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C)renl�rp SYre,et,Suixe LL�iU ,S'uurr�'acel,��`�SI t,�t O: 631.6��tX�t�� fiHAO f CHt7NG P�TIENT II� : Q�3�F8 r�c��: ���i�/s� z�ATE : osI12/1� REFSRRII+TG PHY52CIAN: Tou I,ee ! D.�C . TYPE t7F �XAMI2�XTION: X-rays : Cervical sezies dated D3/12j13 ThozaGia s�zi�,s dated b3�12j1.3 Luo�ab�az s�ries date�d 03�12/1,3 FZ1+mZNt3s : Tk�:�se fi�m� demcnstra�e � righ*. 1at�ral c:���re:: tho��sci� �urvE. This apgarer}�y is due to pcst-tzaumr�v��. mus^�i� spas�r xes::�ltw:.c� fro�n t:h� x�cent �rc�:ar �reh�.c�� cr�sh on C2,r'?;,,'i3 . Trz� nflrm��:. cerv`��a�. :�o�dotyc Gurv� ;,s comp�.�t�E� r�v�YSed. This c't�:fc�;�r:�ty is r��err�d to a� a �ervica2 '�yphosi� and is usua� Iy �.h� resul� c� a �;ot�� vehir.�e cr�s�. T� i.s �rv �pini�n t?-,at �hi.s kyphos�s -.�s ����. tc� ��e tr�ur;a su:�t�i�.n�� �:i the �-�cenr �n�tc�r ���hic '�� ��a��� � c�n t�uf��fs3 . Z� �r,�s d�far�rary �.� ..c�t. ��:x�ctec, �.t U��ri �Z�-C�13�G5� tre pa��en� tc prem�'�ure �e���er�tiv� cha:���s . �i. sma�l nucha? bone is Lrisuaiiz�u �Ti�chi^ 4�^.L s�ft �issu� ' d�rec*3y po�teriur tc t�E C] s����us �r�cess . Tr�� shc��:��-? n�:- �e i,���r����.e� �s an aZ�uis,�ri Frac�ur�. The c�er4:-°ic���. ', f��x_i�r� �riew is un:em�rkas�s�. ;he i�t����.ty �i �h� ��, atlant��,�ti�l art`��ul�tic�r� �s {nt�c� . ihe cer�.ric�I extens:.c�^< view �e�anwtratcs s;me re��.rictecf I:1fl�1t�T1. TI'li9 �ppa�ently ' is aue ta p�at-t:aur:tati� muscle s�asm resu:�uing f:�m tY�:� �e��nt rn;�tc.� �J��icle �rash r�n 0�,'2511? . �'he pas�eri�� j , ver*ebra� b;�d�� �in� �s �_is*�::n���; �� vhe C�s-C4 �ev�l a}� �h� ; c�r�ricai ���er�,�:�<.��� -r�ec�. �I`�i� �e�s���:�:�.� Ncst-txd��ati� �:�'J,8'2t�x1'CC7US ?I:Sti�� Z'�S'ui'�'..1.7:�� �?'�3:1 �.�t? �@GE:rir :[?G��: V�'2"�C?E' CZ"8S� �I: "'��G�°f��f�� . ii � 1IT':'"L'� ���� _S 1.r.�.S12u1.� '?�� �: �5:� � ant�ricr-s�.�ericr corr_�r <::� tr�e Z�� �,r�rtebr�i i���;y. rnf��s r�pres�rz�� a co;zg�r.i`�I an�ma�y an� should ��� ��e �:�te��r�;.�d as ��r*e�ral �ody cc�mpr�ssic�n iract.ure. �arl�% � C7.BC�t:£'ZcitiL�� C11�C �3���5E' iS �;�E3��,'��� c�iK �"�"lE Tr�-La �2':n ?,�i-.F..� �E'�r���� . _ ... _.... _... .,w. . ..._ .:. .,,..—ra; i.,,: fk='�F; ��3 .?? ;;r? _..___.___'�t?"�AG£L?'R fM�t►�l.i�f�, PT:l:�C' �`ent�aZ� 13t�itrlur,g _�" 393?�:.Dur�lpp Streer,Srtt�e Ll.�i1 Sasiru Paut, ?tri�'1'S5l�'�1 U� bS�.t�{l.11(�t1Q �'HA� , CHt�NG P�.TIE?C�'T' ID : fl61568 L�0$: {3�f 1�/68 DAT� : 03j1.2/l3 {CC3NTINt�►E�} x�ztAESS�oNS : 1� P`OSt"'��'a1.l2YYlat1.0 CB.�3.Cr3�. �C�]QS2.S . �) Post--traua�atic thoracic dextroscalic��is . 3) Past-+�xavta�ti� s�stricted �rvioal rau� of mz�tian. 4) Post-traumatic li.s��►az�to�,s ins�2� invo2ving the C�3-�4 ve=tebr�.2. mota.vn tu�i.t. 5) congenita.�l L3 limbu� ban� . S} D�g��afi�i�r� cLi.sc disease at th� L�-L3 and L�-L4 ' lev�Xs . ' ?} Clinical �orr�:latinr� for utu�culaliqaur�ntous in�ury is rscomme ndec�.. ' 8) Th���� fi�.av$ revsael no d+�finite �rideaa� of a recent ' fr�cLur�, c3i.sl�,aation, or osscaus n�:oplastia chang+a to �'. the ext�:nt visua�.�,zed. I I Sc:�t� �, s�I��xiay, �i. �.. , L�'.r�,�` . �. R ' � �:J'!..�`r.� . �. Li..>;',j '` 1 .� i. : � �f. _.�i'�.�� v, II k I �;(}�:s,� Midttwn "?eciicai 3�ild�ng, 282$ :��h�ca�c�r�venue �., {"l�nneaUolis, `1�v 5544; ��1�'RC)i.{)t:i('.li. ��ane:&�2,8'9.!£�tC� Fax: b:2.S79.��22 t I_.3�If �°ww.-<�r�n��';�ic.�"... r.i � 3€z€ne•3«r^svii�e•wc;3n�•h�la��sewc€�e°!'°?ieneae�ciis-?`:ymccitiT CHt�NG THAt7 ?`�Cr`!cS3�' _,�..-C�i�. v.. .`.�'n „ ..�:: , .'IY7V��✓ r'���A ' Ctd/2'512013 - Imaginc� Report: MRi LUMBAR SPthlEi mail Provider: Anthony M. Caok MO Lacation of Care: MlN�IESQTA E?iA�NC?S7iC CENTER (SVIDC} F'i�Y�`sCir�'� �^r,�}Y '�� ��r'�s, �� T�YPE' �F �Xt,i�'f: M�! CF `"`-3E �L�[u��t��ACi�,�L SP1NE INITHG�i �;.C°',�NTRC?S�` TNIS `jIV,�S ��R��4'�Nt�t� �Cti( PV1AG3��?C�M EwPRE� "..�T INGiC,��IC'N� ��c�iatin� �ic�° !cw��:Xtr�r �f"ty ��ir. ' iMPRESSIC7fi! __.__._ �I � �`V1ii£� :7�G�"�f'r:? :V� ��.`�^,i �iS�e3S� :5 �..r�S£"1'c`3f �h� LG-�, ��-�" aC1G ��-�' �£v�`5. G Th@C2 iS c 1E^l�llS �GGiV Nr£?cB�C c:�i�'� c"3Cif£CIUC-SU�B°�`C'!' !?''aty€PI 0±t!�'@ vCC?+ .^.� �� Ii 3. N� evidence fc�r disc �erriai�cn c�r spir�ai stenosis. �� `���`fly`��.;� ��t�1�C�I �'"i�` . � �T�= '� �.� k�: Sat�!�81 IO�C TF?IT� ��;�i' ._ . Scyi'i�31 ?Crt?u T'C ^�1G {.�` �I .t�. . ,,.h � �f A' . �� T ;hr` lf` .:��' 4 :; -�X�! .. 4": ? � .� :".; � e.X d: ;..(;t� R �� , � ,., "tv; The �ati��t rras st��?�U � i�� �en-Yve:C!�; �earir:g S�;pine :osiiiur: I ����t���a �X31't'�!T?d�=.C"" ���t,� �"G-'�' c�tlt� �":-� i8V21S '�@fT'1CtlSffctGa '1G�`�i��'!lG2 `C`i'�ISL °?�rili�fl�� CC SGI('�� I Si�t1GS;V. Ex�t�?inai��?� �i}� e :��-� i�v�=: �e�t,.�?�s,rates a :imbus bc�y at�h� ar,tesior and su�erior as�e�t�f�'�� �a�y �f �:; �"i�.'�' ;� '1C� �LElC,'��"C'C� �� �:�.=^b`". `I�"ti,s�:IG`'3' ::'i �a�l('?r�� ���'1CS15. �x�rnin�tic� �t th� L�-� !�sr�I�emc�str�tes nc ev±�e�ce€cr cisU herri�ticn ��s�inai ster����=�, �Xr'�C'lil'cz�iC`rC; ��y!�i� G.�-� :�VE'= ���i?'�:;?1SiI°ca��5 �"C= °1iEC3`�'tC� �Gf` :ISC- E`Lt`t i�?'`^,r Ti-�r�' ;c �•.G �`d?Ct�'r'�� 'd'C:�t�"�"aIS .^� t�����t��i r3�.>i�ldt iG��t�# �E t3i� i':��,i�i�i g.(�i�K��'''.��3f�. Exar-�inafion �t`he LU-S" lev�l �emorstraEes nG evidenc� for �isc '!�e��iaticn cr s��n�i st�r,-�sis. � �G a�tl�i`t�czi�{ iS u�?""C^,���c�G�, .�::t1° ��`.'£i Cf ��8 �.;rUS .'?'tE;U<�c3"5 �' W!i�li!� '^iw :�!^l�'i.sSc7G'ca! :�2Cc�I Sez� T�ere is diminis"�e� s�an�i wit�in �he �2-�. L�-d and 'u-�" interres�e�rai uiscs �ic,�tec G� Anthany Cc��. �11G �c�CiC�'IOQkSt c'�G,`4'til(( � �C i l�'�.,� ��C '.i.� �t� '.".t�1��.`.,;� i. ���1LG.i i-� NOR.��ti MidtQwn Nte��cai Buaid�ng,28�8 Chscagc�Avenue�.. MYnneacro(is, '�!^d S5�fl7 �"��IItC)1_:C3t>it:'<ai, �hc�ne: 5:2.8'9 �044 ��x:bi2.87��?vi C�I,I��C; www.,t�r?r�ciir��c,.cc;r=� rt� � $laine•Burnsv�lle•�dinzr•N!a�iewnoa•Minnea�olis.p�ymc�t;t^ CNt?NG THAt� ��'i:c�3��' u�.�i. `v�t'.<�i+.,`?v� ;:�`4�`i�:"-��� iJu"y"t' ` E(�ctronically Signed by Anthcsny M. C�ak MD on U4122120�3 at 'i:47 PM !!'4.)It:t"�" ^^:�'tcw� ?`"!c�c�isal �u��d;n�: <82&Ghic�:�e r=v�nue 5., h!innea�w�is, !"±N 5;40' ��£r,, �€?g?g !�nG ;�=ax 5 ��79 E.-�, "��[.;FZt16_t)��K[C��1 �- ` {: i.t�;lC �ww.rUrgr�cti.^.;c..c� .. W �}, �latne°Bur�svi:�e•E�i�a�tl�piewc a°a-?"!inneapc;fis�Plyt��uth CH(7NG THAO F���i� G�e w��''�i1v�� �5����:`'..�NC ;r�4� 04J21/2013 - Imaging Report; MRI C�RVECA� SPttdElmail F�rt�vider: Anthony M. Coak MD '�''e '�' �'�'"`�� ��� Lc�cation o€C�re: MlNNES+�TA DIAGNf)STiC GE�tTER �ME�C} .1.'�.�.-� ,�-„�-�. ��- �� � , �i�YSlCI;�N: R�naid M. i�rrpi_ C7G � ;� .� ^,�;,'; �,: �� _ , :-- _ T'�P� rJF EX.��vt' MRk C� 'HE CER`�ji��1L S�INE'J�1(TH�?4JT�'^N�R�S� ('YlyA FR X€'�" f >r,^ d ..-c'�..5 T1-I�S VVRS FE�F�"JF�ME��"J`N MAGNET�"JM ESFR�� 1.5T �?.:,,;., t _,� , .�."r .�.��,�'.1`�- lNGI�r�TIC�N�� Radiat:r=,� :��r��r �xtr�sri?ies ��ain [IitRPRE551t?N �,�.� ;. f=:?'f'�It1-::�I��C; t�G� i ft'.cz;'G"?'?c'3C1C(' itYstl' :.'c'3UC�! E'X��t1SiC)'� GF t�`� �E'CC'�3��x3' `G�`5iIS t70+'V^ °:;' ��i� SUp�riC� `""la�;if'. `u7���'!� �CSi�Ci�� c.t��h 0# ��.-� �:. �lC S�C'jT'c�.f r�i,itC3L�'C'7ic�l� f u�!'`"i�."?S.C�'�G Vir'I��' Cl '.!�� `v'15Uc"�`sIZ�G� S�iC`r�i �UTG'. v �(R(Rlc`3� R`l;?�?I�VE?i �E3%�f'�re��'V�' �^3Sr ��5�3S�' iS A'C�c2^i ,Ati±h;'� ',!'� °�E.'<^�'SC:c'�I S�'t1F °�✓� ['"<r"�: -wC352�,'CiO(=��Si� �ul���?g and m�rgir�ai s�urr�r�� is ar�sert�t the i�:-�. 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(�t��'..: �����.JtrG3t��J �)���G�) ,�rJ�.Cf4����f zA���. �:,��{���.�.�f G1�1. �'�{G3fQ�nC�: r'J.�Tti`r���. 1�`:'�'!�R :C i:tv �l/IC7�..'I'1C@ ��'(`S€E�"iGS(S Vt��� C�?lt!a� Ss''-S?"tc31 :ctl('<'•3t �J'( C'?�13Cr3( f01��iE'l!13. Examinaticr af��;e ;6-7 leve! de�'ronst�ates snin�rnal posiericr�isc bu,gin� �n� margind( spurring T�er� :s ^:� ��r3dence f�r �tenQSis�r.�e ;entrai ��inai canai cr �eurai f�raminG. �X'c3TY!ICte�.�iO(`t�:'`s�i� a`"-i-�� i�L�@� '��S7�fv`�'7S�€'3�6'S RC £.'�l(t��?1G�' �GC£�lSi., �"t�^CS'lir�.�(C(1 v(' St"�I(`�C S�G''OSIS. �}"E?� 'S uc'�t:C�.a� 2X:c�nc9�,^^ ���` .Y;E ';°,CC�w�l�ci I��'Sli� a�'J�Jd!' `� ?Fi� ��1:'Pfi�;i "'"�t'�iC? :a'�:'"£' t^..f`��tE.-' !r`(dCr','" i�(`" TF�j� ap�earanc� :s �ors�sten: �nEt`� ar �,r��i�-�`�i�rl 'yUe ; ^,:aifc�rirat��^. Ne si�rai �cnc:ma�ity �e�c�st�ate�� �€t�n t�� ��isUa?iZe� S�inai c�r�:. T�e heig±�t y`t'�� v�s��aiized ,�e�'e�ral �odies is •�ueil �ra�ri�sr�ec' ��i2:1\ Midtawn =''�'ed�cal Bu;iding, 282�C'�ieagc av�n�te�.. ^'!inneac�al€� ""�� S{�C' :��;t;F2t)(.t7C�1C'.1I: a!�,c;�€�. 6 :�"° !;iJC� �ax � �.���`J.,h-` C."1,t�1C xrww.ncrz�r:u;:r::c c:r,^.. rLs � 61a9ne•t�ur�s�ville•��ina�Ma�icwc�cd�Mir<neape�[au°t�l,vrr��.uc� CMONG TNAU F��,'r?"��[� C�t�B i�;,��.�.��� �€����i;"_NNC .>�3<,e.< <. There is a smaii rn�c�us reter?ticn �vst �reser,t�t�iChin the sof�tiss+��s �f*t�e pe�ieri�r n�sopharf��x. G��L��i�u �v� �:r;thrny Cock, MG R�€�ie�irt�ist �E;,,`C''t k'�� C�: TrJl1 �EE �,�. �" �u'I�2�`1 a T. �4i`::�'_j'» Electronically �igned by Anthony Nf. Cook Md rsn 04I22120�13 at 1:47 PM l�'�Ft.�ti MFdtov�rn t�tedicaf Building,?828 Chicaga f�venue S_,t�';r�ne��aolis, MN S54Q7 ti�l�ItOL€�GIC,1i� Pi�s�r�n: 6�2_879_!�t�0 �ax:b!2_8?9_C}722 �i.lOit' vr�v�sx.-^c�rar�:_I��3:c�u'r; B.air:e•�S�rK���iii�•�ciir�a•N�a�l�wc���°I'�irir:eapoli�•�'iyrnc�uti� CNt?NG THAO �G'1�1r��G ����. ��j1�'"���+� �rJ��J�7��-��� ;i<��£� 1 G►4t051201�-Transcriptior�; mai[ Pre�vider: Ranald M. Tarre! t?C} Location ai`Care: Noran Neuralogical Clinic, P.A. at�ai( `4�ou Le� C�C 393 M�ry�and Av F St Pau! NIN 55?3� Dear D�-_ Lee ( just cor�pleted tf�e ct�ns�l��:i�;, vr �ur r�ut��l �a:ient Ghr�r�� Tn��- ! ias? s����°t��r a li*fi`� m�r�:r�� i��°� Y��rs agc�. ����•�s ini�o':.v�� �� a��th�� me��,:�v�hicl� u�'#isjo� Pv�s. T��a��s� histar}t c�`� ?'��t�:r�w�}�ici� a�il�s��n°h���ccc�Nr�� an �1�;r '��, 2C?0� She t°�d � �ubse�ues�t r?�;�t�;� ve�i��e accident on Janu���4; ���C�S, and ag�;r� o°� J�tober�, 2�i�. I ��w �����r?��€r� ��1° related to t�at �r�ost 3E,'G�C`i��•CS��'",?�. �E�S �!`�3� ���C�"�5 +,�tc��S�1-G' �'3�� S'=�i "fy`�UI�"E,'u" i0�i� }!"�e�t?'l�'S'`.. .����'?�' "�� C''T?`'���'�-E.'!'}•' `1-f.,'c�iC� ���'�T; �u�; O�thOSB (SijUCIE:S. �nfo�iuna�ely: Ms. �T�hao�a��s the front seat passerger in a v�hicle:i�a�or, Feb*uary 2�, �413, struck another that �p�ar���ly fa�led to yi�fd t�rr��;�?� �r; intersecti�a�- ���was s�unned. �h� c�€�°�`} see� �u��m��dia:e ev�l��ti��. Sh� t��er re���°�e�: t�yc,u e�'��� ���e t�e�,�r ic��velc�p n��c�re si�r;f���r4E ��a:;�c?��: '��ck a�,d t�ack. ��i�. ��� ���'4 dif�er�nf thar� injuries in th���st. !t feels more significant. She i�4as bi,�teral pain radiatinc� out tc��rsards th� shc��}c��rs. She has ��w �a�� ���!� �ith radiat;�n t�wards the kn��. rn��a�y a�^� th��i�ht �i�e. � Ms. Tha� has no other med�vai problems Sl��is not using medicat�c�r� anci has no +�edi;ati�n ailergie�. �n� +�as never s�oked ci�areEtes. Her fami!y hist�ry is �nremarkabie. N�r review of sysE�rns is si�r�ifi�ant far the cfsf�t3se pair� al�r�� �r�th t;7e h�a�a�fi}� �r�� assa�,.a�ed 4:�hs�ea�edness. S�� I�as arx3ety at ti��es i l�er� ar� nu �ther mcsdifi�i:�� €a:;.a�s or �;c�r�s=��P�n�tams c�tl�e°�.�fi�� �ss�c.i�t��i trri�t� i�er t�°,ie` c��r��.�lair�t� Neurt�logic Exami�a,ian: G�n�r�� The �a:�ent �s �c���:�=�t:ve k�,;j!� :r�e exa�?ir�a+,ic��� sre is i^ r9:� ac�f.e dES±ress. 4-���NT Ncr^��{ �����,�I�c, sciera cl�ar, m�.�cosa rnoist. ' Blocad pre�sure 114te�4; pb��s� ��, respiratic�ns 1�_ '� M�nt���t�t�s exar���natic�� r��ve�!s ii�l�. 1"tiac�is �`s��a�� �ri�nt�d t���r�scn p€����rsd ti;���. Sfi�e �is a ���� � �1lS�C�t'lc'�f� e"iSl£� '`.��'!1'lC�tlSt��t���GflC� f BCtCtt 3C1� i`E,"!'3��� t?l?CTIO(�. ��°t��'Y�";?�I�S c� C�44u`�i1i1G� Ci�K'1�N}��;C�{�fi.�'< ��I1�tl�C(° 5 �iu��l�. �e�!T11??{,� I� �fC3�E°t'''-u��, �v�l� Cc"�f� ��7��.^.+`lsl S'T�iE.' ��`� CO'l"t�'i�X�Jm["1�ut1f�S c�t�� �'?iCl� ':t? �Tl c'�c�.S�fc"94-� fu�5f"1€.?'',. Crania( nerve examinatit�n revea(s the pupils are symmetric and reactive. Funduscopic examination reveais nor�na��ascu3ature an� sh��p discs bilaterally. Visual fields are f;�sl;. E�trao��iar rn�,scles are infaet wit�c��t n�sta���us or piosis �=aci��s¢nsa`,ic�� is intact tc�tauch ar�c� t�t��erature. T�e f�G€es�re symrneiric and �?5. }��aring is grflssly int�cfi k�ilat�r�{�y� Th� palafi��(evat�s in Che rnic��ir�e. i�h� trapezius rnuscies are 5r�. The t�nc��e mQVes free4y. �v�`.?!"t�X'�urzf!(l�itiLi? ��4'��'� t':OCiT'c3� i3li€}� c r-„; tG��'��'l1'C1UC„�rt+'JU; ��'��.'`l�i�' '� �''� `:fl c`3�; �'��"E'(?i(f4@S �rJ C1"����"`aC2C`?"1C?t IS !�t7t8�. {�'.-�'t°8�£'��c'3�'BXr�t7iin8�10t1 t"BV�;r��S E(1�c3C��111�@!'-�C�-fICS� 8f1C1 �'';@��-f0-S�11�1 c3�1�3tI@S. .�`.�E�?Y�E3Si(i1t� IS WI��1(t'� (IOCi�lf3{ fif??EtS. ��)R.,�'� M�d�avvn Med�cal Buildi�g.2�28 G4�€caga AveniRe S., Minne?po�is. N3N 554C�7 '�i:EJR��L{)(.IC'rtl, P��re: 6,?.879.`�t3Q F��: 6!2,879_07Z2 C`�.I'�t(: vrww.n..�ra!�:;�.i:.cu.. �i� B��€r���B;�r�svill�•:�d�na•i~laplevv��d•P1inn�xpoli�•P:ym�utt �HONC� THAC} F��rale C3OEi �1�;�1�11�6� ?��5�?x 1-NN� ���" ,, Q�e�t�±�d�n r�flexes: Reflex�s ar� presant a�d symr°�etric in the upper ex.tremities. They are diff��u{t tt��iic€t in kt�� righ�lc�wer�xtrerr°�ity w��n�corr���r-ed�vsth the left, �t��;tur�l Exar�i^Fa`i�^ T"�e� are ��ore �ha� �€��eraf� s;.ab�c�t� tjssue fext±sre char�ges pa?�ated ir+.he p�s�teri����rvi�a�; up�er, �;si �nu �����r b��k re�ac�ns, �h?s� ar�a�1 sli��i;��� ar�t�;� prc.'ninent cc� th�ri��h!tt�a�� �n the ief;. �P�1�'RE�SIQ�: �. 44-year-c�fd�vc�man status p�sf motcr �ehEc�e cc�irisic�n Fet��uary 25. 2013. �'�. €�esu;tant��r��i�al ��r��n. E3� ResuEtant E�:rr3bar sprain_ G. Ass�ciated h�a�iauhe�n� up�e�k�ac� �a�n � [�. �adfa#ing ri�ht upp�r exTrernit�t symptoms. ?"t��<� is �t�s Thac�'s f:�i�rth r?��tc�r ve��i�!e��I?isic�!~ �h� has r��ve{ r�::c�uire� tV1F21 �xarninat��n a�tc1 I think it i� E�S�£-'f?}I�) c'3� t�IIS��(7'C. S�IE� �i�S lE1C>'t:? 5�{'iflCr��`, GESCOCC'�t?i`�. �y�?�li;:, �'irJsE1� ; c'�`?l G�:�CiC2.'�'�t'� VJ,`r: dUtT!Ulc��iV� ':.�?}Ll',` a�� th���ssit�:�iTV a�u�a�rdy;nct q�aene�`a#i�=r�changes This is sc�mething ��re ,>ray be able tc treat�€�e�°e�:ly th�is ;Er��artaurd- i ��ar it is sas�r�>�tk�inc� v,w� r��yy r�e¢� �� ire�t d�ff���r��iy, Sh��vEli r�En�in un�er yo;�r ex�ert gu��9�nc� a;:� fu��kM�r �e��^7;�-:���aE;�ns w:l: ;�e r:�a�� c��ce � "aYje th� res:�l`s o'th� �iagr��stic i�,ac���. Si�cere'y, rrnt%�an Eiectronically Signed by Ronald M. T�rrel ClQ on �4t�8i2�13 a� 3:24 �'M '�UR.t'o ^1i�1t�,rr°. ^9ed�c:l Bu'd':r,�. �$2�t:P3;;,s�.r?�,venue S.�i€xr,ua�ani,s, htlt! �.�#Q? '9i'?'�`.` c#i�� :..aik 4 «���!2��<i '�4°.R 1�Lk# {l�.l(��E _ .u. _ �� C.1.I�,1f:� v.�w�tvf�r���-,.c c c3�� �L 6�;,�,�e��surt�s��l< EdiK,:.�'�1ar!r�r�csotf-�'��r?"ea�xsi�s��'lym�:�>i� CHt}NG THAU Femaie L70B '.�'S'1 a�'1�f�8 1;�'i�8' 1-NR1C :=ya- , fl11251201� -Transcription: mai{ Provider: Ronald M. Tarrel [3Q �acation c�f Ca�s; Nt�ran l�eurolagical Cltnic, P.A. �,��1 t,��i T€t.;p ��� i�G � Ne�ItFz 8�W�IIr���s Chir�practi�C}ini�, 1 GJ� AtC�d� Sf�te 1�tL' � ' St �aU! �w1Ri ��l�� C'i�ar C?r, i.�re� � E i�at�;� ��::>t c;€;.,��i�f�r,'.r!� ::ur�5�ltq�ri€�=n �c,u �e�a.�e5#�� rec��r:��n�� yc>u1 ta<^,t€�:►3t, �,t�,;:�nc; Tt��a II �rs y�� rer�e��er, t�1s_ Tt�a�.� '���tt�� p1eaS�nC��-ye�r-old�,a�o^�an v,rhe! ^�d act�;��l�=€����;u�te� ��,`w�di(ferer;t ; C7rC<iS€.tRS `;ai!!1(�" �c�C;�':1�f1� :l'?� �c��}� �''�o i.r'3rJ �1�'{:� ICtI'Q�`dP.(.� €tl rs R1`J�Qf `JF'�tIC�('�C}��i:;(�t� ;�r`.�?�t fItT1P. Sh� � I ^�ade a reiat�veiy cs��,;�le'e re;..c>v?r�, �r�;nout need f�r nnqa!�q tt�erapies or anvtvpes :' restr;,t>�ns �lnfort�r�ately. an G�et�t;���2, ;�!�'J, she���as d���t ing her ���h€cle wt��r,sn��.tia� brrad side�b� a�€�:�er an the � driveF's skd�_ S�� d���lc[�ec'� siun;fir��ar�i�}� in����see neck an�; t��ck patn. She d;� nUt s�e� out�mrn���ate , ,�',:r��U3'.:Ct1, �li#i S�� L'E.r'.+%�R 'rP.3��`G't'''sMt,"`` �'�?;i vGU�til�fo'�'y'ft�S�@CC` �3£Il�(�Cl��C'�Bt ::(Tt�. "'••JilC�f: 5�°l�5�1�� I '=WR13�#"t>; rT`�`'':3t�tr3't;�_ A1'."15 i;�;rt' $;`tE vtltlt#€t;d�5�L, .t1c3'.`�F'£.-'r�C�,�.�.�1�. �ht? flf;�U�.'f'C� ,`r'?$'!"t° t1E:c�C�3��28{l�� �f,-'C?ec'35f'C�. 4� #C�'i1C!S t0 C;OR?£; %,+1t� �:` � t�.;{r�"'? s i��?F�:�'Y' r�`it?. "?f'C.K R-'Pt €'iP„,^�( �1:3I�t IS �1`:18$f',?°8) �CiC° ,sy`f"'E?hi��; E'�s'i� 9",'-3't�I�IIT`� :�1��,�tT1'Ltt' It°TCS�#'tP. st�.�ul�ers. St~� i-as upp�r b�ck��;r� ��d then bii�teral Mow b�ck Ga�n. She��:nies���er extremiry involvement. �� AII ir; ail. >,�� �ai� h�� t��r.c�rrr� rnr.r�°c�leratsle S�e v��3s orig;n:�l{y v�;rY sli�1 ;�r;; 4firtsaall°�,_;natjln ir �io �r�y ;;U.tf°Ities k��ia r�t;w i!lc3t';e�s irTt�;:r,sL�:: t��:��i tt5t� �<3,=~ is ��€es��'� ��c �f h�c°; nc�t c�n ar�y rra��cat��n �'113�s time, 5?�e �e.nies me�ica`or �11crq es. a'�e d�es �o�����k �t tF�s i�rrG �j.'".�; :1�.'�� :.`�� '.:.r"J� tl3l.?e�,.�'i�.�, 'SiuL�!�I�li. �k( i,C,7f4�."`3��. H�( f;�rt�11 v r<I�t���y G �r=i4r��Y r;-3n;ontr�huE'a+�, He� rr v,Pw of systerns�� sic�n#r�;��nt�c; the h�3�s'��h� nt�c.k, z,n^. tx�ck ���r. St�.� Pe�li����s�i�s a*�y otner syst�r�� prcat�lemc�n �c�mpfc;c r�:vi��.�. Thee� ar�nc�o€;i�r n���i�,€r�� fac.ars ar s gnisyr��ptorr�s �sther�h�isc assaciafe�w��i� �er chi�[c�,���;(ai��t. NE!J����?�i�' EXA'��I�dATI�S� ��r.era; Tt,� pat;�nt is cc�a�efativ� .v r= !�e e�:a^?in�?E:��. She s n ?�o aa3te u��tt Qss. H�'t!���� P3a�rnc���pha��, sc��rae�le�r m,�eosa mc,is[- Blc,od pr�ss�re '32.'i4, pulse c'34, an� �es�!ra:�ons �6. �a�±?siir'',� Sl�tliS �'Xc`i�"1;�1��€GI' tPV�3�S�J�S. i r8f3 IS c�it.,'t'� a;i� Cl!'_{'(1EP.C� �ta�:%P.,tSCIT", p�c�i.� 311£: °lt7lP. �J�1P.IS 8 t�,'Oti):; t,istc�r�an b+i�i den,�n�tr�tes gou� �ecertt ar�d rerrv'e �r�e��tary. She ex�;itii�s a��o� `:.�r�� �f k+�;�wiec`:�e. LanguMge is fiuen�_ f�am�r��€s narmal_ She can� foli��sMn;pl�; aE�� ccmplex �or�srnands and thjr,k ir� an �bsEr�ct f�st��ic��°�. Crt,r� �l r�r;�;�exar�ir:�.��,�? !ev��is t��e ��u���#s s3re s,yrr�rne'r;c �r7� rea:;t�v�:. ��C;�tsse.��i��x�min�;�or� rev��is ,�c3rrn��i ���;.�iat�Ye An�si��=srp �iscs b�I�tF,r��li;r �f�s�a� f��ic�s a�€x f�sli. Ext+��cular m�_��,I�� �re ;ns�ct w�thout 'tit}R,11' '``;i�t<aiu�: '"3c.�i;�.I E�uFI;;.,� �£�:� Ch�:�€ac�Av�rtu�'W ("`.r���aap.;lis, �N �?��{�7 '0�'.(:��.)�.(}fr�� 1�. :a, -•r.i'.. .1.''.?3��.�i:�.�; >.%7x t,;,'.?Z7'�.i�4: E_.I,1'�It www fl<>a-arr:t-^-�;c::�r�-. �'*ay L �S!.°:��-�c 6�r>;,v��l� Ecir��°Ma����co��*�3��,.a=ear�.ahs Pl������th CH{?NG THA{� Femx3le J�.�E3. :;6'1�:1;�� 1�15$7=1-N1v� ;��°. 2 n��s`���'tt�s c�ptos s F�c.sal 5cr��z�f�c?n is i�<�;:.'t.Tc�;!e" anc?tem�aer=�t�.r+� l�+�e '�cie5 �re symn?etrrc�n� 5!� He�ring i�gr�ssiy intact l�Eiaf�r�liy. T�he pala[e el�vaEes Er� t"�� ��s�lir�e. �T�h�#rapezi�as rruscies aee 5�� T�� te���ue �r��;�>es fre�l}r. �`'ch7Es.'!f E;Xs'�TTltf'c9�lC;f" :'E'o£'e3�5 Y?i3"iTr'JI ��;t�K<3i't�,`?°'•?E'��1!Ctli(��"`C9ll�. �J�CF_'tl(�EPi d5 �'`7 iti r�1� EXt�'G'(Tt111ES ���rS(f C;! t!t.�7'::35 S t1t32�G�. Cere���l���xami��tic�n r�ve�4s��:ac:fi�c�er-tcrrtos�anc� �eel-tcrsl,;�? �b�f�ties. �a€t!esk�ng �s w�*,r�n nnrmai litt�i�5. 1.�4.-'�`(3 �t'?1{;(�(1 �£:�{EXE:;S:3€E,3�I"£;"ai:"'.dt°tu Sj!T1111G�'1C. �f1E', tt�E'.5 i31"r: L�u14Y(i,�Cli'1� 'hE''1 �3��3(l°e3I SiftT`iU�a3fEG:'". StIU�'�i��i �'x;3rr2t���tic7n T �E.rx� 3`� r>�Ct•-e t�i�7tz trJf��r�t�� ?€;S�:e`i�XiU:`f:> utl�tt�es ;l2(p�3teG ?htc,:C;11Ct;:t tli(� >?'v5'k,-'C1;t.f _,��',.Cr'3� r"3^ff 1�'g7i?` i?t'3i,{t 'E":3{,t;S T};w%c;� �t}= c1;�},�t,"C':e"�,'�: �7(ET!"'I"lt"? C)r ,4E;s r:t�f':` :�ic'3t? :Jtl°1?� i°�'� ���������� 1 'Tla�: �atier�C 1� �42-Y=��r.�,l� �a��;�rY1�r� s��`�.�s(;c��` �n_at��� �=elw,�wl� cwa4(�5it�r� un i;.�ci�k��r 1 '?;�iL� �. 4�,.ar.�1f �`, t.i::C'1�5��-5ir �S. ,Assuc;�at�U t�ea:�acf��. C R��i�i?ant lumb�r s�rain. '': 5�,o:tp <�¢ 5:3tlli� �F;^n�� '1'r'(��I �'v'�ri �h'3'.• ?f,'C'3t�!€^^b°al(?tlr#�11�(', t?4 �:" gFl!U(.t:S �3'lf" �l�lr�'r"�v StJ�7lf'. 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Tarrel t?Q on 101t?5d2Q04 at 10:51 AM 1t.F�t4ti "1i�€�su,- "N�t9:_ f�,.-1�:r3� 1$i4��i :;�^ Avcnue � !�':;.=?ea�aE?� Miv �::aa{;`° ?tiF'l'k2t11 f)f�;I{�'4t ,. � , 'S ,,t�=;' x �. .'� 4 _'��'s_ t_1.,t'�lt' �-w�,�nar��rri�c,.,��� � � 61,;ce-Bvr�sro:.le idir��.°t'�ap:e�rrs�:��?-E"���r�rea�iaiis�Ply�no�:IF CNC�t�G TNAC} ==�E��:!�: UJ� �6 ?:� ^tf�8 1:���f3? �..�rvC .,a,r= �6=�t2l20C� -Imagi�y Repo�t°X-RA`��`H€�RAC�C SPI�9�f rrkail � €�ravider: V€nton A(bers t3C �.ocation a#Care� MINNESQTA plAGNOSTIC GENTER {lV�DC� PNVSIC���N: Tt�U LE� €�,G. TYPE C�F EXA��: A�' At�� �A?E�A� TH{�RkCI� lND:CATI�NS �ack p�in, Ii�fPRESSEC�N �< ����i,I �iil'1i e71✓41�1Ui1£�J VF }�� ���Ji C.ILiJ��E t tklOi ��i3iE E�, .3 2. Hypokyphasis of �h� thoracic spi��e. .� �F">_'.C�,� i� Clv �`f:���':�' CI� C3SS�v�.45 �r`�3�.'':C}�:)C�`y' t:;C c�f...1,`� `"c3C='.!.iC� .C) ;�'�' a`�:`L£'.tl� VI$ii�t�!-`sw't.�,: �. C;#�r�lt;�; ��orr�l�pic7r� f���� s,�F� t�s���e !nj�ry is r���t��rr�,��d��. Fl�v�iN�;� �h:� ��e ��t �e�Yi�c� r�c�io�rap�s rc��a� � ��ii� ric�ht I�teral c�����xit�° �' ;�€� t��racol�r7ibar sp;ne wEth a r?�ir�imaM left iaferal cc��v�xity of t!�� ��wer t�ora�ic �p���e. �-herp ?� � �TidC'iCCii.� �fC��"`a �r���!'c�3� COfill.}f.'Kl�� C1� �.�''t�' ?�`�IC� i�'0?'c�CiC Sy�(C�E' �lttl�}[ � ET1tCli??��� ��,'.�� �t���?'r�9 ctanvexity c�f !he �ervicatharac3c s�ine. There is a hypokyphc�sis �f th� th�racic spine, �fihe� �Wis�:�liz�G ';�t�ra^i�. ir�i�r����br�l �isc s�aces �r� r��ir�t�€•'ec�. ?�� G�vfir;;t� p�r��p:!��I rnass �5 n�t�d €�n the AP ��i�v��. �ict�ted �y: �ir?ton �. Aibers. DG G���ropr��tie F�adi�l�gist °JI�1rrTtk �+�11'�tG��`V ��J��_ �v'�� F�adsClQqtS' acirmk . , .. . a .., . . . 4���. . . . . . � . 'tUT2'1'4 °`°1€tSCo�-�'°'`it1� .'. �Su��_s_Ea,i���H�k:-.a��-P�v€.��,�e=$ I°'"�s?nc��a1�;�. "�fd 5s'4U7 �t.l.���tfli r��:1C���i _ . ., , �°"` �t?C; ? . =-�2P'�;".:: C L,�\lf_� �.�rh€x=��r�l �r�r_ r� �� �.1.:.,e��i3=�s�<�:(e-Ed;r��•Ma��ewc�eu �'1-r^en�€;s°�'B�rr�cc>}� CNQNG TNAC? � ,.,f;;�, t��r�� ;�'� :a'��iE�+� �w 1�f3'-1-t'�!'�1;� Y�?- ��if�2��Ot�d-Irr�agir�� Repar�° �-��Y �U�41EiA�2 ��IM1�E�mai� P�c�visier:Vinton Alb�rs C?C t.�cation csf Care: M6Nfi�ESC3TA DtAGhtpBTIC CENTER (MC}C� PNl`�iClAtv' T�U LEE �,C. ��Y�� C7� E�CA��I: AP ANC� L�:TE�fi�L LU���IBOSACRAL I�1DlCATI�NS� Back pai��. IMPRESSit?N `�. �l�i�C ''iL�r't 5G��1vSi5 �� t�`�� i�`:i7fc��0�ti�1;��st" 5�:�3!�f,'. �i,�i�� i�ft S'v�?ksLS:S C3a� i�l� �U�?1�ot' S�`!"�,'. �, NypOlflrd�StS �f the IU�1bar Sp��e. 3. L.i��n�:.� ,r�rt���v �� t�� �3 ����e:. `f. f ;:.i'v i�..� E�b"�E..���l,tS i!:.+�' t;7: t��€f. >.S-� f �t�.r F�E. ��. T���r� �s n� e��ider��,� �f ����cus ��t��I�c��� c�r �c�}� fir�ct�re :a the ext�r�t vis�alize�. �. ���nir..ai cc�rrei�sior� f�� s��t t�ss�ue injury is r��or�r���nd�d. FINDIN��: T�� �,v�.�i�' be�r���� r°�di��ra���� �ev��3 � r�i#� rit}t'f' l�t�r�sl �or��rfexity� c��fit�€., lii(�i`c�C4`J�11?'Yt�c�C �St(!i�' t+tt!:�1 t3' Tt?I�� E�?�� �t�tE?i't°�.� L,CD�'1b'�'�.(�'� C'J� ti#�' FTtIC� 3t"1� ��?4'dG't' �11CT'1.1i3� �S�l1"i�> �h�re is � hypoi�rdosis of ine luf°rbar spine, �ioteu i� a iimbus bc�ne at th� ��terosup�ri�r �sp�ct e��t�� �� ���r�ebrai body. ��� lumbar �r?er�,�ert�*bral dis^ s���.�s �r� m��ntair���. T�i�r� i� no ��rid�rtC� �� It;t�b�r s�on�ylQl�sahess�. �E�� it��bar ty�� v�r�e��'a� �re no�ed ���h ; �he ir�,er�ristai lin� at th� L4�5 disc level. The sacroiliac �o�nts a�� s�nr�rnarkab6e f�r a �atier�t �f thiS age. The hip jt�int� 8r� t���nt3ft`Fe�. ��ctated �S� t,'intt�n � Al�rrc �`� ' Ct�iropr�Ci�c Rat��olt�gi�l vla�`rmk `1()R t\ ''�lidtw n^ '"je�'�v.E �iu�.,ir:� :�i� '����,iyr A4'e�ius S Nsr�r3capcl;;. '•tIV aa4t}7 �,# 1'1$4}E 6)�.,1{ 1i �.. ._,., _ �r'`� .:�;c `�< � : �` � .,'.: ' 1_�I.1�1C� vrrn=.�rs�rar�:� t �:��rr, �� � �..��e � r,<av�l;!�-E�it�-•'�^ii�;�Ir.v;t�c�!;��`Al=t•:nea�siis�*��rr�c�v_t}t .�r6''i��QPi�'� �F�4i,�1.� �et`�<`�it; ,.