Michael Wilson

 Patient: 
 Michael Wilson
 NSPT, 
 Acct #: 77852 
 DATE OF BIRTH: 
 28/04/85
 Visit: 24/11/15 
 Physician: Dr Wesley Mathis 
 Phys Phone: 669-466-2020 
 north Salinaa Physical 
 Phys Fax: 761-162-8731 
 SSN: XXX-XX-XXXX 
 Inj. Date: 
 10/05/16 
 1758 N. Main Street 
 Clinician: Chris Temple 
 Salinas, CA, USA, 93906 
 Visits: 
 2 
 Phone: (831) 442-3700 
 Case Mgr: 
 Cxl/Ns: 
 0 
 Fax: (831) 442-3711 
 Payor: 
 MEDRISK 
 Daily Note 
 Diagnosis 
 Left 
 S39.031D 
 Strain of muscle, fascia and tendon of 
 Spine 
 lower back, subsequent encounter 
 General Information 
 This 53 y.o. female presents with complaints of L sided low back pain after straining it while pulling a box at work (12/7/21). 
 Document ID: 002031CA.003 
 Status: Signed off (secure electronic signature) 
 Page 1 of 2 
 Sean Lauer,Lic Applicant PTA; Chris Temple,PT(CA Lic: 294639) 
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