Brandon Baker

 Recv'd Date 20265715 
 Bill DCN: 2065196GJ656811 
 IDEAL MEDICAL RECORDS SERVICE, INC. 
 303 W. Katella Ave. Suite 300, Orange, CA 96567 
 Invoice 
 Phone: 714-380-6714 Fax: 865-658-3659 
 Date: 2014 October 23
 Email: billing@imrservice.com 
 To : 
 Gallagher Bassett 
 P.O. Box 610, CA, Roseville,, 95661-0610 
 965-657-2650 
 965-653-8652 
 CLAIMANT NAME: 
 Maria Barajas 
 ORDERED BY: 
 Claim#: 
 006593-006556-WC-01 
 Law Firm - Perona, Langer, Beck, 
 injury date: 
 2021 June 09
 Serbin, Mendoza, Harrison 
 UR Denial Date: 
 06/10/2021 
 Records Type 
 Date of Service/Records Pick Up 
 Fax Date 
 Date 
 Medical for 
 2017 January 03 
 07/14/2021 
 Independent 
 Medical Review 
