2014-06-12

11:00 pm

Patient: RW
DOB: 06/09/63

6/12/14 - 2300 - RN and MD met with patient to discuss plan and medication regime. At this time the plan is for RN to assess patient twice a day and to give him his medication every morning to self-administer throughout the day. If patient needs to travel without RN he can have two days of medication at a time. RN will be in close contact with patient's assistants to arrange daily meetings. RN will report status of patient to MD via telephone on a daily basis.

During initial meeting patient was pleasant and cooperative. Patient agreed to the plan and appears motivated to make positive changes in his life. Patient was able to identify some negative consequences of current medication usage and looks forward to living a healthier lifestyle. Plan is for RN to monitor patient and current medication regime while patient finishes his work commitment in Boston through mid July. Once patient completes work commitment he will begin a medical detox in LA.

Plt41 pg 01

2014-06-13

03:00 pm

6/13/14 - 1500 - Met with patient in his apartment. Patient continues to be pleasant and cooperative. He stated that he initially started taking opiates after some dental work and became dependant on them. Patient is fearful of coming off of opiates but knows it is what he needs to do. Patient also expressed some emotional trauma, which causes him depression and anxiety. Patient given positive reinforcement for reaching out for help at this time. Patient was given his daily medication. Each medication was discussed with patient and he expressed verbal understanding. When asked to turn over all medications that he had in his possession, assistant gave the following medications to RN:

Crestor 10mg #19
Lexapro 20mg #80
Lexapro 10mg #2
Klonopin 1mg #115
Valtrex 1G #15
Nexium 40mg #41
Hydrocodone 10-325mg #2
Oxycodone 30mg #53 and 2 halves
Dilauded 8mg #2.5

Patient also takes Cialis 10mg daily but chose to keep this in his possession.

Patient states that he currently takes Oxycodone 15mg BID and Oxycodone 30 mg at bedtime - Not Oxycodone 30 mg TID as originally reported. Patient also states that he takes Adderall 2.5 - 5mg BID prn, not Adderall 5mg BID as originally reported.

Patient will be given the following medications on a daily basis to self administer:

Azilect 1mg - 1 tab in am
Klonopin 1mg - 2 tabs in am
Oxycodone 30 mg - 1/2 tab BID, 1 tab at HS
Adderall 10 mg - 1/2 tab BID PRN
Lexapro 20 mg - 1 tab in am
Crestor 10 mg - 1 tab in am
Valtrex 1G - 1 tab in am
Nexium 40 mg - 1 tab in am (patient chose to take in am rather than pm)
PrevPac - 1/2 pack BID
Librium 300 mg - 1 capsule BID
Ambien 10 mg - 1 tab at HS

Patient instructed to leave any medication that he does not take in the pill container and give back to RN at the end of each day. Patient expressed appreciation to medical team for coming to Boston to help him. Patient or assistant will check in with RN later tonight to determine when will be a good time to check in this evening after patient finishes work. Report given to MD via text. Report included current status of patient and requested refills of Valtrex and Cialis.

Plt41 pg 01-03

2014-06-13

07:00 pm

1900 - Patient's assistant came to hotel to pick up 2 days worth of medication as patient will be driving straight to NY when finished filming at 0200. Patient will return to Boston Sunday night. Per assistant patient stated that he is "feeling great today". Assistant voiced concern that patient does not have an appetite and his nutritional intake is poor. Suggested Ensure TID. Assistant instructed to tell patient to please call at anytime with any questions or concerns while he is away. Report given to MD via text. Report included patient's status and what medications were given to patient's assistant to take to NY.

Plt41 pg 03

6/14/14 - Patient in NY. Per assistant he is doing well.

Plt41 pg 03

2014-06-15

04:00 pm

6/15/14 - 1600 - Contacted patient's assistants to find out a good time this evening to check in with patient. I was informed patient would not be arriving back to Boston until late tonight and had a 0600 call time tomorrow morning. I offered to see patient last tonight or before 0600 call time tomorrow but it is preferred that I go to the set to see patient tomorrow. Patient does have morning and afternoon medication. Report given to MD via text.

Plt41 pg 03

2014-06-16

08:00 am

6/16/14 - 0800 - Contacted patient's assistant to find out a good time to go to set to check in with patient. Assistant will call around noon to set a time.

Plt41 pg 04

2014-06-16

03:00 pm

1500 - Spoke to RN at MD's office. Crestor, Valtrex and Cialas will be mailed to hotel today.

Plt41 pg 04

2014-06-16

11:00 pm

2300 - Accompanied patient on set today from 1300 - 2200. Patient appeared focused and worked hard throughout the day. After filming patient and RN spent time talking back at the hotel. Patient states that his GERD feels better and he is experiencing less burning in his esophagus and throat. VS WNL BP 122/79 P 76. Patient stated that he is getting a better night's sleep but still wakes up a few times during the night and is able to fall right back to sleep. Patient stated he is having a hard time focusing in the morning and requested increasing his AM dose of Adderrall to 10mg. Report given to MD and Adderrall will be increased. Patient will also be started on Melatonin 20mg tonight. Patient continues to have a decreased appetite. Ensure TID was suggested again and patient is willing to try it. Patient continues to be pleasant and cooperative. Patient was given HS medications and one day of routine meds were left with patient's assistant for tomorrow. Plan was for patient to go straight to bed as he has an early call in the morning. Plan for tomorrow is for RN to go to set to assess patient sometime during the afternoon. Full report given to MD via telephone.

Medications changes today:

Adderall 5 mg AM discontinued
Adderall 10 mg AM ordered
Melatonin 20 mg HS ordered

Plt41 pg 04

2014-06-17

02:00 pm

6/17/14 - 1400 - Checked in with patient's assistant to see when I could check in with patient today. Plan is to meet up with patient this evening on location and attend concert with patient and staff. Ensure was picked up from pharmacy and will be given to assistant when convenient.

Medication delivered to hotel today:
Valtrex 1G # 90
Melatonin 20mg #60
Cialis 10 mg #30

Plt41 pg 05

2014-06-17

11:30 pm

2330 - Accompanied patient, fiancé, assistants and security to concert. Patient was preoccupied as he was performing with other musicians during the concert. Patient appeared in good spirits but I was unable to spend any one on one time with patient to assess him or speak to him about how he is feeling. Daily routine medications were given to assistant for patient to self-administer tomorrow. Assistant informed me that patient took Adderall 5mg in am today rather than Adderall 10mg, which he had previously requested. Assistant was asked to please have patient call MD tomorrow, as he would like to check in with him. Assistant was also asked to pass on RN and MD's numbers to fiancé as we would both like to speak with her and to obtain her input towards patients treatment needs. Tomorrow patient is off from his current film but has to do some voiceover commitments for a previous film. Plan is for RN to check in with assistant in the afternoon to see when a good time to assess patient would be. Assistant was also asked to find a good time when we could get some blood drawn for lab work that MD is requesting.

Plt41 pg 05

2014-06-17

02:20 pm

1420 - Status report given to MD via telephone. MD will be visiting patient June 22 - 24 and would like labs drawn prior to his visit. Information relayed to patient's assistant and asked to suggest some possible lab draw times that would work over the next few days. Call made to RN to find out lab hours and her availability.

Plt41 pg 05/06

2014-06-17

05:00 pm

1700 - RN is available to draw labs on 6/20 between 1400 - 1600 and on 6/21 anytime before 1100. Quest Diagnostics closes at 5pm M-F and noon on Saturdays. Labs must be dropped off during business hours. Lab orders will be faxed to Quest Diagnostics fax # (number) by MD's office. The following labs will be drawn: CBC, Metabolic Panel, Serum H Pylori, PSA, Thyroid functions, Arthritis Panel and Glycohemoglobin.

Plt41 pg 05/06

2014-06-17

08:00 pm

2000 - Patient is back at hotel for the evening. Per assistant, patient is eating dinner and will be going to bed shortly. HS medications were left for patient to self-administer. Per security guard, patient appears more focused and in a good state of mind over the past few days. RN reminded assistant and security that I am supposed to be seeing the patient on a daily basis. Plan for tomorrow is for RN to go to the set, assess patient and spend time speaking with fiancé about her thoughts and goals for patient's treatment.

Plt41 pg 05/06

2014-06-19

12:30 pm

6/19/14 - 1230 - Report given to MD via telephone. The following are medication orders for today:

Discontinue - Lithium 300mg BID
Order - Lithium 300 TID

Waiting to hear from assistant as to what time RN will visit patient on set.

Plt41 pg 06

2014-06-19

05:00 pm

1700 - Reached out to assistant to see when RN should head over to the set. Informed that it would be better if patient were seen back at the hotel when he was finished filming this evening.

Plt41 pg 07

2014-06-19

11:30 pm

2330 - Met with patient in his apartment. Patient stated that he is exhausted from his work schedule but overall is feeling great. States his stomach no longer bothers him although he does have some esophageal discomfort throughout the day. Encouraged patient to cut down on the amount of redbull and coffee that he is drinking. Patient returned the pill containers that he has been given containing his daily meds. It is noted that patient did not take his HS medications on 6/14, 6/15, and 6/17 - MD informed and ordered Lithium BID to continue for 3 more days before increasing dosage. Patient educated on importance of taking prescribed medication on a continual basis and patient expressed verbal understanding. Patient stated that the Melatonin had a good affect and he slept soundly last night and woke up feeling energetic this morning. Patient spoke to MD via telephone and updated him on his status. Patient's routine medications for tomorrow were left with patient for self - administration. Patient took HS meds and was planning on going to bed immediately. Plan is for RN to visit patient on set tomorrow and for labs to be drawn at 1530.

