SOUTH COUNTY PAIN & REHAB
Maureen D. Miner. M.D.
Diplomate, American Board of Physical Medicine & Rehabilitation
Diplomate, American Board of Pain Medicine
Sub-Specialty Board Certified, Spinal Cord Medicine
Qualified Medical Evaluator
 
  7091 Monterey St., Suite A
Gilroy, CA 95020
Phone: (408) 842-9296
FAX: (408) 842-6878
Date 2016-11-21 Physician MAUREEN D. MINER, MD
Caller Phone Fax
Primary
Complaint
✔ Workers Compensation   Private Insurance   Medicare /2ndInsurance   Self- Pay
Patient’s
Name


Address 		HUDGINS, RENEE 


PO BOX 5586
SALINAS, CA
93915
Claim/Policy#

WCAB#

Date of Injury

Soc Sec #
14-074458 
ADJ9635669 
3/19/2014 
 
Phone
(home/cell) 		831-261-8770  Phone
(work) 		  Birth Date 08/24/1958 


Adjuster Name


INS. Address 		CAROL ARBAUGH   

Employer Name


Address

 NATIVIDAD MEDICAL CENTER 


 
INTERCARE HOLDIONGS INSURANCE
PO BOX 579
ROSEVILLE, CA 95661 
Phone 800-771-5454  Fax 916-781-5549  Phone   Fax  
Appt. TYPE ✔ QME Panel   QME Re–Eval   QME
Applicant		   AME   Med legal   Consult ONLY   Consult&Treat   EMG/NCS
Appt. DATE: 0000-00-00  Appt. TIME  
Interpreter required? ✔ No   Yes Agency/Language   

Referring Physician
Address 		 
Case Manager

Address
   
Phone   Fax   Phone   Fax  

Applicant Attorney
Address 		LAW OFFICES OF JEFFREY L TADE 


Defense Attorney
Address 		BRIAN HULL, ESQ 
1611 BUNKER HILL WAY, STE 190 
SALINAS, CA 93906
PATRICO, HERMANSON & GUZMAN, LLP 
210 CAPITOL ST, STE 7
SALINAS, CA 93901
Phone 831-753-0493  Fax 866-665-4847  Phone 831-676-3255  Fax 831-676-3268 
PROVIDE MEDICAL RECORDS 3 weeks IN ADVANCE
PLEASE DO NOT SEND ORIGIANALS OR CD’S
NO SHOW FEE: $300.00
  
ACKNOWLEDGE ABOVE WITH YOUR INITIALS_____
AND FAX BACK TO OUR OFFICE. THANK YOU