D.N. HHD-CV-21-6140017 S
`
`LUCY BOUCHER
`
`vs.
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`TODD BROWN
`
`:
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`:
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`:
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`SUPERIOR COURT
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`HARTFORD JUDICIAL DISTRICT
`
`NOVEMBER 20, 2024
`
`PLAINTIFF’S POST-HEARING BRIEF REGARDING DAMAGES
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`I.
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`INTRODUCTION
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`On October 23, 2024, the court held a hearing in damages in the present matter.
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`Per the decision, an order was rendered requiring Plaintiff to file a Brief, supporting
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`affidavit(s) and documentation on the issues of damages, and costs.
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`II.
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`ECONOMIC DAMAGES
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`Plaintiff suffered physical injuries from Defendant’s actions when Plaintiff
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`attempted to exit the van operated by Defendant; and the van began moving causing
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`plaintiff to hold the exit door by pushing off with her left foot and moving her left leg and
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`left foot to the left. Then, the van came to an abrupt stop, injuring her shoulder, shoulder
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`blades, and left knee. Plaintiff sought treatment for her injuries at Concentra (Ex 1),
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`Hartford Healthcare (Ex 2), and Select Physical Therapy (Ex 3). Plaintiff’s medical bills
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`total $8,367.33 (Ex 4).
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`Plaintiff missed time from work due to her injuries and subsequent treatment.
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`This caused additional economic damages to Plaintiff. Plaintiff missed a total of 83 days
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`of work due to related doctors’ appointments from her injuries (Ex 4). Plaintiff testified
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`that her hourly pay rate was $10 per hour full time. Therefore, Plaintiff’s lost wages total
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`$6,640.00.
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`Plaintiff’s Economic Damages total $ 15,007.33. (Ex.4).
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`

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`III. NON-ECONOMIC DAMAGES
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`
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`Plaintiff testified to her physical injuries and emotional harm. Plaintiff suffers
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`chronically from her injuries related to her car accident and lives with pain, loss of
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`enjoyment of social activities, and difficulty doing daily tasks and mental anguish.
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`Plaintiff should be compensated for her pain and suffering.
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`V.
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`
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`Litigation Costs
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`The litigation costs total $665.87. (Ex.5).
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`VI. CONCLUSION
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`
`
`In conclusion, back pay damages should be awarded in the amount of $6,640.00.
`
`Her medical bills total $8,367.33. Her total Economic damages are therefore $15,007.33.
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`
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`Compensatory damages should be awarded to compensate the Plaintiff for the
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`pain, suffering, mental anguish and daily difficulty Plaintiff has had to endure due to her
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`injuries following the accident. The precise amount is for the court to determine.
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`Plaintiff’s counsel suggests $75,000.00. Litigation costs of $665.87 should be awarded as
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`well.
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`By /s/ Matthew V. Bertolino
`Matthew V. Bertolino, Esquire
`Sabatini and Associates, LLC
`One Market Square
`Newington, CT 06111
`Tel. No.: 860-667-0839
`Fax No.: 860-667-0867
`e-mail: mbertolino@sabatinilaw.com
`
`Attorney for Plaintiff
`
`2
`
`

`

`ELECTRONIC CERTIFICATE OF SERVICE
`
`I hereby certify that on November 20, 2024, a copy of the foregoing was emailed
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`to the following:
`
`Todd Brown
`128 North West Street
`Feeding Hills, MA 01030
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`/s/ Matthew V. Bertolino
` Matthew V. Bertolino
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`EXHIBIT 1
`EXHIBIT 1
`
`4
`
`

`

`#2/27
`
`Concentra
`
`Transcription
`
`Concentra
`
`Transcription
`
`_
`
`.
`
`258-e442
`EBOSOR, CY 26095 (8€0)
`1980 Doy Bikl Road
`860). 294-Geaz
` INOSOR, C7 06095
`1030 Day HELL Rosd
`
`
`
`Patiert: Sesvke Date8=0366/2019 Service Dota:=99/06/2015Bouchar, Lucy X Patient Boucher, Lacy K
`
`
`
`
`
`Soe, Sat. #|tid bejury Daze=(03/03/2015 Soe. Sec. #frti‘é<S Injury Dates«=63/03/2079
`Owe of Sith.-. - QF Age $3
`.
`Omployer:
`«CA Services
`-
`t ae:
`.
`Age 62
`Employer
`GCA Services
`
`
`
`
`
`
`
`
`Secvica Locatiom: crc ~CEWindsorCNC ~ CT Hindsor : : 4 Schoenhosster Set . m Ee 2 Schoephoester RA - |
`
`
`
`* Service IDK”
`tagpsansss
`* Serwice 1D #:
`ae
`3190540955
`.
`Windsor Locks, CP 06096
`=
`Rindsor Locks, Cr 06096
`.
`Chairs:
`carrcpz7isza
`Cale: 2:
`ca77cs271020
`Slazox
`Jeear Lottus
`Olctaror—
`Jason Lofts
`Diagnosis:
`S46.911K SYBAIS ONSPMUSC/FASC/TERD aYsmu? ARM, EIGAY ABit, UeTT-846.9518
`Offeqmuasis:
`S46.9114
`STRATEN UNS? WUSC/FRSC/TERD AT SHLOG/OP ABM, RIGHT ARM, TNTT-S45.921a
`Motes: tesred clapiny no weekoess. Bo msole atcopiy is present. Yasculat: The psloce sce
`Notes: Respiratory: Reviewed exc fourd to be negative.
`Gastrointestinal; Bavioned and fcana to bn aecatiys,
`2+/2+ balatersliy ond ceplldaxry cefill time is normal hiieterelly. aogative Spurling
`Ss Monexver.
