Preview
Filing# 144263555 E-Filed 02/21/2022 09:12:29 AM
ORDER #: FL0171978
TOTAL PAGES: 4
IN THE CIRCUIT COURT OF THE
SEVENTEENTH JUDICIAL CIRCUIT
IN AND FOR BROWARD COUNTY,
FLORIDA
NADIA SOOKLAL
CASE NO. CACE-21-007718
Plaintiff(s),
VS.
LM GENERAL INSURANCE COMPANY
Defendant(s),
DEFENDANT(S) NOTICE OF PRODUCTION OF DOCUMENTS
FROM NON-PARTY
YOU ARE HEREBY NOTIFIED that after ten (10) days from the date of service of this
Notice, service is by email, and if no objectionis received from any party, the undersigned will
issue or apply to the Clerk of this court for the issuance of the attached Subpoena(s) directed to
the following:
Medical Records Custodian for
THE EYE CENTER
1732 NORTH UNIVERSITY DRIVE
PEMBROKE PINES, FL 33024
Medical Records Custodian for
CLEVELAND CLINIC FLORIDA, WESTON
3100 WESTON ROAD
WESTON, FL 33331
Medical Records Custodian for
STUMPFF CHIROPRACTIC
7860PETERS RD. SUITE F-111
PLANTATION, FL 33324
Medical Records Custodian for
STAND UP MRI OF BOCA RATON, P.A.
KIMBERLY BOULEVARD, SUITE 14
9080
BOCA RATON, FL 33434
Page 1 of 4
*** FILED: BROWARD COUNTY, FL BRENDA D. FORMAN, CLERK 02/21/2022 09:12:29 AM.****
CLAIM NO.: 043927022-0007
ORDER #: FL0171978
TOTAL PAGES: 4
Medical Records Custodian for
INTERVENTIONAL PAIN PHYSICIANS OF SOUTH FLORIDA
7447 NORTH UNIVERSITY DRIVE
TAMARAC, FL 33321
Medical Records Custodian for
ORTHOPAEDIC CENTER OF SOUTH FLORIDA
600 SOUTH PINE ISLAND ROAD, SUITE 300
PLANTATION, FL 33324
Medical Records Custodian for
ALEYDA M. BORGE, MD
9710 STIRLING RD
HOLLYWOOD, FL 33024
Medical Records Custodian for
ANGELICA RODRIGUEZ, DO
1825 NORTH CORPORATE LAKES BOULEVARD
WESTON, FL 33326
Medical Records Custodian for
PRIYANKA GROVER, MD
8397 WEST OAKLAND PARK BOULEVARD
SUNRISE, FL 33351
Medical Records Custodian for
SRINIVAS TUMMALA, MD
1400 NORTHWEST 12TH AVENUE
MIAMI, FL 33136
Medical Records Custodian for
IHOR PIDHORECKY, MD
2301 NORTH UNIVERSITY DRIVE, SUITE 204
PEMBROKE PINES, FL 33024
Medical Records Custodian for
RYAN GREENE, M.D.
2731EXECUTIVE PARK DRIVE, SUITE 1
WESTON, FL 33331
Medical Records Custodian for
SHERMAN SILBER, MD
224 SOUTH WOODS MILL ROAD, SUITE 730
CHESTERFIELD, MO 63017
Page 2 of 4
CLAIM NO.: 043927022-0007
ORDER #: FL0171978
TOTAL PAGES: 4
BillingRecords Custodian for
CCF ITEMIZATION
P.O.BOX 932294
CLEVELAND, OH 44193
Radiology Records Custodian for
CLEVELAND CLINIC FLORIDA, ATTN: RADIOLOGY
3100 WESTON ROAD
WESTON, FL 33331
The above listed are not a party to this lawsuit and are requestedto produce the items listed at
the time and place specifiedin the attached Subpoena(s).
If you wish to receive copies o f these documents, please advise the undersigned,in writing,
and same will be provided, at a cost for photocopies,upon receipt.
COPY CHARGES EXCEED $500.00 FOR THIS PATIENT, PLEASE CONTACT
IF
COMPEX LEGAL SERVICES, INC. AT 888-531-2919 WITH A LIST OF THE CHARGES
INVOLVED IN OBTAINING THESE RECORDS BEFORE CREATING COPIES.
PLEASE BE GOVERNED ACCORDINGLY.
I HEREBY CERTIFY that on the -21-stlay
of February ,
20 -22[ true and correct copy
of the foregoing Defendant(s) Notice of Production of Documents from Non Party has been
furnished by email to:
STEVEN S. FARBMAN, ESQ.
