Health Care Visits, Stays, and Procedures Hospitalizations Admit Date Discharge Date Primary Diagnosis Primary Procedure Hospital Name 5/28/2012 5/29/2012 Infection And Abscess Of The Leg Transfusion Of Packed Cells JAMESON MEMORIAL HOSPITAL 10/27/2011 10/27/2011 Acute Pain Not Applicable UPMC PRESBYTERIAN SHADYSIDE 10/13/2011 10/13/2011 Inflammation And Blood Clot In Vein Of Arm Not Applicable JA...MESON MEMORIAL HOSPITAL 10/7/2011 10/10/2011 Low Back Pain Not Applicable UPMC PRESBYTERIAN SHADYSIDE 8/18/2010 8/19/2010 Slipped Disc In The Lower Back Without Nerve Involvement Excision Of Intervertebral Disc UPMC PRESBYTERIAN SHADYSIDE 7/12/2010 7/13/2010 Narrowing Of The Spinal Canal - Neck Region Other Cervical Fusion Of The Anterior Column, Anterior Technique UPMC PRESBYTERIAN SHADYSIDE Outpatient Surgeries Date Procedure Hospital Name 5/10/2012 Implantation Of Electrodes Around Spinal Cord JAMESON MEMORIAL HOSPITAL Past and Current Medical Conditions Arthritis Asthma Chronic back pain or sciatica Chronic neck pain Depression Office Visits with physicians (or provider groups) Physician Name Physicians Speciality Most Recent Visit COLE, ANDREW K GENERAL PRACTICE 10/19/2012 BEJJANI, GHASSAN K NEUROLOGICAL SURGERY 07/06/2012 WRIGHTSON, JOHN D PHYSICAL MEDICINE & REHABILITA 02/20/2012 ELISCO, ANTHONY J FAMILY PRACTICE 06/23/2011 JAMESON MEMORIAL HOSPITAL HOSPITAL 09/13/2010 Emergency Room Visits Date Of Visit Primary Diagnosis Hospital Name 9/5/2012 Enlarged Lymph Nodes: Swollen Glands JAMESON MEMORIAL HOSPITAL 7/14/2012 Contusion Of The Face, Scalp And Neck JAMESON MEMORIAL HOSPITAL 7/12/2012 Asthma Attack JAMESON MEMORIAL HOSPITAL 7/6/2012 Skin Rash Due To Plants In Contact With Skin JAMESON MEMORIAL HOSPITAL 6/4/2012 Infection And Abscess Of The Leg JAMESON MEMORIAL HOSPITAL 6/1/2012 Infection And Abscess Of The Leg JAMESON MEMORIAL HOSPITAL 5/25/2012 Skin Rash Due To Plants In Contact With Skin JAMESON MEMORIAL HOSPITAL 5/23/2012 Skin Rash Due To Plants In Contact With Skin JAMESON MEMORIAL HOSPITAL 2/1/2012 Asthma Attack JAMESON MEMORIAL HOSPITAL 11/26/2011 Hives JAMESON MEMORIAL HOSPITAL 10/26/2011 Low Back Pain JAMESON MEMORIAL HOSPITAL 4/4/2011 Contusion Of The Face, Scalp And Neck JAMESON MEMORIAL HOSPITAL 1/26/2011 Low Back Pain JAMESON MEMORIAL HOSPITAL 1/3/2011 Depression JAMESON MEMORIAL HOSPITAL 9/16/2010 Hives JAMESON MEMORIAL HOSPITAL 8/25/2010 Other Postoperative Infection Nec JAMESON MEMORIAL HOSPITAL 8/11/2010 Rash JAMESON MEMORIAL HOSPITAL 8/2/2010 Skin Rash Due To Plants In Contact With Skin JAMESON MEMORIAL HOSPITAL Tests and Diagnostics Laboratory Tests Test Date Location Basic Metabolic Panel (Calcium, Total) 10/26/2011 JAMESON MEMORIAL HOSPITAL Blood Count; Complete (Cbc), Automated (Hgb, Hct, Rbc, Wbc And Platelet Count) 7/6/2012 JAMESON MEMORIAL HOSPITAL Blood Count; Complete (Cbc), Automated (Hgb, Hct, Rbc, Wbc And Platelet Count) And Automated Differential Wbc Count 10/26/2011 JAMESON MEMORIAL HOSPITAL Comprehensive Metabolic Panel 7/6/2012 JAMESON MEMORIAL HOSPITAL Creatinine; Other Source 2/20/2012 MILLENIUM LAB OF CA INC Drug Confirmation, Each Procedure 12/20/2010 MILLENIUM LAB OF CA INC Drug Screen, Qualitative; Multiple Drug Classes Chromatographic Method, Each Procedure 7/22/2010 RX TOX Drug Screen, Qualitative; Single Drug Class Method (Eg, Immunoassay, Enzyme Assay), Each Drug Class 12/20/2010 MILLENIUM LAB OF CA INC Hemoglobin; Glycosylated (A1c) 10/27/2011 UPMC PRESBYTERIAN SHADYSIDE Lipid Panel 11/9/2010 BUTLER MEMORIAL HOSPITAL Phenobarbital 2/20/2012 MILLENIUM LAB OF CA INC Prothrombin Time; 7/6/2012 JAMESON MEMORIAL HOSPITAL Thromboplastin Time, Partial (Ptt); Plasma Or Whole Blood 7/6/2012 JAMESON MEMORIAL HOSPITAL Thyroid Stimulating Hormone (Tsh) 10/27/2011 UPMC PRESBYTERIAN SHADYSIDE Prescription Center Drug Name Current Prescribing Physician Date Last Filled Current Pharmacy Low Cost Program DIAZEPAM 5 MG TABLET COLE 12/11/2012 MEDICINE SHOPPE PHAR N/A CYCLOBENZAPRINE 10 MG TABLET ANDREW K COLE, MD 12/5/2012 CVS #04058 N/A HYDROXYZINE HCL 25 MG TABLET ANDREW K COLE, MD 12/5/2012 CVS #04058 N/A NAPROXEN SODIUM 550 MG TAB HESS 12/1/2012 CVS #04058 N/A ALBUTEROL 0.083% INHAL SOLN ANDREW K COLE, MD 11/29/2012 CVS #04058 N/A VENTOLIN HFA 90 MCG INHALER ANDREW K COLE, MD 11/29/2012 CVS #04058 N/A CARISOPRODOL 350 MG TABLET COLE 11/21/2012 MEDICINE SHOPPE PHAR N/A CLONAZEPAM 1 MG TABLET SHARO 11/19/2012 MEDICINE SHOPPE PHAR N/A SERTRALINE HCL 100 MG TABLET SHARO 11/15/2012 MEDICINE SHOPPE PHAR N/A TRAZODONE 150 MG TABLET SHARO 11/15/2012 MEDICINE SHOPPE PHAR N/A CEPHALEXIN 500 MG CAPSULE C. N HERRICK, DO 9/5/2012 CVS #04058 N/A PREDNISONE 20 MG TABLET TODD R FIJEWSKI, MD 7/12/2012 MEDICINE SHOPPE PHAR N/A SULFAMETHOXAZOLE-TMP DS TABLET HERBSMAN 6/3/2012 CVS #04058 N/A AMOXICILLIN 500 MG CAPSULE CROUCH 6/1/2012 CVS #04058 N/A CIMETIDINE 400 MG TABLET TODD R FIJEWSKI, MD 6/1/2012 CVS #04058 N/A TRAZODONE 100 MG TABLET SHARO 5/11/2012 CVS #04058 N/A HYDROXYZINE PAM 25 MG CAP SHEILA M BURICK, MD 5/3/2012 CVS #04058 N/A NAPROXEN 500 MG TABLET ANDREW K COLE, MD 4/23/2012 CVS #04058 N/A AZITHROMYCIN 250 MG TABLET HELLIER 2/2/2012 CVS #04058 N/A METHYLPREDNISOLONE 4 MG DOSEPK HELLIER 2/2/2012 CVS #04058 N/A TRAZODONE 50 MG TABLET SHARO 11/27/2011 CVS #04058 N/A CVS ALLERGY 25 MG CAPSULE ANDREW K