CLIENT NAME: Allstate | CONTRACT NUMBER: 6097 | Reporter Information | First Name:Christina | Last Name:Kinnett | Client Location Information | Location Number:UNK | Location Name:Allstate Financial | Street Address:2940 south 84th street | City:Lincoln | State:NE | Zip Code:68506 | Claimant Information | Employee ID: 00070610 | | First Name:Christina | MI:M | Last Name:Kinnett | Best Contact Method: | Best Contact Phone: 402 540 0492 | Home Address: 4133 Touzaline Ave | City:Lincoln | State:NE | Zip Code:68507 | Personal Email: cmay7@allstate.com | Claimant Schedule Information | Do you work the same schedule each week? Yes No Enter Week 1 as week of FDA | Week 1: | Mon 8.0 | Tue 8.0 | Wed 8.0 | Thur 8.0 | Fri 8.0 | Sat | Sun | Week 2: | Mon | Tue | Wed | Thur | Fri | Sat | Sun | Disability Information | Last Date Worked: 03202015 | First Date Absent:03/23/2015 | Actual/Estimated RTW: UNK | Diagnosis/Disability description:Pregnancy | Is this a work related injury or illness? Yes No | Cause of Disability: | Physician Information | Physician Name: Jeffery Tomjack | Phone Number:402 421 8581 | Fax Number:unk | Next Office Visit:9/22/14 | Hospital Information | Hospital Name:unk | Phone Number:unk | Date Admitted:unk | Date Discharged:unk | Pregnancy Information | Due Date:03/21/2015 | Complicated/High Risk: | Yes | No | Unknown | NA | Notes / Comments: Manual Intake form used. Temporary incident number provided to caller: 091914828600509RB |
Once all applicable incident information has been obtained from the caller utilizing the above script, complete the following steps: 1) Provide the Caller with a Temporary Incident Number utilizing the