Brooke Gordon

 Downtown Medical Center
 Brooke Gordon 
 MRN: 33773659, BIRTH DATE: February 24, 1985, Sex: M 
 377 Daniel Falls
Beckside, NJ 46218
 VISIT: April 02, 2014 
 Result Summary (continued) 
 Documents - Encounter Level on January 14, 2020: (continued) 
 Dr Kimberly Chan, MD 
 Phone: 886-190-6124 
 377 Daniel Falls
Beckside, NJ 46218
 Please sign and return this page only by fax or mail. 
 Plan of Care Approval for Brooke Gordon 
 Thank you for this referral. 
 Dean Harm is a good candidate for continued physical therapy services. Patient has been compliant to 
 home exercise program.
 Respectfully yours, 
 Therapist Signature: 
 Connie Scott, PT, DPT PT60388818 
 February 24, 2021 9:13 pm 
 Plan of Care Approval 
 Total Visit Count: 5 
 Approval of the plan of care as documented 
 Changes to Plan of Care: 
 Hold therapy service until patient follows up at physician office. 
 Physician Signature: 
 Dr Kimberly Chan, MD 
 Approval Date: 
 February 03, 2018 
 Progress Evaluation for Brooke Gordon 
 Page 6 
 BIRTH DATE: February 24, 1985
