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  Abel Acosta, Clerk
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     H.      EXAM / CONSULTATIONS / FINDINGS & FOLLOW-UP:

                                                                       PERSONNEL INVOLVED (PRINT)                                                PHONE

     History taken by:
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  Physical examination performed by:
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                                                                                              *i>**a>*fSf   m<A?
  Assistant:

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                                                                   M^yU-
     N/A • Report attached       /
     Interview observed:
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     CONSULT:

                    TIME CALLED                                RESPONDED                                      SERVICE                                DOCTOR




     IMPRESSIONS, FINDINGS, AND FOLLOW-UP:
     Pediatric Examinations Reveals:

  •          Physical Findings                                                                     No Physical Findings
           •        Exam consistent with history           Q    Specific for abuse                J3--'Exam consistent with history
           •        Exam inconsistent with history         Q    Non-specific for abuse             Q Exam inconsistent with history
     IMPRESSION:
                       : Sz^M${ rtd-?<,£*C -~ sdAd fo&•&<&& <^r\ f^»<^7
     PATIENT RELEASED TO:
                                                     z&T

     PHYSICAL EXAMINER (print / signature):'             -"J       /£> <*£L/2                                    -, /ll.^~)f W' 7/
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 DISPOSITION:                    •   Admit to                                                       Q       Transfer to ED       O-^flome
 CONDITION AT DISCHARGE:                        J3"GGood           Q    Satisfactory          •     Serious
 PLANJ-rCTieck if applicable)
      eassurance regarding health of genitalia.
          'Retym to regular family doctor for routine medical care.
           56py of medical report to caseworker and/or lawenforcement agency.
           Other.

 AFTERCARE INSTRUCTIONS: ^______
 •         Follow up appointment        ~~
.ja^Counseling:
      Counseling:.             £-"/<C '/""^
           Followup lab:
          Atorttfen and verbal information went to parent / guardian / patient (circle)   r
       «"•      ACI        Q     Return to school/work         Q PCP           .^TLiterature                    Q     Referral list          •     Physician list
          Q^fKnliapaXary guidance




                                                                                                                                      ^-iXiimts—•—
                                                                                                                                        PRINTOR IMPflINT PATIENT INFOHMATION

                                                                       CookChildren's.
                                                                                 801 Seventh Avenue
                                                                        Fort Worth, Texas 76104-2796

                                                                       PHYSICAL & SEXUAL ABUSE
                                                                          MEDICAL PROTOCOL
15400 (11/02)
                                                                              (Page 9 of 9)
RUN DATE:         10/11/07                           Cook   Children's       HCIS   LAB   **LIVE**                       PAGE   1

RUN   TIME:       08 2 0                                    Summary Discharge Report

                                                                      LOCATION



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PATIENT:         DEHOYAS,ROSA                               ACCT #: |V00006053842| LOC:            CARE.CMC    U   #:   M002240601
                                                            AGE/SX:    14/F                ROOM:               REG:     06/05/07
REG   DR:        COFFMAN,JAMYE       L   MD                 STATUS:    REG    CLI          BED:                DIS:




      Test                     Day   Date         Time        Result            Reference            Units


      HCG    SERUM               1   JUN      5   1625      NEGATIVE            (NEGATIVE)
      CHLAMYDIA        GENPR     1   JUN      5   1600      NEGATIVE            (NEGATIVE)
      GONORRHEA        GENPR     1   JUN      5   1600      NEGATIVE            (NEGATIVE)
      HEP    C   VIRUS           1   JUN      5   1625      NEGATIVE            (NEGATIVE)




Patient:         DEHOYAS,ROSA                                Age/Sex:    14/F             Acct#V000 0 6 053 842 Unit#M0 0224 0601
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