Kimberly Martin

 From Injury Treatment Center New Orie 
 15046559370 
 19 March 2015 06:33:42 pryr. 
 Page 3 of 70 
 INJURY TREATMENT CENTER 
 NEW ORLEANS 
 THE INJURY RELIEF SPECIALISTS 
 3770 Airline Drive, MetaRic, LA 700xx
 Phone: 504xxxx Fax: 844xxxx
 DOB: 09 October 1997
 Sex: F 
 Patient: Megan Young
 Provider: Injury Treatment Center New Orleans 
 Visit: 14 January 2023 11:00AM 
 Chart: JOKA0000xx
 19 March 2015 
 189.00 lbs 
 Weight 
 BMI 
 29.16 kg/mD 
 Palo 
 8/10 
 Plan: 
 Type 
 Code 
 Modifiers 
 Quantity 
 Description 
 CUSTOM 
 PHONE 
 1.00 UN 
 New Clinical Form: 
 PROCEDURE: 
 1) C7-T1 Epidural Steroid Injection 
 2) Fluoroscopic needle localization of above. 
 ANESTHESIA: local 
 BLOOD LOSS: minimal 
 PROCEDURE IN DETAIL: Informed consent was obtained, explaining risk, benefits, and alternatives of the 
 procedure to the patient. The patient was then taken to the procedure room and placed in the prone position on the procedure table. The surgical site was prepped with 
 Chloroprep solution and a sterile drape was applied.  Using fluoroscopy, the spine was examined. 
 
 E-signed by injury Treatment Center New Orleans on 09 May 2022 8:32AM cm 
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