COLE, MD 11/11/2011 CVS #04058 N/A OXYCODONE HCL 5 MG TABLET SHUJA HASSAN, MD 10/28/2011 CVS #04058 N/A DEXAMETHASONE 4 MG TABLET BEJJANI 10/10/2011 MEDICINE SHOPPE PHAR N/A FAMOTIDINE 20 MG TABLET BEJJANI 10/10/2011 MEDICINE SHOPPE PHAR N/A IBUPROFEN 400 MG TABLET BEJJANI 10/10/2011 MEDICINE SHOPPE PHAR N/A DICYCLOMINE 10 MG CAPSULE ANDREW K COLE, MD 6/5/2011 CVS #04058 N/A HYDROCODON-ACETAMINOPHEN 5-500 MICHAEL D MONTAGNA, DMD 5/17/2011 CVS #04058 N/A DICLOFENAC SOD EC 75 MG TAB JOHN DAVID WRIGHTSON, MD 5/3/2011 CVS #04058 N/A ORPHENADRINE ER 100 MG TABLET JOHN DAVID WRIGHTSON, MD 4/4/2011 CVS #04058 N/A ACETAMINOPHEN-COD #3 TABLET MICHAEL D MONTAGNA, DMD 3/4/2011 CVS #04058 N/A HYDROCODON-ACETAMINOPH 7.5-750 MICHAEL D MONTAGNA, DMD 3/1/2011 CVS #04058 N/A HYDROXYZINE PAM 50 MG CAP ANDREW K COLE, MD 3/1/2011 CVS #04058 N/A TRAMADOL HCL 50 MG TABLET ANTHONY J ELISCO, III, DO 3/1/2011 CVS #04058 N/A METHOCARBAMOL 750 MG TABLET JOHN DAVID WRIGHTSON, MD 2/14/2011 CVS #04058 N/A SERTRALINE HCL 50 MG TABLET SHARO 1/22/2011 CVS #04058 N/A GABAPENTIN 300 MG CAPSULE THOMAS A RANIERI, MD 12/18/2010 CVS #04058 N/A FENTANYL 12 MCG/HR PATCH BEJJANI 8/19/2010 CVS #04058 N/A PERMETHRIN 5% CREAM BREIT 8/11/2010 CVS #04058 N/A MORPHINE SULF ER 30 MG TABLET RANIERI 8/1/2010 CVS #04058 N/A AMITRIPTYLINE HCL 25 MG TAB RANIERI 7/19/2010 CVS #04058 N/A PROPOXYPH-ACETAMINOPHN 100-650 BEJJANI 7/6/2010 CVS #04058 N/A IBUPROFEN 800 MG TABLET MICHAEL D MONTAGNA, DMD 7/2/2010 CVS #04058 N/A CLINDAMYCIN HCL 300 MG CAPSULE MICHAEL D MONTAGNA, DMD 6/23/2010 CVS #04058 N/A Select the date to view the details of an individual claim: Date of Service Provider Status My Cost UPMC HP Cost 10/19/2012 PRIMARY HEALTH NETWORK Paid 0.00 38.50 09/21/2012 UPMC HOME MEDICAL EQUI Paid 0.00 272.29 09/05/2012 JAMESON HEALTH SYSTEM Paid 0.00 86.90 09/05/2012 UPMCS EMERGENCY MEDICI Paid 0.00 38.50 08/13/2012 PRIMARY HEALTH NETWORK Paid 0.00 38.50 07/14/2012 LUCIEN DIAGNOSTIC IMAG Paid 0.00 12.10 07/14/2012 JAMESON HEALTH SYSTEM Paid 0.00 105.05 07/14/2012 UPMCS EMERGENCY MEDICI Paid 0.00 38.50 07/12/2012 JAMESON HEALTH SYSTEM Paid 0.00 135.30 07/12/2012 UPMCS EMERGENCY MEDICI Paid 0.00 55.00 07/10/2012 UPMC PRESBYTERIAN SHAD Paid 0.00 35.78 07/06/2012 UPMC COMMUNITY MEDICINE Paid 0.00 28.60 07/06/2012 JAMESON HEALTH SYSTEM Paid 2.00 63.20 07/06/2012 LUCIEN DIAGNOSTIC IMAG Paid 0.00 11.03 07/06/2012 NORTHWEST REGIONAL CAR Paid 1.00 7.25 07/06/2012 JAMESON HEALTH SYSTEM Paid 0.00 149.27 07/06/2012 UPMCS EMERGENCY MEDICI Paid 0.00 55.00 06/04/2012 JAMESON HEALTH SYSTEM Paid 0.00 38.50 06/01/2012 JAMESON HEALTH SYSTEM Paid 0.00 116.05 06/01/2012 UPMCS EMERGENCY MEDICI