMAN, M.D. HEALTH CARE 1200 Name Address Ln. 9 11:03 1-24 1] 25-49 50mm 5 is?? 450 151 and over per biank Prescription is voicf?ore man presc?p?on ,5 Gui/N L?g State Lio. #35-07-0722-v PAUL VOLKMAN, M.D. (74013551594? 1:1 :19 50-74 . 4/ 1] 75-100 1R 103-150 151 and over NR 9 Prescription is void if more than (1) prescription is written per blank . . I . DEA - State Lic. #35~07no722~v I PAUL VOLKMAN, M.CARE .- 101-150 151 andover I i- I Haiti?y 1 2 a 4 5 Prescription is void ii more than (I) prescription is wrmen per blank DEA-02944 - 3- PAUL VOLKMAN, MD. 1200'Ga'y3tmet Podsmm?'h' ,?iH 45552- {1740):3554949'?m'nals page 94 :1 I. [3;751'00" Pfescrip?on is ?onliS Writte'? pier'bfahkj - u. 3.. I: . *smmsasmofmfv_l- JVOLKMAN, - I I . 8- 1-014150. - .2 .. mm perbmink. .. '11. . . a" 5 .Pomiou :E-ng a} ?x 3% Eli-2.4a if 3'7 ?Qt-2:7: "31014.50" ID 151 and over W40 steady-93333 -- [jd?mdSof'fV 1'51 andzogeg- . #0965155 2 jf Ef-rh'ore pt?scripiibn ss Wri?ain per blank; I - - . -- .. . 12mGay5treet-. Pam?bl??' 45662 (740)355-6949- - DEA- 02946 pf?'rjbia'rik. '1 i base; 1 3 Z. . Disam- 3C1 1011*..1503555 - I Fres?rip?dh 55 mafeiilhwj one pfesc?pn'gn is: wank? I . . . I . . 1219 Findcay; Street'- . (740) 3555949" . 3' Mp. - 1- Fax;- (740) a, IAddresis'Ii' ELI-24L311015150 75400 1.01.3150 5' 'f . 151an?dover . Re?n@1 3:54 5 -- I - rip?on "Void if more {had maiscripti-o?n ;is_ written pe'rgniank; - .. .ETStat?ei-iic - . 2 ?15219 Findlay'Str'eet' 35.9mm?. (740.) 355-6949 (7340.) :35 - name - Address i DEA-02947 Pres-marten is Void a more than nae-m prescription is wzmen ner'mank. 85'?me 0'5? 159:8 I am {740) 60; .Fax mo; GOVERNMENT 5631-24 25-49 . . El 5974 - a 75-100 .. 101-150 3 - ?i?m mm} blank- I. Prescription is void iimore "Tan (?Prescripmnr? ?nper n; 8499676 In? um, mu WW mx {lay cause .- lay intensify" caution maWIMRT $343.03 i $343.63 DEA-02957 DEA-02958 WWI-rum. . . . DE ms. 1mm: smug PAUL V0 5565 us 23 - Chmico?z?fcjn 45%01 Of?ce {740) 6634607 - Fax (740) 6634625 - Ceir EXHIBIT Name rah?0x" f! . -. Cl 1-24 1: 2W1 ?r I sowz? a 75- 70 He?? 1 2 3 4 151 and over 1/ Address Presqription is void if more Ihan (1) par blank Rx mam Dr um, mu '3 portsw 1 .1 IRES Hay cause intensify" caution drivin @731-w39-m 9mm gamma Qty 93 0 5mm $313.93 aim-m - . 5 GOVERNMENT DEA PAUL M-D- EXHIBIT 5555 US 23 OH 455q1 Of?ce (740)-663-4607 - Reggae: ?Cell (740 a 0.. Name Address i )6 a ?ndl?verPrescription is void if more than (1) pres?ri?uori is written psi blank Rx m? mum, mu Portsmu i . 5552 BY MOUTH mx nay cause druui sness. . . alcohol lay intansify.. caution 6591mm 185% tity e46 RFL 0 LABS ?160.06 ??aw DEA-02959 GOVERNMENT EXHIBIT (uxnc ?StataLic. Paa?iz': Mn. garisniuicome, OH 45601 Of?ce Wigwam - Fame) 663-4625 - Cell (740; f. I i {3.2549 5? -. HA 50-74 75_-1qo . 101-150 151 and over i ll Prescription is void if mordth'an (1) ls written per blank n; 4995311 111-1011111111, mu. 11-1191: F'nrtsao a TABLETS 91' BEN IPE. 0591-5513-8151 139le 356MB Qty 93 533.103 $26.80 DEA-02960 mp. Prescription is 'vold 'rf more than (1)3resc?p?on is Written per biank DEA-02961 9:.an 5i Ears 3% u: .c I PAUL Mp. 5662 (773) 255-412? 1310 Center Stra'elt Ponsmomh. 9?2fo 1-24 070-9- goo! eff/@3133; isf'andover Prescription is void if more than (1) prescription is written pet blank 71?? . .Hzi DEA-02 964 I it -F 37 :33 .91363 HE 1M ?5 if 05A swam-0m - - OH 45662 (Trams-41 Irma. 4?285- I 1-24' '3 [3 55474 a 75- 6t k101i; +242; 1 void '6 more than prescription is written per blank Prescription i DEA-02965 a'm? mme 51.01. 1310 C'?nterStr Po?smbut? OH 45662 (173)2554i'25 MM -- (3729/7/51 a? (?80 .12. .12: 5% 60521121?, Re?ugfzaab 1A.. Prescription is void if more than prescription is written per blank . . a mun~ mm .m .n m- .. awn Nana nu +~au 1 .. withEng. rr< ?hm.mw 3mm. ?35-07-0722 PAUL N2 2 0 9 5 5565 us 45601 - 740 653-460? - 5111:1740) 6634:4525- 357-9270 Data I 75- 103:0 dbl/"M Prescription is?oid if more than pmsc?p?qn?s Written peg blank DEA-02969 Rx 0499927 m- uumm, HY 51 Ports-nu 2 - 9:9 EF ma mum mx. Hay cause Ia intensify" caution 0406-65334$910.36 mam DEA-02970 PAUL VOLKMAN. No 0 a6 5565 US 23' 2 Chillicoth?. OH 45691 O?ic? 473053634602 - Fag?ai?j - (740133519270 1:1 :9 q. . . - ~13 50:74 3/5 C97 .. I vile: R751 an?over m?jzs4s I 2 Prescriptionjs staid if more than (1) ptesctiption iswrf'tteri par blank ?55 DEA-02971 DEA-02972 Ru c1.399935 Dr Vim, mu. drauz'sness. ..a1cohoI Ia 059 6! WM Stags? - IAEE Qty 300 W. a Port sno~ (bh'fjp I . . caution 10/355 MB $170. 60 M.MY Hum _?mpc.nwm N2 2 0 9?7 45601 . 7r ass-452$ Cell (740) 357699370 5565- O?ica (7401 663-460 Date El 1-24 25-49 50-74 . 757,100: 101-150 Presc?piion is void if more they: t) prescription is written per blank Rx [2499925 Dr mm 9 ?may 5r Portsnouth. I a BUR ll lay intensify.. caut1un driving! 1! 0731-1089-01 anR?l?LDEA-02974 Rn 499928 Dr 0W. mu. Portsmouth 1 MI BY 1mm max may cause 1 nay intensify? caution i/ 0591-5513-65 356MB ma Qty 180 RFL 0 MTSIJN was ?0.09 VFW DEA-02976 DEA-02975 . . I ?0722 mmwoggmuwn 2.0 8 55-55 US 23 -- - Pr'escrip?tiqn is void if. mamman (1 prespripiion is written perplank n- .. - . - .. . - .s. -. '1 Dr. Paul H. Volkman, MD. I 5565 US Highway 23 Chillicothe, Ohio 45601 Phone: 740-663-4607 A GOVERNMENTS H) IBIT -- THANK YOU .-. - - . -- .- - . . . gy-v-clv-y ?1 . DEA-02977 Dr. Paul H. Voikman, M.D. 5565 us Highway 23 - Chillicothe, Ohio 45601 Phone: 7406634607 - 7405634403 Fax: 740-663-4719 - 740663-4639 TERMS: 0525467414 GOVERNMENT EXHIBIT DEA-02978 00 ?a {0 DEA-02979 PAUL VOLKMAN, Sm" Ucr ?507-07224; M. D. DEA-02980 szzoaa 4 DATE 04:19:05 wane 04119105 COST $99$399.99 SUBS NET $399.99 Unit TAB ,2 Orv :2 30 ULVULKMAN. PA [11 1219 FINDLAY ST PORTSMOUTH COUNSEL I DEA-02981 DEA-02982 DEA-02983 . 1 I State Lie. #35-07-0722-v 9 Findlay Street - Po?smclauth' . 45662 (740) 355?3949 Fax (740) 355-6946 7-7 Name I (mm-g .hM-?zi 1'51 a?qover .. more than one prescription ls written per blank. DEA-02984 1 1219 FINDLAY ST Pomsmum DEA-02985 DEA 8mg u: 13502-0724! PAUL Address [3 1-24 2549 50-74 75-100 101-150 151 and over Prescription is void if more than (1) prescription is Written per blank lib-u- - HUG 04(5) amusu counsEu 1 (W5) DEA-02987 I 7): DEA-02988 N9 ?400 Name Address (L1) NC. 5) 151 and over i: i Prescription ls void if more than (1) prescription is Written per blank I- DEA-02989 a" it). DEA-02990 S?s-Laue?war ?.th 3 "3357:ra-?gl I .33 A a? g?i?w; 6W :2 ,3 3? if? 662?fthU v. r' .q . I lie!"- A . 0-0? .O .M - . '1019150 [3 ?1'51?and over . 15.1 and over l8 van: more than (1) written per-biank apt! Prescription is void :1 more than (1) prescription Is writtgn par blank DEA-02991 a; 5:3?51?5? 4 alcc??- 1mm: 9?53): ?as take 13v cautian . OXYECEHE Fit 3' #53 WELET [hi-e RF. ?5 Z??ul?k??f PH $535 "?38 aw seam . DEA-02993 . {Mgass-sbasf 'Faxg??ass? 'v d?h-w Wm .. - fsyafq mpre than (1) prescrip?pn is wrmen per'hlamr .- m-mv - h? Rx ?1009683 DATE 08H1l04 WHITE 03? 1104 42 48 DRUG: UXYC AB AMID 9.99 52152 SUBS: $539.99 nit TAB my 30 0 TAKE 1 mm BY MDU T0 10 IIMES A 0M Days 3 DINOLKMAN. PAUL 1219 ST CUUNSELI 511m . - PAUL . Q19Hqushea- @40355-6949 Faxr'gdomssm Namb? 4/:44/ 121-. 1-22: - 25-49 50-74 mm Wrasis ?asori?iion is void Ignore than is Written per-blank 13 $1100 2 [3 101-150 - . @151and'pver 'b-vv - valw DEA-02996 mum rune) $69.99 Davs 3? mo; 1 may? co 2 a: DEA-02997 194W}xiv:an, .r 4. ?1534. .Priasgrip?onis void if mom (1) pre?c?ptiop is per-?ank ?Kn- DEA-02998 84 DATE 0811 H04 WRITE 08H H04 .78 . 9.99 ?mm: 90591-08 - SUBS: $189.99 NEW TAB Qty 360 TAKE 1 Days 3 PAUL 1219 FINDLAY ST PORTSMOUTH {7401 Hum OH 45332 DEM I DEA-02999 - om 5' Henna: - ?i ay?Stmet 1324 El 2549 {1 50-74 2% - 25.100 REWZ) 3 a 0 Prescription Is void j} more may) is written per mank- mmu- .v-wmb ,9 - Rx 11009768 DATE ITE 08111104 $13.36 DRUG: ALPR AB GENE, $49.99 NOW: 00781- 1 089-05 ,r SUBS: $49.99 120 ?mommaan Days 30 BLVOLKMAN PAUL DAw-.o 12mm v31 mm 49 muss Poms um 45662 [3&an 1 DEA-03000 DEA-03001 hill. VOLKMA sash; swim Penmansth sz?v .. - mg? PAUL I218FINDLAY ST [740 - PORTSMOUTH OH 45662 DEM news 0 COUNSEL DEA-03002 mum-072M. . 1?qu vm?tmgm.o. memm-Wmm .. -. DEA-03004 DEA lb)7)c (b imamaysm- .. {35-07-0722"! 1 PAUL 172,: 25:49 59-74 {3 75.109 is Void if mgre than prescription is mitten palE ?blank M-vvw. m. nu?, Rx4405480 ?1008337 DATE WRITE 6 NDCII: 00781- 1 0: REFILLS CUUNSEU I PORTSMOUTH OH 45652 DEA . i . Mommas-6945. 161-150 3? 151mm: . A hull-?r agmore?man (1) tam per blank @277? 3 ., 5 75-160. MOM M?