Brittany Suarez

 
 Brittany Suarez DOB: 21/10/99 (76 yo M) Acc No. CR975543 
 [Doc Name: Medical Records-Cora Health-11/04/23-323116] 
 04/10/16 a.m. 08-24-2022 
 6 
 CoraPhysicalTherapy 
 Assessment Report 
 CORA Physical Therapy - Regency 
 | 
 CORA 
 9527 Regency Square Blvd., Unit 105 
 proposed 
 General Eval 
 Jacksonville, FL 322258806 
 Name: Brittany Suarez 
 FOR WORK COMP ONLY 
 SYS1294723 
 DOB: 21/10/99 
 Case Manager: 
 Onset Date: 12/04/15 
 Surgery Date: 
 Eval Date: 08/12/17 
 Occupation: 
 Employer: 
 Ref Provider: Amy Wu APRN 
 Sex: M 
 Medical Dx: M79672 - Pain in left foot, M7542 - Impingement syndrome of left 
 Status: 
 shoulder, M5126 n Other intervertebral disc displacement, lumbar region 
 Last Day: 
 Treatment Dx: 
 Cur PDC: 
 JobReq PDC: 
 97163 
 PHYSICAL THERAPY EVAL HIGH 
 1 
 Marivic Chang, PT, License # PT23745 
 Date: 02/03/19 
 Signature: 
 marrier chang, PT, DPT 
 I have reviewed this plan of treatment and certify a continuing need for services. 
 Physician/NPP: 
 Date: 
 Amy Wu APRN 
 Thank you for this referral and your continued support of CORA Health Services, Inc. 
 Should you have any questions, please feel free to contact me at (904) 647-4263. 
 Brittany Suarez DOB: 21/10/99 (76 yo M) Acc No. CR975543 
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