`-
`Geeitourinary: Revlewsd and found co be negetive.
`Theracic Spine: Appearance is mocmal. teaderneus mot in the thoracic cpine. Anterrcapelas
`Musculenkeietal: Ieft kaee/ right shoulder, joint pain, muscle pain, back puin, Joint
`aveliing, joint stitfress ond myscle seakness, but Reviewed and found to be negative.
`seicle tettercness. Palpetion revrals ne bilateral mscle spases.Raage of norica Livited
`im sll placee. Tlexicn Alta of 0 degrees and painful. Right zotation ABRDM of 30 degrees
`asd painful. Left cotation AROM of 36 degrees and painful. Motor strength norm .Rormal
`motor Cora.
`Weurologic: Sensatiow is istact to light touch in ali dermatones tested. To= muscles
`tesbed display no weakeeas. bo muscle atrophy ia
`Vascular: The puizes are
`2#/2+ bilsteraily and
`illary xefill tine is sormml iilateraliy.
`Neurologic: sansearicn intact to Light touch.
`wait.
`
`Skin: Rormal wichoor rv or iegicos. Morealaxutpor.
`Sbyeicel Exen
`Paychiatric:
`. wood and affect are appropriate.
`Vital signe were reviewed apd found to bc anremarkeble.
`Constitctional: well appearing and wel] sourished.
`in no acate distrras.
`AWEISHESS
`Wead/Face: Moceccephalis and etzraumatic.
`l. Shoulder strain, xcight, initizl encounter (84€.912A)
`Bulnonacy: no inczeased work Of Dreathirg or aligns of reepicetory distress. afl iorg
`2. Thoracic myoEasciel stcain, initial eacoanter ($29.913h)
`€4@ldeg clear te ousculitarice: hileterably.
`Cardiowascular: oormak xate and rhythm, normel §2 and 97, without gallope or mute.
`3. Stesin n€ neck muscle, initial encounter (AY R-10A)
`bieHnen stcaia, left, isitial encounter 15€6.5912a)
`ieisPoyaical Derepy Refercal Physical Therapy Jee Referral Comment! Sequected fora
`Orderes:For: Shoulder strain, right, initial excounter, Strain of neck miscle, initial
`ancounber, Thoracic myofascial strain, initial encounters Ordered Gy: Lofton, Saso
`Performed; Sue: 26M8c2019
`Body Pact = =: Cpper Back Ares
`Laverality 1 ¢ Rigdt
`Body Sart 1 < Shoulder [st
`
`08:16AM;CBS, :
`
`05-01-19
`
`Right Shonider: Apgearance is nomeel. Yenderoses in the enterior glecchmeral fount,
`in the
`va muscle,
`in the anzertor shoolder, in the Lateral ahoalder and in
`ths posterior shoulder, but sot in the supraspinatns mascle. Palpates nonsal. Limited
`range of morton in ail planes. Forward Flextons AROM 120 Segrees with palin. Adgoction:
`RROM 160 degrees. Linited upward caaching, internal aed eaternal rotation. Abduction
`ia 4/5 om the right side with pain. Ieternzt rotation is 5/5 on the right side witkoat
`pain, External cotatiog is 4/5 om the right side with peie. Motor tome ia aormel.
`Becenlogics Bilateral deep tendon reflestes are 2/4. Eenzation is intact to light couch
`in abl dernmatones. The eescles dispisy no wazkoass. Vascular: The puises ace 2+/2+
`bilaterally and capiilary refitl tine Is nornsk hilaterelly. Rorator Coff Testis}:
`positives paintul acc, posttive Howkin = test axl positive espty comm test, bot megetive
`arcp arn test.
`lett Enwe: Appears “ith no ecchymotis, no eifusion, es erythems, po Jaint bypertxophy
`and mo swellipg. Appearance is cormat. There is tewdercess diffusely over the anteronsdiai
`aspect aud over the medi22 jaint Iine, bet ast diffusely over the anterolateral
`et ovax thu isteral joint line, not iz the oosersorface ef the porelis and nor in
`the quadricepy teedon. Falpetes ocrewl. Tull range of aetioa. Scter atrength iv normal
`on che SeEc side, Motor tene is normal.
`Weurciogic: Bilateral deep cesdon reflesed are 2/4. Sensation is iatact ro light couch
`fo oli Germatoenr. The sucles displsy no veskonss. Veecolacs The pulses are 24/2}
`biistecaliy end capillary refill tiee is normal bilaterally. Ligerentaus Laxity Testis}<
`aegative Anterior Drawer sign, oo laxity on valgus ectrees and eo laxity on varus stress.
`Heniscel 7est{st: negotive lateral Mcturray tent and negative medial ueMsrray test.
`Segative Hosmses sige test. Mild pain with McMorrays, bet no sharp pein.
`Cervical Spine: Cervical Splee: Appearance is Bors]. Tentarness in the cight trspeziue
`moscie amt left traperive seeett nat che cervical spine, nor the left parsspinel
`@nd not She right paraspinal. Bliateral copper thoracic sod interacepular awscle. 2ulpation
`ceveale oo bilateral euscle spnem Full cange of action. Pein ip rotation right and
`left. Lotect., Inatect-
`Hevurologic: Sensation te intact te light teach in all dermeatones tested. The woscles
`
`Therapy Order <= fvaloate and Treat
`Start PT, Use muscle relaxer cocly et night. Use lbuprofea.
`Mork restcicticas.
`Recheck friday .
`£LL "TRE PEYIENT & MEDICATZORS FOR ERIS ENCOUUTEA WERE DISPERSE Us TRE CRUTER.