Paid 0.00 96.25 05/29/2012 LAWRENCE CTY ORTHOPEDI Paid 0.00 32.45 05/28/2012 JAMESON HEALTH SYSTEM Paid 3.00 3024.81 05/28/2012 LUCIEN DIAGNOSTIC IMAG Paid 0.00 22.06 05/28/2012 UPMCS EMERGENCY MEDICI Paid 0.00 55.00 05/28/2012 PRIMARY HEALTH NETWORK Paid 0.00 51.15 05/25/2012 JAMESON HEALTH SYSTEM Paid 3.00 83.90 05/25/2012 UPMCS EMERGENCY MEDICI Paid 0.00 38.50 05/23/2012 JAMESON HEALTH SYSTEM Paid 3.00 146.27 05/23/2012 UPMCS EMERGENCY MEDICI Paid 0.00 38.50 05/10/2012 JAMESON HEALTH SYSTEM Paid 3.00 850.60 05/10/2012 LUCIEN DIAGNOSTIC IMAG Paid 0.00 7.63 05/10/2012 JOHN D WRIGHTSON MD Paid 0.00 410.25 05/10/2012 ADVANCED ANESTHESIA ASSOC Paid 0.00 155.07 04/24/2012 PRIMARY HEALTH NETWORK Paid 0.00 38.50 02/22/2012 PRIMARY HEALTH NETWORK Paid 0.00 3.93 02/21/2012 UPMC COMMUNITY MEDICINE Paid 0.00 38.50 02/20/2012 JOHN D WRIGHTSON MD Paid 0.00 59.86 02/20/2012 MILLENIUM LAB OF CA INC Denied 0.00 0.00 02/01/2012 JAMESON HEALTH SYSTEM Paid 0.00 135.30 02/01/2012 UPMCS EMERGENCY MEDICI Paid 0.00 55.00 01/17/2012 UPMC COMMUNITY MEDICINE Paid 0.00 28.60 01/17/2012 PRIMARY HEALTH NETWORK Paid 0.00 38.50 11/26/2011 JAMESON HEALTH SYSTEM Paid 3.00 160.24 11/26/2011 UPMCS EMERGENCY MEDICI Paid 0.00 38.50 11/15/2011 PRIMARY HEALTH NETWORK Paid 0.00 38.50 10/27/2011 UNIVERSITY OF PITTSBUR Paid 0.00 173.90 10/27/2011 UPMC PRESBYTERIAN SHAD Paid 0.00 1042.05 10/27/2011 PITTSBURGH NEUROLOGY C Paid 0.00 32.45 10/27/2011 NOGA AMBULANCE SERVICE Paid 0.00 90.00 10/27/2011 UPMC COMMUNITY MEDICINE Paid 0.00 18.70 10/26/2011 UPMC COMMUNITY MEDICINE Paid 0.00 18.70 10/26/2011 JAMESON HEALTH SYSTEM Paid 3.00 559.52 10/26/2011 LUCIEN DIAGNOSTIC IMAG Paid 0.00 77.00 10/26/2011 UPMCS EMERGENCY MEDICI Paid 0.00 55.00 10/26/2011 NOGA AMBULANCE SERVICE Paid 0.00 246.00 10/18/2011 UPMC COMMUNITY MEDICINE Paid 0.00 28.60 10/14/2011 PRIMARY HEALTH NETWORK Paid 0.00 38.50 10/13/2011 JAMESON HEALTH SYSTEM Paid 0.00 0.00 10/13/2011 LUCIEN DIAGNOSTIC IMAG Paid 0.00 23.32 10/13/2011 PRIMARY HEALTH NETWORK Paid 0.00 38.50 10/13/2011 UPMCS EMERGENCY MEDICI Paid 0.00 55.00 10/13/2011 JAMESON HEALTH SYSTEM Paid 0.00 1010.00 10/13/2011 PRIMARY HEALTH NETWORK Paid 0.00 46.20 10/10/2011 MEDEVAC AMBULANCE Paid 0.00 68.00 10/08/2011 UNIVERSITY OF PITTSBUR Paid 0.00 77.00 10/08/2011 PITTSBURGH NEUROLOGY C Paid 0.00 32.45 10/08/2011 UPMC COMMUNITY MEDICINE Paid 0.00 37.40 10/08/2011 PITTSBURGH NEUROLOGY C Denied 0.00 0.00 10/07/2011 UNIVERSITY OF PITTSBUR Paid 0.00 77.00 10/07/2011 UPMC PRESBYTERIAN SHAD Paid 0.00 1839.00 10/07/2011 NOGA AMBULANCE SERVICE Paid 0.00 242.00 10/07/2011 UNIVERSITY OF PITTSBUR Paid 0.00 55.00 10/07/2011 UPMC COMMUNITY MEDICINE Paid 