�,��. :;�:1'�:1�E�� 1a1:;8'%�-Ntvti, ,:,,r t�C�07J2��d • Irnaginc� Report� X-RAY CERtIiCAI. SPtt�E! mai� PE�vid�r: Vis�ton�tibers QC L�c�tiar� af�are: MiNNESQ�TA C3(AC`,,NOSTIC CENTER (ML}C} PF�YSICIAB�; T�tJ LEE C�.C. TYpE C�F �XAP��� AP t�F'�N MC�UTH. A� LOVt1ER C�RVlCAL, �.ATERAL CERVICA� N��.STRAI�., CE�4�t�lCA� �L��(ON AN�? E�TENSlO� ���T A�1D R4�NT CERVICs�� OBLIi���,JE� I'���C�,i l���t�. '��Ck: ��i�, lh+�PRESSI�N � 1_ }�lsinirrai I�ft sc;�iit�s�s t�f the c�r�s�c�th�racic spi�e. �. C�€�r�ic�l aIQ~��siu. ��S ft�'�iC�i�"?tct� �E�#rC?�I�.i°�1�5?� c�C t?l�' �..x,� ��°vE:� C?!1 f�l� !l�'l�>'�1� �c`�t��r� J;�`,h'. �Vt�`t CTii��ll?"�'t��` retrolisthe�,s at ihe �3 1Qvel c�n the e�ter�sic�n moti�n o� the ��crvical sp�ne. Minira�a! rei�oli�thes��s at th� C� l�ve� t�n the extenston rnati�n c�� th� ��rvi�al sp�ne. Clinical ,-C'.CC£'Ici'!0/- t�C �"aC'�} �'�SLlt' (?��U��' _� �!''��J?�T?!?"=�C1C���. 4. T��rt� :s r�� c�3�i����e �f nss�c�us pathc�l�t��,' cr a�ut� f���xur� tfl ;h� �xtent visu�liz��. F��C31�9C�' T�� w�ight bea�in� radic��ra�hs r����( � �rFini��1 lefr lateral c�nvexiftt �f t�� ��rvic�thc�ra��c ��E��. fihe�e is a c�r�ricai alor�osis. f�oted is cc�fl��r�ita� elor��ation �f b�t�: �7 tr�rs��r�� prQC�ss�s, The cervica! nsurai forar�~�in� are p�t�nt. �'�h� �erv��a1 pr°_ ���rtebr�! �caft t=ssue Sp�Ces are w�t��r� not'mal limits. The o��r:tai� proC�sS is �ntaC# T�:� ���te�i�ir at�an;c��et��ai in�erspac� is t�ithin normai lirrriis. T�e n�ucral lateral view reveais a m�nimai relrolist�esks of C3 �n C4. On the exter�sir�n �otie�r� �af�°�e �e�`di��l spin�. there is � 2 rr�m r�tsplisttaes�s �f C3 or �4 ��vi��h � rnir�ima� r�l��)E�r..�"t�����'�J i�� L/� i�.� l.r�. GiGtc3fGC� �'Sj�: Vir�tt�r� L. f�lb��s. QG � C���ropr�t;�tic R��ic�lt�gi�t i � I ( �� i I � I I � � I 1 ......_ ___...� � _._____._.. ___ .���,����_��_�:��..:_.�� __�_....._��__�___ __._ _ ��ari( 25, 2013 Irene O, Nelsar� State F�r�r� �n�7�r�r�c� P{� Box 522IC� �hc�enix, A7 8 i072-227C� RE: Chvng Thao D�t� ca� E3irtit: OE�J�S/1968 �at� of lnj��ry: 02f?�/201� � �at� t�f Il�1E: t�4%23,�2013 C;la�r����f�lurnber: � 2�-17K�731� � C�ase Numk�Pr: 3C)�f�17 Dear Ms. Nelsc�r�; On �pri( 23, 2(���, I is�t�rvi��Ywec� �nd �x�mi=�ed trris, Cho��; T��a ir� �t. Paul, t�'9ir�ne�gt�, fc�r t(�e �urp�;s� �f an E�deper�det�t C:hirc��raetic E���luation. M�.Thag �;as �nfc���rr�ed tP��t t��e ��srp�se taf this a�apointment wa� fc�r- ar� evaluatian �anly anc� that no treatment wc��alr� �� r�r�r��c�c�, s���� wc�ul�! � dr�cte�r-{��tier7t t��latianshig� E�� �s��blist�ed. Ms. �h�cs ���s �cc-c4ni�anF��i b� � tr�nsl�t�r, �nd v�ith t.���� a��=st_t�r�ce �f t��e tr�nslat�r E �.��s ab1e�t� cc�mr��u;�i�.at� �r.Fel� an�f c��#ain ar� apprc�priate ���d thorcaug}� Eiist�ryr, and fY1s. l�t��t� ackr�c�wledpec3 tl�at sf�e did �Enderstand and cans�nt�d tca tt�e evaluatican. The f�llr�win� is a sumnaary af f�ls. Tl�aca's int�rview ar�d exarr7in�ti�E�, a €�vi��w �rf prc���ided re��.r�rc�s, anc! ��?y opic�icar� as it relates t�o it�c� r�tc�tc�r vehicl� �cci�dc�nt tt�at oc�urrec� ar� �=���ruary 25, Z013. Rer.��rc4s ��vail�k�le fi�r r�view inc(���ied: y e4 +, +' �:�. ttr r�'� �-° � �'-� Y�td�P,'�f;i'l:;�i�;.r�i.1�E�:£'r�rG:?r. . s_�Fr`2 La'a C��`=� ���,.��: r_!;�ir.�+p����: ��F�. �.. ��e _.. __�c�. , hx 95, ;���5�._ S 4t"E'71 314fsPeGfi:+i �._..�.� �.__. .._.____ __ ___W_�..__��T��'�����:�`i 3�__�._.__ ��_.____���__— ____�_�_ _ _____�_. �E; �h�r�g ���h�c� ���� 2 • �ppl=c<�tiar� 1ar B�n�fits * �c:;��c��s�t �Cepc�r�t s �utc? L���s Repc�rt + �te���r�c�ec! St�ternent c�f t:lairr���r�t • C:orr�rriunity Health Chirapractic Clinic � Voyageur Ir�aging • ��a�tP�East �are 5yster-� � • Heaith & 1r�fellrress Ci�iroprac�ie Care • N��r�ar7 Rleur�c�8c��ica6 Clinic HISTORY tJ� I(UJURY �'(f�. ?"��as�� �rc���i���:� r��� f�llta�t�ir��; �7��2c��y c�f a r��tatc}° ti��3P�:c:(� �cciti�r�i tf�at c7�c:ur#E�ci �r� �ebru�=-� �5, ZL1].�?, in suhich sh�= �va� t�f�� frtant �a�s�n��r c�fi � 2��2 T�yot�� (`;�rr�ry. She rec��l(�d ��� ���as r�s�rair���i �t El�e tirnc� �t i?���� �ccicier�i ��r�d ����ribed tE��c� ��cides�t as ���r�ce��ir� �tk3r����h tl�e ir�t����e�:ti�r� �af �-'ayr�e �s�d �'���;�n �,uhen a pc�fit�e u��r ��in�; f���ar�� � left to rigi�t �vent thrcug�� tf�f7 i�jt��rs�ction arid faii�d to yiel�f, and th� v�hicle that Ms. Thao was a p�ss�ng�r of strue_i� that pc�lice c��r or� its p��ser�g�r's sid�, sc� tl�is ��as a fre�rrt-impact �utc� �ccider�t ���e� der�iecf lo�s c�f cor�scic�usness_, air�ag d�=pPc�yrnent, cuts � c�r ble�dir��, t�ul ir��i�atec� th�t ����e ��ad a brui��.� ar� E�er� ri���t kn�� a� a resuit �f t�ittir�g i�l � �n the da�h ir� the u���i�l���. Sf�ie indicated s�he had �mrrrediate si�bjective co��pl�ints of rigk�t knee pa���, ar�d shart{y ther�after h�d strbjectirre compl�ints �f neck pair�, a headachex midback pair�, ���7c# I��w bac:k p�ii�, Sl�e indicafiecl that ir� adc�itic�n ta t�» pc��ice car- tf�at th�y ��r��ck v�rith fi��e�r vehicie, ar�c�t�er �olice officer ciic� �����s�r��t �� the aceic�er7�� � scen�; hr��uev�r�, st�e e�enietf the pres�nce c�f �rt ar-n�ul�n�:� c�s� �ny tr�ns�oet tc� �n �� emergency e�e�a�im�ntz ��r��nt r;ar� f��ilit�, car �ny c�th�r m�c�icai faE;ility to receive n�e�iic�l c�re. � V`Jhera �sl��s� �I���i�� tfae relz�ti�,pn c��m<��e t�� 2he���1�ir.��, �lie inrlicat�d that tt�e ��el�icle �a� ncat st(li �riu�ble ��s tf���,�r� was darnag� te� the fr�nt er��! ar�d she indicat�d tf�at the vel�icl��v��tc��t�sl���. (t�at same day, s��e pres��ted to 1 cau i.ee, C�.C. 51�e received an exarr�inaiic�n and x-rays w�r�Y i�t>i��ir�i��, ar�c� lat�r �k�e �vas t�eatec� witl� rr,assa�;e, h��2 p�cks, c��ir-c��rartic ad�ustr��er�ts, �cupurrctur�, and in-�ffice stren�;thenin� a�d stretchir�g exerc�ises. �h� rated laer pain upori lier �resentatinn tc� Dr_ L�e as � on a scaie r�f 1 to 10 with 1 being ri�ild and 10 k��ir��severe. S��e denied being given a dia�no�is, a df�c��arge dat�, or a ±t%r i`X f 1 f'{1lftOYl1� ______�_._ ..._.__ ��. �_�....__.. ._._..__ �e ._ �____ _����J�_�j�� _�:�:���:_�� ___� _ �__ ,T�� ... KE; C;���ng_[k�ac� �ag�� 3 �€c��r��sis, �t�� r�ic� r�:��;ali, 4�cjv�+�v��r, i}��t P�f:�r �r�iaia= tt�,3air��er�� fr�t����r�t;y ����� t��r�� ti�a��s a wee�, ar�d s��e cc�r�tinues to treat at a fr�cal�ency t�f three tint�s per week. 1�lthen ask�d ab�ut receiving any hc�n�e exereises, she in�ficat�d t��t s}�e r�r�� ���e�criE�e� sarrte 4�arne �tretching with printecl visu�l in�tructions. ! a5ieed h�r ta ��rfc�rrn thc�se ex�r�ise5, ar�ri sF�c� was u�at��ale tn c�t� ��� ��nt� indir.�t�c3 t}�R�t s�7� ne�cJPd ta� s�¢ ��er s����t �n c�rder t� d� th�t, Sf�e e�er�i�t� ���ir�� ar��� ��#diti����a€ pr��vi�er�s ��� ��f��:i��li�t�� k�ut ir��fic�t�c� i���t �����ic� ��ave MRI's �.�f t�e cerv�cal ar�d Itar�b�r spine p��rfc�rr��d. N�v��ev�r, s��e d��s r�ot kr��w the resulfis of��ihc�s� MR1's. �PJhen ��k��ci abc�ut r���:�i��in� ��y wc��k restricti�r�s, h�u�eh�l� r��l��:f����sr�t ��rc4ers, c�€- �n� c�ther ft�rrr�f�l r�sirict��an�, s}�� indicat�d tc� me that s#�� was unem�lr�y�r� at tli� tirn� �,f�tFtt� at:�?c��tat A���d car�tir�u�stc? be urt�mpEe�ye€�. CURRENTSTATUS � c��rifi�d ���itf� Ms. T���cr tk��t E was ir�t�r��stec� ir� ���a�v s�ie is fe�{in�; in g�n�r�! �t tl��i� pe�int rel�tive to t�er injury recc�very� as opposed to the mc�rn�xnt �f th� a�cider�#. Ms, � Thao indicated to me that she continues to have subjective complaints of neck pain, iow back pain, right kr�ee pain, and upper back pain. 5he i�dicated that �he d�aes get aE�c��t � �wn t��> tl5r�� d�y� €�f r�(i�f fr�c�r� h�r chir��arac�*ic c�r��� b�a1 w�as ��n�.�E�l� t�� descritaQ �r��,�t��ir��;tE7at r��(It� ca�rses ��er��rs��t���s t�:,wc�rsee�. � MEDI�AL Nt�TflRY � M�. Ttla�� d�r�€�d � t�is��c��y c�f �ny chronic mecli�al �r�b(e��s, � 4i�� ir�cii��t�d ��f�p d�aes ���v� �� pr���v��7�t� h�st�-�ry t�f �� sr�c�C��r �r�l�icle �r��i�en� s���er� c�r ei�;ht years a�o, whicl� re�ulted i�t ne�k p�in, upper b�ck pain, and low b�ck pain. Sh� treat�d �it�� L�r. Lee f�r that rr�r�t�or vei�icEe a�cid�nt �rjc� ir�dicat�d t���t si�e ��as� nr� ar��c�€n� �yrn�atc�n�atalogy prior�tn the mast rec�nt accident. �ystems re��riew was negativ�. She der�i�c� hauing any apen pr�scriptions for any rrredicatic�ns ai the time r�f my t�r73'l9RQOA07 _...____,,.,_ _�._�.�_� ..�_._.�_.�_�_ _ _.� _..� �.��__.... c����j'j'��i�..,.:����:�__._._...._��.��___ _ RF' �;��r�?ng 1 ha�� Pa�� �i evals�a�t_ic�r� �af ��r. SC?GIAL, 1Nt�RK, AND FAMI�.Y H15TCJRY Ms, Th�c� presen�ed �s a r��ht-�and d�?rn�r�a�t ���`�-y���r-�1� �?ivc�rc.<��� f���rx�ale witl� six � ����Ic�rer�. Sh�der�iecf th� �ise c�f �Ic��7r�1 c�r tok��ccc�. She rlenied ar�y re�ular�exereise. �LCIVICAL EXAMINATIQN �tl�e �i�l��« ��ra5 c�t���erativ�, t�r�i€�nt€�€�, ��lerf�; �nc� r��E���ns�vt� t�t�r�at�gh ft�� ir�t�rvi��,�r �nr� �x�mir�:��tit�r�, Ther€� t��a� nc3 c�b�ic���� e��c�er�ce af a?7y �ct�t� r�+str�ss ar�c: �I���� sat� �tuit� co��fc�f-ta�l�;i tl�rc����h a���c?xirn<�tely 2C� rnir��.tE�s c�f cr�tE=r�,:ic�v�= uriti;o�tt cfis�,lay{r�� .-�ny progressive {�ai�7 b�l�auie�rs �r �7aving�o t�epc�siti�r� f��rself� i€� f�er� ef�air-. 5k7e ��a�r� �� st��t�c! ��c�i�ht �sf � f�et ar�d � wei�ht of 112 �ac��nd�, �t��ic�� c#�d app�ar tc� t�� �ccu rate. There w�re no surgical c�r injury scars noted upon exarrtination. Arti�.�� cer,�ic�a} r�an�� c�t rr��tic�n �a�c�d�ae��e� sul�jectiv� cc�q���ai��r�^�� c?�� r��:rck ���ir� ir3 ��II �I�n�s tesic�c� ar�c� w�s [c�ur��# tr� b� dc��reas��ci glr�t�G�l�y ir� al# ��4�r�es t�stec�. PasSive c�rvicKil ran��x �af r�7<?�i�r� v�rG�� p�t�ft>rrr�ec�, �n� 1 w��-> G�r�a�?le t�a �ut ��r t��r-c�ugh f��'I r�n�� c�f rn�tion as I felt resistance tc� passive ran�e o# mc�tic�n, and she again had suk�j�etive cor�pl�ir�ts c�f r�e{:k pa�n in a1) ran�es te�ted. €3t�th �ctiv� ar��� ����=�e t�tc�racie r�r�gp� of rnc�ti�r�, I�c�w���r�, u��r�� f����r��� tc� b� wi��ji�� nc�rmal lin-�its and pair�fre�. Active lun��ar r�nge af n��oti��n was a�air� fc�ur�c�1�� �ae ci�c��eased glc�baiiy wit�� sul��ectiv€� ��7r���alair��t�s of Icaw t��ck pair7 ir� al� planes tested. Pass�v� lurr�k�ar €�ar��e t�f �t�otiQn, hawever, was found to be within nc�rmaf limit� a�nd pain f���. T�stec� r��nges of ine�tion �p��ari�r3 to t�e dfffc�rc�nt, hc��ue�rer, frc�r�n t��r� ranges c�� r��cat�c�n w�3en s���� w�s ur�:�w�r� that I �vas ass�ssin� h�r. 1 Qr 1:�'t t RfttiQ6S2 __�.�._.__.__. �.�._.�m�. _ _.___.w. ��,�__ _.� �. �_ _. �__� .. ._ . __ .__�._�_., ....�i�'I:�����7�a�:�:�"3_�._._ .�_�.r_�� ��:; t;t�u,�� (���t� �'a�;e 5 �`e3��e��.1{)[i V4c35 s`.'�E?(j't.�1CTl$?Ci l3�slilti 1�I`,3� ?�'ll(l[[llc3� }:�!�"i�St(f', ci�b�� �F1� S�'�}{ii�£'i,� t£?1�t�C''Cft£?�N �£.3 �a��pati�n c�f t��� cer�ric�l, tk�aracic: a�?d (�kr��ar p�ras�inal museles; basically every �I�c�� 1 �c�uc�ic��f, IVi��c��� t�xtt�r� ���s c�r�sistcr�t witi� ���:_. �c�d� ���st����; �r�r! ri�k�t 1���;b� d���r�in�nc�P ��r�a was (�aund�te t�e v�rith��ut ��asrr�, Bc�Ch left �nd r=�t�t seated and supin� str�ig�t le� r��s� ��sts w�r� fc>��sYd tc� be neg�ti�t�, witl�out �ain �?r rad+eular sy�{�tor�t�. �?�tl� I�f� anc� ri�ht c�rvical cc�mpressior� ar�c3 distractic�r� tests were found tc� be negative, withe�ut pain c�r radicular symptc�ms. Sota- Fi��ll t.�st �raas f���ar�d tc� bc� r���ativ�, Ne�l-��valk w�� �e€f�smed adequat�ly, ��s was t�a�- walk. C��e� t�n��ar� �c��lex��s c�f tf�� ����e}r ���� Ic�v,ic�r cx�r�pr�sti�� wca�� �eisk ��r��i a�3r��r���tri�;�l. J�t�S�!�y t£'�Jtl��' W35 �C?U{lU fi'�� �if' ,}•'pli"'lE'°Ci€ G�€ 111`:s�±P'"�3���` Ur �1{lL`1 �.}iE' l#�7(J£'t c�P?� lc��"1�r extren�iti�s. [�11��scle str�n�;t6� tc�stin� of �he c���cal, �c���.�l��r, u�7p�r px�r���i�y, ��nc� '�v���r �xtrerr�i��,= �,��sc;�l���ur���.r�s �E�`> urith�a�t €ep�rtc�c� ��ait�. Pc�stur-e aria(ysis revealed level sl�oufder�s �nd 4�ipsr and ro scc��ioti� c�1��n�e ar sl��t ii7 ��v�i�;���k���ri,�� ��.�as r�c?}�t�. RECORR REVIEW i personally reviewed alf the ree�rds within the #�le, whicF� inc[uded ar� Application far F3�nefit� d�t�r� A��r�i3 �� 2i�1�. t)nd�s`"d�escrit�� yc���r ir�ju�y" M�. 1�hac� (is�ed, "[ injt�r�t� r�r�� ��e�dz r1�ck, �i�N�r l��c��; r����c���c(�, 1«�r ;��ck, �n� r��i�t kn��.� ��7�r�� �� ar� a��ider?i =��por� dated Febr��ry 25t 2�13, v�ahich b�sic�fly c���k�ribes t��� acc�der�t ccansist�r�t with Ms. Thao's histc�ry c�f the acciclent. !t tivas indicatetl in the ��rrat�v� r��n� �tf��t there wer� r��cor�p�ait�ts ��f i�juri�s �� a eesult of t#�is a��ident, ����r� is � re�:�src3�r� �t�tern�nt t3���t� A�ri6 3, 1�1i:3. 1��� tr�r�sc:ripi �af t�a� r�cc��s����3 stat�rj�ent ir�dik�t��d that ski� was alsc� invc�lved �r� a rnc�tc�r �r�ehicle accic�er�t car� fchrur-�ry �, �t�`i�, v�t�en �t�� ��aer�t i��a a c�itci� and tgad fiS,C}t��.�7� i�-� �ar��pe�ty darr��g<� tc� �er vehicle, but she indic�i�ed tihat she was not ir�jt�red as a result c�f�tt�is aceider�t. ���ere is an �utc� loss repart dated ��ril �1, 2�13. T�ere are recc�rds frc�rrt Cc�n�munity Nealth Chirgpractic C�inic fec�m t:h� d�t�s c�f�Febr��ry +a�+^tq+Rnnuao _.__� . ..�_ _._ ___.e� _....�_ __ _... __�._ ._ __._�__�������T��_�.�:,,�4:.�.� _.�__�_ ._�_��.���____�______ _ RE: ��F��?r��;��at? P��,c� �s z5, 2C��3 t4�r��u�h �{�ra[ �, 201_3. S17e ��c-eiv�ci ap�r�axirnat�fy 35 chiropraet�c treatr�rents ;1�? �?'ti)t1��1t�':i° �E.'"ic?. ��4-`: ��iP IiI���E$ �:?f"rTIS t1 ttil�5 i(lC�it";3�k'!� 1�;t°3f �1PC" (°f;l�'� i:{3t"Ct��ril(1tS �,ree� �e��d�ct��. r�eck �ajra, �p�er baci� pai�, rniclback �air�, !ca�� #��ck �air�, arc� ri�;ht knee t�r�ir}. She ��t�� ��=.��r��sed ��it}� ��3�.�, �3�r.�, 84t."., �5�1'.L, �:,�`�3.C��, 53�.21, �:���.��, and 739.�, It a�p��r� t���� t�er �r��trxt��t c��si�t��# caf �}�irc��r�aciit adj�stn�er�ts to t�7� c-�rvi��! ��!c# t?�c�r���i��pirlc=; so�ft tisstj� r�r�ssage, �(�ctrie�! r�t�scle stim��l�ti�r?, ar�c� � �r�ics��t i�vt �:�ek. X-r�ys wer�e �tata�n�d oi the c�rv��a1, �tt�:�r�c�c: ar�� I�n�bar sptne at Voyage�ar Ir��a�i��� PLLC ir� 5t_ Paul. Also providecf fc�r my revi���r are r�car�ls fram Vc�ya�eur Irn�ging clated Marc� �2� ZC713. It ap��ars x-r�y� ��v�E-e �k�tain�c� of ihe cer�,ric�(, ihc�raci�, an�f !u€��k�ar s�ir��, Th� �maressic�r�s ��� `�ca�t ��urrx��, C�.�_, i;�aclud�� ��asttr���mati� cer��,ri<:�( kv�l��>si�, �:����t�r�u����t+c tt���r�c��� c���t�����c�lic��is, �:c�st2r��a�����ic r��t3�L���? c�rvic�( r�r��ck �sf =-r�c�ti�n, and ���ttrauma[ic li�an�c�ntc�us insult in�rolvin�; the C3-4 vertek�r�l n-�atii�r� ur�it. �ic��������a-, � dFd ��-�� s����� t���� ��tu�i x-�r��y filrr�s r�ys��f, ar�� (�r, E�Jlurr�y did P��ot e�.�rr�r�er�t as �o u:��t}�e� o= ni�t t��er� urera ���� G�cc:c�rr���<�r�yin� c�:�g?e€�erative findira�� �3t tlie�� part�cti�(ar lev�ls. �Ti��ee was degen�rative dis� disease nated at tl�� L2 ��3 �nci l3-L� � ��ve��, �r�c� �linica� c��rr�latic�n for rn�.�sc���c�ii���rr�f�r�t��u� inj��e�:n�as recc��m�r�r����l. Adrlitiran��1 rf�cc�rr�s w�re �arr�vi��d tc� me, which inclta�a�� r€�r.r�rc�s frorr� Nea�thE�st Ric� Street Clinic dated March 13, 2(?�8 ihrough April 9, 2013. Most of these visits were #ar general rnedica� i�sues unrelated to Ms. Th�cs's r�ator vehicie ac�ident. Fic�wever, on tk�� � date c�fi Qctob�r 28, 20C�r�, sh� pre�ented with h�adach�s and 6ack pain an� w�s �;i�er� tk?e �iia�°�e�=�s c�� ch�c�nic pair sys�c�rom��. �ra 1ur�� 9, Z�lIC3, she� ��nc� �g�E�t preser��ec' wit� sut�j�etiv� ��n�pl<�ints c�f Ea�c;k pait� and 1��ada�hes. �n �ctc���r �1> ZGIu, �h� prese��tec� ti�ritf� hea�iache, s�r� thrc?at, �:�au��i�g; dnd ���vir�� back p<�ir� radi�tin� u�a tc�the b�ck c�f ihe neck. 5PECIFIC INTERROGATIVES �. ls f/�e �rc��t#�ed trecrtrr?er�r relafied r� t�re Ir��r�r���s r��� c�a�:�`iti��?s c�ic��r�as�� arr�l C�<7�f1t7t('J?1�'Cf lf? f�1f? Ct't�fCG.t fE:'CC?F�t�S.'' The recc�rds fr�am C.omrnunity He�lth Chirapractic C�lir�ic list 1�L7-9 c�d�� 784.C� (l�e�cfact��}, 84?.� (cervic�i sprain,�strt}inj, 84�7,1 {tFtoracic sprainfstrain), 847.2 {Iumbar sp�ain/sts���nj, �3�f.�F3 {cervieal su6lux�f:i�r�j, �33�.21 {tharaeic subluxatian}j �39,20 {lurn�ar subluxatior�}, ar�d 739.6 (segrnental somat.i� dysfunctic�n of t��� rig��t ,�c�:�t�eo�000 _____ _�v __. _____.._ __.�_ __ �_� __ _ _____ �'�'T.�a��� �������R������3���-��—�"__�____._._l,�_�___ �__ _ __�..___�_ f�E: C;9�c�n�; �4�.�c� ���;c: 7 Kne�}. �it�r r���vsE=t,��ir�� tl�e �rovic�ed r�cc�rc�s ar�c� at�taining the 6iistcsry �f tf�e acci�er�t �rc7°r: ��t�. I{��:-�v; ir� rny ���irii�r�, t�°i4 u��s �ra accic��jr�t csi rijilci 5ti��t�x;i.Y, wE�ic`� �c�ulc� Ee �p��r��r�r�tel� tr-��tet� v�ith �:hirc��r�c�ti�. car€� �nd c�rt�inlv ��ol�Ic1 (e�d tc� the d��gr�€��es thut I li�tc��. I#av�+ee��*�, �r� r��y �a�ini��r�, ��s�ci e�r� t��� sev�ril�r c��� ±fi�is �t�cit�er°�� a;�d bas�d �r� t��e f�acE Tt��t sE��� di�� r�����t ��rE=saE��i �c� a� ��r���rg�ncy �3���xarrtrn�r�� nr� ur�ger�t c�re f��:ility f��>r asse=s�m��t, t�e ��Eice r��c��€��; Brr��ir.r�t:ing t��er� �k.�as n�� inj€��� as � r�esult c�f th�s �ccic�ent, and fr��� tF�� m�tSif��1 r�cor�ds w}�ich show t���r�� is a lc�r��standin� I�istory af n€�ck pain, h�aciacl���s, �r�� !����r �-�aek �airt, t:l��ir���7ractic t:�r�� S��t:�E�P�� ���aV� k:e�r� lir��it�c� tv ��i�f��t v�r��k� ���Ic�wr����t��� accic�ent dat�, 2. �r�s�� ��r� vc��r��xarr�i�a�i�ar� c�f�he �a��e�,�rt: Y��r r�€�vs����f rhe s��t����tt��re�c�r�ds, y��u� t::rFtiICC7ti �.X�7f"<`f'?"?C�'e CICt„`7{ CXI?}t �7�3}.)3r'�:�'�?Iz' /£.'Sf't?lC:?7, L�JC74 i�tE' �7C1�IE'I � 5 f�L?�"#t�iflt?t7 F`s�#.'Sf't`:� �)4f t�?� t�=r`.srs�e�r�a:?.'�, 1�12.3�rc t irf�ra!�' E?���c� ��r� <a r�vi�w� �>f fl�� �:�rcati-i����� te��:rc�s ,�s7ci a� I�is�i:>ry ��f*t;e a�cit���t frort� ��, �i�t-�c?� in r�ny c��ainion, tt�is rnay have be�n an accident c�f rY�ilc3 severity, at n�c�st� anci ihere n��ay I�ave b���� c�rvse.:�1, !��v>�c ic, ��r��f ',��s��k��r ���Er��,t�;�ir�� ��f r���I�i s�verii��. �. �,��E'r5�' t?(?�E' ��'E' S�J;'CF�1C :�?E?'Jt'?�£'?7i t?"!c?(:�r��rrjE'� C?fc`�L%�t�'�"t�, �?C}��' K1E#(tlf.lrV CJt`tL� f7CI�J£JY7?€ti•d�' andJor s�+pplementary. . Aft�r r�view3ng ��7� provi��d r��c�rc�s frr�m �c�rnrn�rnity �E�a1th �;hir�pr�cti� �(inic, it t:��a��t�rs t:h��t s!�€� �<�s rc�c���•i��� �r�t�rf��re�ti�1 tl-,�ra�-yP, c��=r�o�r��ctic �cfj��st;?�enf� t� tf�e c�rvica�, ���c�sacic, �t��c� l�r��b�r regicar��; �nd rnass��e. 5��� aEsU i��dieal��ci �c� r�r�� �ha� sl�� � was receiving acu�unct��re; houv�vee; th� recc�rds do nc�t r�flect that. She was alsc� re��ivir�� mc�i=t (�c�t packs. � F3as��l ��n r,-�y �pinic�n# as I ��<�d rr�enti�ned F�c�f��re, th�t t(��i�; was an �ecic�e�nt af mir�imai sev�rit�y, �.�r�ti c:��ir��pr��rt:t: r;�r�� f��rf��ir�fy w���l�� �ave fi���r� �uar�rat�ted, ncs r?�c�re #i����r; tv�rc� passive n��e�aiities� �er tre�tr�ne�t, �,�hich u��s refle�ed in ti�i� rec�r�ds, '� anc� chir-�practic acf�usir��ents to t��e cervical, t��oracic, anc� lun�bar regic�r� wruld have ' be��� n�cessary. �ctive rekiabilitakion ta the ��rvical, tf�aracic, anc� lumbar spine and ��I ri��a�� #���e� w�i.a�� als�; k�e appr��ri�t�, M�ssa�� tl���ra�Y, h�a��r��vEZrp slaUUld ��ave been � iirr��t��d tc� tiar�e c�ne��h�ur rr�ass�g�sessions. 4. Rr� *�;e t�vpe, inter�s�t�r, fr�eguencu, or�d durr�trran c�f �he prc�E�ided s��t���an�r�n� --_ .._.. ...� _._._ __.__ __._.__� -�����C��%�����:��3._......____�� _.��� .�..—_ ,......�.� _—____ _ F��; ������ ����r� F�age �i tre�tr:��ntt'�re�c�f��ctsjs�rvrc�,s c���s�sfier�i wltt� ac�:epted ��ec�ica! sta���l�r�ds c��c� L,'�;;.1t€:t�;'r'':€�7�E'�L;t t'�?v' ��'L'f'It�w C>;#��fE.'C�t?C C.'!?PE'tt��'C�IC°,+t}ttC'�t)? {:i)%�!it�tiJr1`�� F3as�t� �n a r�vic��� c�f t�(ae �rc���i�ed �ec:�rds �r��d � f�ist�ry �f��hF� ac�ic;er�t frc�r��� M;. T�-��e�, ti��is cn,�as dr� accfdent ��f mil� s��°er�i�ty, which� wo��'ci b� app�����r-ia��{}� �re�teci vvit� chi��pr�cti�� ��r� �t a treat�rre�t fr����ncy c�f t��re� tir�a�� a u��€�ek th� fir�st three w��ks; �w� tirn�s � �=eek �h�Y secc�nc� tF�re�x �reeks; <.3�e� «r���Y 2ir��� � �,v��k ;§�e f��ll�wing turc> w�eks. Trea�;�-�ent �hc�ul�f �r���e �ae��i lirr�ited Tc� ?wc� p��ssive rr�cacfaliti�s �e� treatrr�ent and na mc�re th��� three one-hour massag� sessicans, witl� ehirapractie acljustments ta the ceruica�� thc�racic, ant� (����ar re�ic�r�s ar�� an active r�e��ak�ilitatic�n prc�gram for th� cervieal, tl�oracic, ar�d I�mbar s��n� �nd ri�ht k���, Afte� re�i�wir�g �h� prc�vi��d � rt�cc�r�is� in �r�� r��i�ic�r�, ttl� tr����trr�e��t fs��e�u�r�c�� �anc� d�ar��tie�r ��as t�eet� �x��ssi�c�. L�. t/Vt}cr;trr� vc�,�pg �;?rx�}��r�s�s r}f;fa��a�t��rr�'s irr�r�rY, c�'is�a4�, r�t rlisc�rc�Pr? fv'�}.° ph���<<�; �v�;��E,ti;�n s:.3( M�. T►i��c� dit� n�t yie;c;� arky �;�sitsv� nt�{�ic���,�;f: r�r c�°t��c���cl€c tests; t�-rc�r��fr�r��, in r?��y Q�ir�idr�, s��� 6�as retur�r��d t� I�i�r pr�-acci�leni �t�tus and 1 arr� I1fl"c7�?��"��,� c3`��;I�i[1 �3 ',j�t3�?(1C)S':S �C:i �IE.'( c3� �E1?5 �11a1�?. 1'. ��jlQi lti;��'E'�.?C7�;E"t"�'�$6.1"fC7t�/7tJSl�`�� EXC£'IIP.[lt. �i', i`S fr�1£� �`1�J�7F+j't� !X�J�1� �e`,;� f"E'if.1r>' ,*� �7°I"' /;��;`i CJf.�7V?�;y 7'#"?iiE'��,, �tiL'tcdCa;`7"fei ??�CulpJdl�fCd%if:li�c`�tJtiF.?c'� Sased an an obj�ct+vely �c�rmal examination, she is witE�c�ut limitation or restrictic�n. �. Nas t1���r�ti�r?F's c�rrea`i�io,� recr�hed p�ernjr�ry 4tof���? E3�sec� �a� a;� c��}�etiv�iy ne�rrr���i exz�r�tir��fir�r�, it i���s. � .i(1. `vt/t�c�s tirrre frcrr��e t.� exp���:t�� far tl�e pc�zi�r�t's c�c�racliti�r� �� .st�crk�ifirc�, r�e#ati�3e �� lnjuri�s sfastained i� �he February 25, 2033 accident? ?�his is �±�t applicabl� as h�r c�r7dit=on has alreac�y stabili�ed, 11. !s the r���fr�rat tr�c�t�n�r�t ,�lar� ap�rc�prrnte for anc� crr?.5r.str�7t ��lti} tt�e severity c�f the *Urt'i9tftflttlfli .�_�__..__.____��_�_�.�... -_ ___ __:.�_�,������___��_���_._._s _____ �__�.� __��w�. .___m_ _._._ .._.__ .__._ _....____ � R�: ���f�r�� ?���c! ����9 ir���r�e-� vr�o;��it�s��rf�:' �["t7�'"� ��1P ('�i'<(C}�?C�-lC�(f, f�'Ct)�{�5. li ��(?k'i3f5 t�13# S�'lE' I5 �C? C��l�It1UE? �fl t''E?z�l� :3� :3 �rE'C�ULtIC� C��i�l�`�'� �ItT1£'S � Vv�i'�. �11 f71� L?C?I[�It�(�l� ��11.`: li i�'J4C('`i4IL'`�. I�`1 �7t7Y�1 t�E@1c"l�IC;'>rt <lf;i� �(#�(�1lf,rlC� c�5 �h� ���� returne� t� ��r� ��r���accid�r�t �t�tus ar�� r��o f��r����r� treatment i� �r:�r�rar�ted. 2�'. f`.�;� tl�� r�t rl�ci� r�v��t-,r�c� rr�pe�r tt� cc���e�rn th� rer��.���°�cI i,erris s}�,�c,if�e�rr� ,Mir�r��sc�[n str��aat�� ���.1C�i r�='�1��R�c��re�K�e��r�?c�? �ft�r r�vi���tir��; tt�� pravid�d ch"sra�r�ctic r�cords, ther� �nr�r�� Subjective, t�bjec9iv�, ��ess��ent, and Prc�ce�ure sectinr�s listed in t��e r��c�r��s, whie�� are �p�rc�priate, ar��i th�y do a�pear t� egntain the requiree� iterr�s as spec�fi�c� in Minnesota 5iatute 3.48.107 t;t����9 F�c�ctjfit� ke�e��i��. I �a�li��,j�� fit��s <al�tY��i�� �t�5v�tar yr�kjr- c}����t+e�ns rel�tiL�� #c� �Jls. (:�7on� 1I��c�. �>I�asc� f�yExl fr�c� �:tt :�jtl�u3C� �?EE_' ��1��1�#d� �.�il� .��C�1t(t�tl<�� EE"1�t;s(t7?�te(3tl �3E'.C'�?P�T'f.' ��L''c71�i��)�E? �f)t (t=�V�E'Lh� £)( `sk`Od}�{� �I(7'3 �i<�L�E' l'':� �€lC�i�tE'� ��.1°SkIC?C'S li1 ��td= Ci`ic3�tt'�. �it10E'T�'Ijt, � �@S5E'jE'CI"11A5, �.�. Chirc�practQr J�T,stJ�n�s �c,.�az�+�tn�nrtn i . � Aor 11 2013 4:07PM PCR Services 6�0-947-0345 page 1 23-17K7-319 Claim Office: Nebraska Operations Center This is Clairn Representative Irene Nelson with State Farm Insurance�. Today is April 3`�, 2013, approximatety 1:00 p.m. And I'm in the office of Dave Cody speaking with Chong Thao. Is that how you pronounce it? Okay,..regarding an incident February 25, 2013. Uh, reference claim number 23-17K7-319. (All answers given by interpreter unless otherwise noted) Q. Ms, Thao, do I have your perrnission to record our conversation? A. {Ms. Thao) Yes. Q. Can you state your name and spell it for me? A. (Ms. Thao) Chong Thao, C-H-O-N-G T-H-A-O. Q. Thank you. And your birth date? A. June 15, 1960. Q. And what is your address? A. 129 (inaudible) Q. Does she have a driver's license or ID wifh her today7 (Inaudible) A. And the street is Arch. Q. Oh, Arch, okay. And iYs apartment B? A. Yeah. Q. Is it out of St. Paul? A. {Inaudible) A. {Ms. Thao) (Inaudible) St Paul. A. Yes. Q. Okay. Then I'm fine with that. She doesn't(inaudible) and who lives with you right now? A. Her three kids wilh her. Q. And what are their names and ages? A. Okay(inaudible) she doesn't know how to spell their name. Q. All right. A. (Talking simultaneously— inaudible) Q. Male or female? A. A female. Q. Okay. A. Second one is {inaudible) 18 and a female(inaudible} 13 years old (inaudible) and a female. Statement of: Chong Thao Claim#: 23-17K7-319 Page#: 1 10r1'7�111�1�AA7 Apr 11 ?01? 