`
`Bisouselém/Seematy
`Right shoulder stxvais with cotater cuff injury. Hill start PT at outside facitity
`closer to Gome per hec regest.
`Cyclobenzaprine ‘ag “ispensedfor night time use,
`Work restrictions.
`tne dieqoers anid treatment plen ware discassed with the a The petisnt expresees
`understending 203 «s2 told to keep their schedoled appoin:
`or Zollow-wp asd/or
`te cotucn to Ceacent=a.
`
`Heated6Hasstettes
`
`
`
`~~BitcetedBy-Suaraiota——~—~S
`
`Nicteted On: Mar
`7 2015 8:50am
`Oictazed On: Mas
`7 2019 B:5ean
`
`
`
`Printed Date: Printed Dave.=03/05/202903/08/2018 Page 2 Page: 3
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`

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`#3/27
`
`ERILLWansealesion Dats:
`‘Transcription
`Concentra
`DCN: 501367224 “
`ChentSOEG:WPDICOSKBOs
`
`1669 Ony Gili Bead
`
`wmEDGOR, CT 06095
`
`{860} 29¢-B44a2
`
`Windsos Locks, CT 06096
`
`Act.
`
`ths
`
`.
`
`|b
`
`A
`
`———:
`
`CBS‘ ’
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`Padient Service Dale=_-0306/2019Boucher, Lucy #
`
`
`
`Soe. Sec. # a: bejury Date:989:3/83/2019
`Daneof Birth |i Age 62
`Employer:
`GCA Servicer
`Service Location;
`§=ONC — CT Gindese
`4@ Schorphoester Bi
`Service 1D @:
`T190S4B9S6
`Cam &
`CBTICIZ7L020
`Dictator:
`Sasson Loftus
`
`Dhageasis;
`£¢6.911R STEADN ONSP MUSC/FASC/TERD AY SELOR/OF ARM, BIGHT ARK, TMIT-5¢6.5118
`Wotes: Bessen For Visit
`Chist Complaict: The pacient presents today with patient went to get off trazsport
`van end the driver didn ¢ pat in pare and patient Celt » jerk and pain ie the left
`ver.
`inese wight skeslders and back. Self coported. Horkecs Conpensatien — Pationts Occupatico:
`Vitals
`Witai Stans
`Recorded: 1arZ019 O1:24Rt
`lic: 108
`Bate: 68
`Respiration: 16
`Emight: = fc 2 in
`Weight: 205 lb
`Pex Celcrlated: 37.5
`BSA Cakculatod: 1.33
`02 Satrrarion: 192
`Pnet Medical History Roar
`PAST MEDICAL, SOCIRL, FAMILY RISTORY) Won-oontributory based on xaview with patient
`ené/ox comprebeaoive qusstionnalse.
`Ristoxy oF Present Tilness
`P|mer
`Pt
`° passenger ic 4 wan at work. Lt was oarked, amd abe wan getting gut of the
`wide door end the door was open ami shc wa> leaning oo the door with right
`and
`She noted the van was «till sowing. It war not per is park. The driver jieped
`a
`the van anc janed the break caceing har te jork forward ehruptly. She had
`back
`knee twisted ag is got caught in the seat. She has left anterior wets] knee
`her 1
`pein 4710. Bo bruising or swelliog. See has sharp pain xight shoulder witt 8/10 sharp
`pain with reaching. Ess poor BOM. Has tingling in ali 5
`fingere right band. Eas nock
`and interecenglac muscie tightasss 20d opess. She see ceen io the ER sect day. Froated
`for strains. No Xcays indicated.
`QGccupational Eistcsy
`Gad
`Occupational Ristory was
`Pex
`Type of job / dob
`title: wriver
`Kajoc job fuomtiocos: drawer.
`Avecege dally work howra: 8. Average weekly work hours: 37-
`Expected
`
` Ser:Rowiewsd end fouad to be eoystive.
`
`08:16AM' ’
`05-01-19
`
`7 Z01P SrSOMM
`Dictate Ge: plac
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`
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`Printed Date:963705/201° Page: 2
`
`Review of Syatens
`Comstirutiosal: Reviewed ard found.to de neystive.
`Beak and Pacat Seviewsd anid fousc to be negative,
`
` Byes: Reviawac enc fount to be pegatt .
`Cat@icvascular: Hevicwad and found to be cegetive,
`
`IT
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`us
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`

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`#4/27
`
`Concentra’
`
`TranecripGon
`
`LUSU Day RLLL Romd
`
`=6WINDSOR, CY O6O9S
`
`LBS) 298-8467
`
`02/06/2019
`Serwke Date
`Boucher, Lucy #
`Patient:
`
`
`Soc. Sec.$ lejezy Dare==—-027032019Daz-si~e993
`Date of Birth:
`02/03/1557
`Age 62
`Employes:
`GCA Services
`Service Location:
`cist - cr Windsor
`@ Schoepboester Rd
`Service D #:
`1199540356
`Claim &
`C877CS27 3020
`Dictator:
`Jason Lofers
`IMIT-Si6. 911A
`Olaguosic
`S46.9.1A STRAIN WISP MUSC/PAEC/TOAD AT SOLOG/CP ABN, RIGHT APM,
`Moves: Sistory and nmechanios of injury were obtained direstiy from thm patient, “mless otherwise
`noted, anf appesr =o be comgistent vith preasnting synptoms and physical exan.
`
`Windsor Locka, CT 06056
`
`Seapervising physicier coviewsd tha chart aed concurs with the fimsal disposition.
