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EXHIBIT A
Pictures from Incident
EXHIBIT B
Medical Records
Visit Note - February 13, 2025
MEYER, BARBARA
MRN:
3303460
DOB:
01/08/1966
Sex:
Female
PMS ID:
3303460
Page 1Sabrina Jamiel, PA-C (Primary Provider)
Anthony John Petelin, MD (Bill Under)
(480) 905-8485 Work
(480) 905-7274 Fax
Center For Dermatology, PC Scottsdale
14275 North 87th Street
Suite 110
Scottsdale, AZ 85260-3696
Medical History
Reviewed November 22, 2024.
None
Surgical History
Reviewed November 22, 2024.
Other: Knee replacements
Skin Conditions
Reviewed on November 22, 2024.
None
Skin Protection
Reviewed on November 22, 2024.
Do you wear sunscreen?: Yes
If Yes, what SPF?: 50
Do you tan in a tanning salon?: No
Family History of
Melanoma
Reviewed on November 22, 2024.
Do you have a family history of
Melanoma?: No
None
Social History
Reviewed November 22, 2024.
EtOH none
Smoking status - Never smoker
Medications
Reviewed November 22, 2024.
Retin-A 0.025 % Topical - cream
Retin-A 0.025 % Topical - gel
Allergies
Reviewed November 22, 2024.
No known drug allergies
Alerts
No allergy to topical antibiotic
ointments, no artificial joints within
past two years, no artificial heart
valve, no allergy to lidocaine, no
allergy to adhesive, no blood thinners,
no rapid heart beat with epinephrine,
no defibrillator, no mrsa, no
premedication prior to procedures,
and no pacemaker.
ROS
Provider reviewed on Feb 13, 2025.
A focused review of systems was
performed including Hematologic /
Lymphatic and Integumentary and
was notable for Other Skin
Complaints.
No Problems With Bleeding, No
Problems With Healing, And No
Problems With Scarring (hypertrophic
Or Keloid).
Chief Complaints:
Skin Lesion1.
HPI: This is a 59 year old female who:
is an established patient who is being seen for a chief complaint of a skin lesion, located on the right lip. The
lesion is red and rough and raised, moderate in severity and has been present for months. Nothing makes the
lesion better or worse. This lesion has not been treated in the past. She presents today for: evaluation and
management. She has no history of previous skin cancer and no family history of melanoma.
1.
Exam:
An examination was performed including the scalp (including hair inspection), head (including face), face, inspection of
conjunctivae, inspection of eyelids, lips, nose, right ear, left ear, neck, and chest.
I offered the patient a full skin check, patient declines.
General Appearance of the patient is well developed and well nourished.
Orientation: alert and oriented x 3.
Mood and affect: pleasant.
A dermatoscope was used during the exam.
The following people were also present during my examination: , my medical assistant (male)
Impression/Plan:
Hypertrophic Scar
(L91.0)
Firm telangiectatic linear plaque
distributed on the right upper cutaneous lip and right upper lip wet vermillion.
Associated diagnoses: Pruritus, Cutaneous Pain, and Cutaneous Inflammation
Status: Inadequately Controlled
Plan: Counseling.
I counseled the patient regarding the following:
Skin Care: Hypertrophic Scars can be treated with intralesional steroids, and topical high potency steroids. The
vascular component can be treated with pulse dye laser.
Expectations: Hypertrophic Scars are thickened, and some times painful or itchy. Symptoms respond well to
treatment.
Contact Office if: If Hypertrophic Scar fails to resolve, becomes painful or itchy.
I recommended the following:
Silicone Gel
Silicone Sheets
Plan: Intralesional Kenalog.
Treatment Number: 1
Lesions Injected: 1
Medication Injected: 2.5 mg/cc of Kenalog (Created by Diluting a 10mg/ml Solution)
Total Volume Injected: 1cc
Lot Number: 80783320
Expiration Date: 4-2027
Administered by: Sabrina Jamiel PA-C
The risks of atrophy were reviewed with the patient. This procedure was medically necessary because the lesions
that were treated were: enlarging, inflamed, irritated, itchy, and painful.
Plan: Additional Notes.
Traumatic facial scar following injury:
ILK injected today for hypertrophic area of the scar
For further scar revision recommended the following treatments:
Recommended Silagen scar gel twice daily
3 sessions of microneedling [quote: $300 per session]
Recommended pulsed dye laser for purpuric/vascular area [quote: ~$150 although subject to vary based on
1.