LAW OFFICES OF STEVEN S. FARBMAN, PA
7805 SOUTHWEST 6TH COURT
PLANTATION, FL 33324
Page 3 of 4
CLAIM NO.: 043927022-0007
ORDER #: FL0171978
TOTAL PAGES: 4
LAW OFFICE OF ROBERT P. KELLY
PO BOX 7217
LONDON, KY 40742
Telephone: 813-286-0068
Fax: 603-334-7774
Aeysndram.De7,na.co
By:
ALEXANDRA M. DE MAIO, ESQ.
FL BAR NO.: 0048429
PRINCIPLE EMAIL FOR SERVICE OF PLEADINGS:
PLGMAIL@LIBERTYMUTUAL.COM
ALEXANDRA.DEMAIO@LIBERTYMUTUAL.COM
Page 4 of 4
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-001
TOTAL PAGES: 3
IN THE CIRCUIT COURT OF THE
SEVENTEENTH JUDICIAL CIRCUIT
IN AND FOR BROWARD COUNTY,
FLORIDA
NADIA SOOKLAL
CASE NO. CACE-21-007718
Plaintiff(s),
VS.
LM GENERAL INSURANCE COMPANY
Defendant(s),
'
SUBPOENA DUCES TECUM FOR PRODUCTION OF DOCUMENTS
THE STATE OF FLORIDA:
TO: RECORDS CUSTODIAN FOR
THE EYE CENTER MAIN: 954-432-7711
1732 NORTH UNIVERSITY DRIVE
PEMBROKE PINES, FL 33024
YOU ARE COMMANDED to produce without depositionand deliver by mail or fax do Compex
Legal Services, Inc. located at,5481 W. Waters Ave. Suite 108, Tampa, Florida, 33634, Fax:
888-531-2922, after ten (10) days from the date of service of this subpoena, and to have with
you at that time and place the following:
INCLUDE RECORDS OF TREATMENT RENDERED BY: STEPHANIE DAVIS, OD
ALL DOCUMENTS AND RECORDS STORED IN ANY FORMAT OR 1METHOD
INCLUDING, BUT NOT LIMITED TO, ALL 1MEDICAL RECORDS, INTAKE FORMS,
PATIENT COMPLETED FORMS AND/OR DOCUMENTS, CORRESPONDENCE, ALL
OFFICE RECORDS, EMERGENCY ROOM RECORDS OR REPORTS, INPATIENT AND
OUTPATIENT CHARTS AND RECORDS, LIEN FILES, SOAP NOTES, PATHOLOGY
RECORDS AND REPORTS, LAB REPORTS, PHARMACY AND PRESCRIPTION
RECORDS, PHYSICAL THERAPY RECORDS, SIGN-IN SHEETS, ALL DESCRIPTIONS
OF EXERCISES PRESCRIBED, DOCUMENTATION WHICH INDICATE DATE AND
TIME OF PATIENT'S APPOINTMENTS, INSURANCE DOCUMENTS, ALL
RADIOLOGY REPORTS AND READINGS, AND ANY OTHER DOCUMENTS
MAINTAINED PERTAINING TO THE CARE, TREATMENT AND EXAMINATION OF
THE PATIENT; AND
Page 1 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-001
TOTAL PAGES: 3
ALL ITEMIZED STATEMENTS OF THE BILLING CHARGES AND/OR
CONSOLIDATED STATEMENT OF BENEFITS, WITH DIAGNOSTIC AND
PROCEDURE CODES INCLUDING ALL CPT AND ICD-9/ICD-10 CODING AND ALL
HCFA, UB04 AND UB92 BILLS, TO INCLUDE THE TOTAL CHARGES PRIVATE OR
GOVERNMENTAL; ANY AMOUNTS WRITTEN OFF BY THE PROVIDER, AND ANY
AMOUNTS THAT ARE THE PATIENT'S RESPONSIBILITY AND EXPLANATION OF
BENEFITS, PAYMENT HISTORY, RECORDS OF ANY LIENS, ANY INSURANCE
BILLING OR PAYMENTS INFORMATION, EMERGENCY ROOM PIIYSICIANS BILLS
AND RADIOLOGY BILLING FROM ALL SOURCES, TO INCLUDE ANY COMPUTER
GENERATED BILLING OR BILLING STORED IN ANY FORMAT AND PAYMENT
SOFTWARE THAT CONTAINS SAID INFORMATION; AND
COPIES OF ALL ORIGINAL X-RAYS FILMS, CT SCANS, MRIS AND ANY OTHER
SCANS ORIMAGES TAKEN AND/OR MAINTAINED, INCLUDING A
COMPREHENSIVE LIST OF ALL DATES AND BODY PARTS OF ALL FILMS, CT
SCANS, MRIS AND ALL OTHER IMAGES OR SCANS PROVIDED. ALL IMAGES AND
FILMS MUST BE PROVIDED ON CD IF AVAILABLE. NADIA SOOKLAL ; DOB:
SSN:
IFCOPY CHARGES EXCEED $500.00 FOR THIS PATIENT, PLEASE CONTACT
COMPEX LEGAL SERVICES, INC. AT 888-531-2919 WITH A LIST OF THE
CHARGES INVOLVED IN OBTAINING THESE RECORDS BEFORE CREATING
COPIES.