0.00 18.70 06/23/2011 PRIMARY HEALTH NETWORK Paid 0.00 38.50 05/27/2011 JOHN D WRIGHTSON MD Paid 0.00 104.54 05/16/2011 JOHN D WRIGHTSON MD Paid 0.00 59.86 04/25/2011 PRIMARY HEALTH NETWORK Paid 0.00 38.50 04/04/2011 LUCIEN DIAGNOSTIC IMAG Paid 0.00 43.18 04/04/2011 LUCIEN DIAGNOSTIC IMAG Paid 0.00 58.95 04/04/2011 JAMESON HEALTH SYSTEM Paid 0.00 308.55 04/04/2011 UPMCS EMERGENCY MEDICI Paid 0.00 55.00 04/04/2011 JOHN D WRIGHTSON MD Paid 0.00 59.86 03/16/2011 JOHN D WRIGHTSON MD Paid 0.00 0.00 03/08/2011 JOHN D WRIGHTSON MD Paid 0.00 59.86 03/08/2011 JOHN D WRIGHTSON MD Denied 0.00 0.00 02/28/2011 PRIMARY HEALTH NETWORK Paid 0.00 38.50 02/15/2011 UPMC COMMUNITY MEDICINE Paid 0.00 28.60 02/15/2011 PRIMARY HEALTH NETWORK Paid 0.00 38.50 02/14/2011 JOHN D WRIGHTSON MD Paid 0.00 132.62 02/14/2011 MILLENIUM LAB OF CA INC Denied 0.00 0.00 02/14/2011 MILLENIUM LAB OF CA INC Denied 0.00 0.00 02/04/2011 CUSTOM ARTIFICIAL LIMB Paid 0.00 609.05 02/04/2011 JAMESON HEALTH SYSTEM Paid 0.00 88.00 01/28/2011 JAMESON HEALTH SYSTEM Paid 0.00 44.00 01/26/2011 LUCIEN DIAGNOSTIC IMAG Paid 0.00 77.00 01/26/2011 JAMESON HEALTH SYSTEM Paid 6.00 42.38 01/26/2011 LUCIEN DIAGNOSTIC IMAG Paid 0.00 15.53 01/26/2011 NEW CASTLE NEUROLOGY L Paid 0.00 183.34 01/26/2011 JAMESON HEALTH SYSTEM Paid 0.00 438.39 01/26/2011 UPMCS EMERGENCY MEDICI Paid 0.00 55.00 01/24/2011 JAMESON HEALTH SYSTEM Paid 2.00 16.15 01/24/2011 LUCIEN DIAGNOSTIC IMAG Paid 0.00 11.00 01/18/2011 UPMC COMMUNITY MEDICINE Paid 0.00 38.50 01/03/2011 JAMESON HEALTH SYSTEM Paid 6.00 142.50 01/03/2011 UPMCS EMERGENCY MEDICI Paid 0.00 38.50 01/03/2011 NOGA AMBULANCE SERVICE Paid 0.00 134.20 12/21/2010 UPMC COMMUNITY MEDICINE Paid 0.00 28.60 12/20/2010 MILLENIUM LAB OF CA INC Paid 0.00 143.02 12/20/2010 ZZ Paid 0.00 117.99 12/20/2010 ZZ Paid 0.00 233.67 12/16/2010 JAMESON HEALTH SYSTEM Paid 6.00 791.72 12/16/2010 LUCIEN DIAGNOSTIC IMAG Paid 0.00 158.57 12/16/2010 LUCIEN DIAGNOSTIC IMAG Paid 0.00 77.00 12/02/2010 PRIMARY HEALTH NETWORK Paid 0.00 38.50 11/30/2010 UPMC COMMUNITY MEDICINE Paid 0.00 38.50 11/10/2010 JAMESON HEALTH SYSTEM Paid 2.00 49.15 11/10/2010 NORTHWEST REGIONAL CAR Paid 0.00 40.60 11/10/2010 JAMESON HEALTH SYSTEM Paid 0.00 176.00 11/09/2010 BUTLER MEMORIAL HOSPIT Paid 0.00 36.53 11/08/2010 PRIMARY HEALTH NETWORK Paid 0.00 38.50 09/16/2010 JAMESON HEALTH SYSTEM Paid 6.00 177.73 09/16/2010 UPMCS EMERGENCY MEDICI Paid 0.00 55.00 09/13/2010 ALLIED PAIN TREATMENT Paid 0.00 38.50 09/13/2010 JAMESON HEALTH SYSTEM Paid 4.00 62.00 09/09/2010 PRIMARY HEALTH NETWORK Paid 0.00 38.50 08/25/2010 JAMESON HEALTH SYSTEM Paid 6.00 105.10 08/25/2010 UPMCS EMERGENCY MEDICI Paid 0.00 38.50 