4:07PM PCR Services 6'Q-947-0345 page 2 Q. Anyone else live in the house? A. No, that's all. Q. And haw many vehicles uh, are in your household? A. Three cars. Q. Are they ali insured with State Farm Insurance? A. Yes. Q. Okay. And you were in someone else's car during this accident? A. Yes. Q. And what type of car was it? I'm not able to tell from the police report. It indicates it's a Toyota but I don't know what style af vehicle it was. A. Camry. Q. Oh, Camry. Was it a SUV type of car or a sedan? A. (Interpreter) IYs just a smaller car she said. Q. Okay. And where were you seated in the vehicle? A. The passenger's side. Q. In the front seat? A. (Interpreter) Yeah, front. Q. And who else was in the car? A. {Interpreter} I guess the driver is Bella and then her daughter as well (inaudible) Q. And can you tell me about uh, the collision and the impact of the vehiGe, specifically what part of the vehicle was hit? A. Um, head (inaudible) damage. Q. Uh, was that the front end? A. Front end damage. Q. The airbags go off? A. No airbag. Q. Did you have your seatbelt on? A. Yes. Q. The seatbelt hold you back in your seat? A. Yes. Q. All right. And what happened to your body then at the point of im...impact? A. (Interpreter} Okay. So she weni forward and back. And then she also hit her knee on the compartmenE. Q. Okay. Was it your left or your right knee? A. Right. Statement of: Chong Thao Claim#: 23-17K7-319 Page#: 2 1On�O'I11111'7AA9 Apr 11 2013 4:08PM PCR Services 674-947-0345 page 3 Q. Right. Well, obviously, the police came to the scene. Uh, did the police ask if you were injured? A. The police did. Q. Uh, and what were your complaints of injuries at the scene? A. I had neck pain and back pain. Q. Okay. Did you tell the officer that you did? A. (Talking simultaneously- inaudible) Q. Did you go to the emergency room or urgent care after the accident? A. Okay. Um, no, I didn't go to the emergency room (inaudible) I went to Dr. Tooley. Q. Uh, and is Dr, Tooley the only doctor you ever see for any condition? A. I only see him for a car accident, so... Q. Uh, and when you uh, have any other medical condition and iYs not a car accident related uh, where do you go for medical treatment? A. (Interpreter} Okay. A. Uh-huh, A. {Interpreter} Yes, she has a family doctor. Q. And what dinic is that? A. Dr. (inaudible)on Rice Street. A. {Inaudible) Q. Okay. And what do you treat for uh, at that clinic on Rice Street? What medical conditions do you have? A. Just for like any like head pain or like stomach pain or things like that. Q. Are you currently taking any medications? A. No. Q. Okay. And I understand you were in some other uh, car accidents. Uh, when was the last time you had any medical treatment for injuries in those accidents? A. (Interpreter} Okay (inaudible) Dr. (inaudible) Tooley was the last person who she saw for the (inaudible} Q. When was the last time ihat she saw (talking simultaneously—inaudible) A. IYs been a long time. I don't remember. Q. I noticed that you uh, had an accident February 5'h, 2013 where you ran into a dltch and had almost $8,000.00 in property damage to your vehicle. A. {Interpreter) Okay. She said that, yeah, thaYs right. Uh, that was about$6,777.00. Q. All right. And did you seek any medical care after that accident? A. No. Q. Were you injured in that accident? A. No. Statement of: Chong Thao Claim #: 23-17K7-319 Page#: 3 1 O�'I'�'I�1111�A A 0 Apr 11 2013 4:08PM PCR Services 6'O•947-0345 page 4 Q. Tell me about the treatment to your right knee. A. (Interpreter) Uh, she said for her right knee Dr. uh, Tooley massaged and check her legs. Q. All right. Did he do any x-rays on your knee? A. {Interpreter} Um, April 5"' she will go and get uh, x-rays. Q. And where will she go for the x-rays? A. Minneapolis. Q. Is that at uh, Neurology Specialists? A. {Interpreter} She doesn't know (inaudible} Q. All right. Um, but is the doctor doing adjustments um, to your knee? A. Yes, he does. Q. And what did he iell you he thinks is wrong with your right knee? A. No, he didn't say. Q. So you have no understanding of what is wrong with your right knee and yet you're going to uh, Minneapolis to a doctor for it? A. {Interpreter} Okay. Uh, she...okay, so she said that she's going for the x-ray for (inaudible)her whole body. Or...and like...I guess her whole body meaning her neck and her back pain. Q. Okay. But not the knee? A. {Interpreter} Okay. She's getting a MRI on the 5�". Q. All right. A. (Interpreter} Okay. She said she had some x-ray done uh, already and that was by University (inaudible) Q. {Inaudible) Ima...lmaging (inaudible} x-rays of the cervical thoracic and lumbar. A. Oh, yes. Q. Okay. Are you having severe pain in...in your low back? A. Yes. Q. Okay. Is it preventing you from working? A. (Inaudible) I don't do anything heavy (inaudible} Q. And do you work outside the home? A. I'm not working. Q. All right. And uh, what...what type of duties uh, or um, housework are you unable to do at this time `cause oF your pain? A. Okay. So I am able to wash the dishes and (inaudible) yeah, I'm able to wash the dishes. Q. {Inaudible)thank you. Will your client be making a replacement services claim? A. (Attomey} I don't believe so, no. Statement of: Chong Thao Claim#: 23-17K7-319 Page#: 4 1 Or'19�11111�AFfl Apr 11 2.013 4:08PM PCR Services 674-947-0345 page 5 � Q. No. Are you aware that um, if you are disabled from doing um, housework at your...at your home that you can hire someone and be reimbursed? A. (Interpreter) She say she's not gonna do it `cause she has her kids at home (inaudible) Q. Okay. How many tirnes a week are you going to see Dr. Lee? A. Three times (inaudible) Q. Have you noted any improvement in your condition since you started going? A. (Inaudible) Q. Specifically which part of your um, back is doing better? A. My low back. Q. Your low back has improved? A. Yes {inaudible) Q. Qkay. Has your neck pain improved? A. My neck is doing better. Q. The doctor is indicating that um, you're there for a severe headache as well. You didn't tell me about the headache. Are you having headaches? A. I do have headaches too. Q. Uh, are you taking any medication for the headaches? A. I take AdviL Q. How many times a day? A. Once a day. Q. And how many pills and whaYs the milligrams (inaudible) A. And I take one. Q. Is this Advil you had to get like prescription or is it over-the counte�? A. The doctor give it to me. Q. Has the doctor given you any medical equipment? A. No. Q. Did the doctor review the x-ray films with you? A. Ne did tell me but I don't remember what it was about. Q. Okay. And, again, why do you need a MRI? Did he explain to you why you need the MRI? A. Uh, my rnuscles, and things like that, and tissues uh, to see how (inaudible) Q. Okay. A. {Inaudible) Statement of: Chong Thao Claim#: 23-17K7-319 Page#: 5 10r�9�/11A�AR1 Apr 11 2013 4:08PM PCR Services 6'0-947-0345 page 6 Q. Okay. (Inaudible) that she's improving uh, in her pain levels (inaudible) referring her for MRI (inaudible) to verify that those um...that radiology is neoessary and appropriate for the injuries sustained in this accident. A. {Interpreter} She's still in pain but she's not...she's having pain in the neck and her shoulder so she wants to go and see how (talking simultaneously- inaudible) Q. Um, have you thought about going back to your uh, primary doctor on Rice Street? A. No, I haven't. Q. And uh, besides the adjustments at the chiropractor, what other type of treatment is he providing for you? A. Okay. He does the um, electrical uh, stims with the hot packs, and um, he massages me, and then he also do the acupuncture. And the acupuncture uh...not the acupuncture but the chiropractic adjustment. Q. What was the damage to the police vehicle that they hit? A. On the side of the police car. Q. Okay. Did...did the car uh, intrude into that vehicle or did it just hit the door? A. Um, on the passenger door(inaudible) Q. Okay. Um, did either vehicle have to be towed away from the scene? A. (Inaudible) Q. Was there another vehicle involved as well? Were there three orjust the two? A. Just two. Q. Okay. I don't have any ather questions (inaudible) do you have any questions for me? A. No, I don't. Q. Okay. We will be holding all of your medical bills un...until uh, we can send you for a second opinion examination with another doctor(inaudible) what's reasonable and necessary and related to the injuries in this accident. A. Okay. Q. Okay. And I would like to know your availability to attempt another examination. Um, would it be better during the moming or the aftemoon? A. Is there anything around four o'clock(inaudible} Q. I certainly could make it for four o'clock(inaudible) and I'll make it close to your home. A. Okay. Q. Okay. Um (inaudible) do you have any questions for me? A. No, I don't. Q. I'm gonna turn off the recorder now. Thank you. LK/23-17K7-319—Thao, Chong Statement of: Chong Thao Claim#: 23-17K7-319 Page#: 6 1 On'19'1111117A F7 StafeFarm � Payment Log � �� 06-28-2013 Mail to: CODY LAW GROUP CHARTERED 359 COMMERCE CT SAINT PAUL, MN 55127-8506 }���r� ��v���� Ciaim No: 23-17K7-319 Injured Party: CHONG THAO Named Insured: CHONG THAO Address: 129 ARCH ST E APT B Date of Accident: 02-25-2013 SAINT PAUL, MN 55130-4363 Claim Handler: Kate Laven Phone: 888-577-4668 Payment Subtotals `eqorv Amount U50-Personal Injury Protection $5,910.46 Personal Injury Protection-Medical $5,910.46 Summary -Minnesota Medical Expense Limit: $20,000.00 Loss of Income or Services Limit: $20,000.00 Total Medical Expense Paid to Date: $5,910.46 Loss of Income or Services Paid to Date: RBZOOOFJ State Farm Insurance Companies Page 1 j o 0 0 � � o � � � o N N E m °m rn � � � � � � M � Q � � � � �� � � � � a N � � U U U U U U U U U U N N N N N N N N N N � � � � � � � � � � O O O O O O O O O O ' N N N N N d N N N N O O O O O O O O O O , a a a a a a a a` a` a` > > > > > > > > > > C C C C C C C C�C C � N f0 f0 N (0 l0 N l0 N N � O C C C C C C C C C C . 1�/`) N N N N N ��p N N 1�!`1 N N N N N N N N N N N v a a a a a � a a a a o � � � � � � � � � �4,,,1 N N O N � N O O � O O O O O O O O O O , pM (") M (7 f`7 M ('� ('1 M ch ��. LL oD � t+� iA �n N N f� a0 f� � d N N O O N � N N O � � � O O O O O O O O O O C f6 a E 0 U O � =ml � � � � M � � U J O m.? � C '-' N � N CV O N � � N fL l6 N JO �� O O O O O � O � �V �^p (O y � v�i �°n °oo °m ° OO CC � O CD EI M V�i l'�7 N � O (`') ` Q � �� � �M !A di �.L � � fC � Z Z Z Z J J J J U U U U U U U U > > U � � � � � w � w V ? O O O O W 3z� � z� ? � � J � � � N : g O � O w Q U a U U U a � Q � Qa � F=- � M�=- HI-=- ln O Q, O 2 C� p J ? J J J }, ��'� � = ay = you� Qu� ugu� a 0 o cn � xgxxx � = W = W � w � � � � � � � � � � zz � zzz c7 � c7 � wz � � � � � x , a�I � � � � � J O ¢ O Q � qa � � � � � JQ : i�lxxxx ¢ OOOOOOuJ - a UUUUC� ZU > UUU = O N N r u''1 a'O N r O N � C Z' � � N � N N N N N N . � > � O a�o W V M M M M M th � E p I r cn ca �o c� co � � co co >. U E N {� ln ln N ln N ln ll� ln . a � Z o 0 0 0 0 0 0 0 0 0 —i LL O O r� m ch r� r� � r� r� co r� p d N � ��'- O M M M (��] M f`�] m �I O O O O O O O O O O , � r ♦T ♦ �� � C L � James P. Cod Y David K. Cody t The Cody Law Group, Chartered jcody@codylawgroup.com dcody@codylawgroup,com 359 Commerce Court Robert D.Cody Vadnais Heighis, MN 55127 rcody@codylawgroup.com Ph; 651.294,0994 • Fax: 651.292.4955 www.codylawgroup.com June 10, 2013 Cindy Butler Stich, Angell, Kreidler, Dodge & Unke, P.A. The Crossings, Suite 120 250 Second Avenue South Minneapolis, MN 55401 Re: Chong Thao AAA Case Number: 56 600 02252 13 Date of Injury: 02/25/13 Our File Number: 19985 Your File Number: 27427/STFM Dear Cindy: Thank you for your recent Discovery regarding Chong Thao. With the regard to the medical places my client has treated at for the past seven (7) years, they are as follows: 1. Health and Wellness Chiropractic Clinic Dr, Mai True Lee 1008 Arcade Street St. Paul, MN 55106; 2. Health/East Rice Street Clinic 980 Rice Street, St. Paul, MN 55117; 3. Vinson Associates 1394 Jackson Street St. Paul, MN 55117; 4. Voyageur Imaging, PLLC 393 North Dunlap Street Suite LL40 St. Paul, MN 55104; t CIVIL TRIAL SPECIALIST CERTIFIED BY THE NATIONAL BOARD OF TR1AL ADVOCACY AND THE MINNESOTA ST.AI'E B.AR,4SSOClATION t MEMBER UF THE ACADEMI'OF CERTIFIED TRU1L LAWYERS OF MWNESOTA Cindy Butler Stich, Angell, Kreidler, Dodge& Unke, P.A. June 10, 2013 Page 2 5. Noran Neurological Clinic 2828 Chicago Avenue South Suite 200 Minneapolis, MN 55407; 6. Community Health Chiropractic Dr, Tou Lee 393 Maryland Avenue East St. Paul, MN 55130. Thank you. Very truly yours, David K. Cody DKC/ecr Enclosures i I � I 1U1 � N: U /AM U. Scott Uunham, �A b51. 341. 15U6 No, 2197 P, 3 � , AMERICAN ARBITRATION ASSOCTA.TXON MINN�SOTr�NO-�,A,LJ�,T TRiBUNAL Tn the M�ttter of the Arbitration between �� Re: 56 6UU U2252 13 Chong Tha.o � �nd Siate Farm Insurance Compa.nies Cla.im File Number: 23-17K7-319 Accident Date� T'ebruary 25, 2013 Pol#:NA 1'0l Hld: Chong Thao AWARD OF ARBITRATOlt 1, '1'HE UNDERSIC;NED ARBITRAlUX, desi,��nated in accurdunce wi[h MSA GSD.525, huving f�een duly swor�a ar�rL havi«�h�nrd rhe��r-oo�s'c�na'alle�ntinns nf the parties,AN�AXD as follows: 11W�1RD `l'O CLAIMAN'T Medical� Community Health Ghiropractic Clinic $6,670.80 Mileage: $1 U2,69 Interes�: To be Calculated by Paztics Expenses & Costs: lnterpreter $130_00 � ` '1 OTAY,A'V'VATi�: $6,9U3.49 The balance of�he claim is tiereby denied. A�bitrator's compcnsation in che amount of$300.00 shall.be borne liy Respondent and paid as directecl by the American Arbitration Association_ Administrative fees of the American Arbitration Association shall be burne by Responde�t_ T'lars uwarrl is in full seltlernertt of all claims sub �d lo tliis r ixr . iun. , DATE- � b i�'�" � �� SIrNED: D. Scott Dunham,Arbitrator , � � = �c�mn���nit� H�aalth , ; � `. � . . L� ° ,(:1 t, ,�,t.'f' ����ropract�� �'1�ni�. P�.:�. _ � �������,�: �;����E��: �����t� Date: 5-?C1-1 5 DC7B: t�-1>-b8 DUI: ?-25-I 3 Subiecti�re: ?�1s. Thao repc}rts of�ze�dache, neck �ain, u�per bacl:p�in, mid baGk pain, I�u•er back p.�in, and right knee pain tc�day, �he states that she is ��a�iz�� diFfi�ultv sie��in� sorr�e i�i�l�is he�au:�e c?�11e�- �ain. 5he felt relie:�eti ti���zY� the last treatt��ez�t, t1b»etive: Cunsiderabi� hS�pertonicity is noted in the certi�ical, tharacic, and iurnbar musculatures. ��:����e�n�al�'4c�tt�atic ���stu�iction ri�i�t i.r�cc; iifters�:���zerlt�l c���sfuncti��r����d a�ierr�nt� tz�c�ticjr� at C'�'. C:E�, T?. T9, "I�I l, L?, L�, anc� L�, "1`er�dern�ss tc� palp�tit�n in the cer�=iea�, thc�ra�iL, ��n�i It�m�ar r��ic.�ns. Assessment: f'rc���3r��zs i� �oc�ci. P[an: �I'r��ir��t��i tc>�i<iti� c��nsi:�t�d c�f tlle f�7ll��u=i�1�: . Chirc�practic n�anipulati�}n �entl�-� t� the indicated �,=ertebral st�gn�ei7t� . Electrical�n�i�cl� stirnulatic>n u�as a��lied tc� the h��pertonic�t��� mu:�ci�� i�� the ba�:i: . Mvist hot pack v�P�� a��lied to #lse h�pertc�nicity tl�uscles in the ����ck . Sa1-' ti;s�le rnas`a�r ��as .�����l:e� it� tl�e ��i`feete�? 4c>zt ���su�w "I��>u Lee, I).C:�. � � � �.l�;'�:���1 I �omm��r���� t ��1It'0�3�"���14�' � �I����'. � �. �� �`��}r� L�°�� * ` ' Pafiient: C'�lc�t�� �1�"h���� �)ate: S-I�_;� D(�I3: C�-15-fi� D(�I: 2-25-3� Subjeetii�e: P<�tient r�turns tt�day f�r ihc� chiro}�ractic treatmerl� i�r�h� injuries she sustained resulting frc�m a�-''2�'13 car accident. She states that sht e�:periences �ain in h�r neck, right knee, upper hack tc� mic� �ack, ant� (c�wer 1�ack tc�day. :V1c�re pain in the neck to upper back t�dav. t�b',lect,ivet T��ci�z��s� t��? �al�ati�r� i�1 tfz� �c:i°�ic;ai, tl���r°�Cic, a���3 l�z°��ar ����;���n�. Segrnent�llsornaiic dvsf�nctic�n ri�ht l�riee; interse�rnenta( c�����un�ti�r� and��e�a�it mc�tic�n. at C:2, Ct�, �I�2,T�',`��. ��1 i, L�, ��d ���. Palpat�ry inspectie�n r��°e�I�c3 �c����ic��r�h1e� h�.���rt��t�icity ���1�?<�h�� it� �1�e c�r��c;ai> tht?raiic. an�i I���?�htzr ����z4���1at���°�5. Assessment: �'atie�It i� n��kin� a �c�c?d progress and th�: �rc��n��sis is ��?c�c�. f'lan: Fatient w�as treatet� tc�t����� ��ith the foll���in�: . C'hirt�prt�ctic ���az�������tic�r �eta#?�° tc� tl�� i�ldic��tecl Lei��l�r�i� �L=,����e��ts . Electric�al Tn��sc�� s�iznu[�ti�n ��as a��pii�d to tlle I�y�?�rta��icit���i���,l�.� in th�: back , i��c�ist hc�t pack ����� ����?�i��c�t�� �I�e h���rertoniciti� znuscl�.s if� tl�� b��c� . Saf1 tissue ma�sa�e ��°�� ti��Iieti tc7 th� affecteci soft tissue� T�u i�ee. D,C'. �' �� �3���th ,� �c��am��n��� �'�7y+ �+r� 7r � � T � ._� ��t��� � �� lA o�t t.����A4� I�1���.R. P� :-�r �'atie�t: C'hc�ns� �I�l�ac? I�aFe: S-I�-13 DC7i3: 6-I S-�i� I�t�i: "?-2�-I3 �ubiecti��e. 3'<�tient tc���tii�uc��t�� et�t��plain c#`}���acia��e, r�ec� ��i��, �ip�er k?ack tc� It����r �aa��C ��i�`�. ;�r��l ri�;l�Y �;t�te� ��tiiz�. i:Etz��n� h�:r l��ac� fr��iz� �i�l� t� �i�e ���k�� laer t�c�:k pai:� t�rors�, She felt relieve� �from the�hirc��ractic tr�atmex�t [ast �-isit. � ()biecti��e: �c�in�.xpltal'���=����ti� c�ti�t��x��;tic��� ri�ht k�lec; sr�ti;�-��:����r:r�;ai ��stu��Lti��t� ��t�� �berrt�tzt lnc�t�i�j�� at C."'. C'f�. �I�1, �I`�. I`1?, z�i�c� L5. I'aip�tc�ri iz��p�;ctii�n re�eale� c�nsi�eraF�le h��pert��nicit�� ir� t��e �ei-�°icai, t�l«rG�ci�, an� lu�z�k��r �nu�c,ulatures. '�'end�rness tc� �alp�t�c�n ir the ��r1�ic�l, tll�racic, un� l��-n���r re�it����. C:�.•��ittil ���tract��m ����� e1i�:it�c� ��ai�� ir� �h�; ���:��;. Assessment. �'rc����t�sia is ��3c�d. Plan. I tre��ed th���a�i�nt tc�c�a�> ���i��� th� f�llc���i��: . Ghirc���ract�c ���a���p��l��ti���� ti�e��t�t tc� tfle i���3iLat�� �e��t�:l?r�il ;c��r�lea,ts � �lectricaI r�u�cl�.� stirn�t�tian ���as a��li�d tt� the hyp�rtc�nicit�� znuscles it� t�i� back . '�1oi�t hc�t p:�ck �=��s ap�lie� tc� t?1e 1����ertat}icit� musc:l�� ii� t�: b��ck , �i�ft s�i�s�z� rz���:��E��e ����� <�}��l:e�� xc� 4�1�e at"f�::ct�:ci :�c�ft tisst�es '������ 1;��. I�.C`� � �" �or�mc�r����� ���a�t� � �■t ��I�"���`c�£'.��� ��l I1��R .�a �.w �)f I�r� /,ee �'atient: C'��c�n� 'I`l���t� �ate: }-13-1� �t�B; �-15-(�� L?C�I� �'-2�-I� �ctt�iect��s�� 'I'c}����. t��� ����t��z�t �;c�����?Iains �f��:��c���l��. r���:� ��in, u���.r �ack t�1 �7�ici �ac� pair�� lc���°�r �sick pai��, a.�� pain i�� }l�r ri�i�t k���e ic�ti���. `���� state� tl���t hct� complaints are �irectl4• r�latec� to the �`25!13 ear a�.cidez�t. S��e ,tates that her}�eac�ac�� �c�t�ze� �r� at��? c�ft`. ��e: state� tl�:�t �h�: fe�:l� zt Iittl��jit t�ett�r to�a�. CC�biecti�e: '1�'����der�ess t�����lpati�r� Tr� the �:�er�-ica�, t�ic�r<��;i�, ar�ci l��nabar re�it�r�s. �`onsidera�ie I���pert{�nicitt° is pal�aat�d in t13� c�r�=ical, #��c�r���.ic. a�7c� lum�ar I7�u��ulat�xe�. , � , �. • • � Se�n�entz�I:�c�r��ztic ��°��urt�t�c�n r��;ht �net; ���ter����n���ta£ ��5i��:���tac>n ����ci a�erz�sint �����ivn at �°"', �'G. ,I 1, TI`7. T1;, L�, aa�d t.�. . Assessment: F's�ti�;�at is r�z�kin� �� �c�c�d �ro�ress. P�an: �'atieiit���s tr��te� t�a�ay ���itl�the �c�Ik���in�: . �'hirc�q�ractie ����t�i�?��i��ti���� ��r�tiv tc� i43c i���i�ate� ��ertci�����1 �;c����7e��ts . Sc�ft ti�sue n�assage ���as applie�t tc� the af�ected sc�tt tiss+��s "I'����� T���. I�,C:' � �`�mm����t� �Iealr�� �`h�ropra�t�c �`1ini��. P,x�.. �� ���u ���� �'atie��t; C'}�c�i�� �f�11ac� I��#e: �-1 C1-1 3 D(7B; F�-I>-f�8 Dt?I: ?-?5-13 Subiective: Pati���t com�?lains todat� of`rmid back paili, zteck pai��, upper �ack pain, Ic?wcr�ack paia, and right k�iee pain. She states th�t walking too mE�ch makes her pain worse especiaily her right kiiee. She c�ntinues to benefit frorn t�lle chira�ractic ca�•e. Qbieeti�-e: Pa(pat�r�� ii�s�e�fiori re��eaied considerabl� h�perto��icit�� in tlle cer��ical, tht�racic, and lumbar musculatures. Tend�rness tc� palpatian in the c�r��ical, thc�racic, �1d lumbar regic�i�s. �egmental.%sc��natic �y�sfunction ri�l�t k��ee: `sntersegmental aysfuncti�r� a��i� aberram nlotic�n �t C�`�'. (�'6. T''. T>. ,1�'l 1. �.4. Ei��d C,:�. Assessment: �'atient is xnakin�; a go��d pro�t�ess. �'lan: '��1s. `I�h��� t�as treat�d tad�s� ���ith tl��, folloti��il�g: . Chfro�ractic znanipulatic�n ��ntly tt� thz ii�dicated ��erte�r�i se�n�ei�ts . �;lectrical muscle stin�tilati���� was appli�d to tl�e h�pert«��icity rt�uscl�� ii� t�1e b��cl� . ?1�1�ist l�t?t paek ��as a�?plied t�� the f���pertt�nicit� Xn�as�(�, i�1 t}��; bacl� . Soft tissue massa�e was �}a�l�ed tc� tl�e affected soft tis�ue5 Tc�u Lee, I}.C, s � .. �c�nn��r������� �ealth �������t��.���..' ������. �t�`�].• ��4� ��plt ,��C'�' I'atie��: �`�a����.:; `I�����i� F�ate: �-�-lr� I.)C)B: �_�:�_�� DC}I: 2�'?�-1:� Sub'�tz�e: �'atient r�t��r•n� ���i��° ��.�r �l�e ct�irt�pra�.tic �re�imer�t fe�r the injuries:�I��� susl�ine� r�suttzng frc�m a 2-25-13 c�rr accident. �I�e coz�rplains czf headache, neck�ain, Iov�er back�ain,up�e�r bac� Ct� n�itf b�ck pain, and ri�;ht kn�e�ai�� toda��. She st�t��ih��t she h�� ���ore p,��n ii� her i�p�er�?6�ck a��d nec� tc�d3�. �}�� <:�lt s�elie��ed f`ri�rz� t}�e lt�s� C}332'£)�I'iitT1C- II'(;c�tI11�I1�. � (���ec�i����: 'I���ere is cc�n:�ic���•���Ie ���per�ani�,it�- paipa�lc i��th� t;�ri�ical, th�7ra�i�:> at�c� iu��b�r rnc���ulatures. �;e��nLa�t�l:5��rr��t�c ��sf�.�nc�ic,j� r����t k�c:�:; iz��ers��i�lc:r�tai d�=stun��ic��� ��� aberrant mc�ti�ar� at��2, �:"fi, �I'�,T7, T`�), '�I���i, `1�1?, I.,2, ar�€d I.4. 'I"ent�crz���s t� �a3�atic,n i�� tl�� cer��ic�l� tllc�r�3cic. ai�d lun�k���-re�ic��1s, Assessrnent. �'rc��z���5i4 i� �c�c�c�. Ptan: -�`reat�tnet�t tc?d��� cc�nsis�ec� ca�th� ���Ilc?�ir��: . Cl�irc��ra��i� rraa��i�ulatii?z� �ertt:��t� tl�� indi�ateci 1�ert��?r<�� �e�:��er�t� . �lec-tri�al mugcle 5ti�nulatian ���a� ��pliec3 tc� the h��}�Grtc���i�its r7i13��:1�s iz� the h�c� . ���ist I�c�C �ack ��a�� �����li��i ��.? t?�� �����rta�ltcit� r��€�scl�� ir� t��� ������ . Soft tissue znas����; was appiiccl tc?tl�e affected sc�fi tissuea T�c�u L��. �).C. = �:�rt����r�i�� ���alt� : , � ¢�� ��P � ��=�3 �'h�r�pr�ct�c� �'1�n���, P.�- . P��ti�nt� ��c�n�;.I,}���� I�ate: �-s-1 i DC��3: fi-l5-Ei8 1�C)�: ?-�25-13 �ub'ec.L ti�'e: �I`udL���, ���. 'I�l�L�t> repc?rts ��f head�cl��, ��eck ��ir�, u��per h��ck !c? i��id h��:� t���;, 3E����:��<zu� �?air�, anci �-i�:��t k��ee ��ai�z. 4�1e st�t�s tl�t�t 4�}� f'��ls �� littl�??utt�r t��c��;�. �he st�zte� th.3t the I�st tY-e€�tr�Lnt hi�� l�el�e�. She �tate4 th��t �lae i:� ;�t;il 1�<������; �?rf���le€�� v�=ith carrvir���.zr 1�tti��� ar�;��tl�it�� h�avy b�cause c��t°her �a�ir� �`rc�i�� the car ac�,id�nt. �hc continires tc� �enet�t trc�tt� ��� chir�practic ear�., t�l6iecti�se: {.'crosider��lc l�y���rtc���icity ��palpal�;d in tl�e ��t���icG�l, t�c>racit�, ar�d lun��4�r rnuscuiature�. T�nc�ernes�tfl�al�ation in the �:er��XC�i, th�?7•<�eic� ������� lur��bar re�ia�YS. �`�'€�I11f'1;�1�'SC?I?1:1�1{; t�l°�+fllil%?1t?Tl I'l�;�ll: �;_I�E�'; IT1xCi':i�€,�T17t;I1i.`tl� u�5�.iti�C'�lt!*t �1TIC� i3�?�:?'?"i�II� 1T1C}LlE)ti �t (..'. C�+, �.Es. I I, "f`°� ,I f�, � ; 1. S`i`?, 1_�, i�ili� I_,�, A�sessment: }'ati�;nt i4 n��,king a ���d p�c��;r�:ss a��c�the �r��;�3c>5i� is s�c7ac1, P1an: Patient ���a� �rei�tec� �tadav �z�itl� the fc�llo�-in�: . t'l�irc��;r���tic r���$��i����4G�tic�n �intl�°t�� tl�si: in�ictztc� E`trtc��ra3 ����,�Fc��t� . tiuft tissue ma�sa�.�c ��+��s ��pp3ied.tc� the affeetet� sc�f�t tis:�t�es Tc��i I>ee. I�.C;. =� ����m���n�t� �c�G��t�� � � . . ,r�.� Tz,r� � s-'t. �'h�rn�r�ctic� �1�n�c. P. � . - ' �'�tiet�t. C`1��?��� �I��;ai� LJate: �-1-1� DQI3: b-3�-68 DQL• �-�>-I� �ubiectiF��: Pati�nt cc�tnplains c�i neck �ain, light headaehe, u��er �ack paii�, mid h:�ck pain tc.� lc�wcr back�ain, a�zc� rig}�t �:n�e �ain. Sl�e states tl���t :�li� l�G�s l�ead4�cl�� re�;u�arl�= since il�e c�r�ccic�e.