EXHIBIT(S) - 20A (Motion #11) White Plains Hospital Records - White Plains Hospital Records Possible SSN Administratively Redacted June 01, 2022 (2024)

On October 11, 2018 aExhibit,Appendixwas filedinvolving a dispute betweenFrancine Mauro,Francine Mauro As Administrator Of The Estate Of Immacolata Costanzo,andCarerite Centers Llc,Gaurav Malhotra M.D.,Martine Center For Rehabilitation And Nursing,Northern Westchester Hospital,North Shore-Long Island Jewish Health System, Inc,Northwell Health, Inc.,Pharmscript Llc -Third Party Defendant,Salem Acquisition 1, Llc,Salem Hills Rehabilitation And Nursing Center,Schnurmacher Crn F K A Schnurmacher Center For Rehabilitation And Nursing,Schnur Operations Associates Llc,Somers Manor Nursing Home, Inc.,Somers Manor Rehabilitation And Nursing Center,Somers Operating Llc,The Paramount At Somers Rehabilitation And Nursing Center,for Torts - Medical, Dental, or Podiatrist Malpracticein the District Court of Westchester County.

 
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 FILED: WESTCHESTER COUNTY CLERK 06/01/2022 01:24 PM INDEX NO. 66958/2018 NYSCEF DOC. NO. 536 RECEIVED NYSCEF: 06/01/2022 EXHIBIT 20A FILED: FILED: WESTCHESTER WESTCHESTER COUNTY COUNTY CLERK CLERK 06/01/2022 03/11/2022 01:24 05:31 PM INDEX INDEX NO. NO. 66958/2018 66958/2018 PM| NYSCEF NYSCEF DOC. DOC. NO. NO. 536 396 RECEIVED RECEIVED NYSCEF: NYSCEF: 06/01/2022 03/11/2022 White Plains Hospital CERTIFICATION PATIENT NAME: . MEDICAL RECORD NO: EXAM DATES: .· I hereby certify that isa true and accurate copy of the fulland complete rnedical record, . of the a¾ove name patient, that we tiave on file in the Radiology Department at White Plains Hospital i further certifythat this record was inade in the regular course of business of the hospital and,that it was the regular course of business of this hospital to make it,at thistime of the condition, act, transaction, and occ'urrence, or event or within a reasonable time thereafter. I have been authorized to certifythese records as of thisdate. · SIGNED: . Director, Ra ogy Department DATED: 41 EastPost Road | 'WhiteP@ains. NY 10601 I T 914.601.0600 I wphospital.org FILED: FILED: WESTCHESTER WESTCHESTER COUNTY COUNTY CLERK CLERK 06/01/2022 03/11/2022 01:24 05 : 31 PM INDEX INDEX NO. NO. 66958/2018 66958/2018 PM| NYSCEF NYSCEF DOC. DOC. NO. NO. 536 396 RECEIVED RECEIVED NYSCEF: NYSCEF: 06/01/2022 03/11/2022 NAME/MIDolfINrIIALoFPATIENT DA 4 oNTY LAsTNAMUFIRsT G1st33hGnazMoMtfli2iefitsit althlRstE3zíRs 5 EGIO N E sustaming treatment is started, but tums a life Life sustalmng treatment may be ordered for a inal pened to determme f there is benent to the patient.If treatmentcanbestopped out not to be helpful the TreatmentGuidelines No matter what else is chosen,the patient wil mit offer be treated mth digmty and respect andhealthcareproviders comfort measures.Check gae O Comfort measuresentyComfort measuresare medical careand treatment provided unth the primary goal of rehermg pam and other symptomsand wound care and other measures be madeto offer food and fluids by mouth Medicadon turmngmbed Reasonablemeasuresett reducmg suffenng mil Oxygen suctiomng and manual treatment of airway obstruchon will be usedas needed for comfort be used to reheve pain and suffenng O The