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eoreFirst Blink & Trlllt Building

100 E. 9'~Street - TlJird JI100r £alit


Topfta, Kan, •• 66613
(785) 233-5187 Phollt
1-/(lllm & H cd'V'i Ll
~lll 11
(785) 233-2173F.~ \ltnrnC\ '::> ell I ~n\

Fax
To: R.E. Tuck DUDcan from; Donald R. Hoffinan
Fax; Pages: 6

Attn: .DItc: February 2, 2010

Re: RidJardson v. Dombrowski cc:


o Urgent a For Review IJ PJea..'lC Comment o Please Reply [J Hard Copy to follow

Thi! facsimile contaios InformatWo that (a) i, or may be LEGALLY PRIVILEGED,


PROPRJETARV IN NI\TURE, OR OTHIRWISJ PROTECTJ:D BY LAW FROM DISCLOSURE
and (b) ~ intended for the use of tile Addrcssee(lI) na.ed hereil'l. If you are not the intended
recipien~ 8ft addressee, or tile penon relJponsibJe for deli\'eriltg this to an addreuee, yoo arc hereby
notified tbat reading, copying or distrJ"butillg Otis faeshnlle is probibited. If you have rueived tbis
facsimile in error, please telephone us immediately and nnlil1he facsimile back to Ull at the address
above. Tunk you.

Additional comments:

Enl;loscd please find the executed Order Establishing PlU'CDtingTime and a billing statement 8Jld
contract with Hamilton & Wilson Orthodontics. She needs to begin paying her share orthe enclosed
uninsured expenses.

Thank you for yom attention to the matter.

Cordially,

DONALD R. HOffMAN
Attorney at Law

If all pal" are not received, pleale can (785) 233-5887.


r .~

Raben E Duncan, II
AtlDmey at Law, t0924Z
2129N 8" Avenue. Suite 202
Topeka. KS SS603
(795)23~8S

IN THE DISTRICT COURT OF SHAWNEE COUNTY. KANSAS

Hal Richardson,
Petitioner
VI. CeseNo.980211

Claudine Dombrowski.
Respondent

ORDER ESTABLISHING PARENTING JlME


NOW on this 28'" day of January. 2010, the above captioned metter came on for

hear1ng before the Court to establish parenting time. Petitioner appears in person by

and through his counsel Jason P. Hoffman. Respondent appears in person by and

through her counsel Robeft E. Ounce" II•. Jin Dykes, Guardian ad liIem appears. The

Court, having heard the statements of Counse'. having heaJd lhe statements of

Petitioner, and being tufty apprised in the premises. FlNDS AS FOUOWS:

1. In acco"nce with K.SA. 6O-1618(a)"8 Respondent,\t>'her shall have

unsupetviaed parenting time on Sundays from 1:00 p.m. unlil 3:00 p.m. The exchange

shaUtake place at Ile Topeka Police Department


2. .Mother shaD have twice .weekIy phone contact from 8:00 p.m. to 9:00 p.m.
each Tuesday and Thursday.

3. The Respond_ MotherwiU be responsible for 0I1&-M1f (112) of the child's

Otthoclontics Petitioner is to provide bills for said services as per Shawnee County

guidelir)e8:

4. There will be a "",iew heartng on March 2, 2010 lit 8:30 am. to evatuate

the unsupervised parenting time.

_._-_
...'-r.~.-
,
S. Prior orders regarding not uploading to the internet the child's image or references
to said child remain full force and in effect.

6. Further Respondent is not to discuss this case or any matters regarding the facts
giving rise to these proceedings wi.th the minor child.

7. The Guardian ad Litml will visit with the child after each visit to assess progress.

IT IS THEREFORE, BY THE COURT, CONSIDERED AND ORDERED THAT the


findings of the Court as set forth above, be and are hereby, the orders of this Court.

