James Austin

 C 30 December 2015 3:31 PM 557-904-1516 34760532297 pg 1 of 7 
 CLIENT: James Austin 
 CLAIM 
 dos: 14 December 2019 
 
 The patient appears motivated. Patient consents to treatment plan and goals 
 and gives verbal informed consent. 
 
 Goals Time Result Comment Frame 
 100% compliance to HEP In progress 
 At least 10% reduction in Quick DASH In progress 
 
 Dr Kelsey Sandoval DPT This document was electronically signed on 20 January 2022 at 03:29p by Dr Kelsey Sandoval DPT. 
 
 Patient: James Austin Claim#: 
 5765 Diane Glen Apt. 808
New Elizabeth, SD 98689 Phone: 557-904-1516 
 Fax: 683-386-3233 
 WWW.NWRTW.COM 1 OF 5 
 9-9-2019 301347605322971 522019079299492
