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H. EXAM / CONSULTATIONS / FINDINGS & FOLLOW-UP: PERSONNEL INVOLVED (PRINT) PHONE History taken by: Q ' Ctf&fhvyrtl fa-zd. 6*^—&r<--*rr-M Physical examination performed by: <J~, <?<?, W Mg?

Specimens labels and sealed by: UL *fii& T—r- *i>**a>*fSf m<A?

Assistant: Psychosocial assessment taken by: M^yU- N/A • Report attached / Interview observed: D Yes jarfvio 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/ J "• tOCT'**^-v ^v^/^y / v/ 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

j? &£{'• Ctfl &/£~o&£c> '* &9*&U/&A Ck**]-7iX*S 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)

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