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 2011-06-03 Physician MAUREEN D. MINER, MD
Caller Phone Fax
Primary
Complaint
✔ Workers Compensation   Private Insurance   Medicare /2ndInsurance   Self- Pay
Patient’s
Name


Address 		DURAN, SARA 


117 JEFFERSON ST
WATSONVILLE, CA 95076

Claim/Policy#

WCAB#

Date of Injury

Soc Sec #
01104765 
 
07/01/2002 
554-27-8612 
Phone
(home/cell) 		831-345-7869/ CONNIE-831-345-0139  Phone
(work) 		831-728-4616  Birth Date 10/28/1951 


Adjuster Name


INS. Address 		TONY RAMIREZ   

Employer Name


Address

 WATSONVILLE COAST PRODUCE, CO. 


 
SCIF
PO BOX 530957
SAN JOSE, CA 95153-5357 
Phone 888-782-8338  Fax 707-646-0123  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 		ROBERT CARSON, MD (AME) 
Case Manager

Address
2500 HOSPITAL DRIVE, BLDG 1
MOUNTAIN VIEW, CA 94040-4115 		  
Phone 650-969-7808  Fax   Phone   Fax  

Applicant Attorney
Address 		VIC REDULLA 


Defense Attorney
Address 		 
 
1187 NORTH MAIL ST., STE. 115
SALINAS, CA 93906 		 

Phone 831-753-9127  Fax   Phone   Fax  
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