It is now time to refer to Adam Heller s team for successful case closure.
|
|
- Preston Gardner
- 5 years ago
- Views:
Transcription
1 REFERRAL PROCESS If you are reviewing this information it is likely that you are an employer and/or an insurance provider that is in need of assistance to successfully manage an employee that has incurred a work related claim that is in the chronic phase of injury (i.e. >3-6 months). The following describes a common scenario and offers a simple sequence of steps to assist you in creating a referral to Adam Heller s team. Scenario: The employee experienced a work related injury. The muscle strain or neurological diagnosis did not recover within the customary 4-6 weeks. The injured worker was referred to a specialist and/or an alternative physician for a second opinion. The physician and injured worker were not able to advance the medical release for return-to-work and the work restrictions became stagnant. The pain that the injured worker is currently experiencing has been ongoing for > 3-6 months with no end in sight. The employer, insurance provider, treating physician, injured worker and their family members are frustrated and discouraged. This frustration/stress adds to the injured worker s ongoing chronic pain. The treating physician has determined that the medical community has exhausted their options and it is time to discharge the patient from medical care and to create end of healing. The medical, indemnity and reserve dollar costs are nearing or exceeding six figures and continuing to rise. The injured worker may or may not have permanent medical restrictions. It is now time to refer to Adam Heller s team for successful case closure.
2 Referral Steps If you are an employer and/or a workers compensation insurance provider, the following steps will quickly lead you to successful case closure The employer and/or the insurance provider request a referral from the medical provider for the injured worker to connect with Adam. The injured worker fills out the attached (10-question) DPS quiz to provide Adam s team with important information. The attached registration form is completed and submitted to Adam. Contact information is located at the bottom of the registration page. The referral to Adam is initiated by either calling and/or ing Adam. Adam and/or one of his team members will get back to you within hours. Adam s team members will also contact you to explain how Zero Pain Now works and will outline clear expectations of the injured worker and the Zero Pain Now team in this treatment process. Following the initial interview with the injured worker, Adam s team will define clear guidelines about expected treatment timelines and case closure to establish end of healing. The injured worker will continue to schedule their traditional follow-up recheck visits every 2-4 weeks with his/her treating physician to maintain continued communication with the employer and insurance provider. If the treating physician has questions about the injured worker s progress, he/she can contact Adam at the phone/ located at the bottom of the registration form.
3 About the creator of Zero Pain Now: Adam Heller has over 25 years experience as a life coach, business coach and consultant. He helps people live their greatest lives and overcome a variety of obstacles, both personal and professional. He is a Certified Trainer in Neuro-Linguistic Programming, a Master in Time Line Therapy, Integrative Coaching, Hypnotherapy and a Certified Instructor at Deepak Chopra s Center for Well Being. Through the experience of working with people in these multiple modalities, he created Zero Pain Now and the Dynamic Results Academy. Zero Pain now is a more effective incarnation of a treatment technique developed by Dr. John Sarno, an orthopedic surgeon and former professor of rehabilitative medicine at New York University. Dr. Sarno and his colleagues successfully used the original technique for nearly 40 years to help over 30,000 patients at the Howard A. Rusk Institute of Rehabilitative Medicine, New York University Medical Center. Adam Heller has spent 14 years studying neuroscience, neuro-linguistics, psychology, positive psychology, professional coaching and has becoming a known world-wide expert in the mind-body dynamic. These fields of science provided Adam with the tools he needed to expand the original concepts of Dr. Sarno, into a simple to use and time-efficient process. Chronic Repetitive and Recurrent Pain: In chronic or repetitive pain there is the presence of pain beyond the normal healing time (once the structure is stable) and this pain can be intense and debilitating. Once the medical system has exhausted all of its options, chronic or recurrent pain sufferers are typically told one or more of the following: A) the pain is in their heads B) they will need another surgery, or C) they are just going to have to live with it. In the meantime, productivity and quality of life suffer. Hundreds of studies from well-known hospitals and universities have repeatedly demonstrated that there is little to no relationship, post recovery, between structural issues and the degree of pain that the person is suffering. In other words, two people whose spines look identical in x-rays or CT scans can have radically different pain experiences. The same has been demonstrated for conditions such as carpal tunnel syndrome and fibromyalgia. These pain experiences are often a function of stress/tension. The relationship between stress and chronic pain: When people experience stress, there is a predictable response at the level of the autonomic nervous system. This is the reason people sweat when they are nervous, experience an increase in heart-rate when they are pulled over by a police officer or get a stomach ache when anxious. All of these physical responses are driven automatically by the brain and originate below the level of conscious thought. Numerous studies have shown that under times of stress the autonomic response can lead to as much as an 8% decrease in blood flow to various parts of the body. It has also been demonstrated that as little as a 2% decrease in blood flow can generate intense pain in muscle and connective tissues. Many of the mainstream strategies to deal with this pain are designed to improve blood flow. These include things like massage, heat, physical therapy, yoga, stretching and chiropractic. While these can be effective in providing short term relief, the results are often short-lived. The pain returns because these treatments address the symptoms rather than the underlying source of the pain The source of the pain is the psychological process that creates stress, tension and something more accurately described as Diversion Pain Syndrome. Research has consistently shown that rarely does the cause of pain have anything to do with structure. This is evidenced by repeated scientific studies that confirm 2 out of every 3 people who are asymptomatic and have never experienced pain also have structural abnormalities such as bulging and herniated (protruded and extruded) discs.