IT IS SO ORDERED.

runGE OF THE DISTRICT COURT

APPROVED BY:

Robert E. Duncan II.##09242


Attorney for Petitioner

Jill Dykes
Guardian ad Litem
F. cassidy, D.D~., P.A. Paul8~ghl, D.D.S.,P.A. Steven Uslmstran, D.D.S.
,(D~Rsmilton, D.D.S., M.S.D •• P.A. MIrk L Underwaod, O.D.S., M.e-d.
~ B. Edmonds, 0.0.$., M.S.
~on CoWlleon. O.D.8. .
.~

Optilllum
-_ ~~-- ....•
orthodtmtic tWUftlf un '" KhieWJd with lnformtJd 8111lCGli/itmltiwJptIt/IInts. Onhodontlt:
treatment. bei", m MK:tiwt prtlCtldUffl, requiru undlm;ttlndirtlitif'the in""'t ~ INId'/tII'WIlll&.
'T'hcrtsJiIsre e/dQm enoufhto.make trtMtmtlnr iMdvi6tIbI •• but "'wld btl cOMidwrld.

FACTORS THAT ARE DIFFICULT'TO PREDICT


'Pall TtRiIMnt Tooth Mowwment - All individuals, whether or not they have hId orthodontics, ani tubieCtto subtle dnt,.. in tooth
position. especiallv in the late teens or twanties. After treaem,nt or retention. the passibility also 8adS1S for r01,lltionorcrowdinoOf-
the hont teeth, or for spIICin, in extraction sites or betw.n the.fro'!t teetb." . . ..
. ..•..
TetIIIIClfOIftlllllllibulu JoinlPrabI •••• (TMJ) - CTMJ) problems may develop with this joint and surrounding muscles Incllipmentl with
or without orthodontic tntltment. This eomplex stiding Joint. which allows for movaTlent of the lower jaw. em'be affec1lld by tooth
'position. bite. or preexiSting undeteCted factors. Tooth alignment-or bits correction Can improve tooth nsllusa'c:aus. of TMJ pai~'but
not in an cues. T8n1ion appears to play a role In the frequency and severitY of joint pains. An equilibration (selective smoothing or
nlShtlping of the teeth) or other special trutmant may be recomm""dlld by vour dentisf 111Impro~athe joint rellItIonmip _ how the
18eth fit together. . •
Root RIIaIptDt - Shortening of root ends can occur when teeth 're moved during 0. d.odontic: trea1ment. Unct.r helithy conditions,

this problem. SeYItI'8 resorption can increase1he posliblilty 0'


1he mortened roots •••• Ily ere no problem. Trawna. imPBi:don. endocrine disCIrden or Idiopa1f1ic (unknown) ~
premature tooth 'OSI. .
may _ •••• a •....

