Emily Burke

 08 March 2024 10:08:03 EDT 
 To: 18003806151 
 Page: 24/33 
 From: 8332845756 
 Fax: 8332845756 
 Initial Evaluation Note 
 PATIENT NAME: 
 Emily Burke
 BIRTH DATE: 
 27 September 1994
 Sex: F 
 visiting date: 
 24 February 2019
 Visit # 1 
 Provider: 
 Brandon Bensing 
 NPI # 1225662943 
 Clinic Details 
 Case Details 
 Clinic 
 Address 
 Injury Description 
 Injury Onset Date 
 Pleasant Valley Hospital 
 4125 Dick Pond Road 
 Back Pain 
 08 March 2024 
 Phone # 
 Myrtle Beach, SC 29588-6807 
 Diagnosis Codes 
 G40 
 Fax # 
 8332845756 
 Referring Physician 
 Ashley Maybin 
 Subjective Analysis 
 Previous History of Symptoms 
 YES 
 Patient Chief Complaint 
 Patient Goals 
 Patient Problem List 
 Patient suffers from or currently has Hepatitis
 Thyroid problems, Arthritis, Other orthopedic problems, 
 Osteporosis, Chronic pain, Chronic migraines  
 Treated by Dr Juan Lloyd (License #10144) 
 DOS: 11 April 2016
 Page 1 of 6 of Initial Evaluation Note
 