4 Diversion Pain Syndrome (DPS) and Zero Pain Now: We are all aware of the link between stress, tension and pain. The common belief is that stress and tension exacerbate pain. However, successful results with well over 30,000 people have demonstrated that the cause of stress and tension is actually the cause of most sub-acute, chronic, recurrent, repetitive and ongoing pain. Studies and experiential results also show that structure is responsible for pain in less than 3% of these cases. A chain of events originating in the brain has been found to be the actual cause of most sub-acute and chronic pain, tingling, burning, numbness and weakness. Repressed emotions, most commonly anger and rage, are repressed by the unconscious mind. This starts a physiological process managed by the autonomic nervous system that leads to a reduction in blood flow. Since oxygen is carried in blood this creates a slight oxygen deprivation that leads to symptoms such as pain. This is why it is common to experience temporary relief by applying heat. Heat does not unherniate, Unbulge, or unfibromyalgia. Heat simply increases blood (and oxygen) flow to the area and creates temporary relief. By generating pain or other physical symptoms in the body the unconscious mind has created a diversion. A belief exists in the unconscious mind that this pain is more acceptable than dealing directly with the source of the stress and tension. This pattern of turning unconscious emotions into physical pain is known as Diversion Pain Syndrome (DPS). The purpose of DPS is to divert attention from a negative emotion to something physical such as pain. This inner conflict leads to stress and tension and is at the core of DPS. The Process: Through a series of very simple exercises, the recurrent or chronic pain sufferer can learn to effectively address the root cause of the stress/tension and eliminate the pain at its source. The first step in the process is to deliver a complete understanding of what does not cause pain and what does cause pain. The next step in the program has been specifically designed to purposefully activate the limbic system and the prefrontal cortex (The areas of the brain most associated with emotion). Then a very simple exercise based on the concept Applied Neuroplasticity allows the client/patient to become conscious of the formerly repressed emotions thereby ending the pain. Since the purpose of DPS is to divert attention from an unbearable emotion to something physical like pain, once the emotion becomes conscious there is no longer anything from which to divert attention. Normal blood flow is resumed and the physical symptoms end. The person does not need to dredge up old memories or fix something in their life in order for this process to work. All they need to do is acknowledge and verbalize the emotion as the source of the stress/tension in order for the unconscious mind to understand that it is no longer needs to create a diversion. The repetitive or chronic pain sufferer learns to bring the source of their stress to the conscious level more readily and demonstrates to the unconscious mind that it no longer needs to generate pain in response to stress. Similar to the way many medications work, Zero Pain Now targets the brain. However, pain relief from medication is cosmetic and temporary since it is treating the symptom of pain, rather than the cause. The Zero Pain Now process permanently eliminates pain by addressing the underlying cause so that all symptoms are eliminated.
5 Benefits to the Medical Community: Effective and Quick Medical Management and case closure Quick and effective care of the Sub-Acute and chronic patient (>3-6 months) Effectively deals with the true cause of patients Chronic pain (i.e. Diversion Pain Syndrome DPS) vs. a structural abnormality. Adam also stresses that this process originates in their patient s brain with repressed emotions this may challenge their current core beliefs and treatment protocols but Note: This treatment option is not designed to challenge everything they know & do in their clinical practice, but rather to provide them with an additional tool or treatment option for the chronic patient that they do not know what to do with and are out of options for effective treatment. Benefits to the Insurance Community: Provides another tool for the Workers Compensation Carriers to decrease their medical, indemnity, reserve dollar costs and loss ratios. Immediately has an effect on the bottom line and increasing profitability. Substantial time/dollar savings offer a powerful marketing tool when looking for new companies and/or during renewals with existing companies. The process decreases employer s loss ratio, reduces employers premiums and achieves quick case closure. When an insurance carrier approaches their target markets (current or prospective employers) with this pro-active process it creates a difference maker and positions them favorably in a competitive marketplace. Benefits to Business & Industry: The benefits of this process for employers are quite similar to that of the Workers Compensation Insurance Carriers. Employers will benefit from decreased Workers Compensation costs, decreased loss time, decreased loss ratios and as a result, decreased Workers Compensation Premiums. This process speeds up return-to-work for injured employees, increases employee retention and decreases the need for the managers/supervisors to manage the time-consuming return-to-work process. Rather, managers/supervisors will be able to spend the majority of their day on departmental productivity and quality vs. spending 95% or their energy on 5% of their workforce.
