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Please click her for patient information

  1. 1. Name: Rosario Isabel Martinez Primary Insurance: Cigna HealthcareAddress: 17050 Clayton Road Policy #: U12497630 01 Wildwood, MO 63011 Group #: 3235964Phones: Home – (636) 458-7200 Office Visit Co-pay: $20 Cell – (314) 615-1977 In-Network Deductible: $150 Business – (636) 458-8800 Deductible Satisfied YTD: $83Sex: Female Hand: Left Co-insurance: 80% (insurance) 20% (patient)Weight: 155 lbs. Height: 6’ 0” Limitations: No referral needed; 12 visits per yearBirthdate: March 6, 1975SSN: 412-87-9468Marital status: Married Past Surgeries: Tonsillectomy (8/20/1991)Allergies: Penicillin, Hormonal supplements Wisdom teeth removed (4/16/1996)FT Employer: UPS Store Past imaging: X-Ray for broken arm (12/2/1981)Supervisor: Stephen Mitchell MRI for migraines (11/17/2004)Address: 2464 Taylor Rd Wildwood, MO 63040 Medical history: Lyme’s diagnosis (7/3/2003)Phone: (636) 458-8800 Kidney stone (3/28/2007)Emergency Contact: Javier Medina MartinezRelation to Patient: Husband Exercises: Treadmill – 5 times per week for 45 minutes perAddress: 17050 Clayton Road day Wildwood, MO 63011 Pain-free Exercises: NonePhones: Home – (636) 458-7200 Cell – (314) 912-1973 Business – (314) 814-1945 Primary complaint: Back painsPrimary Doctor: Dr. Sheila Thurman Symptoms: Muscle cramps, Lower back painPhysical Therapist: Dr. Joseph Baxter How symptoms started: Lifting a box at work When symptoms started: 3 days ago How pain increases: Walking, ExercisePrevious PT visit: 12 weeks ago How pain decreases: Resting, Pain drugs Location of pain (to draw): Lower backName: Isabel Maria PerezAddress: 17050 Clayton Road Primary Insurance: Cigna Healthcare Wildwood, MO 63011 Policy #: U12497630 01Phones: Home – (636) 458-7200 Group #: 3235964 Cell – (314) 615-1977 Office Visit Co-pay: $20 Business – (636) 458-8800 In-Network Deductible: $150Sex: Female Hand: Right Deductible Satisfied YTD: $35Weight: 135 lbs. Height: 5’ 3” Co-insurance: 80% (insurance) 20% (patient)Birthdate: November 11, 1989 Limitations: No referral needed; 12 visits per yearSSN: 412-87-9468Marital status: SingleAllergies: Pollen, Ragweed, Cats Past Surgeries: Tonsillectomy (8/20/2000) Wisdom teeth removed (4/16/2005)FT Employer: UPS StoreSupervisor: Stephen Mitchell Past imaging: X-Ray for broken arm (12/2/1992)Address: 2464 Taylor Rd MRI for vision problems (11/17/2007) Wildwood, MO 63040Phone: (636) 458-8800 Medical history: Asthma (since 5/1997) High Blood Pressure (since 4/2006)Emergency Contact: Ana Rosa PerezRelation to Patient: MotherAddress: 17050 Clayton Road Wildwood, MO 63011 Exercises: Cycling class – 3 times per week for 1 hour perPhones: Home – (636) 458-7200 day Cell – (314) 912-1973 Pain-free Exercises: NonePrimary Doctor: Dr. Sheila Thurman Primary complaint: Neck and Shoulder painsPhysical Therapist: Dr. Joseph Baxter Symptoms: Stiff neck, Headaches, Muscle cramps How symptoms started: Lifting a box at work When symptoms started: 3 days agoPrevious PT visit: 2 years ago How pain increases: Driving, Exercise How pain decreases: Resting, Pain drugs Location of pain (to draw): Shoulders, Neck
  2. 2. Name: Eva Rosita ChavezAddress: 17050 Clayton Road Primary Insurance: Medicare Wildwood, MO 63011 Policy #: U12497630 01Phones: Home – (636) 458-7200 Group #: 3235964 Cell – (314) 615-1977 Office Visit Co-pay: $20 In-Network Deductible: $150Sex: Female Hand: Left Deductible Satisfied YTD: $150Weight: 125 lbs. Height: 5’ 2” Co-insurance: 80% (insurance) 20% (patient)Birthdate: January 6, 1932 Limitations: No referral needed; No limit on visitsSSN: 412-87-9468Marital status: MarriedAllergies: None Past Surgeries: Knee Surgery (6/17/1952) Mastectomy (8/20/2000)Employer: NoneSupervisor: None Past imaging: MRI for vision problems (11/17/2007)Address: None Medical history: Hypertension (since 8/1996)Phone: None Breast Cancer diagnosis (3/1999) Bladder/Urinary Infection (9/2005)Emergency Contact: Eduardo Javier ChavezRelation to Patient: Husband Exercises: Water aerobics – 3 times per week forAddress: 17050 Clayton Road 30 minutes per day Wildwood, MO 63011 Pain-free Exercises: WalkingPhones: Home – (636) 458-7200 Cell – (314) 912-1973 Primary complaint: Neck pains (whiplash)Primary Doctor: Dr. Sheila Thurman Symptoms: Stiff neck, HeadachesPhysical Therapist: Dr. Joseph Baxter How symptoms started: Car accident When symptoms started: 2 days ago How pain increases: Driving, ExercisePrevious PT visit: 1 week ago How pain decreases: Resting, Pain drugs Location of pain (to draw): NeckName: Angelica Beatriz GuerreroAddress: 17050 Clayton Road Primary Insurance: Anthem Healthcare Wildwood, MO 63011 Policy #: U12497630 01Phones: Home – (636) 458-7200 Group #: 3235964 Cell – (314) 615-1977 Office Visit Co-pay: $20 In-Network Deductible: $150Sex: Female Hand: Right Deductible Satisfied YTD: $150Weight: 140 lbs. Height: 5’ 6” Co-insurance: 80% (insurance) 20% (patient)Birthdate: July 5, 1988 Limitations: No referral needed; 12 visits per yearSSN: 412-87-9468Marital status: SingleAllergies: Airborne allergens, Peanuts, Seafood Past Surgeries: NoneEmployer: Full Time Student Past imaging: Chest X-Ray (3/1989)Supervisor: Washington University MRI for heart problem (3/1989)Address: Campus Box 1089 One Brookings Drive Medical history: Pregnant (due in 5 months) St. Louis, MO 63130 Arrhythmia (irreg. heartbeat)Phone: (314) 935-6000 (3/1989) Blood Anemia (diagnosed 9/1994)Emergency Contact: José Ricardo de LugoRelation to Patient: Friend Exercises: Yoga – 5 times per weekAddress: 17050 Clayton Road Walking – 1 hour per day Wildwood, MO 63011 Pain-free Exercises: Upper body workoutPhones: Cell – (314) 912-1973Primary Doctor: Dr. Sheila Thurman Primary complaint: Left leg and knee painsPhysical Therapist: Dr. Joseph Baxter Symptoms: Severe muscle cramps, swelling of knee How symptoms started: Car accident When symptoms started: 2 days agoPrevious PT visit: Never How pain increases: Driving, Exercise How pain decreases: Resting, Pain drugs Location of pain (to draw): Left leg, below knee
  3. 3. Name: Leticia Raquel Delgado Primary Insurance: Anthem HealthcareAddress: 17050 Clayton Road Policy #: U12497630 01 Wildwood, MO 63011 Group #: 3235964Phones: Home – (636) 458-7200 Office Visit Co-pay: $20 Cell – (314) 615-1977 In-Network Deductible: $150 Business – (636) 458-8800 Deductible Satisfied YTD: $20Sex: Female Hand: Right Co-insurance: 80% (insurance) 20% (patient)Weight: 215 lbs. Height: 5’ 4” Limitations: No referral needed; 12 visits per yearBirthdate: August 23, 1952SSN: 412-87-9468 Past Surgeries: Appendectomy (8/1/1982)Marital status: Married Amputation of right foot (4/2000)Allergies: Hormone supplements, Bee stings Past imaging: MRI for heart problem (3/2001)PT Employer: UPS Store CAT Scan (CT) (6/2007)Supervisor: Stephen MitchellAddress: 2464 Taylor Rd Medical history: Stomach Ulcer (10/1974) Wildwood, MO 63040 Diabetic (diagnosed 9/1977)Phone: (636) 458-8800 *Insulin dependent Skin Psoriases (diagnosed 2/1992)Emergency Contact: Manuel Antonio DelgadoRelation to Patient: HusbandAddress: 17050 Clayton Road Exercises: Yoga – 30 minutes per day Wildwood, MO 63011 Pain-free Exercises: NonePhones: Home – (636) 458-7200 Cell – (314) 912-1973 Business – (314) 814-1945 Primary complaint: Mid-back and chest painsPrimary Doctor: Dr. Sheila Thurman Symptoms: Severe muscle cramps, limited motionPhysical Therapist: Dr. Joseph Baxter How symptoms started: Lifting a box at work When symptoms