Opinion of the Court by
Justice COOPER.
On May 30, 2000, a motor vehicle owned and operated by Appellant, Michael Wayne Parson, crossed the center line of a highway in Jefferson County, Kentucky, and struck a vehicle owned and operated by Lisa Eberle, injuring her and damaging [778]*778her automobile. Appellant was transported to University Hospital where a test of his blood revealed an alcohol concentration of 0.288 grams per deciliter and a test of his urine revealed the presence of an unquantified amount of cocaine and cannabi-noids (marijuana).
Appellant was subsequently convicted by a Jefferson Circuit Court jury of assault in the second degree (wanton) (“assault 2nd”), a Class C- felony, KRS 508.020(l)(c) and (2); operating a motor vehicle while under the influence of intoxicants (fourth offense) (“DUI 4th”), a Class D felony, KRS 189A.010(1) and (5)(d); operating a motor vehicle while license is revoked or suspended for DUI (third offense) (“OSL/DUI 3rd”), a Class D felony, KRS 189A.090(1) and (2)(c); criminal mischief in the first degree (“criminal mischief 1st”), a Class D felony, KRS 512.020; no motor vehicle liability insurance (“no insurance”), KRS 304.39-080(5), a misdemeanor, KRS 304.99-060(l)(a); and expired vehicle registration, KRS 186.170(1), a violation, KRS 186.990(1).
The jury initially sentenced Appellant to imprisonment for ten years for assault 2nd and five years each for DUI 4th, OSL/DUI 3rd, and criminal mischief 1st, and to fines of $1,000 for no insurance and $100 for expired vehicle registration. The jury recommended that the sentences for assault 2nd, DUI 4th and OSL/DUI 3rd be served consecutively and the sentence for criminal mischief 1st be served concurrently for a total of twenty years, the maximum aggregate sentence allowable under KRS 532.110(l)(c). Young v. Commonwealth, Ky., 968 S.W.2d 670, 675 (1998); Hendley v. Commonwealth, Ky., 573 S.W.2d 662, 668 (1978). However, because the jury also found Appellant to be a persistent felony offender in the first degree (“PFO 1st”), KRS 532.080(3), it recommended enhanced sentences of twenty years each for assault 2nd, DUI 4th, and OSL/DUI 3rd, and fifteen years for criminal mischief 1st. KRS 532.080(6)(b). The jury then recommended that all of the enhanced sentences be served concurrently for a total of twenty years, again the maximum aggregate sentence allowable under KRS 532.110(l)(c). Appellant appeals to this Court as a matter of right. Ky. Const. § 110(2)(b).
I. JUROR QUALIFICATION FORMS.
Section 7 of Part II of the Administrative Procedures of the Court of Justice (“Ad.Proc.”) requires that each prospective juror fill out a juror qualification form devised by the Administrative Office of the Courts and submit it to the clerk within five days of the receipt of the juror summons. Part II, Section 7(7) further provides:
The contents of the juror qualification forms shall be made available to the trial judge and to parties or their attorneys of record unless the chief circuit judge or designee determines in any instance in the interest of justice that the information shall be kept confidential or its use limited in whole or in part.
The form is a questionnaire. In addition to identifying data, i.e., name, address, date and place of birth, marital status, and employment, the questionnaire also contains inquiries designed to determine whether the prospective juror is legally disqualified from jury service for any of the reasons set forth in Ad. Proc., Part II, § 8. Finally, it contains questions pertaining to the juror’s experience with the court system, e.g., whether the juror has ever been a party to a lawsuit or been a defendant, witness, or complainant in a criminal case. The very language of Part II, Section 7(7) clarifies that a criminal defendant does not have an absolute right to inspect the completed forms.
[779]*779Thrice, this Court has approved a local rule of the Jefferson Circuit Court that denies a criminal defendant access to the addresses of the jurors who serve on that defendant’s case. Thompkins v. Commonwealth, Ky., 54 S.W.3d 147, 151 (2001); Cornelison v. Commonwealth, Ky., 990 S.W.2d 609, 610 (1999); Samples v. Commonwealth, Ky., 983 S.W.2d 151, 152-53 (1998), overruled on other grounds by Lawson v. Commonwealth, Ky., 53 S.W.3d 534, 544 (2001). Accordingly, instead of copying the larger original forms with the addresses blacked out, the jury pool administrators create a smaller, typewritten (thus fully legible) form containing all of the data provided by the juror except the juror’s address and the juror’s answers to the questions regarding legal qualifications.
