Cynthia Lee

00022 
 Sunset Community Hospital 
 6336 Hernandez Walk
South Nathan, ID 67965 
 Tel: 407-774-9355 
 Sunset Community Hospital 
 Fax: 602-267-6980 
 www.landswickpt.com 
 PHYSICAL THERAPY. INC. 
 Quick SOAP 
 Patient (ID 1 D.O.B): Cynthia Lee (cazaresa I 23 September 2002) 
 Treatment Date: 12 October 2014 11:30 AM 
 Insurance: 
 Gallagher Bassett Services - California 
 Visits: 
 2 
 Episode: 
 R elbow 
 Re-Eval Due: 
 Referrer: 
 Dr Anthony Olson MD 
 Next Follow-up: 
 Diagnosis Codes: 
 Osteoarthritis (I26), Cirrhosis (G35), Influenza (K80)
 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 
 67495 
 Joint Mob/STM/Manual Therapy 
 2 
 SIGNATURE: Bryan Harper, PT, DPT (Random_7_digit_number) 
 Date: 23 March 2019 
 (This document was electronically signed on 23 March 2019 by Bryan Harper) 
 Note written with MWTherapy I Patient ID/Patient (D.O.B): cazaresa/Cynthia Lee (23 September 2002) I dos: 28 April 2016 11:30 AM 
 Page 1 of 1 
 67495 
 27658201159 
 Received 03 December 2017
