DEPARTMENT OF HUMAN SERVICES1515 Arch Street, Philadelphia, PA 19102215-683-4DHS (4347) I.

CITY OF PHILADELPHIA www.phila.gov/dhs '/rD1"

I(;d(j~' 61 {;,,() "j1~ -< chi /J1,[ ~Jf, VfJl1.~("fJ '-4- Deputy commiSSioners'-pfi'S

(J /) ~Q~. ~I") . f~ r: jF. CYNTHIAFIGUEROA /\1(' i "'-u,.,/1 / h()'(ri.4.3 L/fl,i7r.( v~£,,;- SUSAN KINNEVY IY1tr ",lU~/~)I \ I': /if} r ,'/,I..,1.A. MARK MAHER 'I,f~ :-t1, . - 1.PA:fI' , e: ,I, u. I QEI/l MERIWETHER .»: 1" L

D e s. t~L t» fJ\' el s / r- 1-'-( n::> t'- ~ (,,,e,L-)(y('i'L5 ,-}rn ,(j/ J+(f{-;f;tt·e J'VJ.) I- f} V

C s·f . RE:f.Je s,'1) Iha{hcd/Dc.fl/Jeis l1"l iI)'iJ'tJ . !,~q j!)- '(;, {I1 t-; C- CL # 51- h, '1a Y r L.. l/'<- J I 1 ,IDear !f)s. p./J, els 'd ~[b9{l~.~UDUllt.tb;l~The Children's Protective Services of the Philadelphia Department of Human Services has r~~ed a1~lf ~s~~er~ffd a~I'e concerning the above-named child(ren). I have been assigned to investigate this report to determine if a problem exists affectin¥ y?u~. hilll(re.n), an~~n1.icate. d, .to do everythingpossible to help you with this problem. ' h.: lC J~JI.:n3 )~n ll}1..e..,.,Under the law we must investigate every report of suspected child abuse that we receive, e purpose of the law is to protect children from abuse and toprovide rehabilitative services for the child(ren) and parents or c,aregivers involved so a to ensure the well-being of the c~ild(ren) and to preser.ve and

stabilize family hfe whenever possible. ,., ,A, i" /' \ o \ . \ l\t~"(,The nature of the alleged abuse is;ZSfI lows: ItA!) e. M I); '" ' )11tYC:a5fl.e', '.{~ ..cJ-t.. • l} (),j (\:'1 ',' \),i/rrr t 1/ {I-v { "-" ;-\ , e..;\'\., .., " (). i~'V ;)

physical injunes 0 sexual abuse/exploitation 0 medical negle~t " \fl d t.~ ill () 11""~ ,Omental injunes 0 physical neglect :' 0 Imminent risk r.;.(f I, /" C_ ,J I ,,1/'1) \,; fi r_ )

flr 1/..) L tAI'1 j 'It,,-J :~/The report alleges: t h.:t cJ h O,~' l-Nd d~'fJPd<-b:.. (1/r'l Iv f (Vii Co t-: .4-'fe-D, ",'" (1 tAI,~~I(tJ1:.JiCt)1~,,, allegations may be reported to tho appropnat law enforcement officials if appropnate. ( ~ I yl. iff (l pi"', kYou have certain rights accorded to you under the law. You have the right to receive a copy of the report and may wnte the Childl.ine and Ab9se ''I4'1t~..JRegistry at POBox 2675 Harnsburg, PA 17105-2675 for one. If the case goes to Court, you have the nght to an attorney, introdu~e evidence, apd 'A,l.i,cross examine witnesses. If you cannot afford an attorney, you can contact Community Legal Services at (215) 981-3700. J ~\I')~'JI t ~If our investigation cannot determine that there IS substantial evidence of the alleged abuse and your family does not need or want s rvices from theDepartment 0 Human Services, the Child Protective Services Law requires that all information regarding this report be maintained or a period of oneyear from i(; I~,the date the report was received. After that time, the material will be destroyed in no more than 120 days. If y r family does wantservices from our Department or was receivmg services prior to the receipt of this report and Will continue to, all the matenal gathered during theinvestigation will remain in your file but will be clearly marked as "unfounded." This material will be destroyed in no more than 20 days after the yearanniversary of the closing of your case.

Ifwe find that substantial evidence of the alleged child abuse does exist, and you have been named as the perpetrator and t . k that this finding isinaccurate, you have the right to request of the Secretary of the Department of Public Welfare that the report be amende or expunged. Also, if you havebeen named as the perpetrator of the abuse, your ability to obtain employment in any agency which provides care for ildren may be adversely affected.

