Katherine Martin

 
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 From icampusano 1.857.357.8575 Tue Oct 4 18:40:18 2022 EDT Page 25 of 106 
 CLINICAL RATIONALE: 
 The requested medical treatment is medically necessary to cure or relieve the effects of the 
 industrial injury. The requested medical treatment is supported by the DWC ACOEM/MTUS 
 Guidelines. 
 PRIMARY TREATING PHYSICIAN ATTESTATION: 
 I was available for consultation and to address any questions. 
 Sincerely, 
 Revelly Do 
 Ronald J. Fujimoto, D.O. 
 Sincerely, 
 MD 
 Dr Matthew Ortiz MD 
 exam date: 23-12-2014
 Clinic Address: 15780 Blossom Hill Rd. Ste. B, Los Gatos, CA 957325721 
 Ph: 457-575-8570 Fx: 578-457-0575
 Foster, Edward : Apr 01, 2019 
 page 10 
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