James Merritt

00130 
 Dr Shannon Reyes, M.D. 
 Board Certified Orthopaedic Surgeon 
 Qualified Medical Evaluator 
 MAILING ADDRESS 
 03449 Timothy Route Apt. 368
Michaelfort, MH 01799
 PANEL QUALIFIED MEDICAL EVALUATION 
 8471 Heather Square
Grayshire, MO 88587
 RE: 
 Rebecca Perez 
 evaluation date: 
 01/19/03 
 EMPLOYER: 
 Personnel Staffing Group 
 DATE OF INJURY: 
 02/14/06 
 CLAIM NO: 
 009193-045540-WC-01 
 FILE NO: 
 245540-0 
 60 minutes were spent in a face to face evaluation with the examinee. 
 FEE DISCLOSURE 
 ML 102-93-95: This is a Basic Qualified Medical Evaluation. 
