ࡱ> M !bjbj== )WWl**** *tNh-h-h-h-h-C.C.C.-N/N/N/N/N/N/N$dO QSNC.C.C.C.C.SN5h-h-hN555C.h-h--N5C.-N55>>h-\-  **/^>>~N0N> R+0 R>5DATETreatment & CONCLUSIONSDATECorrespondence & Actions TakenCONTACT INFO27 AugHurt on job. Reported verbally to Chris Henry27 AugChris Henry SSA 508.693.1600 X zero (0)1 Sept1 SeptFilled out Workmans Compensation form // transmitted to SSA6 SeptWent to Dr Jacobs. // Ordered Absent from work for 5 days 6 Sept. 10 Sept. Note received for submittal to SSA // Payment from workmans Comp refused. Bill submitted to Insurance company // Sent to MV Hospital ER for x-rays and treatment6 Sept Went to MV Hospital for x-ray // visit billed to Workmans Comp. // Registered as outpatient // Given Brace // no breaks or fractures // Physician Dr. Judith Fisher 6 Sept6 SeptBriefed Chris Henry - SSA14 Sept14 SeptMet with Terri Lee from Dr. Stuart Kendalls Office and Jen from Dr. Jacobss office. Jen will send my records to Terri Lee and Terri Lee will get my records from Dr. Fishers office14 Sept14 SeptBriefed Sue Paris (SSA HR office) on status of injurySue Paris 508.693.9139 X20314 Sept14 SeptBriefed Chris Henry- SSA18 Sept18 SeptSpoke to Christine Pica (One Beacon Insurance- workmans Comp claim adjuster) // Told of visit chronology // Briefed on how accident happened // Current state of injury ( ok, as long as I dont take brace off) // Chuck will call and leave a message after Fri visit 21 Sept with Primary Care Physician //Christine Pica 866.867.6551 FAX 888.332.97882 1 SeptSaw Dr. Kendall // refereed to an orthopedic doctor. Possibly Dr. Monto of West Tisbury. // Wrist disability note received for transmittal to SSADr. Stuart Kendall - MV Hospital 508.693.4676 Fax 508.693.360021 Sept21 SeptWrist disability note given to Chris Henry SSA21 Sept21 SeptAppointment made with Dr. Monto for Oct 1stDr. Monto 508.693.5949 Fax 508.693.031921 Sep21 SeptCalled Christine Pica (One Beacon Insurance- workmans Comp claim adjuster) // briefed on injury and other developments // offered to fax documents24 Sept24 SeptHaving heard less than stellar reports re: Dr. Monto, I decided to see if it was possible to make an appointment with a Dr. Wilsterman of Cape Cod Orthopedics24 Sept 24 SeptCalled Dr. Wilstermans office for possible appointment // talked to Cheryl S., who asked for personal info, explained process, asked for claim adjuster Christine Pica - One Beacon Insurance- workmans Comp claim adjuster) // Suggested that I call C.P. for insurance carrier name and fax # // Appointment will be made after C.S. talks to C.P.Dr. Wilsterman Orthopedic Specialists, Falmouth Ma. 508.548.942324 Sept24 SeptCalled Christine Pica for Info and briefed her on Cheryl S. briefing24 Sept24 SeptCalled Cheryl S. and briefed her on Christine Picas answers // Cheryl S. said that she would call C.P. immediately24 Sept24 SeptBriefed Chris Henry25 Sept25 SeptCall from Sue Paris (SSA HR) RE: a call from a Nurse Case Manager ( One Beacon Insurance) for me25 Sept25 SeptCalled Nurse Case Manager ( Donna) Left message and Phone # // Donna called back and was briefed on events so far // Chuck will call Donna after appointment date is finalized and after the visitNurse Case Manager One Beacon Insurance Donna bowden (800.203.9600 X9705) Fax 866.717.980326 Sept26 SeptCheryl S. (Dr. Wilstermans office) called // Appointment on Oct 2 at 2 pm26 Sept26 SeptDonna Nurse case manager briefed26 Sept26 SeptChristine Claims adjuster briefed1 Oct 1 OctForms mailed to Beacon Insurance2 OctSeen by Dr. Mark Colluchi (Physicians Assistant) His