"\ We ask for your cooperation with our investigation. We know this is a difficult time for everyone involved. ave any questions, please feel free

)w~. . ~/-" Sincerely, Ir tJ)rI(}ffPti/,

fj L., {Vlc(1lfIJ,t" dcOAiJJ~#d+:l!SOCIalWork Supervisor '. /1~1./1 . 11/)".' ",~;,J(t1tb.e,' toe

683-'6'm< Gllf i i r7(l1 {.t I ( /1 JI, , < '"'

<;a.l{ /! " ttveffd!<ti'! \/. " _'. /1Je(~ eLl (fcCr)iltlM/p,/!;JIfyou have a question, complaint, concern, or suggestion about DHS and its operati01-ts~ •...; ) I/J /.0 <:-3. c '

call the Commissioner's Action Response Office at 215-683-4DHS (4347) . 'k'{?Lil' }C.....:..)'IJor visit our website: dhs.phila.gov and click on the "suggestions" link. .' I·~~· 'U· ,

J-,()"t.t/1J i; Ke /'fit c·-r.MSocial Worker683-6825

CPS-Notification-Subjecls ot inCustody (8S·M·21)

Deaysia Daniels-ThomasMRN: 25422718

Temple University Hospital3401 N. Broad Street

Philadelphia, PA 19140(215) 707-3467

Discharge Instructions for:Arrival Date:

Daniels-Thomas, DeaysiaWednesday, March 24, 2010

Thank you for choosing Temple University Hospital for your care today. The examination and treatmentyou have received in the Emergency Department today have been rendered on an emergency basis onlyand are not intended to be a substitute for an effort to provide complete medical care. You should contactyour follow-up physician as it is important that you let him or her check you and report any new orremaining problems since it is impossible to recognize and treat all elements of an injury or illness in asingle emergency care center visit.

Care provided by: CALVO, CARMELA, MD

Diagnosis: Middle Ear Infection; Viral Illness

DISCHARGE INSTRUCTIONS FORMSEar - Middle, Infection (Otitis Media), Child Medication ReconciliationViral IllnessFOLLOW UP INSTRUCTIONS PRESCRIPTIONSPrivate Physician Amoxicillin

When: 1 - 2 days; Reason: If symptoms persist, Children's MotrinFever> 102F, Trouble breathing, Recheck today'scomplaintsSPECIAL NOTESNone

X-RAYS and LAB TESTS:If you had x-rays today they were read by the emergency physician. Your x-rays will also be read by a radiologist within 24 hours. If youhad a culture done it will take 24 to 72 hours to get the results. If there is a change in the x-ray diagnosis or a positive culture, we willcontact you. Please verify your current phone number prior to discharge at the check out desk;

MEDICATIONS:If you received a prescription for medication(s) today, it is important that when you fill this you let the pharmacist know all the othermedications that you are on and any allergies you might have. It is also important that you notify your follow-up physician of all yourmedications including the prescriptions you may receive today.

Patient Copy

Deaysia Daniels-ThomasMRN: 25422718

FOLLOW UP INSTRUCTIONSPrivate Physician

When: 1 - 2 daysReason: If symptoms persist, Fever> 102F, Trouble breathing, Recheck today's complaints

PRESCRIPTIONS

Amoxicillin 400 mg/5mL Oral Suspension for ReconstitutionTake 600 mg by ORAL route every 12 hours for 10 days

Children's Motrin 100 mg/5 mL Oral SuspensionTake 150 mg by ORAL route every 6-8 hours

Deaysia Daniels-ThomasMRN:25422718

Middle Ear Infection, Child(Otitis Media, Child)

A middle ear infection affects the space behind -the eardrum. Thiscondition is known as "otitis media" and it often occurs as acomplication ofthe common cold. It is the second most common diseaseof childhood behind respiratory illnesses.

AN INFECTION WAS FOUND TODAY IN YOUR CHILD'S:o RightEaro Left Ear

HOME CARE INSTRUCTIONS;.- Continue giving medicine, if prescribed, for 10 days or as prescribedeven though your child may feel better after the first few days.~ Only take over-the-counter or prescription medicines for pain,discomfort, or fever as directed by your caregiver.

FOLLOW UP with your caregiver as directed.

Middle Ear

Eustachian Tube

SEEK IMMEDIATE MEDICAL CARE IF:? Your child's problems (symptoms) do not improve within 2 to 3 days.~ An oral temperature above 102° F (38.9° C) or a rectal temperature above 103° F (39.4° C); or if the oraltemperature remains above 101° F (38.3° C) or the rectal temperature remains above 102° F (38.3° C) for threedays.);> You notice unusual fussiness, drowsiness or confusion.? Your child has a headache, neck pain or a stiff neck.? Your child has excessive diarrhea or vomiting.;.- Your child has seizures (convulsions).;.- There is an inability to control pain using the medication as directed.