Prior to voir dire, defense counsel demanded to see the original qualification forms submitted by the jurors selected for the panel in this case, suggesting that the jury pool administrators may have inaccurately transferred information from the original form to the typewritten form. Instead, the jury pool administrators furnished the forms for all of the 248 jurors who had been impaneled for that month— except one, Juror No. 24366, whose original form apparently had been lost or misplaced. Voir dire lasted approximately two hours and Appellant does not claim that defense counsel’s voir dire was restricted in any fashion. After forty-eight minutes of deliberating over peremptory strikes, and after some prompting by the trial judge, defense counsel submitted his peremptory strike list, complaining that he had not had enough time to examine all 248 juror qualification forms. Examination of the peremptory strike sheets revealed that the prosecutor and defense counsel had both struck the same three jurors.
A jury of twelve, plus two alternate jurors, was sworn and seated and the remainder of the jurors were excused. Four witnesses then testified before court adjourned for the day. On the following morning, defense counsel demanded a mistrial claiming that he had now had a full opportunity to examine all 248 juror qualification forms and that he would have struck four different jurors than he actually struck had he not been forced to prematurely complete the exercise of his peremptory strikes. The jurors he claims he would have struck were Juror No. 24366, whose original form was missing; Juror No. 28117, who failed to sign his form and who, therefore, was deemed irresponsible; Juror No. 491, who worked a night shift (information not transferred to the typewritten form); and Juror No. 23788, who wrote “invasion of privacy” in the margin next to the inquiries about his marital status and occupation (though he did furnish the requested information).
It is voir dire that is the “sine qua non to the seating of a fair and impartial jury.” McCarthy v. Commonwealth, Ky., 867 S.W.2d 469, 471 (1993), overruled on other grounds by Lawson v. Commonwealth, supra, at 544. To the extent that juror qualification forms contain information related to subjects other than a juror’s legal qualifications, its purpose is to expedite the voir dire process by eliminating questions routinely asked of every juror.
Juror No. 24366, whose original form was missing, had obviously submitted a form because the data she presumably provided had been transferred from the original form to the typewritten form. Appellant could have made a record on the accuracy question by asking that she be questioned in chambers as to whether the information on the typewritten form was inaccurate or incomplete. He chose not to do so. The fact that Juror No. 28117 was [780]*780the president of a medical staff company leaves us skeptical that Appellant would have exercised a peremptory strike against him solely on grounds that he was “irresponsible.” We note that Appellant did not claim entitlement to a mistrial on grounds that three additional jurors, Nos. 494, 23788, and 26060, whom he failed to peremptorily strike also, did not fully complete their original forms. Juror No. 491 did not request excusal from jury service because she worked at night. If Appellant desired to excuse night-shift workers, he could have inquired during voir dire whether any prospective jurors were so employed. He might have learned that Juror No. 491, like many persons in public employment, had been excused from work while performing jury service. When the issue was raised, the trial judge noted and no one disagreed that Juror No. 491 appeared highly attentive and exhibited no signs of being tired or sleep-deprived. With respect to Juror No. 23788, if Appellant was truly concerned whether a juror considered an inquiry into marital status and occupation an invasion of privacy, he could have so inquired during voir dire. We note in passing that defense counsel refused the prosecutor’s offer to have Juror No. 23788 excused as an alternate juror.
The bottom line on this issue is that it would not have been an abuse of discretion for the trial court to have denied Appellant and his counsel access to the original forms since they contained the jurors’ home addresses. That being so, the trial court could not have abused its discretion in limiting the time for defense counsel to peruse the forms for evidence that might have prompted the exercise of a peremptory strike.
II. URINALYSIS RESULTS.
A screen of a urine sample taken from Appellant at University Hospital approximately one hour after the accident was positive for unquantified amounts of cocaine and marijuana. Appellant made a motion in limine to suppress expected testimony from Dr. George Rodgers, a toxicologist, from testifying that “on the night of the accident, a test of appellant’s urine revealed traces of cocaine and marijuana.” In fact, prior to Dr. Rodgers’s testimony, Alberta Kummer, a medical technician employed at the hospital, testified without objection that she was the person who tested Appellant’s blood and urine samples and that the urine screen was positive for cocaine and marijuana. Also without objection, Kummer introduced a printout of her test results, which is found in the record as Commonwealth’s Exhibit 8. It was this exhibit that was presented to Dr. Rodgers to inform him of the test results. Thus, there was no violation of the motion in limine.
