Prepared for: Juan Diaz(03/09/1980) Prepared by: Juan Diaz Treatment Date: 07/23/2013

Dear $[3.1.2147-Referring_Provider], National Therapy Services LLC 2, Crocker Blvd, Suite 201 Mt. Clements MI 48043 Physical Therapy Progress Note: First Name Codes 97010 97014 97035 97033 97018 97034 97022 90901 97016 97140 97124 97112 97530 97116 97110 97110-1 97704 97012 97542 97002 95831 95851 97001 Last Name Dates of Service Hot / cold pack Electrical Muscle Stimulation Ultrasound(each area) Iontophoresis (15 min. each) Paraffin Bath Contrast Bath Whirlpool Biofeedback Vasopneumatic Therapy Manual Therapy Massage Neuromuscular Re-education Transfer/Bed Mob Training Gait Training Therapeutic Exercise 15 min Therapeutic Ex Add 15 min Orthotic Training 15 min Traction Mechanical W/C Management PT Re-evaluation Manual Muscle testing ROM Measurement PT Evaluation Date of Establishment

Date Plan Established Last Name First Name Diagnosis Pain Level S: O: A: P:

Assessment: (in SOAP format)

Patients Signature Dear $[3.1.2147-Referring_Provider], Se visualiza algoVAS Night Pain

Therapists Signature

Copyright Mavenlive 2013 www.mavenlive.com

Prepared for: Juan Diaz(03/09/1980) Prepared by: Juan Diaz Treatment Date: 07/23/2013

Yes Bilateral Paraesthesia No , Tonicity Hypertonicity Upper Trap Se nota eso Hypotonicity No se observa AROM Flexion SE FLEXIONA BIEN Myotomes C1-2 No se observa /5 C3 3 /5 C4 4 /5 C5 4 /5 C6 2 /5 C7 1 /5 C8 3 /5 Normal Safety Tests Alar Ligament Test Positive Transverse Ligament Test Positive Stability of the Dens Negative Vertebral Artery Positive ,$[3.2.1406-Treatment]$[3.2.1405-Assessment] Seguir tratamiento planeado National Therapy Services LLC 2, Crocker Blvd, Suite 201 Mt. Clements MI 48043 Physical Therapy Progress Note: First Name Last Name Date of Establishment

Copyright Mavenlive 2013 www.mavenlive.com

Prepared for: Juan Diaz(03/09/1980) Prepared by: Juan Diaz Treatment Date: 07/23/2013

Date Plan Established Last Name First Name Diagnosis Pain Level S: O: A: P:

Codes 97010 97014 97035 97033 97018 97034 97022 90901 97016 97140 97124 97112 97530 97116 97110 97110-1 97704 97012 97542 97002 95831 95851 97001

Dates of Service Hot / cold pack Electrical Muscle Stimulation Ultrasound(each area) Iontophoresis (15 min. each) Paraffin Bath Contrast Bath Whirlpool Biofeedback Vasopneumatic Therapy Manual Therapy Massage Neuromuscular Re-education Transfer/Bed Mob Training Gait Training Therapeutic Exercise 15 min Therapeutic Ex Add 15 min Orthotic Training 15 min Traction Mechanical W/C Management PT Re-evaluation Manual Muscle testing ROM Measurement PT Evaluation

Assessment: (in SOAP format)

Patients Signature

Therapists Signature

Thank you for referring Juan Diaz for physical therapy for his $[3.1.2148-Chief_Complaint]. Juan was re-evaluated on ,07/24/2013, below is a summary of their assessment: Cervical Subjective Se visualiza algo VAS Night Pain Yes Bilateral Paraesthesia No Objective Tonicity Hypertonicity

Copyright Mavenlive 2013 www.mavenlive.com

Prepared for: Juan Diaz(03/09/1980) Prepared by: Juan Diaz Treatment Date: 07/23/2013

Upper Trap Se nota eso Hypotonicity No se observa AROM Flexion SE FLEXIONA BIEN Myotomes C1-2 No se observa /5 C3 3 /5 C4 4 /5 C5 4 /5 C6 2 /5 C7 1 /5 C8 3 /5 Normal Safety Tests Alar Ligament Test Positive Transverse Ligament Test Positive Stability of the Dens Negative Vertebral Artery Positive Plan Seguir tratamiento planeado Shoulder Operative History No presenta CX Elbow and Wrist Plan Programacion de fisio Lumbar Plan Verificar Hip Operative Plan Verificar Thoracic Plan Se intentara hacer reparacion