�t. �he �;tat�s that ���:r 4��r��ptc����s arc c�ll �°el;�tc;� tf� the _�;_1; i.��� ;�c�ie��rat. �+�:e f�e13 a•�:.li����ci �rc��a� t3�e chi�-o��•���:tic �r��;ztz��ez�t 14�st ��i�it. Obiective: "�l�trr: i�; c������idet�����1� }��-��rt�.j��`scit� p��l�abl�: i�� 1j�� ��:re iUC�I, t���r<�eic, 4z�Tti l�fn�h�r n���se��lat�a°�:s. '�'csaciex-t�ess tc� �aalpaiic��� ir� i}�e cer�ic°al. t��c�r��ic. an� I��rn&�a�° regic���s. Se�ment�l.��;t���n�tic� �i�':;fun�ti�a�� ri�;�t l:nc�; intersegm�:ntal c���fui7�tic�n a��:� aberrant mation at C"2, C�t�, "I�?. "�V�, "Iy�?,`I�l 1, L.�, �nd L5. �'�ssessment; F'rc����c�sis i� �c�uci. Plan; Patie��t vv�s tr�at�c� tad�;�� ti�itl�the fe�ll�»�ir��; . C'I1lropra�:tie s1�a:7i}�Ltl�iii?t� �ei3tJ� i�� the tli�ic�te�: �`enei�Ct�i sG�;r2�etlt� . Electric��l mu�cl� stir�l�al�tiv�� ���s applieci t« t}�e h��pertc�niciTe ��u��les it� tk�c: �4��k . '�1c?i4t l�c?t ���t�k ��-��,4 <��?r,Ii«� �c� thc ?z��ertz��:�cit� s���sc;l�� il7 tl�e h<tc� . S���t tissue m��sa�e t��� a�piieci tt�� the af'fecteci �c�ft ti�;s���s ,�.E�t� Iw��-; �).C'. ; �om��c�nit� �-�c.}a1�h � . . . , � �.;�� ���� �`h�� {� �racl-�c C�1����c , ..�� , _____ _� _ - _ _ _ I'�.t����t: C`t���ne "I�h�cj Date: �-2(�-]� L)C}I3: 6-i 5-6$ DC?I: 2-?i-l 3 Subiectiti�e: I�>[s. "I��hao returns tc�day �c3r ihe chiropractie tre�t�nent ft�r t}�e injuries sl�e st�stain�cf resi�lti��� fr��m a ?�25��l 3 ear�ccidenL �he states ihat �he has �air� in her neck. entire �acl:, anci ri;,�l�i k�tee tt�J�i�. Sh� sts�tes that her l�eac��ic:��� o�-t�4 gor��: sir�ce tl�t 14�st �i;�it. 5i�e st��e�t�1�at tl�� [«st �hirc��rz�e:tic tre�tn�e:��t pr��t�ic�cc! r�elief fi�>r I�e7. t)biect��-e: I'r:r��i:rtZe�ss tc� �al��atiE�r� in thc� eer��ical. t}�r�raci�, ��nd l���t�ahar re�i��ns. Se�gment��l`s�imatie dt�sfunetiot� right k���e: interscgmen�tai �vsfiz��ctit�n azlc� ak�errant in�atic�n at C'2, C'fi, `I'2, ��[��, '��7, T��, �I��k 1. L4_ and L>, I'alpatorv ir�spe;cti«n rti��e€ile�f eonsi�i�xa�l�; hy��t�oi�icit}� palpable it� tl�e c�r��ic��l, thoraeic, and l���n�har n1a�4c���laT�ir�;. Assessn�ent: �'at;ez�t i5 issaking a goo�r ��rc��r�ss. Ptan: Patient was treated tc�dat� u�ith �he foll�wing: . � �2iI't)��I`iiC�:C TI1i1I7Ij'tl�<��1{)EI 4`.'.�I1i1L'�C) t�l� Ii1C�2CdIGC� �C;T'tt'�?I'i�� SE;4?F71tT11� .�lecirica[ muscle stiml�latic�n ��-as a��lzed�o the l�ti��trtc�i�ieit�� �ni�seles ir� the t�ack � . '��fii:il t2t)i �?:iC� t�.iti �t�'�?�Ii�� fC� (61�: �11���i;ttt?:lltltl t,"ltlS�tE'y il� ��iti' �''z.i:�; . Soft ti5sue m�ssage ��-a� ��pplicc� t�? the affected �<�f�t tissti�es '�I��c�l� Lee, D.t'_ ,I �I i I -� ���mn���n��� ���E����� , �. . t �h�rr���r������ �����c�. �'�.�� . _ ��=� ��,��� ����x F'��tier�t� C'��c�n� I'}l��f.� Date; �-?�-1� L70B: (i-15-fi8 U()I: ?-��-1�� 5nbiective: I'�tic���t r�;pc�r�s t�f�ze�daehe, neck �air�, up��r�ack �t�i�, r��ic� ��c� pair�, lt���°er b�ck p�ci��, ��� ri���t I�n�� �6�i��, ��ae: �tate5 tl�at she �as nat7re �ain in 3���° n�:i:k tc>�ay. `�l�e states ihat��ex���ck ���c� back cc�ratir���e: t�} liurt. She felt r�;lie���:cl frc�t� th�. I�st treatment. C�biectirre. Ter���,rn��s tc� �a1�a�kic�n i1� the certi=ical, tht�raeic, 4�nc� 1L�n1�a�r��ic�ns. C'��r�sidera��(c: 1���ptrtc�tti�;�t� Es �i��t�� i�� the cerviial, i}�c-�racic. ���� �t�z�����r t��u�;�ui��t�r��5. Segmez�talisc�n�azic ciysfiznc-tion ri�l�t k��ee; i�lterse�ine�ni�l ci±�°5f��znctia� �n�l ��errant niz�ti��n at C"?. C'3, C:C�, "I��, "I��S. ��, T1 I, TI?. I.2. I.4, a�1d I�S. AssessmenC: Pro�;nc�sis i� �E����. Ptan: "I��r�atr���rat ���r�<��= �������s;�e� �i the F�allc�v��i���: . Chirc��rattic: �x���ipul�ti�an�e�xtlti�t�3 tize inc�ieatec� vert�Lr��l 5e�;�r����t� . l;l�;ct�-ic�l t��u4c�.l�: �;ti�7���I.atp�?n r�a� G�p�lied tc� tl�e l�ti-pe�tc�ricit� ������;cie�; ir� tl�e hack . Moist I�t�t �a�k ��a;� �p��i�c� tc� tlle hypertunicity muscles iri i�e �ac�; . Sc�ft tis�z��, rnassa�;� ��a� ����al'z�:c� tc� the ��I�I:ectc�c� sc�t't tiss��es `I`t,u I,e�., �),C`. _� �c�rz�m��r��r� �-������t�� � � ��lt'"(��?�`�(.'�lC' ��1t11C'� �. -�► , _ ,'�,. {r,�� � t:`'t' Treatment P[an �'�tfent �tiame: (;lic�n� I:��i��c� [)ate c�f lnjurv': `'-��-1�# I}�te �f�3irth: 6-1�-f;f� 1�ate c�f Re-�;�arn: 4-?`�_I 4 Chief Com l�ints: Hc�ad€�ch�, neck�ain�u�per ba�k ��in, mict b�ek �?ai��, l���er��c�k p�in, ar�d ris�l�t l:nee �a�ir�. Diagnoses: Headache (78�.0♦�, cer��ical sprain/strain (#�"7.0), the�racic s�rain{strai�� (4�7.1�, lurzl���r spr�ir�,`st�°�i�z ���7.��, t;�r��i�.�l s�hlux�-�i�-�z� ��3c},{�R), th��r��ic s��l�It�x�tiet€� (8?�.?1}, luiT���rar �ubluxatic>t� ��3�).2�), and segrn�:.ntal.�c�tnat�c d��f`ut�cticm ri�;l�t kt��:� (739.6}, Tre�tment �'rct�r�nntM19adalitie4: �. C::hira�ractic mt�r�i�ul��tic�n �etatl� tc� t}i� indic�tec� ���rtel�raD se����e��ts �. F�lectrical i�t�scl� stilnt�lati�?�1 tc� t��e h��pertat�i�it� ���i3scle� in t}�� hac�: f��r a� ;��i�s��t�� r. ��c�i�t 1�c�t �i��°i� t�� t}��: }�����rt:���iicit� tZtuscl�:> it� t�ii ��E�c;k fc��- i:� ��;ir��a��s �. �aft tissu� r��assage tc} th�; atfected sof:t tissues fur I� rt�inutes �, I���omt� sxr�ta�the,���in� e�crc�i�e tc� iz�pro���her r��tu�c�ulc�s��.let��l �tren�t�� Tres�ttancMnt �re uc�c:nc��: 2 tc� .� tizr���+ per week t�?r at�c�t�t t��,-elti�e ��isit5 tl�e;n re.-ev��luate. 1'r��nosis� Caoc� C�oais: I'�°�_���jl�rr �;t��t��4 � �� � , � � �� '�, � , �:�tz��I.se�,�I�.�-. � > �„ �,� t����� � �'a���� � � ��lll"C��C�Ctlt' ��I�1IC, �. "�►� �'�;. �%?�� l���c3 I2F,-EXA:��I:�:�TI�,?'�' T'atient: �;}j�>r�� �`l�a�� U�te, �k��?-�� D(?�3. �-1S-G8 DQI: ?-�3-13 Subiectxcc: '�1s. `I`hao�;€�ntii�ues to com�lain of��adache, neek p�i��, u�per taack �3in, mid ba�c-k pait�, lo�:°�r�ack pain, and ri�l�t� knee pain . �I7e ��c�ti���ra�jes her��v�er��ll �ain as�?, c�sn a �c:�ls� t,f'() tc, I t}. �he state� tha� l�er��-mpton�� l�a�°e iin�rc��eci c��m��ar�;d tc� th� in�tiG�t tre��trnent. ���� �t�zt�s th��:h�r p�in incre�i�es wrth��ri:c�rmir�� �s�us���c�lci du�i��;, re��t�ti��e �cti��ities, l��a��- Iiftin�. �iiti��� or star�din� for Ic}n��eri�ti� c�f ciznc�. f,r bel�ci;�3�. �l�c `tates t17a� she 1��e1� bet��r ti�,-itt� chirt��ra�;tic �re�tme:nt anc� �dt=il. Obiecti��e. Ple��e see �TL eran�iT�atic�n fart�l ft�r c�rthc�pec�ic ie�ts, actil�e c�r�ical e�n� lu�t��?<�t°r�r��e c>f:���>tie��, tn�z�c1�;� ;�tr����!he�� t�;:�ts. r�.flex�.� �c�t�. �w,z�c� t�t}�et� i?l�j�cli�� �:T3C�iT1{�5. �i��fI1�I11�.� '�i)3,x:1�3C t��`��Li21C'�ICT� t"I€��1t �ii�it;t�; [i3t�'°`�t'`fT"?It'.tlt;.I� t��'ti�litl`i'i�i$I1 �l2ft`s aberrant mc?tic�i�at C?, C:�, C"b, 'I.l, "I�?, PI��. "I�7. T9> 'I'1 l, 'I`1' 1.?, I_,�, 3nd I.:�. �he i� �I�rt. ct�c��er�r�i�•e, anci �leasG�t��tc�dal'. Assessranent: ',L'�s, �I�}iaca i� t�zakira� � �c?c�c�prc�gre�� a��c�l �i.� ce:rtai����' �3a5 i�i��ri>red fr��t�� t}se cliir��ractic t;ezat��lez�t;� t�-�.at ::1��; r�:c.ei����3. T�3e �e��rit� c?l���c�- �;��ex4�;,�� ��:�i�� l�a� *��i�x��;� tron� �t10 to fr`1{�. �I'�lt r��uscle It�pertonicity� anc� iendern�ss ha�,=e c�c��;reased, i r�cr�nimended �h�fi p;�tie�t und�r��?es cl�zrciprac�ic care as in�ticatet�t in the treatroezit �1��. "I'��� ��r���;���;,sis ��: �c?c���. Plan: I �erfc�rm�i� a r�-e�at��iil�tion on th� ��Is, �I h�c� tc�da��. She ���a� treate:-� t<>d�-�r�- �.��itl� c;hirc�pr�c;tic m��ni�?��Iati��� �;�;ntlg=tt� the i��cticated ���rte�r�! ���r��ent:�, sc�f`t ii����� r�i��s���e. electr�cal rt�tlsc�e 4tit��ul��tic�i�, a�T�i rnt�i�t hi�t pack. I r��ill pre�ci-ib� a l�t�nT� �tt��.r7�tla�a�ir�� exe���;i>e ft>r t,�e �ati�.r�t tf� i�tipr�}�°� P��r ���uss�ul�:�k�letal stre�7�tl�. Tc�u Lee< D.C'. � COMMUI�II'TY H�ALTH �HI�RQF�ACTI� CL.INIC P.A. � �'�'L ��A.MTNA�'IE�I� �'t7RM .._ � �1�IpL'.�"!T�V,'��`' � .._.... �''ii'� ��.�=t,'`: Ls,'^1 .'�` �.�� , �,'�;,� ._. k�.� :.,..�t�..n.� ., ..., , t ., . . . z: _. �IEIGHT 'r�`��G�T � �'� �F � �uLSE '�= :Z,��� T�'��F �:�� �-; R.r�N+�E 0�MflTION E� RviC�#L �R � l�� �, ,,f,� �,. �,��; ;,.� �3a�ian ' '" F�exio� . � �� �aension r� ��_. r� � � Extans�on = ; . t . RT Lst Ftaxi€?n � 145 f � � „ RT LeC F1tx. 0.r 1�� � �-,- ���-.�;-_. . , �. . , �., - c��; ;,'"LRat�`iex, 35 *`��' =.F' L'T`�t Flaxic� , t fA � ,; ._ < < , r ; {� ntgp/y+l � /3 . f�Eil ` 7\� L4411V1{ � /S�_ ._ • yi`.�..��� ���OTStI�� -� v d � �,"I'Ro'�atiQr "1 ��C� �` LTRotatian =�:,3Q %; , ,� ;,i,; ._._. T�1.�f�) .�_G fi�ST' Heel Waik L � -� � � i�emps 1`esi ;L R;,+ _ ; � � ,:_� _.._ �; ,_ Tt�e Walk L R + ' Remborga � R � . ___._ ��..�T�T�T�`� - � Bochter�w's ��R�'�* . ,. � Allc�:'s°I'e�; Z� ;R �ca�ric�l���n�, � R �_��� . �� �:_ � . . ._� �'aa���r; i.� � -s- - - �ho�ldcr Cc�rr, ;';, � ;�-�' . � � ;� ,:,��:�. � Wrig:�;'�':"�st L R �- .- CcrvicaE��s�acti�r� :���� .-� - � Adao�`s Tcss L R * .. w: . , 4"�3I :.. F� �GSto�i�,�. �es° L- � � ..�,.�,� SpurlL�g's`,c�; :�. ,,-� - ..�t�'RINE TESTS ,, j � -�� - > '"� . . , � ��.:� `� �' , ,;. - �L'L'315i�.7as� �n 8�. " ` , . 4. , j 7� L7��NStiJ .....� � � F. .,.o`° ��.LiiYFi����+YP' L x\ � _.. Hft�LR wit�C-�icxion ���:L R `~�- - .... � Mitgrssr�'s �� R ��� � - . .,.�:.:����..�._�._ ��?� t .;� � � ��eomart's�'est L � ,�-- ' ��� Hibb's Test . __ ' ���'�Te�, L �,E . � �g :��.��h � s„� � � :�.s � �rF LE 'Tit�!ti "1'H 'T�STs Le�t Kigh� LtF� 'ti�:,; �h�tsidar�h�g .,, f� ;� ; De�t�i� �5 ,.� , 1 Bieeps�G�-� f� r� Tric��;s ��" ``� _ '� �krisE E?�t.�� �< � �� ��r:�t Flex C "` ', �`5 ��ngar F2ox C8 �� �5 �� ?5 Intercrsse; T E � 1� ,1 r5 �"ib Ant i.A `�__��,_____-`S _.� :� E;xt I-ia1 Lg LS ;� . ; �eroneus Lg�� r'� � 'S �RAItIAI,l��RYE - �l)Olfaction �- �_ ;2? Sigi;; -� ; �3, 4, �; �;�� �iusc;es � '.�� ii''>Sm[Ee t I`"-� �8) F-iC�t'it�g -* t��Sensati�niat;�t�r + : , 1 _ i 9, l4}Swa(l�� �- :� � ;: !� Sh.�>�rttg �° �� � ;�2) Ton�ue P,;�rrr�t. * �_-: R�RLE '�S �$�bse��? ; N•F, 2 — �<t�r:�:�; � �,�e;� t = : � r.�re' � _ _ Y,: °- � � �3r�c�:�,.��. r�5 � ir � Biccps CS_b :' ; ., , , � `�`�ccps Ci � � �. . P�.eila: L-; s� �Ch:iits S: . R„�_____ - Pago : Qf 2 � COMMUNI'I"X H�ALTH �HIF�C►PRA.C'TIC �Lil'�I�C� P.A. , .., . �.. GTL EX�4II�ZPVATIt3N FC}R1Y1 PATIENT?r`AMB I�qTE � -� Pal�ation/Percussion Lcvs( Tsnderness Paipation j j iYluscles Hypertot�icity 1 ; i (0��) ` ! V! t l�` i L, SF R Static M�tion i L � f r { � $U�J0001 US y � �-' � ,� � t"r �L.` . � T!'U CZ1U3 �r'� �,' �' /(![`. ,;�;- � i ..;� ., � ; #= � (�.CY�iC� SCO UIDC � �R1tOR1�01� E � t ` '� i € �Q�401G' ! � �C...i . i .�( , f ' t Cerv'scal aras ine€s s',/ s f��j �.� � ` �`horaCic aras ;na; i f � i _ I i � , �y • _ i ;,,U(T1�81 8.t6y ItSB� ;;�f� `i r . F t i. ��ui�.i1� t _ .� � �i�E��'i^!5 � � a ; ; �� ; � , r�= -,., _ ;FL � _.._._�.----i ;� � � ( ! �,�u8v � � T� � � � rt � f , � ' � 3 ,r ,,� ��„ , t,, f �-.� (_'� � � z,� , ��� 1 � t',5 j� �*�,,� �"� l i ;' � " �',. _,� � F x � � . � :i �.�<_ .. ���'`� },_„� ;._;�� A� x�� ;/`it ,;1 ; i � ��` �r� J 3�, `� �� ,{ ,y f �� ; � ( � � [ W 1� YU; '{r�/' ir'` - u:+ . /�4( � . � � ( � lj! f� ) �� (f 4 F j t t 3.�� 3 � � I �` i `j � � � .. . . . � � j1 � � r '�i . i i !�`�, i E �� � i CI � i 1 i ! ' �`i QtC; il �� . �� ; �' i�� .�" �� / , ;���� . �. . -�% r- , . i/� i I �� ' t. OC�{?I''� �Ig11$t12:r8; � , �r Legond: P•Pain(Ol}0; S-s�asm �"�'•tcn�er Musc:e tanc; :-m:;d 2-mods�atc :�•censidcrablc 4-scvcrc S-sharp I?•dul! NAF'•no atnorme!ftr,di�t�s Vr`NL-with�r. �orr.^,tt! !i^::; ��-j p�s;t5��e (•;nega'ivs ��-cervical T-:h�racie L-�umbar ;.B-;��r back PagC 2 of2 � a ���t�t�ntt� �c'�1�h , � ��r= � ��� � �� ��ir�� ������ �`��rric. �'.�-�. � � __ . _._ �'at��t�t: C.'t3g���� 3�ia�� I�ate: �-I�-1� I�(}�: 6-l:�_t�� I)C)I: :-�'�-3 a �'ubi�cti�°e; I`�}c����°, t}�e pati�t�t r�;pc�rt� r�f}��ac�acl�e, ���cl� ��ai��, ii����r l�ack pain, ���ic� back �ain� It�«�er baek pain, and ri�ht k���� �a�n. `���c �t��tes that �;h� ha;� int?re pa��1 in Y�er ncck tc� up�er b;zc� t��ciaa�. �h� 4t�tes t��a? ��E=r sleep i�: s<�����irY�e�: c�i,:-u�?ted b� t�te: �ais�. Sh� tc:lt reliel�ecl �rc��-r� tl��: �hirt��?t�ac.i� tr�..�trt��:i�t la4t ;��>'st. {)�ecti��e: l�ec?iie�-��es� tc? �a�����tic}t� i�� tl�c uer��ic�:�l, thi�;°�ci�. ar�c� ?������<�r ��e�:�c�s��. C'��tl4ici�rahl� h���rtcaz�icitti is t3t�t�d 'tn the ��€��ical> ti7r�r��ci�;, aizd lu�n�a�r �nitscu�at��e�. `�e�r��unt��l�`��m�atic ���.�tu�xc€�c?�� 1:��?t kt?et; i��ter�r:����ez�tat �I��;�ur��;ti��r-� ar�ti ��h�rr�t�t �7����if�t: at C'v. ��`t�, I �. I' -l.l�`, I,«�, �nd I_�. Assea�ment: I'.�t�L�:t i� t?�:;kir��: <� �,?,.t�� �t������t��� P(an: .I`reat�zl�:r�� ��ciay c.t?t�siste� c?f t(�� f�Il��win�: . C'hit-��pr��cti�: z�t���r���?�al<�ti��n ��r��1t t�� t��e iz�c:��:�tec! `c;rt��?r��l ���r�����t� . I;I�tt�-ic��l ��ZU��I�: :;�ix3�ulatic�r� ��Li� a����li�.� tc� t}�e ht}�ert�?r�icit` �����:����:� it� tl��: �.<s�� . '�''�i?l5i �ll>� �?�C}� 1�'�ti �1��?�Ic`i� 1C` ;�',t' }10(}�'-a��?31t'lt�' ( �14a;�`� ;I; 1�1i: �dl�:� . :i£;�t liSStlf' tI1'41S'i��c ��'�3ti '��(��'�1�'{1 it} :tl� cz,;:`Lt�t� �U�C titi�Cit;� 1E1 ��i� �?ii�:r; uti�� Il��:l� �t�ti �;t'�:, �.).{ �" �`��n��m� ���� ��,�1��� s l�, �������C����� �:t�����.`. �t �. _ ��`. ��>i! ,� �� �'atien�: C°1�c�,��� �°���� Date: =�-lj-l3 L?�B: C�-15-�� SJ�)I. .;-'�'"y_�S �ubiective: 1'atien� ret��rns tt�cla� i�r thc; chis-c�praetic t��eE�tz���:���t fc?r the injuries sl�e sustainie3 re��ultin�� frc�m � ?_�>-1� car a�cide�zt. She cc�rnpl��i�ls �?#'���c� pai��, u��tr hack ta mic� baek �a�n. Ic����tr hack ���ir�. �r�c� ris���t kl�e� t�`�i�� ic�d���-. 5�3� 4ts�t�:� �3���t: 1�<�lkirl� �l� a��c3 c�f:�1��r� tlle �tair� ����es }�er �•i�l�t k:�e� ���i�� �at�rse. 5��: �fat�� th��t shc stii; tix���rierr�,c5 ��air� ��c r�>dr��. fJt�[ective: !'.zl��atz���1 i�7s�ection t���=��1e�3 c<�n4i��ra�le }�ti��t:�°ic�nicitti ��al}�G�h}e i�� t��:: �:er�i�:��l. C�c�r�cic, ar�t� lun��ar r��u�culati�re�. �I��n�ez-t�es4 tt� p��l�atioi� ia� th� cerl�ic��l, t}���raiic, a��ci I�����b��r r�:�i�7s��. ���s�e��tal's�.}�n��ti� d�°sf��r�cti{�1� ri���t k�e�: izi��:��se���lent��l ���4t`��z�ctic�x� �t��c3 �t�trr�s�t n�c�tic�n ��t t�:�', C`t;, 'I�?. �I��, '��'�, '�1 �, �,�. at�c� I.S. s�SSesstilertt: I'a':ie;1f 1s ii�1��i't��.'tt�<�. Plan: '�1s. �`al�� ��'�4 tr�ated t�?da}' i�'it�� the f-olla�vit7�. . t'l�iru�+r��cti� t��at.����l��t���n ;.�e��tl� t�? ?he ir�t�icat�:ci �c:�-tt�r�a1 ,�s.�rn�:nt� . F:Iectrical cl�usc:€� ;�t�r,�ul<�ti�n t��a:� �7���ieci tc} i}ic l�ypei-tc>t�ic:it� �7�u;c�l�s iB� t}�� �?E}��. . '�fc�i5t !xt�C t����;k �� .a� ����?�ie€� tc� ?4��: �1��,ertc}r3i�it� c�lt?:�t;I€� it� ;_I�c }�4�ck . �t�f`t tissu�: ���a�wc��?� ��`�s a�pli�� tu tl�c: �f`f'e��tzfi soi�t tissu�°:� "����u �_e�. I-7.C�-'. I : :`c���r��������� ��a�th _ r t , ����`°�������I�' ��ltll�. .P`,��. _ � I�� I�:� �'�tient° C':hczr��"1�E3ar� I��te: 4-�-13 ���. �-15-�8 � �C��: '?-LS-1� 5nbiectife: Patient r�pUrts c�f ne,ck pain, upper�ack pain, n�ic� k�ack p.�in tc� lc�ti�r�r hack�ain, and right kne�pair�. 513e sCates that her raeck anc� t�aek wcre quii� p�infizl <�ti�e�r tl�e v�=e�i�endo Sh� �t<��es t}�ai �:E����it��, cle<�tlin�. a�s�ctiti��e acti�itie�, t�r 1iStir�� t��ai�e� l��:r �?�iz� ��c�����:. t�biec�i�=e: Ten�e,rnes� io �alp�ti��n in t11e c�r�=ic�a1, t�ioracic, a�1c1 lu�����ir regi«ns. S�:g7ne:��tal.`SC�rn�zti� ci�stur�ctic�i� ri�l�t ki�ee;; it�te��se�ment��l t��si��t�ctic�n a��d al?Lrrai�t t���ii��r� ��t C"2, C�G. T�. �I��, l`�?. "1"11. I..4, anc� L5. Ther� is �:c}r�sidLrahie l�ti�ertc�.��rit� p�zl�}a�?le i:� tlxe cer�rical, tiz�r��:ic, aFi<i lumhar ��usctilatures. A,s�essmen#: I';�d?���t ic}��tir�ue� t�? ir7�pr�>��, � Plan: Patient 1����tr�ated t�da�°with the "allowing: , Chiropra�tic n�<inipulat:i�n �entl�•tc�th� ir�dicatcd vcrtebral st����eizts . �:lectrical nYU�eIL st����tilatio:� ��as a���(ied tc> thc: (7���,crtc}��icit} ���`��cE�::� il� tax�: �?�c}� ,��s�ist hot ��c�k���as appiied t<� tl�e h��pertonicit�� �nl��c.ies ir7 thc, hacl: , `�c��2 ti�sue zl�ass;3�� °��'f�> i����°Iied tc> t��e t�i°fLcted sc�ft ?i�:;��:� �z1 t���: r��c� ��rl<; l>c��N, "I'c��� I���. I�.C`. Cfom�nunit��T Health � : �hir�o t��c�i� �1in��,___..A. ��� ���� ��� � __ _ __ �?____ __. �'atien�� t�'�E��n� '�"han Date: �->-1�� I�OB: 6-1�-b8 I�t)7a 2-2�?-13 Subiective: ?v�s. �I`flao compiaiil5 t�day taf headacl�e, neck pain> n}�per back tt� �nid back pai��, 1�����er��ack�air�, �ncl �S���rr in �jer ri�;t�t �a�te t�:�c�a�°. �l�e �t�zes tt»� her �vt����tc�z��5 ��r�;: c1ir�;�ti� relate�tc� the ?-��-I� car aeci�eilt. �}:e states tl-�at h�r �ain cc}ntinc�e� t�? hut��er h�r e��en�a�. 4��� t�It slis;l�tl� ��:,�t�r�t`t��°t��e I��S� trc:��t���ent. tJbi�c�i�=e: �'c�nsidera�?Ic� 1������rtc�z�iciti° i� ��l��tec� ir�tl�c c�rvie.��l. tl���r�Cic�o �z�d !�z=n���ir niusculatures. Tendtrness tc� palpatii>t� irt tl��; cer�ric��l, t��t�r;i�ic, ���:�3 iurtlbar r��i��t1�. �e�n�e;nt��l`sc�n��itic, cl��sf�zz7ct�i}�� ri�l�t ���ee: intt;rse����t�7t�l t���ii����ti�>n <:�n<i ,z��err<a��t ��aa�ti��r� ��t ���. ���?. �i. ��. � a�, �_,�, zITS� �,,~- Assessment, Patsent is makin� a��od prc��res�. �?'lan; "i reatf��e��t t�3�i���. cc�t�sist�c� c�f`:I�e f-��11��ti�i��`.�r: . C;hirc��araeti�: �nanip�.rl�tiozi��1�tly t�7 Yh� indicr�ted ti°c:rtebrG�i s�;��T�ei7ts • 5l?��Il`�SUt 322�i44z����t; 1§'zi;+ zi�?�"!�3�C� it� ttlL i1��C:C1Ci.� �v,'.II;��;It;� Tt?U��', �.�.�-. _ __ _. _ _' ��., :`3;i7t ' .,.>t?,i°f"st�;; �'..,i� ,�' .'4�:`1 .. . �€'ac1 tr,rt::" �fi?it .14' 'Uri �t;.� ,r,+:'r -ii -�'�iri =� ;om��un��� ��� ��h 1�.,�1I�'d�C���IC ��Ii�iit', �.��.. d'� . ���r� Le� �c`iCI�222: ��"2C)I1�T `�.�1<�i;) ����: �—�—�� D(.7P: 6-15-Ci8 I)C�I: 2-25-13 Subiective: Patient returns today far the ehir�practic treatmei�t fur the iz�auries she sustained t�e.�ultin�; frc�n� a '-?5-�� car �ccic�ent. She�t�m�lair��tad�y c:�f�heacjach�:, �eck pa�T�, ta�?�tr b�c� tc� Ic�wer back ��iti. :��ici ri�:ht kne�� �azn. �hc states t}z�t II�r r��c� a��d bacl� ���:re �aaix���zl c���er il��; ��•c;e�;er�d. �l�e statc.� t}��t she is �a��in�; c�if'ti�ultti c��rr4i��� i��� 1i�`tit�� a��}�t1�ia�� heav� E��������e �}f� �a�:r injurie� aa�� ���iaj frt�s�� the ?-?>-1 W4 car ���idt�z�t. �x��; f'elt r�:1ie��:<1 f:rt�n� t1��: c}�irc��rg�z:tiG t�eatrnent l�s��-i��t. � Obi�ctive: Pg���atc�ry infi��:cti�?t� re��ealed ec�t�sid�rat��e�ivp�rtc?t�i�:it� i�� i�:� ��r1 i�a1, t���r��cic. at�ti It�rr�h�:�r �t�ta��.��lszttsr��. `��'�c���:ni�a1�'sc��i��ti� �3�s�i3���tic��� ��i�l�t �����: az�t�.r�y`:��r��G�:ta� �i�°�f'a��ctic��� ��t��i ��erra�lt s�a��tsc>n at C:w. Ce�i, ,�_�, �I °� �I-i, `I l`', I.�. �t3�i I..:>, ��;��ci�°z��,�:�:� �c� ��a1�at��.x=� ib� �i��- cerw�icaJ, thc�racic, ��n�i Iiambar re�ians. C`er�ical C't��npressic��� a��d C'er��ic�1 I7istr�ction tests eliciteci p�ir� in thc nec�, Assessment: Patiezlt cc�niir�ue� to ianpra�'�;. Pl�nr Patient u�as treated toda�� �rith th� fall�tuing: � . Chira�ractic manipuls�ti�r� �ct�tl���� the inc�ic�tcc� t=e�°���ral se�n�e°��t� . I�:le�trical ;nuscle stin��gl�itic�ii �°as appiiec� tc�th� h�=pe.rt�.���iiit� ���t�s�l�.s :�; �?�� ���c�� .��I�ist hc�t �=��k r���� a��lied ta th� h��p�rtc�nicit;� mus�les in th� �ack . �c�ft tissuc ���ssa�e ���as a�?plied tc� the afl�cted stal`t tas4i�e� in tl�€: I�ack ai7ti n�ck "I'c�� �,ee, I7.t`. � �amr��un���� ��a���� � � ����'Q�C�t'�1C ��II1l'�.�. �`.�ti �� I�rrrr ���c� I'�t'rent� C.h�?t�;� �C�t��t� ��t�: 3-27-2 3 L�C�I3: C�-1�-6� I�CJI: '2-25-1� Subjee#i��e: "l�t�d�}�. tl�e�a�tier�t cc�rnpl�ins c>f r��ck�aair�, �ap�er back ��in> z�1ic� �ack ��ii�, ne�� �a�in,right knee�ain, anc� low�er bacl� ��aii�t. `�he stat�;>tl�s�t l�er �I��7�,>t�t<�tr�ack ���e��t off the rc�a�i or: `';��1:� �t�d 7��e f:t�r�t�t t�� �z��;t��ic��� a�c���t �t ti�.r�i��� i��.�� ?r.it;a1 �°;��� c��� 2'':? 13 ut �,air �lir���. ';1��, :�t6�te�th�t �he d;c� nc7t �c�s'air�e� ���� i��ic�r� fr��t�� tl�e "� `�'l� c�<��- aLci�i�°�t �t7 5t�e �3ici n��t :��;�:� <�n} .,•-,- tnc�ica4 #reatmet�t. S47e :�tatGS tk��t lr�:r c;trrrer�t c��zt�pla�t�ts are airt�iti� r�i��t�:�i t�� t}z� -W�;l i ��:tr ac4ident. `�l�t �t��t�� tl���t t'tc Ia4� c1�ir{>�,�°ac�ic t��c;�tr��e.��; �����}ti���ci r�:li�t`ic�T- ���°r. £Jbjective: `l`here is t;�>nsit�era�1�: hv�<��c�r�ic�t� p��l�rz�l�: ��z th� c�ertiic�al. t��c��°zi�ic. �i��� �un:l�ar �nusculatures. �I���lci�rr���s to ;��3patit��1 ii� tlle ier���c:�l, t��{�rt��i�, an�:1 Ii�r�lt�ar rei�ic��75. ���m�ntal:`�ot��z�tic ���5f-t��lctii�z� ra�l�i �z�ec e i��t�t�,e�i��Lntz�I �i�5f'�.z�cti�;�� 4:z�� z�R��rraz3t i��t�ti�?� ,�t C`?. C�}, t�6, �I°"?, "��, '�,y, -�.I 1. L`. I_,=�, ��t�� I:� �ssessrnent. �'atier�t �c��s��s tt� �� res���a�-ii�l� �t�4iti1��3� tc� c�zir�.���r;ictic rna��i���l��ti<>n, 5oit ti���ze rr�a�4�age, elec�ric��` n��f4�1� �tir�=€�iatii��E. ��n�� ,r���:s� ��c�t ;?.��::�. ��`d11: �3i3£:t`Ilt 1�'<:i�+ IT15II"�IC;��t� �t:? �}C�'�t?T'?11 i3 GlC?kTlt 4?i't:<C�"3a11� t'�:�IL..aC° 'C� Illl��t`C?�'i,' }lt�.�" i1t"C"Ti1�� P`tIT7�t:' c�f motian. �he �•as treated t<�day ti��ith the f-<�ll�?���in�: . �°liirt��r<��tic� t��t��������tic?r� �e��t1�� t�� th� i�,c�ii4�tc:c1 ���-t��r�l ��:;�.���ct�t� .�leLtri�:al mtt�cle sti�1���I.�tit�t� ��a5 ���}�iii;�i tti tlle 1��-�ertc������t�° rnu,ci�:s iz� �1�� hac�k , M�aiSt l���t pa�� 4�'�is x�����Iieit tc� tl�e la��ertc>��icit�� t��iz��:l�:s iz� �l�e ����cl� . Sc�ft ii�s��e ina�;s���e ��.-�� ���pli:c� tc� t}�ti ��f°fe�t�d ;��ft ti��;u�; i�i tlxt r7�:c:k a��<� ����;9� '��c��r T.F��.I�.C:. y. e . �. I .�. l, '�1. RE H.-�B, L. I�. C. , ' t " s ' �-.`� ! � , STRETCHI'�G SER�E� FOR T�-�E L'�P�'�R 80��� RLLES OF �.�FE ST�2ETCHI'�G , `r`r`i:.'.. :1� ��Cr��C 5;."CiC�<,L�' ',:. i;i'.',''(;c1S� ,'11.:5C�C tCf';^:rri�� u",,.".• 3.';.� ' . �."�, .�_'.4 '+« .'��L�r $:'°.`��� . , St''u;,". ',:, ;!'�C �'Q;"f �fR2s.^. ��0�'�SS ;;.`a'�.�.. '.'.w ? �:C:; �,'"'_ . .�: 3 D^r; � ;�o�rce' :nstea�; s:re±�:� t� a �:;in: �f gert;e :eRs�..�. `S. �4V�1�� l�Y Sil`.iv�i � .i�JV 4�� tT 4 �:v � .. .��'P �._..,. P.�d�.. '�. .. �r4,.. ..� 1 S8� L+i1�S� .�;v i�(lgeF (.�'L' `'�.". � �3CG`.}�C C�u1-iiFr G t., ;ib�fi� �c �r�:. "p.4�JS ,.^..'� ,ri'4° S±'�itn v _c:. ^q, c.p� .,, _ _.,_.,. "4.. � ..".>._ .���*"^i:. .. h^,u'; :xt',:sts 'ti� n :aJ.; ��,: _�.< _.2 ::�s �e;. .. . ., ' ✓�\ ��—`a � �,_%�`�"�-- � Y-�~ � '�:'� � + " r � � r � �� � r�,,r„�"� ��--'*`�''�.: /'� ,�''�� ,,. �`�-_.., �%r` '�:'.t` ��� ��� �� ��� �� . �, .... ;eL�>�;7,.. �.:�G:'n.,,�F',t" y".,v"i:' ,L,. _. . 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J>�w. .���i��� . � a_.-�..� ' ,-,.�.�..�--�—_../ / .`�..1 �,.. � . .. . ; , . . . .s2>�M _.__._._ ..._ �--� - �.— ._.._._.... i.:;i-: ��. . . - v„ _.._bt�S .. .-�` • , - . . � ,-�J'_ .�:�,. _ _ ., a S..''.. . „ .... ....._ __z t�� . � � . , ,. .� .. _ . .�-- . , _....—`.�C' ..,. .�C.'c'-.%,^... _."S . / ..:�,,:._.-.r.:. � t t _ , : _ ,... i�� •%'_-•`�`--u -. i° ..�� ~� s� �J _........_.. ...- - .., .... ��j' .� . _ � � . _ � �t- ... .. ., ,- . : ' -�.- j���� 1 � —._.Z--__ � ' , . . .....__ _..... — �V .. i�_ , ' . . .. . =� ` �ea1t�� ,� �t�n�n����t�� �Ia��~opr���-�� C'1�ni��. P,��.. �� ����� �.��� F�ati�nt: �'�c����`��?���c� I�at�.; 3-?5_1� L�(��: G-15-�5 I)t�I: ?-��-1? �ab�ective: �VIs. "I`ha� con�pl�ins c�f t�pper back pain, mi� back��i��, h�a�ac.h�, ne�k pai�i, ri�ht knee�ain. ��s�c� ]c�t�;��:r l�aek�,�zn. Slze �t�tes t}�at h�r nc�k ar��.� u�?pc,r hac,k hurt t�� ��c�st tc��l��. 51a�.� states tl�at benc�in� her l�ea�.-� cic�����a t��c� much makes her i�ecl: }��arts r�3c�r� �±��e fe(t ri:�ie�°c:c� frs����the last chir��xac:tic tr�:atm�nt. Ob,jrective. C-onsidera�le h��p�:rtf�t�icitv is pal�ated i��the cer��i�:�l. tho�r�eic. �inc� lc�n�l�ar �t�usculatur��. �e:�;s�����t��l:sc��natic ��e�iu�zctio�� ri��t kz�e�; intGr-s��;n�e ntal �vs#��xs�cti��n ar�� :��erra��t �7c�t;c�n at C`j. C�, "I„'. �I.�, ,[.��. �[ 1 l, �,?, and I..4. "I�Gn�i�r��e�;s t�� p�ilpatit��� in the c�rt ic���, thc�?rr�cic. ar�� l�itz�h�zr re�:ic)n:�. �ssessment: �'��tic�:�-t �� �7�a�.it7�t� �;c>c�� �>r«�,r�:.s5. Plan: Tre�tment tc���y e��n�i�tec� ��i'tl�� f�3llo�ing;: , C'I�irc��ract��: ►��a��i���latic�r� ���:.z.tl�� ic➢ t��� in��ic.ai<.d �t��c�Y�.�l �;��r��;�t:;� � �3G'L'tZlCel� TT1tISl:�� `i�YlTlti�c���l{>I'I 4�'GLS c`��?�?