Exhibit C: Delaware Workers' Compensation Physician's Report of Worker's Compensation Injury

Summary

This exhibit, filed April 7, 2026 as Document 119-4 in Case No. 1:24-cr-00267-KMW in the U.S. District Court for the District of New Jersey, is a Delaware Workers' Compensation Physician's Report of Worker's Compensation Injury for Adrienne Ponzo, marked as a progress report. It records an exam date of 03/26/2026, a diagnosis of muscle spasm of back (M62.830) and a treatment plan of Rise PT. The form marks 0 hours per day the patient can work and states NO WORK from 03/26/2026 to 05/14/2026, until the next office visit. It is signed by Alexandre Mikhail PA-C, with the next appointment on 05/14/2026.

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Case 1:24-cr-00267-KMW     Document 119-4     Filed 04/07/26     Page 1 of 2 PageID: 684

EXHIBIT C
[illegible]24-cr-00267-KMW     Document 119-4     Filed 04/07/26     Page 2 of 2 Page[illegible]

MR #: [illegible]

DELAWARE WORKERS' COMPENSATION
PHYSICIAN'S REPORT OF WORKER'S COMPENSATION INJURY
A COPY OF THIS REPORT MUST BE SENT TO THE INJURED WORKER, EMPLOYER AND THE INSURER

REPORT TYPE:    __Initial    X Progress    __Closing
WORKER'S NAME:  Adrienne Ponzo
DOB
Date of Injury    01/09/1975
Body Part(s):
EXAM DATE    03/26/2026
Physician's Phone/Fax    (302) 731-2888/(302) 355-4434

Employer Name
Employer Phone/Fax  /
Insurer Name
Insurer Claim No.
Insurer Phone/Fax

INITIAL VISIT ONLY
Injured worker's description of accident/injury:

WORK RELATED MEDICAL DIAGNOSIS (ES)    Muscle spasm of back(M62.830)

TREATMENT PLAN:
Diagnostic Tests
Procedures
Therapy    Rise PT
Medications

Hrs. per day patient can work:   __8+   __[illegible]   __6   __4   __2   X 0

D.O.T Classification of Work

__Sedentary   Exerting up to 10 lbs. of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time.
__Light   Exerting up to 20 lbs. of force occasionally and/or up to 10 lbs. of force frequently and/or negligible amount of force constantly to move objects. Physical Demand requirements are in excess of those for Sedentary Work.
__Medium   Exerting 20 to 50 lbs. of force occasionally and/or 10 to 25 lbs. of force frequently and/or greater than negligible up to 10 lbs. of force constantly to move objects. Physical Demand requirements are in excess of those for Light Work.
__Heavy   Exerting 50 to 100 lbs. of force occasionally and/or 25 to 50 lbs. of force frequently and/or 10 to 20 lbs of force constantly to move objects. Physical Demand requirements are in excess of those for Medium Work.
__Very Heavy   Exerting in excess of 100 lbs. of force occasionally and/or in excess of 50 lbs. of force frequently and/or in excess of 20 lbs. of force constantly to move objects. Physical Demand requirements are in excess of those for Heavy Work.

Definitions:
Occasionally: activity or condition exists up to 1/3 of the time
Frequently: activity or condition exists from 1/3 to 2/3 of the time
Constantly: activity or condition exists from 2/3 or more of the time

Work Postures/Positional tolerances: Comment as appropriate in the space provided regarding the patient's abilities/limitations for the following Postures/Positions.
(e.g. Sitting: No more than 30 minutes continuously)

Sitting:                Squatting:
Standing:               Crawling:
Walking:                Climbing:
Driving:                Repeated arm motions:
Bending:                Repetitive use of wrist/hands:
Turn/Twist:             Reaching up above shoulder:
Kneeling:               Foot controls:

Comments:   NO WORK 03/26/2026 to 05/14/2026 Until Next Office Visit

Above safe work capacities are:   __temporary   __permanent   __anticipate full duty release

Return to work modified duty start date:

RELEASE TO FULL DUTY WITH NO RESTRICTIONS   __YES (Start Date___)   __NO

[signature]
Physician Signature:
Physician Name: Alexandre Mikhail PA-C   Certified Provider:  X YES  __NO   "References the Healthcare Practice Guidelines adopted pursuant to the 19 Del.C. §2322(A)"
Date: 03/26/2026    Next Appointment: 05/14/2026

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gov.uscourts.njd.546707.119.4.pdf

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113,822 bytes

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0154f18e8c7409e51e63b93eb4d07f949970af3af12c318c8822dcc2789a17b6

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gov.uscourts.njd.546707.119.4.pdf

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