Dr. Rodgers testified that traces of marijuana can remain in the body for weeks after ingestion but that traces of cocaine will disappear within twenty-four hours. He could not say when in the twenty-four hour period Appellant had ingested the cocaine but admitted that he also could not say that Appellant had not ingested the cocaine immediately prior to operating his vehicle. And, although he testified in detail to the effects of a blood alcohol concentration of 0.238 grams per deciliter on the motor skills and judgment of a person with that amount of alcohol in his system, he did not know what additional effect would result from a mixture of alcohol and cocaine. Appellant did not move to strike either Kummer’s or Rodgers’s testimony but only moved for an admonition to the jury to disregard all evidence of marijuana and cocaine as irrelevant. The motion was denied.
We upheld the admission of almost identical evidence in both Estep v. Common[781]*781wealth, Ky., 957 S.W.2d 191, 193-94 (1997), and Bush v. Commonwealth, Ky., 839 S.W.2d 550, 555 (1992). In State v. McClain, 525 So.2d 420 (Fla.1988), the Supreme Court of Florida held that even a trace amount of cocaine in the system of a person charged with vehicular homicide would have some relevance, id. at 421; and agreed with the conclusion of a district court of appeals in State v. Weitz, 500 So.2d 657, 659 (Fla.Dist.Ct.App.1986), that such evidence is not inadmissible simply because a toxicologist cannot estimate the degree of impairment caused by its presence. McClain, swpra, at 423. Nevertheless, McClain held that the trial court did not abuse its discretion in suppressing the evidence under Fla. Stat. Ann. § 90.403, Florida’s equivalent of KRE 403. Id. at 422.
Here, the trial court admitted the evidence. Like the court in McClain, we believe that evidence that a person charged with vehicular homicide had intoxicating drugs in his system when the homicide occurred is relevant to the issue of wantonness even without additional evidence of the degree of impairment caused by its presence. KRE 402.
An item of evidence, being but a single link in the chain of proof, need not prove conclusively the proposition for which it is offered. It need not even make that proposition appear more probable than not.... It is enough if the item could reasonably show that a fact is slightly more probable than it would appear without that evidence. Even after the probative force of the evidence is spent, the proposition for which it is offered still can seem quite improbable.
Robert G. Lawson, The Kentucky Evidence Law Handbook § 2.05[3], at 80 (4th ed., LEXIS 2003) (quoting Edward W. Cleary, McCormick on Evidence 542-43 (3d ed.1984)). The evidence was thus admissible unless its probative value was substantially outweighed by its prejudicial effect. KRE 403. This is an issue committed to the sound discretion of the trial court. Commonwealth v. English, Ky., 993 S.W.2d 941, 945 (1999). We conclude that the trial court did not abuse its discretion in admitting the evidence.
III. CHAIN OF CUSTODY.
Christine Kerr testified that she collected the samples of Appellant’s blood and urine in the emergency room at University Hospital on the night in question, that she handed the samples to a medical technician who labeled the samples with Appellant’s name and handed them to another medical technician for delivery to the hospital laboratory, located down the hall from the emergency room. Kummer testified that the samples were delivered to her, that they were labeled with Appellant’s name, and that she tested the blood sample for the presence of alcohol and the urine sample for the presence of various drugs, including cocaine and marijuana. Appellant claims that the Commonwealth failed to prove the chain of custody because it did not produce the testimony of either the person who labeled the samples or the person who delivered them to the laboratory. We disagree.
[I]t is unnecessary to establish a perfect chain of custody or to eliminate all possibility of tampering or misidentification, so long as there is persuasive evidence that the reasonable probability is that the evidence has not been altered in any material respect.
Rabovsky v. Commonwealth, Ky., 973 S.W.2d 6, 8 (1998) (quotation omitted). See also Love v. Commonwealth, Ky., 55 S.W.3d 816, 821 (2001). The evidence offered by Kerr and Kummer proved a reasonable probability that the blood and urine samples delivered to and tested by [782]*782Kummer were the samples collected from Appellant, and that the samples had not been altered in any material respect during the short transit from the emergency room to the laboratory.
IV. WITNESS DEPOSITION.
Three medical doctors, Drs. Peter Latino, David Zhou, and George Rodgers, and a licensed physical therapist, Timothy Ni-chol, testified for the Commonwealth. The first scheduled trial date was August 16, 2001. On the morning of trial, Appellant requested and was granted a continuance after the trial court granted the Commonwealth’s motion to amend the indictment. On the morning of the second scheduled trial date, November 6, 2001, Appellant again requested and was granted a continuance, this time because defense counsel’s investigator, who might be called as a witness, was ill (the investigator did not testify when the trial was finally held), and because defense counsel might possibly have a medical problem as well. The prosecutor objected on grounds that this was the second time the medical witnesses had been subpoenaed and their medical practices disrupted. The trial court inquired whether the parties could agree to present any or all of the medical testimony by deposition and defense counsel (in the presence of Appellant) readily agreed. In response to a statement by the trial judge that if a plea agreement could not be negotiated, they would discuss deposing the doctors and setting the case for trial at a future date, Appellant, himself, responded, “That would be fine, your honor.” A new trial date was scheduled for January 2, 2002.