�i('� lC' �}l� �It'�}�r�iC�ItIGIC�' T11liSC��:S ITl S�IE �};i��C . ��r�ist ��r�t �ack ����:� c��?��li�ci tc� th� �����?��°tc>��ic.it�• rn��s�l�ti ir� tl��:- 'e����:k , �t�#t tisst�e n�ass�l�e ���as a�}�1iec� tc� the affecf�d sc�f't tiss�ies i�� t}ze ��zc�c ar�d nec�; I°�}u l_:e�:, I�.�°. � �omm������� .�c�al�h � �'hiz��_�r�c~t�c� C'Iinic, P. �. ��;f. ���s� � �F�� 1'atient: C:t�c�n�"I�4��c, 3l��te: �-:�'"-�� I�Q�3; b-I 5-68 D()I: '-25-13 Su�iiecti�rc; E'��ie��t� ct�inpl��ins �f headac�he; rxeck pair�: u�pe�r h�ck �c� 1�?��f���°���c€� ��i�s, �s��� ri�ht ki�ee pain to�la��. 41�e �i�a�c:s that he�•h����3��ch� 't4 �uite �?�c� tc}tia�. `�1�� �t�t�s t��at ��cr��:�i=� c���tit�ue� tv b�afh�r e�=er;��cia�. `�he c-i�ratii�ue:� to�et°flelit fi°c�rz� l}ie�:'t7�ro�ra�tic �:ar�, O,bi���tive: Pal�at��r�� i�lspectic�z� rea�e��ec� cc�nsidexabl�1�;��e�c����cit�' in th� c�rvicE�l. t��c�ra�i�;, ar��i l�����ar���us�:ulat��re�. ������ez�tG�l.'�;t}i��atic 4��-sfiin�;tau�� ri�l�t �.��c��; �nt�.��se�;rt�er�t4�i ���f;ancti��,� and <��ec•r£int ttzr?tit�n ��t C ?, t'Ci, I�I. I,S, `I`i, �I�1�, I�=�, a��d L`�. Ittz�ierrt�:�;� tz? j��I��iti�?�i i,� t��e cc,r���ic�I, th��raci�:, ��J�c� lumb��r re�ican�, Assessment: .�'s��a�r�t is i�x����-c}�?���. P1an: Patiez�t ��as tr�atcd t��c��3�° ��it�� �he t�Ilo��-ir��: . C;hirc�prL�ctiL r��<3��ir��lati��n �elz`lti° Yc� ?1�e ir�t?icated �c:-t��rii �e4�f�:t=�t� .�lcupuncture t�� as�z�t chiropractic mai�ipui�tian ai7c� �x�ia�>rnil�ci ��ail� . Sa�t tis�ue m;i�s��c ��a� ap�lic<i tc� the affectcci scaft tissues Tc�u I��e�, T).C. � � C'om�r�un�t�� �c�a�th . ����"4���'���iC ��IIl1t', �. ��►.. ,��� �'��r� .Lee �atient: C:hc�n�"��h��? �Cd�4. 1."a�..���t .k DC�B: 6-1 S-6$ L)t�I: 2-25-1:� �nbiective: Pati�nt r�tt�rns for cl�irc�practi� treattne�li �u�ay #�r tl�G i��jtk��ie� sile s��st��n�Ei r�:sulting frt�zi� u"-?5-t 3 car ��cci�i�:n2. ��� ;tate�� tl:��t ��e h,�s �aic� i�3 h�;3���c�l:, up�er �<�ck tc� anic� bae.k, (c��rei• bac�, and right ���ee t�ada�. �ih�; states tl�<€t I��r hez�c�acl�e ��-��s �c�n� sh�rtl�° a�tir the ehiropractic�reatn�ent lasi�i5it. 51�� st�Ce� th�t th� la�t tr�:��t�z�eni ��a�, l,el��t�� her ar��i �he f��;ls a �ittle�it hetter��ci��. {)bj�ecti���: �e�r�:e�ltalrsotnatic �ivsfu«ciic�t� ri�;}�t ki�ee; i��tc.rse��nen:t�il ci��ft�nctic��� .�r�� ab�nan? a��c�tic�n �� CS�. C"��. �3�i. T2, "T`�. ��7, fil�. L�, anci I.�, �'t�I�atc>� irrs��.x�°tic�z� r�:��e<�le�i �c�n�;ider��hle ���±��S�t�tc�s�rc���- �s��:l�e cerv��:.�1, �l�f�r•aci�;, ���c� ���rr��c�r n7u4���§g�t�sr�4. y1�=��c��rz�e�s tt> �a����i<��� i�� t}��: ��.rvi�al. t}�c�r���ic. ����ci E���n�ar rc�dc�i�s. Assessment: Patitinl 5��:m:� t�� he n�akir�; � �,c?c�d �rz��r�;s5. 4'e;stercia�. I recei�ed tl�e p��tier�t`:� ?�-rati�rep��n ����n: �'c���a���3r I����sx�<� �r�c� 1 rr�:E�� �t, . Flan: I tre�te� g1Z� �atiettt�t�€�a�� ���itl� th� �'c��}c�c��in�: .Chiropractic manipulation �ently to the indicated vert�k�ral se�,mer�ts . Electrical �nu�cle st:i.���ulatit?�� j��s a��alied tc� the Ia��p�.r���s��i�:it� �xlustles i�� tl�� l>�icl� , Mcaist l�cat�a�k ��as z��plie� tcj the hy�ert�-�raicity� rz�ctscl�� �z�thf:, E���ck , Sc�ft tissui; r��as�age ��as a��Ii�ci #v tl�� at��ited sc�ft ti�:�u�s ii� tE��: ��e�;k an� ���ck Tou Lee. I�.(:. � ; ��IXII�IU����' .H�����1 ��li'!?�"J�`��'�I� ��1i11�. �. �. �� ���Y� L�� F�t�c;nt C`l�c�ng 'I'l�z�c� �3�t�. M�w?�3-I� I�(�I3: E-1�-68 I�C�I: 2-2�-13 Sub"ecti�re. Pa�ien�c����lains of he��c����h�, ri�ht knee: ��in. neck �a<�i�3, t1��er l��ck tc} mici h�ck ��i�. ��c3 1c����a� ha�:� :��iz� tc�c����•. ���e �t�t��t�at lz�:�r �<�ir ci�:�ti�3�,�s tr� h��t1��:4� �.�;.�����<� 4he }��a� 6� t�rr�E�le.headacl�e teac�a�i. `�I�� feit xelie��e� ii°�tn tt�e tr�atr���:nt la�t �isit, tl�b'___,��c#iv°�: Patient���� t���derness tc� pal��tic�n in the cer��ica1, tllc�raric, an�3 1�rz���ar r��ic�n�_ S��ment�rlf4at��ati� c3��1-un�:tic�n ri��3i {.°nee; interse�;zz����iai c��sf�r�ICtion aTZCi ����err���it rtic�tit��z at �;�, �':3, C:6, 'I 1, .I"� l,°�. �I?� T"1 i. I'1 r. I_�, anc� I�:�. I'ai�?atc�r�- i�zs�?ectic7n r����aled �;E�nsidera�l� �����?�ric���icitti in tl�� c�:�A�i��l, t�ZC,r��ci�:. G�t�� I�a����a�� €nusc��i��t��r�:�. ��sessment: �'at��►�; �aa� r�s��an���� ���ec�t���tcly tu r�cL�lt t��e��tn7ttat. I'c��la�. I r�L�i�e�1 t17e p�tient's X-ray filrzts frc�n� V�va�eur Iznagin� via rnail a��d I ti•ie���d ihetn. ���c�t?: �I`��ICtT3�C2� lt�t�42� �t?II'�l:�tzt� t)����1L, ��E.�?�s{310'1114�: , C�h�rc�p�raetic z�a�i�r�1�t��rt ��z�tly� �c� �h� inc�i�a�te�� ���,t�te�r�l s�.�rt�c��t� . �I�ctrical n�uscle stirt�ulatiot� ����s ap��ic:�i tc� the h����rti�n�ci?� �n�sscl�s i7� tl�e I,a�� . ���ist hat pack���s a��Iied t�c� ih� Ii��pGrtc�zlieity mi�scles in the back . �t�ft tissue t�a�sas�e �.*���� ��+�?lie�i tc� th� <�f'f���ctec� sc}ft tissa�::� ir� t�ie ���c�; <zt�c3 ����°l� Tc�u I,e�,, �,C;. = �+��nmunit�� ��aa�th � ��ll�'(J��'?�"�Cti� ��1�1IC. ����. �� �c�r� .��� �'atier;t: C'��c��7�ti`I'I�ac� llat�� �-�>-�3 I�t)B: 6_t>_C�� L7C�I: �-�:�-I; �ubiectxve: T��da�r. ��s� '["hac� cor7a�t�i�as c?i�hcadacl��;, neck ��ain, ���pez��a�k ��ain, inid b��� �ain, ri�ht l:nei �E��n. :�sid Ic����er ba�4; ���in. 4he states t��a# s}3� ��aa� head��ch� f`r��r�� tit:�e tc? tirn� �.fter th� �-�''�-1� c�r acci�ent. She �ta;es thz�t t���� i��c�. �ain at�� ��,�Lk �air� �c}nti����e tt� i��tcr�;:r� ��rth h�r�cti��ity° t�f4c�ail}° Ii�i���. She �tat�,� tl��t the la�t chrrc�pr�ct�c tre��tt�rrer�t �rt��idec� reli�f for her. ()�iect��e; Palp��c��°v i��:��a�c:tic�n r��°�;�le� cc��:�i�era�Sle�����+�rtcar�icit�� �����a�le iz1 the; ce���.ical. tl�c�r�cie, �nc� tii���bar ���usc��latul•es. �`e��der�l�s4 tc� pa��a�it�n i�z�t�� �;er������I, tlioracic�and Eazmbai° re�ic�ns. Se�n�ez�talisc�����tic �}'sf:u��cti��i1 ri�;��t �nec; a�tterse�zi���<t��l d�5i'u�actic>z� at�� aberrant ra�c�tit�J� �t 4:}�. ('�, C"Ei. 'I'�', 'I��, .I,�e I.�, "l�l l, �1"I�. I��. ar�� I,�. Assessmenti: Pati�nt c,on�inues Co im�rc���e and she is making a �oc,d pre��ress. P1an: �'atsc;nt ti��a:� tre,�te�i t�?da� l�it�� th� ft�>�t���:?t.�: . Cl�iro�ractic ma��ip�il��tic�r� �ei�tlti tc� the i�.�f:catc�i ��erti��Et�i >�;�t��cr�t4 . Electrical musc�e stiznul�tic�n ���as appli�;d t�� the ���°p�:���nicat� �����sc3e:�; it� t�ie t���ci� ,'��Ic�ist ho�pack ����s ap�li��i tcs the 1�y��ert��nicii�� �Z��c�es in t�le� �ack . .�3C>���;��L14. 2?7�14tiz3�?t'. ��`G�S ��'?�}ilt.'.'t� ii> i�IC: `e3�`ti,i'��'C� 4C?�1 11�>il('� ti? ��I� ��3i'�i :lTli� I�t'i'�i ��C>El �,����.f�. �' �`ommu�i��- 1���alt�a � ����"� �'���I� ��lI2I�, P.��.. �� I`c>€� L�� Patietzt: Cl�at�� ���'h�c? F���t�: � -: 1-l�� I?�B: 6-15-E�8 � DC)I; 2-��-1� Sub'ec� tive: PatienY ret��zrns f{3r chirc�practic ir�atment tt�c����� f«r th€: injl�ri��� s�e s�xs��ine� resul�in� f'rc���� � �-��pl j car ��rcic��llt, Sl��.y c��r���lai��4 c�i'n�:�l� �?d�i��. ri�lat kr��� �s�i�x. ��c��ac��e, u�per back tc� i�ni�i l���ck �?ai��, <�nci Ivd���;r bacl; pain tc�cia��. Sh�: �tatc, tt�at 1�er ���:k ���a� paiE�t��l �°esterda}° from �.�c�kin� ai�d washing dishes. She cc�ntin��e4 to b�:netit lroni the e.hirc7practic care. �he f�lt reli�v°ec� #'rc?ra� t��e l��st chirc?pr�ctic treat���ent. Obiective: `[�here i� cc�z��i��ra�le hy=p�i��nicii�f pal��t?le �n tl�� �c��tc;ric�-t-:.�r�,`ic�1,thc�ra�;ic, x�z�cl �um�ar r��;ic�77s. 'I"eti��rnc:�s t�� �ai���ti�>t� in t1�e c:r:r�=ic��l, tl�c�r���,ic, at��3 li���11���r a���i��s��. ��g��a�:rzt�lt`sc�?����t�c c���sfur�cti��r� �•i�}�t k��e.�; ic�ter4e�.j�c�at��l ���sf�i��cti��a� <�t�c� <��e:r°rL�T�fi ���f�ti<�t� at C:2, (�;3, C;h. "I l, 1'`� -1;�. I � l; "� 1`�. I:��, L�, <ztid I��. ,�.ssessment: 1'E�tient see���s tc� E1e ci�ai;iz�� a ��t��l prt��re�s ���1� tl�� mt�scie 1��;=�et-�c�nicit��� l��s d�cr�ase�i. I ref`�:.ret� '�f�. 1�l�4ic� c'ut tf�;-.�-ra1, ��` 0 �,�����:��z=°1���.�47ia�=�}. �Ilc �,rc.iLr?��:�i t�g ��} tt3r t�t� X-ra}��Iace ��l��re is c1t?�:�:r tta }Y�r ��c�u�e. t v��iil re��ieti� tltc: X-i°�:z� �ilir�:� t�it�7 ���s. "�h<��� ���hen tl���� be�;an�te�va�labi�. k'1an: `I�reata���.r�t t€���a� c���1�€,t�� c�#�t�i� �`c�llc���-it��. .�hirc�g�r�ctic tr�az�ipu��tic?n �e.i�t3�� to tl�e irx�iicatec� �.�e��tehral ���j7�c��ts , Electrical �t�u�cle �tiz�-�ulatit�x� ��-��s applie:d t� t}��; h�pertc�i�i�:iE�� r����sci�� :t� t��� t����:k .�'Ic?ist l�c,i ��ack���a> <��?�liec� tc� tl�e la���tr�c}t�icit�• rr�uscles i�3 t��e �a�k . Soft tissue ma�sa�c���s applie� tc� thc �ffect�d sc��t tissue� in the neck ��nci ba�k Tc��� �..e�, L7��;. _ �`a�munX��� �-leal�h � ��I�C} �"�C�I�' ��ll�ti�'. �.��, Jf I�r� L�� _ .�__�___ __r__�__ _�__� � __ _ _ � � Patie7�t� �°}��n� T�����:� I7ate: �-�-I� I�t3�3: 6-I�+-(i�s t7C?�: 2-25-�3 �abiecti��e: ��ti�n�c��nti=lt��s t� co�plaii� af heac�ache, ��eck �ain, up�er back to ��ni� ��ck p�ir�, right knee��is�, an� 1���•ex batk pain. ��h� state�that Iier s��t�npton�s are e�acerb��teii �y li#�ting, k�eav��cl�ar�in�, t��;neli���„ �r z���?etitiv� activitie5. �he states th�t she still has � l��t t�#���ain f`r«r�j tl�e �-2�-13 c.�r ac�i��r�t. �11e s�<�t�s t}��t the last c.hiro�ra�cti�: treatztierlt �rc��ide� ���lief�f'��r���t�. Qbjectiue: C€����id�ra�le ta �e�•ere n-�usc.le h��pert«nicit�� i� �aip�te�.� in th�. ��}st�ri�jr �er�i�:s�l, thora�i�. ��nti I�is��ar r��;ic�ns, �t�;n�eait�lis�?mat�� �la�:�ui�cti��r� ��i�;h� �n�s; ir�tcr��:��x�e.��t��J c�v��uncticar� �ir�d ���;rra�lt n�c�ti��t� �t C:�'. C:S, C;�i. 'I"'.^yl�:+. 'T`7. `T��?, "i`l I, I�l�'. L?. L,�. ant� I.,�. `I"ea�ciernc�ss ic� ���:1�E�titj�� ir� t�e c�;r��ic;stl, th��racic, at�ti 1€�t��7<�r r��i��x��. Assessment: 1'��tie��f i�; i;t�����t���i���. Pl�n: I treateci ?1��s. `T`I���o tc7cia�-ti��itl� th�: fc�ll�u��in�: .Chirc�practic n�:���i;?ulatie�rl ��ntly �t� t}�e in��ie��te� �;:rtei,r��s' ��;;,�r��er�ts < Electriaai musele stimulatic�n was applie�3 tt� t�I�e hv�ertc�nicity zn��s�;I�s i�� rl�t- �.�c� . �1c�ist hc�t ��ack ����� a��alied t€� the lxl�e�-t�?nicit� r�iu>c3es i�� t}zt back . Soft tissu� massa�e ��-as e��plied to the affected sc�1:t tissues ,I c�u �:.;€:�< L?.C`, s �ommun���- Heal�h Ch��o��,a��ic �lini�:. P.��.. � ���� Ir»� ,��� P�tien�u C"��c�z��'I�"��c� I)atc: 3-�-1� L7�B: 6-IS�fi�s � i){�I: 2-25-13 Subiertiv�� P�ti��t c:c�r���t4iins c�#vh�;atiziche, ►nid b<�ck ���in, ri��1t 1�nee }���i��, l���u�.r���� �air�, neck�ain, and u�p�r back p�in tf�d���. �he �tates that she ex�eri�nces pain ��l �he �ime�nd l��,r heac�ache is c��ite��vere tc�day. S�e �tat�s tllat she f�lt t�rr���c�ra�.���lief fr��m ti�e, la�� tre�t���ent. ObieCtive; Palpat�ry ins}�eetic��� rel�e�i�.c� ��t�siderable tE, se,�����r� h�=p�rtc�i�icit�� i�; �hc� �:�r��i�a?, th�racic, and iu�nbar n�lu�cul�tt�res. I'�tient I3ad tertderne.s� t� pa��ation i�� tk�c �.er�-�c�al. ���a��raeie, �u�tl l�t7n:haz-re�ic}r��. `�e�rt��:rlt�l:-�E��°t��t��: �1��<f��rsctii>12 ri�k�t �f���: intc:°t��;e�;z��e��tt�1 �.i��;f'�.���°ti���� z���c( ak�crrant ���c?tic�r.�t f:'', C.`�, t;(>. I �, "I"�, (:�, 1;" "I�{?, `��� l, I�i�, ��, a�l�� L�. �ssessment: F'atie.r°�t i> qu;te s�����ti�� tc? r����s�s��e a��.l �?al�ba�i��z��. Plan: Tre�tn�ent tc�day cc�nsistec� €�f�th� fc�llo�ving: . Chirc�practic mai�iptzlatic�n �entl`� tc� th� i��ciicated ti•irtehrai �e�;r�enis . I:��lccTrical n�ia5��e :�ti�t���iatic�n E�-as ����li�:c� t<� tl�e. I��-;�ert<:>��ic.�t�. ,x�iasLl�s iz� t��� ���c:l��. . Mozs� hc�t pack ��a� applied tc� the ll�=��;�-tc�F�icit�� muscle� it� t��e; �;�c� . S�ft tissuc� z�a4sa��. u�ray ap}�[i�;d tt:� tl�� �ffc�c;ted �«ft tis5uc�� ir�t��� r�eck ����d i�ack 'I'ou L�ee, L�.t�;, ,� �Qrra►m��n�t�� �e�1th �`h�raprac�ie �`Iinic. P.�.. �t ���� L�� Treatment P'1an F'atient �ame: C`���»��r `I,�a�i�� T�xte t�f Injc�r�. ?_�'�-l_� i?afe of�irth: �i-1 5-ti� D�te r�f��xa�rn: 2-2;-1; Chief Complaints: ��eadache, neck pair�. upper �aek paii�, n1ic� �ack p��in, Ic�t���.r hack � p�in, anc� right kriee pain. Uia�t�a�ses: I�L�eadac;he (784.C��e c;�ervical s�rain�`:�tra:i�� �$�7.t7�, t��ar�cic spr�i���strain (847.�}, lun��ar ��rain'st�•air� ���7.?}, ce;�-��ica� sublu���tic?� {�;�.�?$}. thc?r��ic subli�xatic�� (f�3�.?'l}, lu�nhar �ublu�atit�n (��{?.'t}), anc� se�rne�ta�.'s�r3�ati�, ci��stunctic�z� ri�;ht I�ne€; (r?9.C�). Treatm�nt Pr��raml:�ttc�daiiti�s: l. �hir€�prac�ic ��z�i��i1��i��n �;�ntl�.� t����c. i��di����:�: ���rt�el����l �:��r�l�nts 2. �:..�ecti°ical ���u��Ie stit���a1�z�.ic���t�� tl�e ����:rtt��i�t�it, r����scl�.� nt�t:�t� l�ac�: ii�r 1:? ��il�u��:� �. '����isi lic�t ��a�� tc� t}�e i�e��et;�i�i�;it, f��u���e; ir� tl�� t�acn fc�r :� ���i`�ut�� �. S�i't tissue ���assage to the a�f'ected s�ft tissues f�r l a minl�t�� �i. H��me stre�c;}����� �:xeriise t�� imprc?�=e t���erall r��n�e ��f Yric�ti��n Trcatment Frequencv: � ti�>�es �er �eek t�r at�c�ut f�ttr tc? tii e 4}eeks t�1en r�-evaivat�. Prognosis: Czuar�ed Goals: �'re-inj t�r�° status ,� ___ , .�_ , ti._ _ __ ��, .. � ��' � � Tou L�c.I�.��. _���_.____�__ �c • +�o �tt��t��� �ea�t� .: �`h��~c� r�c.��i�� �I����c�. �"'. �. �� z��� �.� �� ����;�:��� c:n���,������� � �Jatc;; �_2�_l; DC�I�: f>�-��-t3� D(�I; Z-25-1`� Subiecti�`e: '��. ��la�� is �z 4� �•ears c?I� fe���l����l�c� presez��� �c�cit��° ��-ith t�le c�}mpl<�ints <>�� �eadache, txet;k p��a��, a��er k��ck�ain, ��id �acl� pain, la��r�r I�ack�ain, an� ri�;ht kriee �ain f�ll�win�by�a?_��-13 car accid�i�t. �h�, states that ��n �� �cale t) tcs lO, 1� bein� se��ere, �h=�t sl�� �rould currentl�= rt�t� her ����;.rag� pair� ai abc�t�t �J out of l t:�, �h� st�tzs that slte w�s a seat-k�eItet� �asscnger siitin� in tl�e trc�nt�ass4:.n�er seat t���� 2012 `I'���•c�ta C'an�z�- tl�at �it a p�lice car th��t r� Chrough a r�c� light, Sh� st�t�s that she ���as in��olved in r��otc�r a-ehicle a�cid�nts �r� 2{�{�?, ?C}t}�, "'OC}�. t�nci �.l�c�ut ?{�l�? t,�� ?�?1 1 . 4��� i� �.urr�;nfl� t�r�e���plc:�rec�. �1�`ec���, I'lct�sc 4ee (°"I�I. ��aix�i��atic�t� f��rt�� f��r ��~tl�<>;�=::<lie t�.5.:�. a��i��: �:er�•ieal ��t3ci i���t��3tir I"lin�� ()5�7:1�7LI�)II. Tf:�C'Lt':` tt.�`;`?. ia2tiz!E.SI:b :iliE':.�?C�1 tf`�\. i117t� '�)432�I C�L�jI'{.�1�"t.' �IT1C�lz2i_';i. , �iG�,'T11CTlI`u'�;`�Ci`I?G1$iC C�a1;;�Ll�tC`�''s�?Ii t`I�`�ll d4I3Ci;: IIlI�ISf:f�,'S;C'-Iltzfi t�1�;�tiCli.:lit:sl"; ii27i.� <i��C':'1`��Ilt �4€t>1;5`=I1 :42 �i, �J, �'�, �{�, � �. ^I�, � >. � �. �C}, `�� �, � 1�, ��,�, �.�_ ?I�t"� �`�. Asses�mei�t. I ��l�t� ?i� s�citr ;�1;;. `I�l���c> c��ii 1i��- X-r�.��� z��ax:: o��� iz-4��:'��r=:�. it�at�t it�yl�;t�i1i�;. f�?;°�r7?����� c.neroachtnerzt, anor�i�if�:�, ��r c�t��er c.,�nlpli�atic�r�s th�t rni�ht t��:cz�ntr�iz�dicati<>r� t<7 cl�ir�3pr�c:�tic treat�t�ent. I rc��n�men��� t1x�}t '��s. "I'l�a� untier�c�es th�°�c ti��l�s �tr ����:�k f'c}r ��E�����t f���ir tc� fivi; weel�s af'con�en�ative �a�5i��e care cc�l�si�ting �rimaril}� ��t i3�i���practic mzu�ip��l�tiv� ther��y a� tt?lerated and t�ther passi��e mc-�dalities tc� ccmp�ement tl�c� �7�ani�i�i�ti1��: treatnitn� inc;ii�c�i1�� �lec:�ricai t��u4�1� stin�ula�ic�n, rnc�i�t ��c>t ���a�k, ��1� sL�it ti�sue �slass���:: ti�ei� �-c-exz�z77. I <acl�i�e�i '�'Ss. Tha�; nc�t tc� lif't <��- c�z-n an�-t��i��g �tat•1 tc� �r������t ��;�ravt�tit�t� c?f l�c:r ����ZC;iti��.�. `I�l�� pr��nc�si� iti �;uarci�ti. Plan: I'�����,���it�� ���e e:���7��it�atic��� t��c�a�. '�-'�s. T������ 1�as �r€:��t�� ��•;�1� �hi�•c��raetic ����ini�+u�b�tii?r� �entl}� tc� t��c �nc�i��tec� ��rte�t�4a1 ��:�r�ler3ts 4��d �t��t tis>u� �1�a:����e ��� i��e af#�ctcci s���t�is�:���>. `I�au I.ee, TJ.C:. � � C�IVIIkIt,�ht�`TY H�AL.T`H GHI�Rt'�PRA�TIC GL.,I�IIC l�.,A. CT'L �XX.��.��I:�ATIC?:� fiC7R.:'�1 r , .8�f11$�iY 1�'�:>C:AY;.:,'. 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C C C 3 -� � .. ._.. , ,_' � x :J .- ... . . ... ... ... .. .,.> �_ .. � . :�= �ommunit�g �Iealth . . . . . .�;�: �haxc���a�#�� C1�n�e, P'.A. ���: ����� ���� �����r�����- ��. �t��_; �ttr'. I)a��it� k. C'«d�� "l�h� �`c?c��- Ifa�� (.�ro��� C:h��z��r�� 3�� C.'ammc rce C'c>t�rt �'a�l��ai:: Il�i�lits, ?�1� ����'? ���; �`�>t��r C'l��:iltz'C.)«r P�ri_ient: C1���t�� �l��lzd�c? I)ate of�3irtt�: £�-IS-fi� I�a1� c�#`Inj�zt���: ?-?'�-1 y L?ear ��tt�. C`��c��: ;�`�s �'r�t� �;r7c���. '���. 'E"�Sa« lza�; h�i:t� tr�;Git��� ��t z��� c���fi�� ii�r t��:: in,��ri�� s���; �u�f,�it�eci ��c.;;t,�Ifiirt� (i°����t � t-`Lbrt�;�t� ��. �'�J I? ��1�3�1�: �c:�i�i;;tat, `�}3� �t��ic�� tl�,�t �l�e: ��;:�:�<� ��at-���lt�t� ��as5�n�er 4ittir�f,� in tl�e fi°��nt p<�s�;e���er �eat ��t t� ?{}l? I-����<}tzi C'atnr� that hit E� pc�lice car �hat �ai���h����ls�,t� a d-e� li�llt. ()n F�br�uaz� '�, 2�}l>, 'v1s. 'I.ht�c� presen�ed in my c�fticc��litil the fc�l�r����in� cc�m�laints� headache_ n�ck pai1�. u}�p�:r I�ack �ai��, znid �ar.k pain, lc?�,��er�?ack�ain, �nd right knc��� pait°�. � I �}Lrf��rr���,c� �� cc�����itt� �la�5iea� �;������i��<�1ii��� c,s� '�'i4. 1 l��zf:? ;lt���i�-�� he�- ir�itial �i:�it i�� t7��' �,t�fa�:e. �Ihe i��it�<�l 4ii<��.�r�t�s<� ���:�� 1��acit�cll�: t♦:��-�.4��, c€:r�ical �prail�.str�iin t�±4j.t)). thc�ra�it s�r�iil'strain {�47.1}, lt��l�b�r s�rain!strt�in {8�7.2), cer�>�c��l st�bluKation (8>��.(}�), tlu>r�i�i� st��ltthx�tit?t� {8 i��.?�). ��irt�l��r st�hl�i�:ati<�7� (���).?r};�. aa�t� �,e�r�t���i��l "�c�a����ti� dysfi�n�tit���� ri�ht ki�e� (7,�9,C�}. 1�9y treatme.nt incluc�Gti ehirc��r�a�tic adj����tm�.nts. electrical �nus�l�; stirriulatic�n, r�tc�ist h�t pack. at�d sr�f't ti�sue massat�e. In ac�ditit�i� t�r� the ii� c�f'�ice tr�atir�e�7t. u�e c�id pr«��id� ���i� a�it�� a c:�,�rx-�� c�f�rc�l�ti�hi[it��ti�°� �tretc6�isl� ��nc� tlexihilitti �x�:r�i:�cs. {)ur f:itirc��rac€ic tre�tit7��nt�; ha�� ��r�?t icled �1�. '1�hac� ��itii :;��:zlifiicar�t �yi���t�jr����tic r�:iie°f' an�� ilnpr�����x� l��r f��n�,tic�nal c�i�at�ilitie�. �`he znitial tre�trs���r� fr�:c�ue-nci�� at C;o���n7unit� He��lt}l Chiz-���r�etic C`lir�ic, P_,��. ti��e.�e tl�r�;e ti���es �i►����el:_ ;'�s lier cc�r�c�itic�t� irn�r���ed, tl�e tri.:ati���:��t fi•c:z�uer�ci�:� ���;re; rei����ec�. C'urrentl�°, she i4 tre��tin�c�n .�"PR?�„ �a.�is. (��4?t1(iT�tic;i�} _ _._ ___ __ ....._ _ _. _ ,�'l:' �i:.t1�',rr_57,.! �:�i"fIetc� ��,.I:tii ' �;F:l�t< i�3.lti'I �I� . IFIj' It1<t;#=�,rre. ff��rt-;��� �.,,ria • ftlt: r�Sl.F-1,4_ .y1Fi ; �on�mur�it�y �Ie�lt� :� . . . . r�t:� �hi�"t}��"i�C�'1C ��i�llC� �«�. �� T`rrt� 1 c'c� `I}3at:}. C`l�c>��� l:'E:a�;s: '' i>f� T}�e ser�+ices I �rc�vide�! ��er�: neces�ar� <ifld i��;re caus�ill� relate.ci tr> tl�� accident c�f� F°e2>ni�r� '�. '(}1�, `I'l}e �arrr��?cant tl���t I r��4zr�ecl fi�r- tl�c ��r�;ices �:.�� s�e;�s��t�a�k�l�° ��t t1�� �i���c: and �tace tha�the s�r�-ic�;4��er� prc��,ic��ti, [f'`°c�u �re in nce:d c�f`��rzy��tl�9itit�rl��1 itaft�rrnatic���. �1�:��s� ci�� nc�t }�e�it��t� tc� ct�r�t��ct rt��o ,C�h��r�k vc��a. � . `° ��"`�_ �, r, _�{��� I:�:�. 1),C',. '�1.`�. _ __ _ _ _ __ _ __ __ _ __ —......... . .s a 1ir�f � a'<F, _���3 '�F.a-t��a�r�= #,�::�r_t,, t.��_, �1�1',�trr. �1_ :. l��r`r�t>?arf,+s- r#i�?i-;;`��°..,.,rrri • 1 i�.t rr��j;.�,i" °vJt; � �c�n��r����r��t�, �c.�alt� . �'��i���� �����°�.�� ���������� ��� . ��� ����� ��A£$ P�tiet�t: C`l�c���� "�1����� Date: t)-1 �--1� I?OF�: �-1�-t��d I�C:)I� �-��-1:� Suh'ecti�c,� :�1s. �:I���c� �:ijrn�+���ir�� nf n�:c� �ai��, 1����-er t���:� �a�3i��, u��er t�ack tc� rnid ��c� pain, �n�l ri�f�t ��:c� ��zir� tc�c�ici��. 5��t st�te4 th�t !-�c�r:;c�r�.����it�t� ar�: �iirc:ct�� rela��.c�i tc> t��e 2d�1-13 �:ar ac�:ic��;tlt. ����: st��te� [f��t :�}�� f'eei� ��c;ttur r�c>�e c�:}�za���r�uci t�a l?tii�re.. �he �,tat�� tP��t tl�t I�z�t �:3�;rc���r����ic tr�t�t�t�c��� a?rc���iti�d r�;lict`��:,r �,�r. O�,ecti�c `�c�.j����?.�1.<c�x��txti� �it�t=�r:��iu�� rit�;:t �:��r��, z����z�:��:�tnLr�t��l d�4f�.nctic�r� ��ci abe�rrant �2�otio� �zt� C'�. ��C"l. �l �4 'I�c�, ��1�, �n� I��. f'al��tar�• ins��ct�c�t�r��ea.led r��ilti musc��lar hy��rtonirit�• ��t�l�ah;� �n f�e t�t�sterfnr �er�:c�l. ���c�racic, u���cl 3��n�har �t��ter}c�r re�ia�7s. �'ati�r�t hac� ic���:�G��°t�css tt� ���l���ti�:��> >i� t��U �.er���ical, tl��or�cic:, an� 1um�?ar i°e�ic�ns. Assessrnent: �'rr>�nt��is i� �c����i. Pfan: 'I�r���t �l,e ���atieait on �'IZ'`v �iu�i�. "I r���tc��e:�t tt�cia� c;c�a1`ist�cl t�t t�1�: i�>ll����°ir��: .�.�11P(��}is�C?i� illiiiii��ii:lti(�"s3 i.',till��i tE) �}st' tili�t(:f]$f::{a �f:i�C'��I'il� Si',;:I71t'Z1tS .�l�ctric�l nau�cle sti�nt�lati�?n ����� ap�liec� ta the hyper�o�icit�� n�f�4c.les in the �ack . ?������� l?c�t �?ack ��'ti� ��?�1�e�3 tt� th� 1"���e.i'tr�rx�cE'v ��'t��c'°Ls �I? �?�e; ��,s�:� . ��i't iiss�e rllassa�?e w�as a}�pliec� ta t11�; afticted sof`t tissues Tt�u I�ee, I).�.°. � �� {��ar����u������� ��.���t� � k' � i • �{ � ������ �'`c-����{�� �-������.�4 �s:'�1• t�1: �t`1Ll �L'f,' �c3�i�fl�: �,ali)I34.? ��31zi�> �'��t; �%_�k>�t I.7l.ttJ. �?—.e...4.._�1f1 L��i. ^—��'�-'� S�bl�cti�e: '�`Is. Tlir�c� �c�r���iai��s c-�t��eck �ain, u��er E��c:k t� zni�� back pait�, Ic�w�r�aack p�in_ anc� ri�ilt kn�:e ���ix� tc�da�. Sh� 4t�tes t���t r�n a sc4����£�-�ta 1��, l t� l�ein� s����;re, th�t sh� «=�3��I� c���cntjt rz�tc l��r G��er�i�� p��i�� ��t�tt�c�t�t gic��at ���f 1�. ���� 4�atc.s th��t l�cr ;;}�=�`��tc�r�s ha�:�� imp��ti?�ed c3�•er tllt cc>ur:;�, t>f chirapracti���artc�ft;at h4r �aa��eral� pain h�.s redu�:ed. S�xe �tat�:� t��at �,l�e; �ic�G;� r���t �°°�w�a�a•ie��c�:s p��ir� as s���;�.}� �s �ef:«re. �l�c, st��Ls t�a�t thc chirt��racti� trcat�s��nt� �r� ��el�3�ul fc��h��• in r�lie���ng 13er��in. �bieetiti�e: �I`�1e3•e is �ni�d �����er2c�r�i�;it�� palp�blc if� tlz� ��r�i��I,��c�ratir., �nd lun�bar rnu�ci7lat��res. �G�n�t:��tG�lis<��natic �?�f`�unczii}�� iitJ?it k��c:�: int{:.rse�s�ental d�'�fi�nctic���t�� aberrant i��c�ti�-�n �� C��?, ��l, T?,�I��1`'. ��a<� L.�. `�I�"�:��d�rn�ss tc> ������atic�x� it� the c�rs�ical, tht�raeie, a�id Iuml�ar re�Itzns. Assessment. Pa:ient cer•tai3�1�- (�a� iT���rt��-ecl fron� the chirt��ractir. tre�tments that she reccivec�. �I`lae� w�.:�.�c�rit�� ���l��r�rain �ta4 r���t��,�� fr�t�� �).`1�3�c� > l�� s;nc� �€���€ it�itial e�atni'�:�tiE:�n I Ite t31t�5�,+: �zl�,er-ttyi..��tl ��z��.l t�*�c��rne:�s �z��:�e tic;�re<j4�:��. I3ec:�G�s� c�f'��e�� great in�pr��t•en�ent. 1 �ecidcci tc� treat the patie�tt ��n �'Rti �?asis. ...—,--�. Plan. `I r�cat pati�:nt ot �������;�,� Treatn�ent t���a�- �.onsisted r�t t�le t€�l�c�wi���: � .Chiro�r�ic�tic m�nipul�tion �e�ltiy ta tl�e zndicated �=erte�ral se���7ent� .Electric��d t�3u�;�le stir��ulatiQn was appliec� tc7 the hypertc�nicitv r��uscl�s in the back .h�oist hc�t p�ct� ���a5 a��lied tc� fl�� h�y-pertc��i�it�° €nusc3es in tli��aack . �c�ft ti�s��� mr��s,��c ��'a� a�,�lied tc�t}�e ��f�i�cttcl s���`t tiss�.�i:� T��l��:e, ��.��, � ��rnr��c���t�� c���t�� . ��l�i"C)�t"�1�.'�14�� �������, .:�►. I.�r: T'rJr� Ct��� Pati�n�: t.'!��>�i��' _I�Ci�:��? I)at�. 9-{�-1� f�t3I3: ��w�;�r�4 I�OI: �-�fi-1= Subiecti�e: I'�tie�it c{7t��plains �f nec��?ain, upp�r back pain, mid baek pain to lc�wer�ack pain, ar��i ri��t l:nc�e paii� tc�ciay. �h�. st�2�s that h�r pair� can�inues ta h�th�r her and interfert ���itl� 12er �a�ti�-itii�< cFt dz�il�P li�°i���. �h� ie,# re���ve�3 (a•arr� t}le 'sast c�irc��ractzc tr��tsx�L���. Cl�jeeti�•e: l'ct�<��.rne�5 tc7 ����i��ati�zl ir� tl�e cer��ic.al, tl�c?rs3ci�, �n�i liim�ar re�io��s. 5e�mental/s�rn�tzc d�°��uncti��z ri�la�t kt�c�e; inters�����ent�al �}�sfur�ctio�z and aberrant �nr�tic�� at C'2, C'C�. �I�`�_,I�, ,I'�, �I`S l. �z�c� I.�. `T�l�er�: is n�id�i 1��>�e1-i«r�i�ifi� �alpahlc ii1 tlir�en°ieal. thc�raci�, az�d �u����r r��c�sc;ulat��x��s, A�sessment: F'7�c}�na4is iti g«��c3 ��nci �}ae is ir���.ki���;� �c�c�d �?r���r�:��;. Pl�n: P�ti�,nt��tis treateci t��c��t� ��ri�(� t�t:� �'c����}���i��: � . Chira�+r�ctiG �nE���i;,t�i€�tion �,ent1�- t� the iz�di��tcc� ��er������i ���rmenzs . F�:lectric��l n���:�ilc: �tii���z3ati;,n t�,�a� applied t� i_(�c h���?ert�nicit�� m��s�l�,� in tl�e �?�ek . I��oist ����t �}a�;3� t��� a����i�:c� t�, tl�� �}����;rtc�r�ici�ti° ;�a�s�;les in tl�L 1?ac� . Sc�ft tissue massa�e ���a� a��lieci t� the affe�ted soft ti��ues '[�c�u I:c�e, 1�7.C`. .� �.�'c��n�������i��� ��.��I�h + � s • Chirop�-�ctic �,I�n��, P.��. ��� �r��� re� �7ii�.lt;�1�:. �_�(�f.�:��:' .k �ii�4' �BtG: �)_=�-�5 ��)��: (r-�`-f>� �.)