08/19/2010 EBI MEDICAL SYSTEMS IN Paid 0.00 154.00 08/18/2010 UPP ANESTHESIA Paid 0.00 299.84 08/18/2010 UNIVERSITY OF PITTSBUR Paid 0.00 8.84 08/18/2010 UNIVERSITY OF PITTSBUR Paid 0.00 8.25 08/18/2010 UNIVERSITY OF PITTSBUR Paid 0.00 154.00 08/18/2010 UNIVERSITY OF PITTSBUR Paid 0.00 7.63 08/18/2010 UPMC PRESBYTERIAN SHAD Paid 6.00 1833.00 08/18/2010 UPMC COMMUNITY MEDICINE Paid 0.00 1100.00 08/18/2010 UPP ANESTHESIA Paid 0.00 53.90 08/18/2010 UPMC COMMUNITY MEDICINE Paid 0.00 18.70 08/18/2010 CLINICAL & INTERVENT Paid 0.00 8.25 08/18/2010 CLINICAL & INTERVENT Paid 0.00 8.25 08/18/2010 PITTSBURGH NEUROLOGY C Paid 0.00 32.45 08/18/2010 PRIME CARE INTERNAL ME Paid 0.00 46.20 08/17/2010 UNIVERSITY OF PITTSBUR Paid 0.00 55.00 08/11/2010 JAMESON HEALTH SYSTEM Paid 6.00 80.90 08/11/2010 UPMCS EMERGENCY MEDICI Paid 0.00 38.50 08/03/2010 LUCIEN DIAGNOSTIC IMAG Paid 0.00 157.42 08/03/2010 JAMESON HEALTH SYSTEM Paid 4.00 434.64 08/02/2010 LUCIEN DIAGNOSTIC IMAG Paid 0.00 11.00 08/02/2010 NORTHWESTERN PENNSYLVA Paid 0.00 75.16 08/02/2010 JAMESON HEALTH SYSTEM Paid 4.00 80.15 08/02/2010 JAMESON HEALTH SYSTEM Paid 2.00 147.27 08/02/2010 ALLIED PAIN TREATMENT Paid 0.00 139.66 08/02/2010 UPMCS EMERGENCY MEDICI Paid 0.00 38.50 08/02/2010 ALLIED PAIN TREATMENT Paid 0.00 12.10 07/22/2010 RX TOX INC Paid 0.00 77.17 07/19/2010 ALLIED PAIN TREATMENT Paid 0.00 99.41 07/19/2010 JAMESON HEALTH SYSTEM Paid 4.00 62.00 07/13/2010 UPP ANESTHESIA Paid 0.00 53.90 07/12/2010 UNIVERSITY OF PITTSBUR Paid 0.00 7.63 07/12/2010 UPP ANESTHESIA Paid 0.00 374.80 07/12/2010 UPMC PRESBYTERIAN SHAD Paid 6.00 1833.00 07/12/2010 PRIME CARE INTERNAL ME Paid 0.00 72.60 07/12/2010 UPMC COMMUNITY MEDICINE Paid 0.00 1373.21 07/07/2010 BUTLER MEMORIAL HOSPIT Paid 0.00 0.00 07/07/2010 PRIMARY HEALTH NETWORK Paid 0.00 38.50 07/07/2010 WEST PENN ALLEGHENY ON Denied 0.00 0.00 07/07/2010 WEST PENN ALLEGHENY ON Paid 0.00 60.67 07/07/2010 BUTLER MEMORIAL HOSPIT Paid 0.00 314.81 07/06/2010 UPMC COMMUNITY MEDICINE Paid 0.00 28.60 07/06/2010 LUCIEN DIAGNOSTIC IMAG Paid 0.00 11.03 07/06/2010 JAMESON HEALTH SYSTEM Paid 4.00 60.25 07/06/2010 NORTHWEST REGIONAL CAR Paid 2.00 6.25 07/02/2010 JAMESON HEALTH SYSTEM Paid 0.00 44.00 06/11/2010 JAMESON HEALTH SYSTEM Paid 0.00 132.00 06/07/2010 PRIMARY HEALTH NETWORK Paid 0.00 28.60 06/01/2010 UPMC COMMUNITY MEDICINE Paid 0.00 84.62 05/24/2010 PRIMARY HEALTH NETWORK Paid 0.00 28.60 Health Insurance Spending Summary Spending Summary: 01/01/2012 to 12/15/2012 Deductible Co-Pay Co-Insurance UPMC HP Cost Member Responsibility Total Medical Services: $0.00 $15.00 $0.00 $6,735.95 $15.00 $6,750.95 Pharmacy: $0.00 $76.00 $0.00 $1,480.34 $76.00 $1,556.34 Total: $0.00 $91.00 $0.00 $8,216.29 $91.00 $8,307.29 Deductible: Amount member is responsible for based upon current plan benefit, before other coverage benefits apply Co-Pay: (abbreviation for Co-Payment) Amount for medical services or pharmacy costs that member is responsible for paying on the current benefit plan Co-insurance amount: amount that may be due after the members deductible is met based upon the current benefit plan UPMC HP Cost: Total cost that UPMC Health Plan is responsible for paying Member Responsibility: Total cost the member is responsible for paying (including the deductible, co-payment, and co-insurance amounts) Total: Total cost of medical services and/or pharmacy costs The following information is provided for THOMAS E. GENNOCK SR. and is provided by UPMC UNIVERSITY OF PITTSBURGH NEUROSURGICAL ASSOCIATES / UNIVERSITY OF PITTSBURGH MEDICAL CENTER Dr.Ghassan Bejjani, MD RE: Gennock, Thomas DOV; 01/31/2011 Administrative office Aiken Professional Bldg. Suite 400 532 South Aiken ave. Pittsburgh, pa. 15232 412-623-6910 Toll Free 1-866-835-5928 Fax 412-623-6911 HERE IS THE ORIGINAL MEDICAL RECORDS WHICH I HAVE SUBMITTED TO YOU , Diagnosis Studies, MRI DATED 05/06/2010. MRI was reviewed and showed the presence of C5-C6 and C6-C7 degenerative changes with moderate canal stenosis and significant neural foraminal stenosis. The patient underwent surgery in the form of C5,C6,C7 anterior cervical diskectomy with allograft fusion and plating July 12, 2010. August 17, 2010. Patient was found to have foot drop and was sent to Shadyside Hospital ER. PATIENT UNDERWENT SURGERY in the form of a right lateral L5-S1 diskectomy. Nov. 30th, 2010. Arm / leg / feet and hand numbness which was constant. Weakness throughout extremities. Patient was admitted and was recommended to undergo imaging of the total spine as well as EMGs. Dec 21, 2010. MRI was reviewed and showeed the presence of mild athritic changes in the cervical spine. Patient is diagnosed with Cervical Spondylosis. Patient also had L5-S1 HNP. D: 01/31/2011 10:20 PM (EST) T: 02/01/2011 04:18 AM (EST) RADIOGRAPHIC REVIEW : Diagnosis studies reviewed; March 14,2011 1.) Cd provided containing MRI study of cervical spine dated 05/06/2010. Study demonstrates degenerative disease at C5-C6 AND C6-C7 with degenerative bulging disc at this level creating mild to moderate Spinal Stenosis at C5-C6 and C6-C7. Aug 3,2010 2.) MRI study of thoratic spine demonstrating degenerative changes. Aug 3,2010 3.) MRI study of the lumbar spine demonstrating degenerative disease with minimal bulging. Dec.14,2010 4.) MRI study cervical spine demonstrating a well decompressed spinal canal from C5-C7. Dec 16,2010 5.) MRI study of the thoratic spine with normal degenerative disc disease. Dec 16, 2010 6.) MRI study of the lumbar spine demonstrating once again degenerative disc disease with minimal bulging. 