Dr. Jonathon Hammond III

 Recv'd Date 20246715 
 Bill DCN: 2046196GJ466811 
 IDEAL MEDICAL RECORDS SERVICE, INC. 
 303 W. Katella Ave. Suite 300, Orange, CA 94667 
 Invoice 
 Phone: 714-380-6714 Fax: 846-468-3469 
 Date: 2015 Dec 11
 Email: billing@imrservice.com 
 To : 
 Gallagher Bassett 
 P.O. Box 610, CA, Roseville,, 95661-0610 
 946-467-2460 
 946-463-8462 
 CLAIMANT NAME: 
 Maria Barajas 
 ORDERED BY: 
 Claim#: 
 004693-004656-WC-01 
 Law Firm - Perona, Langer, Beck, 
 injury date: 
 2018 Jun 20
 Serbin, Mendoza, Harrison 
 UR Denial Date: 
 06/10/2021 
 Records Type 
 Date of Service/Records Pick Up 
 Fax Date 
 Date 
 Medical for 
 2021 Oct 27 
 07/14/2021 
 Independent 
 Medical Review 