�)r' �-�'�-��s �;abiectil�e: T�odat�, tlt� ��ati���t a•e.tur��s ����a}� ft�r tl7e chiro�ractie triatment �l�or tl�e inj��rie� she sustainecl re��iltir�g fr�a��z a 2-�5-I 3 car accicient, She st�tes that sl»ttas �ain in her n�ck, up�er back, n�id t?ack, ic���er t��ck, anc� right kr3�e toda}�. She c{�ntinues to �enefit frr�rs�� tl�e c��;i�c+�?r�-�c;ti�, care, ()�iceti�e: I',�l���tc}r} iFss��ct���r1 re�,ei�l�:ci rx�i(d 1�����i�tc���icit�� ;�al�;at�lz: in tl�e cervical, tharacic, ari�� }umhar rilusc�ilat�res. Ten�i�,rnes�ta pal�?�tioY3 in tl�e cervieal, tharacic; an� l�un�ar re�ic�ns. S�;�r��ental��5�?��atic c�v�functi��n ri�,t�t knee; ir3tersegin�ntal di�sf�t��lction and aberrant m«tic�rl at C'2. C6, 'I�l, �T7, T12, L4, and I.S. Assessment: F'�itierlt i� i�lakiti�.r, a goc?�i prc��ress. Plan: P��tien� ���as treate�� tc�c�a�� t��itll th� f���ili���-in�. . C:hirc��ractic rz�arai���l<�tit��� s��-ni[�° t�� thc ini��ica�ecj �ei-tebr�tl s���rr�ents . Electric.��zl mtil��:le stirz�ulatit�n G��as �ipplieci ta tl�� hy��.rt�ilicrt}� muscles in t1�e baci� . ?�1c-,i�� 1��>t pa�i� �{{�� ��t�:ie:i tt� tllt ?�v}�ec•tti}��ic:it� r��;.tcle� i��t tl�� �a��: . Sc�ft tissl�e massa�e u•as <�pplied to the affectec� sc,ft tissues Tc�u 1_.ee. I�.C:. .�_ �:`ott�nlun�t� �c����th ��'Elt`Q�}}l'�('�'1C' ��II111', P.:�'�►. nr: T'c>u L�� �'atier�t: C'h�t;€� �I'}�t�c> Date: B-�R-I� I)()13: �?-1�-EiR DOI: ?-?�-1; Subiective: F'atient �•et�arns f'�r chirc��ractic care t«clay f�or th�. injuries she sustained resulting fr��iz� a ?=?�-I 3 cat�aceident. S}�� e�arnpla�ns c�f upper back pain, neck pain, mid baek�ain tc> lt����er t�aek pa:n. anJ sc�re�less in }�e�r ri�l�t krlee tc�d���°. Sl�e states t}aat tlle last e��irc�p�°t��tic trE:aE���ent }�<.�� ?�el��e�. . _ Oblecfi���e: I'alp�3t«r�� in,����;�ii�n re�eal�;�3 rs7ilc� ntu�cle hypertc�r�icit�' in th�posteri��r tlxe cen�ica(, thoracic, �nt�i l�iz�lbar i•��ions. �I`end�r���ss t� palpation in the cervical, thoracic, and 3umbar regions. �e�,inent��li�c�mt3tic c�ysfizi�ctic�zi rigl�t kr�e�, in�terse�menlal ��ysfi�nctic�n and aberrar�t i��uti��n ��t f`?. C(i. T?, T�, T1?. �n�3 L�. �ssessnxent: Prf�gnc�sis is �z�ac�. P1an: I'atient ti�-as treated tc�d3�• ���ith the fo11c����ing� .Cl�irapr�ctic r1�a.nipulatiiar� �eritll�tc� tl3e in�iii:-��t�:.d verfiebral se�;r���nts . Electric�l int�scle stin�ulatiE>�� ti��as ap�lied to the ht-pertc�r�ieity� muscles in the t�ac�k . I�1c�i�t hi�>t ��auk ����s a}�p,ie�3 t�7 t}�e ra}�p�:rtc���icitv rt�s�r4cles il� the hack . Soft tis�ue massage ��as app;ied t<� tlze al�#'�:ctec� sc�ft tissues Tou Lce, I).C�. .� Cc�mm��nit�� Healt�l� �hir���►r-ac�ti€.� �`linic�, P.1�. r�t: r���� L�=� I'ati�nE: C"�►1{�n� �I���•a�� Date: 8=?6-1� DC}�: (,-]�-t�� DOI: ?-?�_1� Snbiective: '1�9s. "�I�hac� c��mpl��ins �3t'neck pait�, U��er hack to �nici baek pain. l�v�rer back pai�t, az�d ri�l�t k��ee p�in t�7��a��. Sh�; state� tll��t shr:1�G��; ���ore pE�in in tl��; h�r u�per back and neck tc�c����-_ She: (��lt r�:li�ti-c�3 f'rc�z�z� t�ie l�ist tr���t;���e�lt. (Jbieeti��e: `�egmet�t<�;`si�i���tic citisf��s�ctian ri�l�t kslce; i�Ittrsegn�entt�l ci}sf�znctic�n a�i� a�?errant rnc�ticsi� at C'2, `1��, �I�?, `I��1"?, and I.��. Te�ndc-rness tc� �alpatic�n in the �.er�ical, thc�ra�ic, �at�d lu��E���t- re�;i��n4. �I`?�ere is n�iltl t�t�p�rt��nicit� �alpahle in tl�e- cer�•ical, th��racic. and lumbar tnu;�culatlir�es. Assessment: l'rt��rii�si� i� �c�c:>i�. Plan: �I`reatment tt�ciay cc}nsisted c�f the fc?31t����in�: . Chirt�pr��ctic m��nipul��ti��n �eritl�� t�� thc indic<�t�=c� ver-�ehr��l se�r��e�1�� . Eiectrical z��iascle stimalat�e�r� ua� ����lied 1c� the hy�ertc�nieat�° �r�usc.le:: ir� the back . �-'It?ist ht}? �?ac� ua� a��plieci t�� t��e h��cr•tc?rici;� t7���sc:ies ;z� t3��: l�ack . Soft ti�sue massa�e ti4°as applied to the affected sc�ft ti�sues "I�c-�u I,ee. D.C'. � � � Commu���t�� �H��Ith � L ����~{��r����� i...� ������ .����l.• �,�� �1)ft �.£.'t' P�ti�t�i: Che����TI�a€� I7ate: R-v i-x� DC)g: (�-15-t�� D(�I: L-�'�i-(� �Subiec#i4�c: �1�. T�aa�� c�����pl�ir;s c�f��Gck ��ii;. 1����er 1�<��k ��7ir. }�e���iG�che. ��pper hack tc� s�icl ��c:k �6�i��. �rz�i rif>}�t }�t��e �air� tc��a}. `s'�c st.����� th�st ��-c+lc����t� sittin� c�r staradin�;, liftin�. c�r r��etiti�%� acti�itic�s �T:al:e� }��;r pair� �lc�rse. '�l�� statc�ti���i ���� Iast ctziroprt�cti� tz�e�t:me��t �?�����ic�c:c� �°�Ii���t'��r ���:�� Obiectiz�e: `���,m�nial'�;E:,r�i��ti� �l��sfa���ctic>�� r��l�t �t�ec.; ir�t�;��;e�rz�e.ntal c���sf��nctic�r� a�xci abcrrant n�t�tic�t� �t C"4. Tl. T5. �'9. T�2. an� I,:�. �alp.it�?r�° t��s�e�iit�n re;ve�lei� tnild hS'��'rtoni�.��� �aa�?<able i�� #��e �.`r�:�ic.4�1. tliara�cic. �3n�1 lt��nh��r Fn��s�ul3ture�. Tenderness tc� ��alp�tic>n i�� th�: ��c��� ��r�� ��.r���o �ssessment: Prc?�t�c�tii� is s�c�«cl. �'lan: Tre�tment t€�t�a�� cc��lsist�ci c�f�t:l1e f-c?l��ati�rin�: . t'l�irt�practic r����t�i�?�a�G�ti���� �e�tl�� tt� tl�e it��i���t�ci �-�:rte�z��z1 �c�:r���:nts , �.I�c:tric�l tt��jsc�� sti:n��lati{:�n ���a5 ��?��li�;d tc? the ����pert�nzcit���z���scic�� in tF�e hack . ?��Ic�i�t hc�t ���ek r�a� a���]'e�� t� �i�c: !�}•���rtc�nieit�° r�r����te� in t}�e hsac[� . Sc�ft ti5sui� tr�assa�?e ��as ��p��li��l tz� t��c: :�f`1��t�c� s���t tissues Tc�u Lee, I�.C�. �' �omm��init��T �Hcalrh � , Chiropractic Clinic, Ff1�.. _ r�� T��I� L�� P�ti�z�t: C'ho11g Th�t� i�ate: �-;�?-1:s L}C}�3: 6-1 s-62i I�t�I. ?-25-i� �ubieetir•e: �'atient repc�rts �>f r�tck }�ziir�, upper l���ek p��in, mid back p�in, lo��rer back ��in, anci ri�i�t knec ����in. She �t��tes that she� fe�ls t��uc.�� b�tter �ZC��� can�pared t� befc�re az�d tl�at her sym�.�tc�rns �j�3ve irt3l�rt���ec�. �he f�elt r�=lievecl frat�� t�e I�.�s� tr�;atanez�t. Obiective: '��1ild h��pertonicit�}� is nated in �he c�rvical, thor�cie, anci lumbar rn�sculatt�res. 5egtnental'sc�maii� c1��5#�ur�cti��n ri�l�t knee; interse�inental d}�sfunetic�ri�nd aberra��t m�tic�n aC C2. C fi, 'I°". �'S. �I��. ��I�12, 1,�, ��� I.;. Tr.ndern�ss t� palpati��T� �n the eervical, thc�r�cic, an�i ltzmr�ti- �-L�i�nS. Asses�t: Pr�gnosis is gt>i>� and the z�luscfe hypertonicity l�as d�ereased. Plaii: T�-eats�,errt tc��ia�� ic�r�4i4tet� ��f tl�e- foitowiz��;: . C'hir���ractic mani�aulatic�n �cntly tc� tl�� indicated �rer�.eb��al �e�ments . EA:le�trie��l z�:�€�cl� 4tit��4�iatii�r7 u;�5 zig�pli�:�? t�> tY�e �����?ec�tc,nic�t� ��uscics i�� tl�e h���k . Moist hot pack was applied io the l�yp�rtonicit} muscie4 in the �iack . �oft tissti� nl�.�s��e �r���< ;��-�I�liecl tc� the afl-ecteci �oft tissues Z�ou Lee, �.C'. � C'omm��n�t�� Health � • . . � . . Ch�rapra�t�c �..11ni�, P.��. ��: Tt��� r���� Patient: C'Izt�n� �l,h�t� �7ate: 8-t�i-I s I�E�}�: 6-1 S-6f� I)(}I: �-2>-14 Suhiecti��e. I'�tie,nt r�t��rr�� tc��l;��� f���� tl:e �hirta}�rac-tic treat�s�ei�t fc�r tl�e ii�j��ries s��� su�tained resciltin� frc�n� a �?�`�;_l� car Gicc�ident_ �}�e c��mplains c,f'he��ciacl�e. n�ck �ain, b�ck pain, anc� r��ht knee paii�tc>c�ay°. I'a�icr�t �tat�s tl��3t �;1�� is frttst��attd t��� l�e�� physicaI lin�itatic�i�s. Qbieetivc; P<ilpatary' insp�ction reve�le� ���iid tc� tnoderate h}�pertonicity palpabie in thC� ce-rvical. thc�r�cic, a��t� lu«ib�r r��u�culatures. Se�r�Ze�lt�lisr�n��tic ciysf�tinctic7n right kn�e; iilterse�me�ltal d�>sfu��ctiarl anc� aherrant rl�otian �t C"2, C6, 7'?, 'I���. '�I��9, T 11, and ��5, Tenc�erness tc� palpatit�n in t13�� cGr�ri�a?. tE�c�r�ci�;, anc� 1��m�?3r re�i�n�. Assessment: I'ragnosis is gc�od. Plan: Pati�nt ��-as trea€e� t�da�� ���ith tl�e ft�llou�riil�� . Chir�practic manipulati��n �entlt-t« tlle indicated vertebral s�t;ments . F_,�ectrical r�,��scle stit���.iia<.ic>r t�;s a;���lic>�.� t�� t��e ljv�irt��r,ic�t� mu5cle� i:t the back . Ntoist hat pack was a�plied ta the 1-�ypert��ni�ity �Y�uscles in the b�ck . Sc�ft tissue ma�s3ge ��:as a}�;�lie:� ±c� t3�e aft�ctec� soft tis��te� "I�t�u I.ee, I�.C'�, � Communit��� Hc�alth ��lli"O�}t'���1� ��IIIiC, �.�. 1)� 'I'rtrr 1�E� 1'atient: Cl�c��Y��I�h�iu I�att: �-l�-13 DC)��: f�-l:�-E�� L7(�I: 2-��-1� finblective: `I't,c�a�-. tl�e �?ati�i�t cc�m�lains �?f neek �ain, �ipper t�ack pain, heacia�.he, mid t�ack pai�l, l�j���r b:ici: �?aii�, al��i ris:flt kr�et �?�;:�:T�. �}7G sEates t}�.�t �l�c: is gettin� hetter z�c�tk an�i �E�e se��rit�� «i`l�er pain 1�a5 c�ecreasec�. She state� tlzat tl�e c}�irc?practic treatrryent� prc?vicie �u�st�ntia6 relicf for her. �bieetive: S�gm�r�t�l`son�atic d�=sfunctic�n right knee: interseg�nental d�'sfunctic�n an�i a�errant mation e�t C,?< �E>, T1. T7. �i�12, I_,4. anc� I,5_ Tenc�ern�.ss ta pal�atic�n in the cervical. thc�racic, and lt�mbar regi����s. '�1ii� t� �lc�aerate hy�pi:rt�izicity is tic3ted in t��� cervical, thoracic, and lumbar n�i�scul�t�re5. Assessmenf: Progr�asi:� i� �o�7ti. "I�h� mtxsile t�}�pert�»licit�� has decreas�.d. j�l�R: �Tl,ditl`�17t lCwii.:\ �;ti:)[��i�1�C� i?� ;;li: �E']�(��l;t?��'. . Chiropractic nzani�?�.tlattot� �;ently t�� the ir�dic�ted �seriek�ral sc�r���nt� .Electrie��1 �?�uscle �tin�i�latior� u�as appliec� tc� the llvpert�nicity m���cle� in the ba�k .Moist ��t�t pa�k ���as appEi�d to the li�•�Lrt��nicit}� m�z��le-;� ii� tlae t���ck . 5t>ft ti�sue ����l�s��=c t�r;s ��p��lies3 tc, t}�e ��ffecte�� sc�lt tisst�e,. Tr�u I,ce, I).C'. .� C'c�mmunit�� Hea1�h � ` � . . �hir�practi�° �;�inlc, P.��. c��: Tr�r� Lc�cj Patient: C;hon�'1�'h��a �I�atc_ 8-�-!� I)�I3; �i-15-(i8 DOI: ?-2`?-1� �ubi�ti; �,�s. �I�hac� repc�rts of l�taciaclz�, n�;ck pai��, ti�?pet� E?ac�; ��ain, i��i�� b��ck paira. It�wer�ack �air�, ari�i r��;l�t k=it:� ��air� tc�ci��. She �tates th��t s��e 17a� �i�a�ia��1u e�ery ��t�t�° ��nd th�t� s����e thr '.-��-'i �:ar �3cci<ient. She states t}Z��t slle i;� frustrate�i s��smetimes becaus�:. c�f hcr pain anci headaclie. Obi��; �'loder�i� hy��erj�?t�icity is r�c�t�a in tl�e cei�vical, thor�cic, and lun�bar musclzlature�, Segn��ntal�sc�matie c�5`si�u��ctic�n rigl�t knee�; it�Cerseg�lental d��stunctic�n ai�d aberrat�t z-nation at C:2, C6, 'I��"?, -I�, "�r 1 1. and 1_,`�. �`e����'rrtess tc� �alpatic�n in �Il� cer��ical. thoracic, anci lumhar re�ions. Asses�t: �'rc?�nc�sis is �o�7�i ancj sl�e is makii�� a gc��?� prc}�;res4. Plan: �t rti att�i�r3t tc?�at' �:«n�ist�� c?1�t1��: Cc�lla��'i���: .Chiro�rac,tic maz�ipulatic�n �e�ltty to the if»iicat�d �-er#e1�ra1 ���ments .Electrical n1i���le stir��u]aCior� ���as a}�pti�� t� ihe h}�pertonicitv nluscles in ihe back . Mc�ist hot p�3ck ��a� ��ppl��� t«tl�� 3,y}�t��tt�nict�y z������i�=� ir� t.��� b�icl� . S��i't tis���e r��assa�e ���is <����,li�L°cl tc> t!�e af�l-ectec! sc,it t�ssue� Tc��Lee, ll.�'. � 1...��������t"�'Y I .i�'c.`����� , �. . . i�)l: �f)tl ��'C' � �hlrc�p�r�c�t�c �`��n��, P',��. F'a��er�t: (�;��ct�� ..��1����� �)ate: R-y-l� I)(�13: ��-�h-�;� T�C�I: �-��-�_} Sub'eeti�°e, �'atier�t ::tates tl�at s}ae �;�:p�riencc.��air�in h�:r r�eck. �z�p�er ne k t u����r�c� __._!�----- ri�ht knee= �u1d to����r�ack tod�}�. S�e d�mc�n5trates�f rnc��-��a�n�n tc>�iat'. 5��� �t{�tc�th�t l<}c3kit�s� ��:�ti�'�} t�?�-? �?1u�t� a�-��k�s ller nLck ��urts m<�re. (�bi� e� ��-�,��r��`=;;`' t��' 4���1}���ti��=��;�ne�., inr�.i�.�l.��`nt�a� ci� funciio hand al�err�nt �r�c�tic�t� t,.-�> �e�tnental'�c��°��=�t�� ����unctic�n ri�h g � at�`2, C:;6, �`�s°��, °�11. 1.�, <�n� I�;�. �'za��?�7tc�r�� i��5�i��t'son r�4���led rne�cier�te ��t��r�c�ni��ty, �alpable it�th�; ����'i�'.al. tlzc�r�cic, anc� 1urz�b:3r z����sc�i4��t��r��. :�SSQSgII1CIt�: �`c1Clt:i3� 1S I71%��ITIL;c`I LT.C}�� ��S'�>��.TI't:4,�, �t2C� t�1t. sz•C;4.'_I €_`�i5 i� �'Cl{1L�, P1an: Patient was txeated tr�day�}jith the follc�wing: .C`hirc��ractic r��ani�ulatic�n �ent[�T tc�the indic�teci ���rte'�r��1 �c�r�aents .E.te�tric<il muscle stinlulatic�n wa:�a�a�li�ri tn tl�e hy��rtc�r�ic��m���c� in the ba�:k .Mc��st t��t pa�.� ��°as ���ppl�e�4 t�� t���;�������rtc�nicit�' ����c��,� �z� . Sc�ft tisst�e i��assa�e was ap�?tie� t�the affected so�i ti���.��s °Tou Lee. I).�`. �...� �"omm ��it�� c.������ � . , . � . . ����{��'�t��.���� ��-������� �s��s - iT ,�+�'C' �� �t� F'atier.t: t"I�t�n;.� 7`ltt�E:-> , „ ��s`i�C',: l—`!]_i� 1�(�B' f?-?�-()4 �(�1; ?-Z�_l� �u�iYective: l L��la�. 1,°��, "I`1.�it� �:����,,�1>�i��� i-�i�J�ea�����;1��-, r�L:ck ��E�ir�� u�p�r�.ict� tc� �ni� h,�c�; �ain, lu��°er k�E�c� �s7in. a��c� ri��t k.ti�e ��ain tr.�d�iv �l�e st��t�s t1���t hcr ct��nplaiatt� �r� dire�tl� rc:lat�{j te� the �' ,�`1�+ �:��r :s��:ic�ent. Sh�.� ;t�t�;� th��t sh� c�t� nc�� Ii!`t an��thira� f�ea���° �i�catxse c�f hc:r 1}ack ����� frc�m tl�c: "?�,'l�; iar acci��e��t. Ot�jective: ��c�tier��t� l�ti}�e�-tc���icit� is pa���ad�:u iri it��; �e�����.al, t}�c�rt�ci�, anc� le�r��l�t-�r �nusc�ilature�. `�e��n�ntall�c�m�iic d��sfu�etian ri�l�t knee; in�c.rsc�rnental dysfunctic�n and ��ezxant mc��inn �t �,'2, C;f�, TI, '�1��7, T12, 1=t, and L�. Ter�derrses5 tt� �alpatic>n in the cer�°ica3, t}���r�cic. �i��rc� 1���aiE�s�r ��e�ic��24. ,��ses� I}rc��t�<,�;i� i4 t;«E��. Pl�n. Ps�ti�;t�t ����s tr�at�;ci t�����° 1�:'it}� t��c f��?�lc���i��g: .�hirt�pra�.tic m�����zlation �e��tl�° tt� th�; ir��iic�itcd��ertc t�r�� s�s����ei�t5 .El�cfir��:b�l ��u��.l�; ��i�z�ttlat����: ���4 a����li�;cl tc� tl�� h����r-ti���ic,��� rrit���..1�,:: �� llae �a�k . Moist hc�t pa�:k ���as ap}�liec� tc� t�he h}=pc�-tt�nicit�� r�;usc�es in��a� �?ack � . �c�ft tissue c�YassG�4,�G ��as ap�Iie�i t�� tl�e �ff�c:ted �c�?ft ti:�sue4 �`c�u IJei. I�.��. , � �"on� �� �t-�� ���a�t�h � t . . �~-� . . ��1ir0��"��C'�1�.' �..��IIIIC. .��. I)r. 7"r�rr I��� �'atieni: C'ilc��a� I�1����� I.�at�: -�-�'�)-�3 I)(��3: t�-I;-t;4 I�t)I� �'-`Z,~_1; Snbjeetive: Patic�lt cc�mplaz��s tc�day c�3:u}��er �ack �ain, 1c>�,er bacl� pain, mid back pain, neck pain,and right �ne� p�in. Sh� stat�s that �he �till has �ain f�r��m the 2-��-13 ear ac-cident. �he �tate� that hc���ai�� ;�ncs �T� ���c� �ca���rl d��en�,i��; t�x� }3�r�����il� ���ti�it��;�. _Cbiec�ive: I'�1��t{�r�° i��sS�rctif�a7 reG�ealcc� a������er��t� 1�����;�°tc���icitcr ir: ;I�� c�rvic,al, t���r�cic:, �r�ti lum�ar mt�sculatut-�.�. Se�Yn��1tal='somatic ���f�uncti�n ri�l�t l�r�e�,; int�rsc�t�n�:n�al �ys�'uncti�� �nc� a��rrant motic��z ��t(�;��. C`h. I"�, "I��S, 'I�1 l. I_,�, r�nc� I:`�. �T�r-n�crne.:�� tc���l�atic�n in the�en�ic�I, thc�ra�ic, and luz��ar rc�gi�-�r�s. Assessment: Patient is ma�:i��� a �ot�� pr��ress. � Pla�. Ms, Thac� ��� tre:�tect t��av witl� t1�� f�llo���it��� . C.hirc�practic rz�ar�ip��latic�r� g�;ntls tc� i��:, inc�ic�te.ci ���r�eE�ral �G.����c:r�ts . �lectrical muscl� stii�ntzla�ita�, ����as a�plied ���th� hti�pert���ieit�� �n��scl�s in the bac�k . ?��I�i�t 1�{7t }�a:� ��as ���piii�i t�} t��e }7ti-p�ri�nbcit� r���zscle� :�1 :}�e �����: . S�fr tissue n�assa�e ti��a5 ap�liecl t� tl�e, �ff�,ete�i soft ti��ue5 "1�c��z Le�. I�.CF. , �: �'o�m��ni��y He��th . � C�hir�r��ra�t�c �'linic, P.��. ��: ���� �.��f� ������,�: c:������:�n���� �)ate: ?-2?-1� L)t��3: t>_�:�-��� �4I: `'-z�-1� � �ut�i�etive: C;��?�� r�tc�i•��� tc}da�' fc�r the chir��r�ctii t��ee�tmer�t for the inj�iri��s�i� ��tsfiaitl�t� r����itir�f� f`r���� �� "-�:�-(3 c��r<��cid�:nt. 41�c r�p�,rts c�f lc}urer�ac� p��n, ne�k ��ir�. upper back tc� ����d ���;� ��ait3. 4�n�i r°i�ht I�nee p�in tc��ay. Sl�� �c�ntin�s�s tc� ben�f�t f`ron� thc �,h€rc��r:��tic care� �biecti��e< �����;:re is r��t�d�r��te hs�?e��tc�n�c it} �al��abl� in t}�e c�;r�i�<�1, thc�raci�:, ;�i�d �t.tm��r r��usc�.ilatur�s. 4e�ni���tal:`sc��n��tic c�ysfunctic�F7 right k�lee; irlte�-se�;mental c�i�si�rnctit�i� �r�c� abet`r�n� ����t:����-���"'. C'(;. `�I]� "�I�{:?. `I�1 t. �T�!`?. a��d I_�_ `I�er�cl�rl�c,ss to ��I�?.�ti�?n ir� t�� � c�.r��ical, ih��racic. az3� ltzi3�bar re�ic�ns. Assessment: Patzent is makin� a t�aod progress. Plan: Treatmc,nt tc�c���• cr��siste�d c?f the fc�llowin�: . C'h�a�s��,��a�:�ic �n�r�ig���(t�ti�3�� 4�c:rstl� ic� t��� i=.ld�c��t��i 1Lxt�:hr:�I �c�r���r�t:� . Eleeiric�l rntas�le stinx�rlat�ic�n u'3s applied C�the hti=pertc?nicit�� mu�cEes in t}�e ��c.k _ �1c�ist 1�c�t ���:1� ��a� a��?�ie�� t�� tl�c. I�t��ert«�zicitti t����s4Ic5 ira thc hG��� . Sc�ft ti�st�e: rt��.�;s��€° ����:: ap��licd tc� t1�e atfectec� sof-t tisstres `I"t-��a�_,�:�:4 I).�", : �c�mmunit.�, ����t� . ����{��.}�'i���t�.� �������, �:��• �P. �(Jii �L'[' �'�ti�z�t: C1zc�z�� I"h���� I}�te: ��1 t�_t i �{�T�. �-1�-E�� Lll.l1. ^`�1_? t S�bi�cCi��e: 'vls. T1���7 c-�»t��iain� �?f headaehe, ne.ck ��ain.�ipper ���k tc7 ic��er back p�in, �nc� righi k���e pain tc�cl��y. ��e st�t�s t��t�� l�er I�eaclache is q�zite �ac� t��t�ai�. She states ihat she is���vin� a h<zrd .ir��c ��r�c�:.nt.r;.tir�c�tc�c�ay h�c€�?�se of'h�r ��ir� at�c� he��ci��c}�e. t�hiect���e: F'al�at£?a-� i��s}��ct.��r� rca��<.�lec3 m��cicrate h�,'��.rt���it;ii�� i�� ihe cer�•ic;a�, thc�rac�ca ��ci lumhar ��usci�l��tures. `fe�r��:r�t�l;sc�rr�atic ci��sfunctin�� ri���� kn�ey intez•se�mez�tal �i��functic�n a��t� ab�rr���t ���g�ti�?r� �� �'�, C`��, '1�1, T5. �T��}. �`12, I_�, �d L��S_ T����ci�rne�4 te� ��lpatit��� in tl�e. cervic�S, t}�c�rr��:ic, a��d ]�unbar reg�c�zas. Assessment: F'rogr���si1 i� ������c�. Y'lan, I�1s. "l��hao ��-as tre��tcc€ tr�da�° ���itl� the fc>]locvin�: >Cllirc�practic ��l,�ni��zl��tic�t� �,�c��t1� tc� ti��: indi�ate� verte����al se����ents . A����uncture to �ssist chirt��z�acti�, �r���r�i�ulatinn �nci rninit��ir�r��ain . iiC��:$ 1.t541it I'IzI;�4i1�C' iS.3", ��'��_�::�-� d€# i�1k' t3�ff'i:t�:Cz wC?�� tt5'�li�:°s �C��1 �.:�t.'. �).�v. � Cc�rr�mun�t��� �ealth . '�. � � . . � �h�ro�����c��I� ��.��n�c, P.�'�. ��; ��a�� ������ Treatment Plan Pati�nt Nazn�; t�°}���n� �C��liao Date of Injur�=: v-25-13 Date of�3irth: �i-��-f}�; I)ate n#'Re-F..,xar�: ?_1,-i? C;hief Camnlaints: l_I�;adache, �zc��. pai��, up�er �ack p��ir�, r�ti�i back �ain, It�wer E�ack �a�ino ��nd ri�1�i kne.e paiz.. Dia�nc�ses: Neaciaclte (75�.0), cer��ic�zl s�?rairU'strain (847.t}j,th«r�cic �prain!strain {�47.1}, ltimbar s�?rainf'�traiz� 4`8�7.?), c�:r��ic:al sut?1u��tit�n {839.08}, thcaracic sut�luxation {���#.`'.t�, I�zr�l��r s�.�hl�a�,atic�r� (��t).`'(l}. ���d se�n�erct�l.'sr�������i� cl�'sf�r��ti�n ri�l�t k��ee � t�-�`?.�;t. 'I`r�a�rr�cnt �'rcf�raml:��oc[aliti�s: 1. Chirc��ractic n�ani�,ulatic�n �entiy to the indicated vertehral segn�e.nts ?. I;lectric�l rr���scl�. :�tirnula?ic�r� tc�t}�e l�}=�e.rt�r�ici��> n����cle� it� th� t��ck fc�r �� n�iz��te� 3. I�foi�t iu�r��ack tc� �h�;�����ae�rtar�ici�y n�uscl�s in t��, �ack �e�r 1 S minu�es �. Soft tissi�e �nassa�e tc� tne aff�cted sc��t tissues f�r 15 mznutes � Trea�tment Freauencv: � t�-� ? ti�nes �e�•u�ee�k Fc�r a�c�ut tv���1�� visit� then r�-�;v�Iua#e. Prt��nc�ris: Ci������ Goals; 1're-i��jt�rs �tt�tu� -, _, , _. _ � �,- _�-. - , . h�-� - -:: �.�� _k..:,�f _.. ........._.._ TC}U: f t, � �,l' � .. f n�.� ;` _�.; : �c�mmt�n�t�� �ealth �. . . . , . . �'h�roprac��c� C..1�n�c, �',:�.� 1��: r��r� ���� I2E�-EXAMI:�'ATION � Patieni: C`I�e�n� Tli�c� , T)ate; 7-1�-1� D��3: 6-1�-fi� DOI: 2-25-13 Snbieetiv�: �I����t�,��-. '��t4_ �E�l�ao Got���lains t7f i�e��ci�c:�le, ��eck pai��. ��ppe-r l���ck pair�, �:�i{��aci: �i pain> Ic���er b��ek paial, al�d rit;ht kne� �ain, She st�te� tl���t c�n a scale 0 tr� 10; IC� ��in� se�ere, ! that she u�c�irld eurrently ra�e her a��et�age �ain at a�nut � ��rzt of� l 0, She state� that her sy�mp�oms � have imprt�tired a���i 17er paii� t7as ��e�illceel c����r�tl�e c�urse c�i�el�irc�pra�:tic� care. Sl1e states that �� sitting ar siandif�� ft�r Ion� p�riods t>f�time, liftin�anything heavy, �erformin� certain acti�ities, i, or heavier �l�}�sieal c�ertion r��akes I�er �ain ti�-«rse. She fiel� better u�itl� chiroprac2i�treatment I� and rest. �he �tates that the c�riropractic tr�atments are hel�f��il �inci he-nefieial for h�r. � ' C}bjective: Piease sc�e ��TI, �xa�t�ination furn� f<}r �ervical and lu��har rang� of�miatit�li, �i orthopedzc tests, nlu�cle�s strengthen tests. retl�xes tesis, muscl� hvpertc�nzcit}r, and other 'I ohjeetive fin�3ir��s. Se�;mLntal sc�matic �i�sfunction rigl�t ���ee; int�rsc�ment��l ci�stunction ��nd ; aberrant motic�n at C2, C'S, CC, T1, 'T�?, 'I���, �I'9, T11. T12. I_,=�, and I�3. � Assessment; '��s. 'i�har� certai��l�� has irr��r�leci �i�ci thE- s�ier�iC� «f�}��r a��e.r�a�e p�ir� �ias re-�u�,ecl fi�om 9i10 to Srr`1C} sir�ce the initial examin�tion. H_�r ra�i��; c�i i�lotzon is ti��ithin nc�nnal Iimit. Her muscle hypert��nicity an� t�nde�•ne5s 1�����e c�e�reasc-c�. 1 rec-�n�t�len�i�d tl�at '���. T��a�� l�n��r��es chir�prac�ic care as itldic�tet� ir� thc tr��tr��ent �lan. �I�h� pr���nc��is i� �o<�d. Plan: I �erfi�rn�e� a re-exar7�inaiior� ort ��Is. T`llafl today. Sh�: u-as als��tr�ated tnday witlt �� chiropractic tnanipula�tic�n �enti}� to t�ile ;n�i���t�;c3 �•�,rt��rai Le��n�;nt�. �;le-ctric�f r��uscl� s�in�ulatit�f�. mc�ist hr�t p���ck, ��nd sc?f't tiss�i� massage. i "I'au I,ee, I}.C. Ct�MMt�iNIT'Y H�ALTH �HIRt?PF�ACTIG �Li�i� P.A, C;TL ��i�7iNAT`TC�:� FOI�.�� �. _._ y�l'Y'c�il.,�`i�r a .�Sir� /�e i .�.....,.... _.. ..._.� �� f ? £',,w. ,' , ...�.<x"i�'e _.—..�.... .. ... . �✓ .„�st e/� ..v�."T�d •� . . . , r�. . ° ..-......�m...- __"__ -_ r , A..,,_. _.,W....,,- � ��� F3}'' a _.__ HEIGHT ��,�`E:CiHT �- . L 7 S>� _ i���- ;'... � �x;-� �v� ``-r` "� %. E F M�°I'I(�'`i CERVICA� �,�;x���x .x ° .� �fexian � x _ FEex��� '��, ,. -�`c� �-;, Extansion „� . Exte�sia� "� �.�Ldt�i°A w.� r�< ��'�..�'>�'i�?� /?S L,T Lat FEexic�� f4 :,T Lat �I�x �..__..e:�?�. f j�� � �3C � ' �- RT���ation = RT Rt��ticr; � ��` ���--�._�S� �'�e ° �,T R�tation � i$� �-%�" ,��t L�`R�tat��n � ��€� � __ �<�_�....�°� . _ . , , , , , , _ �rt�tp1� T�t�r �+ ^� f r ;.�� t� =: .', . , , >.=�,�,�_./ { � ., ,� _..;/ > k. < . ... ; , +3dfl;l�l;tlP�i::�t �_, " ;.. � .. j} T C� .i T b:; -.-, ' .,;,: _ � _ p P.w, r„�,r"4 F��cI'r�a�k �_ ,� , : ., � �{em�s F.._. �, �� , . <v� '..C'..-!'� `�� .� � ,_.. Tve �Jtslx � FZ i'� � r .�^"<b�c�;� t. �� ������r�sr� B�chttrt�v'� L R -� �-_ A1'en`s?`esi L R '- Ce�'vical C4m�. L R ? . �� �. `+'a(s�3�a . � R - �ttAUldcr Lomp, L R.� - � ��': r t�'rig;�t`s T`�s; L F °- _ _.._me � . � � ;°.�e� _ Fr „ ��'.� r�ds��a's"I��t �, � '`�. ��r�`�e�!�:�trcc;:e� 3,. _ ,. . _ � ;_�� ��Bi t; R_ t ��-: �ustoa.a��, '��.st L R S�ur;ng>s�'es, � ,. �� ° � _„�,��-., _ ���.T_�s�rs ;._ ,. r. ;- ��I� � L R .. ; , .._ - _. , � � � ,��. G�e�:����`� = L_�- �_r. , .:�:<�. ',��< s-.. -,- _ f_� < G�_ ., -__ : . L � �- » Pa�;ic§� ����re -L� � Braggards ; �.' LR with C-F!e���r: � R � M�(�ra^rf�s L R �- .._._.__._.�e� �°����` ,. k'it tiE _ Hib�'sTost ;, R _ Ye�mar:`s `�'e�; L. :o � - x- ��. ,��-t< � �t��'�'�`es; � :t ,_..� �_ _'� `�er�a', E�..�.�_..� ^��� r�.r:� , t��iT7S LE�TIt.��;GTH'I`EST'a � Left Righ; �ef� R:�h' Sho�;3derShn;g �� � .5 — De';c � t i� r4 �. � Bi�opsC�-6 _ _� '" f5 `�,:ce�s �.� � :�. l� - �f�la"t�Xt,�`� f,j '� ,e �,�'E":w` � vX � '� � '`� . . ` � � �. . �-�., .-- . fnf�Y::�r��.' A ' " ,� �� ?C �'t�agCt Fiex t,� . , ; Tib�nt L" ,_ _��__,._ ;'� � F•:xt �-3�> Lg L� _u.�, r� P�ronctis Lg SI �';� " ` %�_ _ C..�ANIAL N�RYES �.- ,- ,r _ ,�. (����i��Cj3�h 'fi �'.�ir:i l' °, `' �J �� �F��:�S`W:�. �. i � (S�Scnsat;.n'r^�te= -� �=y , � c�:tly ! '�; '�ie�rRr�� � E�r.- �.� 1 a i? �if, `li?"f�o : 1 4.' �'!'il �+.'1,R 3�t,S Y�^? � i -� � " L {9, t 4)Swailvw � . , , ` . �_ ., R,�FLEXES –.��sent � H��pn ,. ?�o;-n.;ai , F:;:{�e- = vpn, � „?' ,�. � -> L �.. �-�.�.;�:�d r�.t.i _.� L Biceps CS-5 �-- � E .�� -�t,__ .:tei��zr i�.a K �z� �"�a�tps C? R =- I- .� �Gk:ilieS Si-? �__�._. _ �''�"--- �..� �n�: � �. .. C���ur��� H��c.�rx �H��a��AC �c C�.���c P,A. � c�r�, ���c�TA�r�o;� �o��� ; F�t�`rI��+T�d�s?�,�� " �r'��`� _.�, - �B�U��l0II1'��T'Ct13S�Ui1 , L.eve1 = Tcndcr�scss P�ipatE��° � '"�I�:s�'!�s � Hy�crtOnt�it}` fFi.�1� � '7 f # i�j;'v: �( � {� 4 �. �7� t 1 ,.,�5;,, Ft.fyt r3 ! : ' r t" f -c. i J";:veCv: U? "�_...��"d; Z.�t''.� # � k �';'6 CZ.3US i.. `xf'..F'` c�j' � i ,.�: f` i' '� i ` � t ;i���..� � 1 { Y t, ,_,{,y8('e( .�'iC&'" i6� �`�� �3S��ItbO{.�i � � f_�. ! i ' .. � �C,ItOiQ � ,-.'