`hevivicy Staten and Aettrictions
`Treateent Bracns:
`Rerurning for follos~up: Friday
`activity Statos
`Retucn to noditead work/sectivity todey.
`S@ork Doretion
`Patient say vork their entice onift.
`Restrictions: KZY ~ Gccasionslly = up to 3 brs/day, Frequently =< ap to 6 hrs/day,
`Constantiy = op to § hoers or greater per dey
`May lift up te 10 ibe cccasioosily
`He reaching above shoulders with affected exrrenityis).
`ADCITIOWAL RZETATCTIONS AND LIMITATIONS: Bo diving work veticiens. Ka reaching or Lifting
`with right aon.
`PXTTEMT INSTRUCTIONS:
`
`Signatures
`Electrooicaily signed by : Jaron inftus, BA~C; Max 6 2019 Z:4iDH EST ~ Axcthor
`Blectronicolly siqned hy : Amarilivs Rodriguez, 4.0.2 Mar
`7 2013
`§:59R% EST - Adninistracive
`
`08:16AM;CBS' /
`
`05-01-19
`
`Rictated On: Mme
`Printed Date:
`
`7 2015 SrSnne
`03/08/2029
`
`Oictated G¥l Jascc Lotto
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`Page
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`¢
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`#5/27
`
`Concentra
`
`Tenenecipaon
`
`Concentra
`
`Tonneceenett
`
` 2980 Day Hihl Qoad weenson, cr 06095 (860) 2798-84482
`
`
`1080 Day Bit) Boma
`HIMDSOR, CT D6035
`(a6ey 258-8442
`
`~~
`
`Diacasatoo/Sumary
`Slight improvement todey. Continue PE ard pork zestrictions.
`The diagnoses ao4 treatment plan were ciscnssed with the pattent. The patiene expressed
`umlerstandiay and was told co keep theirs schedeled appointments fer fcklow-up and/or
`fo return to Concentra.
`
`Supesvisieg physician reviewed the chert acd comocurs with the floal disposition.
`Betivity Stacce anc Restrictleos
`@reatment Stetis:
`Beturaing for follow-up: 1 weak
`Activity S5tatas
`Weturn to modified work/aciivity voday.
`Mork Duration
`Patient aay work thefc entine shift.
`Restricttann: KRY - Oosasiansliy ~ up to 3 bravday, Preyenatly =~ up co & hrs/day,
`Cemstaatiy = up to § hours or grester per oxy
`May itfc up ta 10 Ibs omsnionsliy
`Ro reaching above abouicerse with aftected extcomity ts).
`ADDITIONAL REETRICTLOGS AND LISITATIONG: Yo dciving werk vebicles.
`PRIISHT TRKOTANCTIONS:
`
`Siematurces
`Elactrosicelly signed by : Jasqa Lotus, @A-Cz Mex 11 2019
`Blectronicaily signed by : Terese Allen, 4.D.s Har 37 2619
`
`1:59PM BS - Author
`9:14Pa EST ~ adeioistretive
`
`
`03/11/2019
`Service Dats:
`Beuctere Lucy #
`Patient
`Potter
`Boucver, Lucy
`Service Date;
`exit/enis
`
`
`Sor, Sec # TY Injury Date=03/03/2019Inkry Date: 63/03/2013 Suc. Soc. # t
`
`
`
`
`Dare ofRintix|sd Age 62 Employer:=ca ServicasEmployers. GCA Sexwicea Date of Bide Age: 62
`
`
`
`
`Sesvice Location:
`«GS - CT Windsor
`fare
`4 Sctoeplmester Ad :
`Survice Locatios:
`«cH ~ CT Rintecr
`,
`4 Schoephrester Bé
`Service ID #&
`rigosaan2z4
`.
`:
`Service ID #:
`1190524024
`“indsbr Locks, CF RGO3E
`Fa
`©
`Clain @:
`CBITTSIFLGDD.
`Winteor Locks, Cr 26986
`Chain
`CBI7CS771020
`Dictator
`Javon Loftus
`Dicearar:
`Jeeon inftes
`g
`Magaods:
`$46.92LA SIRAIM URSP MISC/FASC/TEND AT SHLDS/UF ARM, RIGHT ARH. IYTT-S46.921a
`Obkgsesis:
`SM6.S11A STRAT UNGP MOSC/FAGC/TOND AT SERDE/GP ARM, RIGHT ARM, PATY-s46,9228
`Noles: Goummmta:. elevated biocd pressure today-
`:
`Motes:BHO MEDICATIONS tere VRRSCATBED O& DISFENSED FOR THIS HBCoUNTaN_
`Cocstiraticnal: well
`ant weil ferithed. in o> acete distress.
`fead/Face: Bornocephalic ant atranaaric.
`Pulmewary: ac incimaned work of breathing or signs of respiratory distress. ali Jung
`fields clear to auscultation bilareraliy.
`Carticrascelars noutal rate and rhythe,Vora) Sl end S2, vithoot gallops ox rubs.
`Right Shoulder: Apgesranoe in normal. Tenderness in the anterior Glennmwneral 4oint,
`in the
`tus muscle, in Lhe -trapeartius misvie, in Che anbarior shoulder and
`is the
`shoulder, bet mou in the aC foinc. Falpmtes monssl. hiatted cange of
`motion in all planes. Lecks esd xangs of intcroal end extarms] cotation- Abductian
`iw 4/5 on the zight side with gain. Eatecns] rotation is 4/5 on the right side wits
`pain. Motce tome as normal.