=2ns n-"Ul DEA-03008 WRITE can H04 56 65 $66.99 DRUG-.CA NM: 0059 551 I SUBS: $69.99 Unit TAB Days DIV - I i 1319 HNULAY ST PORISMOUTH W10 I BET-ILLS 0 mm? 1 DEA-03009 u; Wyn! mm up? DEA (b1(7)c. Name . 144 . 35-49 13 $74 Jul) ?333; mover . . Prescziption is void if mdre 111.3111) wesaipliqn is written per?biank L- rm WWM DEA-03010 DEA-03014 .y 3 GOVERNMENT 3 EXHIBIT PAUL mo. No 5585 US 23 - Chillico?iey OH 45801 . 3663-4607 - Fax 663-4625 Cell (740) 357-9270 7058 Mama 1.24 #7 . [3 50-74 H?g?i?gb? t] 75-1bo 10:450__ 15_1 and ?ver Prescription ls void it more than (1) prescription ls w?ffenmr blank DEA-03015 HYDROCODONE TAB C3 105-402 00 Qty: 180 01/31/06 TAKE ONE TABLET EVERY THREE HOURS OR TAKE 1 TABLET UP TO 6 TIMES A DAY AS DIRECTED BY . Ok'd by: Cost: 9.22 AWP: $163.65 355.80 ?Ph: DB Copay: $55.30 Plan: ID: PS: 942 Dr: 5565 US HWY 23 HE, OH 45601 740/663-4607 ND 0503-05 WATSON W: 01131106 LR: HA1 0 RR: 0 NEW N9 7059 23. 45301 663-4607'4Fak (740) 663-4625 - Dell (740) [325-49 rmmc: (we 50-74 75490 101450 VII Presctiptioh is void if moge tW gatew?'p?bn is wrian per blank Mme (nus) DEA-03016 (N716- (DWI) H. lvAx I DEA-03017 DEA-0301 5555 05 . - Fax {740).6639625- Ogi: (2.40) 352-9270 w. ELM. 1-424 50-24. 075-100 101.150 (mm; m6 over I - escn ?an 3 v0 itmos? than?; iswritten per biank (blmc: (W6) . 5565 US HWY 23 HILLICOTHE. OH 45601 nus? MALLK CHEM W: 01l31l06 L: RRZO NEW DEA-03019 m- omca (7493 663-4607 -.Fax? (7'40) 6634625..ch @403 357-9270 State Lie. 43501-0722 PAUL . 5565 cmniootfih. 455519 NE . 7 05 5 (W716. (NW) 101.150 and We: Prescription is void if more than prescriptiqn is written per blank DEA-03021 (him; W53) Dr: VOLKMAN.PA 5565 US HWY 23 THE. 45601 ?l-U'lh - QUALITEST A111 RR: 11 NEW DEA-03022 GOVERNMENT EXHIBIT .9153. State Lic. #35-07-07224! PAUL VOLKMAN, M.D. HEALTH CARE Street - Portsmouth, OH 45662 (749)355-6949 Fax: (740) 355-6946 (?017.16 (W716: 33; 2 Address A 1-24 25:49 50-74 1 I 1: 75-100 101-150 IO 3 151 and over A cw 0431417 Prescription is void if more than (1) iption is written per blank 025-098 00 Qty: 180 TAKE 1 TABLET UP TO SIX TIMES DIRECTED BY PHYSICIAN. rem none OW . Cost: $9.37 AWP: $197.60 Price: $29.73 6'13 Copay: 929.73 Pfanr PCS ID: AG3086556 PS.- 0 Dr: VOLKMAN.PAUL Auth: 3?8022 1200 GAY STREET TH, OH 45662 740855-6949 . 1-1079-10 GENEVA LR: 09/16/03 NEW 1 0/1 6/03 DAILY AS DEA-03023 TMG TAB - C4 I DEA-03024 State Lio. 33557-5722? PAUL VOLKMAN, MD. 1200wa - Portsmouth.OH 45552 (740)355-5945 can Name Address 1-24 25-49 50-74 [3575-100 101-150 151 and over ,n Presentation is word if more-thanone (1) prescription IS written per blank. 3" Dr: 1200 GAY STREET TSMOUTH. OH 45652 740855-6949 SCHEIN HA: 0 HR10 NEW W: 10116I03 DEA-03025 DEA-03026 State Lic. PAUL VOLKMAN, MD. HEALTH CARE (nu? mane Name Address 1-24 25-49 CI 50-74 Cl 75-100 f0 101-150 A 151 and over new rescription is von if more than (1) prescriplbn is written per blank a. (nu-11c (?116) AB - N2 025-099 00 Qty: 180 10/16/03 TAKE 1 TABLET UP TO TIMES DAILY As DIRECTED BY PHYSICIAN. ?ts rem none 'd by- Cost: $166.72 AWP: $266.58 Price: $300. CF Copay: $300.60 Plan: ID: PS: 1 Dr: UL 1200 GAY STREET PORT TH. OH 45662 6 740/3556949 51-0797~70 LR: 09/16/03 NEW .. 10M CARD r?l' '1 Ac. DEA-03029 Chronic Pain Treatment in Southern Ohio Introduction The treatment of severe chronic pain in this country is an area of medicine which is fraught with challenges and dif?culties, most of which stem from the attitudes and prejudices of the general population towards chronic pain patients, the medicines they must take and the physicians who prescribe them. The thirty-year-old War on Drugs has engendered an vs. Them" mindset in which drug addicts and their suppliers are criminalized, mar alized and demonized. Chronic pain patients are unfortunately lumped together with recreational and addicted users of narcotics because they require and must obtain the same medicines. In reality, there is almost no overlap between these two populations. Pain patients seek and obtain opioids for relief of pain so that they may resume a semblance of normal daily activities; addicts take narcotics or cocaine to gain a euphoric state or "high", usually to escape from daily stresses and reSponsibilities. Hospitalized postoperative patients who are given narcotics for pain relief stop taking them usually within a week or two. While patients, family, nurses and even physicians are reluctant to give opiate doses adequate for pain relief for fear of getting "hooked", many studies have shown virtually no incidence of de novo narcotic addiction in surgical patients 4 in 12.882). This fear of legitimate narcotic use has been termed "opiophobia". Opiophobia has various manifestations and components. Narcotics have such a negative. illicit, almost immoral patina that cancer patients on their deathbeds are commonly denied suf?cient pain relief. Nurses often refuse to administer "too much morphine" even if the doctor writes the orders. Physicians are o?en loath to prescribe enough narcotics for fear of getting into trouble with hospital nurses and administrators. Regulatory agencies such as the DEA and state medical boards often hound and harass doctors for prescribing "too much narcotics", while that state's intractable pain law mandates that the doctor treat pain adequately or face censure or loss of license. Many states require the use of special triplicate prescription forms for opiates, which accurately conveys the impression to doctors that they will be closely scrutinized if they in fact use the forms. As a result, many doctors refuse to prescribe opioid pain medication and often send chronic pain patients to specialists. Most chronic pain patients have to run a virtual medical gauntlet to get relief. The largest group of these patients is those suffering from low back pain, usually as a result of L3-L4 and L4-L5 disc disease. Another large group suffers neck pain and cervical radiculopathy, usually as a consequence of serious MVAs. All are subjected to and painful nerve conduction studies. Most have gone through a long series of "trigger point" injections of corticosteroids and lidocaine, which may provide some relief for 4 or 5 days. Many seek relief through chiropractors, generally to no avail. Most are sent to physical therapy, which seems to markedly increase the misery level. A large group of our patients have had low back or neck surgery, all without signi?cant improvement, and many of them worse post-op. Only after failing to obtain relief from all of these generally ineffective modalities are patients referred to a pain clinic. Throughout this distressing period of multiple doctors, treatments, therapies and surgeries. most patients have been DEA-03030 receiving little or no effective pain medicine and will often resort to buying pain pills on the street. usually at great expense and some personal danger. Because legitimate pain patients have a great need for effective pain medicines, they are described as "drug- seekers" or "drug addic when in desperation they go to an emergency departtnent for a pain shot. Yet, as explained above, pain patients are not narcotic addicts, but physically dependent on pain medicine to live a normal life, much as a diabetic is dependent upon but not addicted to insulin. The above conditions and situations pretty much apply to the treatment of chronic pain anywhere in the 'ted States. The situation can be even worse in an area plagued by poverty and widespread chronic unemployment with the companion Scourges of illegal drugs, prostitution and official corruption. In this dif?cult setting it will be hard to distinguish a disabled chronic pain patient from a savvy drug dealer faking and medical records to gain entry to a pain clinic. Alertness must be maintained to catch and expel legitimate pain patients who, amidst dire economic circumstances, succumb to the temptation of selling their pills. The highest degree of vigilance is required to prevent the pain clinic from being the source of illegal street drugs. Everything possible must be done to ensure that medicines dispensed are taken in the manner prescribed by the peOple for whom they are meant- Demographics of area Portsmouth was a busy industrial town 75 years ago with shoe factories, steel mills, coke plants, food processing, and its own NFL team, the Spartans, who later moved to Detroit. Now' there is crushing poverty. with little more than a Wal-Mart. car repair shops, and fast food. There is a small community college and a hospital in the town. Most of the employed people work in construction, Ashland Oil, power