Med Changes:

Discontinue: Lithium 300mg TID
Order: Lithium 300mg TID x 3 days.

Plt41 pg 07

2014-06-20

05:00 pm

6/20/14 - 1700 Went to set to see patient. States he did not sleep well last night but feels it was due to emotional stress. Patient states he has been drinking lots of water today and was able to eat 50% of lunch. Labs were drawn and dropped off at the lab. Results will be faxed to MD's office when available. Patient plans on relaxing and staying in Boston for his next two days off. Plan is for RN to check in with assistant to set up a time to see patient tomorrow. Routine meds for Saturday were left with assistant to give to patient to self - administer.

Plt41 pg 07/08

6/21/14 - Patient is spending the day relaxing with his fiancé in his apartment. Routine medications for Sunday were given to patient's security guard to give to patient for self-administration. Texted patient to set up time to meet with MD tomorrow and did not get a response.

Plt41 pg 08

2014-06-22

09:00 pm

6/22/14 - 2100 - Met with patient and MD. Reviewed all medications, patient's status and plan for detox off opiates when he is finished filming. Patient is in agreement of current plan. Patient states he is sleeping better but feels mildly sedated throughout day and depressed for the past 3 days. Patient feels this is situational rather than related to any medications he is taking. Patient spoke about his difficult childhood and current mood swings. It was explained to patient that once his medications have reached therapeutic effect he should experience increased mood stability and he will be able to benefit more from therapy. Patient states his stomach issues have diminished and he does not have any medical complaints at this time. Patient was given his routine medications for Monday to self-administer.

Medication changes:

Discontinue: Lithium 300mg BID
Order: Lithium 900mg HS
Discontinue Adderall 5 mg in afternoon
Order: Adderall 10 mg in afternoon

Plt41 pg 08

2014-06-23

02:00 pm

6/23/14 - 1400 - Plan was for RN and MD to visit patient on set today. Patient's assistant informed us that the set was very chaotic and patient would like to meet with us tomorrow on his day off instead.

Plt41 pg 09

2014-06-23

10:10 pm

2210 - RN met with patient's security and assistant and was informed that patient and his fiancé will be leaving early morning to go to a Spa for Tuesday and Wednesday. Plan is for MD and RN to meet with patient and fiancé before they leave in the morning. Assistant given patient's routine meds for the next three days to self-administer while he is away.

Plt41 pg 09

2014-06-23

11:00 pm

2300 - Per MD we will only be meeting with patient's fiancé tomorrow.

Plt41 pg 09

2014-06-24

12:00 pm

6/24/14 - 1200 - RN and MD met with patient's fiancé to inform her of treatment plan for patient. Fiancé voiced concerns of patient's behavior while using drugs and alcohol. She is in agreement of treatment plan and supportive of patient's decision to detox after he finishes filming. Fiancé was educated on patient's current medication regime and feels comfortable with treatment he is receiving. She was encouraged to call RN or MD with any questions or concerns that might arise.

Plt41 pg 09

6/25/14 - Patient is away at for the day and will not be seen today.

Plt41 pg 09

2014-06-26

02:15 pm

6/26/14 - 1415 - RN went to set to assess patient. He stated he has been experiencing "jerking movements" in his hands and legs for the past two days and he feels lethargic throughout the day. MD informed and plan is to stop Lithium at this time and see if patient feels better and symptoms subside, Patient informed of medication change and educated that he should feel better within 24 - 36 hrs and asked to report and changes to RN.

Plt41 pg 9/10

2014-06-26

09:15 pm

2115 - Patient's fiancé called. Medication changes were discussed with her and she was asked to remove Lithium from patient's medication box that she was in possession of. Fiancé expressed to RN that she feels patient's "jerky movements" and clenched jaw started when adderall dosage was increased. She was informed that this was a possibility but we should only make one change at a time so we could r/o what was causing side effects. Fiancé expressed understanding. MD informed of fiancé's concerns.

Medication Changes:

Lithium 600 mg at HS discontinued

Plt41 pg 10

2014-06-27

03:00 pm

6/27/14 - 1500 - Per assistant patient appears more alert today. RN will not see patient on set today but will assess him first thing tomorrow morning.

Plt41 pg 10

2014-06-28

09:30 am

6/28/14 - 0930 - Met with patient in his apartment. Patient reports feeling more energetic since discontinuing Lithium. Patient stated others commented yesterday that appeared to be feeling better. Patient states he continues to have some jerky movements of his hands but it seems to be decreasing. Patient educated that side effects could last up to 36 hrs after last dose of medication. VS BP 111/69, P 61. Patient will be going to his island for the next 3 days. He was given MD's number to call on his way to airport to review lab results. Patient and his fiancé were given RN's and MD's email addresses as they stated this was the best way to communicate from the island. Patient was given 4 days worth of routine medications and will self-administer. Patient informed that RN would like to see him on Tuesday to assess how he is feeling. Patient instructed to call, email or text if needed while he is away. Patient's status reported to MD via telephone.

Plt41 pg 10/11

6/29/14 - Patient away with fiancé and did not contact RN. RN spoke with patient's sister and updated her on status of treatment. Sister will speak with patient in the next few days and will update RN and MD on plan for detox when filming is finished.

Plt41 pg 11

6/30/14 - Patient continues to be away and has not contacted RN. Plan is for patient to return last this evening.

Plt41 pg 11

2014-07-01

11:00 am

7/1/14 - 1100 - RN contacted patient's assistant and requested a time to visit patient on set to assess him. Assistant will contact RN after lunch to set up a time.

Plt41 pg 11

2014-07-01

05:30 pm

1730 - Visited patient on set. Plan was to give him a urine drug screen but it was not an appropriate time or place. Patient stated that he feels much better since stopping the Lithium. Stated he could feel when the medication was no longer in his system and no longer has any complaints of jerky movements in hands and legs, no longer feels lethargic during the day and no longer feels "cloudy". Patient states that he is sleeping well at night and feels his mood has improved over the last few days. Patient continues to have poor nutritional intake and does not like the Ensure. Patient is able to eat small portions at a time and is encouraged to try other protein shakes throughout the day. Patient was given daily routine meds for 7/2/14 and will self-administer. Status reported to MD via telephone.

Plt41 pg 11

7/2/14 - Patient has the day off from work and will be spending time with his fiancé and children. Daily routine medications for 7/3/14 given to assistant to give to patient for self - administration. Plan for tomorrow is for RN to visit patient on set.

Plt41 pg 12

2014-07-03

08:30 pm

7/3/14 - 2030 - RN visited set where patient was working from 1100 - 1900. RN spent time with patient's sister who stated she felt her brother was looking and feeling good. Plan of detoxing patient was discussed with his sister and she is going to try to solidify dates and location of detox. Patient was busy filming majority of day and took a 45 min nap during his lunch period. RN briefly spoke with patient and he stated that all is well and had no complaints or concerns at this time. Plan is for patient to travel to his island early tomorrow morning and return last Sunday night. MD notified that urine drug screen has not yet been administered and ordered it to be completed Monday. Routine medications for 7/4/14 - 7/7/14 given to patient's assistant. Assistant will give to patient to self-administer while away. Plan is for RN to visit patient on set on Monday but will be available via phone or email if needed before. Full report given to MD via email.

Plt41 pg 12

7/4/14 - Per patient's sister, patient left for island this morning. He was in good spirits and had no physical complaints. Sister will be flying home today and coming back on 7/7/14 to spend time with her brother and will try to firm up plan for detox.

Plt41 pg 12

7/5/17 - Patient away and did not contact RN.

Plt41 pg 12

7/6/14 - Patient away and did not contact RN. Per security staff patient will return around 11pm tonight and has a 6am call time tomorrow.

Plt41 pg 12

2014-07-07

11:15 am

7/7/14 - 1115 - Waiting to hear from patient's assistant to find out a good time to visit patient on set today to assess him and do a urine drug screen.

Plt41 pg 13

2014-07-07

12:30 pm

1230 - Per assistant filming was cancelled today and patient will be spending the day with his fiancé and children. MD informed and ok'd urine drug screen to be done in the next day or two.

Plt41 pg 13

2014-07-07

09:30 pm

2130 - Saw patient in his apartment. Patient stated he is feeling great. Stated he feels restful after his time away on his island. Patient was relaxing with his fiancé for the evening. Routine meds for 7/08/14 left with patient to self-administer tomorrow. Plan is for RN to visit patient on the set tomorrow.

Plt41 pg 13

2014-07-08

01:00 am

7/8/14 - 1300 - Per patient's assistant it will be a short day on the set today and it would be better for me to see patient tomorrow.

Plt41 pg 13

2014-07-09

07:30 pm

7/9/14 - 1930 - Spent the majority of the day on set with patient today. Urine drug screen completed and results given to MD. MD will discuss results with patient. Patient states that he is feeling great. States he feels he is getting REM sleep every night and wakes up feeling energetic. States he still has a limited appetite but eats "just enough". Plan for detox was discussed with patient's sister and MD. Plan continues to be for patient to finish his work commitment and detox in LA or on his island at the end of July. MD will come to visit patient on 7/14/14 to further discuss plan. Routine medications for 7/10/14 & 7/11/14 left with patient for self-administration.

