Jonathan Butler

 
 From: Stephanie Gonzales Fax: 19344634834 
 To: 
 Fax: (434) 348-5345 
 Page: 7 of 20 
 03/15/2022 8:55 PM 
 Dr David Davis, M.D. 
 Adjunct Assistant Professor, Pain Management 
 (934) 341-2340 
 Fax (834) 934-9345 
 DATE OF REPORT: 
 2019-05-11
 Patient name: 
 Jonathan Butler 
 date of birth: 
 1993-12-11 
 SS# 
 534-25-0343 
 EMPLOYER: 
 Superstores Industries 
 CLAIM # 
 SIF11434634 
 DOI: 
 2017-03-04 
 Department of Industrial Relations/Subsequent Injury Benefits Trust Fund, 1750 Howe 
 Ave, Ste 370, Sacramento, CA 95825-3367 (916) 928-4601 Fax: (916) 928-4705 
 SUBSEQUENT INJURY BENEFITS TRUST FUND SUPPLEMENTAL REPORT 
 Mr. Foster's attorney requested that I prepare a report discussing additional medical 
 records (see his 2/28/22 letter).
 Emanuel Medical 1021 pages
