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 DA BARBARA L. KIELY, ESQ. Phone 831-372-6888 Fax 831-372-6891
Primary
Complaint
✔ Workers Compensation   Private Insurance   Medicare /2ndInsurance   Self- Pay
Patient’s
Name


Address 		ROCHA, DANIEL 


951 LUPIN DRIVE
SALINAS, CA
93906
Claim/Policy#

WCAB#

Date of Injury

Soc Sec #
0000900086 
ADJ1078498 
11/30/1989 
 
Phone
(home/cell) 		  Phone
(work) 		  Birth Date 10/25/1950 


Adjuster Name


INS. Address 		SANDRA LOPEZ   

Employer Name


Address

 CITY OF SALINAS 


200 LINCOLN AVE.
SALINAS, CA
93906 
JT2 INTEGRATED RESOURCES
P.O. BOX 8021
PLEASANTON, CA
94588 
Phone 209-624-5502  Fax 925-474-0247  Phone 831-758-7416  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 		N/A 
Case Manager

Address 		N/A
   
Phone   Fax   Phone   Fax  

Applicant Attorney
Address 		TODD McFARREN, ESQ. @ ROL&M 


Defense Attorney
Address 		BARBARA L. KIELY, ESQ 
19 E. BEACH STREET 
WATSONVILLE, CA
95076 		P.O. BOX 19 
PACIFIC GROVE, CA
93950
Phone 831-728-4200  Fax 831-728-5789  Phone 831-372-6888  Fax 831-372-6891 
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