Chad Myers

  
 From dcatalyst16 
 18443858095 
 8/29/2022 10:58:59 PDT 
 Page 12 of 17 
 (3) 10 Week(s) F/U TVV 
 Follow up with Dr Gary Green, M.D. 
 PRIMARY TREATING PHYSICIAN ATTESTATION: 
 This report was scribed by Aspeitia, Cassandra. 
 / declare under penalty of perjury that this report is true and correct to the best of my knowledge and that / have not violated Labor Code 搂 139.3. 
 Sincerely, 
 Dr Gary Green MD 
 Exm Date: 29/06/19 
 RehabOne 
 RehabOne Programs MEDICAL 
 PRESCRIPTION Industrial 
 Patient: Chad Myers 
 Exm Date: 29/06/19  
 Performing Provider: Dr Gary Green MD 
 THERAPY: 
 Acupuncture: Body Parts: low back. Performed by Brent Dauphin, L.A.c. License# CA 15447 
 with RehabOne Programs in Salinas. : 2x/week for 3 weeks. 
 Clinical Rationale: 
 The requested medical treatment is medically necessary to cure or relieve the effects of the 
 16Corona, Araceli : Aug 25, 2022 
 page 11
