Jessica Bennett

 
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 From icampusano 1.844.385.8095 Tue Oct 4 18:40:18 2022 EDT Page 27 of 106 
 Industrial Injury Info: 
 date of birth: 
 Apr 13, 1990 
 Adjuster: 
 Leticia Bailon 
 Claim # 
 PZC55955255 
 Phone # 
 755-255-1553 X 1551 
 injury date: 
 Dec 25, 2023 
 Fax # 
 855-552-6551 
 Insurance: Crum and Forester 
 Patient Info: 
 Address: 
 700 Flower St., Turlock, CA 95380 
 Phone (C): 
 Pref. Lang.: 
 Un 
 Phone (H): 255-551-3550 
 Diagnosis: 
 M24.255 
 Disorder of ligament, left ankle 
 M55.2 
 Plantar fascial fibromatosis 
 Case Type: 
 Work Compensation 
 Foster, Edward : Apr 01, 2019 
 page 12 
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