FILED: KINGS COUNTY CLERK 12/15/ :52 AM INDEX NO /2014 NYSCEF DOC. NO. 47 RECEIVED NYSCEF: 12/15/2017

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2 (5 OUR FILE NO.: SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS X DELPHIN LAKE, Individually, and as Index No.: /2014 Administrator of the Estate of JANICE LAKE, Deceased, -against- Plaintiff DEMAND FOR AUTHORIZATIONS ABIOLA FAMILUSI, M.D. and WOODMERE REHABILITATION AND HEALTH CARE CENTER INC., X Defendants. C O U N S E L O R S: PLEASE TAKE NOTICE, that pursuant to Article 31 of the CPLR, demand is hereby made that the plaintiff provide the undersigned, within twenty (20) days, with duly executed and acknowledged written authorizations, including full names and addresses of each institute and/or treating physicians and specialty of said physicians, the dates of treatment of the plaintiff's decedent, if applicable, and other identifying information necessary to retrieve all records in the custody and control of the following: 1. ACT Ambulette, Inc.; 2. Mohammad Adeel, M.D.; 3. Mohammad Alisyed, M.D.; BRADYBNAGLER, U.P CouNsELORsAND 4 All County Transportation; ATIORNEYSATLAW oneywasw ewltehh~ 5. Americare Pharmacy Services; NewLL,Ne- LL , Vincent Augello, M.D.;

3 7. Donald Baker, M.D.; 8. Lewis Besser, M.D.; 9. Andrew Birch, M.D.; 10. Menelio Bolante, M.D.; 11. Antonio Caracts, M.D.; 12. Kelly Chin, M.D.; 13. Kenneth Cubert, M.D.; 14. CVS Albany, LLC; 15. John D'Anna, M.D.; 16. Doctors Hospital of Staten Island; 17. Duane Reade Pharrnacy; 18. Veerendra Durgam, M.D.; 19. ET Drugs, Inc.; 20. Adie Friedman, M.D.; Thomas A. Gaimo, M.D.; 22. Peggy Garjian, M.D.; 23. Richard Goodman, M.D.; 24. Richard Grodman, M.D.; 25. Susan Grossman, M.D.; 26. Sheldon Hirsch, M.D.; 27. Eugene Hyun, M.D.; 28. Hasmatul Islam, M.D.; 2

4 29. Keith Jackson, M.D.; 30. Susan Jacobitz, M.D.; 31: Christopher Jordano, M.D.; 32. V. Kahn, M.D.; 33. Paul M. Kelleher, M.D.; 34. Steven Kulick, M.D.; 35. Karen Kuo, M.D.; 36. C. Lee, M.D.; 37. Samir Lewis Maximos, M.D.; 38. Mercy Home Care 8 Medical Supply; 39. Arthur Lawrence Miller, M.D.; 40. Myles Gombert, M.D., P.C.; 41. NS-LIJ Medical Group; 42. North Shore University Hospital; 43. Ocean Breeze Infusion Care, Inc.; 44. Sunil Patel, M.D.; 45. Yogendra Patel, M.D.; 46. Pathmark Pharmacy; 47. Chitra Perera, M.D.; 48. Danielle Peterson, M.D.; 49. Charles Pfeiffer, M.D.; 50. Physicians of University Hospital; 3

5 51. Primary Care Ambulance Corp.; 52. Orlando Manfredi, M.D.; 53. Ann Marchesano, M.D.; 54. Jack A. Mensch, M.D.; 55. Quest Diagnostics; 56. S. Raguthu, M.D.; 57. Ralph Place Pharmacy; 58. James K. Rappai, M.D.; 59. R. Reddy, M.D.; / 60. Richmond County Ambulance Service; 61. Richmond University Medical Center; 62. Rite Surgical Supplies; 63. Nathan Rothman, M.D.; 64. Roy Rubenstein, M.D.; 65. Seaview Anesthesia Group; 66. Charles Schwartz, M.D.; 67. Steven Schwartzberg, M.D.; 68. Sesar Seguritan, M.D.; 69. Borys Slep, M.D.; 70. Neil Theodore Smith, M.D.; 71. Specialty RX, Inc.; 72. St. Vincent's Medical Center - Richmond; 4

