FL Thomas K. Jones

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Claribel Burke
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1 FL Thomas K. Jones Claimant Photo

2 40 Facility Medical Canvass Report GII-PII File #: PA Subject s Name: Thomas K Jones Client: Aliases: Tom Client Contact: Date of Birth: January 2, 1956 Claim # Age: 60 SSN: XX-XX-7888, issued in Pennsylvania Date of Loss: 02/1/2016 Current Address: 123 Thomas St, Pittsburg, PA Date Completed: Aug 30, 2016 Summary An inquiry was made in efforts to ascertain if the claimant, identified as Thomas K Jones, had received treatment or services from medical providers located near the claimant s residence location. Six (6) facilities confirmed that they had provided services to the claimant and seven (7) facilities required a faxed, signed, medical release before any information could be released. Below is the list of the facilities contacted. Recommendations There are no recommendations at this time. GII-PII Intelligence and Investigations Page 1

3 Medical Canvass Click on the red hyperlink for specific details Facility Address City, State Phone Contact Contact Walgreens Specialty Pharmacy 5956 Penn Circle South PA Ruthie Confirmed Rite Aid Pharmacy West Pennsylvania Med Express 1800 Morningside Avenue 4800 Friendship Avenue 5201 Baum Boulevard PA Pharmacist Confirmed PA Shelly Confirmed PA Andi Confirmed Concentra Urgent Care 15 Freeport Road, Suite 100 PA Lori Confirmed MRI 4800 Friendship Avenue PA Kim Confirmed Saint Clair 1000 Bower Hill Road PA Debbie UPMC Shadyside 5230 Centre Avenue PA Mariah Saint Margaret 815 Freeport Road PA Mariah Mercy Health Center 1515 Locust Street PA Mariah Allegheny Orthopedic Associates 4815 Liberty Avenue, Suite 252 PA Sherri Department of Orthopedic Surgery th Avenue, Suite 1010 PA Catina Three Rivers Orthopedic Associates 200 Delafield Road, Suite 1040 PA Carol CVS Pharmacy Medicine Shoppe Allegheny General LIfecare 6231 Penn Avenue 5020 Centre Avenue 320 E. North Avenue 225 Pennsylvania Avenue East Liberty, PA Shelby No PA Brandy No PA Sara No PA Karen No GII-PII Intelligence and Investigations Page 2

4 Ohio Valley General Forbes Regional UMPC Urgent Care 25 Heckel Road 2570 Haymaker Road 5231 Centre Avenue McKees Rocks, PA Janet No Monroeville, PA Barbara No PA Shauntel No Doctors Express Urgent Care 874 Butler Street, Suite 2 PA Beth No Steele Valley Express Care Urgent Care Center Allegheny Urgent Care 4630 Brown Hill Road 420 E. North Avenue 100 S. Jackson Avenue PA Kelly No PA Jana No PA Cathy No Radiology & Imaging Services 4401 Penn Avenue, Floor 2 PA Geneva No Premier Imaging Orthopedic Associates of Pittsburg Greater Pittsburgh Orthopedic 4801 McKnight Road, Suite Centre Avenue, Suite Brownsville Road, Suite C PA Phillip No PA Diane No PA Linda No McMahon Orthopedic & Rehab 2100 Janes Street, Suite 410 PA Sue No Allied Orthopedic Associates Renaissance Orthopedic Allegheny Physical Keystone Physical Tri State Physical Physical Now 700 River Avenue 300 Halket Street 5770 Baum Boulevard 5100 Liberty Avenue 300 Chapel Harbor Drive, Suite Alpha Drive PA Mike No PA Greg No PA Annette No PA Chris No PA Sandy No PA Michael No GII-PII Intelligence and Investigations Page 3

Fox Chapel Physical Anchor Physical Nova Care Rehabilitation Pittsburgh Physical Medicine Squirrell Hill Physical 1339 Freeport Road 539 Greenfield Avenue 6318 Forbes Avenue 5854 Baum Boulevard 1154