6 REGISTRATION TODAYS DATE DATE OF BIRTH APPLICANTS NAME FIRST MI LAST ADDRESS CITY/STATE ZIP HOME/CELL TELEPHONE REFERRING DIAGNOSIS PATIENTS SIGNATURE PROVIDERS SIGNATURE PROVIDERS ADDRESS PROVIDERS PHONE # CONTACT INFORMATION: Adam Heller The Pain Relief Expert adam@zeropainnow.com Phone: (949) Fax: (855) Zero Pain Now Here's To Your Pain Free Life
Guide to Dental Benefit Plans
Guide to Dental Benefit Plans 211 E. Chicago Ave. Suite 1100 Chicago, IL 60611-2691 aae.org 2017 Patients often assume that dental coverage is similar to medical insurance, and they are shocked and angry
More information634 N. STATE STREET, WESTERVILLE OH, (614) 901-WELL
eas 634 N. STATE STREET, WESTERVILLE OH, 43082 (614) 901-WELL www.abilitychiro.com Name: Age: Date: Address: City: State: Zip Code: Alternate Address: City: State: Zip Code: Cell Phone: ( ) Cell Phone
More informationHome Address. City Postal Code Home Telephone # Business Telephone # Address. Emergency Contact Name, Address, Phone#
Date Name / / last first middle initial Personal Health # - Male Female Home Address City Postal Code Home Telephone # Business Telephone # Cell # E-Mail Address Best way to contact you: Home # Work #
More informationPhysical Evidence Chiropractic 7035 Beracasa Way, Suite 103 Boca Raton Florida, Phone# (561) Fax# (561)
7035 Beracasa Way, Suite 103 Boca Raton Florida, 33433 Phone# (561)674-1217 Fax# (561)361-4999 Date File # PERSONAL HISTORY Last Name First Name middle Address City State Zip Date of Birth Age Social Security
More informationInsurance Guide For Dental Healthcare Professionals
Insurance Guide For Dental Healthcare Professionals Dental Benefits Basics What is dental insurance? Unlike traditional insurance, dental benefits are not meant to cover all oral healthcare needs. The
More informationTOP RYDE CHIROPRACTIC
1. Ankle Pain Conditions Helped by Chiropractic The ankle joint is made up of ligaments, tendons, nerves, and a disc to cushion motion. Distortions of motion of the ankle can strain the ligaments and muscles
More informationRetiree Dental Open Enrollment
Retiree Dental Open Enrollment November 1 December 15, 2017 Open Enrollment Fact Sheet Delta Dental Information Sheet Delta Dental Enrollment Form Delta Dental Direct Debit Application Retiree Dental Plan
More informationThe aging population and the case for integrating Manual Osteopathy in the normal healthcare framework. Marinus van Aarle (B.Sc)
The aging population and the case for integrating Manual Osteopathy in the normal healthcare framework Marinus van Aarle (B.Sc) National Academy of Osteopathy Research Thesis February 12, 2016 Hypothesis:
More information10 SECRETS TO ENDING BACK & BODY PAIN
10 SECRETS TO ENDING BACK & BODY PAIN From Adam Heller Author of YOU RE ABOUT TO LEARN THE 10 WAYS YOU KEEP YOURSELF STUCK IN PAIN AND THE SECRET TO NOT ONLY BECOMING PAIN FREE BUT STAYING PAIN FREE FOREVER
More informationAcute Low Back Pain. North American Spine Society Public Education Series
Acute Low Back Pain North American Spine Society Public Education Series What Is Acute Low Back Pain? Acute low back pain (LBP) is defined as low back pain present for up to six weeks. It may be experienced
More informationGENERAL INFORMATION PROFESSIONAL REFERRAL INFORMATION
SO THAT WE MAY BETTER SERVE YOU, PLEASE COMPLETE THE FOLLOWING FORM AND EITHER BRING THE COMPLETED FORM WITH YOU TO YOUR FIRST APPOINTEMNT OR SCAN IT AND EMAIL IT TO OFFICE, PRIOR TO YOUR APPOINTMENT LORRAINE@ANALIPSONMD.COM
More informationToday s Date: What are your health goals? Symptom relief and preventing its return 100% optimum health and wellbeing on every level available to me
Today s : MHSC REGISTRATION # (6 DIGIT) (9 DIGIT) First Name: Last Name: I am a Male/Female (circle) Birthday (d/m/y): / / Current Age: Street Address: City: Province: Postal Code: Home #: Work #: Cell
More informationPatient Information Form
Patient Information Name: First Middle Last Address: City: State: Zip: Telephone: Home Cell Work Date of Birth: Social Security Number: (SSN is only needed if getting super-bills for potential insurance
More informationCONDITIONS OF SERVICES RENDERED
CONDITIONS OF SERVICES RENDERED FINANCIAL AGREEMENT: I agree, whether I sign as agent or as patient, that in consideration of the services to be rendered to the patient, I hereby individually obligate
More informationWorkers Compensation Questionnaire. Name: Address: Telephone: City: State: Zip: Social Security Number: Cell Phone: Home phone: Work Phone:
Workers Compensation Questionnaire Name: Address: Telephone: City: State: Zip: Social Security Number: Email: Cell Phone: Home phone: Work Phone: Date of birth Sex: Male Female Marital States S M D W Date
More informationAPPLICATION FOR SERVICES
APPLICATION FOR SERVICES CLIENT - PERSONAL INFORMATION First Name M.I. Last Name Today s Street Address City State Zip Birth date Home phone (ok to leave msg? Y - N) Cell phone (ok to leave msg? Y - N
More informationEarly Intervention in the Utilities Sector Best Practices Lead to Real Results
Early Intervention in the Utilities Sector Best Practices Lead to Real Results Jim Allivato, ATC, CEIS - ATI Worksite Solutions Edison Electric Institute Sept. 29, 2015 About Jim Jim Allivato, BS, ATC,
More informationSUMMARY. Pensions (assessment) (hernia); Pensions (Rating Schedule) (unlisted condition).
