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 1969-12-31 Physician MAUREEN D. MINER, MD
Caller Phone Fax
Primary
Complaint
✔ Workers Compensation   Private Insurance   Medicare /2ndInsurance   Self- Pay
Patient’s
Name


Address 		Elizabeth Alvarado 


11581 Walnut St
Livingston, CA 95334

Claim/Policy#

WCAB#

Date of Injury

Soc Sec #
06395110 
ADJ12281915 
09/18/2018 
557-41-8003 
Phone
(home/cell) 		209-427-8963  Phone
(work) 		209-427-8963  Birth Date 02/01/1973 


Adjuster Name


INS. Address 		Ms. Cammy C. Lee-Jin   

Employer Name


Address

 Del Valle Farm Labor Services 


4131 North State Highway 59
Merced, CA 95348 
SCIF
PO Box 3171
Suisun City, CA 94585-6171
 
Phone 209-476-2537  Fax 707-646-8116  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:2577695
Gilroy 
Phone   Fax   Phone   Fax  

Applicant Attorney
Address 		Tola Yang, Esq 


Defense Attorney
Address 		Steven Sanghera, Esq 
Grossman Law Office: 
7161 N. Howard St, Ste. 202
Fresno, CA 93720 		SCIF INSURED FRESNO 
PO Box 65005
Fresno, CA 93650
Phone 559-221-2261  Fax 559-226-3517  Phone 559-433-2900  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