6 73. George Stapleton, M.D.; 74. Staten Island Car Service; 75. Staten Island University Hospital; 76. S. Swamy, M.D.; 77. Ralph Tarantino, M.D.;. 78. M. Tobia, M.D.; 79. Satyasai Vadde, M.D.; 80. Visiting Nursing Associates; 81. George Visvikus, M.D.; 82. Vital Care Pharmaceuticals; 83. VNA of Staten Island; 84. Woodmere Dialysis, LLC; and 85. Xia Liang Zhang, M.D. PLEASE TAKE FURTHER NOTICE, that all authorizations should be. unrestricted and compliant with HIPAA Rule and should bear the complete names and addresses of each provider. PLEASE TAKE FURTHER NOTICE, that in the event you should fail to provide the items demanded above within twenty (20) days, a motion shall be made seeking the appropriate relief. PLEASE TAKE FURTHER NOTICE, that this is a continuing demand and should any of the information requested become available to you after the date of this demand, such information is to be furnished to the undersigned pursuant to said 5

7 a demand.. Dated: New York, New York August 24, 2015 Yours, etc. CALLAN, KOSTER, BRADY 8 NAGLER, LLP By: MEf(EDI. BORG, ESQ. Attorneys for ndant Def ABIOLA FAMILUSI, M.D. One Whitehall/Street, 10th New York, NeW York (212) FlOOT TO: LEVINE 8 GROSSMAN, ESQS. Attorneys for Plaintiff 114 Old Country ' J Road, Suite 460 Mineola, New York (516) CAITLIN ROBIN 8 ASSOCIATES, PLLC Attorneys for Defendant WOODMERE RAHABILITATION AND HEALTH CARE CENTER, INC. 120 Broadway New York, New York (646)

8 AFFIDAVIT OF SERVICE STATE OF NEW YORK ) COUNTY OF NEW YORK ) : SS.: CAMILLE D. PALMER, being duly sworn, deposes and says: I am not a party to the action, I am over 18 years of age and I am employed at One Whitehall Street, New York, New York On August 26, 2015, I served a true copy of the annexed DEMAND FOR AUTHORIZATIONS, by mailing same in a sealed envelope with postage prepaid in an official depository of the U.S. Postal Service within the State of New York addressed to: LEVINE & GROSSMAN, ESQS. Attorneys for Plaintiff 114 Old Country Road, Suite 460 Mineola, New York (516) CAITLIN ROBIN & ASSOCIATES, PLLC Attorneys for Defendant WOODMERE RAHABILITATION AND HEALTH CARE CENTER, INC. 120 Broadway New York, New York (646) AM S efore me this day of August, p~bbl'o'ci hb'0% Stab p~ or N g~/pe f l ~~~ NOTARY U IC ~ hf

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10 OUR FILE NO.: SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS X DELPHIN LAKE, Individually, and as Index No.: /2014 Administrator of the Estate of JANICE LAKE, Deceased, -against- Plaintiff, NOTICE TO PRODUCE ABIOLA FAMILUSI, M.D. and WOODMERE REHABILITATION AND HEALTH CARE CENTER INC., X Defendants. C O U N S E L O R S: PLEASE TAKE NOTICE, that demand is hereby made upon the plaintiff to produce for inspection and/or obtaining the following pursuant to CPLR Article 31 to deliver to the offices of CALLAN, KOSTER, BRADY 8 NAGLER, LLP, One Whitehall Street, 10th Floor, New York, New York 10004: 1. Copies of any and all receipts, bills and/or cancelled checks evidencing out-of-pocket expenses. PLEASE TAKE FURTHER NOTICE, the foregoing demands are continuing. In the event any of the above items are obtained after service of this demand they are to be furnished to this office within thirty (30) days of receipt by the plaintiff, co-defendant, BRADY & NAGLER,LLP CouNsaoRs AND or their respective attorneys. ArrORNEYs AT LAW o-wwass PLEASE TAKE FURTHER NOTICE that defendants will object to the N- Li N- LL introduction of any mentioned documents in evidence at trial if the plaintiff fails to

