Bobby Skinner

 
 l'have not violated Labor Code 13. s and the contents of the report and bill are true and correct to the best of my 
 knowledge. Signed this date, Solano County, California. 
 11.00 
 DATE: 
 T 97.1 P 72 R 12 B/P 163/78 
 CURRENT MEDS: 
 See lied list 
 1/:44 in WT162 HT 56 Last Tetanus: 
 ALLERGIES/ADVERSE REACTIONS 
 Patient Instruction: 
 Acceptable level: 
 Pain: Yes pain No Ley 18 
 MEDICATIONS: NEDA 
 Learner: 
 Patient: 
 Pain is the primary reason for this visit 
 LATEX: to 
 Family: 
 26 yo Male c/o fugist area pair at 
 Teaching Method: 
 Verbal Presentation: 
 R) Leg Injured by slipping happened 
 Demonstration: 
 Written Materials: 
 is days ago u. Day puts) 
 Medication: 
- 
 Medications dispensed: 
 2130pm RDJUOQ 60ms PM toradol MSaympe 
 OCCUPATIONAL HEALTH 
 Provider: Dr.kitchens 
 Date of Service: 
 09 Feb 2024
 Time: 10:11 
 1101 B Gale Wilson Blvd. Suite 203, Fairfield, CA 94533 (707) 646-4600 
 Patient: 
 DOB: 26 Oct 2000
 Initial Visit 
 Employed 
 DOI: 20 Feb 2023
 
 163 
 17 May 2015
