IME/CME Scheduling Worksheet

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1 Indep Troy D. Lowell, M.D. Tel: (352) Ocala Orthopaedic Care, PL Fax: (352) SE 3 rd CT, Ocala, FL Orthopaedic surgery Surgery of the Spine Joint Replacement IME/CME Scheduling Worksheet Claimant s name DOB / / SSN - - Injury date / / Injury type Body part(s) Amount of records inches Requesting party name Phone ( ) - Fax ( ) - Ideally, when do you want this IME scheduled? Additional comments PLEASE SEND RECORDS ELECTRONICALLY to arrive at least three days prior to IME/CME scheduled date. (Mail disc or to IMAGES of testing performed must be received three days prior to IME/CME date. Reports alone are not enough. With every IME/CME needs to be a cover letter clearing informing Dr Lowell why you are requesting him to do this evaluation and the specific questions you wish him to address.

2 Troy Lowell, MD TIN Services and Associated Fee Schedule Independent Medical Examination: $1000 Record review with IME: $500 each inch for first six inches $250 each inch for anything over six inches Record review without IME: $500 each inch and includes oral conference $750 for written report Deposition for work comp case: $400 Deposition for non-work comp: $500 per hour Videographer presence: $200 Phone conference: $200 for every fifteen minutes Expedited requests: $1500. (Appropriate when you want something prior to our next opening.) In person testimony: $4000 for half day, $7000 for full day check must be in our office at least three weeks before testimony date. One date and time much be decided on three weeks before trial. Reschedules made within three weeks of the trial will cost $500. Work comp evaluations with option to treat: $650 (Record review charge may apply) Travel expense: $400 each hour Surveillance review: $500 each hour All services are to be prepaid. All records, checks, and images need to be in our office one week before date of service. Cancellation Policy Cancellation with less than 72 hours notice (and no-shows) will result in no refund of prepayment. If IME is rescheduled after no-show, record review fee will not be recharged; only a repeat IME fee of $1000 will be due. Cancellation of trial testimony before two weeks of testimony date will result in full refund minus $1000 non-refundable booking fee. Cancellation within two weeks will be non-refundable. UPDATED 4/12/12

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4 TROY D. LOWELL, M.D. Ocala Orthopaedic Care 2965 SE 3 rd CT Ocala, FL (352) Curriculum Vitæ EDUCATION Harvard University, Cambridge, Massachusetts Bachelor of Arts Magna Cum Laude in Chemistry, June 1984 University of Medicine and Dentistry of New Jersey Rutgers Medical School Doctor of Medicine, June 1988 Hoes Lane, Piscataway, New Jersey New York University Medical Center Bellevue Hospital Center New York Veterans Administration Hospital Intern in Surgery, June 1988 to June 1989 Chairman: Address: Frank Spencer, M.D. Department of Surgery Bellevue Hospital 27th Street & 1st Avenue New York, NY Resident in Orthopædic Surgery, July 1989 to June 1993 Chairman: Theodore R. Waugh, M.D. Address: Department of Orthopædic Surgery Bellevue Hospital 10N 27 27th Street & 1st Avenue New York, NY Hospital For Joint Diseases Orthopædic Institute Fellow in Spine Surgery, August 1993 to August 1994 Program Director: Michael Neuwirth, M.D. Address: 301 East 17th Street New York, NY HONORS John Harvard Scholarship for Academic Distinction, Harvard University,1980,1983,1984 AΩA 1987 (Junior Year), Rutgers Medical School LICENSURE Florida: ME

5 Troy D. Lowell, M.D. Page 2 of 4 New York: CERTIFICATION American Board of Orthopaedic Surgery, July 1996 Recertification July, 2006 National Board of Medical Examiners, 1989 MEMBERSHIPS North American Spine Society American Academy of Orthopaedic Surgeons Florida Medical Association Marion County Medical Association PRACTICE Ocala Orthopaedic Group, July 1997 Dec S.E. 17 th Street, Suite 100 Ocala, FL Florida Joint Replacement Center, June 1995 June Hanff Lane New Port Richey, FL (813) Florida Spine Institutue, July 1994 June Drew Street Clearwater, FL (813) APPOINTMENTS Teaching Assistant in Surgery, June New York University Medical Center. Teaching Assistant in Orthopædic Surgery, July New York University Medical Center. Clinical Assistant Instructor, July 1993 July 1994 New York University Medical Center Provisional Staff, August 1994 August 1995 Courtesy Staff, September 1995 Present Clearwater Community Hospital 1521 E. Druid Road Clearwater, FL Active Staff, June 1995 July 1997 Morton Plant Mease Hospitals Dunedin and Clearwater, FL

6 Troy D. Lowell, M.D. Page 3 of 4 Active Staff, June 1995 July 1997 Columbia HCA New Port Richey Hospital New Port Richey, FL Courtesy Staff, 1995 July 1997 Helen Ellis Memorial Hospital Tarpon Springs, FL Active Staff, July 1997 present Munroe Regional Medical Center Ocala, FL Active Staff, July 1997 present Ocala Regional Medical Center Ocala, FL PUBLICATIONS Errico TJ, Fardon DF, Lowell TD. Open discectomy as treatment for herniated nucleus pulposus of the lumbar spine. The Spine Journal 3 (2003) 45S-49S. Lowell TD, Errico TJ, Eskenazi MS. Use of epidural steroids after discectomy may predispose to infection. Spine Feb 15;25(4): Errico TJ, Fardon DF, Lowell TD. Contemporary Concepts In Spine Care. Open Discectomy as Treatment for Herniated Nucleus Pulposus of the Lumbar Spine. Spine 20:16 (1995) pp Lowell TD, Errico TJ, Fehlings M, Ladosci L, DiBartolo, T. Microdiscectomy for lumbar disc herniation: A review of 100 cases. Orthopedics 1995 Oct; 18(10): pp Lowell, TD, Errico TJ. Update on Lumbar Discectomy. Advances in Operative Orthopaedics, vol. 2. pp : Mosby Year Book. PRESENTATIONS Lowell, TD, Errico TJ. The operative treatment of lumbar herniated nucleus pulposus. Current Opinion in Orthopedics 1993, 4;II: Epidural Steroids After Microdiscectomy may Predispose to Infection. Annual Meeting of American Academy of Orthopedic Surgeons, New Orleans, LA, March 1, 1994.

7 Troy D. Lowell, M.D. Page 4 of 4 Epidural Steroids After Microdiscectomy may Predispose to Infection. North American Spine Society Annual Meeting, San Diego, CA, October 16, Is the Prognosis Better After L5-S1 Discectomy Than After L4-5 Discectomy?, North American Spine Society Annual Meeting, Boston, MA, July 10, 1992.

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