7.) Additional studies which where reviewed by UPMC Shadyside Stentor. X-Ray of the cervical spine with a marker at what appears to be the C4-5 LEVEL dated 07/12/2010. 8.) X-Ray of right ankle which appears to be normal dated 08/18/2010. No evidence of a fracture. ( Foot Drop ) 08/18/2010 9.)MRI study of the cervical spine demonstrates a C5- through C7 anterior cervical discectomy and fusion. 08/18/2010 10.) MRI study of the lumbar spine demonstrating minor degenerative disc disease with minimal bulging. 08/18/2010 11.) X-Ray of the lumbar spine with a marker at the L5-S1 level JAMESON HEALTH SYSTEMS DEPARTMENT OF MEDICAL IMAGING 1211 WILMINGTON RD. NEW CASTLE, PA. 16105-2595 MRI0198 MRI THORATIC UNENHANCED EXAM DATE : 08/03/2010 10:37 AM There is mild disc space narrowing in the lower thoracic region most significant at T10-11. Mild postenor disc bulging noted at T7-8 and T10-11resulting in mild impression upon the anterior aspect of the thecal sac. There is a Schmorl node defectinvolving the inferior endplate of the T10 vertabral body. Mild disc space narrowing and de generative changes most significant at the T7-8 AND T10-11 level. MRI0218 Dec 16,2010 10:45 am Slighr desiccasion of disc material and disc space narrowing at L4-5 and L5-S1 neural foramen stenosis. Small amount of increased T2 signal within the left multifidus muscle, longissimus thoratic cyst muscle and quadratus lomborum muscles on the left T12 to L2 levels MRI0198 MRI THORATIC EXAM DATE 12/16/2010 10:21 AM NO CHANGE MINIMAL DISK SPACE NARROWING AND DISK BULGE AT T7-8 AND T10-11 MRI0215 MRI CERVICAL EXAM DATE 12/16/2010 11:15 am Prior anterior fixationdiskectomy C5-6 and C6-7. Metalic artifacts limits exam at this level. Minimul disk bulge and degenerative change at C5-6 and C6-7. Minimal foraminal compromise is seen bilaterally C5-6 with moderate foraminal compromise bilaterally at c6-7. PREVERTEBRAL SOFT TISSUES ARE UNREMARKABLE Foraminal encroachment C5-6 and C6-7 status post anterior diskectomy and fixation. Foramen compromise and canal compromise is diminished as compared to prior study of 5/10. RAD2240 CERVICAL SPINE 2 VIEWS AP/LAT EXAM DATE 01/24/2011 9:22 AM Post operative fusion, pain No change compared to prior studies. Minimal scattered degenerative changes are noted. Unremarkable post operative cervical spine
Posted on: Tue, 08 Oct 2013 00:43:46 +0000
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