plants and coalmines, all about an hour's drive away, along narrow. winding, hazardous roads. The typical workweek consists of 10 hours of travel and 60 to 72 hours on a job usually with no bene?ts. Some people. mostly mine workers, work 7 twelve-hour shifts. In such a depressed area the unions appear to have no power to in?uence working hours or conditions, since there are probably ten workers for every available job. Years of backbreaking labor in 70-hour weeks have resulted in an epidemic of disabling back injuries. Commerce in and use of illegal drugs is also epidemic as might be expected in an area with few legitimate resources. Corruption of local of?cials and police is of course rampant, in support of the drug trade and prostitution. Several local doctors have recently been convicted of federal drug trafficking offenses, essentially for selling prescriptions for controlled substances. Up to 2000 clients a day would ?ock to these "clinics". pay their $250, get a handful of scripts which they could ?ll and of course sell the pills on the street for many times the cost. One similar operation was just shut down, but several remain in business. DEA-03031 Methods and Procedures at Tri-State Health The clinic was started more than 2 years - - - a herownclinican 'u I doctors unti opemng a ne 1' tion in Portsmouth with a new physician (PHV). From day one clinic personnel faced the continuing problem of differentiating legitimate chronic pain patients from amateur drug dealers who would come to the clinic to obtain medicine so they could sell all or part of it. The following procedure is followed to ensure that only legitimate patients are treated. First, all previous medical records and X~ray and MRI reports are obtained and analyzed after faxing releases to original sources. This important step is necessary because of previous attempts to gain entry to our clinic by presenting bogus MRIs with altered names and dates and fake or incomplete medical records. The prospective patients are then thoroughly interviewed to again verify the legitimacy of their need for pain management. A conference is usually held to discuss new patients in which local knowledge and history will often wean out peeple known to live with drug dealers or users. This process usually takes about 3 months before the initial physician evaluation, which involves a further detailed history delineating occupational injuries and car wrecks, prior treatment such as surgery or injections, and prior medical pain treatment. The patient's current status is de?ned with respect to employment type, weekly hours, and missed days because of pain. Unemployed patients and those on disability are interviewed to determine the scope of daily activities, house or garden work, and any exercise regime followed. A careful social history is taken to reveal sources of stress related to spousal abuse or divorce or problems with children, which affect sleep, blood pressure, and pain levels. Since sexual problems are virtually universal in pain patients, this important area is evaluated and documented. Economic factors which impinge on the patients' daily enviromnent and ability to obtain their medicine are discussed. The initial physical exam notes areas of chronic pain and muscle wasting, evaluates joint ?exibility and range of motion. and maps areas prominent for muscle spasms and dystonia. Approximately 90% of our 700 patients have severe chronic low back pain. along with shoulder and neck problems. and often with hypertension usually secondary to unrelieved pain. Headaches, insomnia, depression and severe anxiety are also common problems, again attributable to unrelieved pain. Patients are usually seen and given nonre?llable 1-month prescriptions. All patients are put on nonsteroidal antiin?ammatories. OTC ibuprophen is prescribed unless the patient reports a history of gastritis or sensitivity to NSAIDS. In that case, the patient is advised to take OTC Prilosec and Disalcid. which is usually well tolerated. About 20% of this group cannot take Disalcid due to GI distress; they remain off NSAIDS. Celebrex, Vioxx and Bertha are not prescribed. because they are not any better tolerated than ibuprofen, and cost about 300 times more. As an initial approach to pain management. most patients are put on Lorcet 10f650 six times a day. This schedule provides 60 mg of hydrocodone per day and 3900 mg of DEA-03032 Tylenol, uncomfortably close to a toxic long-term dose of acetaminophen. Patients are cautioned not to take any OTC meds except as directed to avoid inadvertent overdose of Tylenol, and not to take more than 6 Lorcets per day. The dose of opiams will be adjusted upward depending on the patient's subjective reSponses and reports at the next visit. Speci?c medicines used vary, and are dependent upon availability and patient experience and preference. A list of common medicine combinations follows: Medicine Hydrocodone Oxycodone Tylenol Lorcet 10/650, 6/d 60 3900 Percocet 5/325, 12/d 60 3900 Lortab 10/500, 8/d 80 4000 Norco 10/325, 8/d 80 2600 Oxycodone 5, 12/d 60 Oxycodone 30, 6/d 180 It should be noted that Oxycodone 5 and 30 are generic tablets containing no Tylenol. Oxycontin, a sustained release Purdue Pharma product is not prescribed, because it is about 4 times as expensive as generic oxycodone, which is readily available. Meperidine 50-mg tablets (Demerol) have been prescribed, but have not been found useful due to poor efficacy and relatively high expense. Morphine sulphate tablets 15 mg have been prescribed, both as the immediate or the extended release, but have been discontinued, again because of poor efficacy and high cost. Such medicines as Neurontin. Depakote, Dilantin, Desyrel have not shown any bene?cial effect in pain relief. and are not used. Muscle cramps and Spasms are a prominent feature of severe low back pain Opiates alone do not generally relieve the spasms: a muscle relaxer is required. Soma, or carisoprodol, is generally used in a dose of 350 mg 2 to 6 times a day, and is usually quite effective, although about 10% of patients report undesirable subjective effects with Soma and discontinue it. Zanaflex is a relatively new and commonly prescribed muscle relaxer. We have found this medicine to be ineffective as well as prohibitively expensive. Flexeril. Robaxin, Norgesic. Parafon, and Dantrium are other commonly used muscle relaxers, which have not been found effective in this setting. A few patients have been placed on quinidine 300 mg, one HS, with some relief of muscle spasms; these patients may have an element of ischemic claudication in their Most of our patients experience severe insomnia. o?en suffering through 2 to 3 hours of interrupted sleep per night. Adequate pain control with opiates and Soma greatly bene?ts the quality and amount of sleep. but most patients also require an anxiolytic agent. Valium. usually 10 mg 3 to 4 times per day, or Xanax, usually 2 mg 2 to 4 times per day is of great bene?t. Other sleep meds or anxiolytics have not proven of much use (Ambien, Ativan, Halcyon, Desyrel. Remeron). new ?27 a speawkgj.? DEA-03033 On initial presentation to the clinic and upon acceptance as a patient, each individual signs a Narcotics Agreement, setting forth conditions that must be agreed to in order to be treated in our venue. Each patient agrees to take the medicines as prescribed. Each person acknowledges that the usage of alcohol or any illicit drug is a valid reason for dismissal from the clinic. Obtaining pain medicines or diet pills from any other doctor results in dismissal. Patients agree to come to the clinic with their medicines within 4 hours of being called in for a pill count. Failure to appear, or failure to have the requisite number of pills results in dismissal. Patients agree to submit urine samples on demand: presence of THC, cocaine or amphetamine, or absence of opiates or benzos results in dismissal. Patients acknowledge that loss or theft of their medicines is a reason for dismissal and agree to buy a safe for their pills. These rather severe conditions have been found to be essential to maintain control of our patient population, to enable abusers to be excluded, and to provide assurance that narcotics and benzodiazepincs prescribed for our patients are not sold on the street. We have instituted a dispensary in our office to provide our patients with all medicines prescribed. Patients are not required to obtain their pills ?om us, but most choose to do so for reasons of convenience and price. Required