Plt41 pg 13

7/10/14 - Medications delivered by MD's office:

Ambien 10mg #30
Oxycodone HCL 30mg #15
Adderall 10mg #60
Cialis 10mg #30
Azilect 1mg #30

Plt41 pg 14

7/11/14 - Patient working long hours on set today. RN met up with patient's fiancé and gave her his daily routine medications for the weekend (7/12 - 7/14) for self - administration. Patient will be filming through the night tonight and plans on sleeping all day Saturday and relaxing on Sunday. Plan is for MD to arrive on 7/14 and will discuss next step of treatment with patient.

Plt41 pg 14

7/12/13 - Spoke to patient's assistant and patient is feeling fine and will not need to be seen before the MD arrives on Monday. They will notify RN if anything changes.

Plt41 pg 14

7/13/14 - Checked in with patient's assistant and no changes at this time.

Plt41 pg 14

7/14/14 - MD arrived this afternoon. Plan is for MD and RN to spend time with patient tomorrow before he leaves for work. RN will check in with assistant in the morning to confirm meeting. Routine meds for 7/15/14 given to assistant to give to patient for self-admininstaration.

Plt41 pg 14

2014-07-15

11:00 am

7/15/14 - 1100 - Per assistant patient is in a rush to get to work. Assistant will be in contact later this afternoon to set up a time for RN and MD to visit patient on set.

Plt41 pg 14

2014-07-15

11:00 pm

2300 - RN and MD met with patient. Results of drug test were discussed. The next step in treatment plan is for patient to finish filming and return to la in one week. RN will stay with patient and continue to monitor medications through approximately 8/1/14. At that time patient and RN will go to patients vacation home and will detox in a safe and quiet environment. MD will assess patient prior to detox and will visit patient and RN at his vacation home to assess and supervise detox. Patient is in agreement with plan. Patient was given his daily routine medications for 7/16 & 7/17 to self-administer.

Plt41 pg 15

2014-07-17

12:00 pm

7/17/14 - 1200 - Patient's assistant contacted RN to say that patient would be filming last tonight and has a night shoot tomorrow night. Assistant requested that RN meet up with patient's fiancé to give her patient's routine medications for the weekend.

Plt41 pg 15

2014-07-17

09:30 pm

2130 - Dropped patient's routine medications for 7/18 - 7/21/14 off to his fiancé. Patient will continue to self - administer his medications on a daily basis. Fiancé instructed to call RN if needed over the weekend. Plan is for RN to visit patient on set on Monday.

Plt41 pg 15

2014-07-21

11:40 am

7/21/14 - 1140 - Patient will have a short day on the set today - it will be his last day filming, Plan is for RN to visit him in his apartment when he is finished working for the day.

Plt41 pg 15

2014-07-21

09:45 pm

2145 - RN visited patient in his apartment. He has mixed emotions about filming being finished. States he always gets a bid sad when a project is finished. Talked about future plans and he is looking forward to relaxing on the island in a week or so. Plan is for RN to fly home tomorrow - patient will fly back to LA tomorrow. RN and patient will meet back up in LA on Thursday. Daily routine medications for 7/22 - 7/24 given to patient for self-administration.

Plt41 pg 15/16

2014-07-24

06:00 pm

7/24/14 - 1800 - RN and MD met with patient in his home. All medications were reviewed with patient and no changes will be made at this time. Patient is scheduled for an endoscopy, colonoscopy, lung scan and heart scan on 7/28/14. Preparations for tests were discussed with patient. Prep meds and instructions will be delivered to his home tomorrow. Patient expressed verbal understanding of preparations.

Plt41 pg 16

7/25/14 - Patient's assistant was given prep medications and instructions to deliver to patient today. Patient is aware of his dietary restrictions to start on Sunday morning and to start his prep medications at 6pm on 7/27/14. Patient instructed to call RN or MD if he has any questions or concerns.

Plt41 pg 16

2014-07-27

09:00 pm

7/27/14 - 2100 - RN spoke to assistant and all is set to meet patient at first test tomorrow at 7am.

Plt41 pg 16

7/28/14 - Patient met MD and RN and underwent a colonoscopy, endoscopy, lung scan and heart scan. Initial results came back as non-significant and were discussed with patient. When finals results come in, MD will discuss with patient. Patient was alert and orientated after the tests and was escorted home by his assistant.

Checked in with patient and his fiancé a few hrs after test. Fiance said patient felt fine and had slept majority of day. Patient's assistant given patients routine medications for 7/29 & 7/30. He will give to patient to self - administer.

New Meds Orders as of 7/28/14

Discontinue Crestor 10 mg QAM.

Plt41 pg 16/17

7/31/14 - RN was suppose to meet patient at his studio today but patient slept through recording session. RN met with patients assistant and gave him his rountine medications from 7/31 - 8/4/14. RN and MD will meet with patient on 8/4/14 to discuss detox plan for the island.

Plt41 pg 17

8/4/14 - RN and MD met with patient in his home. MD and patient spoke privately for about an hr. Per MD patient is nervous but continues to be in agreement to detox once we get to the island. Patient was given his routine meds for 8/5 - 8/7. Plan is to leave for the island in the next day or two.

Plt41 pg 17

8/7/14 - Trip to island has been postponed for one more day due to personal issues for the patient. Assistant requested that RN deliver one more day of routine medications to patient in his downtown home. Medications for 8/8/14 delivered to patients security guard to be given to patient for self-administration.

Plt41 pg 17

8/8/14 - Arrived on island today. Plan is for patient to continue to take routine meds through tomorrow at HS. At that time he will not take his Oxycodone and detox medications will be initiated.

Plt41 pg 17

8/9/14 - Patient expressed fears of never feeling normal without his drugs. Reassured him that this is a normal feeling and to just focus on one day at a time and see how he feels on a day-to-day basis. Patient encouraged to be open and honest with how he is feeling physically and emotionally throughout the detox process and assured we will keep his safe and comfortable. Patient took his routine meds today. His HS dosage of Oxycodone was discontinued and replaced with phenobarb 64.8 mg and baclofen 20mg. Patient was also given his routine morning medications minus the discontinued Klonopin and Oxycodone. Patient was left Phenobarb 64.8mg and Baclofen 20mg in addition to morning meds. Patient will self-administer medications. Patient was left with written instructions of what meds he was taking. Patient was also left with an automatic BP cuff and shown how to use machine. Patient encouraged to check BP prior to administering meds and if he starts to feel any withdrawal s/s. Patient expressed verbal understanding and patient's fiancé demonstrated using the BP machine. Patient was instructed to call RN if he needs anything throughout the night. If patient does not need RN throughout the night he was instructed that RN needs to see him 1 hr after he takes his morning medications to assess how he is feeling. MD will arrive tomorrow evening.

New medications orders as of 8/9/14

Discontinue Oxycodone 30 mg - 1/2 tab BID, 1 tab at HS
Discontinue Klonopin 1mg - 2 tabs in am
Start Phenobarb 64.8mg q6-8 hr while awake
Start Baclofen 20 mg QID prn body aches

Plt41 pg 17/18

2014-08-10

01:30 am

8/10/14 - 0130 - Patient's fiancé contacted RN and said patient feels like he needs more "help". Fiancé stated that patient had taken Pheno 64.8mg about 50 min ago. Patient stated his body felt "twitchy". Patient instructed to take Pheno 16.2 mg along with his HS medications and try to go to sleep. Fiancé instructed to let RN know if patient is not asleep within an hr.

Plt41 pg 18

2014-08-10

10:00 am

1000 - MD's flight has been cancelled. Arrangements are being made for him to arrive on the island 8/12/14.

Plt41 pg 19

2014-08-10

01:30 pm

1330 - Per patient's fiancé, patient fell asleep immediately after taking his HS meds and additional pheno and is currently still sleeping.

Plt41 pg 19

2014-08-10

04.15 pm

1615 - Patient awake and states he feels ok. States he is having some cravings but physically he feels better than expected. No s/s of withdrawal noted at this time and no complaints from patient. VS BP 117/78, P 72. Patient self-administered routine morning medications along with Pheno 64.8 mg and Baclofen 20mg. Patient will self administer afternoon and HS medications and call RN if needed. Patient and fiancé educated on all medications and instructed to check BP prior to administering any medications.

Detox orders for today:

Phenobarb 64.8 mg BID
Phenobarb 16.2 mg prn BID breakthrough withdrawal
Phenobarb 80 mg HS
Baclofen 20 mg TID
Neurontin 600 mg BID PRN anxiety / agitation
Clonodine 0.1 mg q6-8 hr prn withdrawal
Zofran 8mg q6h prn nausea
Imodium 2-4mg prn diarrhea, may repeat in 1 hr in needed
Vistaril 25mg prn qHS if still awake 1 hr after routine HS meds

Plt41 pg 19

2014-08-10

06:00 pm

1800 - Patient's status reported to MD via telephone. Additional orders given

Phenobarb 32.4 - 64.8 prn Q3h breakthrough withdrawal D/C phenobarb

Plt41 pg 19

2014-08-10

08:20 pm

2020 - Patient's fiancé reported that patient took afternoon meds at 2000. BP 116/67, P 81.

