Cynthia Johnson

 
 Cynthia Johnson DOB: 03 Jul 1995 (89 yo M) Acc No. CR536963 
 [Doc Name: Medical Records-Cora Health-10 Aug 2017-323116] 
 12 Oct 2020 a.m. 08-24-2022 
 6 
 CoraPhysicalTherapy 
 Assessment Report 
 CORA Physical Therapy - Regency 
 | 
 CORA 
 9527 Regency Square Blvd., Unit 105 
 proposed 
 General Eval 
 Jacksonville, FL 322258806 
 Name: Cynthia Johnson 
 FOR WORK COMP ONLY 
 SYS1294723 
 DOB: 03 Jul 1995 
 Case Manager: 
 Onset Date: 12 Dec 2020 
 Surgery Date: 
 Eval Date: 01 Apr 2021 
 Occupation: 
 Employer: 
 Ref Provider: Amy Wu APRN 
 Sex: M 
 Medical Dx: M79672 - Pain in left foot, M7542 - Impingement syndrome of left 
 Status: 
 shoulder, M5126 n Other intervertebral disc displacement, lumbar region 
 Last Day: 
 Treatment Dx: 
 Cur PDC: 
 JobReq PDC: 
 97163 
 PHYSICAL THERAPY EVAL HIGH 
 1 
 Marivic Chang, PT, License # PT23745 
 Date: 21 Sep 2015 
 Signature: 
 marrier chang, PT, DPT 
 I have reviewed this plan of treatment and certify a continuing need for services. 
 Physician/NPP: 
 Date: 
 Amy Wu APRN 
 Thank you for this referral and your continued support of CORA Health Services, Inc. 
 Should you have any questions, please feel free to contact me at (904) 647-4263. 
 Cynthia Johnson DOB: 03 Jul 1995 (89 yo M) Acc No. CR536963 
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