Physician's Progress Report

WoRK BC

IHOLAND, MARK Electronic Form 11 Submitted by Physician
Claim number

Date of service: 2026-02-05
(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 HAS BEEN AGITATED AND IRRITABLE. HAS BEEN WEARING PADS AND SLEEPING IN THE CLOSET 'IT'S
[A COMFORT THING' WIFE SUSPECTS HE IS ON AUTISTIC SPECTRUM. REPORTS BP HAS BEEN STABLE 122/78. IMP ?MIGRAINE
ISECONDARY TO NOISE EXPOSURE, ACUTE STRESS REACTION ?7?UNDERLYING NEURODIVERGENT CONDITION. PLAN C/W
MIGRAINE PREVENTION WITH COENZYME Q10, WOULD RECOMMEND PSYCHIATRY ASSESSMENT. REMAIN

IOFF WORK FOR NOW COMMENCE SEROQUEL 12.5MG NOCTE. MEDITATION, MINDFULNESS. REVIEW 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 14-20 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? Yes
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