Gary Burns

 Prairie Hill Hospital
 Gary Burns 
 MRN: 33773659, BIRTHDATE: 06/1990/04, Sex: M 
 94867 Ramirez Lock Apt. 187
Swansonbury, KS 51243
 Visit Day: 05/2023/02 
 Result Summary (continued) 
 Documents - Encounter Level on 11/2014/30: (continued) 
 Dr Kimberly Huber, MD 
 Phone: 355-808-4625 
 94867 Ramirez Lock Apt. 187
Swansonbury, KS 51243
 Please sign and return this page only by fax or mail. 
 Plan of Care Approval for Gary Burns 
 Thank you for this referral. 
 Dean Harm is a good candidate for continued physical therapy services. Patient has been compliant to 
 home exercise program.
 Respectfully yours, 
 Therapist Signature: 
 David Ward, PT, DPT PT60388818 
 01/2023/05 9:13 pm 
 Plan of Care Approval 
 Total Visit Count: 5 
 Approval of the plan of care as documented 
 Changes to Plan of Care: 
 Hold therapy service until patient follows up at physician office. 
 Physician Signature: 
 Dr Kimberly Huber, MD 
 Approval Date: 
 12/2019/10 
 Progress Evaluation for Gary Burns 
 Page 6 
 BIRTHDATE: 06/1990/04