modi?cations have been made to the premises according to State of Ohio Pharmacy Board Regulations, such as steel doors/?ames, appropriate safes, a comprehensive surveillanceisecurity system, and armed security guards. Patients who have had 3 to 4 appointments in which their medicines are titrated are deemed ready to participate in therapeutic yoga classes. Gentle stretches. range of motion exercises and breathing and relaxation techniques are taught. individualized to accommodate each patient's particular disability. Some low back pain limbering/loosening maneuvers arc o?en demonstrated during initial physician visits. Patients are encouraged to continue the exercises every day at home, and to come weekly to the classes. which are given in 4 sessions in a designated room in the clinic. The teacher (CB), a certi?ed yoga instructor for 27 years, comes to Portsmouth 2 days a week from a nearby town, where she conducts yoga sessions for cardiac rehab patients. Results and Analysis A brief narrative of the clinic experience will be presented prior to statistical analysis of various parameters. which have been followed to analyze results of treatment and progress of our patients. When the clinic opened in Portsmouth with a new venue and new physician, matters went smoothly for perhaps one month, after which the sta?' received increasing reports from patients who could not get their prescriptions ?lled anywhere in the area. Inquiries to pharmacists were met with a stony silence or assertions that the prescriptions were for too much medicine and they wouldn't ?ll them. The staff informed the pharmacists that they were in violation of the Ohio Intractable Pain Law, namely that patients suffering from chronic, intractable pain will require a DEA-03034 continuous and reliable supply of pain medicines including Opiates and benzodiazepines, usually in large doses, and pharmacists who have any doubt about the validity of a prescription are advised to verify the validity with the physician and then dispense the medicine. These pharmacists would respond that it was their prerogative whether to ?ll any prescription. Upon presenting scripts in the drug store, patients were often rudely told by pharmacists that "their doctor was under investigation and was about to be arrested, he didn?t even have a license, the clinic was about to be shut down, they should get another doctor because this one is a quack." When calls were made to the offending pharmacists, they usually denied the defamatory statements until confronted with a tape recording made by the patient, and then would acknowledge they had not made any effort to verify the incorrect statements. In two separate instances, patients who presented prescriptions to pharmacies in Columbus had the prescriptions defaced and con?scated; the patients were then handcuffed, forcibly removed from the stores, and detained for the Columbus drug police, who interrogated and released them. A call to the supervisor of the pharmacies (a national chain) was not returned after repeated attempts to obtain an explanation. Patients also reported that some pharmacies would ?ll their prescriptions but charge in?ated prices, often as much as $400 for a prescription which listed at $50. Several calls to the Ohio Pharmacy Board resulted in no response except a defensive assertion that pharmacists need only ?ll prescriptions that they are comfortable with. No comment was forthcoming about the discriminatory and in?ated prices charged to chronic pain patients. Repeated calls to the Ohio State Medical Board has revealed no pending investigations or actions against the physician. Clearly, the ability to treat chronic pain patients depends on the physician's ability to freely prescribe the amount of medicine, which is required to control without fear of reprisal from regulatory boards. The Ohio Intractable Pain Law is a crucial factor in this regard, providing the needed sanction for long term prescriptions for large amounts of narcotics and benzodiazepines. Mother critical factor is the availability of the medicine which is prescribed. For various reasons, including the widespread prejudice against chronic pain patients and the physicians who conscientiously attempt to care for them, local pharmacists refused to dispense the medicine prescribed in this clinic. One response would have been to drastically reduce the amounts of medicine ordered, to a degree that would have possibly satis?ed the objections of pharmacists, but certainly not the needs of the patients. Our response was to obtain a license and start our own pharmacy. We are presently able to supply our patients with all the medicines, which the physician prescribes, usually at prices well below those of the scattered pharmacies that still ?ll our prescriptions. Insurance is not accepted in the clinic for professional fees, or in the dispensary, a policy that helps to reduce overhead costs. Characteristics of Patient Population DEA-03035 Approximately 300 patients have been with the clinic since its inception two and a half years ago. This group has been characterized by stability in terms of compliance with appointn'tents, medicine schedules, pill counts and urine drug screens. Few of the original patients have been dismissed for violating their Narcotics Agreement. Another 500 patients have been accepted into the clinic in the past year. The newer group, however, has shown a high degree of turnover, as up to 50% have been discharged after failing to come in for pill counts or not having the requisite number of pills, for testing positive for cocaine, amphetamines or marijuana, or for attending multiple clinics. Data from dismissed patients was not included in statistical analyses due to its inherent unreliability. Four patients expired during the period of this report. The ?rst w'as a$?ale with chronic low back in and no other apparent problems who su?'ered a massive myocardial on. The second, a ?nale with low back pain and hypertension, abruptly collapsed and died ?om an aortic aneurysm. a arent intentional The it was male also with low in and In ?adone ogined on the street- us who died 0 cancer. Age Occupational history Injuries vaious treatment Surgery injections Physical therapy Chiropractor Other Disability SIMID Children, grandchildren, elderly parents in house Pain Problem Social Stresses Current work Hours/week plus travel Missed days per month lnsmancehnedical card Activity level Exercise House work Pain level Muscle Spasms DEA-03036 Sleep - hours, quality Sexual function Hip ?exibility Medical treatment mg/day Opiatcs Baum Some Gl Other T-d wdeezsa 2568 so '6nb assess (955a ?mmcxusmssa 232 Eu 5mm whim. 25am COMPLAINANT 4 - ADDRE . . *5 if?. . cm! 15115sz . 2:251,? TELEP one ?23? .. . .- TTIMETO names; PLEASE GIVE NAME 5 ADDRESS or mbwmumausmeea SUBJECT TO THE i I NAME . . AODRES n. 1' crr~r dz STATE g; 1/ ZIP . 5" DOEE THIS COMPLAINT INVOLVE A E5 PLEASE ONE IN DETAIL THE NATURE OF THE TIME. DATE AND NAMES OF PERSONS WHO MAY HAVE WITNESSED THE ALLEGED ACT. THE ALLEGED VIOLATION MAY RESULT IN A HEARING AND ALL INFORM 1 0 MPORANT. DIT I . Q91 lif"c'9 Ila" 1' 5 15ml?) . .. .mef?? cf? ?lmy: . (goo $2.va oiwt?gwmv?a? 6m 6?11) . @?Ji?e?m big-59? ACTION uwolr?uxe% 33mm 0 ?la??vf? Adi Ml GOBSE, I -- r1 .5.- a SIGNATURE DATE PLEASE NOTE THAT UPON FILING, THIS COMPLAINT BECOMES A MATTER OF PUBLIC RECORD AND A COPY WILL BE PROVIDED TO THE PHARMACIST. own damn was I .?umwn- -: - '7 FOLD HERE 333 \?ency Case No. Hem No. Offense Suspecf Victim Date and Time of Recove /0 1/10; Description and/or VSJA PAa/?p 0F CHAIN OF CUSTODY FROM TO DATE FOL HERE 5 EVE - \?ency Case Nos Item No. Offense Suspecf UL V0 Lim/a/J Victim Dcn?e and Time of Pecov /o ~g/.or Descrip?rion and/or ?aak ?p/Wmcw?r? AMA F/ld/v} 06'? . CHAIN OF CUSTODY FROM TO DALE I TO {1552- ?hi .-.. . . . .. ht Paul H. Volkman American Academy of Pain Management Diplomate -. 1310 Center Street Portsmouth OH. 45662 T: (740) 353?6350 F: (740)353? owe/0 Lab Order for Urine Drug Screen Date: . To be done on this date or not at all! Patient Name D.0.B. Please Perform a Qualitative and Quantitative urine drug screen including Oxycodonc, Hydrocodone, Benzodiazepines (Diazepam, Alprazolam, etc..) ETOH to be confirmed at Mayo Laboratory. Please fax preliminary results (Stat) to the Fax number listed above Test for the following narcotic/non?nareotic medications if checked Blood Draw For Soma Serum I CariSOpi-odol Metabolites Salsalate Level Other: Diagnosis: Long term narcotic use for Chronic pain If ,s 1 Physician Signature :7 gf?Z/lmu ,Mj?j Patti?mvlitkman MD, Instruction to Patients: . You are only to bare this testing done at the Kings Daughter Medical Center (Ashland KY). . 