Visit Note - February 13, 2025
MEYER, BARBARA
MRN:
3303460
DOB:
01/08/1966
Sex:
Female
PMS ID:
3303460
Page 2Sabrina Jamiel, PA-C (Primary Provider)
Anthony John Petelin, MD (Bill Under)
(480) 905-8485 Work
(480) 905-7274 Fax
Center For Dermatology, PC Scottsdale
14275 North 87th Street
Suite 110
Scottsdale, AZ 85260-3696
Plastic Surgery
History
Reviewed November 22, 2024.
Skin Conditions
Reviewed on November 22, 2024.
None
Skin Protection
Reviewed on November 22, 2024.
Do you wear sunscreen?: Yes
If Yes, what SPF?: 50
Do you tan in a tanning salon?: No
Family History of
Melanoma
Reviewed on November 22, 2024.
Do you have a family history of
Melanoma?: No
None
provider]
Plan: Additional Notes.
Of note there is another hypertrophic scar on the mucosal surface of the lip - recommended against any ILK
injection due to pain of injection
Patient will consult with ENT if scar tissue on mucosal lip is persisting, enlarging, painful, etc
Irritated Seborrheic Keratosis
(L82.0)
Stuck-on inflamed papule(s) with crust
located on the left lateral superior chest.
Associated diagnoses: Cutaneous Inflammation, Other Disturbances of Skin Sensation, Pruritus, and Cutaneous
Pain
Plan: Counseling.
I counseled the patient regarding the following:
Skin Care: Irritated Seborrheic Keratoses can be removed with cryotherapy.
Expectations: Irritated Seborrheic Keratoses are benign growths that become inflamed, itchy, tender, traumatized,
caught on clothing, or exhibit bleeding or crusting. Because the are symptomatic, they can be treated with
cryotherapy.
Contact Office if: If Irritated Seborrheic Keratosis fails to resolve despite treatment, or if you develop a side effect
from therapy, such as unbearable crusting, scabbing, redness and tenderness.
Plan: Liquid Nitrogen.
A total of 1 lesion was treated with liquid nitrogen, located on the left lateral superior chest. This procedure was
medically necessary because the lesions that were treated were: enlarging, inflamed, irritated, itchy, painful,
rubbing on clothing, and new. The patient's consent was obtained including but not limited to risks of crusting,
scabbing, blistering, scarring, darker or lighter pigmentary change, recurrence, incomplete removal and infection.
2.
MIPS
Plan: MIPS Quality.
Quality 226 (Tobacco Use Screening and Cessation Intervention): Patient screened for tobacco use and is an
ex/non-smoker
3.
Follow up PRN
Staff:
Sabrina Jamiel, PA-C (Primary Provider)
Jose Nuno (scribe)
Petelin, Anthony MD (Bill Under)
Visit Note - February 13, 2025
MEYER, BARBARA
MRN:
3303460
DOB:
01/08/1966
Sex:
Female
PMS ID:
3303460
Page 3Sabrina Jamiel, PA-C (Primary Provider)
Anthony John Petelin, MD (Bill Under)
(480) 905-8485 Work
(480) 905-7274 Fax
Center For Dermatology, PC Scottsdale
14275 North 87th Street
Suite 110
Scottsdale, AZ 85260-3696
Visit Note - February 13, 2025
MEYER, BARBARA
MRN:
3303460
DOB:
01/08/1966
Sex:
Female
PMS ID:
3303460
Page 4Sabrina Jamiel, PA-C (Primary Provider)
Anthony John Petelin, MD (Bill Under)
(480) 905-8485 Work
(480) 905-7274 Fax
Center For Dermatology, PC Scottsdale
14275 North 87th Street
Suite 110
Scottsdale, AZ 85260-3696
Visit Note - February 13, 2025
MEYER, BARBARA
MRN:
3303460
DOB:
01/08/1966
Sex:
Female
PMS ID:
3303460
Page 5Sabrina Jamiel, PA-C (Primary Provider)
Anthony John Petelin, MD (Bill Under)
(480) 905-8485 Work
(480) 905-7274 Fax
Center For Dermatology, PC Scottsdale
14275 North 87th Street
Suite 110
Scottsdale, AZ 85260-3696
I, Jose Nuno am scribing for, and in the presence of Sabrina Jamiel, PA-C.
Electronically Signed By: Jose Nuno, 02/13/2025 09:13 PM MST
I, Sabrina Jamiel, PA-C, personally performed the services described in the documentation as scribed by Jose Nuno in my presence, and confirm it is
both accurate and complete.
Electronically Signed By: Sabrina Jamiel, PA-C, 02/13/2025 09:13 PM MST
EXHIBIT C
Medical Bills