SUMMARY DECISION NO. 879/98 Pensions (assessment) (hernia); Pensions (Rating Schedule) (unlisted condition). The worker suffered a hernia in December 1989, which was surgically repaired in January 1990.
More informationChiropractic for pediatric development and adult health
Raleigh Specific Chiropractic Chiropractic for pediatric development and adult health 7721 Six Forks Rd. Suite 138 Raleigh, NC 27615 (919) 846-7004 Items to bring to your first visit: All new patient paperwork
More informationDear Patients, We have good news to share with you!
Dear Patients, We have good news to share with you! It gives us great pleasure to introduce the Grand Marais Family Dentistry Benefits Plan. This in-house dental savings plan offers affordable care for
More informationWhy choose Ottauquechee PT
Why does your back hurt? Low back pain is one of the most common patient complaints affecting 80% of adults at some point in their lives. Generally the source of pain is in the spine and/or its supporting
More informationSAVE THE DATE!!!!
www.mhrecovery.org SAVE THE DATE!!!! CERTIFIED PEER SPECIALIST TRAINING IS COMING TO HARRISBURG, PA!!! FACILITATED BY COPELAND CENTER NATIONAL DIRECTOR FOR WELLNESS & EDUCATION, GINA KAYE CALHOUN NOW ACCEPTING
More informationCORPORATE. Work-Fit INJURY SOLUTIONS. Helping Workers Get Better And Stay Better
CORPORATE Work-Fit INJURY SOLUTIONS Helping Workers Get Better And Stay Better 905.845.9540 www.workfitphysiotherapy.ca Hospital owned and operated. All net proceeds support hospital programs. Get The
More informationHealthPartners Inspire Special Needs Basic Care Clinical Care Planning and Resource Guide CHRONIC PAIN
The following evidence based guideline was used in developing this clinical care guide: National Institute of Health (NIH National Institute of Neurological Disorders and Stroke), Mount Sinai Beth Israel
More informationNEW CHIROPRACTIC PATIENT INFORMATION Dr. Bryan Mock, LLC 2101 Greentree Rd Pittsburgh, PA
NEW CHIROPRACTIC PATIENT INFORMATION Dr. Bryan Mock, LLC 2101 Greentree Rd Pittsburgh, PA 15220 412-668-2089 Allergies: WELCOME The doctor and staff would like to welcome you and want to provide you with
More informationFamily First Chiropractic
Family First Chiropractic Personal Information Title: (Check one) Mr. Mrs. Ms. Miss Other First Name Middle Initial Last Name Street City State Zip Code Email Home Phone ( ) - Cell Phone ( ) - Date of
More informationCascadia Chiropractic Centre
Name: Cascadia Chiropractic Centre New Patient Information & Clinical Record Date: Date of Birth: Your age: Care Card #: Address: City/Prov: Postal Code: Phone: Cell: Work Phone: E-mail Address: Marital
More informationCARPAL TUNNEL SYNDROME
A Patient s Guide to CARPAL TUNNEL SYNDROME Improved Treatment with Active Release Treatment Dr Jason Gray BHK DC MSc Dr Stephanie Gray BSc DC GRAYCHIROPRACTIC Improved Treatment For Carpal Tunnel Syndrome
More informationSUMMARY DECISION NO. 529/97. Recurrences (compensable injury).
