Kevin Floyd

 Patient: 
 Kevin Floyd
 NSPT, 
 Acct #: 64017 
 BIRTH DATE: 
 07-05-1993
 Date of Visit: 20-12-2020 
 Physician: Dr Monica Davenport 
 Phys Phone: 312-123-7966 
 north Salinaa Physical 
 Phys Fax: 979-590-1052 
 SSN: XXX-XX-XXXX 
 Inj. Date: 
 02-06-2017 
 1758 N. Main Street 
 Clinician: Chris Temple 
 Salinas, CA, USA, 93906 
 Visits: 
 2 
 Phone: (831) 442-3700 
 Case Mgr: 
 Cxl/Ns: 
 0 
 Fax: (831) 442-3711 
 Payor: 
 MEDRISK 
 Daily Note 
 Diagnosis 
 Left 
 S39.050D 
 Strain of muscle, fascia and tendon of 
 Spine 
 lower back, subsequent encounter 
 General Information 
 This 27 y.o. female presents with complaints of L sided low back pain after straining it while pulling a box at work (12/7/21). 
 Document ID: 002031CA.003 
 Status: Signed off (secure electronic signature) 
 Page 1 of 2 
 Sean Lauer,Lic Applicant PTA; Chris Temple,PT(CA Lic: 294639) 
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