`Heurelegic: Ailareral deep teedoa refiexen are 2/4, Soneation is intact to Lb
`touch
`in G11 Getmatomes. The nascleschesdisplay no ungirens. Vascular: The pulses are 2t/2+
`bilaterally ant
`is pormal Dliaterelly. Botator Cuff Testis}:
`eum test.
`en Painful arc, positive Eawkin 4 test and positive ampty can test, bot nogstive
`Oarvicat Spina: Cervical Spine: Appearance i> normal. Teederneas ta the right paracpinal
`{wvscnlar, CS, C& and C7 } and right trapezius mmecle, Pot mot the cervinal spine, .
`tot the ieft perespinat std oot the left traperins woscls. Pelpation reveals no bilaterel
`muscle spayna. Limited ranges of notice. Flexion: ARON of 43 degrees, Right Botatiasc:
`ARON of 55 Gegrees ast painful. Left Rotation: ABOM of 55 degrpes and peictol. Intact.
`Totact.
`Baucologic: Saosation is intect to ilght tewch fo alt cerzatcess tested. rho auscles
`vested display no weakases. Bo mcacle atrophy ia peneunt. Vewcular: The pulees ara
`2072+ bflatexally and capihlery refill tine is nore] bilateraliy. eegative Spurliang
`= Menecrer.
`Thoracic Spine: Appearance fs normal. Tenderness in the right partspinal, bot act
`in the thoracic spine. Right wppar thoracic and interscapular muscle tenderness, Faloates
`Doras! .Range ¢f motion limited in ali plencs. Plesion dH of 60
`Race and painfal,
`Right rotation AROM of 35 degrees oni] peinful. Loft rocotion ARCH
`35 degrees ani
`puinful. Motaz strength mormel.
`Daurclog2c: Seneation Ac iotsect to light rouch in #ll dereataess tested. The susclen
`Tasted display so weakuess. Bo muscle atcophy is praesent. Vescolar: Yoo pelees acu
`2+/24 bilaterally and caplilsry sefill <ime f4 norms bilaterally.
`Maurclogics sensation iorecce to light teuch. nomen gait.
`Paychiatric:
`- nood and affect are appropriate.
`Yurecticnel Restoration and Statmas of Hacling
`2.
`agBogaul Sa approximately 25% of the way toward meeting the physical requiracents
`ASSESSHERT
`1. Stouldex strain, right, initisl ercoenter {545.971A)
`2. Stesin of peck mascie, initial epcounter (Si6-L1A>
`3. Thoracic myofascial strain, initial enrenuter [525.0190]
`on
`hi Beer strain, left, initia] encaynter (506.912A}
`Censtinva spscie relaker when at bane. Continuwe PI. Ketheck 1 week.
`
`:16AM;CBS
`05-01-19
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`
`
`——"Wiktktes@yJessterreus———O—=—“‘“S*S*S™~*”Dictsredy=SancoleftsO—~—S
`08‘ /
`
`Dictated On: Nex 17 2019 9:25eW
`Oictated Da: Mor IT 2015 $25
`ee
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`Printed Date:903/12/2019 Page 2
`Printed Date:
`03/18/2019
`Page 3
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`#6/27
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`SRLTreceniscieDet:
`DCN: 501383643 ~~
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`Concentra
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`Transcription
`
`1080 Gsy Mill Rosd
`
`)=6WIREGOE, Cr 06695
`
`Boacher, Lucy #
`
`Service Dale
`03/11/2013
`Patten:
`injury Date:
`§=—.030342019
`Soc. Sec. #
`pane Ramos
`fomoenaem sot
`§=oac - CI Windsor
`4 Schoephoester BS
`Servece Location:
`1190864026
`Service © 4:
`C677C9275020
`“imieor tocks, tr 06056
`Chin #
`Jason Lofeus
`Olictator.
`f4€,913N
`STRAT DMS? MUSC/FASC/TESD AY SHLOR/UP ABH, RIGH? ARM, THIT-S46. 911A
`Dlegaesis=:
`Notes: Beason For Visiz-
`Chief Cosplaint: The patient pretents today witk petiemt left keee, caget shomldar
`ack beck iojucy with neck pain. Self reported. Borkers Compenaation — Patieat «= Cccepstion:
`dxciver-
`Vitals
`Vital Signs
`Racorded: Llsarz0le 12:25
`Syatolic: 154
`Diastolic:
`Bezct. Rate: 97
`Aespiration: 1€¢
`Beight: 5 Tc 2 in
`waight: 205 1b
`BMI Calculated: 37.5
`BSA& Colcnieted: 1.52
`02 Saturation: 100
`Peat Macical Sistory Bavior
`PAST MEDICAL. EOCIAL,-TAMELY MISTURY: Non-comtcibutory based on review of interval
`hiatory.
`OSetory of Prusoot Ilinass
`Pt has comtinsed pain rignt cervical meecles, rignt Crapezibs and interscapuler mosclas.
`Pain is eching aml scoetincs abarp «ith spasm with G/L0 pein. Hse right shoulde- 8/10
`Dernkug pain. Fain with cesctriog and Lifting. Sas tingling occasionally ia cight axe
`and bend. Gas 3720 occasional ebacp left anterior medial knee pais with twisting aoticus.
`Ste bes started PY at outside Eacility. Has beso taking muscle relaxer with sose relief,
`
`CleatSUD: WROSISyOS
`[650+ 296-3442
`nyg
`
`
`
`16AM
`08:
`05-01-19 GsetazesQo:Mar272019Seas
`
`7
`
`a
`
`
`
`miat 3
`
`Reviey of gyaters
`Consticetiogal; Reviewed amd found ta be negetive.
`Head and face: Reviewed and fonnd to be oegativo.
`Eyoot Revierad and found to be cegative.