-�� ' ' _ � ` �' %; j` >i�� LCt'YiCB; PSt65 i�18l,c �- ` � ' � � � "��19r�CiC at8sa;tt9; � `Y``� c' `{� � � \ � . �� i ,:m�ar ��a:asG'r:p' ,�'.; �'1.�? ; ' r� � '11..;cus { E '��-�„� j _ f i �3r:��^f`;;'sS . � id �_.�...f�...,+..( �:.< . ; "`_�';Y � _ E S� � r.:, i . . . j ,��..:'.�.` � 1 T�7 } � i< ( � ! � � ° i i � �,� -T-��-1----3 E k.. , ,_.- i ��.� � � .�...�... � -� : � �f,. E t :"'" ."�` �, i ��:'� 3 e, ; Y f� ;� �;•,n y�` t ; :,,r„�'' j . _ 5 T � ( ' f ' ... 1 � :i.; �"""� ^ �+� , .�\ r ,?"� i � ` ; .�� � (�' f �-.��..�' ''.,v' �> ��C' � � t � �i r ,.: � ,r i 'y� , C�` n_ t { / a,• I �3 ( y £ i �� t � �.k i Y � , , f � � : '�., � : ; .. �� � } . � ' , �M.� ; `�,. l� _�} . . ry�.� E � � ��� �3�� R��+ � . i . .. . . ..��� t � € �t7�C; �:.:�� ��''�,•---° - ' .�(?ti^.��C�:'�S �I�22'�TI.L�'� �"+*~""" ' r x_, � �, r ..,� � � � T C^� t ;1S S C I�t' f l� � T,Cdt 8:� . hC G � S��"�C S �',8.r v;. ' y i.���nd; �'-��i;; t 3�' �=5pas� � � � �,. ��r ,;-;,r�t;.. ._ . ..., ._ � e:;; � ��-;so a�;�4r�zis(fir,�:n�s Wt�L-kv�t�l;n nor;�;a: I,a�,ti; ;�! ,��s,.;x� , j^c��;�va .c�;^ . umv,a. � F�i�C.�. G r.�. � �om�x��������� �ealth .. ♦ "! e s � ��ll�'(?�l'c`���lC`. ���-III�I�`� .�..��. D�: "1'rt�� Lt�,� P�tien�: �:.hc>�£� "I'k��c� I�ate: 7-�2-l> I�C�I3: t�-�i-t�� T)�I: 2-2 S-1:� Subiecxivc: Patient reparts c�f I�e�dach�, neck pain, up�er L�ack p�in, t�iid ba�� pain< Ic�ti�er k�a�k ��ain. e��ci ri�ht kn�e �airx. S�� states thc�t hcr �ac;k ��as �ainfazl last ni�ht #rc�m cookin�anc� cleanin�. She felt re��aeved frc�m tlie lasi treatm�nt, � C�biective: 't�lc�tiera�c 1�����et�i��niei�S� i� nated i�l the cervical. �}���racit:, ati�3 I�tn�f�<�r �nusc�ulatur�s. 4�;�ment�lis��atic c���functit�n r•i���t k���e: in�t�rse�rzlen�al c�ys��unctior� ar�c� aben�nl mc�ti4-�n at C�?, C`6, `T?, T5, T9, T12, I�2, L�, a�l�i I,S, Tez-��erness tc��aipa�iol� it� i��cer��i�;ai,tl�oracic, ar�d lunlhar� re�iar�s. Assessment: I pl�n tc� re-��xarrr t���pa�i�.t7i �n the��:.xt ��isit. Plan: Trcat�nent tf7dav cz�i�sistec� ��f�the �'c�ilc����in�;: .Chir�apractic �nani�ul�tic�n �entl�'ti�o Ch�e indic�tec� r-�rtc.�ir�l �L�xn���ts . �:lee�riczi} ;�k2scl� stil���zlatic,�� �ti��:� a��Iie.c� t� th� ���ertc?n:cit�° n�uscl�s it� t}�e �ac�:. . �c�ist hc�# p<�ck ��as �i��?liec3 tc� "th� hy��:rt�}t�ieit� t��tscle�, ira ti�c hack .Saft tisst�c massa�e ti�as <����liecl to tl�e aFfectecl s€�f1 tissues `I`c�u Lee. D.C;. �o��unit�� Health � . �hirt�p�-���t��.� �'linic, �'.�►. ���: ���� ���t� ��i��.�r: ���'���� -�.����;, ����: 7-t ta-�� r�c��: �-�s-�s � ���. 4�3.���;�t �ubiecfi��e: �ts. "I°ha�� returns tada}�fc�r th� ehirc�pr�ctic tr�atm�t�t f�r thr; itljurie�s s�e sustained resul2in� trc�m a ?-2�-13 car accid�nt. �he cc�mplain� of having pain in h�r n�c�k, entire up��r l�ack tc� lc��•er t�ack, and rigl�t knee t<?cia}�. `�}�e s€ates that her sv�r�pt�zns ha�e itt��res�,�eci a ic>i t��'�r tl�e c{�urse c?t`�.hi�-t��racti�; ���-e. `���� slates �l�ae �l�e f�c�l�, l��it��� �t�ar� �ompar�d tc� �efc�re. (3biective: "1�`er���ernes� ��� ��l�a�i€��� i�� tl��� c�rv°ica1, th��•a�i�, and lumbar regi���s. �egmentalz`sr�mati� c�}tsftxr�cticf�� right kt�ee; i�1�er�e�;r��e��t�1 d�-s#i�nctic��� ��nd .�l�errant m��ic�n at C2, C:�, 'I°2, `�`7, `I�'1 �, 1;�, ��n� �,�. 1'�Ipatory� ins�ection rt����-�alz� m�acf�r�it�, h���ertr�nicily palpable in the�;er��ic�al, th��°acic. ai�� l��ml�ar t��u��:ulaturc�s. Assessment: �'atient is rrza�il�g���;c�oti �ro�ress. "l��he �r��asc.�e 1����?ertc�nieiC�� has decr��s�ci� Ptan: �'atient ��as trLate.c� tc�d��= ���it}� the ��a[It�c��in�: .Chiropra�tic r���ipufatic��� g�ritl�° fira the inc�icated �-ert�br�I �e�rnen�s . Electri�:ai �IC�4cli� sti�nt�iatic�i� w��_4 ���l�cci t€� t}�� I��-�?�rtc���ic-it� �nu�c:les in the ksack .I��oist ht�t �ack G�as ap�lied tc� th� ��y�?�rtc�nicit� tn��scic:5 ir� t}��: b��ck . 5c�ft tissue rnassage wa> applieci tr� thc; atfectec� sc�1t tiss��t;s � Tou Iaee. D.C�. ,;. �`orr�m��nit-�� He�lt�h ��I1�'()�Y"�t'�:1€.` l_..��1�1�C, P`.:�. 1)r: Tr�rc L,��� �'a��t��t; C:l��:�rf.t I�:ac� I�ate: i-��-1�' �C:}B: f�-14-b8 I�C)I; �-25-13 �ubiective: �'ati�nt� c�m�l�i�1s of li€�ht h�ad��h�. n�.ck �air�, r��per l,�Gk ��in, micl bac� �ain to lower haek �air�, and riE„ht knee pain �oda��, She�tates that hcr s�rmptc�ms are r�lated tc� tl�e �?-?�-1 i €�r�r acc.ide��t. �he statcs hcr �t�ir� in�r�.as�:� ���ith Ii(tin�, he��ier physi�al ex�rtion, c�r r�;�etiti�=� activ�ties. C)t�iecti�°e: YI'�����err��:4�: t�� ���t��4�tz��t� it� th� cer�ic-�I. t�����-acic;. �z��� I�ztt�l�ar re��v���, ��grr�entai,'sorr�afiic d�=sfunc,t��r� ri���� knee: int�;rsegmental d}sfi�n�ti�>n �nci a1��rr�nt m�tio� at �?, C'�i, 'I�2, T�, T�, Tl l. ���d I,=�. �I.herc. is ���c�d�rz�te t�� c�>��i��er��l?l� h��pertc�t�ici��� �al�al�le in the�er��i�al, tl�c�racic, �nr� li�����r ti�u�cul�itur��. Asses�men#: Pro�n�jsis is �����i. � P`lan: P{�tien� ���as tre�tec� t«�4��' ��%iti� t��� 1c�ilck��ir��� .Chirc�practi� r��anipuiatic}n �ently� t�� the indi�atec� �e.rte����al se����:nt� .Elec,trical rni�scl�; stir�zulatit��i wa�a��ali�d t�tli� hy�pert{�nicit���nuscles �n tl�e. hack .?Vloist l�ot pac.�: was ap�liecl tc� the�l�r prrtc�nir.it�'rnuscle� in t}�i; ��ack . �c�ft tissu� ma�;�agt ��°��s ap�liec3 tc� il�e a�f�cted �c�fr tfssue� 'Tc�u I_�ee. D.C, I .� � ���mm��lit��� I���I�h � '� C�hir��pr�c��tic �linic* �.�. r��: ����f r��� Patient: C:�c�n� '����a� I��t�: °7-1-�:� I)(}B: 6-1�-6� Dt�i: v-��-I:� �ubiectiti=e: M�. "I�hao repc�rts �f neck �air�, upper back tc� mid bac�k pain, lou�er�ack �ain, �r�d ri�ht �r�e.� ��i�� t����t�y. `��e states thrzt she is stzll h��°in��r �?roblem ��ith carn°in�c�r riftizzg a�lythir��; he��ti�� l,ec��a��: c�f`i�er p�in fr�t�� �1�� cG�r ac�i�;�,rlt. ���e s�atc:� that t}�� la�t chirc�pract�c trea�n�ent prcr�°i��� r�;lie[�f�c�r her. C)1�jective� �e�nzent�l:`sum�tic �ys#ur�ctic�n rig��t k��ee; i��terse�rt��,nt�l d�rsfunctic�n and at�errant motion �t C2. C'>, T1, �'7. �I"�, Tl?, I_:2. ��nct L4� ��t�c�r�ra��, tt� ��nsiderabl� hyp����nit�ity� i� ¢�alpate�� in th� �en�ic��, f13c�r�ci�. �nc� l�anlbar mtzsc,ulat:t�res. Tendernes� t� paipatiora in th� cerv°ic�l, th�racic:, ai�d Iun��ar re�i��r�s. A9sessment: Pr��g����is is �ood. Plan: Pat�en( �-as treated tocia�� ���itl� tl�e fnll��in�: .Chirapr��tic r�aaipul�tic�z� �,et�tl}�t�:} t��e ine�ae.at�� ���r��hrG�� �+��s����ts . Electric�I mu�cle stimula�ic>n was at��iicd t� Thc �y��rtc>ni�itv tnl��r.les i1� th� �ack .'��Ic�€st }�t�t p�cl� ti�°as ,����li�c� i�� �i�c: l�y�°�e°rtc��dci4� r;Y�z��1�s ir�t�.e h��k . 4e�i� Tis���e ma�sa�e����s a�plied to thc affected �c�ft t�tisues �l�cau I_;�:e:, I}.C'. : �'on�r�t�n�t��� Healtl� � . � . . � . . C�h�rop�•ac��c.� �.,��n�c, �'.��, ���: ���x� ��� 1'a�ient: ('h��t��T}�ac? I�at�: �-?�-�° T)(Ew}�3: �-1�-�� I�f�T: '?-?>-1:� �ubiec�iF�e: T'��tie��t r��turns tc�clal� I�r tl�e chirf�practic tre4�t��r��n1 fc?r the �njt�r��es �h� �€i��a�111�tj i't��;€lilltliy' ��t"(}T21 �3 �� �`� ��� tlli,)'s.�)1"1'��11CCG �#CC;I��.t;Ilt. �}1(: �;"t)T?1����:,t7S Cl{ l.i��±�3�I' �at;�i �C) mid ba�k �asn, heac�acl�e. r��ck paan, Iower E�ack pain, an��i ri�ht kn�e �±�in tc�da�=. 5he st�fes� t���t hf:.�t�ec:k �a�n is n3t�st 1��t}�er�€�r��e E:��r h�:r t�>d<���. {�biective: �+egn�ent���'sc>in�tic clvsfi�rlcti«n ri�ht knc;e; int�rse�in�:nt<�l c���sfunc.tic�n anc� ��+erra.z�t�nat.ian at C`2, C,6. �1�l, '1��i, `1�`�, �I�l 1, T I?, ��t�tl Is�. "f,���d�ri��s4 to p��lpatior� in the � c�r��i�,�I. th��r��ic, ��nd l�zm�a�°re�;it:�l�s. Ther� is mc�c��i��iti t�� cf�r�s��ea���?l� k�;���er�c�ni�;it� ��1pa�I� i�1 the c.�rvicala th«racic, �n� lk�tn��r ��u�cttlature�, Assessrnent: Pz�u�nc}sb�; is �c��?�i. Pian: `I`reatme��i totla� �«nsist�,� t�f tl�� fc�llt���=in�: .Chirc�practic ��atlip�il�tiot� ��ntl�- tc� tlie in�icate� 4�erte�?ral se�t���:rlts . �-Iectrical �?�l;�c'e st3�����l��Ei���7 e�-��;� G����Iie�i t�� t}�L k�����c;r��?I�i�i�1 ���u>c14� ii� �l�e E���ck .Moist hc7t �.i�k������ ���li�;e1 t�tk�� hy��rtc�nicit� ��nuscles i�� t}le �ack . �<�f't tissue �n���,�����: t�a�; i�:���ii�°ci tc� �:��e a�i::c:?ec� �;c�f: t�;�����:� ��u L,ee, D.C. � omrt�un�t� �Icalth . � t • r • +���r+���a�t�� �I�n�c, .��. ���. ��� c���� �'atient: C.'hc?i�s� l`�a�� . I3at�: 6-2E�-I a I�(7�3: fi-15-E�� I?(>I: �-L1-1 i Subiec#ive: 1'�ti�nt c;��mpl�ir�s tc�d�y t�f'neck p�in, t�}�per hack�?ain, lt�wer k�ack pain. micl b:3ck paiF�, and ri�ht knee pai�a. �he �tates th�t ��alkii�� ��� anc� �it�v�=n th;, stairs ��a1:�4 P��:e ri�I�t knec: p�in ��•c�rse. �l�e c:��t�ti��u�;s t�7 ber�ef-tt f�rc�n: t1�c. ci�ir���ract�c rr�re. f)biecti�=e; "I�er�tl��-nes� tc� ��r�l��tic,r� ifa �hc cc r�i�al, tl�c?rz��:ic, a���i I�zn�h��r rct�ic�n�. �e�mental�sc�r��atit, d}�s�unctic�n ri�ht kt�€e; 'sntersegn��;nt��I �l��iu�actic�n �nc� aberrax�t mc�tian �t C2. CE�> °1�2. T�, "I°1 I. [.�a an� I.4. Palpat�-sr�� i��s��cti�»� re�e�le� n�c�c�erat� fc� c�nsiderabic l���p�r��z�icitt• in th� eer��ic�1, tl�c�raeie. ���d Iut�nbar para5piz�a( �nuscle5. � Assessment. �'r���n��si� i:� �;c3��. I'lan; Ms_ "T'hao u°as treate� tc�day �itl�� the f-�lle»�in�: .Chixc�practic� manipulatic�n �et�tly° t� t1�e izidi�,fit�.�d ve�ehrai ��gm��t� . �;Iectric�I int�scle �timula�:ic�n utas appliec� tc� the 31}'pert��nicitv izauscles in tl�� k�ack . Mcaist hc>t pack was a�?plic:-d tc� tlse hypet-tonicit� muscles i�� t�,� back . ��ft tiss�e ��a5c���;�; �.��s ��S�li�.�:� tc> tl��; �9�F�cte<� st�ft ti:;s��es :1,���� I.�e�, i�.C'. :. _ �omnr����i���T �c���t�� . e a * • ��IC(3��'�i:�lt.' ���I�IC'. �•.�-�. I)Y. 1`()C� LC'c' Pati�nt. C�hc�n� Thao i�ate: �i-?�-1; D�)I3: 6-I�-6� i��3�: �-�'�-1; Subiecti��e: ��::, i`����c� c��ir��,���in� ��f l�e�adac:�e, �Z�:�;� ��;i��. E.��}�Lr �ack �e� n�ic! �}��ck pait�, tatii�er b�ck pain, ar,c� ��a�n in h�:t-ri�ilt k��e�; t��c�ay�. Shi sti�i�s tl�at l�c.r c«n7plaint, are c�irectl�° rel�ted t�? tY�e ?-?�-I� car ��;cic�ent. ..�'sl�� s�ates il�at it i�; h�rr� fc��-lie�-tc� �erfc�rr�l tertair� dail�� a�tie�itie� �iec.a�ise ��I�hcr pain fr��in t17e car��ceic����t. SI�e fe�t reli��eci frc�r�� t�t ��st Cr�3����;nt. � 4biertive: T�ncterrrn�ss tc� palpaiiin in tl7�eer�tical, thc�ra�ic, and iuml�ar r�gic�ns. � ?Vf�derate tt, cc�nsiderG��le h��pe�rtaF�ic�ity i� palpa��c� it� the ce�•vical, tht�ra�:ic> and lurri�ar � museulatures. Segr��tntal�''s�a�atic c����fiuT�ciic�n ri�l�t l:rle;c, it�te�5e�rn�;nta1 c3��:furactic��a anci aberr��r�t �tlotic��� at �'', �`1, T�', 'I�I?,.I_,�. E�zlci I,�. A�;sessment: �'atiLr�t i� t-s���?�it�� .3 �c�c>c� ��rc��res� ���ICi i}t=: ��-�``�t;t��,i� is �i���s. P[an. �'atiea�t ����;� tz�<;<�ic:�1 #���fz�� E�ith t:l�c f:calic9r�ica�;: . Clairc��rac�i� �������i�i�ld�ti�:�z� s�e��tlz t�� �1�� ia�c�ic.c�"t�:ci ��c.rtc:l��-ai �,ei;i�erdt4 , Ele�;tcieal m«scle �tiznuiation �a�as a���lied tra the hyp�rtc�nicit�= rt�uscles in t}�e ba��l� . I�'i���st hc�i pac:k w��-�s �p�ali�d to tlle h4'pertani�,it��rz�tz��:.Ic�s ar� t:he ��ek � . So�tis��ie �r�z�ssa��: �a4 ���4ie�3 �a the afie�te:� 5c�f-t t�ssue� Tc�u I:ee. I�.�'. ' ( � o n�un�t�, �eal�h ,. . � h« �} ( t.( . .f pq ''j'' J �ll��(.d��»�trYl�is �,,. ����14 .�i.�R l,l�. L�)�� fa�r�l Paeient� Chc�n�, Tlzac� I:late� b-'l-I; I)C1B: C�-15-(�8 T)C�I� �`-":�-1� �ubiecti�=e� I'�ti�c�t r°c������•t� c�f�r���k �air�. ����er �?s�c}� ��<�in. rn�ci �i�ck tc� �t���Y�r ���.� p4�=�-�, and right k��ee �air� ti��a�. �he ;�tafes t��at hea�� lii'ti�t� n��l:es I}er back hurts rz�rc�re. Sl��. states that h�r p�ia�c��r�tinue4 tc� ��t�r�ere v��i�t� t��r acCi��iti�� e��f`c��.ily li��ing. €)�►iective: Pal��tor��in�pet;tion rct��aled r��c�derate tc� cc�tx�idera�l�. h�°�ertanicit��° in thc: �ervi��1, t����racic, a���c� Iun��l��r����zsc�zlature�. ��'er�d��rne���t�c� �al�?�tior� in�the cer��ical, t�loracic, �id lumt�ar re-gion�. 5c�mt-ntairtsc��n�ti�dys�urs�;ti���� ri�l�t kr��e; ir�t��rsegn�er�tal dysfu�aetit���and al�e.rr�nt tt�c�tit���.�t C�, C'(�, '�I'3. �i'�, �I�1�', z��nc� L,S. �.�.���.r`l��v��: ����}���i���';�.`.j �4 ��)f��.1. �lan: I treatec� t��L �ati�:t�t t�����` �,r��i�l� t��� ft�31��ti�-i���: .C`hir�a�ractic m�ni�u�atic�z. �entlz� t� the i��c�icat��3 vcrtebr�] sr�naents . I:��Iettricai n}tts��� sti���tai�ti���� e�:a5 G�g��si��� iE� t�1�: l�y�crt��x�i<it� �t3��sci�:s ir� ��e ��:ck . ?�!fc�i�t l���t ��Gtcl;��a� �����li�.ci �c� t��: la�p�rtc���:cit�' rlfzi:��1�:� i�� tl1� �?acE� . 'ioft ti�sue rnassa�e ��as ap�licd ic� the affect�� :;c�ft tiss�ae� �1�ou L�:e. LL:�,�`. �� omm��r����� � �alt� . � � M M • ��11�'C��I `�C�i� ��IIIIC, _ •��• �lt: T�fJt� I<�'C' �'�tient� t;��c�r��; ,:'����> I�lafe' (�-l�)_I� Dt7�3: 6-15-�� DOI: 2_2�_l_> Sutbieetive: '�!I:4. 'I�h�r� ret�trn� tc�da�� �Cor th� chir���ra�ctic �r�atrt�eni for t}�e injuri�s she sustaineti res�i4ting frt�nz :� 2'�'��"13 car acci��nt. �he c�in�laiti� t?f l�ati�i�� �ai�a i�� l�er rs�;-ek. �app�r ���ck tc� ,��ic� �7ac�, �-i�:.�r��� k��ee,����1 ]t�w�t 1����:k tc�c�a;�. `�3��: (�It ���li��°�ci t:rc�r:� t}�� l��t chiropr�ctic treatrne���. Obiecti�►te: ��I�r:���ferz���s �1�� �,�l�atic��� in tl�c ��r��ica�, thc����cic��. ��nc� Iun�i��-regic�s. Palp�tc�r�r in���s�tic�n re�-ealed cc�z�sic�era�l� ��}�pertc�nicit�� �<�lpahl� in the c�ervical. thvracic. and (umbar rrzusculat��r�:s. `���;�r�ent����c��natic dy�,�itr�ctir��� ri�;ht i�r�ee; i��tc°rse�r�����t�l �ivsfuneti�n anc� ahea•.����t r1�c?tian at �'�', C`E�. 'I 2, T�). 'I�1 l. I_.-�> art� I_.�. Assessment: Patie��t i� ntaki���, a �t�od prc��ress and the �ro�nc>�is is �t�c��i. Plan: F'atient u�a5 tr�:��t��3 t������ v+ith the fc�11«���ir��: . C'h.iz`c��ractic zr�anipul�itic�rl ge��tl���c� the inc�3icatec� �•et�t.et?ral se�rt7enCs � .�;8ect?��c<�1 rt���:;cle st=n�ul���:if��� ��,�� ���?lie.��t�? tl�e. �cpertc���i���i� ����sc:ie` iz� tl�e �,�c� . �1c�ist h���t pack w��s �pplied to the ��}'pert.c���icity nauscies iri th� t�ack . ,��c�ft ti��ue n���s�<��e���s a��li�d tc? the ai'fec.tec� �c�ft tis�u�.s Tou i,ee. �.).C'. : �c�rr�mu������ �c.xalth . , �hi�•o��-�c��c �'linic. �'.5�.. ��� ��t� �Ej£� ��tien�i. t`hc�n� ��l�h���� I�a�e: G-17-l� Z�C�I�: ta-1>-�� I�OI: 2-25-I� ��zbiectivc. '�i4. I°1�az� �°L�c7rts c�f`��eac�act�e, ���.ck �Sain, t���e�� E��ck ���in, Tn:d back �airt, lc�we,r baek �ain, az�c� ri�l°�t ���ee �?�ir� �c��a}'. She st�te; t}�at she c�cc�sic�t�all�'has heac���c.he :�ince tl�e car�cc:ide��t. 4he �tai�;s tl�at �l�e l�as mc�re ���ir� in tl�� left s�d� c�t I�er neck tc��<��°. t)biective: �I�here i� moc�erate� ���� cc�n4i�i��a�le h��pert�anic,itv° ��lpahle in the c�r��ic:af, thoraeic. at�c� Iurr���ar rt����,�,��latc�a�,s. ���n��nt4�l-sc��n<itic ���sfi�r�Ltic�n ri�l�t knce; intersegryaerital d}-��unctic�� ��d aber��a�nt i�tc�i��n ��t C"�, t.`�>, �T2."�I'�, T� l, at�d Ia�. `I`enderr��:ss tc� palp��tic�i� z�� the icr��i�;���, tl���r<�cic, ��nd ]����hat- r�g;ic>n5. �ssessment: I'ro�nt�si4 is �<>c��. Plan: Treatr��nt tc>dz�' cc�nsistc�j c�f the ft?Ilcl���i���: � C"hiro�r�jrti� r� :�r�i����t��ti��+.� �r.�r�t�� tc> t}�� lr��:u,�tc.�i �e.rtc��-�rax ;,�:�����rt� .�Iec�ric��l n��ascl� �tii��ta�atit�z� 1�a� a��iie�c� tc� th�: lz�p�.rtc�r-zi�,zt}° mu��,les irt�t�e��-�.k ,Moist hc�t�acl: ��=as a�plied t�� the h���erit�nicity muscl�� in th� back s e,Dl3t6. 6Plt,T6,g.A.- Cdlld�,TG4�4� 4�"G&.'Z �t.,lt,..lt.k�\A Lt.J 4�Y4� KAAf4����.��E �T�..#(i �A���.f�t' I E �fltl �<�f', T�.��. ,� � om�n�u��it�� ����t�� hir��.�����t�ri�� �'�i�a��� P# � . _ r��: ���� �,��� Pati�nt. C:;hc>i�� �}�<�c� I:�ate: �-14-l 3 I�OI3: fi-I:±-C�� JC�fJI; ?-25-3 3 �ubiect►r�c: I€.��1.��, �i:;. t}��c� �:f�n����air::� c��`s���ic ��ai��, �a�`?�cr t����,� ��aiz�, t��ici Iaac� �?;zit�,. lc�u�er b�ck p<�i��, ar��� ri�}lt l�r��� 4�ai��. `�he �tates that she feels s�i�l�tlt� hetter today. �he s�:�tes tl��t tl�� la;�t tr���d�x��:r�t }t�� hel�ed. Qbiect��re: �c��.�er�te �t� cc?n�i�c-r�t�1� h�'pert�nicit�` is pal��tet� in tl�e cervical, thc�racic., �n� Iur����r rz�usculattzz��s. �i���nental%�satnatic ��srs�unction ri�ht �t�ee: irzters��;n-��n�al ����funct�c�t� ant� �ber���nt n�c��ic�n at C��, C�fi. 'I�l, �I`?,�I.1�. �1��, anci ���. T�-n��ern��s tc� ��lp�tic?r� iy� �1�� ��:r��c<�., tht�?�•��cit, ��g�c� I�iax�E,ar rc�������. ��sessm�nt: I'ri,�t�t��i� i5 �eac�ci aE�c� �}3e, l��s i�nprr��°ed si�z�� the 14�st vi5it, Plan: 'I°reatrs�e��t tc>c���� et�r�sisted c��i�c fc�llt����itig: . �'hir�?��t�-<�ciic ����>�ip��1��;i�>ra �.s.cntl�� tr� tlie in�i��t�,� �-e��tik�r��! 5�.�r����nt::� .�;lectrical tt�usil� sti���ulati«n ���a� a�a�lied "tc� t��� lt�-p�,r-ti�t�icit}' rntxsc.le� in tl�e l�ael� .'���ist hc�t pdck u�a� ���?1ie.d �c� tl�t� ��t�ertoniiity rt��z:�cle� i�l tl�e h�ck e �`si3fl tl aSt1E I�I�I�`�<it.E ��c:`+ :i�?�'iitL� 1£? :�1�'. tl�s�i°l£.:i� ,�.t���1 21��L1�,`�. �'OU I.G�, I�.C�- �om�����t�� �[c.��lt�h �' .�► r��: ��,�� r��� .bir���•����� �`Iini�. . . �Pat���lt; C'h�����"ha� I�ate: 6-12-13 �t��3: t�-I4-�$ I�C)I: 2�2�-1� Su�riertiw°e: l'��tie��t cc�tx��slaiz�;� c�t"��cl� �G�ir., u�?�er ����:I� ���i��, nai� k�ac�; pai��. i�l��r �a�:� ��axn. �ZC�ri�l�t kz�e:e �Saii�. `�he 5t��te:s th;�t sh� was tos:;in�and t�xrnin� al1 ni�l�� last ni�l�t h�cau�c t?f her �ain. She 4ts�ies that 41�e is ex�7�iu:�teci t��da�°. {)b'ect'tve: �aegme��talr"sc�nla�ic, c��-`fur�clic�n �•i�h� kizee: int�rst�tnental d�ssfunctic�n anc� a��errant rizr�tion �t C,�, ��;(�, "[�l� �f���. �1�I"w. I.=��. at�e� L�, ��I��c�er�te t� cr�r��ii�t�rat�ae 1�ype�tt?niciiy is r�c�t�,c� in t}�e cer�°ic.��l, tl���r�cic. r�c�� [17������rr rr���sc�il£it:��res "I��:.a�<:ie�-��e�:� t« ��lpatic�t� it� il��; cer��i�,�jl, thc���czc, ��� l�ftn��<�r�-��;i���s. Assess�►en�: P��ti�n�Lc�c��?er�t�� f�(1�°��itl� the �1�ir��raetzc tr�atz�����t tad�y. Plan: Tre�tme-nt to�.�� c�nsz�t�d c�f t��e fc�Ilc�va�zng: . �`��irc�practic zt�r��3i�����tif�t� ��r�tl� tc� rl�e ir�c3ic.�t��] ��r�tc�?��-z�i �e{��t��nt� . �;lectricat n�u5c;e sunit�latiot� �va�, ap�iiec� t�� t}�e l���e�°t���li�it�• r��uscles in the �aci� .Moist hot pack was ap�?�iec�l tc> the h�r�ertc�r�icit� �nusclis in�he t�ae� . it�ft ti:�st�� m��5sa��: ��'a� izp���ec� tc� tr�� r��'f:eci�:c� ���1t ta:��;��t�. "T�u Lee, I)_E`. : �amnlunit�� �ealth . Ch�r��practic� �linic�, P.��. ��: 1���� �.,��_ Patient: C:l�c�n��T��aac3 Iaate� 6-10-13 �(�B: 6-};_{�8 DOI: 2-25-1 5 SubiectiF•e: M�. Tha« cc�sn�li�if��; �f'l�ead��ci�e. up�?e�•�6��.k tf� rnic� back ��ain, nec� pain. 1�?���r 1�ack pain, an�! ri�}�t knee ��ail� tc�c���y'. �?he states tl�ial �he �er he�dacl3e it3r�lt-s c�n anc� t-�f�f. Sl��; states that i���chirupractic t�re�.tn1e17t� �ru���c�e r�lief'i�ar }�e-r, t)biective: There i� m«�I�r�te tc7 cc�nsic�erable hsperic�r�ir-itw� ��alpal7l� in tl�� cervic�i. t}�aracic, atT�i lun�t�ar mu�c�il�t�ir��5. l r;r�c3�rn��� to pal;��itior� in ti�=�: �er�ii;��i. t}�c�ra�ac, <�ricl lliz��har r�;�ic�ns. �egmental!sc�mat't� d}rs#'�ln�tioY� ri�hl� kn�e; i��ter�egmezltal cit�sfiinctic�n an� aherrant inc�ti��i� at C2, C6, T2, "I��, ��'t�, T l 1, �nd 1�,5. .�ssessment: I'rc��,nc�sis i� �c?t}Gi. Plan: Patient w�as tre4�(�eci t�c�av �uith tl1� fo(lo�:°ir�g: . C'hir�practic nlani�ulaCi«n �ent1G� to th� indicate� �crtehral Se��nents . �',��Cti'I�a; T�lti���� St;I11:1�3Ti{)*:t lt�i4 :if�}"`�,c� tt? t�"1t' ��tj'c2`'t}.1aClt� 7�,?14C'��� iTl t.�"l� ���lC'IC . Moist ht�t pack w�.� applied to th� h��pertoi�icit�� �nuscle� in the bac�k . Sc�ft tissue mz��sage ti�as applie;ci tc� tt�e aC�ectet� 4<,ft tissues `l�au L�e. D,C'�. .� �omm���it�r H�alth . l��lll"{��?�``CIC�1C l��llllC`� �.�. ;Dt: 7"(Il� �:�'f` Patient: �`h�ng Thai-� L7ate: b-7-13 I)C�I3: (�-��-f?f� T){71. 2-2?-13 Subiective: I�t�d��y, tl�e �aati�nt e,{ar��plains c�f heaclaehe. u�pLr back pair�. tx�id hack �ain, ��eek pai��, ic�t4��er bac.k ��ait�, a11d ri�l�t ki���: pai«. �1��, states th�xt t�ed- pair� gc�es up ancl �c������ from da�� tc? c��y. She states that her nee� and 1�ack �re still ht�rtin�. Obiective: F�lpatc�ry ii��pection ��eveale-d moderate t_c� c-u��sicl���abl� ��y'perte�nic.ity �a1pal�le it�the eer�°ic�il� thc�r��cie. dinc� l�i�nb�r r��u�e��latur�.s, _[�en�ie�•r��ss ��� �alpatic�Ti ii� t��e tht>rac�s:. cervicai, and iumbar regic�ns. Se�n�zntal>�omatic dtsfunction t-ight I�ne�; i��ters�;gment�l dvsfuncti��n anc� abe.rra«# mc�tic�n at C2, C'6, T�, T�.T�. 7'1 l, and I_;5. r'�ssesstnc�nt: �'rt�+4�:��i4�s5 ts f�<;c�c� ,�nc: she is tnal�in� z� �t}t�c� p�c�t ;t:��. Plan: 'I��reatmer�t toda�� cot�sisteci of the f�lic�ti�ing: . Chir���ractic ma�u���iati���1 �ell�tlti•to the inclicatc�c� a��rte��ral �egt�ltnt� . ��lectrict.J �����5�l;� s'irx;t�la�ic>1� ti�zi� ����t,iie�i tc� t}�e IT����t-tc,:�icit� ���u�.le� ir.: tl�� �,�:��i: . Moist hot�ac�k w�as a����lie�l t{� the hypertanic:it}� n�us�les i�t the back . Sc�ft tis�ue macsa�e �v�j� r���pliec� tt, the �f�f`ected tiott ti�sus:s Tc�u I�ee, I:3.C:. �_ ������� c..�����:�� . �` f�'hirc����a�t�� �1in�c, P.��.. ��� ���x� r�s�j F'ati�nt: C-����r�� �`I���t� L�ate: �-�-13 �7t��3: fi-15-E�� I�C�I: 2-?5-1� Sut�ieetive: Patient r�;turns ft}r ehir�practic care tc�day f<?r the injuries she 5ust�ine� resuitin�Crc�m a 2-?�-1� c.ar E�ccadent. She 1a��s she has p<�in ir� 13er neck. u�?�er �?ack ta tnici ��cl�, 1����:r ba��, a���i ris�;�t k���:� t�?cia�. `�E�e st4�tes tllar s}�e f'��t ��etter afier t}�t 1���;t treatme��ta 4��e :�tat�;s t}iat st�e hti� nzore pain ir1 the i�eck toc�a�. Obicetitie: �Vl�>fi�r�te t�� cc�nsi�trabie h���ertc�r.i�itt ;s j�f�te�l i7� the c�,rtical, tl�t�raci�, anc� �itr���ar musculatur��. I"�,t�c���-71e�;s ac? ��Ipatic��� it� tl�e cc;r�ti-i�<�I. tl���i acic. E���d ���n�har regic�n�, �e�menta��'s��maiic� �l�r�;fiz�zc.tic�n r��ht kne.e: irlterse��;r�ieritt�l ci<<s�tunci:io�a an� ab�rrar�t xnoti��n at C'2. C:;fi. "C,?, "T7 .1�l i, az�c� L�. .As�essment. �';ztient is ii�E�kii�� :� �c�i�c� �:�o�r���. Plan: Patier�t was treated tc�day ti��ith fnllowin�: .�':hirapra�.tic m�nipulati�n �es�tl��tc� the indicat�d verte�r�l s��m�nts . �:��,ctr�ca� n�uscle. sti�n�zl�jti�}�� z����s �ppliet:i tc� t}�e 1�1�p�rt��rlicif� m��s�:l�:� iz� the l,a�k .��c�is�hot pack was applied t� the hy�aertoniczty inusclew i�� the back . !�c�ft tiss�x� massa�e utas a�?�liecl to the affecteri sc�it tissueti �I`��Lee, 1).�', o � e - -� � �.�.�r������� ������ �-� �����t�� � t . • � ,-r,. � ?;� �.�:�:x , .■ �hi�•����r����'���.� �� ���c�. - � . . I'atient: �:hz�n� l iiz��} [)atc: �-;�1; I}(�F3: �-1�-C,fi L)(JI: 2-2�-1 i Sebiec#iv�: '�°�:�. "�T°��a� retszr-ns t�c�ay- fc�r thc,c;hirc�pra�:tic treatment f<�r tl3e ir�juries �h� ��a4tainc� ��3�r��t�l.t,� frc���1 s3 �?-?:?_l? rar�ccit�ent. 4h� cc�an�ala�:�s c�f]la��in� ��in in l��r n�ck. up�?er h��c� tc� r7�ici �a�i�, ri�}7� 4;.��ce. ant� Ic��er l�ac.k t��dE��. �he states tl��t �3�e fe�1:� 4���;l�tl`� �etter tc�ciz.�°. �+��e :�t��te� tl���t t1�e ?ast cl��r°t��?ractic tre��tmcnt �rc��i�ied reliei tc�i-her�and ���e 1��c� , �t�{�t� ���:�k�����. C)biecti�°e� I'a��?at�}t�} isi�pe�ti�>�� ��e��ealed s��c}derat�: tc? ec�n4i��:rri'�;e l�ti��?�rtt�s�icit� �al�aE�i�: �n th�: ��r��i�<rl. tl��}r�cic. ����c�3 1�,������ar n�uscuiat�ures_ .l��eYlder���s�t�7 pal��atiun in the c�r��ical. �hc�rac.ic, �i�c3 1�ztr;b��r re�i�>z��. `�et�tnGr�talr`5�.�trlatic d���f�ur�c-ti��►� a`i���t �nee: imerse�;irtental ��,�tut�ct����� :����i �.���;�°r��€�t r��c�':it��� ��t �'�, C::��. .I.,, � ^ ..£..1 i, �,-�, ����i ,.'� �sse�sr�a�nt; 1'G�ts�t�t ��art��in��-��a� in��rQ��ecl fi-��rz� Yh� �11irc>pr�cti� treatt�ent��th��t s�e r�,cei��e�, P�an: "�-r�s�t���Lx�� :�:�ci;�t cf�rx�i��e.� ��f°t��� ����?It�uii��: o Cl�izc��r�c;tzc� z����r1i���i�ti<�i� ����tl�� to t�e zndicate�v��rte;�ra1 se�rn�n�s . F;lec.tri���l �i��i�rl� �ti���ulati�>r� ���a� si�?�l��c�to the h�°�erts>nic$t�� r��uscEes �n th� t?��ck . '�•1«ist ���>� �<����: �e��. ����lic.c� :�:� t}�� l�t��ert��rnicit� s������1t� iz� t��e l���r� . SL}ft ii�;�t�e ���a��;L��` `�•;�y <:ap��li;;u ±�� t;�e aifeL��:d s���� tis:�u�s �c�u L��a I�_C;_ _ ���r�-��r����i���� ������Ir�� .�.� . . . . . ,; ,., � ,�� . � '_ ������t�e �[��I� r����, . .r1t , . �h�� � _. - . �'atient; Chcsn� 1�iz��c7 � L?ate: 5-�1-�� [��)�3: E7-1�-t?� I7t�i: ?-25-1� Subieetit�c+: '��tw. 'I'l��ic� �:E�r��t��=�ir�s c?f����clacf�e,upper bac4: ?c� r7�i�i h��ck ����i�2. ne�;k p.