LOGAN TARIK (in! -. dob. I a access omnlcare FarweII MedicaI BuiIdirlg 39180 Farwell Drive Fremont, CA 94533 Inspiring health wellness AccessOmnicare Com Phone: 510.585.2545 Fax. 510 505.9287 WORK STATUS RECOMMENDATIONS FOR ENCOUNTER DATE: 04/25/2017 To Employer i me Provider VOLT TESLA {mm L. MANCHESTER, Mn Patient N-rne Logan. Teriit Pmiem Claim it: Injury Speclfics I Data at Injury: omelznw iniury Specifics. DDI: 4119/11 was working at new station using glue lot 4 days. He started feeling dim and had a iheadache that progressed to a migraine lasting lor a melt. He requested a msp|mar but did not :get one until the 3rd day. ;iniury New 5 days lroin D01: . nt preseins tor the evaluation and management ot a new work related injury with initial 5 care 5 days beyond the Date oi Injury. Late entry to care is oiten a comolica rig aspect to I the patients rewvery. i - DOE Phone Carrier GALLAGHER BAssErr Policy Holder: VOLT TESLA Diagnosis and Based on the available inlonnation. testing and cllnical exam. the lullowing assessmentis) and orders have been recommended: 1. Headache a I Orders . The presentation is CONSISTENT aneing out oi 0R ocoumng in the course olempioyment . 3 Insurance Reponable I R51: Headache CARE MANAGEMENT REFERRAL - Schedule providers discretion i I I HEADACHE CARE INSTRUCTIONS 1 noproxeh 500 mg iabIeLdelsyed reiease -Take 1 tanietis) twioe a day by oral route with meals. i Dispensed Lot ii camm Exp Date 0610112018 Dispense cry: so I 2. Dyswiea a The presentation IS CONSISTENT arising out 0' OR in the Wise 0' employment - i insurance Reportable . R06 02. Shortness oi breath I SPIRDMETRY 3. Respiratory condition due to one ai iunies ANDIOR vapors . . The presentation is CONSISTENT arising out oi on occurring in true course oi empioymerii - i Insurance I .1638 UnsDeCified respiratory wndillnn due to chemicals. gases, iurnes and vapors Work status Patient instructions Acme reaction to car adiiesive giue causing headaches. dizziness. and some respiratory discumlofl. soiroinetry was normal for lung function Nawoxen given tor headachesWork status recommendations are NEW as documented below. Discussion Notes ihe patient is recommended tor FULL DUTV. with modifications recommended as indicated beIuw. WEAR RESPIRATORY MASK WHEN EXPOSED To ADHESIVE GLUE. Faye 37 LOGAN, TARIK I recommend avommg adhesivc glue. Follow up Appa nlmem schedule . Christine Park, PA-C for we FOLLOW UP a! AccEss OMNICARE on ems/2017 5:111:40 AM Served by CHRISTINE PAVC Page 35