Plt41 pg 20

2014-08-10

09:15 pm

2115 - Patients fiancé contacted RN to report patient is experiencing runny nose, chills, aches and watery eyes. RN assessed patient and gave prn phenobarb, clonodine and aleve. Contacted MD to bring Motrin when he comes on Tuesday. VS 117/82, P 74.

Plt41 pg 20

2014-08-10

10:10 pm

2210 - Patient states he had some relief with prn meds. VS 116/75, P 72. Patient instructed to take his HS meds between 0100 - 0200 so he can start to get on a regular sleep cycle. Patient and fiancé encouraged to call RN if needed during the night.

Plt41 pg 20

2014-08-11

02:20 am

8/11/14 -

0220 - Patient's fiancé contacted RN. Stated she had given patient his HS meds along with Phenobarb 81 mg and Baclofen 20 mg at 0100. Stated patient is complaining of being in a lot of discomfort - muscle spasms, chills and pains. Instructed to give patient a prn phenobarb 32.4 mg and neurontin 300 mg and to let RN know if it has an affect on patient.

Plt41 pg 20

2014-08-11

03:35 am

0335 - Patients fiancé contacted RN to inform that patient is still awake and continues to complain of discomfort. Instructed to give vistaril 25 mg.

Plt41 pg 20

2014-08-11

04:45 am

0445 - Patients fiancé contacted RN to inform that patient is still awake and complaining of muscle spasms and pain. Instructed to have him take a hot shower and take Neurontin 600 mg.

Plt41 pg 20

2014-08-11

05:40 am

0540 - Patient continues to be awake and complain of muscle spams and pain. RN assessed patient - he had restless legs, muscle twitches, complained of feeling like skin was crawling. BP 124/83 P 63. Magnesium 1 tab and Toradol 30 mg IM administered. Patient encouraged to take a warm shower and did so with assistance from his fiancé. After show patient felt better and restless legs had calmed down. Patient was able to sit still in bed.

Plt41 pg 21

2014-08-11

06:00 am

0600 - Status reported to MD.

Increase pheno to 97.2mg Q4-6h

Plt41 pg 21

2014-08-11

06:15 am

0615 - AM dose of Phenobarb 97.2 mg and Baclofen 20 mg given to patient. Patient was relaxing in bed and felt as thought he could finally go to sleep. RN instructed patient to call when he wakes up in the morning / afternoon. Encouraged him to wake and take his next dose of meds around noon.

Plt41 pg 21

2014-08-12

10:30 am

8/12/14 -

1030 - Per fiancé, patient slept till 1000. Meds given at 1010. VS 117/83 P68. Patient states he feels much better this morning. Medications will be increased today. MD arriving this morning and will assess patient.

New Medicaiton orders:

Phenobarb 120 mg q4-6h

Per fiancé - patient took meds at 1534 VS 112/65

Plt41 pg 21

2014-08-12

05:15 pm

1715 - Patient's fiancé text called and reported patient was c/o headache, deep chills, restlessness and body aches. VS 114/69 P 65. Went to see patient. MD ordered

Motrin 800 mg QID,
Requip .5mg stat and at HS

Patient states he feels better after taking Motrin

Plt41 pg 22

2014-08-12

10:00 pm

2200 - Patient, Fiance, RN and MD had dinner together. Patient was in good spirits and expressed appreciation for RN and MD to treat him on the island. Patient continues to be fearful of who he will be off medications but continues to have a positive attitude toward detox process. Patient had no w/d complaints throughout dinner.

Plt41 pg 22

2014-08-12

10:50 pm

2250 - Patient's fiancé called to say that patient is "not feeling well" and his hands are "twitching bad" - Instructed to give him his HS meds and have him lie down. Fiance instructed to call RN if patient does not fall asleep within 30 min.

Plt41 pg 22

2014-08-13

12:30 pm

8/13/14

1230 - Patient slept through the night. Took his am meds at 1240. RN and MD assessed patient. Hand spasms noted. No meds changes at this time.

Plt41 pg 22

2014-08-13

01:40 pm

1340 - Patients fiancé text to say he wasn't feeling well. MD orders Pheno 64.8 mg, Neurontin 600 mg Stat. Patient and fiancé informed that today and tomorrow will be the most difficult days and to keep in close contact with us.

Plt41 pg 22

2014-08-13

04:30 pm

1630 - Fiancé text to say patients feels much better.

Plt41 pg 22

2014-08-13

05:00 pm

1700 - Fiance text to ask is MD could come to talk with patient privately - stating "something has come up". RN drove MD to meet with patient.

Plt41 pg 23

2014-08-13

06:30 pm

1830 - Patient feels he has a herpes outbreak and is upset that he might have given virus to fiancé. Valtrex increased.

Valtrex 1G TID x2 Day

Plt41 pg 23

2014-08-13

07:30 pm

1930 - Fiancé text to say that patient is emotional over possibility of giving fiancé virus. MD went to talk to him. Patient feeling much better after discussion.

Plt41 pg 23

2014-08-13

08:40 pm

2040 - Fiance text to say that patient was feeling "heeby geebies" - Intsructed to next dose of detox meds. (pheno 4, neurontin 2, baclofen)

Plt41 pg 23

2014-08-13

11:15 pm

2315 - HS meds given - no complaints at this time.

Plt41 pg 23

2014-08-14

12:30 am

8/14/14

0030 - Fiancé tex to say that patient complaining of "cramp, bloating. Instruced to give Bentyl 20 mg. VS 116/56. Fiance instructed to call RN if patient still awake in 30 min.

Plt41 pg 23

2014-08-14

11:20 am

******1120 - Fiancé text to say that patient feels much better. AM meds given at 1030, VS 117/76

Plt41 pg 23

2014-08-14

03:15 pm

1515 - Fiancé administered afternoon meds. VS 115/70. States patient is feeling great today.

Plt41 pg 23

2014-08-14

04:00 pm

1600 - MD spent time with patient.

Plt41 pg 23

2014-08-14

10:00 pm

2200 - HS meds given 99/66 - Clonodine held.

Plt41 pg 23

2014-08-14

11:50 pm

2350 - Text from fiancé that patient is "jonesing" - Instructed fiancé to give patient HS meds.

Plt41 pg 24

2014-08-15

01:30 am

8/15/14 -

0130 - Text from fiancé that patient is "paranoid" and trying to fight with fiancé. States he is "angry" and "freaking out" - RN and MD went to assess patient.

Plt41 pg 24

2014-08-15

02:00 am

0200 - Seroquel 25mg, Pheno 96.4mg, Toradol 45mg IM, given and patient escorted to bed.

Plt41 pg 24

2014-08-16

10:30 am

8/16/14 -

1030 - Per patient's fiancé patient woke up and was feeling restless. AM meds were given and patient fell asleep.

Plt41 pg 24

2014-08-16

02:00 pm

1400 - RN and MD assessed patient and administered meds

Plt41 pg 24

2014-08-16

05:00 pm

1700 - RN and MD assessed patient and administered meds

Plt41 pg 24

2014-08-16

08:00 pm

2000 - RN and MD assessed patient and administered meds. Current med regime is keeping patient comfortable.

Med Changes:

Pheno 64.2 Q4H
d/c Clonodine 0.1mg
Neurontin 300 TID, 600 HS
d/c Requip 1 mg
Seroquel 12.5 TID, 25mg HS

Plt41 pg 24

2014-08-16

11:00 pm

2300 - Patient feel asleep at 2200 - Missed his HS medications.

Plt41 pg 25

2014-08-17

08:30 am

8/17/14

0830 - Patient awake VS 132/82 P 82. RN and MD assessed patient. Patient is social but appears guarded. Discussed med changes with patient and he is on board to continue taper.

Phenobarb 64.2 TID
Seroquel 25mg BID, 50mg HS

Plt41 pg 25

2014-08-17

02:00 pm

1400 - Patient called to ask if we were tapering him today. Reminded him that he got the same dose this am but we are spreading the dose out. Patient stated he was ok to wait till dose.

Plt41 pg 25

2014-08-17

03:45 pm

1545 - Patients fiancé came to get MD and RN stating that patient was erratic and paranoid. RN and MD found patient sitting quietly on his porch. Patient was calm and stated he was frustrated with the process of detoxing. Stated he thought he should be feeling better by now. RN and MD sat with patient and listened to his express his frustrations with how he was feeling physically and emotionally. Patient reassured that what he is feeling is part of the process. Patient stated he wanted to speed the process up and it was agreed between patient and treatment team that we should go back to LA tomorrow and start the next stage of patient's treatment.

Plt41 pg 25

2014-08-18

01:00 am

8/18/14 - 0100 - text from fiancé that patient is upset and irritable. MD and RN went to assess patient. He states he had a fight with fiancé and is questioning whether or not he can emotionally and physically handle detox. Complains of agitation and nausea. RN and MD gave patient emotional support. MD ordered:

Seroquel 100mg - STAT
Phenergan 100 mg IM - STAT

Patient was escorted to bed. Plan is to leave the island tomorrow.

Plt41 pg 25/26

2014-08-18

09:00 am

8/19/14 - 0900 - RN and MD went to check in on patient. Patient is still agreeing that it is best to leave the island but is unsure if he wants to continue detox when he arrives back to LA. MD sat with patient and discussed all the benefits of continuing treatment. AM meds administered. Plan is to leave the island at 1800.