�in. lc�r�=er hack p�� n. ��nc9 ri�l�rt ���ee p��irl ti�d�}�. She states th��t she �1�� n�€�re pair� in her neck totiav. '�l�e �tat�s ;�Ztit �>Ln��is��; :�t tl�c fze�k tc�c� m�ic:h make� ��er f1ec� �ai�l ���arse. `�he felt reliLee�� irc���: t��e lt�st trea����e�ii. C�biective: �I�i�ti�rnes� Et? p��Ep,�tit�z� ia� the neck :�f�t3 hack. `�egn�el�tai-5c���la�ic ci}'sfi�nctic�t� right kA��e�; interse�x�ental d}�sfunctic�n �nd aberrant ri�otion at C`2, C`6, 'I�?, "I��S, Z`9, Z`1 I, an�3 L.S, I'al�?a?��r��i�as��cti�n ret�ealed r��oderate to consid�rable hv�?ertc�nicity �al�sanle in the il'�t€C:Ai, tZ<}>'�iilt:. i�iii� �1.1S�,1��:�i" II?114C:U�ftlUCtS. ��t�I'� ��T'C!I111ITC?II :II E�1C' i:E',:'1yfCc11 PC�I()Il. Assessment: �)��tT�.;j�()`is`+ 1J ���1Ci. P►an: �I�reatniez�t ti��iati� c�nsisted c�f t}�e full�u�ing: . C'hirc7� i�t;� ��at�it�i�lati�1�� t���;t!� t�; tt;e it�cii�.��*eJ �-ertehra� s€;�znf.:i�t� . Electric,a] rl�uscle stln�ulat3tm ���as ��ppiied to��he l�y��rtc�nicitti° inuscles in lhe b��ck . ?�1c>ist l�e' z>��cl� ti�tis ,���lied tc, thG 1��;��,ertc>nicit�� muscles i�� tl�e t�ack . Sc?1-t ti4���e .�7 i��<<��� 1��i� a��,�lieti t<� i�e a,�fected ���5't ti;s�ie4 "I`c�u Lee. I).C�. = �'onr�mun�r� I�ea�rh .� , ' . . • ` ') ', �T E.�E.� L e f' �.`h�rop� �cr1c �'I� n�c . P.��,. _ I'��tiella: C'hc,r� i}�ac� Date: 5-2�)-1� DOB: 6-1�-6$ DC)I; ?-��_l; �ubiective: Patient retu�xls ic�d�y for t��� chiropractie treatment f�r the iiijui•ies she �t��tained resultin� fr�m a 2-25-1� car ac�ic�ent. �he complains of headache, neck pain, lower back pai�1, upper back to Iz�id back pain. and right knee pain tc�daV. SI1e states that she fe�Is better no�� c��n�are� tt� �lie init�.�l treattnent. ShE� state� that the chir�pr�~tii treatments prot�ide reli�l't-c?r her. fJbiecti��e: F'alpatc�ry in�}�ectic��� r�v��ied znudc�rat� to consi�erable hypertonicit�����l�able in the cer�ric�l, t}���rt�cic, �nd ]u�Y����r iz�us�ul��tures. I'e��d�rnes< t�;} �<��pz3ticm in t�le ct;E-���c��i. thc�racic, �z�d lu�n�ar re�icros. �ie�;nlentalr`�c�matic c�vsf�uncti�}n ri�llt knee; interse�inenta[ dystuncti�?ti and aberrazlt zn��ticm at C'2, C'6. T?, T>. 'I��}, Tl i, at�d 1_S. Assessment: �'atietlt certainlv ��a� impra�,e� f`rt�ra� t�}�e chir�practic trc:atme�at thz�t she receiv��i. 'I�he muscl�hypertonicit� ha5 decr�;ttseci. Ptan: Pat�ient 1�-as tr�ated tot�a} ��°itt� tl�� ��c�11o���ing: . C`l�iropract�c mani�?ialatiorl �entl� to the indicated lertehr�l �e�in�nts . �:;lec:trical 1i3t�4cle sti�.���Iati���� ��.�� �3}�plie� t�� zhe ls��etsc�nicit� mu>cies i�s tf�e back . Maist hot pack uas ap�lied tc� the h}�pertonicity muscles in the back . �c?ft tis�tie, r��asst��e ��-a� �z�pli�d tc� the �iffecte�3 soft tifi���t4 "I'oli Le�:. T�.C. = `��r�����t�� .I����1�-� f �II"��"���i� ��li�Ilt'. �. �=�. _�` ��t�� �,�� F'�tiei�t. C:°������� `I�I�G�t� �at�: �-2�-1� D0�3: �-I�-Eiti I:��}I� L-��-1� �;ub`+ee�, tive: 'I`o�a��, the �atient coanplai�l�af`neck paiz�, �.zpper t�ack pain, headache, mic� bac� pain, lo�er �?ack p��n, and ri�ht kn�� pain. 5he s�ate�that h�r��in ec�ntinues tc� bc�tl��r her. 5�� felt r��ie�e� �'rc�t�� t��G �:.�irc?�r��c?ic t�•���ti�-��nt l�st �%i;�it. t�biect�ve. �e�?�e�tall�c�rt�atic d�����unction right kn�e; irlterse�n�ex�tal dysfuncti�n ar�c�aberrant n�c�tic3rt at C2. C'�, .I'I. `I°:f. °I:`]?. I��. �+t��i I_.�. "���n�i�n�as� �€� �a���ati��t� ir� th� cer�ica�, t}�c�rs��i�, an€� lur�al��r rct;�c���:. C'c>���i�3er�k�1� h����rtan�c�:ti i� ����tec� in t17c c�r��ical, thc�racic, at�� lum�ar tnu:�c�z��tur�.:se . , As�e�sment: �'rc��nc?si� is �c?c�t�. 1?lan; Tre�t���e��t tc�c�a� c�>z�,s�i�d c�i'tl�< fvllv��i;��: � >C'hiro�zactic �n�ni�aulatian �entl�� tcr t�� indicated vertebral se�rn�r�t� . ��I�ctrical m�scle sti�nulatic�a� ti�=t�5 a��?(i�d tt? the I�y�p�rt��r�i�ity z��c�sca�� in the �ack , �v1oi��hat�ack ���a�a�pli�d tc�the hyper�onicitv �nusc�es in the�ack . �c�#� tisst�� ��a�;sa�e r�Gi�; ���?p!�e�3 tt-� �he �f+�:cte� s��ft :i�s��es. T`�� �.���. I�.C`. C•L•� James P.C � David K.Cody t 'The Cody Law Group, Chartered Jcody@codylawgroup.com dcody@codylawgroup,com Robert D.Cody 359 Commerce Court rcody@codylawgroup.com Vadnais Heights, MN 55127 Ph: 651.294.0994 • Fax: 651.292.4955 www.codylawgroup.com f��l�C� !1 �� F�B 2 6 2��4 February 21,Zoi4 CITY CL�F�K City of St. Paul Attn: City Clerk 15 West Kellogg Boulevard Suite 210 St. Paul,MN 55102 RE: Our Client: Chong Thao Your Driver: Michele Leann Giampolo Claim No.: unknown DOI: 02/25/13 File No: 19985 To Whom It May Concern: I have been retained by Chong Thao to represent her in all matters arising out of a motor vehicle accident of February 25, 2013 with your insured Please direct all future correspondence and communications to my office. I am at this time enclosing a copy of an arbitration booklet which was recently utilized in a no-fault arbitration relative to this case. This booklet contains all the medical report and records that you will need to evaluate this claim. I am also enclosing a copy of the arbitrator's Award. Thank you and we look forward to working with you. i ry tru yours . Cody DKC/jen '� Enclosures t CML TRIAL SPECIALIST CER7"IFIED BY THE NATIONAL BOARD OF 7RIAL ADVOCACY AND THE MINNESOTA STATE BAR ASSOCIATION t MEMBER OF THE ACADEMY OF CERTIFIED TRIAL LAWYERS OF MINNESOTA TABLE OF CONTENTS CHONG THAO AND STATE FARM INSURANCE COMPANIES 56 600 02252 13 A. CLAIMANT'S STATEMENT OF THE CASE B. ACCIDENT REPORT C. PROPERTY DAMAGE PHOTOS D. DISCONTINUANCE OF BENEFITS LETTER E. PETITION FOR NO-FALTL,T ARBITRATION F. COMMUNITY HEALTH CHIROPRACTIC CLINC -REPORT, RECORDS & BILL G. VOYAGEUR IMAGING -RECORDS & BILLING H. NORAN NEUROLOGICAL CLINIC -RECORDS & BILLING I. NORAN NEUROLOGICAL CLINIC - PRIOR RECORDS J. INDEPENDENT MEDICAL EXAMINATION OF DR. JESSE TERNUS K. CLAIMANT'S RECORDED STATEMENT TRANSCRIPT L. PIP PAYMENT LOG M.CLAIMANT'S RESPONSE TO DISCOVERY N. MEDICAL MILEAGE DOCUMENTATION O. COSTS � i i ! � I I AMERICAN ARBITRATION ASSOCIATION In the Matter of the Arbitration Between: Chong Thao, Case No. 56 600 02252 13 Claimant, and STATEMENT OF THE CASE OF CLAIMANT State Farm Insurance Companies, Respondent. The above-captioned arbitration arises out of a motor vehicle accident which occurred on February 25, 2013. At that time the Claimant Chong Thao was a front-passenger in a 2012 Toyota Corolla motor vehicle traveling westbound on Phalen Blvd. in the city of St. Paul. As the vehicle approached the intersection with Payne Ave., the light was red for vehicles on Payne. As they entered the intersection, the end of their vehicle struck the passenger side of a 2005 Ford inotor vehicle operated by Michele Giampolo. Ms. Giampolo was northbound on Payne Ave. and failed to stop for the red light. On impact Claimant was moved in and about the motor vehicle but did not sustain any interior contacts, The accident was investigated by the St. Paul Police Department and Claimant was not in need of any emergency medical assistance. Immediately following the accident, Claimant developed pain in her head, neck, upper back, mid back, low back and right knee. Claimant did elect to seek chiropractic treatment and - ] - presented to Dr. Tou Lee at Community Health Chiropractic Clinic on February 25, 2013. After performing a physical examination and obtaining x-rays, Dr. Lee diagnosed a cervical, thoracic and lumbar sprain/strain. He then began a course of chiropractic treatment involving manual manipulation and conjunctive therapy including electrical muscle stimulation, hot pack therapy and myofascial release therapy. Treatment was initiated on a three time per week basis. To supplement the in-office treatment, Dr. Lee provided Claimant with a course of home- based rehabilitative stretching and flexibility exercises on at a reevaluation on March 27, 2013. Due to Claimant's persistent neck and low back pain as well as radicular-like symptoms down her right leg and her shoulders, Dr. Lee decided to refer Claimant to Dr. Ronald Tarrel at the Noran Clinic for a neurological consultation on April 5, 2012. On examination, Dr. Tarrel noted having difficulties eliciting reflexes with the right leg. He also noted moderate tissue texture changes throughout the neck and back. He then recommended that Claimant undergo cervical and lumbar MRI scans. Dr. Tarrel also advised Claimant to continue with the course of conservative treatment provided by Dr. Lee. The MRI scans, conducted at the Minnesota Diagnostic Center on April 21, 2013, were both were determined to be within normal limits aside from degeneration. In terms of Claimant's treatment with Dr. Lee, by July of 2013 she was treating at a rate of two times per week. , Claimant did attend an independent medical examination with Dr. Jesse Ternus on April 23, 2013. Based on Dr. Ternus's evaluation, no-fault benefits were retroactively discontinued effective April 8, 2013. -2 - In terms of the Claimant's past medical history, she has been involved in several prior motor vehicle accidents. In May of 2004, Claimant was involved in an accident for which she began a course of treatment with Dr. Lee. She was also referred to Dr. Ronald Tarrel at the Noran Clinic. Claimant was involved in a second accident in January of 2005 and again treated with Dr. Lee due to head, neck, and low back pain. She was referred back to Dr. Tarrel at the Noran Clinic and advised to continue the course of conservative treatment provided by Dr. Lee. Finally, Claimant sustained neck and back injuries in an October 2010 motor vehicle accident for which she treated with Dr. Mai True Lee. She was referred to Dr. Tarrel following due to head, neck, and bilateral shoulder pain. He did recommend continued treatment with Dr. Mai True Lee and did not feel any diagnostic testing was necessary. Claimant has treated through HealthEast Rice Street Clinic for general health. - 3 - At this time the Claiinant presents to the arbitrator for his consideration the follo��ving outstanding claims: 1. Community Health Chiropractic Clinic $11,061.90 2. Medical Mileage $143.81 Dr.Lee: 61 visits x 3.56 mi. x$.55 = $119.44 Noran: 2 visits x 22.16 mi.x$.55 =$24.37 3. Late Payment Penalty - to be determined by parties in event of favorable award 4. Costs as follows: a. AAA Filing Fee $35.00 b. Noran Neurological Clinic Records $54.97 � Respectfully submitted, Date James P. Cody, #0391050 � Attorney for Claimant ' 359 Commerce Court Vadnais Heights, N1N 55127 (651) 294-0994 -4 - �;y' �•_ t rn�. , , , ta+'` , � . r� ._...... .. ..__.__ _..._. ._ _, :...:. trg}.�.2`,�?+' - .... - - . _......_ . .. lMJ1 CA£f NO MIENUEU }SS 'ffi. $-��-'. •. f� " ��"`' �"<4�.�� �—_—A 13038053 N �;� �*' g Hit-/�-AUN PUBPRJC VFM�f.Y.F.S KILLEO JURED 5�.'N - � MONTTi M1E. YEAF 1�'�On 4ttIT�RYTIME C 1� Y f�2 �0 b0 Y ,,, ,� * 2 25 2013 " 1117 m RGLTCSYSiEU. F'JUiFN�JMBFNOR3TRFFTN�LIE RQ40YMYpREf.iY.lk (� (� � N E �IxTERGC�TIOM�I C0. - - 't(M, }�� �H,O�� Z �, 10 Pa ne Ave. 5 � "� �'s �" ` �p�y Hp C'ry INT EtEM REFERENCE P01NT 9IX1TE 9�'S iU�TF.�.5'4EE',COR?IM.M',Ufi�LTTIAtk 62 �,,,,, +_• 10 Phalen Blvd � ��- y, . .., h• _ •� . .. fo���.��C.S.ION 'JRIVEGLICiN5ENU1.6ER. -0��.• SLAT� CYA54 fi�l3T4TU5 �POSITIOH CPoYEPUGENSENUMBER.I STRTE .^.USS 0.SIALIIY �70F� Ol A101070008902 MN D ; O1 k701140056508 MN D �� FICTOFZ N^llE;'�iqif,4!OCLt.:AST) UATEOfDIRTN 4�"NME�F�RST,MIUM.E,IAST) DAT[0=EI0.TH FACiOR� BELLA BEE YANG 02 16 �5 � MICHELE LEANN GIAMPOLO OS 28 82 41N�JER 1pp(1E55 _-- ORNnI.TN.REfiTR�[.T_FMIMI:S. 'JNVI�i.TN RESTRif.i 'JVER O1 763 Marion St. N• . 367 Grove St. N Ol Pensu crtv,,rr.n.ziv --.an.sr..rF.z�� P�r� O1 St. Paul 55117 763-245-3600 St. Paul 55101 �1 �� PCpNND �WMtESS ScX �=_E�pT y,FEEG�T �:RBnG klE..^. WJSEV ���AOON�SS SE% SniEEOP1 3M'E!(1PT MaBnG EJECT INJSEV R��'a�ol O1 "��`� F ?�4 `'� 04 06 05 N `�" F �'�4 `�`04 06 05 N O1 � ( µCML TYCF. GRIM IYPE TOMOSV 1EFORI /.MBUUNCES'EHVICE RUHNJMOER M1�LCyH}I 1(�'�E CRUG TYf�E T7HOS TMYSPORT MIBULWCESERVIGE R�INNUFABEfi � 98 I� 98 N ^I. o �€ST (�p },T ' T T ST �O'HF.R y. •,: 70 1V'.� JV 1V;- �UfNk0. i � aen M. �.. :+a^ ...: <..m.�..t� ��'a .r�::..it .. ....:�.-. a.. . ...;�.. �' :.. . ...... ...., ..., ..�.. � .�..r. .� �:�e: CCCJP �.�OKNE�tHYE•` •. FIRE UWN_NN/�ME F1RF. OCCJP 0� YANG BELLA BEE N City of St. Paul N. O1 � ---........_ ' VEHttP I�DOR:59 TOiE� j MORFES T�)/iti0 'E4TYP O1 923 MARICN J1 �1 Y; ; 367 Grove St. _ Y Gi VENUSE GILV.ST�LE.Z�P —�.__ V�JIIMG ��ECT .CllYfiiATF.1W Vl1LLING DIFECT VEHUSE O1 SAINT PAUL MN 55117 "1�` 07 St. Paul, MN 55101 °"I� O1 O1 ; oM:�oc w�xc i���OEI YFM �o:�a � Fo rd 4 d � �0$i�W rlt i �3��� O1 TOYT , CBA 201 TAN UNGSEV R4T�N �STftEG "EMREG S�Edi�nCEOFEiE�M3 MOST�NFMEVEHi�•�PIAT�( STIiE4 1'E4NREti: . 3E�uCFO�F..�YfS �r JpSTM�AUEVF. �GSEV� 03 331KHT ':. MN 3 Ol � Ol 4. POLICE MN 13 � O1 I I I �1 �3 ! _..__.... a � F���p�.�� VOL:(:VNJMBF.R < INSJWNCE{U�!!T]) GO�IL'/NUfABE� ;American Family I1870-6290-01-56-FPP � City of St. Paul I ..NtG06D�M/:NA WWYED W+[T!:rill ��� �NSPtlaCOEi wlNEU ruZIM'�-MGCM+V T„� p�� IF ACCIDENT INYOLVED A COMMERCIAL MOTOR VEHICIE,SCHOOI BUS,OR HEAD START BUS nnc *TM�E ( � � �REMEMBER T�O NOTIFY THE STATE PATROL(raquired under MS 169J83 and 569.4511). � - � ��+. C^IAMERCN�`IE!11�_eNlIL1P%F'- T1��Ff.�R.i�FR'UMF MTNJMpE:�. ��'�� C(1MMf11CIAlvFhlrtF.NUMBER��UJTORC:iaRIEa�NMt OIl?N�M9ER I � . IMSSENC.ERS/Wi1N�315 . ..... . . . .UNIt VOSTN CA'_Oi&RTM SE%�TVGE UEE AINBh4 EJEC� IIJJSEV T011051'TW\NSiORT . .. . ❑N.d AMBSAVICE a,�n-.naim Chong Thao (651-855-8193) O1 03 6/35/ F 09 04 06 05 N N, po.,�Fa 6 AMPSfftv�E � !tl;Ht�JMFltR �essica vang (763-295-3600) O1 OS 6/�i/ F 09 04 06 OS N N p�„�Ea � nM09=RVH:E �U4kJ1.fBF.R AAIB �OTMER I .,..,,t,S....... . ........ ..... ... .......... ... .., ,. . ..,,..:.._.._....._v ...... .. . � � .nFF:��GTNFaM1.1FGEDPF?EaTY�NO�ESCR1�'IOV�X:V.lMGIUi'itCV[fI�Y L/lNiYIL'.(TN A4MIMJEii�9, ONM FOfMi!'F T �'ONT�GNUF1[fER f .. ,y��,_—T-s^'.__'-�:.xbC........ .... . �.,,-. �;_.. 5 C�r. . ..... ... , . .. . D VYC , CTW ��~ .N,WRATIVE. Y :-:. ��. X\ Q 1 i �1 "�' d� . . � . � .a> � ' t. - .. __ . __..._ .. ::.;, *i ��. s tie�s ;_, j� ',� ,,, P�A Vehicle #1 Traveling west bound on Phalen blvd ,. �3 ;' had yellow light. Vehicle #2 had red light and ` s K'CNI(1!!O ��^TM �' entered into intersection heading north bound on ~ 01 01 ,s � ' Payne Ave.. Vehicle #1 struck Vehicle #2 in the '� O40RiD^uE �€; � � �: intersection.� No compla�int-of injuri�es.-��Both ;;. �+*"r� ,i„ N ;'I ,, vehicles were towed. i 04 �rvc uf r;z r' Phari Bbe �^�1 s eEfi 98 ?;: — — — �,� — � _ ' 30 ? • "� � -i ' � S C i/t i1kH: ���µMR ,.-. � . ... . . .. ...... ...... . .. . .. . Z �r� 02 J NTMKF.NS :�'�: �. . ...... ... . . .. . . .. .. " GRESE1dT - � -wE�Tl�i[A3 R(IFS:Jt _ __ _ � _ — .. . . .... . .. .. .. . . ... � . O S �� � �.:� . ... . . ... . . . . .. .� UG1Yi i : r. M�SJAF O� O 1 �; � � ; ; �;°� ,z I� _ � �. � ; _ _ Y uuriaw , w.., - .. . . .. . . ... .. . .,. F��� _ 05 � : � . O1 ` __ > ._.... _ . . _...._. ' IGEnCr v'niXOlSf�i!tJM �ciAT[PA'ROL IGCRl �oF=eeF��Kr+u�wroe�,ocee St Paul PD ❑SHEri�FF Q or en Sergeant Patrick Cheshier 115 , �, �-`�+ � ,� �. �� ;� :� � ;e �.. �,� — ' � -"; �; �`_� �� � � o �;,�. .:� � "-s _ :,� � � �:;. � � . � , a=, � ,� �� ; ��: �, � � ��< �d' f�F. ,�: ��� ;i ��;9 ��� �� `� fr?" � .;:., � ,:�,�. -� ,y°"' a ���' �: 'a •:� �r :_. �E i ..,: _ ��.� `, s. � . �:� �_ � ;�. �:�j' �� %. .:r r�;L. � ��'i k. �,%` .:� :k f: 3 ��� 4 � � A_ �� � S; �'- ,t '�`i�� ... . . .. ..��� .: L.. �'; } � �. E� � ��,.. �q�� ^� d�� a �. ,x^` \� i�� � � � � 4 . �. a �r 3 M � �,: ��` �.g: � �`;I , 'I � � `�,&l��y�lii � r,g,". 3 ��� 'k�;'ra�: � s � a ..'�.` „:;. x,: }:. ',� � ` d : � � . '� �' �-; '.t , `�: � -_� � , , �: � �"' � �� � �'a � �_ FS. ....�.# �..,. T� �£ � � e�� �:.;�� �,� �,�, �� - � �,_.x �«� n;. �� :.� £. >. �y �. �,„,,.: �' 3, �- � f: ¢1 §' �'' qg,e �.�.�� � � r, ,� �...� 4� � .,. � ��r�t��M��X 9YiC�� L: GV €J State Farm insurance Companies CODY L.AVtI O�FI�E �� �x��7C 359 C�MMER�E CT �t?qertix��&5tl'2•2�7fl � VADNAES !-�EIGHTS MN 55127 RE: Cl�im t�urnb�r� 23�17K7-319 Po3icy Nu�ber �QC�fi-$67-23 Our lnsured Chong ThaQ �at� �� Lo�s February 25, Zi�13 Dear ►Vlr Go�iy I would iike to thar�k y�ur client fc�r atiending the Independent Chiropractic Examinatian with Dr Jesse Ternus on Aprii 23, 2013 I've enclosed a copy gf Dr, Ternus' repart for y�ur review. A�ter a physical examir�ation an�i � r�view �f the m�dical records, �r. Tern�s apin�s Chong Thao sustained n�ild �ervical ih�raciw, and lumbar �prain/strains as a resul± of the �e�ruary �5_ 2013 motor�rehicie a�cident � �� �� Dr. T�rnus' ��inic�� cf�iro�racti��re��r��=�t ak a fre�uency �f ?hr�� t�r��es a week for Ch� fi��t three weeks, two times a week for the second three weeks. and ane time a week for the �erriair?in� two we�ks� which shou(� I�ave b�en 1im€t�d to tv�t� passive r;��dalifies �er�reat�nent ! anei n� rnc�re ihan three ane ��ur massage ses�ion: w�uld hav� been apprapriate ' Dr T�rn��s o�ines Chc�ng Thao i� at pr�-ir�j�ry s�atus ar?d d�es not require any a�gair�g chiroprectic andtc�r passive care therapy. E3ased �� Dr. Terr�us' repart csf findinc�� alc�ny w�fh a rev�ew �f th�file. Siate Farrn w�l! be dis��r�tinuing Na-�a��lt benef�ts f�r c�iroprac�ic an�f`�r pass�ve care thera�y wat�e lo�s. �n� repiaeement services clasms effective eic�ht weeks post-accident or February 15. 2003. If you shc�uld disagree with �ur decision and the amaunt ir� dispute is �`f O,GOC' or less. yo�t h�ve th� right t� a�taitraie yr�t�r c�ai� To i�stiate the arbitraticar� prcrc�ss. you n��d tc� ��sntact tt�� Ar�erican Arbitratic�n Assc�ci�tior� at E� � Bar�k Plaza. Su�te 70U, 2�0 South 6th Stre�t, Minneapalis. Minnesc�ta 55402, �elephone number 612 332 6545. for detaiis regarding the arbitratian proces& Stat� Farm Ins�arance reserves the right tca object to arbifratian of c�ve�-age q���sti�ns ar I�ga! questic�ns be��nc! the jurisdi�tior� of as� �rbi#rator. A�y a,n,� �l! cia�ms s���m�t�ed ta State Farrn #�s��r�nce �rflrr tt�e date c��ihis letter vdill be r�vierrved sub�ect to Dr. Ternus` recommenda#�ons and finding�. If any furih�r rnedical . . �.r;�:.r<<,d�::;��' '1 .�,�t�-f<3 �..�;�.,.. `"u �r..,v�-��, �`ww7.,n�i-�. ...�. cc��� �,��v o���c� �,�-����-�m� ���� 2 inf'orma�i�r� su�€�ces w�rranting additiona( review by Dr. Ternus, please ct�nt�ct me �rnmediately �C}f'�0(iS9i��.'f�tlt��- Shouid y�u or your clier�t hav� any questit�ns or ��ncerns, or w�sh ta discuss this rr�atter further please da n�t hesitafie to cantact me. S�rt�e`�IY % �= �- , -�; . _��-� �_ ttene O Nelsan, CLU> Claim Representative 651 365 $960 88$ 577 4668 ext 365 8960 State Farr� Mutual Autc�mobile Insurance Gc�mpany 19�292112�2922 �nLiosure cc: GI�C}NG TNAC} 129 ARCH ST � APT 8 SAiNT F�AIJ€� NEN �5130-�i3e�3 f � � � � � '����� ,� . �ame� �. ��d v t1{.xV�t��i �t�t�Y "T I.Ty`,:' C3 %Y��JRI`J�1'(,I.I� � �''�7_ �::;t� �t , _ �.;!� ., _ �I��}��� E���vf�� �.����� (�r-«t�}�, �.�1e�artc°s°���3 Robert 6, Cody � .., s ,7 ."1� 7 , � �.,.c. ,���v�'`;<�C�..i'��°�fC3li�3. :JC�.,, `,. , -- . �_. r� .. .,:, �..}i . ":;1f_ l. ......, ;'�'�)I'1� � �. �'�)�.3 1mc:r�c�i�; .lr��i����zti�,t� '�:��:��ci�ti���� `�+?(j `ti,c�tltl� ,`�,3etl' `�Et'�et, �t�1t� ?{.kt '�tir���e���,�,9�,. �9� ;`�-�f�`' I..�:�: t`I�c��a;� .l l3<i�� �.�r�vi �t;jt�� I <�t���� Ir��t�t��:}�� ( ��r=���;i:�� t 3c1r I ik: '�tt��th�t�; (�l�)<l'� �)iD�t' i3� �.Ct';.; (} '`+` i i 1 tz 1�'P�f,€�� It '�1„� ('�3���er��: I:���l�>5wcl ?��:r�E�itl� tur ii€ir�� ��i�<��L fi���� t����°�: �E��si�:5 {?R�tli� ]'�:titior� i��r :�rhitr�iti�>�1. t�>�.Lt�i��- ��itl� , - , , _ • �1�� �i�:���a�1. i}�L Ii�����r<�t�t�s� ��f�� b��l��� ;���u tlz� ���.(�t� fiE�t�� ��� ��� tl�� ��hca�� �t�t�tltiel mattLr. �'t'C� li� �'t�i�lt'`�, 1'J '�' � �.:; �j �, t�l�� �. ���3ti'� �)�.�.���31tY2i� �:i1C'�t?`*liS"t'� � , . �._>._ �.. :::7 ,—�;t��v� �. ��-�', .. .. _ :��r�i_ . . . _.._ . .. ;i�. ; ''�_.. — . . . . . . _ s . . ,_ ,.�-. _ ... ._..< _. . ?- c _ �,'111°:ItIC .��� ;��ItBI`[`It=�`1�It)ti •�.4�s()('I,�`i°I()'� 1�'c�titi��r� fc�r 1���-I��au�t��z•t�i�rati�>� �l�e ����r�ac:�+ c}t�tl�� C'ia�i���a��t�yj, ����°su�ir�t tt� `�1.�.:1. f>>13.�s?�, l��:r�h1 tir�d�r{s) tl�e f'c�llc���it��,� �1i4��t�ir az�i5ing t�ut c�I`a r�c�-lt�i�lt i�4lirar�ce �t�1i�:� 1ar re�olut�c�ri u��ci�t�thN t�lint�esi�ta �t�-�`at�1t C'c>tn�rehet�si�e c>r Cc�llisi�>r� C)���t�a�e .`1utc����c���ilc �r�surar�ce ,=�rh�tr�itit�n ��i�(t; ��ci►i�i��i5t�:ret� 1�� th� ,��mcr�carl .lrhitrat►c�n ASSt}ciatic>��. �tate I�ar��� IrlSUrt�t��e C:c3i��;�an� , � In����°��nc� (`�:�t-r�������� I c�Iic� ";: _____�..... ___ _--�-�... `�tt-��t: 1't) �3r�� ��''<{) C`E��i►r� ;:: `'3-1`?�7-�1�) _.� �.._._� � C,51-�C��-���if) __ C`it�-: I'lu��r�ix �t:�te: .��. 1i�?: f���:)?�' i'f�����e f,•: ��tjli�:���ai?le��:r: C`l�c��x;.'. C 1�R�E? :�.c�i�ic;a�t I)at+:: E)`' ?�;1� '�atn� ��f�C:"1G�ir�r�rai�t(�) I��'Iirit�r "I-��t��l .f1�1�t�t�nt f'Iain�e� �;;.c)(}{l,1'? ac�c� c:�l��tinui��� (�'}3c:�sa;� 1`�tzic� }�, �; *I'leasc; �;ee 4ittachec� iti�n�i:?:atic>r� �I�arii�� I�c�c��It IZ�i7�ityt�i�; `�t_ I'����1. ���'� � <3f�fi�-rr� t}��t�l�e st�i;c�=•t��atiti��� �jric� ��rr�c��if�t �l�in��d �c�n:tainL�3 l��r�in i� tc> �Ie hest c>i"�nv kz����-(eci�e. �)<iti�. r -� I' J; i jM,.. �il}?T1�C�; °, ''""'�%'�,, �.._ _.._. �.- _ _. ��___ _ ^ � , �� 4'��1u�t h� >t���e _ �ain�i�r�i c>r (:'i�iin�ant"s Ite}�re��:nt�tiv�) 1'h��ne:: f�:��-���i-h 1��� '�x����e c�f 1il�l�� �,��rr���: ���(u�i�� 'I�hf�i� �__ _.. .._ _.�. __-- ;�<i�rc�;,; ��'c� l;. .�rc�� .1�?t. E3 t_'it� St, I'��t�l �;t;�ii�: �=1'� Ii�: ��l��t) if`��t� <�ttt�r-r.�� r���1 ���° r�::��,��:��:��tiz:4.� �����. ;�1c°���;�; �:c>t����l�t.c itc�ft�� 1�ilc�r�: .1ttt�t�ttc:� I)�tt`i�i i�. (.��>��ti I'ltt}t�c': {fi�] )?t)�-(}t)c}.� ____. . ....__._____._ _ __ :1t�i�rs�,s: ;;�� C i�n�n�e���:c C'c���rt C'it�': �'6i�r�ais i iei�}�t4 `�t��te: ':�1Iv 1i�?: `�:�t"7 (1�� i�>I1�>ti�i��� ������t he i���:�t�clecl: - I�l�r��: t:�����w t�f t�ae �i����� ���;titic�n. � - 1`����€� c����ic:�; ��f't}�i; iterz�iratic�ia ��#�elair�l dttailin��. ���frY�es c>f�prc�viders, c�atts c�f�service cl�3it�r7�d. a��ci tc�t�t3 ar�c�crz�t:� ����in0.� fc}r n�e�3ic.�l cl��ii�4. 1�c�r ���.��c� �{?4s c(�iii�as cic:tail �rt�splc�ter:�. ratcs c?�� �a�°, daies r�t�c:l��i�7��d �crt�ict5 anti t�ial �rtic�t�ilts �����iz���;. An�� supp��rti�t�c�t�ct�rncnt�ti�n shc��(ci E�cy incluc��d. - InS�iran�.� e�c�n��p�����'s 1�:1ter r�I�de��i�l c�r cc�►15�:.nt tc� at•bitrate. - tic���-�Gf�������z�hli.: ��5.()f) t�liri�„� i�e 4c}��ck i�X<�t�� ��s���G�1��c tc� .=�ra��°rii�r�� :�'��-hitre�ti��n :'1s���ci;�tic>��). �;G�1�� i«: i'��1��:rical� .lrhitrati��a� >�:��i�ci��tic>n �'()t} �c�tatl� �i�;th �Stree:t ltlt} I'illsbur} t.;e�lter I��lirtx7����+:?(i4< �1?�: �54�1`_' ��, � �`?`�� 1 ;� � � � _.;� � ��. �,��v�, ��__ �:�e,���v:�� S��te�arm��� r -�;,� �N:r:� � ,cs . ' ''�� A�t'(� �1�, �Q�_ 4'�yage�r lrt��g=ng �'il�, State Farm Ciaims �Q�93 �'�l Dunl�p Sir �.�� Box 5?_27� � �t P�ul IVIN 5�1 C}4 ?l��en�x A�85�7�-217G � ��: C:laim Numb�r. 23-17K?-319 CJ��e o��o�s: Februar�+�5, 2�13 C7ur lnsured: Chong Thao ��ti�r�t; Chc�r�g Th�o ��ccc�unt NUr��ber: DC7� Gr'151�968 �a�eis; of S�rvice: 3f12i201� - pre��nt To iNht�m (t M�y Cor�cern: '�'� h��� r���ived yo�r bili fc�r treatment render�d ta the ab�+ve p��ier�t c�� 3'12���13-- ��es���. There �rv�ll b� � d�l�y in payment �af Ehis bill b�cause uve hax� n�t yet rec�ived the Applieatia� ft�r �]�--Fault ���efits f�m� fgr 4hi5 p�'ient. I� vQ�� �����' ���y c�u���irE��. �leas� cont�c� �as. Sincerely, Irer�e C� Nelsc�n i ks �laim Repr�s�ntative :�51� 365-8�rau �lat� Farrr� ���utu�ai�auto^�obii� �ns�aran€�e Car�panv cc: Cady Law�raup �hartered 35� Comm�rce CT S�ir� P�ul �b1h1 �5�21-85�� �!��iI;Ft1(".`l:ti ;1�tI31 (Rf'�l�lt)'� :1`��C)('I:-��l`1(}'� �.'1-�c�r��.�� I:`1���,3. � C.`l��i t�t1r���t�_ �:�. 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