SUMMARY DECISION NO. 529/97 Recurrences (compensable injury). The worker suffered a low back injury in 1984. The worker appealed a decision of the Appeals Officer denying entitlement for recurrences in
More informationIntroducing your. Wellness Coaching Program
Introducing your Wellness Coaching Program Being healthy is the cornerstone of a happy life. If you don t have your health, nothing else matters. But today s fast-paced lifestyle makes it all too easy
More informationEmotional Intelligence and NLP for better project people Lysa
Emotional Intelligence and NLP for better project people Lysa Morrison @lysam8 Copyright 2015 Lysa Morrison Reasons projects fail Three of the most common causes of project failure according to the National
More informationBecome a Partner with Your Clinician to Improve Your Health
What is health? You may think this is a simple question or even a silly one. Everyone knows that being healthy means not feeling sick or having a disease. Right? But health is more than this. The World
More informationBrisbin Family Chiropractic
Information reviewed with patient: Dr. Initials Today s Date Brisbin Family Chiropractic Name: Sex: Male Female Address: City: Postal Code: Home Ph# Work# Ext# Cell# Preferred number (circle one) Home
More informationChiropractic Healthcare
ebook 3 Chiropractic Healthcare Sciatica - Sleep Back Pain Prevention Chapter 1 3 My Doctor Told Me I Have Sciatica Chapter 2 7 Sciatica & Low Back Pain Prevention Chapter 3 12 Proper Sleeping Positions
More informationSHOULDER PAIN. A Patient s Guide to. Improved Treatment for Common Shoulder Conditions with Active Release Treatment
A Patient s Guide to SHOULDER PAIN Improved Treatment for Common Shoulder Conditions with Active Release Treatment Dr Jason Gray BHK DC MSc Dr Stephanie Gray BSc DC GRAYCHIROPRACTIC Improved Treatment
More informationRelease & Waiver Synergy Studio
Release & Waiver Synergy Studio I,, have enrolled in a program of physical activity, including but not limited to, body conditioning machinery used during the workouts offered by Synergy Studio. I affirm
More informationWORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1053/08
WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1053/08 BEFORE: B.L. Cook : Vice-Chair M. Christie : Member Representative of Employers A. Grande : Member Representative of Workers HEARING:
More informationPATIENT ENTRANCE FORM
PATIENT ENTRANCE FORM Name _ Date Address City/ Province Postal Code Home Telephone Work Telephone Email Address Would like email reminders for appointments? Yes No Date of Birth (Day/Month/Year) Age Marital
More informationHypnotherapy Practitioner Diploma. Module 1
Hypnotherapy Practitioner Diploma Module 1 Hypnosis Dispelling some of the Myths Myth: You can be hypnotised to do things against your will The hypnotherapist is merely a guide or facilitator. He/she cannot
More informationPATIENT REGISTRATION FORM
PATIENT REGISTRATION FORM NAME: D.O.B AGE: SEX: STREET: CITY: STATE: ZIP: SS #: ETHNICITY: RACE: LANGUAGE: PHONE # TO LEAVE A PERSONAL MESSAGE: HOME PHONE #: WORK #: CELL #: E MAIL ADDRESS: EMERGENCY CONTACT:
More informationSPINE PROGRAM NEW PATIENT FORM
Name: Date of Birth: Today s Date: Are you right or left handed? What are your goals for the visit? Who referred you to us? Primary Doctor Another Doctor Dr. Of what specialty? Someone else: PAIN 1. Tell
More informationService. Solutions. Success.
Service. Solutions. Success. CAWA-4022 2009 Dental Health Services 01/09 About Dental Health Services Founded by Godfrey Pernell, D.D.S. in 1974, Dental Health Services was one of the first companies to
More informationWORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1339/11
WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1339/11 BEFORE: E.J. Smith: Vice-Chair HEARING: June 20, 2011, at Toronto Written DATE OF DECISION: July 5, 2011 NEUTRAL CITATION: 2011 ONWSIAT
More informationCarpal Tunnel Wrist Exercises Chiropractic Acupuncture
Carpal Tunnel Wrist Exercises Chiropractic Acupuncture 1 / 6 2 / 6 3 / 6 Carpal Tunnel Wrist Exercises Chiropractic What is carpal tunnel syndrome? Carpal tunnel syndrome (CTS) occurs when the median nerve,
More informationG O A L S E T T I N G G U I D E
GOAL SETTING GUIDE All Learning Behavior and Change is unconscious. Prime directives of the unconscious mind The conscious mind is the goal-setter The unconscious mind is the goal-getter 1. Stores memories.
