Kendra Dennis

00130 
 Dr Patricia Wagner, M.D. 
 Board Certified Orthopaedic Surgeon 
 Qualified Medical Evaluator 
 MAILING ADDRESS 
 8514 Baird Curve Apt. 810
Ericaburgh, PW 79631
 PANEL QUALIFIED MEDICAL EVALUATION 
 Unit 2129 Box 7299
DPO AP 08338
 RE: 
 Thomas Taylor 
 date of evaluation: 
 2014 September 02 
 EMPLOYER: 
 Personnel Staffing Group 
 Date of Injury: 
 2015 February 11 
 CLAIM NO: 
 009193-051541-WC-01 
 FILE NO: 
 251541-0 
 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. 