On November 21, 2001, the Commonwealth took the videotaped deposition of Timothy Nichol, the licensed physical therapist. The deposition was taken in the courtroom before a special judge who presided due to the illness of the regular judge. Appellant and his counsel were present and counsel was afforded and exercised the right of cross-examination. In addition to testifying to the nature and extent of the victim’s injuries and his treatment thereof, Nichol stated under oath that he had made arrangements to be in Minnesota during the Christmas holidays from December 22 through January 2, and in Nevada for a company meeting from January 3 through January 7. At the conclusion of the deposition, defense counsel served Nichol with a subpoena to appear in person at trial on January 2, 2002. At a hearing on December 20, 2001, the regular trial judge quashed the subpoena and Niehol’s testimony was presented to the jury in the form of the videotaped deposition.
The Confrontation Clause of the Sixth Amendment of the United States Constitution guarantees a criminal defendant the right to confront his accusers at trial. California v. Green, 399 U.S. 149, 157, 90 S.Ct. 1930, 1934-35, 26 L.Ed.2d 489 (1970) (“[I]t is this literal right to ‘confront’ the' witness at the time of trial that forms the core of the values furthered by the Confrontation Clause.”); Barber v. Page, 390 U.S. 719, 725, 88 S.Ct. 1318, 1322, 20 L.Ed.2d 255 (1968) (“The right to confrontation is basically a trial right.”). “Testimonial statements of witnesses absent from trial have been admitted only where the declarant is unavailable, and only where the defendant has had a prior opportunity to cross-examine.” Crawford v. Washington, 541 U.S. 36, -, 124 S.Ct. 1354, 1369, 158 L.Ed.2d 177 (2004). KRE 804(a)(5) provides that a witness is unavailable for purposes of admission of former testimony, KRE 804(b)(1), if the witness “[i]s absent from the hearing and the proponent of the statement has been unable to procure the declarant’s attendance by process or other reasonable means.” When [783]*783the right of confrontation is implicated, there is an additional requirement that the proponent of the witness have made a good faith effort to obtain the witness’s presence at trial. Barber, supra, at 725, 88 S.Ct. at 1822. Contrary to the prosecutor’s assertion at the December 20, 2001, hearing, the mere absence of the witness from the jurisdiction does not constitute “unavailability,” and RCr 7.10(1) cannot be so interpreted. Brumley v. Wingard, 269 F.Bd 629, 640 (6th Cir.2001) (construing Ohio Crim. R. 15(F), a rule almost identical to RCr 7.10). Obviously, Nichol was not “unavailable” in the constitutional sense.1
However, even “the most basic rights of criminal defendants are subject to waiver.” New York v. Hill, 528 U.S. 110, 114, 120 S.Ct. 659, 663, 145 L.Ed.2d 560 (2000) (internal quote omitted). E g., right to a speedy trial, Barker v. Wingo, 407 U.S. 514, 529, 92 S.Ct. 2182, 2191, 83 L.Ed.2d 101 (1972), Dunaway v. Commonwealth, Ky., 60 S.W.3d 563, 571 (2001); right to a public trial, Levine v. United States, 362 U.S. 610, 619, 80 S.Ct. 1038, 1044, 4 L.Ed.2d 989 (1960); right to a trial by jury, Adams v. United States ex rel. McCann, 317 U.S. 269, 275, 63 S.Ct. 236, 240, 87 L.Ed. 268 (1942), Short v. Commonwealth, Ky., 519 S.W.2d 828, 832-33 (1975), superseded by rule as stated in Jackson v. Commonwealth, Ky., 113 S.W.3d 128, 131-32 (2003); right to counsel, Faretta v. California, 422 U.S. 806, 819, 95 S.Ct. 2525, 2533, 45 L.Ed.2d 562 (1975), Wake v. Barker, Ky., 514 S.W.2d 692, 695-96 (1974); right to testify on one’s own behalf, Rock v. Arkansas, 483 U.S. 44, 52, 107 S.Ct. 2704, 2709, 97 L.Ed.2d 37 (1987), Crawley v. Commonwealth, Ky., 107 S.W.3d 197, 199 (2003); right to be present at all stages of trial, United States v. Gagnon, 470 U.S. 522, 528, 105 S.Ct. 1482, 1485, 84 L.Ed.2d 486 (1985), Fugate v. Commonwealth, Ky., 62 S.W.3d 15, 19 (2001); right to appeal, Johnson v. Commonwealth, Ky., 120 S.W.3d 704, 706 (2003).
