Examined by: David L. Johnson, D.C.

On February 5, 2004 Susan Martin was asked to describe her current and past health history. Susan related that on February 1, 2004 she experienced a motor vehicle accident.

MOTOR VEHICLE ACCIDENT DESCRIPTION

Mrs. Martin relates that at the time of the accident she was the driver of a vehicle which she describes as a compact car. Her vehicle was stopped when the impact occurred. Susan indicates that the other vehicle involved in the accident is best described as a full size truck. Susan states that the vehicle she was in was struck squarely from behind by the other vehicle involved in accident. At the time of the accident the other vehicle was moving at a moderate speed.

At the time of the accident Mrs. Martin states that she was not wearing her seat belt and was not wearing her shoulder harness. The airbag in Mrs. Martin's vehicle did not deploy. Susan indicates that she was not anticipating the impact and was not braced. At the point of the impact she was looking straight ahead. Mrs. Martin does not believe she lost consciousness due to the trauma of the accident.

CURRENT SYMPTOMS

Mrs. Martin came to the office for evaluation of the following symptoms:

- Headaches which affect the entire head. The intensity is described as severe.

- Upper neck pain which affects both sides of her neck. The pain is described as a throbbing sensation. The intensity is described as moderate to severe. Susan estimates that she has had neck pain constantly since the date of onset. The neck pain is getting worse as time goes on.

- Lower neck pain which affects both sides of her neck. The pain is described as a throbbing sensation. The intensity is described as moderate to severe. Susan estimates that she has had neck pain constantly since the date of onset. The neck pain is getting worse as time goes on.

- Right shoulder pain which is accompanied by stiffness. The pain is described as a dull ache. The intensity is described as moderate. Susan estimates that she has had shoulder pain two or more times a day on average since the date of onset. The shoulder pain is staying about the same as time goes on.

- Left shoulder pain. The pain is described as a dull ache. The intensity is described as moderate. Susan estimates that she has had shoulder pain with function since the date of onset. The shoulder pain is getting worse as time goes on.

- Chest pain and difficulty breathing when at its worst.

Mrs. Martin did seek treatment for these symptoms. Susan received treatment from a medical doctor. She described her symptoms following that treatment as being unchanged by the treatment.

CURRENT TREATMENT

Currently taking PPA/GG & Amoxil. Susan is avoiding certain tasks in the home, avoiding certain tasks at work, and resting the injured area in an attempt to alleviate her symptoms.

PERSONAL HABITS

Mrs. Martin indicated that she does not smoke. Susan does drink caffeinated beverages at a rate of more than three cups or cans a day.

FAMILY HISTORY

Mrs. Martin states that there are individuals with high blood pressure and diabetes in her family. There is no history of epilepsy, cardiovascular problems, pulmonary problems, cancer, birth defects, headaches, back problems, or neck problems in her family.