WoRK BC

Physician's Progress Report

IHOLAND, MARK
Claim number

Electronic Form 11 Submitted by Physician

Home phone number:

Date of service: 2026-03-09

(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

236 9943376

Employer Information
Employer/organization name:
Phone number:

BC RAPID TRANSIT
604 5203641

Clinical Information

(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

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

IHE REMAINS OFF WORK. WAS SEEN IN ER BY PSYCHIATRIST- HAS BEEN STARTED SETRALINE RISPERIDONE AND TRAZODONE.
IHE IS SLEEPING MUCH BETTER. NOT HEARD FROM WCB ABOUT ENT ASSESSMENT YET. HEADACHE HAS IMPROVED SCORES
1/10 IMPROVED ON NURTEC. ONGOING LEFT EARACHE 3-4/10. HE IS STILL SLEEPING IN A TENT WITH WEIGHTED BLANKET. IMP
MIGRAINE, MDD WITH ANXIOUS DISTRESS. PLAN C/W SETRALINE RISPERIDONE AND TRAZO

DONE. NOT FIT FOR GRTW AT THIS TIME. WILL REFER TO ENT AND NEUROLOGIST VIA MSP. 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