Plt41 pg 26

notes say date is 8/19, but has to be 8/18

2014-08-18

03:00 pm

1500 - Patient's fiancé administered afternoon dose of medications.

Plt41 pg 26

notes say date is 8/19, but has to be 8/18

2014-08-18

06:30 pm

1830 - Upon leaving the island patient appears to be in good spirits. He states that the med combination that he is on making him comfortable and he agrees to continue treatment once back to LA.

Plt41 pg 26

notes say date is 8/19, but has to be 8/18

2014-08-18

09:30 pm

2130 - Patient complains of body aches - evening dose of medications administered.

Plt41 pg 26

notes say date is 8/19, but has to be 8/18

2014-08-18

11:35 pm

2335 - Arrived back in LA. Patient was social for 1/2 the flight home and then rested for the last 1/2 flight home. Upon arrival at LAX patient and fiancé head back to house downtown. Fiancé was given patient's HS meds and AM meds for 8/20/21. Plan is for RN to see patient in the morning.

Plt41 pg 26

notes say date is 8/19, but has to be 8/18

2014-08-19

01:35 am

8/20/14 - 0135 - Patient's fiancé text that patient took HS meds at this time. BP 122/78

New Med Orders:

Lamicatal 6.25mg QD

Plt41 pg 27

notes say date is 8/20, but has to be 8/19

2014-08-19

09:15 am

0915 - RN received text from patient's fiancé - patient self - administered medications at 0915 - BP 134/79. Fiancé states, "he feels great." Plan is for RN to see patient at 4pm.

Plt41 pg 27

notes say date is 8/20, but has to be 8/19

2014-08-19

04:30 pm

1630 - RN saw patient in his downtown home. He was in good spirits and denied any w/d s/s at this time. States he is glad to be home and back on track. Patient educated on new medications and warned of possible side effects. Patient was off to see his daughter on her fist day of filming. Plan is for RN to move into a hotel close by and will see the patient on a daily basis and leave medications for one day at a time. Patient and Fiancé instructed to call RN if needed at any time.

Plt41 pg 27

notes say date is 8/20, but has to be 8/19

2014-08-19

09:35 pm

2135 - Received text from Fiancé saying that he is "feeling it but doesn't want to go to bed yet". Fiancé instructed to give Pheno 64.8mg now and patient can take the rest of HS meds when he is ready to go to sleep. Patient also complains of body aches at this time. Motrin 800 mg given.

Plt41 pg 27

notes say date is 8/20, but has to be 8/19

2014-08-19

11:15 pm

2315 - RN received text from fiancé stating "he's manic, full on flipping out, give up, not to call you guys". Instructed to give HS meds and additional Seroquel 50 mg and to call if RN needs to go assess patient.

Plt41 pg 27

notes say date is 8/20, but has to be 8/19

2014-08-20

12:10 am

8/20/14

0010 - RN received text from fiancé stating, "he seems calmer, not as crazed".

Plt41 pg 27/28

2014-08-20

08:20 am

0820 - RN received text from fiancé stating, "we need help, he's at the border, refusing to take his meds." Fiancé informed RN would come right over.

Plt41 pg 28

2014-08-20

12:30 pm

1230 - RN and MD spend time talking with patient. Patient expressed frustration with the detox process and with not liking how the phenobarb was making him feel. Initially, he stated he was done with the process and no longer wanted MD and RN's services. After processing his feelings and realizing how far he had come and that part of his wanting to give up was due to tension between him and his fiancé. Patient, Fiancé, RN and MD came up with a plan for Fiancé to take a few days for herself and patient was willing to continue treatment but was going to refuse Phenobarbital from this point forward. Patient took AM medications except Phenobarbital at 1020 RN and MD informed patient of the dangers of stopping medication abruptly and offered to shorten the taper but patient refused to take pheno all together. Patient requested Xanax for breakthrough anxiety while going off pheno abruptly. MD agreed to prescribe Xanax 0.5 #15 and patient could keep in his possession as long as RN could randomly count meds to see how many he had taken.

New Medication Orders

D/C Phenobarbital 64.2 TID
Xanax 0.5 mg - 1-2 tabs prn q4-6 h severe anxiety. May keep on person.

Current Med Orders:

Cialis 10gm QD
Valtrex 1G QD
Nexium 40mg QD
Lexapro 30mg QD
Neurontin 300 BID, 600mg HS
Neurontin 100 mg prn anxiety q4-6h
Adderall 10mg BID
Seroquel 25mg BID, 50mg HS
Ambien 10mg QHS
Melatonin 20mg QHS
Bently 20mg prn BID abdominal cramping
Motrin 800mg prn TID pain
Toradol 60mg IM prn Q8h pain
Immodium 2mg prn diarrhea
Xanax 0.5mg prn Q4-6h severe anxiety


Patient may self-administer all medications with the exception of Toradol IM.

Plt41 pg 28/29

2014-08-20

03:00 pm

1500 - Patient agreed to have RN stay with him throughout the day / evening to monitor how he would feel after stopping the Phenobarbital abruptly. Patient complains of increase anxiety but is not requesting prn medication. Stating he wants to sit with feelings and see if he can work through them. Patient given positive reinforcement for behaviors.

Plt41 pg 29

2014-08-20

04:10 pm

1610 - Afternoon meds administered. VS 137/98 P62. Patient c/o body aches - Toradol IM given

Plt41 pg 29

2014-08-20

07:30 pm

1930 - Patient continues to have a diminished appetite. Ate 25% of pasta dinner.

Plt41 pg 29

2014-08-20

09:05 pm

2105 - Patient starting to fall asleep on the couch. Administered HS meds.

Plt41 pg 29

2014-08-21

01:30 am

8/21/14 - 0130 - Patient continues to sleep soundly on the couch.

Plt41 pg 30

2014-08-21

03:15 am

0315 - Patient continues to sleep soundly on the couch.

Plt41 pg 30

2014-08-21

05:45 am

0545 - Patient awake, reading on the couch. No complaints at this time.

Plt41 pg 30

2014-08-21

07:00 am

0700 - AM meds administered. Patient states he is feeling less groggy since stopping the pheno and can feel his mind becoming clearer. Patient states he is determined to be sober and is glad that he has now stopped all detox medications.

Plt41 pg 30

2014-08-21

07:45 am

0745 - Patient ate 25% of English muffin for breakfast. C/o body aches - Toradol IM given.

Plt41 pg 30

2014-08-21

01:40 pm

1340 - Patient continues to have a positive attitude towards sobriety. He has called a sober friend for support and feels it was helpful to speak with someone who understands what he is going through. Patient encouraged to reach out to other sober friends and set up some accountability for his sobriety. Patient's sister has come to spend the day / night with him. Patient was given meds for the remainder of the day and for tomorrow morning and instructed to check in with RN. RN will be close by at a hotel if needed.

Plt41 pg 30

2014-08-21

08:10 pm

2010 - Received text from patient that he has been chatting with his sister all evening and is really enjoying how he is feeling. Patient encouraged to call RN at anytime during the night if needed. If not, to call RN when he awakes in the am.

Plt41 pg 30

2014-08-22

07:30 am

8/22/14 - 0730 - Received a text from patient's sister Christi that patient took his afternoon meds at 1600 and HS meds around 0130 and was asleep by 0210. She stated that patient had an appetite and ate a sandwich late last night. Per sister patient took Xanax 0.5 mg around 1700. Per sister, patient continues to sleep at this time.

Plt41 pg 30/31

2014-08-22

09:30 am

0930 - Received text from sister that patient is up and has taken his AM medications. Sister asked to tell patient that RN would be by in about an hour to see him.

Plt41 pg 31

2014-08-22

10:20 am

1020 - Arrived at patient's house and he is in good spirits. Patient refused breakfast as he stated he still not does not have an appetite.

Report given to MD via telephone. New med orders:

D/C Lamicatal 6.25mg QD
Start Lamicatl 12.5 mg QD x 7days.

Plt41 pg 31

2014-08-22

02:00 pm

1400 - Patient c/o body aches and abdominal cramping. Torordol 60 mg IM and Bentyl 20 mg PO administered.

Plt41 pg 31

2014-08-22

03:20 pm

1520 - Patient c/o diarrhea. Given bottle of Imodium to self - administer as needed, Patient took Imodium 4 mg at this time. VS 141/78 P95.

Plt41 pg 31

2014-08-22

08:20 pm

2020 - Plan is for patient to spend the weekend at his children's house. Per MD okay to given patient his routine meds to self - administer throughout the weekend. Patient asked to touch base with RN throughout the weekend and reminded to stay on a regular sleep schedule. Plan is to see patient when he returns to his home Sunday evening.

Plt41 pg 31

2014-08-23

10:25 am

8/23/14

1025 - Received a text from patient that "all is well".

Plt41 pg 31/32

2014-08-23

07:40 pm

1940 - Checked in with patient via text and got a response, "been very good, I am still a raw nerve and, of course, the receptors are buzzing with electricity." Per text patient plans on having dinner out with some friends tonight and will check in tomorrow.

Plt41 pg 32

2014-08-24

11:25 am

8/24/14

1125 - Checked in with patient via text message. Plan is to see patient later this evening to see how he is doing and to give him his routine medications for tomorrow to self-administer.

