RE: INJURED:
M.R.#:
Employer:
DATE OF EXAM:
Carrier:
DATE OF INJURY:
Date of report:
PERMANENT AND STATIONARY REPORT: LEFT KNEE
S:
XXX was last seen in this office on 2/3/05 for a follow-up of his left knee
chondromalacia.
His condition may be considered permanent and stationary as of that date.
FACTORS OF DISABILITY
Subjective complaints: Occasional minimal pain with deep squatting activities.
Objective findings: Girth measurements: Thigh measured 15 cm over the superior pole of
the patella; 40/04 cm. Calf: 33/33 cm.
PERMANENT DISABILITY: Based on the patient's objective findings and subjective
complaints, it is my belief the patient does not have a ratable permanent disability with
regards to his left knee.
CAUSATION: Work related injury.
APPORTIONMENT: No apportionable factors.
FUTURE MEDICAL TREATMENT: The patient should be maintaining a strengthening
range of motion program and using at home exercise for which she has been well instructed.
VOCATIONAL REHABILITATION: The patient has and may continue his regular work
activity without restriction. Vocational rehabilitation is not indicated nor anticipated.
RECORD REVIEW: Approximately 30 minutes was spent reviewing medical records in
preparation of this report.
I have not violated Labor Code Section 139.3 and the contents of this report and bill are true and correct to
the best of my knowledge. This statement is made under penalty of perjury.”
Date of Report: ____________
Dated the ____________ day of ________ 2005
At Santa Clara County, California
______________________________________
Warren King, M.D.
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