Stephen Cooper

 
 Stephen Cooper DOB: January 24, 1992 (25 yo M) Acc No. 16732 Doc Name: June 23, 2020 Inj 
 LA Health Solutions 
 3001 Division Street, Suite 104, Metairie, LA 70002 
 606 Colonial Drive, Suite A, Baton Rouge, LA 70806 
 T: (504) 262-8889 F: 504-603-2826 
 POST PROCEDURE PAIN ASSESSMENT 
 USE THE LETTERS BELOW TO INDICATE THE TYPE & LOCATION OF YOUR SENSATIONS RIGHT NOW 
 A - ACHE 
 B - - BURNING 
 N - NUMBNESS 
 S - STABBING 
 T - TINGLING 
 P - PINS & NEEDLES 
 Post Procedure Pain 
 x 
 Patient Signature: Jostfullt 
 Witness: 
 Date: November 11, 2018 
 Stephen Cooper DOB: January 24, 1992 (25 yo M) Acc No. 16732 Doc Name: June 23, 2020 Inj 
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