Plt41 pg 32

2014-08-24

06:30 pm

1830 - Plan is to meet patient at his house around 2000.

Plt41 pg 32

2014-08-24

07:30 pm

1930 - Patient text to say that he was staying with his kids longer than expected and would let RN know when he was headed back to his house.

Plt41 pg 32

2014-08-24

09:30 pm

2130 - Patient text RN to say that he needed to increase his Valterx. Patient instructed to use the ointment given to him on Friday to self-administer. Patient stated it was at his house, not with him. Call to MD to report patient status.


New Medication Order:

d/c Valtrex 1G QD
Start Valtrex 1 G TID

Plt41 pg 32

2014-08-25

10:00 am

1000 - Met patient at the house of his children and gave him Acyclovier Ointment. New Medication Order - Acyclovier Ointment 1% - Apply as needed up to 3x per day. Patient stated he was enjoying spending time with his children with a clear mind. He took his daughter shopping and the spa and took his son to a comedy show. Plan is for patient to visit his daughter on set today and then meet with RN, MD and fiancé at 1600. Patient given his routine meds for 8/25/14 and 8/26/14.

Plt41 pg 33

2014-08-25

07:00 pm

1900 - Meeting at MD's house was quite stressful for patient. Him and his fiancé are having a hard time communicating and understanding each other's point of view and feelings. A few times during the meeting patient wanted to give up process and talked about going out and relapsing. Per MD stat order - patient was given prn dosage of Neurontin 600mg and Seroquel 50 mg to help with his anxiety. Patient was able to talk through his feelings and agreed to stay working with treatment team. Plan is for fiancé to start therapy tomorrow, patient will continue with current treatment plan through movie shoot and start individual therapy as soon as he is back in LA. By end of meeting patient and fiancé were emotionally stable and agreed to go home and have a relaxing night and not to continue discussion while alone with each other. Patient will call MD or RN if needed throughout the evening.

Plt41 pg 33

2014-08-26

01:00 pm

1300 - Visited patient in his home. He stated last night was peaceful and he fell asleep early on the couch and had a good nights sleep. Stated him and his fiancé had no further discussions about relationship and just enjoyed each others company throughout the evening. Patient given routine meds for 8/27/14 for self-administration. Plan is for patient to go play music with his friend this evening; he will call RN if needed.

Plt41 pg 33/34

2014-08-27

09:00 am

8/27/14 - 0900 - Received text from patient's sister that patient had been recording music with his friend till 0500 and did not go to sleep till 0700 and is currently still sleeping. Sister stated that patient and his fiancé has a disagreement last night and that patient was able to remain calm and handled situation appropriately.

Plt41 pg 34

2014-08-27

01:30 pm

1330 - Patient awake and self-administered routine morning medications. Patient expressing feeling about argument with fiancé and feels relationship is putting unwanted stress on him right now. Patient given positive reinforcement for recognizing triggers and some healthy coping mechanisms for stress were discussed. RN counted patient's Xanax and he has taken #9 tabs since prescription was filled on 8/20/14. Patient reminded that the Xanax as only to be used when his anxiety reach 8/10 and he should use alternative methods of stress relief before taking medication. Patient expressed verbal understanding.

Plt41 pg 34

2014-08-27

04:00 pm

1600 - Patient off to play music with friend and will self-administer routine afternoon medication.

Plt41 pg 34

2014-08-27

09:30 pm

2130 - Patient back home. Per patient he had a long conversation with fiancé and they both understand that right now is a time to work on themselves as individuals. Patient's fiancé now has a RN to help her anxiety and to monitor her while starting a new mood stabilizer medication. Patient feels this will take some stress of their relationship and in return take some stress off of him. Patient is in good spirits. Plan is to leave for London this evening.

Plt41 pg 34/35

2014-08-28

02:30 am

8/28/14 - 0230 -On plane flying to London. Patient self administered routine HS medications 1hr ago and fell asleep at 0210.
*Time change now 8 hrs ahead

Plt41 pg 35

2014-08-28

06:00 pm

1800 - Landed in London. Patient self-administered routine AM medications. Patient slept about 5 hrs on plane. Complains of body aches and neck tension. PRN Toradol 60 IM given with good effect.

Plt41 pg 35

2014-08-28

10:30 pm

2230 - Patient and fiancé are settling into hotel. Patient was given routine medications for 8/29/30 that he will self-administer. He is ordering dinner to eat in hotel. Plan is for RN to see patient at 1030 tomorrow morning before he leaves for work.

Plt41 pg 35

2014-08-29

11:00 am

8/29/14 -

1100 - Patient is awake and preparing for his first day of work. He is pleasant and social. Patient self-administered AM medications and a prn Motrin 800 mg for body aches. Patient did not take his Seroquel 25mg this am as he wanted to see how he felt without it as he has some concerns of sedations while having to work. MD notified. Plan is for patient to touch base with RN this evening when he arrives back to hotel.

Med orders:

d/c Valterex 1G TID
Valtrex 1G BID

Plt41 pg 35

2014-08-29

11:30 pm

2330 - Per patient's security, patient had a good day at work and is now home preparing for bed.

Plt41 pg 36

2014-08-30

12:30 pm

8/30/14 -

1230 - Patient text RN at 1015 stating he had a HA. Patient assessed - Toradol IM 60mg administered LUOQ at 1030 with good effect. Patient stated he had a good day at work yesterday and could tell he was more creative now that he is no longer taking opiates. Patient stated he felt fatigued in the afternoon and requested in increase Adderall while he is filming over the next month. Patient reminded he might just be feeling jet lagged and to see how he feels over the next few days. Patient also complains about tension in his shoulders and neck. RN suggested getting a massage today. Patient self-administered routine AM medications at 1115. Plan is for patient to read script for a while and possibly get a massage later this afternoon. Patient will check in later. Patient status reported to MD via email.

New Medication Order

Aderall 10mg 1/2 - 1 tab daily prn lethargy

Plt41 pg 36

2014-08-30

09:30 pm

2130 - Patient text RN to say that he was going to dinner with his fiancé and was feeling pain and tension in his neck. Assessed patient and Motrin 800mg and Baclofen 20mg was given with good effect. Patient stated he had self-administered his afternoon meds around 1500. Patient instructed to call RN during the night if needed. If not needed to text when he wakes up so RN can check in.

Plt41 pg 36

2014-08-31

11:20 am

8/31/14

1120 - Patient text to say that he was having neck and shoulder pain. RN assessed patient and administered Toradol 60mg IM ROUQ and Baclofen 20mg. Patient encouraged to do some stretching exercises and get a massage today. Patient's fiancé stated that she would make an appt for him. Patient stated he took his routine AM medications around 1000. Report emailed to MD. Plan is for RN to check in with patient around 1800.

Plt41 pg 36/37

2014-08-31

09:00 pm

2100 - Patient and Fiancé went out for the afternoon shopping. Patient ate 50% lunch of a salad. This evening patient, fiancé and both RN's went to the Tate museum. Patient was in great spirits and was focused on the museum and stated he really enjoyed himself. Patient self-administered routine medications at 1500. Patient continues to complain of body aches but does not request medication at this time. Plan is for patient to get a massage this evening and go to sleep early as he has to work early tomorrow morning.

Plt41 pg 37

2014-09-01

06:30 am

9/1/14

0630 - Patient awake and self-administered routine AM medications at this time. Stated his body aches feel much better after his massage last night. Patient encouraged to drink plenty of water throughout the day today. Patient is alert and energetic and looking forward to his first day of work. Plan is for RN to visit patient on set this afternoon.

Plt41 pg 37

2014-09-01

06:45 pm

1845 - RN went to set to check in with patient. He complained of body aches and stated his body was tightening up throughout the day. Torodol 60mg IM ROUQ given and Baclofen 20mg given at 1530. Patient stated he self administered in routine afternoon meds at 1230 and stated he was feeling lethargic. Adderall 5mg prn given at 1800. Patient will check in with RN upon arriving back at hotel this evening.

Plt41 pg 37/38

2014-09-01

10:10 pm

2210 - Patient back at hotel. Planning on going to bed shortly as he is exhausted. No complaints at this time.

Plt41 pg 38

Plt41 pg 38

2014-09-02

07:30 am

0730 - Patient had a hard time waking up this morning. RN noted that he did not take his HS medications last night but states he slept soundly. Patient stated he was exhausted and fell asleep and forgot to self-administer medications. Patient self-administered routine AM medications at 0645. Complained he was still experiencing body aches and had night sweats during the night. Toradol 60mg IM LUOQ and Baclfen 20mg prn given at 0725. Patient is off to work. RN will visit patient on set this afternoon.