started: 4 days ago How pain increases: Driving, Exercise, RestingPrevious PT visit: 4 years ago How pain decreases: Pain drugs Location of pain (to draw): Mid-back; chestName: Cristián David TrabaAddress: 17050 Clayton Road Primary Insurance: Cigna Healthcare Wildwood, MO 63011 Policy #: U12497630 01Phones: Home – (636) 458-7200 Group #: 3235964 Cell – (314) 615-1977 Office Visit Co-pay: $20 Business – (636) 458-8800 In-Network Deductible: $150Sex: Male Hand: Right Deductible Satisfied YTD: $150Weight: 215 lbs. Height: 6’ 3” Co-insurance: 80% (insurance) 20% (patient)Birthdate: December 23, 1965 Limitations: No referral needed; 12 visits per yearSSN: 412-87-9468Marital status: MarriedAllergies: None Past Surgeries: Tonsillectomy (8/20/1976) Wisdom teeth removed (4/16/1977)FT Employer: UPS StoreSupervisor: Stephen Mitchell Past imaging: Chiropractic Exam X-rays (1/2002)Address: 2464 Taylor Rd Chest X-Ray (3/2005) Wildwood, MO 63040 MRI for heart problem (3/2005)Phone: (636) 458-8800 Medical history: Mild heart attack(3/2005)Emergency Contact: Elena Kathryn TrabaRelation to Patient: WifeAddress: 17050 Clayton Road Exercises: Treadmill – 5 times per week for 45 minutes per Wildwood, MO 63011 dayPhones: Home – (636) 458-7200 Pain-free Exercises: None Cell – (314) 912-1973Primary Doctor: Dr. Sheila Thurman Primary complaint: Back painsPhysical Therapist: Dr. Joseph Baxter Symptoms: Muscle cramps, Lower back pain How symptoms started: Lifting a box at work When symptoms started: 3 days agoPrevious PT visit: Never How pain increases: Walking, Exercise How pain decreases: Resting, Pain drugs Location of pain (to draw): Lower back
  4. 4. Name: Miguel Esteban Rodriguez Primary Insurance: Cigna HealthcareAddress: 17050 Clayton Road Policy #: U12497630 01 Wildwood, MO 63011 Group #: 3235964Phones: Home – (636) 458-7200 Office Visit Co-pay: $20 Cell – (314) 615-1977 In-Network Deductible: $150 Business – (636) 458-8800 Deductible Satisfied YTD: $45Sex: Male Hand: Left Co-insurance: 80% (insurance) 20% (patient)Weight: 215 lbs. Height: 6’ 4” Limitations: No referral needed; 12 visits per yearBirthdate: February 29, 1981SSN: 412-87-9468Marital status: Married Past Surgeries: Tonsillectomy (8/20/2001)Allergies: Dairy products, Citrus fruit, BenadrylPT Employer: UPS Store Past imaging: Chiropractic Exam X-rays (1/2005)Supervisor: Stephen MitchellAddress: 2464 Taylor Rd Wildwood, MO 63040 Medical history: Asthma (since 10/1987)Phone: (636) 458-8800 Hepatitis C (diagnosed 2/2007) Groin Hernia (4/2007)Emergency Contact: Ana Maria RodriguezRelation to Patient: Wife Exercises: Judo classes – 5 times per week for 1 hour perAddress: 17050 Clayton Road day Wildwood, MO 63011 Pain-free Exercises: WalkingPhones: Home – (636) 458-7200 Cell – (314) 912-1973 Business – (314) 814-1945 Primary complaint: Right elbow painsPrimary Doctor: Dr. Sheila Thurman Symptoms: Severe aches, limited motionPhysical Therapist: Dr. Joseph Baxter How symptoms started: Lifting a box at work When symptoms started: 5 days ago How pain increases: Exercise, MovementPrevious PT visit: Never How pain decreases: Resting, Pain drugs Location of pain (to draw): Right elbow areaName: Sergio Francisco GarciaAddress: 17050 Clayton Road Primary Insurance: Medicare Wildwood, MO 63011 Policy #: U12497630 01Phones: Home – (636) 458-7200 Group #: 3235964 Cell – (314) 615-1977 Office Visit Co-pay: $20 In-Network Deductible: $150Sex: Male Hand: Right Deductible Satisfied YTD: $150Weight: 155 lbs. Height: 5’ 10” Co-insurance: 80% (insurance) 20% (patient)Birthdate: September 18, 1939 Limitations: No referral needed; no limit on visitsSSN: 412-87-9468Marital status: Single Past Surgeries: Prostate Cancer (3/1988)Allergies: NoneEmployer: None Past imaging: Chest X-rays (monthly