Judy Johnson

 
 I have not violated Labor Code 139.3 and the contents of the report and bill are true and correct to the best of my 
 knowledge. Signed this date, Solano County, California. 
 DATE: 2020-31-08 
 CURRENT MEDS: 
 See med List 
 (0935) 
 No Level: 8/10 
 ALLERGIES/ADVERSE REACTIONS 
 Patient Instruction: 
 Pain: 
 Yes 
 MEDICATIONS: nKDA 
 Acceptable pain level: 
 Learner: 
 Pain Is the primary reason for this visit 
 LATEX: no 
 Patient: 
 Family: 
 Rev IS train and MRI rese 
 Teaching Method: 
 Verbal Presentation: 
 Cort pun W lower back unable Demonstration: 
 Written Materials: 
 to set & Stend A protest 
 Medication: 
 Medications dispensed: 
 Description 
 OCCUPATIONAL HEALTH 
 Provider: SHEILA LEDERER, PA 
 A NorthBay Affiliate 
 Keeping Solano's Workforce Healthy 
 date of service: 2017-07-02 
 Patient: MEJIA-GALLEGO, 
 D.O.B: 1996-30-12 
 FLORENTINO 
 Follow Up Visit 
 Employer : CHEVY'S-FF 
 doi : 2019-23-06
 OH-26 Rev. 03-12 
 230
