Mrs. Kathleen Gutierrez

00022 
 Seaside Medical 
 PSC 3662, Box 8453
APO AA 18276 
 Tel: 859-556-2518 
 Seaside Medical 
 Fax: 337-117-4625 
 www.landswickpt.com 
 PHYSICAL THERAPY. INC. 
 Quick SOAP 
 Patient (ID 1 DOB): Mrs. Kathleen Gutierrez (cazaresa I 1984 April 15) 
 Treatment Date: 2014 July 11 11:30 AM 
 Insurance: 
 Gallagher Bassett Services - California 
 Visits: 
 2 
 Episode: 
 R elbow 
 Re-Eval Due: 
 Referrer: 
 Dr Shane Adkins MD 
 Next Follow-up: 
 Diagnosis Codes: 
 Asthma (K80), Multiple Sclerosis (K50), Congestive Heart Failure (I26)
 SOAP 
 Subjective 
 Pt reports that she was a little sore after last session.
 Objective 
 Tx: STM triceps, wrist extensors, wrist supinators, biceps; CFM along medial and lateral epicondyles; 
 Plan 
 Cont per POC. 
 EXERCISE FLOWSHEET 
 See hard copy for list of exercises. 
 CHARGESHEET 
 Time Information 
 Total Direct Time 
 30 Minutes 
 Billing Codes 
 Code 
 Description 
 Units 
 Comments 
 12023 
 Joint Mob/STM/Manual Therapy 
 2 
 signature: Robert Bond, PT, DPT (Random_7_digit_number) 
 Date: 2023 April 15 
 (This document was electronically signed on 2023 April 15 by Robert Bond) 
 Note written with MWTherapy I Patient ID/Patient (DOB): cazaresa/Mrs. Kathleen Gutierrez (1984 April 15) I dos: 2023 September 16 11:30 AM 
 Page 1 of 1 
 12023 
 68584141752 
 Received 2016 June 19
