METHODIST PATIENT'S COPY MEDICAL EMERGENCY SERVICE CORPORATION PATIENT NO ADMIT DAJE DISCHARGE DATE DOCTORS CODE DOCTORS NAME SERVICE FIC PE DAYS 2 70/1803 X AMOUNT OF UTA 1500 STADIUM DRIVE PATIENT NAME VAN.LT, RUSIRT F BILL TO: VAANLY, SLBERT 214 E 500 LLS, in INTRANCE COMPANY COMPANY I COMPANY 2 COMPANY 3 INDIANAPOLIS, INDIAΝΑ 46202 PLEASE DETACH AND RETURN THIS STUB WITH YOUR PAYMENT TO INSURE PROPER CREDIT TRANSACTION DESCRIPTION 22012200секом 222122040401-204-3 4N4L3د 1222122040701SLO MAIT 224122040157 LABSーしたと 12211220CJXRAY-CHEST Cli 12221220CC. DRUGS 22212200CCROUS 122212202こしていくういう 122212202000201005 1220122005CCITELEPHONE 122112210120CM-SCRIPT しこいつ 12221221102041.k. SUPPLY 1224122110ECI.R. SUPPLY 22212211C.C.C.R. SUPPLY 222212211070... SUPPLY 12221221105552.3. SUPPLY 2221214-R PR CLAR 12221221ICCIPECOVERY BELO 1222122141e7L-54-COL/ANT,AU 1222122120kmous 112221221CCEDRUSS 122212212CLC2UGS 1222122120002R005 12221221RECEDAGOS 12221221201250RCO 12221221231CCLS SUPPLY 12. 22112219 CULTELEPHONE PARENT TOTALS FILE # A9-182277 MRS. LILLIAN NEVIN HERE IS MY RESPONSE TO YOUR LETTER OF DECE BER 14, 1976 1. Yes, the very first time I had any trouble with my back wos on 9-6-71. This happened at the post office (old facility Penn. Avo.) while I was on the clock and working. I filed a CA-1 report that day and went to the industrial clinic for an examination. There was no doctor on duty at the time (late evening but I did see a medical student who was there. This injury was a very sharp pain in the lower back. Also for several days I walked leaning to right. I saw a doctor about this but I don't remember his name or address. I missed coveral days of work but it finally went away and I returned to work. The CA-l is still in my file but no other forms or reorts were filled out and I never heard any more of it. < I have had numerous incidents since that time (mostly at work) but they were temporary and I didn't get any treatment for them. The next more serious incident occured about 2 years later (73) about June of that year. It first started while I was loading trays on a mutter at work. I thought it would pass (like most of the other incident I had incured up to that time) But over the next several days I be come worse. I had continued to work and go about my other activities. One after noon while playing tennis it seemed to get worse. I staged off work and went to see a chiropractor. I will try and got his name but I believed his has retired since then. He treated me for about a weck and the pain and discomfort let up and I re turned to work. The noxt serious epinode occured July 10th 1976. Prior to this 4, I had been feeling a discomfort in my right leg. I first noticed this at work while I was loading a tray of mail on a dispatch cobtainer. This bother me while I would play tennis. I went to Dr. Lee with this complaint and he examined (you have his *report of his treatment). He treated me for about a week and released me to go back to full work on July 17th 1976. On July 17th while casing mail I turned to the right to throw alotter. I had applied pressure to my right foot and pivoted at the same time. I experienced a very sharp pain to my lower back. This was a different type of pain than I incured on the 10th. I worked for one hour and then I went home sick. I could hardly walk and was leaning to the right side. I went back to Dr Lee, he prescribed muscle relaxers and complete inactivity. I did this for several weeks but I did not improve. I then went to Dr. Fulton (chiropractor) and he gave me a x-ray and treatments. After a week he said that he probably couldn't help me. He recommended a surgeon. I went to this surgoon (Dr. Fansett) and he said I would need surgery to correct my problem. This was about the 13th of Ocyober 1976 but this should be in his report to you. 2. This is covered in my response to question 1 above. 3. Also covered in statement 1 above. 4. I have playrd tennis since my last year of grade school (Summer of 62). I played varisty tennis in high school for 4 years (63-66). After high school I have continued to play tennis until the present time. During these 14 years I would usually play (weather pomittin) 3-4 hours each day and about 5-6 days a week. I have also played some winter tonnis in the various alubs aroun town. |