Chase Ramirez

 Prairie Hill Hospital
 Chase Ramirez 
 MRN: 33773659, BIRTH DATE: September 29, 1984, Sex: M 
 713 Alicia Overpass
Lake Maryhaven, PR 37172
 Visit Day: August 04, 2021 
 Result Summary (continued) 
 Documents - Encounter Level on August 30, 2020: (continued) 
 Dr Edwin White, MD 
 Phone: 666-989-8406 
 713 Alicia Overpass
Lake Maryhaven, PR 37172
 Please sign and return this page only by fax or mail. 
 Plan of Care Approval for Chase Ramirez 
 Thank you for this referral. 
 Dean Harm is a good candidate for continued physical therapy services. Patient has been compliant to 
 home exercise program.
 Respectfully yours, 
 Therapist Signature: 
 Jesus Gordon, PT, DPT PT60388818 
 April 22, 2022 9:13 pm 
 Plan of Care Approval 
 Total Visit Count: 5 
 Approval of the plan of care as documented 
 Changes to Plan of Care: 
 Hold therapy service until patient follows up at physician office. 
 Physician Signature: 
 Dr Edwin White, MD 
 Approval Date: 
 January 10, 2019 
 Progress Evaluation for Chase Ramirez 
 Page 6 
 BIRTH DATE: September 29, 1984
