Rebecca Flores
 
 
 2015/06/05 
 eCW (Schaubhut, Roslyn ) 
 Rebecca Flores DOB: 1987/01/05 (78 yo M) Acc No. 39486 
 REFERRAL 
 KATE MCDONALD, MD 
 Rebecca Flores 
 Family Practice 
 1987/01/05 
 ,,- 
 Tel: Fax: 
 Reason For Referral: 
 Authorization No: 
 Authorization Type: 
 Reason: 
 Please evaluate and treat. 
 Diagnosis: 
 G44.309 - Post-concussion headache 
 S06.0X0A - Concussion without loss of consciousness, initial encounter 
 E/M Codes: 
 Procedures: 
 Visits Allowed: 
 0 
 Unit Type: 
 V (VISIT) 
 Start Date: 
 04/19/2021 
 End Date: 
 04/19/2022 
 Notes: 
 Clinical Notes: 
 Structured 
 Data: 
 Kate 
 ml 
 Provider NPI: 
 1679594212 
 Electronically signed by McDonald, Kate on 2022/27/12 at 02:42 PM CDT