Plt41 pg 38

2014-09-02

04:00 pm

1600 - Visited patient on set. States he is having some break through anxiety and is taking Xanax 1.5 mg prn for the past 3 days. Patient asked if Xanax .5 - 1mg could be added to routine morning medications. Patient educated on how Xanax is addictive and our goal is to have patient only use Xanax in emergency situations while we are increasing Lamictal throughout next couple of weeks. Will discuss options with MD. Patient stated was still experiencing body aches but did not require any prn medications. Plan is for patient to attend an awards ceremony tonight and will be picked up for work tomorrow at 0730. RN will visit patient on set again tomorrow. Patient given all routine medications to self administer for 9/3/14

Plt41 pg 38/39

2014-09-02

09:50 pm

2150 - Spoke to MD. New medication orders:

D/C Seroquel 25mg QAM
Start Seroquel 50mg QAM

Plt41 pg 39

2014-09-03

05:30 pm

9/3/14 - 1730 Visited patient on set from 1400 - 1700. Patient was in good spirits but complained of continually feel lethargic due to his long work days. Patient told RN that he took an additional Adderall 10mg yesterday. He took medication from today's med box. RN refilled today's med box and explained to patient that he could not increase his medications on his own. Per MD - B12 will be delivered tomorrow and this will help with patient's energy. RN will discuss other options with MD tonight. Patient complained of continued body aches and Toradol 60mg IM LOUQ administered with good effect. Patient given routine medications for 9/4/14. Plan is for patient to work till 2200 tonight. RN will come to set again tomorrow to assess patient.

New Med Order:
Adderall 10mg – 1/2 - 1 tab prn lethargy QD during work days

Plt41 pg 39

2014-09-04

12:30 pm

9/4/14 - 1230 - Per assistant, RN unable to go to set due to transportation. Per assistant, patient ok with seeing RN at home, after work.

Plt41 pg 39

2014-09-04

12:30 am

0030 - Patient home from work. Complained of body aches and muscle tension in neck 6/10 Toradol 60 mg IM LOUQ, baclofen 20mg administered with good effect. Explained to patient that MD would like patient to only take an extra dose of adderall during the work week and rest when needed on the weekends. MD would also like patient to try not to take any Xanax over the weekend to give his body a break from the benzos. Patient reminded that Xanax is for emergency anxiety of 8/10. Patient verbally agreed. VS 121/74 P92. Patient self-administered HS meds at this time and is going straight to bed. Patient requested to RN come to work with him tomorrow. Plan is to meet at house at 11:30am.

Plt41 pg 39/40

2014-09-05

01:00 pm

9/5/14 - 1300 - Currently at set with patient. Stated he self-administered routine AM meds at 1100 along with a prn Xanax 0.5mg. Patient complains of mild neck / shoulder tension and pain. Patient shown some stretching exercises and practiced them with good effect. Patient encouraged to stretch every morning after his shower. Patient also encourage to get weekly massages to work out the tension in his shoulder and neck. Patient agreed to do so over the weekend.

Plt41 pg 40

2014-09-05

03:30 pm

1530 - Patient relaxing in trailer between shoots. B12 1cc administered ROUQ.

Plt41 pg 40

2014-09-05

09:40 pm

2140 - Patient back home from work. Fiancé expressed some concerns about his decreased appetite. Patient agreed he does not have an appetite but explained to fiancé that he is drinking protein shakes during the day. Patient agrees to work on some nutritional goals after the weekend. Patient plans on spending the weekend at home relaxing. He is given routine medications for 9/6 & 9/7 with instructions to call RN if needed at all during the weekend.

Plt41 pg 40

2014-09-06

09:25 pm

9/6/14 - 2125 - RN checked in with patient via text message and patient replied "all's well...Great day!!! Went to see play for about 11 minutes and split at intermission!!! Fucking dreadful!!! Now going to get a bite to eat... Definitely different with the Adderall!!! Struggled to stay awake during the play... More pleasant with, for sure. But, I'm up for the experiment!!!" Status reported to MD via telephone.

Plt41 pg 40/41

2014-09-07

04:00 pm

9/7/14 - 1600 – RN went to see patient in his home. He stated he has a nice weekend with his fiancé and he is pleased with how they are communicating and with how they are getting along. He states he continues to feel clearer every day and is thrilled with his creativity at work. He expressed gratitude for his "clarity" and is very happy to have the "blue mini beast" off his back. Patient given positive reinforcement for all the positive changes that he has made in his life over the past month. Patient states that he was not able to go the weekend without taking any Xanax. States he took Xanax 1mg before going out yesterday evening. Again, patient reminded to limit the Xanax for severe, breakthrough anxiety. Patient verbally agreed. B12 100mg 1cc administered ROUQ. Patient given rountine medications for 9/8/14. Plan is for patient to relax and play music for the evening and then get a massage at 2100. RN will go to set tomorrow at 1300 to check in with patient.

Plt41 pg 41

2014-09-08

12:30 pm

9/8/14 - 1230 - RN received text from patient assistant that he is wrapped for the day and will be heading home soon. New plan is for RN to see patient at his home at 1500.

Plt41 pg 41

2014-09-08

08:30 pm

2030 - RN with patient from 1500 - 2010. Patient continues to be in good spirits and be motivated for "clarity". Patient stated that he was able to not take any Xanax yesterday. Complained of mild anxiety at 1630 and self-administered Inderal 40mg VS 127/77 p 80. Patient encouraged using the gym, pool and sauna in his home to work through some of his anxiety rather than reaching for medications. Patient agreed and went to turn on sauna for later use. Patient and RN set up a plan to work on his nutritional goals starting this week. RN went over goals with chef. Plan is for chef to pack small portions of protein and veggies and for patient to have small portions throughout the day. Patient agreed to try replacing some of the red bulls he drinks with coconut water throughout the day. Patient eating dinner of fries and a burger when RN leaves. Patient has the day off from work tomorrow and will text RN in the morning to set up a time to visit tomorrow.

Plt41 pg 41/42

2014-09-09

03:00 pm

9/9/14

1500 - Went to see client in his home. He stated that he slept well last night and self administered routine AM meds at 1030. Patient stated that he feels he is still experiencing anxiety throughout the day and would like to try other medication options. Status reported to MD - Inderal LA 80mg PRN QD ordered. Inderal administered at 1330 VS 117/74 p79. Patient continues to complain of body aches 5/10 Motrin 800 mg, Baclofen 20mg administered at 1400 with good effect. Plan is for patient to get a massage at 1700. Patient stated he ate 75% of his dinner last night and has been drinking coconut water throughout the day today.

New Med Orders:
D/C Lamictal 25mg QD
Start Lamictal 37.5mg QD x7D
Inderal LA 80mg QD PRN anxiety

Plt41 pg 42

2014-09-10

01:00 pm

9/10/14

1300 - Per assistant, RN is unable to go to patient's work to see him due to transportation issues. Patient will be seen at his home when he is finished with work.

Plt41 pg 42

2014-09-10

09:20 pm

2120 - RN received call from patient's assistant stating the patient was requesting an extra dose of Adderall and had asked assistant to take it from tomorrow's meds. Assistant instructed to tell patient that he cold not do that and reminded assistant that patient is not allowed to self medicate and change his medications without speaking to MD and situations like this are why RN needs to see patient while he is at work.

Plt41 pg 43

2014-09-10

10:15 pm

2215 - Received text from patient that he is on his way home, stating that "he feels a little weird. Trying to rule out possibilities.......... No biggie, though! Promise though. Might be lack of sleep, or a lack of food??? Patient informed RN would be at house to see him when he got home.

Plt41 pg 43

2014-09-10

11:30 pm

2330 - Met with patient. He complained of body aches and nausea. Phenergan 100ml IM RUOQ administered with good effect. Patient reminded the importance of eating small portions throughout the day. While RN was visiting patient, fiancé came in and tried to start at argument with him. Patient was able to stay calm and talk his fiancé down. Patient given positive reinforcement for his reaction. RN encourage patient to take his HS meds within the next 30 minutes and to get some rest. Patient was exhausted but in good spirits when RN left home. Plan is for RN to visit patient at work tomorrow.

Plt41 pg 43

2014-09-11

10:10 pm

9/11/14

2210 - Spent the day with patient at work. His appetite has mildly increased. For breakfast he ate 2 hard-boiled eggs, for lunch he had 1/2 tuna sandwich and had a protein shake for late afternoon snack. Patient stated he self-administered routine AM meds at 1100 and routine afternoon meds at 1710. At 1500 patient complained of neck and shoulder pain 7/10 - Baclofen 20mg, Motrin 800 mg administered. AT 1720 - Patient continued to complain of neck and shoulder pain 6/10 - Toradol 60mg IM LOUQ administered with good effect as pain decreased to 2/10. Plan is for MD to arrive tomorrow morning and MD and RN will visit patient at work. Patient given all routine meds for 9/12/14 for self - administration.

Plt41 pg 43/44

2014-09-12

05:00 pm

9/12/14 - 1700 - RN and MD visited patient at work. Patient continues to be satisfied with his "clarity" progress and expresses appreciated for medical team. Patient expressed some concerns with fiancé's behavior and how it is adding stress to his life. Patient given positive reinforcement on how he is working through his emotions and redirected to continuing to work on himself as his fiancé is continuing to work with her treatment team. MD gave patient some communication techniques to use with his fiancé when confrontation situations arise. MD also suggested it was time for patient to begin working with a psychiatrists and patient agreed. Patient informed MD and RN that he will be traveling to France with his fiancé this weekend. MD and patient decided it would best for patient and fiancé to travel without treatment team so they could be alone and focus on one another for the weekend. RN gave patient all routine medications for 9/14, 9/14, 9/15 for self-administration. Per MD orders patient was given Xanax 1mg #5 and Adderall 10mg #5 as prn medications for his trip. Plan is for RN to check in with patient via text msgs throughout the weekend and will see him back at work on Monday.

