Samantha Anderson

 Recv'd Date 20275715 
 Bill DCN: 2075196GJ756811 
 IDEAL MEDICAL RECORDS SERVICE, INC. 
 303 W. Katella Ave. Suite 300, Orange, CA 97567 
 Invoice 
 Phone: 714-380-6714 Fax: 875-758-3759 
 Date: 05-12-2018
 Email: billing@imrservice.com 
 To : 
 Gallagher Bassett 
 P.O. Box 610, CA, Roseville,, 95661-0610 
 975-757-2750 
 975-753-8752 
 CLAIMANT NAME: 
 Maria Barajas 
 ORDERED BY: 
 Claim#: 
 007593-007556-WC-01 
 Law Firm - Perona, Langer, Beck, 
 DATE OF INJURY: 
 06-12-2021
 Serbin, Mendoza, Harrison 
 UR Denial Date: 
 06/10/2021 
 Records Type 
 Date of Service/Records Pick Up 
 Fax Date 
 Date 
 Medical for 
 09-06-2019 
 07/14/2021 
 Independent 
 Medical Review 
