WoRK BC Initial Worker Interview
Mental Health Adjudication

Worker's last name First name Middle initial WorkSafeBC claim number

HOLAND MARK 42647461

float. Water provides compression on the body and improves relaxation. Self-massage in sauna, focus on
ears and neck. Ear plugs. Ear Pain and headaches persist.

Thursday 12-Feb Treatment and Continuing Symptoms Headaches have subsided. Ear pain persists in left
ear. 2-6 out of 10. Mental symptoms, anxiety, loss of concentration, fatigue. Sleep loss. Over-active stress
response. Not driving. Limited physical activity (not skiing with my daughter).

Medical information/treatment

Physician/walk-in clinic Mental health practitioner (e.g., counsellor,
Dr. Gbogboade Ademiyi psychiatrist, psychologist)

Foremed Clinic 604 522 2206

Not yet

Royal Columbian twice

Amplifon Surrey-778 900 6962

Have you been given a diagnosis and/or prescribed medication for your current symptoms? (yes/no)
No diagnosis for health or MH symptoms

Prednisone for ear pain
Quetiapine for sleep (12.5 mg)
Migraine meds-sumatriptan (nurtec for when migraines are extreme)

Blexton (Anti histamine)-Urticaria

Have you ever sought treatment for a mental health issue before? Or do you have any pre-existing mental
health issues? (yes/no)

No

Coping/symptoms/ Date of psychological change

What are your current symptoms?

e Sleep changes-difficulty sleeping, intermittent

e Changes to appetite-okay now but was decreased before

e Alcohol, tobacco, drugs-none (W switched to nicotine gum from cigarettes on January 12, 2026; cut
out caffeine about 2 weeks ago (W was drinking caffeinated drinks in morning)

e Social activities - not skiing

e Ear pain

e Migraine symptoms
e =©Anxiety

e Loss of concentration

e Fatigue

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