patient wilt receive medicahon by mouth or througha vem heart momtonng and all other necessarytreatment, Limited medicalintenantions basedon MotST orders. ONo Undtations on medicalinterventions willrecewe all needed treatments. The patent InstruchansforIntubatlanandMechardcalVentilation Chedpos out of (ungs.Treatments (DN0 Do not place a tube down the pahent's throat orconnect to a breathmg machmethat pumps air mtoand Donotintubate O bechecked if full CPRis cheded m SectionA.) are available for symptoms of shortness of breath, such as oxyg en and morphme. (This box should act O A trial period Checkone or both and mecharket O 'itubation wentilation ONoninvasive ts appropriate ventl1stion (e.g. BlPA1415thshealth care professional agreesthatit needed Placea tube down the patent s throat and connectto a breathmg machmeas long as Intubation and long-term mechanicalventitation,if 1smedically needed Futureifospitalization/Transfer Check eag O or severe symptoms cannotbe otherwise contround. Bonot send tothe hospitalunlesspatn O Sendtothe based hospiteL tf necessary,on MOLSTorders. ArtificialtyAdministeredMuldsandNutritionwhenapatientcan no longereatordnnk.hquidfoodorfundscanbegwenbyatubeinsertedmthe stomacher fluids can be gwen by a small plashetube(catheter)1nserted directly mto the vein If a patient choosesnot tohave e1thera f eeding tube or IV tube ond N flmds thnds. food and fluids are offered as tolerated usmg careful hand feedmg Check one each for feedmg O No feeding tube O NoNftulds O of feeding tube A trialperiod Nfluf O A triatperiodof de O tong-term feeding tube.1f needed Check ORR Antibiotics Doonotuse antiMotics. Usp other comfortmeasures torelieve symptoms. O Determinesseer of antibiotics wheninfection timftation comrs, O Use to treat antibiotics mfectons. medicattyindicated. if about startmg or stopping treatments discussedwith the doctor or aboutothertreatments OtherInstructions not bstedabove (diatysis.transfusions.etc.) Life- ent for IningTreatmentOrders(Section E) (Sameas Section B which is the consent for Secbon A) O Checkif verbal consent (leave signature Ime blank) FRINrNAMEof ofctsloN MAKER PRINT FIR wiTNEssNAMe MTsECoaDwiTNEsSNAME OPatent Whoroads the decision? itealth CareAgentO evidence of patents Based on clear and corencing wishes O O Pubhc Health Law SurrogateMinor's Parent/Guardian O 517504$urrogate PhysiciansignatureforSectionE PU st liAT PRINTPHV5lefANNAME oATE/T1e DOH (6/10) Page2oth ThisMOLST appmvedby the m500H )bem ansettrap. FILED: FILED: WESTCHESTER WESTCHESTER COUNTY COUNTY CLERK CLERK 06/01/2022 03/11/2022 01:24 05:31 PM INDEX INDEX NO. NO. 66958/2018 66958/2018 PM) NYSCEF NYSCEF DOC. DOC. NO. NO. 536 396 RECEIVED RECEIVED NYSCEF: NYSCEF: 06/01/2022 03/11/2022 D ’AsT NAME/FIRST NAME/MIGottINritALoFPATIENr oATEof BIRTH(MM/DD/mry) Review and Renewal of MOLSF Onlemen thisMOLST Form thephysidananatravlawtheformfromdmototimeasthalawrapdres.andalso "IfthepatentmovesfromoneLocatantoanothertoreceivecarc,er "Ifthepatienthasa or majorchangemhealthstatus(forbetteroruorse) "Ifthopatentorotherdeasion makerchangeshisorhernnnd4bouttreatment Reviewer'sName Location of Review Date/Time andSignature (eg , Hospital, NH, Physician'sofRa) Qutcomeof Review orm ded,newformcompleted O Formvoided nonewform Nochange OFormvolded newformcompleted OFormvoided nonewform Nochange .