Christina Johnson

 C 2014 Apr 28 3:31 PM 694-972-9794 56350129543 pg 1 of 7 
 CLIENT: Christina Johnson 
 CLAIM 
 DOS: 2022 May 24 
 
 The patient appears motivated. Patient consents to treatment plan and goals 
 and gives verbal informed consent. 
 
 Goals Time Result Comment Frame 
 100% compliance to HEP In progress 
 At least 10% reduction in Quick DASH In progress 
 
 Dr Michael Davidson DPT This document was electronically signed on 2018 Nov 18 at 03:29p by Dr Michael Davidson DPT. 
 
 Patient: Christina Johnson Claim#: 
 39331 Clarke Key
Lake Steven, NV 16992 Phone: 694-972-9794 
 Fax: 175-242-1743 
 WWW.NWRTW.COM 1 OF 5 
 9-9-2019 301563501295431 522019076271222
