Robert Caldwell

 
 From dcatalyst16 
 18443858095 
 8/29/2022 10:58:59 PDT 
 Page 13 of 17 
 Dr Michael Johnson MD 
 Today's Date: 2015 December 12
 RehabOne Medical Group, Inc. 
 All Clinics' US Mail Address: 13980 Blossom Hill Road, STE B Los Gatos, CA 97532 
 Industrial Injury Info: 
 BIRTH DATE: 
 2000 December 22 
 Adjuster: Jennifer Restori 
 Claim # 
 00548963781-WC-01 
 Phone # 916-757-7536 
 date of injury: 
 2017 April 19 
 Fax # 
 866-750-0758 
 Insurance: Gallagher Bassett (Corona) 
 Patient Info: 
 Address: 
 67552 Jennifer Cove
West Joshua, MS 66600
 Phone (C): 831-750-3759 
 Pref. Lang.: 
 English 
 Diagnosis: 
 M75.17 
 Intervertebral disc disorders with radiculopathy, lumbosacral region 
 Case Type: 
 Work Compensation 
 176 Robert Caldwell : Aug 25, 2022 
 page 12 