Plt41 pg 44

2014-09-13

08:10 pm

9/13/14 - 2010 - RN checked in with patient via text msg. Patient returned text and stated he was doing well and was "sort of" catching up on sleep.

Plt41 pg 44

9/14/14 - Did not hear from patient today. Per his sister he is doing well and will return to London late tonight.

Plt41 pg 45

2014-09-15

07:00 pm

9/15/14 – 1900 – RN and MD went to visit patient at his work. Patient stated he had a nice weekend and that things were peaceful between him and his fiancé. Patient spoke about really enjoying being at his house in France for the first time in three years and being able to enjoy it with a clear mind. Patient continues to complain of neck pain and waking in the mornings with a headache. MD feels this is from tendinitis in the neck and will order cortisone IM to be delivered on 9/17/14. Patient given all routine medications for 9/16/17 for self-administration. Plan is for RN and MD to see patient tomorrow at his home as he had the day off from work.

Plt41 pg 45

2014-09-16

01:00 pm

9/16/14 - 1300 - MD met with patient briefly this morning. RN did not see patient but left his routine medications for 9/16/14 with his fiancé to give to patient for self-administration. Plan is for patient to spend day relaxing and playing music with a friend. RN and MD will see patient at 11 am tomorrow.

Plt41 pg 45

1850 - Patient text RN to see if the medication for his neck had arrived. Patient reminded that it should be here tomorrow morning and that RN and MD would see him around 11am for the injection.

D/C Lamictal 37.5mg
Start Lamical 50mg QD x14 D
Start Xanaflex 4mg QID prn neck pain / tension
Start Prednisone 20mg QD x2D

Plt41 pg 45

2014-09-17

11:00 am

9/17/14 - 1100 - RN and MD arrive at patients home and he is still sleeping.

Plt41 pg 45

2014-09-17

11:50 am

1150 - Patient awake. MD administers cortisone injections for tendinitis. Patient tolerates well. Patient informed of new order of prednisone and zanaflex. Plan if for patient to relax in the morning and then spend the afternoon with a friend playing music. Patient informed to contact RN or MD if feeling any side effects from injections. Patient given all routine medications for 9/18/14 for self-administration.

Plt41 pg 46

2014-09-17

03:05 pm

1505 - RN checked in with patient via text to see how his neck and head was feeling after injections. Patient replied, "all is well so far."

Plt41 pg 46

9/18/14 - RN and MD visited patient at work. Patient stated he slept well last night and woke up without a headache this morning. Patient states, "this is life changing". Patient encouraged taking a zanaflex for muscle tensions this afternoon rather than a xanax. Patient is willing to try. At 1400 patient requested a zanaflex prn - one hr later patient stated he felt better and was going to try to get through the day without taking any xanax. Plan is for patient to work till 2200 and then perform with a friend at his concert. Patient given routine medications for 9/19, 9/20 for self-administration. RN will visit patient at work tomorrow.

Plt41 pg 46

2014-09-19

02:00 pm

9/19/20

1400 - RN with patient on set today. Set is extremely warm and patient is feeling lethargic. Patient continues to take the prn dosage of adderall in the afternoon stating that he does not have enough energy to get through the day. Report given to MD and per MD - continue current adderall regime and see if patient will get more sleep after finace leaves for NY. If getting more sleep does not help, MD will increase Adderall dosage. Patient states his neck continues to feel great and has not complaints at this time.

Plt41 pg 46/47

2014-09-19

08:35 pm

2035 - While performing a stunt at work, patient hurt his neck. Patient c/o neck pain and headache and is worried that stunt has ruined what the MD had just fixed with the cortisone injection. Call to MD and Stat order of Toradol 60mg IM - LUOQ, and Balofen 20 mg given. Patient states he is in pain but still wishes to go play music with his friend tonight. Patient instructed to call RN if pain increases or is he feels dizzy or nauseous throughout the night. Patient given routine medications for 9/20/14 for sel-administration.

Plt41 pg 47

2014-09-20

01:00 pm

9/20/14 -

1300 - RN received at text from patient's fiancé asking to come over and check on patient as he is in a lot of pain from injury at work yesterday. Upon arrival at house patient c/o of head and neck pain 7/10, dizziness, nausea VS 114/78, p84. Call to MD - per MD he would like patient to have a CT scan of head and neck to r/o any fractures or bleeding. Per MD order - Stat Toradol 60mg IM LOUQ, Baclofen 20mg, zofran 4mg SL given. Call to patient's sister to inform production company of patient's status. Production company is arranging a local MD to come and assess patient.

Plt41 pg 47

2014-09-20

03:00 pm

1500 - Local MD assessed patient and patient diagnosed with whiplash and mild concussion. MD ordered CT scan of head and neck to r/o fractures or bleeding. MD ordered - Tylenol 1G prn q4h as needed.

Plt41 pg 47

2014-09-20

04:30 pm

1630 - Patient taken to London Clinic for CT Scan. Scan was well tolerated - Per technician results reported to ordering MD and scan was negative.

Plt41 pg 47

2014-09-20

04:45 pm

1645 - Local MD called to confirm all tests were negative and told patient to take it easy for next 24 hrs.

Plt41 pg 48

2014-09-20

05:15 pm

1715 - Patient back at house relaxing with fiancé. States his pain has decreased to 3/10. Plan is for patient to stay in and relax tonight. Will call RN if pain increases or if he experiences any nausea, dizziness or blurred vision.

Plt41 pg 48

2014-09-20

11:30 pm

2330 - RN text patient to check in. States his neck pain and headache are at a 6/10. RN went to house and administered Toradol 60mg IM ROUQ. Patient given routine meds for 8/21 to self - administer. Patient informed to call RN if he expereiences any of the symptoms we have discussed.

Plt41 pg 48

2014-09-21

11:30 am

9/21/14

1130 - Received text from patient that he woke up and cracked his neck and it was the "loudest crack ever" and he feels much better today. RN went to visit patient and gave him Toradol 60mg IM to help with any residual inflammation. Plan is for patient to relax during the day and to go play music with a friend tonight. Patient will call RN if needed. Patient given routine meds for 8/22/14 for self-administration. RN will visit patient on set tomorrow.

Plt41 pg 48

2014-09-21

11:30 pm

2330 - AT 2130 RN received text from patient asking if this RN and Erin, RN could come to house and he would explain when we got there. Upon arrival we were told that some personal photos of fiancé had been hacked and posted to internet. Patient's fiancé was extremely upset. Both RN's sat with patient and fiancé and talked about feelings and how to work together as a couple and get through this. Couple given positive reinforcement for how they were handling this stressful situation. At 2315 – both patient and fiancé took HS medications and said they were going upstairs to go to bed.

Plt41 pg 48/49

2014-09-22

01:25 am

0125 - RN received text from patient stating that he had been in an argument with fiancé and she "had a nasty freakout" and he would like RN to come give him "some fuckin' knockout yum, yum. RN instructed patient to take prn Neurontin 300mg prn and Seroquel 50mg and that RN was on her way over.

Plt41 pg 49

2014-09-22

03:30 am

0330 - Upon arriving at the home patient was sitting in kitchen with scraped and bloody knuckles on R hand. Patient stated he had punched white board in kitchen after fight. Patient stated he had been texting his friend explaining why he didn't show up to play music and fiancé got upset that he was not giving her enough support and the fight escalated from there. Call to MD at 0145 and instructed to given a Stat order of Ambien 10mg to help patient get to sleep as he has an early work day. After taking medication - patient refused to lie down as he didn't want fiancé to think he didn't care by falling asleep. Patient was able to talk through his feelings and realized that he had not caused this argument. At 0300 fiancé came downstairs (she had been talking with Erin, RN) and asked fiancé to come to back. RN asked fiancé and patient to not discuss argument anymore tonight as patient needed to get to sleep. They both agreed. RN let patient know she would stay at house to make sure things remained calm for the rest of the night.

Plt41 pg 49

2014-09-22

06:30 am

0630 - Patient up for work. Stated he slept about an hr. Patient informed RN that he would be taking extra adderall throughout the day as he could not get through work without it. Report given to MD via email. RN will visit patient at work in a few hrs.

Plt41 pg 49/50

2014-09-22

07:30 pm

1930 - Patient stated he took an additional Adderall 5mg with his routine morning medications and took and additional Adderall 10 mg in the afternoon. Report given to MD. MD is ok with patient taking additional Adderall at this time but does not want to increase his routine dosage until we see how he feels after fiancé leaves for NY tomorrow and patient will get more sleep. Patient and fiancé texted throughout the day and appear to be in a better place. Patient instructed to go to bed early tonight and to not stay up late discussing relationship. RN is now living in house with patient and informed patient to text if he needs anything throughout the night.

Plt41 pg 50

2014-09-23

08:20 am

9/23/14

0820 - Patient up and off to work. Stated he stayed up last but things with fiancé were peaceful. No complaints at this time. Patient given routine meds for the day and took AM meds at this time. RN will see patient at set later in the day.

Plt41 pg 50

2014-09-23

04:00 pm

1600 - Patient took and additional Adderall 5 mg at this time.

Plt41 pg 50

2014-09-23

10:10 pm

2210 - Patient home from work. Ate a healthy dinner and took HS meds at this time. Patient plans to sleep on the couch tonight so given pillow and a blanket. Patient is falling asleep when RN leaves him on couch.

Plt41 pg 50