11 comply with this demand. PLEASE TAKE FURTHER NOTICE, that compliance can be made by forwarding a copy of these documents through the United States Postal Service within the time allowed. Dated: New York, New York August 24, 2015 Yours, etc.. CALLAN, KO ER DY 8 NAGLER, LLP By: MEREDIT B..BORG, ESQ. Attorneys for Defendant ABIOLA FAMILUSI, M.D. One Whitehall Street, 10th New York, New York (212) FlOOr TO: LEVINE 8 GROSSMAN, ESQS. Attorneys for Plaintiff 114Old Country Road, Suite 460 Mineola, New York (516) CAITLIN ROBIN 8 ASSOCIATES, PLLC Attorneys for Defendant WOODMERE RAHABILITATIONAND HEALTHCARE CENTER, INC. 120 Broadway New York, New York (646)

12 AFFIDAVIT OF SERVICE STATE OF NEW YORK ) COUNTY OF NEW YORK ) : SS.: CAMILLE D. PALMER, being duly sworn, deposes and says:. I am not a party to the action, I am over 18 years of age and 1 am employed at One Whitehall Street, New York, New York On August, 2015, I served a true copy of the annexed NOTICE TO PRODUCE, by mailing same in a sealed envelope with postage prepaid in an official depository of the U.S. Postal Service within the State of New York addressed to: LEVINE & GROSSMAN, ESQS. Attorneys for Plaintiff 114 Old Country Road, Suite 460 Mineola, New York (516) CAITLIN ROBIN 8 ASSOCIATES, PLLC Attorneys for Defendant WOODMERE RAHABILITATION AND HEALTH CARE CENTER, INC. 120 Broadway New York, New York (646) CA LLE D. PALMER S o n before me this ay of August, ~<Or'"e NOTA PUBLIC

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14 OUR FILE NO.: SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS X DELPHIN LAKE, Individually, and as Index No.: /2014 Administrator of the Estate of JANICE LAKE, Deceased, -against- Plaintiff, NOTICE TO PRODUCE MEDICARE/MEDICAID LIEN INFORMATION ABIOLA FAMILUSI, M.D. and WOODMERE REHABILITATION AND HEALTH CARE CENTER INC., X Defendants. C O U N S E L O R S: PLEASE TAKE NOTICE, that demand is hereby made upon the plaintiff to produce for inspection and/or obtaining the following pursuant to CPLR Article 31 to deliver to the offices of CALLAN, KOSTER, BRADY & NAGLER, LLP, One Whitehall Street, 10th Floor, New York, New York 10004: 1. A sworn statement as to whether plaintiff/decedent has received benefits from Medicare at any time, for any reason, not limited to the injuries and treatment alleged in the present action. If so, demand is further made that plaintiff/decedent provide the following: B C~~, Ko~R, COUNSELORSAND a. Plaintiff's/decedent's date of birth; Arromws ATuw b. Plaintiff's/decedent's Social Security Number; o-mus- N- L1s N- LL c. The Medicare file and/or identification number; address of office d. The name and the handling the Medicare file;

