Our Client: Dihusmania Ross Gainza
Location: nw 45 ave and 15 st
Time: 9:20 PM
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
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.