Physician's Progress Report

WoRK BC

IHOLAND, MARK Electronic Form 11 Submitted by Physician
Claim number

Date of service: 2026-03-27
(Are you the worker's regular physician? Yes

lf yes, how long has the worker been you patient? 0-6 months
Who rendered first treatment? RCH ER
Receiving concurrent treatment? No

Demographic Information

Last name: HOLAND

First name: MARK

|Gender: Male

Date of birth: 1978-09-04

Personal health number: 9128-549-738
(Address: 311-318 AGNES ST
City: NEW WESTMINSTER
Province: BC

Postal code: V3L0J3

Home phone number: 236 9943376
Employer Information

Employer/organization name: BC RAPID TRANSIT
Phone number: 604 5203641
(Address: 6800 14TH AVE
City: BURNABY, BC
Postal code: V3L0J3

Injury

Prior / Other Problems Affecting Injury, Recovery, and Disability
IKNOWN MIGRAINE SUFFERER

Diagnosis: HEADACHE

Injury Date: 2026-01-22

Side of Body: N

ICD9 Code: 7840 HEADACHE

ICSA BP/Side: 01100 BRAIN

ICSA NOI: 12610 DEAFNESS, HEARING LOSS OR IMPAIRMENT

Clinical Information
\What happened? Subjective Sx, Examination, investigations, treatments/meds, Specialist Consult?

IHE REMAINS OFF WORK. SETRALINE RISPERIDONE AND TRAZODONE. HE IS SLEEPING BETTER. HE SAW AN AUDIOLOGIST AND
IWAS ADVISED HE HAD 'HYPERACUSIS' WAS RECOMMENDED SOUND THERAPY. WCB CLAIM HAS BEEN DENIED. HE IS APPEALING
DECISION. HEADACHE RESOLVED. ONGOING LEFT EARACHE 4-5/10 (STABLE). HE IS STILL SLEEPING IN A TENT WITH WEIGHTED
BLANKET. IMP MIGRAINE, MDD WITH ANXIOUS DISTRESS. PLAN C/W SERTRALINE RIS

IPERIDONE AND TRAZODONE. NOT FIT FOR GRTW AT THIS TIME. HAVE REFERRED TO ENT AND NEUROLOGIST VIA MSP. REFILLED
MEDS. R/V IN 2 WEEKS

Return to Work Planning
ls the worker now medically capable of working full duties, full time? No

lf no, what are the current physical and/or psychological restrictions?

IPSYCHOLOGICAL DISTRESS

Estimated date before the worker will be able to return to the workplace Greater than 20 days
in any capacity:
lf appropriate, is the worker now ready for a rehabilitation program? Yes

If yes, select 'Work Conditioning Program' or 'Other': Work Conditioning
Do you wish to consult with WCB physician or nurse advisor? No
If possible, please estimate date of Maximal Medical Recovery (full 0002-11-30

recovery or best possible recovery):

Electronic Form 11 Page 1 of 2