Patient will be treated here for physical therapy for 2-3 times a week for 4-6 weeks. Juan Diaz Thank you for referring Juan Diaz for physical therapy for his $[3.1.2148-Chief_Complaint]. Juan was evaluated on 07/23/2013, below is a summary of their assessment:

Thank you for referring Juan Diaz for physical therapy for his $[3.1.2148-Chief_Complaint]. Juan was evaluated on 07/23/2013, below is a summary of their assessment:
Copyright Mavenlive 2013 www.mavenlive.com

Prepared for: Juan Diaz(03/09/1980) Prepared by: Juan Diaz Treatment Date: 07/23/2013

Cervical Subjective Se visualiza algo VAS Night Pain Yes Bilateral Paraesthesia No Objective Tonicity Hypertonicity Upper Trap Se nota eso Hypotonicity No se observa AROM Flexion SE FLEXIONA BIEN Myotomes C1-2 No se observa /5 C3 3 /5 C4 4 /5 C5 4 /5 C6 2 /5 C7 1 /5 C8 3 /5 Normal Safety Tests Alar Ligament Test Positive Transverse Ligament Test Positive Stability of the Dens Negative Vertebral Artery Positive Plan Seguir tratamiento planeado Shoulder Operative History No presenta CX Elbow and Wrist Plan Programacion de fisio Lumbar Plan Verificar Hip Operative Plan Verificar Thoracic Plan Se intentara hacer reparacion

Copyright Mavenlive 2013 www.mavenlive.com

Prepared for: Juan Diaz(03/09/1980) Prepared by: Juan Diaz Treatment Date: 07/23/2013

Patient will be treated here for physical therapy for 2-3 times a week for 4-6 weeks. Juan Diaz Subjective: Se visualiza algoVAS Night Pain Yes Bilateral Paraesthesia No

Objective: Tonicity Hypertonicity Upper Trap Se nota eso Hypotonicity No se observa AROM Flexion SE FLEXIONA BIEN Myotomes C1-2 No se observa /5 C3 3 /5 C4 4 /5 C5 4 /5 C6 2 /5 C7 1 /5 C8 3 /5 Normal Safety Tests Alar Ligament Test Positive Transverse Ligament Test Positive Stability of the Dens Negative Vertebral Artery Positive

Assessment: $[3.2.1405-Assessment] Plan: Seguir tratamiento planeado Operative Procedure: $[3.2.439-Operative_Procedure] History: No presenta CX Objective: $[3.2.1771-Objective] Assessment: $[3.2.1762-Assessment]
Copyright Mavenlive 2013 www.mavenlive.com

Prepared for: Juan Diaz(03/09/1980) Prepared by: Juan Diaz Treatment Date: 07/23/2013

Plan: $[3.2.1770-Plan] Subjective: $[3.2.1654-Subjective] Objective: $[3.2.1655-Objective] Assessment: $[3.2.1656-Assessment] Plan: Programacion de fisio Subjective: $[3.2.1318-Subjective] Objective: $[3.2.1319-Objective] Assessment: $[3.2.1320-Assessment] Plan: Verificar Operative Procedure: $[3.2.1851-Operative_Procedure] History: $[3.2.1904-History] Objective: $[3.2.1919-Objective] Assessment: $[3.2.1920-Assessment] Plan: Verificar Subjective: $[3.2.1942-Subjective] Objective: $[3.2.1943-Objective] Assessment: $[3.2.1944-Assessment] Plan: Se intentara hacer reparacion

Sincerely,

Juan Diaz

Copyright Mavenlive 2013 www.mavenlive.com

Today's Date: 07/24/2013 Prepared by: Juan Diaz Prepared for: Juan Diaz

Scapular Retraction and Depression Frequency: with all exercises

- Pull shoulder blades down and together as if you are tucking them - Do not hike shoulders. in your back pockets. - Do not squeeze shoulder blades back beyond neutral.

Codmans/Pendular Exercises

- Keep arm completely relaxed. - Do not actively move your shoulder. - Move your arm front to back/side to side/circles using momentum. - You should not experience any pain. - Pendular motion.

Copyright Mavenlive 2013 www.mavenlive.com