`ERT: Reviewsd aed found tobe negative.
`ve.
`Cardiovanculart Peviewed and [ound ta be
`12,
`Respiratory: Seviewed and found to be
`Gastroiocestinal: Raviewsd anc faud to be negative,
`Genitourinary: Reviewed aed fouml to be aegative.
`Wuseculoskeleralz joint pain, mzscle gain, back pain and neck pein
`Integumentary: Revieved and found to be negative.
`Meaxclogical: erviswod and fonnd to Be segarive.
`Bayentatric: Reviewerand found-to he negative. -
`Eaodecring: Heviewed and Foond bo be negetiua.
`Senstolegic and Lynpnatic: Reviewed and found to be neqetive.
`Physical Ruan
`Arnorwal vital signa wesc discussed with the patiest.
`
`-
`
`z
`
`CBS‘ ’
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`
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`
`
`~"‘WienstadBy:SaeenWoftvees—s—_S
`
`
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`Pranced Date:903/18/26c5 Page. ft
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`

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`#7/27
`
`Concentra
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`Transcription
`
`Concentra
`
`Transcription
`
`.
`
`
`1088 Gzy Hill Road WIKEMOR, cy OCG9S
`(B60) 298-8467
`
`1600 Oey Mil2 foed
`
`WINDSOR, Cr GEO9S
`
`1660) 299-8842
`
`5
`
`Uiseesetenfaamary
`Slew progress. Malciple atreins with poor prograss. Contimue eT. Refill cyolobenzaprice
`vods<, Continue vork ceescrictions.
`The diaqooees and trestumpt plan were discussed with the patient. Me paticot expressed
`oandexrstanding andi wes told to keep their achedtled appointecats for follow-up and/or
`to return to Concentra.
`
`Sypexvieing physician reviewed the chart and concurs with the fical disposition.
`Activity States ent Kestrictians
`Teeetoect Status:
`Retarnitg fox follow-up: i week
`ky States
`Return th emdified work/activity caday.
`Bork Duration
`Patient may work tbeis sotire chift.
`Restrictions: KEY - Gocemlopeliy = up co 3 bra/day, Frequently ~- up to 6 bre/cey,
`Constantly ~ up to B houce or greater per day
`May 11fz np to 15 is occasionally
`Bo reaching above sbouidecs with affected axtceoity(si,
`Ro equatring.
`Ro ineclicg-
`ADDCIIOMAL RESTRICTIOUS AUD LINDTETIOnS: Wo driving wort venicle.
`EXTTENT IRSTROCTIOKS:
`
`Signetures
`Electrosicably aigned by +> Sasom Lefts, PA-Gi Sax 18 2019 3:3374 EST ~ Rethor
`Electrosiceally signed by : Teresa Allen, 4.0.) Sec 18 2039
`7:36PM EST ~ acinanistretive
`
`9-03/25/2012
`Service Ota:
`Bouchar, Lacy N
`Pasient.
`031€/2019
`Service Date;
`Boucher, lecy 6
`Patient;
`
`
`
`Sou Sex. # injury Date:$=03/03/2019ingary Date: 03/03/2029 Soc.Sec, # hi:
`
`
`
`
`
`
`
`Dare of Gre: .- Sempleyer..SCA Servicesé Age 62 - o Date of Birth: Age 62 Employer; GCA gervices
`
`
`
`Service Locators
`ONC - CT Windsor
`HN 4 Schoephooster BS
`.
`:
`ServiceLocation,
`7 CX Windsor
`2
`‘
`@ Schosphosster ad
`Service 1D &
`1290565143
`an
`:
`xe
`Service10 2:
`ys0sasisz
`ei
`Chain @:
`CATICDZ7AVZG
`3
`Windsor Locke, CT 06036
`Cala *:.
`cerics27i0720
`- Windsor iorke, C? 06056
`Dictator:
`Pasa Leftes
`i
`Oictacer:
`Zasoa Lefeus
`Diagnosis:
`SOG.$12ZA © STRAIN OF UNSP SUSC/TEMD AT LOKERLBS LSVEL, LEFT L5G, TUTT-585.9228
`Degeosts:
`S86.5224
`STBAIB OP UHO2 HUSC/TENDRY LOWER LDG LEVEL, BRET G86, TRIT-286. 922A
`gr
`Motes: Cardloragezlar: Extrenities are warm with no edamd or varicas?ties.
`"8
`Notes: Yollow up «ith your dcotor to ciscuss elevated Blood Pressure.
`Right Shouléear: Appearance ia noceal. Terdersass in the traperixs miscie, in the
`ALL TumPREIEOY S MEDICATIONS FOR THIS EROOCITZR GEER DISPENSED iM THR CENTER.
`anterior shcalder, In thn literal ehoulder and in the posterior shoulder. Palpates
`”
`.
`acral. Linited reage of potion in all planes, Locksemi zenge of internal and cateroul
`rotation. Abduction is 5/5 on the right side with psin. External rotetian ie 1/5 ca
`the xight aide with pais, Motor towe is normst.
`Beurelogic: Bilateral doe¢ Cordon raflezas are 2/4. Sensation ie intact co Ligst mh
`in all Carwatomes. The onscles display no weskxness- Vazcnrar: The pulses are 7+/2+
`Bilaterally and czpillary refill tiow fs comms! bilaterally. Rotator O-ff Seat is):
`positive peintol exc, positive Bawkin s Gest and pouitive owpty can test, bat oegstive
`dxop arn wnst.