verbal conclusions: 1) Accident aggravated a pre-existing arthritic condition 2) Work may aggravate the injury 3) Dr. Colluchi will write a report and send it to Donna (One Beacon Insurance) and will send a copy to me 4) Softer brace was issued 5) Wrote note for SSA stating Out of Work until further notice 6)Requested that I schedule Hand Therapy // gave me 2 referrals on Island 7) Next Appointment scheduled for Oct 30 @ 2:20 pm 8) May recommend seeing a hand specialistDr. Mark Colluchi Orthopedic Specialists, Falmouth Ma.2 Oct2 OctBriefed Donna (One Beacon Insurance)2 Oct2 OctBriefed Christine Pica (One Beacon Insurance)2 Oct2 OctBriefed Chris Henry (SSA)3 Oct3 OctOut of Work note submitted to Chris Henry - SSA3 Oct3 OctCalled Donna she will call referral Hand Therapists and if they are not suitable will check for other hand therapists in the area3 Oct3 OctCall form Donna recommends Cape Cod Hand Therapy, Falmouth // Chuck will make an initial Evaluation appointment and get a Treatment Plan and fax it to Donna at 866.717.98033 Oct 3 Oct Appointment made with Cape Cod Hand Therapy (Annette) for 16 Oct @ 11:30Cape Cod Hand Therapy 508.540.55593 Oct3 OctBriefed Donna (One Beacon Insurance)3 Oct3 OctBriefed Christine Pica (One Beacon Insurance)3 Oct3 OctBriefed Chris Henry (SSA)6 Oct Cape Cod Hand Therapy Initial Appointment16 Oct Cape Cod Hand Therapy Evaluation, Ultrasound, Massage, Hot Wax, Exercise25 Oct Cape Cod Hand Therapy Ultrasound, Massage, Hot Wax, Exercise26 Oct 26 Oct Letter from Genex Letter of Introduction30 Oct Cape Cod Hand Therapy Evaluation, Ultrasound, Massage, Hot Wax, Exercise30 OctDr Collucci, Office Visit, Prescription (Naprosyn (Naproxen Tab 500 MG) 1 TAB BOD fpr 30 days30 Oct30 OctRequest from 1 Beacon to Dr. Collucci for info Report indicates lifting limited to 0 lbs, Carry/Pull limited to 0 lbs., Position limitations 0 use of R hand, 0 repetitive movement R wrist/hand//evaluate for tear1 Nov Cape Cod Hand Therapy Evaluation, Ultrasound, Massage, Hot Wax, Exercise5 Nov Cape Cod Hand Therapy Evaluation, Ultrasound, Massage, Hot Wax, Exercise7 Nov Cape Cod Hand Therapy Evaluation, Ultrasound, Massage, Hot Wax, Exercise14 Nov Cape Cod Hand Therapy Evaluation, Ultrasound, Massage, Hot Wax, Exercise16 Nov Cape Cod Hand Therapy Evaluation, Ultrasound, Massage, Hot Wax, Exercise CONCLUSION- Possible Scaphord-Lunate Ligament tear16 Nov 16 Nov Letter from Genex, Outpatient Approved Determination Letter for disapproval of additional therapy sessions21 Nov 21 Nov Request from 1 Beacon (Donna Bowden) 1 Beacon Ins. for information30 Nov 30 Nov Letter from Genex, Outpatient Approved Determination Letter for contrast x-ray of wrist27 DecMRI, Falmouth Hospital MRI IMPRESSION: Probable partial tear of the scapholunate ligament27 Dec3 Jan Orthepedic Specialist Dr Collucci CONCLUSION Probable partial tear of the Scapholunate ligament//Not able to progress with Therapy, pain is worse with OT, improves with rest and immobilization brace  20 FebDr. Mitoli Initial Evaluation20 FebDr. Mitoli 508.495.716020 FebXray Falmouth HospitalDr Mitoli - Shot18 Mar18 MarLetter from Genex, Outpatient Adverse Determination Letter- Explore/treat wrist joint arthrotomy wrist joint w/out biopsy joint exploration w/o removal of foreign body not approved Appeal process paperwork included21 Apr21 AprLetter from 1 beacon (Donna Bowden) discontinuing medical case management services8 May8 MayLetter from MES Solutions Medical evaluation requested by 1 Beacon Is. 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