Michelle Johnson

00130 
 Dr Alicia Collier, M.D. 
 Board Certified Orthopaedic Surgeon 
 Qualified Medical Evaluator 
 MAILING ADDRESS 
 96028 Bowman Passage Suite 555
Brownton, MN 10732
 PANEL QUALIFIED MEDICAL EVALUATION 
 311 Brown Plain
Smithmouth, NM 11907
 RE: 
 Sharon Barnes 
 DATE OF EVALUATION: 
 2015-01-15 
 EMPLOYER: 
 Personnel Staffing Group 
 date of injury: 
 2022-10-17 
 CLAIM NO: 
 009193-064085-WC-01 
 FILE NO: 
 264085-0 
 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. 