More informationTHE LUMBAR SPINE (BACK)
THE LUMBAR SPINE (BACK) At a glance Chronic back pain, especially in the area of the lumbar spine (lower back), is a widespread condition. It can be assumed that 75 % of all people have it sometimes or
More informationMEETING Mental Health Challenges
MEETING Mental Health Challenges in a POWERFUL WAY EAGALA Model Equine-Assisted Psychotherapy EAGALA Model equine-assisted psychotherapy (EAP) is experiencing rapid growth around the globe. Why? In two
More informationMRC S RECOVERY COACH ACADEMY APPLICATION
MRC S RECOVERY COACH ACADEMY APPLICATION TRAINING DATES I AM APPLYING FOR: April 23-27, 2018 I AM APPLYING: MRC SCHOLARSHIP EMPLOYEE OF AN ORGANIZATION SELF-FUNDED Other (please specify) IF APPLYING WITH
More information2018 Attachment & Trauma Conference
2018 Attachment & Trauma Conference Awareness Regulation Healing November 3-5, 2018 Location: St. Catharines Golf Club Featuring Key Note Speaker: Dr. Janina Fisher licensed clinical psychologist in private
More informationSocial Security No. Date of Birth Sex Male Female Height Weight lbs Occupation Marital Status
Workers Compensation Intake Form File Number (Office Use) Patient Information: Today s Date Home Phone Name Cell Phone I prefer to be called Preferred Contact Home Cell Email Social Security No. Date of
More informationWORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1077/15
WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1077/15 BEFORE: R. Nairn: Vice-Chair HEARING: May 28, 2015 at Toronto Written DATE OF DECISION: August 21, 2015 NEUTRAL CITATION: 2015 ONWSIAT
More informationHealthy Smiles Dental Discount Plan
Healthy Smiles Dental Discount Plan Riverpoint Family Dentistry would like to provide excellent dental care to our local Albuquerque & Rio Rancho community. The costs of dental insurance premiums have
More informationTherapy & Sports Medicine at the Berger Health and Wellness Center
Therapy & Sports Medicine at the Berger Health and Wellness Center The therapy and sports medicine team you ve come to know and trust is here for your therapeutic needs. 1280 North Court Street Circleville
More informationSUMMARY. Decision No May-2001 M. Faubert View Full Decision 6 Page(s) Keywords: Permanent impairment {NEL} References: Act Citation WCA
SUMMARY Decision No. 1442 01 30-May-2001 M. Faubert View Full Decision 6 Page(s) Keywords: Permanent impairment {NEL} References: Act Citation WCA Other Case Reference [w3201] Style of Cause: 2001 ONWSIAT
More informationDR. MARK HOOPER DR. MARK THURSTON DR. NICK HERBERT
DR. MARK HOOPER DR. MARK THURSTON DR. NICK HERBERT Patient (First) (Middle) (Last) Address City State Zip E-mail address Home Phone # Cell Phone # Would you like an appointment reminder? Text( ) Call(
More informationMEDICAL HISTORY FORM
MEDICAL HISTORY FORM Patient Name: Date of Birth: Date: Email: Address: Emergency Contact (name, relationship to patient, & phone): Height: Weight: Right/Left Hand Dominant: [ ] Male [ ] Female What area
More informationThe Invisible Cause of Chronic Pain
1 The Invisible Cause of Chronic Pain This guide is for people who ve tried many different treatments for chronic pain - and are still in pain. www.lifeafterpain.com 2 How would you like to get to the
More informationA Cancer Patient s Guide to Radiation Therapy
RADIATION THERAPY A Cancer Patient s Guide to Radiation Therapy In this booklet you will learn about: What is radiation therapy The different stages in your treatment What happens during each stage Managing
More informationThe Department of Labor and Training is an equal opportunity employer/program; auxiliary aids and services are available on request to individuals
Chief Judge Robert F. Arrigan Rehabilitation Center 249 Blackstone Boulevard Providence, RI 02906 (401) 243-1200 Fax (401) 222-3887 www.dlt.ri.gov/arrigan The Department of Labor and Training is an equal
More informationPiriformis Syndrome. Midwest Bone & Joint Institute 2350 Royal Boulevard Suite 200 Elgin, IL Phone: Fax:
A Patient s Guide to Piriformis Syndrome 2350 Royal Boulevard Suite 200 Elgin, IL 60123 Phone: 847.931.5300 Fax: 847.931.9072 DISCLAIMER: The information in this booklet is compiled from a variety of sources.
More informationSEEDS OF HOPE FAMILY CHIROPRACTIC HEALTH HISTORY
SEEDS OF HOPE FAMILY CHIROPRACTIC HEALTH HISTORY Welcome! PLEASE PRINT CLEARLY PERSONAL DATA Today s Date First name MI: Last name: Nickname Gender M F Age Date of Birth SS# (optional) Current address
More informationHear better, Live fully.