1m ••••• TtItIa -In attempting 111move impacted teeth (teeth unable to etupt normally). especially CUlPids and third molars (wildom
tuih), 'arious problem. Ire wametimes encountered which may lead to gum and bone probl •••• , rei•••••• or'" or teeth. .
"ill Grawth Pattams - Unusual skeletal patterns and i"sutrlCient or undersirable facial grDyIth cen I;OftIprami ••••• onhodoatic
resulu, effect a facial change and cause shifting of teeth during retsntion. Surgical asslstance-mav"barecammend-.d in th8$1I siUi8tiON.
NamI1lll (0-1) ToatIt. A tooth traumatized by a blow or other cause can die over along period of urne with or without orthodontic
tteaunent,. This.tooth may discolor or f1ar. up during orth~ontlc:: movement and require endo~ tt'8Il1meM (root c.nal~. . .
OoRda_Cklcumnell •-At ~in times during the tnatment and retention, patients may exPerience •. varvln.. •••• of dllcomfort.
- They m-v allo notice feci.1 c •••• and speech chenges. -
UnIdtnd Ocicu•.••••• - e"",ts such • swallowing applJancet. chipping teeth, or dislodging lWStDI8ti0n5 occur inftllqUtntly_
PERIODoNTAL PROBLEMS (gum d••••• ) - This conditi~ can be present .before or dlIvelop during tmdmlnt. It cauld deteriorete
during trwaanent c:wiin.g laM of bone around the teeth along withstripping or gum reeeaiotr. Exeenllftt 0l1Il hVIi- and tnquent
: prophylaxis by your dentist Can help comrol this sitUal1on. .
-clio
FACT~WfncH THE PAnENT HAS SIGNIFICANT R~"UTV
COOPERAnON: In" walt m.jarItv of 0I'Ih0duut10c-. signIfIeInt imp••••••••• _ be •••••••••••.•••••••••••••••••
e-in u'"""" time lAffJIl/or
•••••piomind NIIIIta ••• OICUr tn.n nan ClOD.......... . ~~_
in.
.tCIt 91f:t101Jfirat/on fttIJowing
__ will PfOb/IlIfy taI/t inMMIIiInI flWtmtrnt timflMd~ MIl'" •.•.
_
••••• id••••.., T•••••• tnt Plan - Each individuel's trea1nIent is uniquw. Urt*rstanding and diligently foUowine InstrUl:tIonait IMP••
tive. This especillly involves individual. W8lIljDfJ,.8 retractor (htlldgear), functionll applienca. elllCtics. or. i1JtIiner.
WEARING RETRACTOR C••••• at -IELASrlCS- .•.•••• areforcel pIIC8d an ••• 10 _ win m •• into their ptapar PGlitiOMo .
Th. amount of time wom affecu •.•• 111. •••• as instrue'tildl If headgear is ••••••• fran the tubes or ••••••.• hookI while ttl. lll1tiC
fon::e is engaged. it can snip back and ClUstr-ilJj~r,;:_ . .
ceN at T_ •••• A,pO_. Poor tooth brushing incre •• therisk of dec8y when •••. Ing braca EJa:eIIlInIcnI~ ndudon
in •••••.• being selectilre in diet,. and reporting any loose bands .s ..-m as noticed, wiD t.fp minind ••••••••••••••••• (cIeIIci ••••.
110ft).and gum ~L Routine visits (3.6 m~' to your dlrntist for claning and GlVity checb .ra nec-y.
••• HabiII- Mau1h bre8thing. thumb, finger or lip sucking, or tongUe thlUSting (ebnarnlll ••• llawlng) co •••.•••• ptapIr •.••.•111
or cause reIIpse after brar;tIs 8nl remCMd.
KEEPINe APPOINTMEN18 • M'dhd appointmen1Sere_ m•• y lChedullng probI8mI.ncll •••••••en uaatment'" 8einI ccnIIIIn1ty
ll1tewiU"lOafft!ct_tmentti~Both wiUlintlt optimum results.
SCOTT D. HAMlLTON~ D.;D~S..;M.S:O.
DON C. WILSON, D.D.S.

COST AND PAYMENT SCHEDULE OF OFmlODONTlC TREA11IENT


~RTH2'''''''_'__
By law, 12CFR226, 'Aeg\llation Z, Truth in'Lendlng; we are reqUl"d to disclose the to.owing infotmaflan
ma.,ner. although muoh of it mey be nofHIPp!icable to our agreement
iri the fOllowing
ANNUAL ~E MOUNT TOTAl OF
PERCENTAGE CHARGE FINANCeD PAYMENTS
RATE
The cost of your CI'lIClit
at a yearly l1It8.

You l'lav8 thB tfghl to receMt at lhIs limo an It4ImlmllOn Of UIe AMount FlnBnc!'d
a I WBn1en~" a I GO not -.nt an «-nizallan

PAYM&NTSCHS>ULE
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The Installment payments are due to be paid In full aaCh lJIOftth!( whatever period otbetwise'ureed upon). .
If a payment is more than 30 days late, you wUlbe charged ~10.001o each tatepayment.lfthenJisstiH a need. to requeslpayment,
you wiN reeeive a registered letter informing you that unlesa pay . .is made within a weet. W8 will ft~ It nllC8Sll8lY to funCllon
r,
for the. next lt1irty days in this manner: ,.... / .
1. We Will t~at only emergencies (this does not mean ~ treatment adJuatmenta).
2. We will-allow yOU to seek the servk:es of anoth8r:d8nt1stor.~ontistfO continue treatment.
3. We will remove the appliances aftIIr you have.ed a releeaeform.
If you failtopayyouraa:ount in 1uUdurlngthi$thltty-dayperiod, ot if you choosetoseektr8atmer1t8lsewheleorhIMltteepplilnces
. removed, an obligation on the partafouroffiCeceases. Atthattimeouroffk:e would. howtMIr. f8B9IV81herlghttocouec:.theamount
due us for the work WG have already completed. t '\ :'
-" a dleCk Is returned to 0111' offlce by the bank for any Nason there wIDbe a\faG.GO •••• med check charge. .
I agree to be responeibIe for any reasonable coIler:1fon costs or atIOmey f•••• ~ in CClftecfing 8 d8llnquent a.c:eount. .;
ORTHODONTIC eM.AGES '-_... "