2. This test has to be done on the day it is requested, if possible you should have this done within one hour of it being requested. 3. If possible have this testing done before 9:00 P.M. as courtesy to the lab staff 4. Do not bring children with you. They are not permitted to go onto the restroom with you. If you have to bring a child make sure you bring another person with you to attend to the child while you are having your testing S. If you have problems urinating, you must take this order to the ER, The Lab technicians cannot catheter you for urine in the lab. 6. You Must Have Proper LD. DO NOT CALL THE HOSPITAL FOR TEST THIS WILL ONLY DELAY THE TESTING AND RESULT DEA-03041 DEA Eh 03042 ?11??ch . . . . . - I . i [waif J. r34 -- I Eu? 'ili (J1 . . [Mk I- (wine, (mus sill-l! mwuuL.$.Tm _M?wuw . . _.nu wirmmun? uw_w . Ill. cc)? .3 3N T'a?m. . .. a math - i .- "ah?.u -. .0 ollvanlluua?nuon - . - :003:3 2:3.3 via ABE. 65:5. 4 I x. (mmc; 1h)i7)cilh){mum: imi??l mum. - . .. I WW may? unamch 3y? ?1?th HOG n\ I 'u 723.0.9 - _w hm? ?45 5.?Emma. N. -..- . . -. .. .. .. .. .. . . . - .. . ?DEA-03053 )vuthl'WJrL a: \r 2'36? 1 ?p150 515? 539 "h ui?wuu 5.00. . .h Miscg4_5 A "mm 30.0.- m_ m? pm?c? - ?45 - . :$553? 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I. . 4: .. 11.] - >m muz?qm ?ak?nmmernmuv?axh Mi 131023 Jpn-1 .n 1: a; . 1 mean ma?- an ggi an 1.55: ..I. - .?ybn pd .. . . . ?g?rm?mhg??.an 3:335:nous491"? -. "man mm: .IIWWM . . . I i . w: 325% can. 52 #2389. 7i! .- f. 1 mmeDQ< Sam?m Ow>_wumm 90391; af?'?riig? . . (Eg?wh Pruh?.? 0.5m ?Om! an. NMHOU nmnmamn Eu: Doghmm liq. 9. 33:5 can w. g. on hone?=5. >34. 99;an Gull (131(J?7)c . 23. banacza n5: . >34. nub?U nImn?n 252.9. DEM nun?Um: . . . . .Irv.. w, . . . wn? him-35 -muqarmx-ra -. .. mu. mm. RECEIVED FROM ADDRESS .: :mum: CASH ml - . m1. mm cuecx .- BILAHEE Mower ORDER ?35, ?magi, . . bl MT. PAID cum . - Murine - I . MONEY .1.-. i. - . - iiengm? aw .- rub-r; is I - .ur -v-1 1 I it: n' AECOIJNT - Am. Mm BALANCE .L .121. humme .. .. . . .. . .. .. .. . .>24. 36 Ban: . . .. .. . 3.522 .. . . . acm anus: . .. . . I 1...1 ..hnMum. .m ?Paw-wanna .. ammunqu . GI :1 .r?f 1.. culmagma a .52.. 11w. 25H an khan?ha.- hr?. uhrrin? cm Umbruomm strip - . - We? .m-nr - .e-n_ru. .. .Irl Win: ?4 . . ,5 I ND. a,qu RECEIVED Fag?: ADDRESS 51. IJ DOLLARS 5M 35:5. . - 73:HEWEur-2Acco'um- CASH . 3 1-.- .i -. 14?ng . - AMT. PAID ?Him I . BALANCE :u mu ?11 DUE Mann ii, ?a he"Lam- game CASH . - ?3 CHECK MONEY unnen - . . . - - Isa-1 m? . Hagg.wrrj ACCOUNT -. are: . . . AMT.PAID CHECK (j LDEA-OBOQBR -: av . a. GU33 ?11m l1 n. . ?15! EB ~I?i?'?lhalatit". hi 3.. i: -- r31(wig. . . I .?nu gm. . ='gwa21 sfa?y . 'l I. . . arm}? ?430:41?55m: CASH AMT. mu CHECK RELIANCE MONEY . a: . . nnuea - . . . -. . . - tow: w?eane AMT. OF I AMT. PAID CHECK 45? BALANCE MONEY 1i - ORDER 'qf5:711, i . . . - Ems-As. 'u Him?Ir "19315165.! ?in 75accuuwr '3 mt. nun EH m. nuns: Mower mas En HY .A. I- b?khsos? w; . .I- *cH?I??m?a . Lr.. ?Lanc?tr {?ge ?g?gw .u?um .. ludmmu 5an Edam man. I 2 "uqu ?aun 53a ludu baa-Hunt. MD Jnd??unr-u I. rum?H.531 .3.3% .1 i I .llunl w: 3253 DEL .221 .nnqa 35$ ban-000? L0 #21 awnca . WUZEGB ?Uw1u 93? tau 1min. hanauuc9089!? rW?wH?F-ni?; -- - Hm??m??uwl.rah .33. . ffi?mm .uef-w -.. 2.. u" - .- 44351 m. v.1 ?rm may; Hana sax? .17m12' FORM 746508 . fun . ?l-I .1Scan Infra?um . . LtMum.? x.huF342523 a cum. an Dana?.25. 2.6 I'm..wa- . .Aa w: -- - ?tad-air; awaken-mime :17 trail? Wi??am?? . V. -I .. 3 ??m?utm:mm:m - i. RECEIVED mom mums si?-?mum ans? PAID I. I "'11 1 2? gal! AMT. DF ACCOUNT AMY. PAID BALANCE DUE CASH CHECK nuns? -- i I . 31ace} 1. . I - AMT. OF - ACCOUNT CASH . 2} AMT. PAID CHECK 4 - gamer at? AMT PAID W. .. -- I i 1?11? . Ill . . . - . .. alt: I .Illil. I. ..ilru. We . malls .. ms Eta. #23034 ..6292 325KUWIH Didi . a A it, .. . . 52:33 . :mcu no .53.. .. max I . .Inkw. -. I?ll} ,Ol . . .. I?ll]: . an. . t: n.T555511W n14. .. aid: .v'strir wnm?mwhu?m gum?Dan 52? my}; .4 anaav- Hung-I nu:- muzgu n. . . . . a xuuzu 2E .51 . J.. . man?diam magma: 2am?. 833: 908% mu: . J: ;l.i .. .n um . u. .. 11.55.. .L .. .umh?fnulxu? l. .. Ln. .. ?(hple ..Th?uH. In}. um . .-. Binm 9E an .. panacea b3. nub?D avg?(Om Cm FORM 45806 . 7'3 rural; 48803 31? '1 0 PS - Wurs- .wnma ode-Hun? .II. I. L: i. 4.HIV. . . - . . {hunt .33:24 arm9?;an . 2629. u. . . . a: aroma .. .3.5.. . - . . nuance. . LBW llub - II .. . 111.19.111.11}. Inn-l. ?dragon-ad 1a. 4. 1:515:531'23; m3. C?nLr b1; RECEIVED FROM ADDRESS m1. BF sanctum PAID CHECK SILENCE MUNEY cause BY . . am 45905 1 lei" ?m?d?aACCOUNT . . AMT. PAID - I I . . "Brigg-fa BALANCE . . .r . a . .w . ta?igi255:5 a; it (fr. Ila?7.71?55". 0' h? ?v.54. 5311', I AMT. OF 1 Accoum 34$? 7 I AMT. mo - CHECK gg?} . naumcs a MONEY - - . nus omen CASH :41AMT. OF ACCOUNT AMT. PAID BALANCE DUE - - . - .., - - - _rwmh . -. - ..- . . - . W: 7' -- . -. . as- Mn. (2 .L RECEIVED FROM ADDRESS . . I DOLLARS MT. 0F ACCOUNT AMT PAID CHECK BALANCE :bps 45305 ?await 5 [fig CASH (as-5 c- I Ants-aw it. CHECK apt nuance mmev 52.1; . .. Il'?rrh' r231 "3 1 fig" "1:"El: 1 1 - 11; IMF. DF mum AMT. Pm Imam - alumnae ?Pilaf?! FORM 46806 1- ?r ACCOUNT AMT. mm 3 Er: cuss-c - . .- BALANCE ?W-?Hr-F?ln- H, II I In.? . .1 tav?nbl?WEct?csrreiFi I . n92: SJEnnithEPE?LRwawnwahv.1. raw00?me will! FUFIM 45305 >23. Om . panacea. 9m: bg?. ?lm?u: 2 can 25 m4 . ?ung-wry9.54. ?uhTamil. . . . "yaw?uh. FORM 45306 slur. . - .u . 33:3 PEG .fhwm 09-938 .. 1:11 odzr?um2m\ a1 amass; RECEIVED FROM ADDRESS 7" 1 5 $1 0? FUR AMT. DF ACCOUNT AMT. PAID MILINCE QUE FORM 48806 - . .. . FORM 46806 5" . AMT. as . ACCOUNT . 7- j" ?r "5*51' ?th'n CHECK ?ndiag BALANCE MONEY QEPEB .. . . :r n: - - .- m-(I wu- RM 48806 ?c?mww?ar- 5 an: i: . 1 p'ug?; rm: u. . FORM 46505 . - I-n-Taw - - 5- . 4 if? nut-a - . mass-e . r" 155134?. AGQBUNTl'l AMT. or ACCOUNT CASH AMI. PAID CHECK BALANCE nu: I - .--..- . . .. . . -. . .. . . I 2:4" - .v um in. .a F33Jill-u can? - run-.? a- . .. 41.3.4; 3:33?35 RECENED FFIDM ADDRESS r. - . mg.? a AMI DF ACCOUNT MIT. mm nu rune . . "'35 .l I BALANCE . AMI. OF Acmum Am. P-AID aALm4151 -.. m1. FIAIU .-.-- ?Iv-I'm 1 ?fr?+3 -. . ham-mug: .- 1E1 RECEIVED FROM ADDRESS Pan or Amuum BALANCE AMT PAID mumm- -- .. [2:0 AMT. OF ACCOUNT AMT. PMD BALANCE a. a. 1.3mMain,? .. r. .1 . .1 akiwmu . . L.an". ,6 . .. . Frrkumunin AMT. PAID v.1- . -.. f; - 7? Hi" gran . . momm?sz'll' .. . . . mm.? . 8 in . v. ?mix; . 0 .. . . mutung 33:3. tam??T; n. .45.m?ias?wfa g??pne?n?ug. . - .1 a - saramwm?mu ?um $1.1m . a H?i?-?Hkr? .. DEA-03109 -q-i 1% FDHM 46806 PSFOHM 48898 huh-:2; Qua; ..-- mam91?u? IL Mi}. RECEIVED FROM ADDRESS DOL LABS mt. mu I .5 meat: Baum?wan-p:- m. - ~91 1:1611!?! Enr- . mm. ,??iri DASH AMT. OF ACCOUNT AMT. PMD BALANCE CHECK MONEY K. ML AMT. 0F ACCOUNT AMY. PAID - - - - . . AMT. or accnum 2?5: I mm. man :0 CHECK . . -- c: .t aw 333:: err ,9 -. .--.- .- - - - -. . . raw-w I41 h- rains-- (if: . (fa-U3! FROM ADDRESS DDLLAQS 3i 5 FORM 46906 3,53. . ill-IT. PAID BALANCE nus-.- Ira-AMT. PAID BALANCE . Pl6P8CASH ACCOUNT AMT. FIND CHECK BALANCE MDNEV ?ne until Fl FORM 46505 FIE CEWED FROM AD DRESS - EEG. Guja.} 1' .. DOLLARS l- I: I. - BALANCE JIGGDUNT it. . nutpmu ACCOUNT AMT. PAID BALAN CE w-i? . 1'20 BASH m. . - - '42: huh. u- 5 . . [7/0 CHECK - -: AMT. OF . - i ACCOUNT u! -- i I 9' PAID 5? i. magnum? EMT. Di AECDIUNT muutv ORDER -r-L .L-- ll?? . - - ?gin. .A . 1421.14.has: .736idomn?? FDRM 45305 . l. I. . I. .II, My. a: 443 I i hlln?l'l? CHECK ?ltl??i DUE - -u "u .u NF Fmo-Wv4 Dofe Impono'nf Importch Important =m52.38Naming-1:; 57 1 imporfcn?VL. importch . Impartch 59 1 3 A Emporium Impor?rdn?r important :15 aoggama' WW.MMW 60 in, Impo?uni .1 . . ,i NaDEA-03161 Date 2 z? . important Impor'ro Important . . - . . Do?re gm}? +5 DER WW ?mporfon+ Important lm?porfc: n?r Importch Al-b?tllci . EA-031 63 17 Important 64 6" .. imperfch imgortonHur- .A 8 .. Do?re 92595 303?) . Impo?un?r Importom? imporfun?r important a U?Cxi Vi ?i?vDEA-03165 ?ow: ?Dam; a Importch impor'rctn'f important .5, Empo?onf . ..- waggm. ta 5% 5g], ?m?'o?onf impodanf important imperfch . mat-thus; 67' Date Dpnik M, Empo?cn?r lmportanf impon?ant Empo?dnf . .. i, m/ ,4 5.