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 2020-05-21 Physician MAUREEN D. MINER, MD
Caller Phone Fax
Primary
Complaint
✔ Workers Compensation   Private Insurance   Medicare /2ndInsurance   Self- Pay
Patient’s
Name


Address 		ARTEAGA, ALEXANDER 


120 Iris Drive
Salinas, CA 93906

Claim/Policy#

WCAB#

Date of Injury

Soc Sec #
30204292943-0001 
ADJ12936555 
01/07/2020 
645-36-9356 
Phone
(home/cell) 		  Phone
(work) 		  Birth Date 06/16/1993 


Adjuster Name


INS. Address 		Sara Vasquez   

Employer Name


Address

 Dole Food Company, Inc. 


 
Sedgwick Claims Management Services Inc.
P.O. Box 14573
Lexington, KY 40512-4573 
Phone 916-636-1566  Fax 859-264-4368  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: 7324077 
Phone   Fax   Phone   Fax  

Applicant Attorney
Address 		Ryan T. O'Connell, Esq. 


Defense Attorney
Address 		Boone T. White, Esq. 
ROL&M 
245 W. Laurel Drive
Salinas, CA 93906 		Witzig, Hannah, Sanders & Reagan, LLP 
600 Ocean Street
Santa Cruz, CA 95060
Phone 831-227-2340  Fax 831-443-6419  Phone 831-425-2835  Fax 831-425-2839 
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