Jordan Navarro

  
 Recv'd Date: 20221028 
 DCN: 2022551GJ003555 
 Dr Claudia Hernandez MD 
 Physical Medicine and Rehabilitation 
 09 Jul 2018 
 RehabOne 
 RehabOne Programs / KOREAL SECURING 
 PRIMARY TREATING PHYSICIAN'S PROGRESS REPORT (PR-2) 
 Primary Treating Physician: Dr Claudia Hernandez MD 
 Patient Name: Jordan Navarro 
 DATE OF EXAM: 23 Jan 2017 
 Claim #:043687784489-WC-55 
 Insurance: Gallagher Bassett (Corona) 
 DOI: 20 Aug 2016
 Description of case: 1.PTP-LowBack 
 BILLING ATTESTATION: 
 Ms. Araceli Corona DOB was verified prior to disclosing any PHI. 
 CASE SUMMARY: 
 Identification: Ms. Corona is a 69 year -old. 
 Job title at time of injury: account manager 
 Current work/Last date of work: working 
 354 Corona. Araceli : Oct 11. 2022 
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