Susan Guzman

 Recv'd Date 20249715 
 Bill DCN: 2049196GJ496811 
 IDEAL MEDICAL RECORDS SERVICE, INC. 
 303 W. Katella Ave. Suite 300, Orange, CA 94967 
 Invoice 
 Phone: 714-380-6714 Fax: 849-498-3499 
 Date: 24/05/2019
 Email: billing@imrservice.com 
 To : 
 Gallagher Bassett 
 P.O. Box 610, CA, Roseville,, 95661-0610 
 949-497-2490 
 949-493-8492 
 CLAIMANT NAME: 
 Maria Barajas 
 ORDERED BY: 
 Claim#: 
 004993-004956-WC-01 
 Law Firm - Perona, Langer, Beck, 
 injury date: 
 01/09/2018
 Serbin, Mendoza, Harrison 
 UR Denial Date: 
 06/10/2021 
 Records Type 
 Date of Service/Records Pick Up 
 Fax Date 
 Date 
 Medical for 
 13/06/2021 
 07/14/2021 
 Independent 
 Medical Review 