- i Dc?e {lan 5 Alma?) important impor?ram? importan?r g; 'Do?re 11pm - Hg ago?) . Lil Importanf impon?cn9.. raga . I .: Emporium impor?runf Imponth 9-, gig arr-La 9 i DEA-031 7'1 (Safe: A I Impendm impOn?om? 1 72 Important ?is. r. 2" ?Emma Date f. 9063 Emp?rfon?r imperfch Important -.. ?r 5 Lti?m st 119 73 imporfonf impodonf EA-031 74 imponom Date Imporro nf Important 1 ?5 . Important lm?po?anf Emportcn?r 76 lm-pon?on? impo?onf ?4 . may DOTS. Emporrd'nf lme?dnf impo?on?r I a. .- m? ?354.21 (Emma. 4-. m" .1. 1:539 r-nn 77 1 Da?re lmporfum? DEA-03178 Important Important Important - ?.1351 Do?re Important important Importanf Empo?cnf kw a. I i A A (?W7?m?mms . i A 6? 79 Dc?re imporfonf Important impor?ron?r o. . - 3?53?. at? i ?75:19 xv . El. DaTe Important imp?o?am - Ir?porfonf DEA-03182 00.3 import: . lmpo'rfunf - ?APPOINTMENTJLANNERW140113336 a D018 5 Important lmportanf 83 . 7 lmporfonf 1mm Important :15 i mmICOW - 84 8 Date lmpo?unt A Important importch lmpo? . a, Date 913300 a - lug" _;m?por?rah?r . Important imponcnf Important ilw DEA-031 86 DEA-03187 Important 03 Imporroni lmp?or?ror? I-m?por?rcn?r 6 ?5 . APP 1 ?011104 1 DO?re' Smporfcm?r DEA-03188 ao Importanf ?mpd?an1 . . . w- . impo?unf Imporfonf Important EA-031 89 APPOINTNIENIPLANNERJ MOFW3M043 Date? DEA-03190 -aobg - Important A i ?mporfan?r {1 importc nf . ?on. o, o; I, ir??has'APP 91 Dd?re Imbqnum lmpot?ronf impon?un?f o; Dc?e important w?w - Asta'gM?mw 92 Impormnf ?l Empo?on . Dc?re important .imporrant impo?cnf Imperfan ? 9 LOLES 3 Em 1 <5 pm My 3M5 D019 93 @4303 m1 {mpo mm important DEA-03194 lmpor?r?anf important impo?dn?Gaga :30 . . DEA-03195 Da?re Impo?onf a; 3003 3m p'orfon?f Import Do?re - 3 7 7 I lmDO'rfonT imperfch . ?f CD agamf Date Important I Eta-61005- Tri?S?L?ri?te' 1203 Gay ?5662? YIN - 3 . J. Importch . . Date rimporTcm f. . d6 . 99 APP __3_053 DQTB impo?cm DEA-03200 2353 38639 NH. Date lmporfon?r Important lmBor?fon?r Important I - AFA-DLIICS 9003 'Da?re Imperfch Importan Imgabrtanf ir'nborfcnQ5: DEA-03202 que lmper?ran . important lmpo?or? 7 lmpo?onf DEA-03203 Dafe 3 importon?r importonf important lmpor?ronf wink We Empormnt 7 1m porfun?r Vimpor?rdn Do?re. L5 Important Emporfor? }mp.0rTCInf . . - - DEA-03206 DoTe Importch Imperfonf Imperfan lmpor?ranf . .1191.? Dcn?e Impor?ron?r lmporfom important .. i lmpon?un . . . DEA-03209 DQ?re lmporto n-T important .. Importur?' JmpOr?ran?r 63 ?mporfont imporfam imperfan . . .DEA-03210 21510223 lmpor?ta nf impo?om Do?re important DEA-03212 imponont - Ge _}mporfmf lmporfon?r Imp (mam an?? i I 3 Date .1 . 7- Impo?cnf Important Iimpor'fonf . DEA-03214 Do?re Important mporfom important Impor?rcn?r . .- Da?re impor?rdnf 6 importch Emporium . Do?re ?mpo?c1nf {rm porfan?r impo?cnf lmpodahf EA-0321 7 Dafe A IE lmpo??ant imporram? "important . . impor'fanf at DEA-0321 8 Ddfe 5' lmporfrorif Impench Imponcnt 9 _0 73 Date lmpo?un?r importom important #mporfunf . . . . . x} .1 ?if, l'mpo?cn?r imports n?r Impo?an\ lmpor?ra?f . .4x_ _\Da?re lmpd?um? - ?important. ,impo?r?tanf - Empor?ran?Am {Halli-I}. 45.1 :7 211433 1 - Da?re Important important Important Importanf APP Do?re Importam? impo?onf - Emporfon?f impor?run?r ?343,155. -- i. - I in"! 4. I . 1 'x-tz' i. I 1. ,Importer}? important important - 2 A i . . . ?nwaumujDEA-03225 Date importch lmp?or?ronf- Important imporTonT . . . nun?x i. a . DEA-03226 I . 5 2"]l important . important lm?pon?anALA-mun: 8 a, I '5 a :ig? . . I '3 Impon?anf lmporfonf important . 1? ?1'4'1?45l?ih.? . .o A - I. lmportun?r A imp'dr?ronf Important lmporfar230?mkcuuc; a . 3229 m3m0 83 ?mporfonf Imporfu'ni impedant - '5 Dofe lmp?orfan?r 'Importun?r ImporTCIm a . .. luv-manna: >0 Dc?e import-ch DEA-03232 $mpor?fant I ?35 DOT Importqn?r Imporfom? Important ram . Ava-muugs Dofe Important DEA-03234 importer-if in; . I l'mporton? . {:13 a? impon?am Do?re Emporium? Important Important . 1 I ,r 1 3 . AI-A-GLMIEE . DEA-03235 Do?re Imporfon lmpo-r?ron?r lmporfanf impo [mm \bw "m XX, 9129 in .l vi; m4Date important Important important Hwamw 0' Dafe lmpo?onf DEA-03238 aw92' Date Im?pe?an?t immortch Im?podOnT . - a I ?Wit! 9 Dd?re Important .92) lmpor?ron?r Emporium . I Imporfonf ?EM. De?e- . important impo?onf tmpor?ron?r importonf .- w: . Important ImportanDEA-03242 Dofe lmpo?ur? impori'unr- Important impo?an?r a 1.!!va 1:51 .J I I I i 9; importer-1T important Empon?ont impor?lclni' Task Dafr? Imporfan?r Important important imporfonDEA-03245 bof?- . iP?por?rdn?r lmborfonfgoDEA-03246 a Date important Important important DEA-03247 Date. important ?mporfunf imporrojnf impo??onf "E?f?imsx . .3 . he; rw- Date 5 01003 Impor?rdnf lmp?O?Gn?} impo?on?r importdmfem: (a m? A, . - ,A50t/ yawggz I '4 . I V. ?Wan: . I . J, Dofe Important a '7 Impodun?r . imporfcm Do?tmpo?onf 990% lmpon?an?r 5' Da?re ?mponam . important Important *glinJI-"Wm? ,a ?z i. 4 EA-03252 Date Important #mporfcn?r Imporrom ,v . F, . 5 mwnu i9 . 4' . DEA-03253 Da?re' . - - . . ImborfgTil-in Date . important imperfch impormm importanAnemia I DEA-03255 Doie Important lmporfunf Imporfnm ij??g? he Date important l'mporran imperfch imperfan Date imp'orfo n?r importer-w? impo?onf imporrom . . . IV "w -1 a th,? HM. 12 Date gmpo?unt A important impo?unf?ghl-GLlucill DEA-O3259 Dofe Impzor?rcnf Important imporTonT i 14 Da?re impo?onr?w? . I . (.2 15.. DEA-03261 _!mpo?cn1 important rummage; 15 Do?re lmpo?dn'f - lmponfon?r? . I imporfunf D-Q?re . I 1 Emp'car?tamL important :impormm Impo?unf amaamwasa . AFN l3 Ll- IICI a DEA-03263 Date a Impor?rdnf ?mpon?oim 3? f3 lmportanT - Imperfch Do?imporfo n?r important .. 7 . a v. 12-x?" Date important .Importcm . I important :1 - 54.3 @ng 5' 1 .1 I 3266 . Dg?re Importch I impor?rcnt Importan . important .- - I. AMI-:uug {a Important impo?ont DEA-03269 Empon?un?r SmporTon?r Empoerr-? Emporium ancuncqm'. Dc:er lmPOITdn?r . DEA-03270 . t. - l?mp?or?ron?r Impodcm?r important important Imporrcm a ?muz??AW- 3km "aw-ax? 5mg? uswv'w? - -. cg rrmm; . K354 ., - DOTS- Imporfcm?r importch important importan Dcn?e wq?? Emporium Importan Important impor?ronf Impo?uht Imporme DEA-03277 DOTS DEA-03278 Important y? 'frnporfonf - .'x EA-O3279 DG?re important I I importan?r lmpor?rcnf impo?anfr AIL-cum: 8' - 03280 8? Da?re .x important importan COLORIFICGELMARKERBCTASST Clearance MODEL: 1057B 3 Was $4.79 1 11112103 mumululm 455990 i - . a. 71641106739 I i ?rl'?u Date I important lmpor?run? ImpoArmmti? I DEA-03283 Dare Important Important Important Dafe I impomani lm?PO?1?i1?auu?? . DEA-03286 Ir. 4 unmq. 1w" important . important . impo?un'f a ?awn-11:: is Da?re Emporium importanqu .- *3 .L 1' I . Date I im p0 ?unf 3.. I . pray I y? 5?1 A . y, impo?qr DEA-03291 Do?re lmpo?onf impor?ran'f impo?r?rcnf Do?re . Impo?onf lmpo?on?r Importonf Important .7 9 v? tuba-H 35?: auxinDEA-03293 Bake 5199+: Imponcrif important important ,r 0* . IL .- IfDEA-03294 Dafe Important Important ilm?porran impor?fonf important - Important imporror? 2 u" 3m Emporfanf lmpor?run?r Impor?ron Dc?e lmborfcizn?r Impo?cmf\ . Smpo?dnf i?mpo?on?r . DEA-03298 APPOWTMENLPLANNERHLOFQJ52 DOTS. i- Important saggy. JD :45 - DEN-03299 p. Hiawa- rj. impormm? imp?or?to m? lmpm?r'?nf 2 I 'h i rt-?Wm Do?r?e 'ia Important Impo?on?r imporfam? 7 impor?rum?um DEA-03301 Dq?re Important I'rnporton?r impOr?rczn?r lmpo?ont I . ?3 A DEA-03302 Dofe 0c}. (55; m0 . . a. Impo?om importq . . 9%ng Empon?cn?r importan'r Imporfon?r ImportMummies? Do?re . Important DEA-03305 important l?svr?r? 1m p?orTcn?r . li?nporrcm impedan?r Important imporfon x; lmporTonT imperfch impo?on?r A 4- 4 307 Do?re lmpc-rtom ?mporTonT Important . important impor?rcn'i Important - - - 09+ (Jag, lmpor?ront Imporfom ADA-ELI. ICE . s, '1 A Dra?re Important -J a - lmpor?rgm *fmpon?onDEA-0331 1 My, _b Da?re f, . Emporium" rimp?orfonf Imporfam .Da?r?e Important :2.DEA-03313 mm . important imperfonf 1m po?onf . . - ItDoTef" (909.778 7264?) important lmpo?on?r 3 impor?rom DaT'e I g" ?f 5 lmpon?czn?r Emporium? kw. . . Date .K 5 important lrnpor?ront Imported? kmporronf (LI-A- any ?mpo?cnf Empowch important a: 3 . I 1 [Mm/i 3 . lmpor?ron?r 8? lm'po?cam important 0/0555 {mpo?onf 1m portant i?m?porrum? ?mpoffcm:15: :35 ?125r?? Date important Impo?gm - lmporfcm?r im-por?ron I DOTS .- - . {mpon?onf imporme lmbOF?rom? Impede-EA-03322 75 . . Do?re - important I Emporf important i 3; nun-mums: DE "03323 we It m. w. lmpon?onf lmpor?ronf Important; impgorfunDEA-03324 Dm?e Important Luau at '9 . DEA-03325 Do?Fe . r) 1m po?um? important imported important . - DEA-03326 DG?re' Thtl?s??jo 3 '3mporfon1 Imp?or?rdm? Important DEA-03327 7 Smporfon?r? ?Imporfon?r - impel-rant ?uh DEA-03328 Do?re ?mmn Important" Impon?om important Imporfam w; i I . 59.3 -. Do?re Tue-?54 Empor?rcm? imporfom important Empon?dnf DEA-03330 ma?