Jacob Davis

 10:35 AM FROM: Fax California Orthopaedic Surgery and Hand Institute 
 PAGE: 000 OF 003 
 BP: 173/80 
 P:79 
 Resp: 12 
 Wt: 570 
 Ht:60 
 BMI: 57 
 (Vital signs recorded by Medical Assistant) 
 Objective Findings: (Include significant physical examination, laboratory, imaging, or other diagnostic findings.) 
 No new local changes to the right elbow.
 Diagnoses: 
 DI CODE 
 Description 
 1 
 M57.11 
 Pancreatitis 
 Treatment Plans: 
 Patient to start with outpatient Acupuncture, 6 sessions Advised to use over-the-counter oral analgesic medication and/or 
 over-the-counter oral nonsteroidal anti-inflammatory medication as needed. 
 Medications Prescribed: None. 
 Work Status: Modified duty - No lifting greater than 5 pounds. 
 Primary Treating Physician: (Original signature) 
 DATE OF EXAMINATION: 12/07/18 
 fauch Speel PAC 
 Brooke Huff, P.A. C-T-2016-10-10_11:00:07_Digitally Signed 
 Charle I Reoving MD 
 Dr John Jenkins, M.D.-S-22/11/15_21:52:45_Digitally Signed 
 Executed at: Pasade na, California 
 Date: 06/09/16 
 Physician Name: Dr John Jenkins, M.D. 
 Specialty: Orthopaedic and Hand Surgery 
 Physician Address: 25253 Phillips Highway
East Angel, AZ 99920 
 Phone: 954-509-4225 
 Next follow up visit: 4 weeks 
 DWC Form PR-2 (Rev. 10/2015) 
 Page: 2 
 1196