Likewise, a criminal defendant may waive the constitutional right of confrontation. Illinois v. Allen, 397 U.S. 337, 342-43, 90 S.Ct. 1057, 1060-61, 25 L.Ed.2d 353 (1970); Richmond v. Commonwealth, Ky., 637 S.W.2d 642, 646 (1982); Bonar v. Commonwealth, 180 Ky. 338, 202 S.W. 676, 679 (1918). Appellant clearly waived his right to confront Nichol at trial when defense counsel, with Appellant’s acquiescence, agreed that the testimony of medical witnesses could be presented by deposition. Richmond, supra, at 644 (waiver by counsel: “[The defendant] could have been [present] if his attorney had so chosen.”). Federal courts have uniformly held that counsel can waive a criminal defendant’s Sixth Amendment right of Confrontation “so long as the defendant does not dissent from his attorney’s decision, and so long as it can be said that the attorney’s decision was a legitimate trial tactic or part of a prudent trial strategy.” United States v. Reveles, 190 F.3d 678, 683 n. 6 (5th Cir.1999) (quoting United States v. Stephens, 609 F.2d 230, 232-33 (5th Cir.1980)). See also United States v. Cooper, 243 F.3d 411, 418 (7th Cir.2001) (same); United States v. Plitman, 194 F.3d 59, 64 (2d Cir.1999) (“[W]e reject [the] argument that a defendant in every instance personally must waive the right to confront the witnesses against him.”); Hawkins v. Hannigan, 185 F.3d 1146, 1155 (10th Cir.1999) (upholding evidentiary stipulation against Sixth Amendment challenge because “there is no evidence that [784]*784[defendant] disagreed with or objected to his counsel’s decision”); Wilson v. Gray, 345 F.2d 282, 286 (9th Cir.1965) (“[T]he accused may waive his right to cross examination and confrontation and... the waiver of this right may be accomplished by the accused’s counsel as a matter of trial tactics or strategy.”); Cruzado v. Puerto Rico, 210 F.2d 789, 791 (1st Cir. 1954) (“[WJhere an accused is represented by counsel, we do not see why counsel, in his presence and on his behalf, may not make an effective waiver of [the right of confrontation].”).2 Here, defense counsel agreed to the deposition either in exchange for a continuance or, as noted infra, for the purpose of obtaining pretrial discovery to which he otherwise was not entitled. Appellant was present and did not dissent from the waiver. The only remaining issue is whether Appellant could renege on his waiver after Nichol’s deposition was completed.
Application of the contractual principle of estoppel has been applied to agreements between prosecutor and defendant in a criminal case.
It seems obvious that if the state makes a promise to an accused and the accused takes no action in reliance on the promise, the state may withdraw the offer. No agreement has been reached. There is nothing to enforce. The prosecutor’s right to withdraw is equal to his right to withhold an offer.
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However, if the offer is made by the prosecution and accepted by the accused, either by entering a plea or by taking action to his detriment in reli- ■ anee on the offer, then the agreement becomes binding and enforceable.
Commonwealth v. Reyes, Ky., 764 S.W.2d 62, 64-65 (1989) (emphasis added) (quotation omitted).
When, however, the defendant detrimentally relies on the government’s promise, the resulting harm from this induced reliance implicates due process guarantees. This basic estoppel principle was recognized by the Court in Santobello [Santobello v. New York, 404 U.S. 257, 92 S.Ct. 495, 30 L.Ed.2d 427 (1971)]; when a defendant pleads guilty in reliance on an agreement with the prosecutor, that promise must be fulfilled. San-tobello arguably could be extended to cover the situation where the defendant has not yet entered the plea, but has relied on the bargain in such a way that a fair trial would no longer be possible.
Gov’t Virgin Islands v. Scotland, 614 F.2d 360, 365 (3rd Cir.1980).