`Left Hnee: Appezrance is eormal. There ia teniornees diffusely over the anterolateral
`aspect, diffuesly over the scteromedial aspect, cver the lateral yount }ine and over
`the eadial joint line. Peipates agrmal. Toll range cE motion. Motor atrangth is moral
`bilaterally. Motor tose is normal. Ligamentons Lexfty Testis}= no laxity on valgus
`atrass avd mo Loxityom verus atrass. Meniscal Testis}:
`we interal McMurray
`.
`test andi megative medial McMurray test. Hecative Eomans =
`test. Lens pala today.
`Cervical Bpines Cervinal Spina: Appesrance ir nara]. Tennernasn in tho lott potespinsl,
`rignt paraspinz] and right trapezins avecle, bul mot the cervical epine. Lower cerrical
`and trap tenderness mostly os right. Peapstion revecia no bilaceral suevle spasm.
`Linited raage of motion. Rigat Rotatlan: aeet of
`degrees aod painfal. left Rotetian:
`aBOM oc $5 Geuress and painfel. Intact. Intact.
`Beurmlogic: Sensation ix intact to light toerch in au derestomes rested. fhe ausci=s
`tested display so weakness. Ho emsole atropty1e presear. Vascalar: Zhe pulves sre
`24/26 ‘bilaterally awd capillary <ofitl tine
`mores? bilateralty, segative Spurling
`3 Mareacuer.
`Thoracic Spins:
`appearance is oommsl. Teniecoess tn tha left parespical ami in the
`sight paraspinal, bet nat ia the thoracic apine. interecapular muscle tenderooss.
`wid throacic. Palpates vores]. Meror strength normal.
`Gcurclogic: sensation intact te light touch, mormal gait.
`Pwychiatric:
`. nood and afliect are appropriate.
`Functional Bestoration aod Status of Bextliag
`Bbecy Boucher ‘e approximately 25% cf che vay tovard mecting che physical roquirencute
`of ber job.
`ASSESSVENZ
`(346.912a)
`1. Koen strain, Ieft, initial ensounter
`2. Shoulder strain.
`» inikinl encamter (345.9314)
`3. Strain of next mosclc, initis! saccuster (S16. tKZA}
`« Thoracic myofasclul ytcain, initial encounter (529.0194)
`Placa
`i. Staxt: Cyclobenzaprine 3Cl 10 MG Oral tabiet: TARE 1 TASEET 3 TEMES GAIET AS
`ED
`Se By: Loftvs, Jacon: Dispense: 5 Days 7; #215 Tablet; welll2: O:For: Thersacic ayefuectal
`strain, imitie? epcounter> DM < MB; Vorified Traneniasioa to CORCESTAR — WINDSOR —
`WARTIPORD; Last Updated Gy: Syrtam, SureScripts; 3/19/201> 3:08:12 PS
`Cestime PT. Try to remin active.
`Refill onecle relaxer today.
`
`CBS. :
`16AM
`
`GictatadAy:Seiontotems cred Gys wi
`
`
`
`
`
`08
`Cactalet On: Mar af 2028 7:34
`Oictaved Cer: Mes 28 2917 7.38e
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`Pressed Date:903/20/2015 Printed Daves=03/20/2019Page 2 Page: 3
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`05-01-19
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`

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`#8/27
`
`CBS. '
`16AM
`08
`
`05-01-19
`
`
`——e—
`Po
`
`
`Boucher Lucy Service Dake.=0315/2035Patient Boucher, tocy H
`
`
`
`poe Sac. Sec.# ingusy Date,=03/03/2019i
`
`prime
`serviceLoca
`fee
`amt achonmoet
`
`Secvice Locatiog®§=CNT - CT Mindeor 4 Schoephoeerer 24
`© #:
`1399549243
`eeeoe
`ane
`edtlisn xéinie ox tenes
`carecieriaae
`~~ cease a
`
`Diagnosis:
`S86,012R SYRAIN OF DUSP MUSC/PEND AT LOWER LOG EAVES, LAY? L8G, IBIT-386.5124
`i.
`Ppaan Wavesy Seaase For Vanit
`Gitef Complaint: The patient preserts today with patiest recheck Car back, neck, lest
`1EPOIOT
`“ EF]
`Rnee and right shoulder. Workers Coepensation — Patient = Corcupstion= driver.
`ie
`Vitels
`Vital Signe
`Recnréec: 18Mar2013 12:57PH
`Systolic: 148
`Olactolic: 106
`Heart Mate: 85
`Reepirsticn: 16
`Heigtt: 3 tt 2 in
`Weight: 265 ib
`BHI Celeulated: 37.5
`BSA Calculated: 1.93
`02 Saviration;: $8
`;
`Past Medical Wistocy Meviex
`PAST MeDICAL, SUCTAL, FAMILY HISTORT: Won-contribatory bused on review of interval
`historr.
`.
`History ef Present Ilivess
`jure (s}: Contimess to Seve right cervical,
`ivoy Soucher is returiog for @ recheck of
`has contiqued 16ft maee pain anterior,
`traperius and right shogider pain, 8/10, She
`Hedia 1 and lateral “itm 7/19. Mid thoracic pain sed tigniaers with 9716 at tines
`with bending. Go punbness. Sbe hes been teking Ibuprofen amt muscle celaner. She reports
`that whe is ingroving today with giyeicel thorapy. She is wot working...
`Review of Systens
`Constitetiowsl: Reviewed and found ta he nagative.
`Sead and Pace: Reviewed anc found to ba negative.
`Eyes: Pevievad and found to be negative.
`EST: Peeiewed and fousd to be segetive.
`Cardiovasculac: Reviewed end found to be naygetive.
`pirutory: Reviewed end found to be nogativo.
