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 2020-11-15 Physician MAUREEN D. MINER, MD
Caller Phone Fax
Primary
Complaint
✔ Workers Compensation   Private Insurance   Medicare /2ndInsurance   Self- Pay
Patient’s
Name


Address 		CASTANEDA, JOSE 


8080 Swanston Lane
Gilroy, CA 95020

Claim/Policy#

WCAB#

Date of Injury

Soc Sec #
33120950 
ADJ13064703 
02/19/2020 
916-32-1457 
Phone
(home/cell) 		408-691-1636  Phone
(work) 		  Birth Date 11/18/1997 


Adjuster Name


INS. Address 		Lynette Bailey   

Employer Name


Address

 Zanker Road Resources Management 


980 State Highway 25
Gilroy, CA 95020 
Berkshire Hathaway Homestate Companies
P.O Box 881716
San Francisco, CA 94188 
Phone 800-661-6029  Fax 415-675-5469  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: 7351863 
Phone   Fax   Phone   Fax  

Applicant Attorney
Address 		Christopher C. Cramer, Esq. 


Defense Attorney
Address 		 
Robbins, Strunk & Cramer 
7459 Monterey St., Ste. A
Gilroy, CA 95020 		 

Phone 408-848-1113  Fax 408-848-8303  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