These cases, of course, involved situations where the government sought to welsh on its agreement after a criminal defendant had acted in detrimental reliance thereon, thus implicating due process considerations. Nevertheless, we have held that a criminal defendant may not obtain a tactical advantage by claiming lack of confrontation after his attorney initially attended a witness’s court-ordered deposition but voluntarily departed prior to its conclusion. Carter v. Commonwealth, Ky., 782 S.W.2d 597, 599-600 [785]*785(1989), overruled, on other grounds by Norton v. Commonwealth, Ky., 37 S.W.3d 750, 753 (2001), habeas granted on other grounds by Carter v. Sowders, supra, note 2 (defendant did not personally attend deposition and evidence did not prove he had actual notice thereof, thus he could not be deemed to have waived confrontation). See also Estep, 957 S.W.2d at 193 (defendant could not complain on appeal of use of videotaped deposition where she agreed prior to trial that expert’s deposition could be used as evidence). Cf. People v. Couch, 48 Cal.App.4th 1053, 56 Cal.Rptr.2d 220, 221-22 (1996) (defendant estopped from challenging on appeal sentence to which he had agreed in plea bargain); State v. Crosby, 338 So.2d 584, 593 (La.1976) (defendants’ agreement to concede venue in exchange for prosecutor’s agreement not to exhibit admissible and relevant, but gruesome, photographs necessary to prove venue, precluded defendants from claiming on appeal that trial court forced them to stipulate venue).
There is no provision in our criminal rules that would have allowed Appellant to take a discovery deposition of a witness for the Commonwealth. Rigsby v. Commonwealth, Ky., 495 S.W.2d 795, 798 (1973), overruled on other grounds by Pendleton v. Commonwealth, Ky., 685 S.W.2d 549, 552 (1985). Here, Appellant would accomplish what he otherwise could not have accomplished were he permitted to agree to a deposition, RCr 7.10(3), then welsh on the agreement after the deposition was concluded and thereby obtain discovery of the nature of the witness’s testimony. Obviously, the decision to make the belated objection was premeditated because defense counsel came to the deposition armed with the subpoena that he withheld until learning what the testimony would be. We will not speculate as to whether Appellant’s purpose was to obtain discovery by subterfuge, to deprive the Commonwealth of Nichol’s testimony at trial, or to obtain yet another continuance. Regardless, the Commonwealth acted in detrimental reliance on the agreement by (1) agreeing to a trial date on which a key witness could not be present, and (2) making a key witness available for a deposition that otherwise could not have been obtained. We conclude that principles of estoppel and fundamental fairness preclude Appellant from claiming a denial of his right of confrontation under these circumstances.
Furthermore, because the deposition was videotaped in the courtroom with the witness in the witness box, the jury was able to “weigh the demeanor of the witness” in a courtroom setting. Barber v. Page, supra, at 725, 88 S.Ct. at 1322. Nor was Appellant denied the right of cross-examination or the right to “meet the witness[ ] face to face.” Ky. Const. § 11. A judge presided over the testimony just as would have occurred at trial. Thus, we conclude that even if there had been error, it would have been harmless beyond a reasonable doubt. Chapman v. California, 386 U.S. 18, 22, 87 S.Ct. 824, 827, 17 L.Ed.2d 705 (1967) (even constitutional errors are subject to harmless error analysis). Of course, even if an error had occurred, it would only affect the conviction and sentence for assault 2nd since Nichol’s testimony addressed only the serious physical injury element of that offense.
V. SERIOUS PHYSICAL INJURY.
One of the elements that distinguishes the Class C felony of assault 2nd (wanton), KRS 508.020(l)(c), from the Class A misdemeanor of assault in the fourth degree (wanton) (“assault 4th”), KRS 508.030(l)(a), is whether the injury sustained by the victim was a “physical injury” or a “serious physical injury.” [786]*786Those terms are defined as follows in KRS 500.080:
(13) “Physical injury” means substantial physical pain or any impairment of physical condition;
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(15) “Serious physical injury” means physical injury which creates a substantial risk of death, or which causes serious and prolonged disfigurement, prolonged impairment of health, or prolonged loss or impairment of the function of any bodily organ.
(Emphasis added.) The trial judge instructed the jury on both assault 2nd and assault 4th as lesser included offenses of the indicted offense of assault in the first degree. Appellant claims it was error to instruct on assault 2nd because the evidence was insufficient to support a finding by the jury that the victim, Lisa Eberle, sustained a serious physical injury.
