Request #19-1691

Our Client: Dihusmania Ross Gainza
D/Incident: 06/01/2019
D/Birth: 06/02/1979
Location: nw 45 ave and 15 st
Time: 9:20 PM
Dear Sir/Madam:
This office represents Dihusmania Ross Gainza for injuries sustained on or about 06/01/2019. I understand that our
client was treated or transported by fire rescue. Please forward all FIRE RESCUE REPORTS AND ITEMIZED BILLS, in
electronic format ONLY, for our client from 06/01/2019 to the present. Please see attached Hi-Tech request and HIPAA
as required Electronic Delivery options:
 Fax #: (866) 323-5485
 Email:
 Online Portal: Please provide link and access information as needed.
 USB or CD format
Attached you will find our client's insurance information for your records. If you do not receive proper payment from the
PIP insurer, please contact us immediately as our office will handle any PIP claims arising from this accident. If you
received any payments from health insurance, please make all required contractual adjustments.
Thank you in advance for your prompt attention to this matter. Should you have any questions, please contact me.


June 11, 2019 via email







Point of Contact

Alberto Diaz

Department Assignment Public
June 12, 2019, 3:40pm
Request Opened Public
Request received via email
June 12, 2019, 3:40pm