AGREEMENT BETWEEN PATIENT AND HEALTHCARE TEAM:Your signature on this document represents an understanding between you and the healthcare team that took.care of you today. That means that you: I

;.- Understand these discharge instructions.;.- Will monitor your child's condition.;.- Will seek immediate medical care as instructed.

Document Released: 09/27/2006 Document Re-Released: 06/05/2009

ExitCare® Patient Information ©2009 ExitCare, LLC.

Viral IllnessYour exam indicates you have a viral illness.

SYMPTOMS;.- Fever.;.- Muscle aches.

;.- Stomach upsets.;.- Sore throat.

Page I of9

Deaysia Daniels-ThomasMRN: 25422718

>- Headache.» Fatigue.

> Dry cough.

Antibiotic drugs are not effective in viral illnesses. They are only given when there is a secondary bacterialinfection.

TREATMENT> Bed rest.> Increasing oral fluid intake of clear, non-caffeinated drinks like ginger ale, fruit juices, water, or sports(electrolyte) drinks, and> Medicine to relieve specific symptoms such as cough, pain, or diarrhea. Only take over-the-counter orprescription medicines for pain, discomfort, or fever as directed by your caregiver. .

Please call your caregiver if you are not better after 2-3 days of symptom treatment.

CALL OR RETURN HERE RIGHT AWAY IF YOUR ILLNESS GETS MORE SEVERE, OR YOUDEVELOP ANY OTHER NEW SYMPTOMS, SUCH AS» A fever above 1030 F (39.40 C).» Vomiting for more than a day.> Severe headache or other pain.> Stiff neck.>- Trouble breathing.>- Visual problems.>- "Blackouts" or fainting.

Document Released: 01/25/2006 Document Re-Released: 06/05/2009

ExitCare® Patient Information ©2009 ExitCare, LLC.

IMPORTANT NOTE: This is a summary and does not contain all possible information about this product. Forcomplete information about this product or your specific health needs, ask your health care professional.Always seek the advice of your health care professional if you have any questions about this product or yourmedical condition. This information is not intended as individual medical advice and does not substitute for theknowledge and judgment of your health care professional. This information does not contain any assurancesthat this product is safe, effective, or appropriate. for you.

AMOXICILLIN SUSPENSION - ORAL

(a-MOX-i-SIL-in)

COMMON BRAND NAME(S): Amoxil, Trimox, Wymox

USES: Amoxicillin is a penicillin-type antibiotic used to treat a wide variety of bacterial infections. It works bystopping the growth of bacteria.

This antibiotic treats only bacterial infections. It will not work for viral infections (e.g.,.common cold; flu).Unnecessary use or overuse of any antibiotic can lead to its decreased effectiveness.

HOW TO USE: Shake the bottle well before each dose. Take this medication by mouth with or without food,usually every 8 or 12 hours, or as directed by the doctor. .

Page 2 of9

Deaysia Daniels- ThomasMRN: 25422718

Discharge Information Home Medication FormTemple University HospitalTemple University Hospital EmergencyDepartment

Name: Deaysia Daniels-Thomas Visit Date: 03/24/1022:30Age: 3 years Gender: Female MRN: 25422718

V~nID:405005630026Physician: CALVO, CARMELA

Thank you for visiting Temple University Hospital. This form contains information about your medications. It is importantthat you read and understand this information.

H Md d d d " thl isltome e s recor e urmg IS VIS I

Drug, Route & Dose Frequency Reason ContinueIbuprofen Oral Yes No PCPAcetaminophen Oral Yes No PCP

Route Rate Duration Given AtOral 03/2501:36

p "f " d d " ltrescnpuons you receive urmq your VISI :

Drug & Dose Route Frequency Reason Next DoseAmoxiciliin 600 mg Oral every 12 hours Infectious

ProcessChildren's Motrin 150 mg Oral every 6-8 hours

Home Medications ou should continue to take:Drug, Route & Dose Frequency Reason

Home Medications ou should STOP takinDrug, Route & Dose Frequency Reason

You should follow up with your primary care physician after discharge regarding continuation of thesemedications:I Drug, Route & Dose Frequency Reason

NotesYou will need to see your MD to get refills.

PLEASE GIVE THIS FORM TO YOUR NEXT PROVIDER OF MEDICAL SERVICE (DOCTOR, CLINIC, HOME CARE,ETC.)

Page 1 of I

Deaysia Daniels-ThomasMRN: 25422718

your usual dosing schedule. Do not double the dose to catch up.

STORAGE: Store at room temperature according to product directions away from light and moisture. Do notstore in the bathroom. Keep all medicines away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discardthis product when it is expired or no longer needed. Consult your pharmacist or local waste disposal companyfor more details about how to safely discard your product. .

Information last revised July 2009 Copyright( c) 2009 First DataBank, Inc.

Page 9 of9