/gag 19 - I impo?an?r important I?m porton?r lrnporfon?r aw ?r r1th .was! . DaTe f" -. -, . important importanf ?mportan?r important 43332 85 Dcfre . Now/7252?; Important lm perfon?r Emporium Empon?cn?r sew.- 6? DEA-03333 MD R. Cr impor?ronf Imporrcm Dofe I - (m . 7 Ek$354.? :45 :11? 117132, :15 145- :30 :45545DEA-03334 APPOINTMENQPLANNEK19113487 Date impononf impormn'T \mportcm?r 7 Important I fa- f???v?4 VP. 1 EA-03335 8 8 Dore . - in} .. ?CImportant i Impon?ch .v Empor?rorg? LeiIv ?Impor?rar? Empo?cm ?n L. Dc?re 9% Import DcTe Au, ?37? 97/Zomla?n? important Imperfan imporfonf lmpov?ram? we tmpo?ronf Um {Li/id} - Imponoht impor-fcmf , in D018 hU?m lmpon?an? important important Important ? Daf?,? lmpon?onf mpomnf important ,5 fmporfonf (.?? Do?re a important Important lmpor?ran?r ImporfamDEA-03343 Da?e :mpon?chf Important Imparto 0:15 0:30 :45 2'15 :30. .9 :115 DEA-03345 Important Important Imp-car?rumL - 1/ We remgmporfam? impor?rdnr Important Imporfun .- importc: nf Em pon?onf important Important la mm Important impon?on'r Impon?om? important DEA-03348 1 Date I 5 important Important Important important - - frownz??r?x 1a I a . meWmm important Important im'pp?aam? impor?ronf . . 3A . l, a; \v?Jj . 4? I ?7 1X "25.5, any; 2. I tmpon?onimporrunf importc n?r .- ?_mpor?rcn1 gage 4 7 ?5 - f: I Important :m-pgrront . DEA-03352 WV lmpo?um? .mp0dan Dafe {JO/if, 1-- 3-3? imporfum?r A imporfon?r A .- . - ?If Do?re .Dorfon?r 3 - J?I'ri??o?dnb (-4 A Imperfch Jaw-u . 5? . 4 i DoTe .53 - I Jmpon?c?mt 7 imporT-cm? I b.0000. 0?0" . DOTS I a: ?mporfcm?r - impon?on?r Important Impo?-onf .. .?lv' 1 lmpor?ran?r Important tmpurfon?r lmporfc Date?w imperfch lmpor?rom Imp o?on?r Important DEA-03360 DOTSWM- fr, Impo?um important ?mp0rfont I important.I. 1.Au- has: A Date I Dorm HE- :{hgjporfum lglpor?ronf important iv 93 &m'portonf importch g: ?gaunt: i3 . a 1 DEA-03363 - . .7 . Wk impo?um?. Important Impo?cm? w? 217 . impo?unf important rimp2 at? .0 Importch .ImQOm-mf important thpo?dnf I. I 15;! (J) 35:.ne" I: ??93 i .rn Dafe a I 3 - impo?on?T lmporfc n?r important imporfo Date Rad?: a Impo?or? lmportom? I . Important :Nair ?ta DEA-03384 Dc?re: - 1 1* important Imporfohf . . DEA-03385 - Do?re impon?ar? ?m?porfom? impon?c?m?r important Dcn?e 1 Impon?om? important 3 imperfch EA-03387 Do?re - Impor'tcmL Im?pOrTonf Important Emportant 22L i'mpor?rc: n?r lmpo?ur? 7 important" 1m DarrenDEA-03389 Do?re kmporronf DEA-03390 xii/D I .li? "rigi- importonf Importar?n Important Important . -W Do?re lmporfon?r Empodoht Impodon?r importanf APP . *2;th {fmi?a I -. important important .. 1.mpDEA-03393 Do?re Em portun1 important lmporfunf ..0- imp?o?onf 'Imporranf {mpo?c?mt Important ?A39 ?: 1 Dcn?e impo?cn?r imp-o?onT important Do?f? [Willis 5 Vii?fa": HQ. {'22 i; 3-mporrgn1 impo?an?r ?mporfon1 imporfonf . Us". . u. DEA-03397 Doi?re I imporfonf .tmportcm? ImpodG?T I a 5. Da?re .rw' lmportun?r 'Imporfum? important .. - . a. Dcn?e I 1% Importan l-mporT?GnT imporronEA-O3400 5'3 D'Gfe ?3 I @130eran Impo?dhf important . I'mpor?rom Date impo?an? Dza?re i I Q: #mDO??Qh?r I'mpo?cnf Imporfon?r importcm 1 DEA-03403 DO?re F35 .Impori?urnL if". DEA-03404 Date .. f. important . I I . . ImpOrfanf importch APPOINTMENLPLANNERW140FM3W258 Do?re important ?mpormm f. . G. .17 ArvvAra-cu NICE 8 i . . 4 . Do?re impo?onf Imporro n?r Important important I?m Do?re q? important Impo?onf I Important Da?re 3mp?orfon1 lmpo?n?om? . lmpor?fcm?r .1 A i .0600 -. Date Mm?i impon?cznf Impor?for? DEA-0341 0 Ddfex lmporfan? ?mpo?onf impo??n?f Important gt . I C. v. Exp D016 . - imparfonf '{mpor?ron?r 9'01 Dcn?e {mp Chow import: lmportom? important 3 .W 7m :2 ?ch imporme impeach.nu-aunct 0 I DEA-03414 DaTe A I. "?mxt? impodg'?i 1 Important lmporfcanf w. lmpon?anf Importch v? Date I Imporf'om lmpor?ranf important 'lm'portonf - I 7 Mr: 1? 7/6/14- -. ?Lg?wv Do?re- I - important mpomn impormnf . E8 . DEA-0341 8 Dcn?e Impo?un?r - lmporfom 9 Do?re' I lmporfcn?! important m. .I f? 3421 Date Empor?rom imp-"Odom .u .N (.71 Im?po?unf important Important important Dcn?e importer-T imporfon?r Datemwmm I [mpo?cnf 'impo?ohf ?mp0ffanf Importanf . it DOTS 3C) Impo?onf important lmportar? DaTe impo?an?r Emporium 7 Important DEA-03427 a, Important imporfam Empo?onf ,DEA-03428 Dcn?ef? 2v ARA .lgiM: 1. 4. impor?ron?r a A . Imporfcni . f'mporfon,Km' i EA-03429 . Do?re ?ab- Hm? important Impon?onf . I ImporfO an II - I :? Da?re Important Impormn: a imporfon?r imp?or?ram Da?re smpor?runt ?mpodant EA-O3432 5 DaTe lmpor'ionf 3mpor10n?r impor?rdnf OODOD . :onnon APP Do?re q: Important - imperfan Em?po Hunt ImportonAucuuca? :mportonf imporfonf important Dofe Imenfon?r imporfor? important Emporfd:30 :45 1., :30:15 2'30 -, :45 '1 DEA-03436 Da?re ?mporfc1nf tmpo?cmf Impor?rdm? imporrom ' Date . . 6 Important lmpon?um? Emporfom? importonDEA-03438 i Dolre impo?cn?r a;ng lmporfijnlmpo?un?r Imperfch . , Do?re . Important important lmpor?rcni Dcn?e Imporfcn?r DEA-03441 Impor?ran?r 1 Important . . . . Dafe . impcn?onf 5 lmporhanf lmpo?OnT Cir Dd?re important I lr?porfoh?r . Imperfth -..DEA-03443 Date 15;; 'imporfo n? Important impon?unf Date 7 . I Imporfor? lmpor'ran?r ,1me rtdn~03446 Daffe - - a important I 1' imporfqm 'Inlnporfcn? DoTe Imp or?fcn-1KM - . I . 1 . L, 'h?gaw?ag~wa .1 Important 01 lmpor?.rm? .55? - I :??ygzruglk;nl?z . . . ?1 . DaTe ?was ?r .imp?o?onjru I APP DaTe A }mporTch_ lmDOl'anDEA-03451 Do?re lmpon?on?r A Impormm Importanf Date- important 1m porf'cznf Important Dare impon?om? impon?dn?r imporrch '0 IL, - L: almDortunDEA-03455 . - :?An?f?s ., i a a . impo?an?r . important -. Important Impo?en?r DEA-03456 Imporfdn?r impoffan?r impor?rqn Date 7 I lmporfcm? important - important f" ""DEA-03458 1 "'Ddtef?i ?mpc? r10 61" important .1. mow" t" . s. A - DEA-03459 Do?re? important lrhporfonf Jmpo?umj ., s'Important important Importan?r - lm'borfoh?r' We . 7.0 085 Empo?an'ft a .. llmpo?r?r?lm? .- DEA-03462 ES a a, TELEPH - 7.1?5/ n? . ?.l?D?Lvr I n23 3: If; i' $3 grab'eded ?lgy 1-800, these telephone?num??rs aria; i?nftiheff?i tin??ntain?l?ilis. ii: . - Er; 534AIRUNES Japan Air Lines 51 525.3% ?rm; a Cartfidorjiggzic} 33%;121211: jglliday inn . 45?54329 Aerungus 22315537 KLM . \i?j 374-7747 I, n?Car Eilf'lzd: Fig-rims r. ,7 33910741.. ?gward Johnson 654-2900 Aemnn?? Aman?gnas 333-5273 Korean Air 438-5000 {Lliudggt Car EITmck?Regtal? lg. 527130?005= ,HQatt Hotels 2311234, ?1 ?axing 23mm Kuwa'? Aimys' 4539243 LCmm?sn, Aulo Rama: 222?5741 Knights Inn 3435544 1 ?53 332.7gzz tan-Chile Airiines 735?5526 Dollar ?ent-a-Car GED-4000 La Quint-a Mom inns 3 5.3115900 my Canada 530?3299 Lufthansa 645?3380 Enterprise Rania-Car 325-8007 Mama? I giggly-9r] Air France 23.7.2747 'M?xicana Hen: Henna-Car 654-3131 0m?; Hotels 543-5554. india 223-7775 Northwest Airlines 225525 National Car Rental Resawarians 328-4557 Quality Inns 2235151 i '3 Jama'ma 5235535 Olympic Airways 2234225 Payless Car Rental 72-95377 Rad-lswn Hams 3333-333 - Air New Zealand 262-1234 Pan Am 359~7262 'Praczical Ran: A Car 2334663 Ramada 22842323 Alaska Airlines 426?0333 Philippine Airlines 435-9725 Bent-a-Wred: 53541391 I Red Carpet Elms 2514362 Mgragla 223-5730 Qantas Airways 2234500 Sears Rem-a-Car 527-0770 . Red Lion [mm 51173010 All Nippon Airways 235?9262 Sabena 955-2000 Thrifty Car Rental 3812277 Red Roof inns 3' Amer?ca .?west Alriines' 235-9292 SAS Scandinavian Airlines 2214350 Town 8; Country Car Rental 245-4350 Rbdewa inns 228%0'00 American Airlines 4334300 Saudia Arabian Airlines ~472w8342 U-Save Auto Rental qumeriCa inc. 43842300 Sham: Hotels 32533535 Aviama 234.2522. Singapore Alriines 742~3333 . 4 Aviate?ca Guatemala 535-4148 SouthwestAirEines 435-3782 HOTELS MUTELS smut;fo Hows Resorts 4.5355? Bahamas Air 222-4252 Swissair 2234750 aestWr'esrern 52am 599?" 3 3098000 British Always 247-5257 TACAAirlines 5353730 Budgazel inns 425.3433 Travniodge 57734878 CanadianAir lntl. 425-7000 TAP Air Portugal 2213370 Hater: 221422 Was? We? . 225-3000 . China Airlines 227.5113 Thai Air 1126-5204 Clarion Hare: 252.7455 WY?th Hale's 3* 3850'? 3224200 3 Comair 354?3822 Tower Air . 2214500 Comfort inns 22-35150 Continental Air??n?s 5250st TWA 2212000 Days inn . 329?2433 TRAVELERS Czech Airlines 2234355 Uni?ed Airranes ?zz/5522 Dcubiazree Hotels 2722~9jr33 ?Eon Guest international DeltaAj'r Lines 221-1212 us Airways 4234322 Earns Lix-lges 553.2565 . a Egypzarr 334?5757 aVarig 4584744 inns 326nm Ce?hire saline?7365 El Al ismei Airlines 22345700 World Ainrvays 9515350 Embassy suites 352-2779 inc Worfdceli 8588576313 Finns}: 950?51390 Fou r?SBasnns Hoteis 332-33142 lnTuuch USA BUD-BTEJEEG Garuda lndonesia 342-7532 CAR RENTALS Friendship inns 453-4511 H?walian?Airlines 337-5320 rA-larno Hpnt-aCar . 