These items will be inspectedand may be copied at that time. You will not be requiredto
surrender the originalitems. You mav comply with this subpoena bv providing legible
copies of the items to be produced to COMPEX LEGAL SERVICES, INC., the agent of
the attornev whose name appears on this subpoena, on or before the scheduled date of
production. "The records requested will be used for this litigation onlv and will be
returned or destroved after litigation is complete.'" Please contact Compex Legal Services,
Inc. directlyand send all Medical Records, Bills,Films, and all other items necessary for
compliance to:
COMPEX LEGAL SERVICES, INC.
5481 W. WATERS AVE. SUITE 108, TAMPA, FLORIDA, 33634
Tel: 888-531-2919, Fax: 888-531-2922
You may condition the preparationof the copies upon the payment in advance of the reasonable
cost ofpreparation.You have the rightto objectto the production pursuant to this subpoena at
any time before productionby givingwritten notice to the attorney whose name appears on this
subpoena.
THIS WILL NOT BE A DEPOSITION, NO TESTIMONY WILL BE TAKEN.
If you fail to: (1) appear as specified;or (2) furnish the records instead of appearing as provided
above; or (3) object to this subpoena, you may be in contempt of court. You are subpoenaed by
the attorney whose name appears on this subpoena and unless excused from this subpoena by the
attorney or the Court, you shall respond to this subpoena as directed.
Page 2 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-001
TOTAL PAGES: 3
CERTIFICATE OF NOTICE
Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45
CFR Parts 160 and 164, I hereby certify that I have complied with the regulations and
requirements to obtain patient health information and that the representations below are true
and correct:
1. I have made
a good faith attempt to provide written notice to the above-named patient,
through counsel, of intent to obtain the patient's health information pursuant to this
subpoena;
2. The written or proceeding in which
notice provided sufficient information about this litigation
the protected health information is requested to permit the patient to raise an objection to
the court or administrative tribunal; and
3. The time of the patient to raise objections to the court or administrative tribunal has elapsed
and (check one)
No objections were filed;or
All objections filed by the patient were resolved by the court or administrative
tribunal and the disclosures being sought are consistent with such resolutions.
Objection was filed but per agreement of counsel, objection has been resolved.
ALEXANDRA M. DE MAIO, ESQ. Dated:
Attorney for Defendant(s)
LM General Insurance Company
FL Bar No. 0048429
LAW OFFICE OF ROBERT P. KELLY
P.O. BOX 7217 By:
LONDON, KY 40742 For the Court
Telephone: 813-868-8121
Page 3 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-002
TOTAL PAGES: 3
IN THE CIRCUIT COURT OF THE
SEVENTEENTH JUDICIAL CIRCUIT
IN AND FOR BROWARD COUNTY,
FLORIDA
NADIA SOOKLAL
CASE NO. CACE-21-007718
Plaintiff(s),
VS.
