Fax Server 2/23/2026 9:58:11 AM PST PAGE 3/005 Fax Server
TO:Dr. Ademiluyi COMPANY:

Regarding: 42647461 MARK HOLAND Page 2

Thank you for your earliest attention to this matter. If you have questions, you may call
my direct line, 250.354.5765, or the toll free line 1.888.967.5377, local 5765.

Sincerely,
Ms Madison Davidson

Office Assistant Ill AO
Case Management Services

Enclosure(s):10D17 Request for Severed Physician/Psychiatrist Records
Worker's Signed Release Form 69W1 Worker Auth Release Personal
Info

PLEASE INCLUDE CLAIM OR ACCOUNT NUMBER IN ALL CORRESPONDENCE

Workers’ Compensation Board of British Columbla
o EP R080 - MO ~ 4