--- O Foravoidednewformcompleted O Farmvoidedno new form ided newformcompleted cllu --dedno-- O Nothange Q O O Forevoidednewformcompleted Formvmded nonewform ONochange O Formvoided,newformcompleted O Formwo1dednonewform O Nochange O Formvoidednewform completed O Forevoidednonewform ONochange O Formwotded newformcompleted O Fonnvoidednonewform O Nochange O hrmwo1ded newformcompleted OFormvoided nonewform O Nochange O Formwotded newformcompleted O Fonnverded,nonewform D Nochange Q Formvoidednewformcompleted OFormwo1ded nonewform DOH5003 16/10)PageSof4 FILED: FILED: WESTCHESTER WESTCHESTER COUNTY COUNTY CLERK CLERK 06/01/2022 03/11/2022 01:24 05:31 PM INDEX INDEX NO. NO. 66958/2018 66958/2018 PM) NYSCEF NY SCE F DOC. DOC . NO. NO. 536 396 RECEIVED RECE IVE D NYSCEF: NY SCE F: 06/01/2022 03/11/2022 LASTNAMEmRSTNAME/M100E NinALoFPATIENT DATEoFNRTH(MN/oD/YWV) Review and Renewalof MOIST Orderson1his MOLST Fenn controundf om foge 3 ReviewersName Locationof Review Date/Time and Signature (e.gHospital, NH Physician'sOffice) Outcomeof Review O Nochange O Formvoided,newformcompleted O Formvolded,nonewfonn ONothange OFormvolded newformcompleted O Fonnvoided,sonewform ONcchange OFormvoided newform completed O Formeded,qanewfonn ONothange OFonnvoided newformcompleted O Formvoided no newfonn ONochange O Formvelded,newformcompleted O Formycided,sonewform O Nathange OForevoidednewformcompleted O Formvoidednonewform O Nochange O Fonnvoidednewform completed O Formvoided.nonewform ONochange OFormvoided newformcompleted O Formvoidednonewform O Nochange O Formvoidednewformcompleted O Formvoided,so newform ONochange O Formvoidednewformcompleted OFormvoided nonewform ONochange O Formveded newformcompleted OFormvoided no newform ONochange O Fonnvoidednewformcomplete O Formvoidedno newform D0115003 16hD)Page4 of4 FILED: FILED: WESTCHESTER WESTCHESTER COUNTY COUNTY CLERK CLERK 06/01/2022 03/11/2022 01:24 05:31 PM INDEX INDEX NO. NO. 66958/2018 66958/2018 PM| NYSCEF NY SCE F DOC. DOC . NO. NO. 536 396 RECEIVED RECE IVE D NYSCEF: NY SCE F: 06/01/2022 03/11/2022 " NEJIfYORKSTATEDEPARTMENTOFHEALTH Medical0rders for Life-Sustaining Treatment (MOLST) tasTNAM F1 IN E/MIDDLE Male eMolsTNuM8ER(THisIs NoTANeMotsTFoRM) (DNR)and Do-Not-Resuscitate 0tlier Treatment Life-Sustaining (LSU This tsa medicalorder form that tells others the patient'smshes for tife sustaming treatment. A health careprofessionalmust completeor changethe MOLST form, basedon the patients current medical condmon,values,mshesand MOLSTInstrucsons,If the patient is unable tomake medicaldeosions. the orders should refted patient wishes, as bestunderstood by the health care agent or surrogate, sign the Mol5T form.Alt health careprofessionalsmust Aphynaanmust follow these medicatordersas the panent movesfrom onelocation te another,unlessa physican examinesthe patient,reviews the orders and changesthem. MOLSTis generally for patents with serious health conditions. The patentor otherdension-makershouldwork wdh the physinan and considerasiong the physroan to fillout a MOLSTform lf tho patient: * Wants te avad treatment. orreceiveanyorailhfesustainmg " Reades malong-termcare term card services. fachty orreqIreslong " Might dle athm thenext