Emily Jordan

  
 MPT I McLaughlin Physical Therapy 
 3120 20th St 
 Physical Therapy 
 Metairie, LA 70002xxxx
 Initial 
 Phone: xxxxxxxxxxx 
 Fax: xxxxxxxxxxx 
 Examination 
 Patient Name: Mary Wade
 Date of Initial Examination: 14/11/01 
 Date of Birth: 97/02/27
 Injury/Onset/Change of Status Date: 22/11/23
 Referring Physician(s): Pappas, Nick MD 
 Diagnosis: ICD10: M25.511: Pain in right shoulder
 Surgery: (Date/Type) 16/11/04 C Spine Fusion 
 Treatment Diagnosis: ICD10: M25.511: Pain in right 
 shoulder, M75.111 Incomplete rotator cuff tear or rupture of 
 right shoulder, not specified as traumatic 
 Subjective 
 Treatment Side: Right 
 History of Present Condition/Mechanism of Injury: Pt is a 61 year old female who presents to PT complaining of neck and 
 (R) shoulder pain 2 partial RC tear / bursitis with history of multi level C spine fusion. 
 Objective 
 Outcome Measurement Tools 
 Upper Extremity 
 Upper Extremity Quick DASH 
 65.91/100 
 Observation 
 Standing Posture Rounded Shoulders
 Range of Motion 
 1 of 60
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