`
`Gzuatrointestinsl: Reviewed and found to de
`"s
`Genitourinary: Reviewet ond found to be x
`.
`
`Muscalosxslatal: joivt pain, suscie pain and back pein.
`_ Integueepotary: seviewed and fousd to be negative
`Yeasologioals: Reviewed acd fonud tc be nagative.
`Poychiatric: Reviewed and found ro be negative.
`Endocrine: Reviewed end feand co be nmegetiwe.
`Beasteclogic and Lynpistic: Reviewed and foend to be aegetive.
`Physical txen
`4
`abnornsi vital sicos wexs discassen with the patisat.
`Commentsi. ELevated SP again today. I ciscuseed this with the pt. She needs to see
`ber PCR regecdiag the 2TH.
`Constiteticeal: well appeuriag acd well neurieshed. in no ecote distreas.
`
`wf
`
`:
`
`‘
`
`2
`
`Printed Date,
`
`«03/20/7029
`
`Page
`
`EBILLTrrraariesion Onis;
`wine
`
`DCN: 501389403
`CianHila ¥IPDILISOs4S
`
`Concentra
`
`«
`
`Transcription
`
`Sead/face: Morsocephsiic 29G atraumatic. OSotated Ont Mar 3@ 7015 T.J4m
`
`Carcass
`
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`Pa:
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`#9/27
`
`Concentra
`
`‘Transcription
`
`Concentra
`
`Transeription
`
`°
`
`
`
`1080 bay Wil Sead=WEWOSOR, C2 06095 B50 298-8447 1086 Day Bill Boat WIVOSOR, CP 06085 (860) 290-8442
`
`
`
`
`
`
`
`3
`
`:
`
`~
`
`-
`Discossicn/Summary
`Mew script written for curside Pt for 6 PT visits.
`The diagnoses and cresteent pian were Sincensed with the petient. The patisnk expressed
`understaoding sad eas told to Keep their achedsled eppointaeats Bor follow-—ap and/or
`te sctucy to Concentra.
`
`
`
`
`Pacteat: Service Dare:9965/25/2919Boucher, Lucy M Patient: Boucher, iucy M Services Date «93/25/2019
`
`
`
`
`
`
`
`Soc. Sec, Injery Date.=00/03/2019 Sox, Sec. s|iS2 injury 03/03/2019
`
`Dore of etic
`Ape 62
`Employer:
`GCA Services
`Oueoftai:
`Agu 62
`-Smployer,
`© GR. Services
`Service Location:
`«TMC - CE Miodsor:.
`_ _*
`,# Schoephosster Ba
`ServiceLowaxion:
`csc < Cr Miedscc
`2 Stnaepborster &4
`‘Service ID #
`1298854315
`;
`ot
`ServiceID #:
`1S5DES4326
`=
`‘Chaim a
`- caTtCg272020°
`-
`“Windsor Sacks, CT 06395
`Ciniem
`Ca77C9271028 -
`;
`Windsor Locks, CI 06096
`;
`:
`=~
`Okeranor:
`_ Tomesa Allen
`Diet
`Teresa Allen
`.
`
`Diagnosis: 3B6.012R STRAIN OF URSP MUSC/THED AT TOMER IBF LEVEL, LEFT LEG, “INTT-S86. 722% S8E-512ZA STARK GW UAGP BUSC/TAMD A? LOMBR LEG LEVEL, LAGS LEG, IBIT-SEE.912K TRagnosis:
`
`
`
`Motes: Tategueentery: Reviewed ang founc’to be negative. -
`Notes Maaniad by: :Allen, Yereca: Mar 25 2015 4:16 Hi ESE
`Fancticual Resterstica snd Gtateus of Hesling
`Meurclogical: Reviewed and found ta be negative.
`.
`Psychiatric: Rasiewed and found to be negative.
`Eidncrize: Revigwed and touxl to be negutive.
`.
`terySomes is npproxLoately251 of thd way toward meting ths physical <equiremonts
`beastologte aod Lymphatic: Reviewed and found to be aegetive.
`ASSESSMENT
`Physical Buan -.
`4. Thesacic sprain (S23. 5NRAI
`¥ital signs were ceviewnd and found to be corenarkeble.
`2. Cesvicul etrain ($16.3xxR}
`Constitutional; in soderate Glatxess.
`3. Bight zhoolder «train (S¢6.911A)
`Bead/Tuce: Moommcepheiic ent atraxnmstric.
`4. Strain of left Kner (586.4178)
`Eyes: comjunctive ond lide with no seclling, erythema or discharge. Pupile are equzl,
`Plan
`conc, ani reactive to light and comes clasr. Bxtraccole: sovements intact.
`Pulmanery: to increased work of breathing or signs of respiratory dtstrese. Chast
`WO HEDICKTIONS WERE PRESCRIBED OF DISPERSED FOR THIS ENCOuKZER.
`is maxrmel in appearance.
`Cardiowsacelac: mommal xate and rhyths, nocns} 51 aud $2, wtthoat gallops or rute.
`Exteemities are varm with so edens oc varicosities. capillery ref{ll wes normal. Radial
`pelscs are sore.
`Right Shoulder: . Appeacs with no deformity, no dislocation, na sechpecsis, no effusion,
`eo erytherm and =p swelling. Diffnsely cigtt ehoclder. Palpation seraxie 2c crecirus
`and no vareth. Poll range of ection. Pain with ali BCH. Motor tom is normal.
`:
`@ourologic: Bilateral deep tondop ceflexes arm 2/4. Semsetion is iptact to
`touch
`in ali Gematcoes. The moscles
`no wenkcers. Vascular: Zhe polees are 2+/2+
`Diletecally amt capillary r