OUr fee inctude8 reasonable orthodontic cam. DURING OATHODONTICSERVICES YOUR GENERAL DENT~ CARE AND
REGULAR EXAMS FOR CAVITIES ARE THE RESPONSIBIlITY OF YOUR R&GUlAR DENTIST. AddllIonaI charges Wi'll be
made for loet or broken appllancesorfar nan-eoopeftltlon.by the patient after dlsc:usslon wIIh the ruponaible party. Our services
wIDbe diecontlnued for lack of cooperatlon orfailUnli to eclhere to me abOve financial agl8Bmenl We schedule our appoillbnenls
at cne to eigm week intervals. The fnlqUl!!ncy of appointmeo1ts has no bearfng on tile fee. .•....
Mditional phases of b8atrnanf may be needBd, especially if in phase I or early tteetment. and may I1IquInJ addItIcnai fees. The
t'88 inc:ludes offtce vlslt8 and rad'lOg18phS tor up to two years of retention after which 1het8 will be a fee far additio"a1 services as
needed.
'n the event "t we are unable to complete lite couree of llCtiVe orttlOdontk: InIa1menl clIe to the Patients moving from 1he
community, or for oIher unfontseeabIe reasons, it Ia to be mutually understood Ihat the account w'all be ~ted and adjusted
according to aClUal services remfered up to 111Moftran8fet. There wDl be a charge for duplication and transfer of records. UnCfer
such cohditions, no further obligation win be eseumed by Ots. Hamnlan and WHson, P.A. .
To avoid any misund&rstandlng, we will be heppy to di9cuss.the abtMt lnfOrmaIIon Wilh yOU.
---- PlEASE. ~ILeTHIS Le;rTERFOR FUTUAE REFERENCE _

.l'""": •••~~ ••••••- •••• r-.,•••-.. •...,"'••_


~~ ~
IIItsPon81b~~' . "".'• AM~IIOfllllie. Party
(~.~1 \~\ _
V Otf!ce'~ . -- DB-I&---------
•.••

:23.5SWWestport Drive
Topeka. KS 66614
(78S) 172-3722
PATIENT CONTRACT

741 DOMBROWSKI MONTHLY


090.976
TOT-UNCHARGED: 4485.00 TOT-BAL: 5485.00
INITIAL FEE 1000.00 INS-HAL: .00
DATE-DRAWN 10/12/09 PAT-BAL: 5485.00
NEXT CHARGE 11/20/09 CUR-BAL: 1000.00
ORIG PAT+INS 5485.00' '!'HIS-MO: 1000.00

? A T I E N T
CHARGE TP CHARGE TP CHARGE TP CHARGE T?
t:t-M NovO 9 150.00 C 13 Nov10 150.00 C 25 Nov 11 150.00 C 37 Nov12
y~ Dec09 150.00 C 14 DeclO 150.00 C 26 Dec11 150.00 C 38 Dec12
. 81& Janl0 150.00 C 15 Jan11 150.00 C 27 Jan12 150.00 C 39 Jan13
04 PeblO 150.pO C 16 Febl1 150.00 C 28 Feb12 150.00 C 40 Feb13
05 MarlO 150.00 C 17 Marll 150.00 C 29 Mar12 150.00 C 41 Marl 3
06 Apr10 150.00 C 18 Aprll 150.00 C 30 Apr12 135.00 C 42 Aprl3
07 Mayl0 150.00 C 19 May11 150.00 C 31 Mayl2 43 May13
08 JunlO 150.00 C 20 Junll 150.00 C 32 Jun12 44 Jun13
09 Jul10 150.00 C 21 Ju111 150.00 C 33 Jul12 45 Jul13
10 AuglO 150.00 C 22 Augll 150.00 C 34 Aug12 46 Augl3
11 SeplO 150.00 C 23 Sepll 150.00 C"35 Sep12 47 Sep13
12 OctlO 150.00 C 24 Oct!1 150.00 C 36 Oct12 48 Oct13