Following the collision, Eberle was transported by ambulance to University Hospital where she was diagnosed with multiple contusions and strains, a laceration of the elbow which was sutured, and a cervical strain, described by Dr. Latino, the emergency room physician, as a stretching of the ligaments and muscles of the neck. She was discharged and referred to her family physician, Dr. Lynn Riley. Dr. Riley referred Eberle to Nichol for physical therapy. Nichol diagnosed headaches, cervical neck pain, lack of range of cervical motion caused by muscle spasms, upper thoracic pain, and numbness of the right arm. He administered physical therapy treatments to Eberle on twenty-seven occasions between June 20 and October 13, 2000. Because he was unable to reheve her symptoms, he suggested that Dr. Riley refer Eberle to a pain management specialist. Accordingly, Dr. Riley referred Eberle to Dr. David Zhou.
Dr. Zhou testified that he first saw Eberle on October 30, 2000, and diagnosed headaches and neck pain caused by the May 30, 2000, vehicular assault. He injected anti-inflammatory medications into her neck and prescribed oral anti-inflammatory medications and muscle relaxants. He continued to treat her periodically and was still treating her at the time of trial. Her last visit was on December 28, 2000, five days before trial. At that time, she still suffered from neck pain, although the numbness in her arms had improved and her headaches had dramatically improved. She was still taking oral anti-inflammatory medications and muscle relaxants and Dr. Zhou was considering referring her for additional physical therapy.
Eberle testified that her employment history included working in a department store, a factory, and as a roofer. At the time of the assault, she was employed full-time as a baby-sitter for children whose parents worked a night shift. After the assault, she quit work in part because of her injuries and the frequency of her physical therapy visits and in part because her domestic companion earned enough income from his employment to support both of them. She testified that she still suffers from neck pain and that she did not “choose not to work.”
Appellant claims that Eberle sustained only “substantial physical pain” as a result of the assault, thus only a “physical injury.” The Commonwealth claims that Eberle also sustained “prolonged impairment of health” as a result of the assault, thus the jury was properly instructed on the offense of assault 2nd. We agree with the Commonwealth.
In Luttrell v. Commonwealth, Ky., 554 S.W.2d 75 (1977), we held that a police officer who was shot in the chest with bird shot, was hospitalized for five days, and [787]*787was off work for approximately six weeks had not, as a matter of law, sustained a serious physical injury. Id. at 77-79. And in Souder v. Commonwealth, Ky., 719 S.W.2d 730 (1986), we held that a child who sustained bruising, a swollen arm, and burns in and about the mouth from a cigarette or cigarette lighter, none of which required follow-up treatment after an emergency room visit, had not sustained a serious physical injury. Id. at 732. However, in Commonwealth v. Hocker, Ky., 865 S.W.2d 323 (1993), we held that an assault victim who sustained facial contusions and lacerations requiring sutures, the loss of several teeth which were successfully reimplanted, and a nondisplaced linear fracture of the skull followed by symptoms of concussion but no neurologic injury, was properly found to have sustained a serious physical injury. Id. at 324-25. In Meredith v. Commonwealth, Ky.App., 628 S.W.2d 887 (1982), the Court of Appeals held that the language, “impairment of physical condition,” in the definition of “physical injury” simply means “injury.” Id. at 888. See also Hubbard v. Commonwealth, Ky.App., 932 S.W.2d 381, 383 (1996).
We have not previously addressed what constitutes “prolonged impairment of health” in the context of the definition of “serious physical injury.” However, in Cronin v. State, 454 A.2d 735 (Del.1982), it was held that evidence that two of the victim’s teeth were dislodged during the assault, that subsequent dental surgery failed to leave the teeth in proper alignment, and that the victim was unable to chew certain foods for four months after the assault was sufficient evidence of “prolonged impairment of health” to constitute “serious physical injury.” Id. at 736-37.
We conclude that pain is an “impairment of health.” If the pain is substantial, but not prolonged, it constitutes a “physical injury;” but if it is prolonged, then it is a “serious physical injury.” Eberle’s injuries resulted not only in headaches and neck pain, but also muscle spasms causing decreased range of neck motion, and numbness of her right arm. The numbness continued at least until her treatment by Dr. Zhou, which did not begin until five months after the assault. A jury could reasonably believe from the evidence that the combination of pain, lost range of motion, and arm numbness contributed substantially to Eberle’s decision not to return to public employment. A jury could also believe that Eberle was still suffering from the effects of her injuries on the day of trial, nineteen months after the assault, and that the duration of those effects constituted a “prolonged impairment of health.” Thus, the jury was properly instructed on the offense of assault 2nd.
VI. DOUBLE ENHANCEMENT.
Appellant asserts that his sentences for DUI 4th and OSL/DUI 3rd were improperly enhanced under the PFO statute because the same offenses used to enhance the present DUI and OSL/DUI convictions to Class D felonies were also used to enhance prior offenses to Class D felonies, which were then used for present PFO enhancement.
