Kevin Pineda

  
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 December 16, 2021 at 3:22:24 PM EST 
 SVMC 
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 Received 
 SVMC 
 07/2015/13 
 12:17:46 PM 
 PAGE 
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 Fax Server 
 DOD Salinas 
 Kevin Pineda
 558 Abbott St Ste A 
 MRN: 311xxxx, DOB: 09/1988/19, Sex: F 
 DOCTORS 
 ON DUTY 
 State of California 
 Division of Worker's Compensation 
 PRIMARY TREATING PHYSICIAN'S PROGRESS REPORT  
 
 Other: 
 PATIENT: 
 Last: 
 Corona 
 First: Araceli 
 Middle: 
 Zip: 93xxx 
 Date of Injury: 08/2018/18

 DOB: 
 09/1988/19 
 Occupation: 
 SSN: 617xxxxxx 
 Phone: 83xxxxx 
 CLAIMS ADMINISTRATOR: 
 Name: Gallagher Bassett 
 Claim #: 0054850xxxx
 Address: Po Box 28xxx 
 City: 
 Clinton 
 Zip: 
 52733xxxx 
 Phone: 866xxxx
 EMPLOYER NAME: Healthcare Services Group 
 Subjective Complaints: Worker's Compensation (WC DOI 01/2016/09 BACK) 
 Diagnoses: 
 1. 
 Lumbar strain, subsequent encounter 
 Treatment Plan: 
 TREATMENT PLAN: Light work starting 12/15/2021.Physical therapy. Return 12/23/2021. 
  
 DATE OF SERVICE 
 06/2021/25
 CHIEF COMPLAINT: 
 Chief Complaint 
 Patient presents with 
 Worker's Compensation 
 BACK 
 
 Ashley Rosales
 558 Abbott St Ste A 
 MRN: 311xxxx, DOB: 09/1988/19, Sex: F 
 Salinas CA 9390xxx
 Page 16 
 Printed by Arizpe, Crystal, MA at 01/2016/09 12:16 PM 
