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 2019-01-21 Physician MAUREEN D. MINER, MD
Caller Phone Fax
Primary
Complaint
✔ Workers Compensation   Private Insurance   Medicare /2ndInsurance   Self- Pay
Patient’s
Name


Address 		RUELAS, JUANITA 


320 Hayes St. #J
Salinas, CA 93906

Claim/Policy#

WCAB#

Date of Injury

Soc Sec #
529979 
ADJ11244569 
09/30/2016 
 
Phone
(home/cell) 		831-676-6021  Phone
(work) 		  Birth Date 02/25/1963 


Adjuster Name


INS. Address 		Andrew Ellis   

Employer Name


Address

 Alisal Union School District 


1205 Ease Market Street
Salinas, CA 93905 
Keenan Associates
P.O. Box 2707
Torrance, CA 90509 
Phone 408-441-0754 ext. 6118  Fax 408-436-9306  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
  panel: 2341627 
Phone   Fax   Phone   Fax  

Applicant Attorney
Address 		Sandra L. Rocca, Esq. 


Defense Attorney
Address 		 
ROL&M 
245 West Laurel Drive
Salinas, CA 93906 		 

Phone 831-443-1051  Fax 831-443-6419  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