EPIC Hearing Healthcare 3191 W. Temple Ave Suite 200 Pomona, CA 91768 Corporate Toll Free: 877.606.3742 Email: sales@epichearing.com www.epichearing.com Hear better, Live fully. ASO-2013 ASO Savings Plan
More informationLIST YOUR HEALTH CONCERNS BELOW
8209 Natures Way Unit 115 Lakewood Ranch, Florida 34202 (941) 877.1507 Name Date / / Age Male Female Address City State Zip Phone: Home Cell Cell Phone Provider Email Date of Birth / / Employer s Name
More informationSPRINGFIELD CLINIC S
SPRINGFIELD CLINIC S HEAD INJURY MANAGEMENT GUIDE FOR PARENTS Given the complexities of concussion management, Springfield Clinic recognizes the importance of managing concussions on an individualized
More informationFamily First Chiropractic
Personal Information Title: (Check one) Mr. Mrs. Ms. Miss Other First Name Middle Initial Last Name Street City State Zip Code Email Home Phone ( ) - Cell Phone ( ) - Date of Birth / / Sex: Male Female
More information!"#$%#&'()*$+(,-'#$ 846 Laurel Avenue Saint Paul Minnesota Fax:
"#$%#&'()*$+(,-'#$ 846 Laurel Avenue Saint Paul Minnesota 55104-7110 651 227 8776 Fax: 651 227 1055 SusanClarkeDC@comcast.net www.healingcircle.com GENERAL INFORMATION Date.. Name SS #. FIRST MIDDLE LAST
More informationOUTPATIENT TREATMENT WESTPORT, CONNECTICUT
OUTPATIENT TREATMENT WESTPORT, CONNECTICUT ABOUT CLEARPOINT At Clearpoint, we focus on healing the whole person: mind, body, and spirit. Our comprehensive care methods set clients up for long-term success
More informationDepartmental Concussion Guidelines
Concussion Plan Departmental Concussion Guidelines The following guidelines have been developed in accordance with Alabama A&M s Mission Statement and service goal of providing quality healthcare services
More informationVan Wyk Chiropractic Center Terms of Acceptance and Privacy Policy
Van Wyk Chiropractic Center Terms of Acceptance and Privacy Policy Terms of Acceptance When a patient seeks health care in our office and we accept a patient for such care, it is essential the patient
More informationERI Safety Videos Videos for Safety Meetings. ERGONOMICS EMPLOYEE TRAINING: Preventing Musculoskeletal Disorders. Leader s Guide 2001, ERI PRODUCTIONS
ERI Safety Videos Videos for Safety Meetings 2120 ERGONOMICS EMPLOYEE TRAINING: Preventing Musculoskeletal Disorders Leader s Guide 2001, ERI PRODUCTIONS ERGONOMICS EMPLOYEE TRAINING: Preventing Musculoskeletal
More informationPrimary Health Concerns Please use the following to best describe the primary reason you are seeking medical care today.
Patient Intake Form 30 E. 60 th Street #302 - New York, NY 10022 New Patient Special Consultation Notes: For: (OFFICE USE ONLY) Full Name (First, Last) Date Referral: How did you hear about us? Who should
More informationPrimary (First) Complaint and Location
Name: : File #: Case Type: Sex: Birth : Age: Social Security #: Address: Residence and Mailing City State Zip Code Home Phone: Mobile Phone: Email: Occupation: Employer: Work Phone: Marital Status: S M
More informationWORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 73/09
WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 73/09 BEFORE: N. Jugnundan: Vice-Chair HEARING: January 12, 2009 at Toronto Oral DATE OF DECISION: January 20, 2009 NEUTRAL CITATION: 2009 ONWSIAT
More informationTHE ANGLETM. Guaranteed To Help Reduce Low-Back Pain
Guaranteed To Help Reduce Low-Back Pain THE ANGLETM From Back Support Systems Over One Million Satisfied Customers The Angle is a state-of-the-art, US-patented product designed for those suffering from
More informationBEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. F & F CAROLYN SANCHEZ, EMPLOYEE OPINION FILED MARCH 30, 2010
BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION CLAIM NO. F709437 & F502600 CAROLYN SANCHEZ, EMPLOYEE TYSON POULTRY, INC., SELF INSURED EMPLOYER CLAIMANT RESPONDENT OPINION FILED MARCH 30, 2010 Hearing
More informationDENTAL PLAN. For Student Health Insurance Plan (SHIP) Members
DENTAL PLAN For Student Health Insurance Plan (SHIP) Members 2008 2009 Cornell University students and dependents who are members of the Student Health Insurance Plan may enroll in an optional dental insurance
More informationKEY TO LIFE CHIROPRACTIC
KEY TO LIFE CHIROPRACTIC REGISTRATION FORM Date Home Phone Cell Phone Email Last Name First Name Middle Initial Street Address City State Zip Sex M F Birth Date Occupation How did you hear about this office?
More informationYoga & Pain Relief Suzie Newcome
Disclosure statement: I am the founder and co-owner of Namaspa and have no other disclosures. Yoga & Pain Relief Suzie Newcome Founder & Co-Owner of Namaspa Yoga, in Bend since 2007 500hr EYT and member
More informationMORE EXPERTISE. MORE CHOICES. MORE EFFECTIVE SOLUTIONS.
