Rebecca Malone

 
 14-04-30 19:59:15 EDT 
 To: 19531226831 
 Page: 05/631 
 From: Lauris Rigdon 
 Fax: 3314931231 
 Signatures 
 Treating Provider Signature 
 Initiated by Maria Stalder, PT, DPT on 21-08-27 14:56 EDT. License #: 049147 
 Electronically co-signed by Mary Smith, PT on 21-06-27 16:01 EDT. License #: 024318 
 Patient Shauna Becker (DOB: 95-06-30) 
 Treated by Maria Stalder, PT, DPT (License #319131) 
 DOS: 20-02-27
 Page 4 of 31 of Plan of Care