5 Fox Chapel Physical Anchor Physical Nova Care Rehabilitation Pittsburgh Physical Medicine Squirrell Hill Physical 1339 Freeport Road 539 Greenfield Avenue 6318 Forbes Avenue 5854 Baum Boulevard 1154 Greenfield Avenue PA Charlene No PA Debbie No PA Sharon No PA Jeff No PA Tosha No GII-PII Intelligence and Investigations Page 4

6 Canvas Specifics: Walgreens Specialty Pharmacy Walgreens Specialty Pharmacy confirmed a record for claimant. Please fax a signed release to for more information. *Please Note: This is a mail order pharmacy, no local retail location. Rite Aid Pharmacy Rite Aid Pharmacy confirmed a record for claimant. Please fax a signed release to for more information. West Pennsylvania West Pennsylvania confirmed a record for claimant. Please fax a signed release to for more information. Med Express Urgent Care Med Express Urgent Care confirmed a record for claimant. Claimant has been seen at this location for worker s comp visits and physicals. Please fax a signed release to for more information. Concentra Urgent Care Concentra Urgent Care confirmed a record for claimant. Claimant has been seen at this location for physicals. Please fax a signed release to for more information. MRI MRI confirmed a record for claimant. Please fax a signed release to for more information. Saint Clair Saint Clair could not confirm a record for claimant without a signed release. Please mail a signed release to Saint Clair, 1000 Bower Hill Road, PA for more information. UPMC Shadyside UPMC Shadyside could not confirm a record for claimant without a signed release. Please fax a signed release to for more information. * Please Note: You must send a request naming this location specifically. Saint Margaret Saint Margaret could not confirm a record for claimant without a signed release. Please fax a signed release to for more information. * Please Note: You must send a request naming this location specifically. Mercy Health Center Mercy Health Center could not confirm a record for claimant without a signed release. Please fax a signed release to for more information. * Please Note: You must send a request naming this location specifically. Allegheny Orthopedic Associates Allegheny Orthopedic Associates could not confirm a record for claimant without a signed release. Please fax a signed release to for more information. Department of Orthopedic Surgery Department of Orthopedic Surgery could not confirm a record for claimant without a signed release. Please fax a signed release to for more information. Three Rivers Orthopedic Associates Three Rivers Orthopedic Associates could not confirm a record for claimant without a signed release. Please fax a signed release to for more information. GII-PII Intelligence and Investigations Page 5

7 Disclaimer Public records and available public profiles, information, and data are subject to change, error and omissions. Information provided in the report appears as it is displayed from the source material on this particular date. Information contained within these reports cannot in all cases be considered free from error or defect, data is sometimes entered poorly, communicated incorrectly and/or processed improperly by third parties of which GII cannot monitor or control. Certified copies of specific legal documents may also be warranted for identifying official records. If you are relying on or taking any action with any provided data, it should be independently verified. Independent identification includes the identity of any person(s) identified in this report or work product. In the majority of circumstances GII is not provided an identifying photograph of the person(s) prior to our investigation. GII utilizes maximum efforts to identify the proper person(s) during the course of our investigation. This process can include situations that make confirmed identification of person(s) or subject(s) not possible. GII DISCAIMS ANY AND ALL WARRANTIES, WHETHER EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMMITED TO THE IMPLIED WARRANTY OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, OR ANY WARRANTY THAT THE SERVICE OR DATA WILL BE ACCURATE OR ERROR-FREE. IN NO EVENT SHALL THE COMPANY OR ANY OTHER PARTY INVOLVED IN PROVIDING SERVICES UNDER THIS AGREEMENT BE LIABLE TO CLIENT OR ANY THIRD PARTY FOR ANY DIRECT, INDIRECT, SPECIAL, CONSEQUENTIAL PUNITIVE OR INCIDENTAL DAMAGES ARISING OUT OF THE USE, PARTIAL USE, OR RELIANCE OF THE SERVICES OR DATA PROVIDED BY WITHIN THIS REPORT WHETHER ARISING IN CONTRACT OR IN TORT, OR RESULTING FROM THE FAULT OR NEGLIGENCE OF THE COMPANY. GII-PII Intelligence and Investigations Page 6

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