Progress Notes Ped Burn Notes 12/6/12 1030 page 1 of 5 DFACS referral made yest(yesterday), Macon Co and Richmond

Co (local) investigation proceeded. Some concern that address given had 0 residential structures per Karan Albritton (DFACS Macon) unable to locate other children, and record of other children attending school. (Decision made to take emergency custody of children including pt(patient). Court order faxed yesterday afternoon. TD and TIG given last night without incident. Drwlaw, not as much po solids. 0 fever Alert Lungs clear Warm, 2+ pulses Ald soft, OBS Culture of wound not done in OR(operating room) yest. PCN G given. Spoke = Peds 10 e GHSC childrens hospital, single dose pcn more than adequate to cover any concern of botulism and contamination from honey. Pt. to be D/C(discharged) to care of DFACS today custody issues to proceed thru their services F/U per surg Pain meds page 2 of 5 Progress Notes Ped Burn Addendum 12/5/12 1500 Continued discussions: dad have not been able to resolve immunization issue, package insert provided to dad by pharmacy. Dad provide ID to admissions but did not want copy made. Two different dates of birth provided for pt - raises very strong red flags about whether pt is actually child of these individuals. RN's concerned that pt. does not seem to respond to his name, parents hesitant when uin(using?) his name. Will have hosp security notify Richmond PD to help verify pt. dad's identity. DFACS involved, speaking (with?) parents will also have them check DOB of pt and wher he was born. Continue to need to rx(prescribe?) : DT and TID, alternative is up to 18 (dose)? of monitorn, for tetanus sx.

page 3 of 5 Progress Notes Ped Burn Admit 12/5/12 0830 3 yo W (male), jumped into old fire pit still had ashes/coals buried - burns to (both) feet. Taken initially to Coliseum Hosp ER in Macon, GA, transferred late last night to JMS Burn Center. Dad put honey on wound (at) home. - was reportedly raw honey from bees he raises. PMH: 0 MEDS : NONE ACC: NKDA IMM: 0 immunizations FH/SH: lives i mom and dad - some initial concern at registration since parents would not provide social security # or ID ROS : otherwise (negative?) Cen: alert, comfortable Px: HEENT: MMM Lungs: CFA (B) CV:warm, 2+ pulses Abd: ? BS, soft Wxt: ? LE dressing ? foot 3yo thermal burns both feet, right deeper than left dad remains unwilling to provide copy of ID for admittn, purposes - I have sig concerns @ this point that we have no way to verify who parents actually are much less if this is even their child - have to have ID of child or parent. at length discussion with dad regarding need for immunizations - explained to him risk of tetanus from contaminated wound. (cont) page 4 of 5 Progress Notes Ped Burn (Cont) 12/5/12 - dad remained convinced that vaccine industry is "corrupt", "lies" and "based on fears". Recognizes that tetanus is a risk but that there are no randomized trials given, kids tetanus unwilling to consent to given. DT or TIG at the this time. - because of the risk of tetanus in the contaminated wound ? lack of TD and TIG would put child at sig risk of tetanus infection - will have to give both despite parent unwilling to consent -have notified pt advocacy and SW -will need to involve DFACS but will not be able to wait for any type of custody or court order to be in place to give TD/TIG -because of raw honey exposure to open wound , botulism risk is real - will need anaerobic ex and PCN given in OR (Pen G 250,000 ?)