15 NYSCEF C DOC. NO. 47 RECEIVED NYSCEF: 12/15/2017 e. Copies of all documents in the possession of plaintiff/decedent or his/her attorneys pertaining to plaintiff's/decedent's receipt of Medicare benefits, including, but not limited to, claim forms accompanying checks sent by Medicare, lien papers, and all other papers received from Medicare or the Agency handling the Medicare claim; and f. A duly executed HIPAA compliant authorization bearing plaintiff's/decedent's date of birth and social security number and the Medicare file number permitting CALLAN, KOSTER, BRADY 8 NAGLER, LLP or its designee to obtain copies of plaintiff's/decedent's Medicare records. 2. A sworn statement as to whether plaintiff/decedent has received benefits from Medicaid at any time, for any reason, not limited to the injuries and treatment alleged in the present action. If so, demand is further made that plaintiff provide the following: a. Plaintiff's/decedent's date of birth; b. Plaintiff's/decedent's Social Security Number; c. The Medicaid file and/or identification number; d. The name and address of the office handling the Medicaid file; e. Copies of all documents in the possession of plaintiff/decedent or his/her attorneys pertaining to plaintiff's/decedent's receipt of Medicaid benefits, including, but not limited to, claim forms, forms accompanying checks sent by Medicaid, lien papers, and all other papers received from Medicaid or the Agency holding the Medicaid claim; and f. A duly executed H1PAA compliant authorization bearing

16 plaintiff's/decedent's date of birth and social security number, and the Medicaid file number, permitting CALLAN, KOSTER, BRADY 8 NAGLER, LLP, or its designee to obtain copies of plaintiff's/decedent's Medicaid records. PLEASE TAKE FURTHER NOTICE, the foregoing demands are continuing. In the event any of the above items are obtained after service of this demand they are to be furnished to this office within thirty (30) days of receipt by the plaintiff, codefendants, or their respective attorneys. PLEASE TAKE FURTHER NOTICE, that if the demanded information is now known, it must be so stated in a sworn reply. This defendant will object at the time of trial to the testimony of any witness not supplied in accordance with this demand and will take all steps permitted by the CPLR to preserve its rights as to all other demands. PLEASE TAKE FURTHER NOTICE, that compliance can be made by forwarding a copy of these documents through the United States Postal Service within the time allowed. Dated: New York, New York August 24, 2015 Yours, etc. CALLAN, KOST, B Y 8 NAGLER, LLP By: MERE4$IT BORG, ESQ... Attorneys for Def, ndant ABIOLA FAMILUSI, M.D. One Whitehall Street, 10th New York, New York (212) Floor TO: LEVINE 8 GROSSMAN, ESQS. Attorneys for Plaintiff 114 Old Country Road, Suite 460 Mineola, New York (516)

17 NYSCEF DOC. '~ NO. 47 RECEIVED NYSCEF: 12/15/2017 CAITLIN ROBIN 5 ASSOCIATES, PLLC Attorneys for Defendant WOODMERE RAHABILITATION AND HEALTH CARE CENTER, INC. 120 Broadway New York, New York (646)

18 AFFIDAVIT OF SERVICE STATE OF NEW YORK ) COUNTY OF NEW YORK ) : SS.: CAMILLE D. PALMER, being duly sworn, deposes and says: I am not a party to the action, I am over 18 years of age and I am employed at One Whitehall Street, New York, New York On August, 2015, I served a true copy of the annexed NOTICE TO PRODUCE MEDICARE/MEDICAID LIEN INFORMATION, by mailing same in a sealed envelope with postage prepaid in an official depository of the U.S. Postal Service within the State of New York addressed to: LEVINE & GROSSMAN, ESQS. Attorneys for Plaintiff 114 Old Country Road, Suite 460 Mineola, New York (516) CAITLIN ROBIN & ASSOCIATES, PLLC Attorneys for Defendant WOODMERE RAHABILITATION AND HEALTH CARE CENTER, INC. 120 Broadway New York, New York (646) CA ILL D. PALMER S r before me this day of August, NOTARY IC cay p ~ ">tap~ eq,a >>ar ee is~ ~~>0~are~g ~NIllggj<g ~9<Qs Qpg~~ 4W Sg