STATUS REPORT - Download as DOC

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					                                                STATUS REPORT


December 31, 2007

TO:      Marian Cartee, Claims Adjuster
         Montana State Fund
         P.O. Box 4759
         Helena, Montana 59604-4759

RE:      Injured Worker:      FAVERO, Michael
         Claim Number:        041000123437
         Date of Claim:       January 4, 2007

Current Medical Status:
       1. Attending physician:
       2. Surgery:
       3. Days post operative status:
       4.

Current Work Status:
      1.    Time of injury employer: Alternative Staffing/LC Staffing.
      2.    Time of injury job: Painter.
      3.    Time of injury wage:
      4.    Time of injury job analysis:
MMI and Impairment Rating:

Other:

Appointments:
  From:
      Mary Jane Barrett, MS, RN
      Certified Case Mgr. / Certified Legal Nurse Consultant / Certified Medical Investigator III
      Forensic Nursing, Inc.
      13 O’Brien Avenue
      Whitefish, MT 59937
      Telephone: 406.257.8658       Fax: 406.257.8553 E-mail: mjb@mjnurse.com
      MJB/alf




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