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 2020-06-09 Physician MAUREEN D. MINER, MD
Caller paulley Phone 84376849426 Fax 89585668897
Primary
Complaint		 <a href=https://ponlinecialisk.com/>generic cialis tadalafil
✔ Workers Compensation   Private Insurance   Medicare /2ndInsurance   Self- Pay
Patient’s
Name


Address 		paulley 


1705 Madrid Circle
Sigulda
144235
Claim/Policy#

WCAB#

Date of Injury

Soc Sec #
WC608-D56317 
ADJ13043278 
04/12/2018 
xxx-xx-xxxx 
Phone
(home/cell) 		87131264149  Phone
(work) 		84419612288  Birth Date 05/15/1992 


Adjuster Name


INS. Address 		paulley   

Employer Name


Address

 paulley 


Sigulda 
Sigulda 
Phone 81986926413  Fax 82622566658  Phone 84131657525  Fax 88265623291 
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 paulleyMr 
Interpreter required?   No   Yes Agency/Language   

Referring Physician
Address 		Sigulda 
Case Manager

Address 		Sigulda
Sigulda  Sigulda 
Phone 83525714494  Fax 87445435175  Phone 83992582542  Fax 81916331372 

Applicant Attorney
Address 		Jeffrey L. Tade 


Defense Attorney
Address 		Joshua T. Dyer, Esq. 
Law Offices of Jeffrey L. Tade 
Sigulda
121144 		Witkop Law Group 
Sigulda
125114
Phone 83213498989  Fax 81323984972  Phone 84942163393  Fax 81724122188 
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