MORE EXPERTISE. MORE CHOICES. MORE EFFECTIVE SOLUTIONS. ...DELIVERED BY A TEAM OF EXPERTS DEDICATED TO YOUR RETURN TO HEALTH. Whether you ve suffered a brain or spinal injury or are battling a painful
More informationthe ebook on To learn more about human dynamics, grab your copy of: Sales is a People Game. PEOPLE RICH PUBLISHING Australian Business Number: 40 137 075 435 PO Box 39 NORTHLANDS WA 6905 AUSTRALIA All
More informationInitial Visit Forms. Life in Motion Chiropractic & Wellness 6139 Route 96 -Suite 1 Farmington, NY (585)
Initial Visit Forms 6139 Route 96 -Suite 1 Patient Name: Patient Intake Form Name: Date: Address: City: State: Zip: Home #: ( ) Cell #: ( ) Work #: ( ) E-mail: Preferred method of contact: Date of Birth:
More informationWORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 482/07
WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 482/07 BEFORE: S. Peckover: Vice-Chair HEARING: March 2, 2007 at Toronto Oral DATE OF DECISION: April 5, 2007 NEUTRAL CITATION: 2007 ONWSIAT
More informationLUCAS CHIROPRACTIC 903 Howard St. Walla Walla WA PATIENT INTAKE - update
LUCAS CHIROPRACTIC 903 Howard St. Walla Walla WA 99362 PATIENT INTAKE - update Name Today s Date / / Date of Birth / / Address City State Zip Please check box for preferred communication means E-Mail Home
More informationAcknowledgment of Clinic Terms
Acknowledgment of Clinic Terms Our GOAL The goal of CHIRO-FIT, Inc. is to detect and correct subluxations of the spine and body. We do not focus on the treatment of pain and disease, instead aim to help
More informationSUMMARY DECISION NO. 984/98. Delay (onset of symptoms). DECIDED BY: Sandomirsky; Rao; Howes DATE: 31/01/2001 NUMBER OF PAGES: 6 pages ACT: WCA
SUMMARY DECISION NO. 984/98 Delay (onset of symptoms). DECIDED BY: Sandomirsky; Rao; Howes DATE: 31/01/2001 NUMBER OF PAGES: 6 pages ACT: WCA 2001 ONWSIAT 247 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL
More informationBEHAVIOUR CHANGE in patients with chronic illness
How to influence BEHAVIOUR CHANGE in patients with chronic illness with Elise Wald 17 & 18 March 2014 (2 day workshop) RRMH Function & Convention Centre Seminar room 2, Melbourne, VIC Register online today!
More informationPatient Introduction (age 13-21)
#204, 1740 Gordon Drive Kelowna, BC V1Y 3H2 250-868-4880 www.lifeworkschiropractic.ca wecare@lifeworkschiropractic.ca Patient Introduction (age 13-21) Personal History: Your Name: First (Nick-name) Last
More informationThe Value of Adding Chiropractic Care to Worksite Health Clinics
4 th National Association of Worksite Health Centers Annual Forum September 8, 2016, Milwaukee, Wisconsin Curt A. Krause, DC, MS Cerner Healthe Clinic LinkedIn Profile: http://t.co/l0twuh2s9r Slide 1:
More informationEmbodied Self-Awareness
WELL-BEING & TRAUMA RECOVERY PRACTICES A Three-Day Workshop in Embodied Self-Awareness with Alan Fogel PhD, LMT Friday 10th April - Sunday 12th April 2015 Recent research into the physiological and neurological
More informationWho may we thank for referring you? Office Only LIST YOUR HEALTH CONCERNS BELOW. If you had the condition before, when? When did this episode start?
Name Date / / Age Male / Female Address City State Zip Phone: Home Cell Cell Phone Provider Date of Birth / / Email Address Occupation Employer s Name Single / Married / Divorced / Widowed Spouse s Name
More informationDescribe the pain and it s location:
WELCOME TO ZIVKOVIC CHIROPRACTIC CENTER DATE: Please print clearly and fill in completely. ABOUT YOU: Patient Name:_ What do you prefer to be called:_ SS# Street Address City State Zip Date of Birth: Age:
More informationPrimary Care Physician: If Yes, where? Current work status: Full-Time Part-Time Self-Employed Unemployed Disability Retired
Name: Date of Birth: Primary Care Physician: Referring Physician: Have you had physical therapy during this calendar year? Yes No Have you had occupational therapy during this calendar year? Yes No If
More informationHE 250 PERSONAL HEALTH. Stress
HE 250 PERSONAL HEALTH Stress Stress Stress General state of the body, mind, and emotions when an environmental stressor has triggered the stress response Stressor Events or agents in the environment that
More informationCase Studies. Any other questions? medicom.us
Case Studies Radiology Group Uses Medicom to Replace Cumbersome Cloud to Efficiently Send Imaging Studies to Referring Physicians Location: Florida, United States Business Challenge: Referring physicians
More informationCOMPANY & CURRICULUM OVERVIEW INTRODUCTION TO POWER PILATES. FOR MORE INFORMATION PLEASE CONTACT: PH
1 COMPANY & CURRICULUM OVERVIEW INTRODUCTION TO POWER PILATES 2... POWER PILATES IS ABSOLUTELY CONTAGIOUS. I tried it out because I was told I would see results in only a few weeks while actually having
More information2018 Tobacco/Smoke Free Affidavit
2018 Tobacco/Smoke Free Affidavit In an effort to promote and support the health and wellness of employees, the Columbus Consolidated Government will impose a $50.00 per month or $23.08 biweekly surcharge
More informationSAFETY QUOTIENT. EMPLOYER REPORT For Hiring, Training & Coaching. June 20, Kelly Sample
SAFETY QUOTIENT TM EMPLOYER REPORT For Hiring, Training & Coaching Kelly Sample support@talentclick.com June 20, 2017 PART A SAFETY RISK FACTORS Safety Personality Defined This section is a summary of
More information