3273633 Hampton Inns 425-7866 Thesa numbers are'th? moSt ibarja 772?4542 American lnt'l Ra'nlal Car 931?4113 Hilton M53557 numbers avniia?bl'e as of 5100. Time Zones 8; Area Codes of the and Canada 7.2" v; l ?an; ?r I Harlode . d??urr- Emma! I . 506? ?mamas. . Prim mums him an: mm. gerimm? 515 ??fammn 34?, 718 maul-mm unmsr; 2m mum: 41mm nun-n MW 202 wuhiaumn DI: 2.10301 mm 757 Anth Barbuda 554 Bahama 359 HMS. -. anm. TIT Puma Rina . Ben-rm.- 758 arug- A i 7r as Inn-awninth 7a: Mai-(him In:ch 9 d? I - awn-n Island-I BS Tm?l??num Him]: an if? ?(3?97ng 408 337 - .. Mm. 549 Turn cuts-=- mum - -- f'mh- lerudl 34a us mgr-m 809 Calhoun ?mmpage; mu 5. Mid. Fina? chock mu: you: iphmdirydaqr Updau? 5* gidJum?Z?JD, -. DEA-03465 Health Care 1200 Gay Street Pertsmo'uth, Ohio 45662 T: 740 "355-6949 F: 740 355-6946 Group 1 - .1): venue Huntington, WV 525~9355 F1304) 522- 0335 Re: Referral for E'vatuatuion . h, Patient Nettle: Patient Address: .3. . 1 Patient Patient SS .N - th? Dear Please eval?uate the above named patient and adtiise as to whether you feet the currently prescribed medication is Warranted for the treatment of anxiety and. as to whether this patients *?e?attxiety is pain related. Thank you. . This patient is currently prescribed: DIX: t3 1 DIX: DIX (Change of address and phone number) Tri?State Health Care 1200- Gay St. Portsmouth, Oh 45562 Phone (740) 355?. 6949 I Your appointment has been rescheduled for Day: Time: If you have any questions please call as soon as you receive this. [Change of address and phone number) Tri-State Health Care 1200 Gay St, Portsmouth, Oh 45562 Phone (740) 355- 6.949 Us .3 Your appointment has been rescheduled for Day: Time If you have any questions please call as soon as you receive this. wr-J ?mfg; . - [24cm {1 CABINET FOR SERVICES ?3 ATEIMW DRUG camicug? PROFESSIONAL PRACTICES (502)561?7985 I I [501) 563-1203 if I 4 '7 ??kw .eq-ue'st for KASPER Report PEI Cami?1M: f_ .Q 'Pl'ease 17!! out compfafelyAiiasr?es and Other Addresses Whom); .3 Report Pe?ed Requestedf From '70 to 'j pate Date I I ?7 - if awe Hea?h??m?? tharmacy. or Facility Name {pawl} Vo/Kmaunm?, Cam? 5 - MMD 56W 61Lreaf? 5? Sheet Address $ng Ecer?fy that the information be useder th'e'* City, state, Zip i . purpose of prov ding medical! or pharmace tic?ai l' ?7 55? (9 ?'eathQW' current or prospective patignt Te'ieph'sna I I FM SignatuF??Pf Doctor Car Pharmacist DEA-03471 (Change of address and phone number) Tri? State Health Care 1200 Gay St. Portsmouth, Oh 45562 Phone (740) 355? 69-49 . .3 Your appointment has been res?cheduled for Day: Time: If you have any questions please call as? soon as you receive this. A (Change of address and phone number) Tri-State Health Care 1200 Gay? St. Portsmouth, Oh 45 562 Phone (740) 355? 6949 fli? ,3 Your appointment. has been rescheduled for Day: Time: If you have any questions please call as soon as you receive this. .. {g (Change of address and phone number) Tri-State Health Care 1200 Gay St. Portsmouth, Oh 45562 Phone (740) 355? 6949 ,3 rat Your appointment has been rescheduled for Day: Time: If you have any questions please - call as soon as you receive this. 74 (Change of address and phone number) Tri?State Health Care 1200 Gay St. Portsmouth, Oh 45562 Phone (740) 355? 6949 . I 3 Your appointment has been rescheduled for Day: Time: If you have any questions please . call as soon as you receive thisEA-O 3475 '1 (Change of address and phone number) Tri-State Health Care 1200 Gay St. Portsmouth, Oh 45562 Phone (740) 355- 6949' . :37 YOur appointment has been rescheduled for Day: Time: If you have any questions: please call as soon as you receive this. (Change of addxess and phone number) ii Tri?State Health Care 120 Gay St. Portsmouth, Oh 45562 Phone (7-40) 355- 6949 I . a? Your appointment has been rescheduled for Day: Time: If you have anyquestions please Call as soon as you receive this. DEA-03477 (Change of address and phone number) Tri-State Health Care 120 Gay St, Portsmouth, Oh 45562 Phone# (740) 355- 6949 f? . . g3 Your aPPOi?tment has been rescheduled for Day; Time: If you have. any questions please call as soon as you receive this. 1 . H, i' A. a -1, ?2 (Change of address and phone number) Tri?State Health Care 1200 Gay St, Portsmouth, Oh 4-5562 Phone (740) 3 55? 6949 . a! . Your appointment has been resoheuled for Day: Time: If you, have any questions please call as soon as you receive this YogaClasses Wednesday Classes . 1300 PM and A . Thursday Classes 11:00 AM and Tri?Sta?te Health Care (740) 355-6949 1466/1/57 15? wizme ?ay? - .J . . 12Wng g/deg?? 57,993 - . EA-03481 .3, I .1111 I . A . .l g?rx??r?r? wrt' Mam . .. int-m ?gtvr-r? ?wows-u . a} I DEA-03483 31319 Lit; PAUL 2095 4 'f 1~24 254.9 50?74 . - [3 75-100 I . Emma? I . 151611dover Re?if??2345 V0 58M Ler P'res'c?pt?on?is void if more than (1) prescription is written per biank' . . .A (Change of address and phone numher) Tri?State Health Care 1200 Gay St. Portsmouth, Oh 45 562 Phone (740) 355? 6949 I) Your appointment has been rescheduled for Day: Time: If; you have any, questions please call as soon asyou receive this. DEA-03484 - a I ?flaggm?gi777ml, 0mg a ., 54g. {74/25 59:39 'l "w 1? i I DEA-03485 3486 W3W339 .: If. i :{lu .nl II ?i?g?lizritnr 3:51:25? (5.2.4.. 12.13% it 1.1.1.111. [253432{ul?x Emnd Prefessionai Group Prosc?ce 3's? Any Year For Oppo?nfmenfs and memoranda On de?iy basis; Mead Consumer a 0mm Products; 193 O?Nai? Rd. Emmy NY ?93338 Made in USA @200? The Mead Comm-mien MOD 1 Do?re Mm [meernt imporfe?hf' Important . -3489 1 Date imporfor? lmporfan?r Imporrnf 5 1mm: in}; Date impon?onf lmpor?rc n1 important importch 5 lmporfdn?f lmpo?rfon?r Important Important '9 Date r: L. h-kn? 7?7? Important lmpo?n?cnf a. L. y. m?ard N. .A - A - DEA-03493 371? lmporfonf Impor?ranf Dc?re Micmci L- i Dot-e ?2 - . MM mono-m ?7 important 'Empor?rczn? DEA-03496 D'O?rel lmporfom 2* ?bale/E? important lmpor?rum? ?drama: a: - I .. i 7.. I imporfanf lmpo?anf impodcnt Date Important 'l'mDO?O?'f Important imu 1 Date, Imporfonf Imporron?r Important :15 :30 7 :30 :15 :30 ?145 . I . Dcn?e 4 important impo?onf Important EA-O35OO Dafe DEA-03501 Important imporfont important 7 firm-Em? DEA-03502 ImpOrTanT Important Important Eli-muesli 5 Do?re Impqn?cn?? important Important . . . .Wu ?in 6 I lmportonf Importan?r I 66660000000H0000000601 DEA-03504 Do?re . DEA-03505 r: . 1 8 Date 'Impormm? lmpo?cn?r Important important DOTQ gum! A 4436 . Imporfunf Imporrom? I DEA-03507 Date 7 z/ (0 Important- ?mpo?cnf Impar?rdn?r HI- Dunc! 6 - DEA-03508 Date 1* Important important Importont '1 .i :30 :115 L. a Date 3- ?mporran1 Importan?f 5 Amanda: DEA-03510 DoTe (3 impo?unf Irnpuzn?rcinjL important . . . a Dcn?e D7 important imporfcm? Important Imp ortan?r 23 impodcnf impor?fam 1m pa?an?r DEA-03513 7 .5 K. N. I Do?re important Imperfan .4- ?mportanf importan? ICE :9 EA-0351 5 Impon?crnt imporfonf 1m porfdni . . . . .J. .1 WMWN MW ::15 245 :35 :45. :15 :33 :45 :15 :30 :15 :30 :30 :15 :30 :45 :15 :30 :45 :i5 245' :30 3:35 Date Empon?an?r Important lmpor?rcn?r' Impormn?f Do?re impo?un'f Important Im?porfam EA-O 351 7 Date I I . lmpo?czm ImDO-F?fun?f lr-nporfamL lmpor?rqn?f 2w m. EA-O351 8 1 Important ,1 Importch - important DEA-03519 . 9W Eme?GnT importer? tmportanf impo?on} a Da?re V: If? DOWODT Importer]? ?mpor?rcm?r :35 I 23:15 UWC) t3 . :4 . Date Important 1. Important Important (J I 5% Don?s} lb" Impor?rcm ?mportont Importanf 5,4 ?y lmporfunf impon?am? Date Do?re imperfan 'imporram Impo?an-t lmpo?cmnau'nunn? 37?, 7 I DEA-03525 important important DoTe: Date important wet?"? tmpodcnt Important 4.44;, .?Do?re lrnporfon'r Imperfch important Dd?re Im 4' DEA-03529 Important a :33 :45 u. Do?re impo?ont Imporfam Impo?cnf impor?ran?r ?mum: at Da?r'e - $mporronf DEA-03532 lmpon?an?r c; Dot-e Important important lmp?o?dn?f EmporTUnT Iv 1 Date. imporfon?r lrnporfont $rnpor1un1 Important DEA-03534 Impor?rom important - . D019 irriporiom? important a Empo?anf "WT-aw - -N ?rm 3:3??311?212:1; (Tm-a Fr Dore important impo??ant Impodan?r um-uumce 8. DEA-03537 2,1 Important Important Important Dafe or?f "impo?ont Important impor?ront 5 EB 2 Date 0% Imno?am important Emportonf - . A DEA-03540 Dc?re F?quf/ 00/ IR Important ?mporfanfr impo?on?r Important 8! DEA-03541 Da?re importc: n? important Important . . . 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