year If tho patent has a developmentaldisabilityand does not have ability to decide, the doctor must follow speciat procedures and attach theappmprrate legat requirementschecklist. ResuscNationInstructions When the Patient Has NoPulse and/orts Not Bmath§no Check gag CPROrder Attempt Cardio-Puhnenary Resuscitation CPRmvolves arhfloal breathmg and forceful pressure on the chest to try to restart the heart. It usually mvolves electncshock (defibnllation) and a plastic tube down the throat into the mndpipe to assist lt means that all medical treatments ell breathmg (intubation) be done to prolong ltfe when the h stops or breathmg stops, mcluding being placedon a breathmg machmeand bemg transferred to the hospital R0rder0oNot Atlampt Resuscitation (Allow Natural Death) This means do not begm CPR,as defined above to make the heart or breathmg start agam1f either stops. Consent forResuscitation histructions (SectionA) The pahent can makea deosNn about resusatation if he or she has the ability todeode about resusatation if the patent does NOThave the abdity to deade about resusolation and has a health care pmxy, the health care agent makes this deasion.lf there is nc health care proxy another person mil deade,chosen froma bst basedon NY5 tas OCheckilverbalconsent(Leavesignaturc hne blank) smNATunt DATE/TIME PAI e oFDEctsfoN PRI STWITNEss NAME PRINTsecoNDWITNE5s NAME Who made the dectsfont Q O O }Iealth CareAgent PubhcHealth law 5urrogate O Mmors Parent/Guardian O §U50 b Surmgate P(rysician Signature forSectionsA and 8 PHVs1cfAN st E PAtNTPHYs1ctAN NAME DATE/DMe 9HVsIGANLICENsE NUMBER PKVsKIANPNoN E/PAGER NOMBER .. .. Check ciladmncedrrectwes knoimto have been completed O Health care ProxyO livagWdt O Organ Donation O Documentaton of oral Advance DIrechve DOH 16/10)Page1ol 4 MEPMpermatsductmareof 5( to other health professronals & elecOome reguby as ottessoryfirr Duerment FILED: FILED: WESTCHESTER WESTCHESTER COUNTY COUNTY CLERK CLERK 06/01/2022 03/11/2022 01:24 05:31 PM INDEX INDEX NO. NO. 66958/2018 66958/2018 PM) NYSCEF NYSCEF DOC. DOC. NO. NO. 536 396 RECEIVED RECEIVED NYSCEF: NYSCEF: 06/01/2022 03/11/2022 LAstNAMEmRsTNAMpMIDDLeINMALoF PATIENT DATEof STATH (MMfDDJYWVI SECTIONE . bfesustaimngtreatment maybeorderedforatrialperiodtodetermineifthere sbeneRttothepatientJiahfesustalmngtreatmentisstarted buttums outnottobehelpful,thetreatmentcanbestopped TreatmentGuldelinesNo matterwhatelseIschosen,thepatientwdlbetreatedwiththgrntyand respect andhealthcareprovidersalloffer Comfortmeasures.Check alla DComfort measuresonly Comfortmeasuresare medicalcareandtreatmentprovidedwiththeprimarygoalofreKevingpamandothersymptomsand reducmgsuffenng.Reasonablemeasureswillbemadetoofferfoodandfluidsby mouth.Medicabon.turnmginbeiLwoundcareandothermeasures Oxygen willbeusedtorelievepanandsuffering suchonmgandmanualtreatmentofairwayobstruchonwillbeusedasneededforcomfort. OLimitedmediadinterventionsThepatentwillreceivemedicationby basedonMOLSTorders. mouthorthroughavem,heartmenitonagandallothernecessarytreatment. Onotimitationsonmedicatfnterventions Thepaffectwittreceiveallneededtreatments In forfntubationandMechanicalVentilationorectang Donatintubata(DN0 Donotplaceatubedownthepatientsthroatorconnecttoabreathmg machinethatpumpsairmtoandoutoftungs.Treatments