Nathan Hicks

 
 MAY-02-2017 12:47 From: 
 2092165909 
 To: 2163365 
 Page: 3/4 
 Date: 5/1/2017 Time 12:10 PM To: 5303,6909,50305306 @ 12302130909 
 Page: 001 
 CRUM & FORSTER 
 common 
 1100 Town and Country Road Suite 550 
 Orange, CA 92868 
 1 1 830 309 9309 
 F +1 830 302 5301 
 5/1/2017 
 RE: 
 Employee: 
 Nathan Hicks 
 Employer: SUPER STORE INDUSTRIES; MID VA 
 injury date: 24/06/19 
 Dear Patrick Guerrero, D.O., 
 The request for medical treatment for the above referenced patient was received on 4/28/2017 and a decision was 
 made on 5/1/2017. 
 Please do not staple your billing documents. 
 Sincerely, 
 NANCY TURCIOS 
 Enclosed: Proof of Service 
 003048 
 0308