The present DUI and OSL convictions resulted from verdicts rendered during the first phase of the trial. They were enhanced to DUI 4th and OSL/DUI 3rd during a second, separate phase of the trial. See Com v. Ramsey, Ky., 920 S.W.2d 526, 528-29 (1996) (prior DUI convictions used to enhance the underlying offense cannot be introduced in the guilt phase of the trial). To obtain the respective enhancements, the Commonwealth was required to prove three prior DUI convictions occurring within five years of May 30, 2000, and [788]*788two prior OSL/DUI convictions. KRS 189A.010(5)(c), (10); KRS 189A.090(2)(c).3 The Commonwealth proved five prior DUI convictions occurring on April 21, 1999, November 11, 1997, October 20, 1997, July 22, 1997, and January 20, 1997;4 and two prior OSL/DUI convictions occurring on November 11, 1997, and October 20, 1997. After hearing this evidence, the jury returned additional verdicts enhancing the original convictions to DUI 4th and OSL/ DUI 3rd, Class D felonies.
The trial then proceeded into the combination penalty/PFO phase. KRS 532.055(2), (3). For PFO 1st enhancement, the Commonwealth was required to prove at least two prior felony convictions, one of which must have satisfied one of the time limitation requirements in KRS 532.080(3)(c), e.g., that Appellant completed service of the sentence imposed on any of the prior felony convictions within five years prior to the date of the commission of the present felony offense. Id., (3)(c)(l). The Commonwealth proved four prior felony convictions,5 ie., DUI 4th and OSL/ DUI 3rd convictions occurring on March 24, 1998, and two separate convictions of obtaining controlled substances by fraud or forgery, KRS 218A.140(l)(c), occurring on April 24, 1990, and October 31, 1990. Because the sentences for the March 24, 1998, convictions were ordered to be served concurrently, they merged into one conviction for PFO purposes. KRS 532.080(4). The Commonwealth concedes that only the March 24, 1998, convictions satisfy the time limitation requirements of KRS 532.080(3)(c)(l) and KRS 532.080(2)(c) (same requirements apply to PFO 1st and PFO 2nd enhancement). Thus, if that conviction cannot be used for PFO enhancement of his present DUI 4th and OSL/DUI 3rd convictions, the enhanced sentences for those convictions must be vacated.6
We agree that at least some of the same prior convictions used to enhance the offenses underlying the March 14, 1998, convictions to Class D felonies were also used to enhance to Class D felonies the DUI and DUI/OSL offenses of which Appellant was convicted in this case. However, the 1998 DUI 4th conviction was only one offense, not four offenses consisting of that offense plus the three prior offenses used to prove that the offense was a Class D felony. Likewise, the 1998 DUI/OSL 3rd conviction was for only one offense, not three offenses;- Appellant’s present conviction of DUI 4th is for only one offense, not four; and his present conviction of OSL/ DUI 3rd is for only one offense, not three. The only prior DUI and DUI/OSL convic[789]*789tions used to obtain PFO enhancement of Appellant’s present convictions were the March 24, 1998, felony convictions. Since those convictions were not used to enhance Appellant’s present DUI and DUI/OSL convictions to Class D felonies, they were properly used for PFO enhancement under KRS 532.080(6)(b). Corman v. Commonwealth, Ky.App., 908 S.W.2d 122, 124 (1995) (prior conviction of OSL/DUI 3rd could be used for PFO enhancement of present conviction of DUI 4th even though a prior DUI conviction that was a predicate for the OSL/DUI 3rd conviction was also used to prove that the present conviction was Appellant’s fourth DUI conviction). See also Commonwealth v. Grimes, Ky., 698 S.W.2d 836, 837 (1985) (penalty for second offense controlled substance conviction could be further enhanced under PFO statute where the prior offense used for PFO enhancement was not the same prior offense used to prove that the underlying controlled substance offense was a second offense); Eary v. Commonwealth, Ky., 659 S.W.2d 198, 200 (1983) (penalty for conviction of possession of a handgun by a convicted felon, KRS 527.040, could be further enhanced under PFO statute where prior felony conviction used to prove the convicted felon element of the underlying offense was a different conviction from those used for PFO enhancement).
Accordingly, the judgment of convictions and sentences imposed by the Jefferson Circuit Court are affirmed.
LAMBERT, C.J.; GRAVES, JOHNSTONE, and WINTERSHEIMER, JJ., concur.
KELLER, J., concurs in part and dissents in part by separate opinion, with STUMBO, J., joining that opinion.