reavariableforsymptomsofshortnessofbreath,suchasoxygenandmorpinne (Thisboxshould notbechecked OAtrialper1ed Check one or both ffultCPRischeckedmSectionA.) OIntubathxtandmechanicalventitation ONoninvasivevenslation(e.g.gtPAPLifthehealthcareprofessionatagreesthatitisappropriate OBstubationandLong4ermmechanicalventilation.ffnemindPlaceatubedownthepatientsthroatandconnecttoabreathmgmadineaslongas itismedicallyneeded FutureHospitalizatlan/IkansfatCheck Que 00snotsendtothehospitatunlesspainorseveresymptomscannotbootherwisecontretted. Osendtothehospital,ifnecessary,basedonNDt5Terders. Artiflel AdministeredFluidsandNutritionWhenapatient stomachor cannolongereatordrink,bquidfoodorfluidscanbegivenbyatubeinserted m the dscanbegivenbyasmallplastictube(catheter)inserteddirectlymtothevein.lfapanentchoosesnottohaveeitherafeedmgtubeorIV Check one eachfor Avids,foodandfundsareofferedastoleratedusingcarefulhandfeeding feedmg tubeand N fimds ONefeedingtube . O NoIVfluids OAtitatperiodoffeedingtube OAtr(atperiodofIVfluhis O tang-termfeediastube.ifneeded AntibioticsCheckong ODonotuseantibioticsUseother comfortmeasurestorelievesymptoms, ODetermineuseorlimitationofantibiotkswheninfectfenoccurs. OUseantibiotlestotreatInfections,ifmedicaUyindicateth OtherInstructionsaboutstarting orstop`ngtreatmentsdiscussedwiththedoctororaboutothertreatmentsnotlistedabove(dialysis,transfusions,etr.) Co fo Life-Sustaini Treatment0rders(SectionE)(SameasSectionB,whichistheconsentforSectionA) sl6N OCheckifverbalconsent(Leavesignature Imeblank) DATt/rmE PRINT GEOslQN PRINTFI NAME rt/I 0 Miod4 AA PRINTsecoNownNEssNAMe gw Whomadethedecisfors OPatient O‰ealthCareAgent OBasedondearandconvindngevidenceofpatient'sunshes OPuDheHealthi.awSurrogate ONinofsParent/Guardian O§1750-b5urrogate Physiciansignaturefor$ectionE mgt½ ft t2s) PHVstcIAN sIGNAruRI PRINTPitYSICIAN NAME DATeJTIME DOH (6/t01Page2of4 The S1 bythe MGDOHJ\wusem ottsetbagr. FILED: FILED: WESTCHESTER WESTCHESTER COUNTY COUNTY CLERK CLERK 06/01/2022 03/11/2022 01:24 05:31 PM INDEX INDEX NO. NO. 66958/2018 66958/2018 PM) NYSCEF NYSCEF DOC. DOC. NO. NO. 536 396 RECEIVED RECEIVED NYSCEF: NYSCEF: 06/01/2022 03/11/2022 IASTNAME/FIRST NAMt/DDDLEIN1fU(L of PATIENT DATEoFBIRTH(NN/OD/VM) Reviewand RenewatofM015Tordersoft1hisMOLST Form ....... . .. . Thephyskfantnusteviesthelbrmfam tima to time ss the lawre tuires, andalso " Ifthe patentn ovas from one location toanother toreceive car or * If the patient h asa major change tc health status (for better ar yorse), or "It the patient o otherdeds1on makerchangeshisorhermudi.bout treatment ReviewersName Location of Review Date/IIme and Signature (e.g , Hospital NH, Physician'soffice) Outcomeof Review ONo change O Formvolded,newfonn completed O Formwolde4nonewform O No thange O Fore voided new formcompleted OForm voided,nonew form O Nochange O Form voided.new form completed O Form voided,nonew form O Nochange O Form veded, new form completed O Formvelded pe new form O No change O Form volded new form completed O Form ycided,nonew form ONochange O Formvelded newfonn completed Form volded no new form O No change O ForavadeAnewformcompleted OFonn voide4nonew form O No change O Form velded new form completed O Fore voided no new fonn O No change O Formwo1ded,newfomi completed