since 2/2001)Supervisor: NoneAddress: None Medical history: Prostate Cancer (diagnosed 1/1988)Phone: None Hypertension (since 8/1996) Weak Heart Valve (since 2/2001)Emergency Contact: Carmen Lucinda Encarnación Osteoporosis (diagnosed 5/2003)Relation to Patient: DaughterAddress: 3462 Normandy Dr. Exercises: Water aerobics – 3 times per week for St. Louis, MO 63121 30 minutes per dayPhones: Home – (314) 516-7375 Pain-free Exercises: None Cell – (314) 912-1973 Business – (314) 814-1945 Primary complaint: Knee, Elbow, and Hip painsPrimary Doctor: Dr. Sheila Thurman Symptoms: Severe aches, limited motionPhysical Therapist: Dr. Joseph Baxter How symptoms started: Osteoporosis When symptoms started: 5/2003 How pain increases: Exercise, MovementPrevious PT visit: 1 month ago How pain decreases: Resting, Pain drugs Location of pain (to draw): Knee, Elbow, and Hip
  5. 5. Name: Nicolás Jaime Bolero Primary Insurance: Anthem HealthcareAddress: 17050 Clayton Road Policy #: U12497630 01 Wildwood, MO 63011 Group #: 3235964Phones: Home – (636) 458-7200 Office Visit Co-pay: $20 Cell – (314) 615-1977 In-Network Deductible: $150 Business – (636) 458-8800 Deductible Satisfied YTD: $60Sex: Male Hand: Left Co-insurance: 80% (insurance) 20% (patient)Weight: 240 lbs. Height: 6’ 7” Limitations: No referral needed; 12 visits per yearBirthdate: April 3, 1990SSN: 412-87-9468Marital status: Single Past Surgeries: Repaired torn ACL (10/2007)Allergies: Peanuts, Penicillin, DogsFT Employer: UPS Store Past imaging: ACL (6/2007)Supervisor: Stephen MitchellAddress: 2464 Taylor Rd Wildwood, MO 63040 Medical history: Torn ACL (diagnosed 6/2007)Phone: (636) 458-8800Emergency Contact: Elena Isabel Bolero Exercises: Whole body weight training –Relation to Patient: Mother 5 times per week for 1 hour per dayAddress: 17050 Clayton Road Pain-free Exercises: Upper body weight training Wildwood, MO 63011Phones: Home – (636) 458-7200 Cell – (314) 912-1973 Primary complaint: Left knee Symptoms: Severe aches, limited motionPrimary Doctor: Dr. Sheila Thurman How symptoms started: Torn ACL (football)Physical Therapist: Dr. Joseph Baxter When symptoms started: 6/2007 How pain increases: Exercise, Movement How pain decreases: Resting, Pain drugsPrevious PT visit: 3 months ago Location of pain (to draw): Left kneeName: Pedro Arturo Villamil Primary Insurance: Anthem HealthcareAddress: 17050 Clayton Road Policy #: U12497630 01 Wildwood, MO 63011 Group #: 3235964Phones: Home – (636) 458-7200 Office Visit Co-pay: $20 Cell – (314) 615-1977 In-Network Deductible: $150 Business – (636) 458-8800 Deductible Satisfied YTD: $85Sex: Male Hand: Right Co-insurance: 80% (insurance) 20% (patient)Weight: 140 lbs. Height: 5’ 8” Limitations: No referral needed; 12 visits per yearBirthdate: May 13, 1977SSN: 412-87-9468Marital status: Married Past Surgeries: NoneAllergies: Airborne allergens, Peanuts, SeafoodPT Employer: UPS Store Past imaging: NoneSupervisor: Stephen MitchellAddress: 2464 Taylor Rd Wildwood, MO 63040 Medical history: Asthma (diagnosed 9/1982)Phone: (636) 458-8800 Night sweats (since 4 days ago)Emergency Contact: Rosa Adela Villamil Exercises: Treadmill – 5 times per week for 45 minutes perRelation to Patient: Wife dayAddress: 17050 Clayton Road Pain-free Exercises: None Wildwood, MO 63011Phones: Home – (636) 458-7200 Cell – (314) 912-1973 Primary complaint: Back painsPrimary Doctor: Dr. Sheila Thurman Symptoms: Muscle cramps, Lower back painPhysical Therapist: Dr. Joseph Baxter How symptoms started: Lifting a box at work When symptoms started: 3 days ago How pain increases: Walking, ExercisePrevious PT visit: Never How pain decreases: Resting, Pain drugs
  6. 6. Location of pain (to draw): Lower back

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