WoRK BC

Physician's Progress Report

IHOLAND, MARK
Claim number

Electronic Form 11 Submitted by Physician

Date of service: 2026-02-10

(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

HE

PA\

Rel
Is ¢
lf ni
PS
Es'

IEARACHE 2/10. SLEEP
DS AT NIGHT- HE WETS THEM SO HE DOESN'T HAVE TO GET UP. REPORTS BP HAS BEEN NORMAL. IMP MIGRAINE ANXIETY
DISORDER UNSPECIFIED. PLAN C/W MIGRAINE PREVENTION WITH COENZYME Q10, WOULD R

IECOMMEND PSYCHIAT!
INOCTE. REVIEW IN 2 WEEKS

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? Subjec'

REMAINS OFF WOR

urn to Work Planning

0, what are the curren

he worker now medically capable of working full duties, full time? No

ive Sx, Examination, investigations, treatments/meds, Specialist Consult?
K. ONGOING SEVERE ANXIETY. HEADACHE HAS IMPROVED SCORES 1/10 IMPROVED ON NURTEC. LEFT
HAS IMPROVED SOMEWHAT WITH SEROQUEL. HE IS NOW SLEEPING IN A SLEEP TENT. STILL WEARING

RY/PSYCHOLOGY ASSESSMENT. REMAIN OFF WORK FOR NOW C/W PRN NURTEC + SEROQUEL 12.5MG

physical and/or psychological restrictions?

YCHOLOGICAL DIST!

If yes, select 'Work Conditioning Program' or 'Other': Work Conditioning
Do you wish to consult with WCB physician or nurse advisor? Yes
If possible, please estimate date of Maximal Medical Recovery (full 0002-11-30

recovery or best possible recovery):

imated 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

RESS

Electronic Form 11

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