LM GENERAL INSURANCE COMPANY
Defendant(s),
'
SUBPOENA DUCES TECUM FOR PRODUCTION OF DOCUMENTS
THE STATE OF FLORIDA:
TO: RECORDS CUSTODIAN FOR
CLEVELAND CLINIC FLORIDA, WESTON MAIN: 954-689-5000, B: 866-621-6385, F:
954-689-5110
3100 WESTON ROAD
WESTON, FL 33331
YOU ARE COMMANDED to produce without depositionand deliver by mail or fax do Compex
Legal Services, Inc. located at, 5481 W. Waters Ave. Suite 108, Tampa, Florida, 33634, Fax:
888-531-2922, after ten (10) days from the date of service of this subpoena, and to have with
you at that time and place the following:
ALL DOCUMENTS AND RECORDS STORED IN ANY FORMAT OR 1METHOD
INCLUDING, BUT NOT LIMITED TO, ALL 1MEDICAL RECORDS, INTAKE FORMS,
PATIENT COMPLETED FORMS AND/OR DOCUMENTS, CORRESPONDENCE, ALL
OFFICE RECORDS, EMERGENCY ROOM RECORDS OR REPORTS, INPATIENT AND
OUTPATIENT CHARTS AND RECORDS, LIEN FILES, SOAP NOTES, PATHOLOGY
RECORDS AND REPORTS, LAB REPORTS, PHARMACY AND PRESCRIPTION
RECORDS, PHYSICAL THERAPY RECORDS, SIGN-IN SHEETS, ALL DESCRIPTIONS
OF EXERCISES PRESCRIBED, DOCUMENTATION WHICH INDICATE DATE AND
TIME OF PATIENT'S APPOINTMENTS, INSURANCE DOCUMENTS, ALL
RADIOLOGY REPORTS AND READINGS, AND ANY OTHER DOCUMENTS
1MAINTAINED PERTAINING TO THE CARE, TREATMENT AND EXAMINATION
OF THE PATIENT. NADIA SOOKLAL ; DOB: SSN:
Page 1 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-002
TOTAL PAGES: 3
IFCOPY CHARGES EXCEED $500.00 FOR THIS PATIENT, PLEASE CONTACT
COMPEX LEGAL SERVICES, INC. AT 888-531-2919 WITH A LIST OF THE
CHARGES INVOLVED IN OBTAINING THESE RECORDS BEFORE CREATING
COPIES.
These items will be inspectedand may be copied at that time. You will not be requiredto
surrender the originalitems. You mav comply with this subpoena bv providing legible
copies of the items to be produced to COMPEX LEGAL SERVICES, INC., the agent of
the attornev whose name appears on this subpoena, on or before the scheduled date of
production. "The records requested will be used for this litigation onlv and will be
returned or destroved after litigation is complete.'" Please contact Compex Legal Services,
Inc. directlyand send all Medical Records, Bills,Films, and all other items necessary for
compliance to:
COMPEX LEGAL SERVICES, INC.
5481 W. WATERS AVE. SUITE 108, TAMPA, FLORIDA, 33634
Tel: 888-531-2919, Fax: 888-531-2922
You may condition the preparationof the copiesupon the payment in advance of the reasonable
cost ofpreparation.You have the rightto objectto the production pursuant to this subpoena at
any time before production by giving written notice to the attorney whose name appears on this
subpoena.
THIS WILL NOT BE A DEPOSITION, NO TESTIMONY WILL BE TAKEN.
or (2) furnish the records instead of appearing as provided
If you fail to: (1) appear as specified;
above; or (3) objectto this subpoena, you may be in contempt of court. You are subpoenaed by
the attorney whose name appears on this subpoena and unless excused from this subpoena by the
attorney or the Court, you shall respond to this subpoena as directed.
Page 2 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-002
TOTAL PAGES: 3
CERTIFICATE OF NOTICE
Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45
CFR Parts 160 and 164, I hereby certify that I have complied with the regulations and
requirements to obtain patient health information and that the representations below are true
and correct:
1. I have made
a good faith attempt to provide written notice to the above-named patient,
through counsel, of intent to obtain the patient's health information pursuant to this
subpoena;
2. The written or proceeding in which
notice provided sufficient information about this litigation
the protected health information is requested to permit the patient to raise an objection to
the court or administrative tribunal; and
3. The time of the patient to raise objections to the court or administrative tribunal has elapsed
and (check one)
No objections were filed;or
All objections filed by the patient were resolved by the court or administrative
tribunal and the disclosures being sought are consistent with such resolutions.
Objection was filed but per agreement of counsel, objection has been resolved.
ALEXANDRA M. DE MAIO, ESQ. Dated:
Attorney for Defendant(s)
LM General Insurance Company
FL Bar No. 0048429
LAW OFFICE OF ROBERT P. KELLY
P.O. BOX 7217 By:
LONDON, KY 40742 For the Court
Telephone: 813-868-8121
Page 3 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-003
TOTAL PAGES: 3
IN THE CIRCUIT COURT OF THE
SEVENTEENTH JUDICIAL CIRCUIT
IN AND FOR BROWARD COUNTY,
FLORIDA
NADIA SOOKLAL
CASE NO. CACE-21-007718
Plaintiff(s),
VS.
LM GENERAL INSURANCE COMPANY
Defendant(s),
'
SUBPOENA DUCES TECUM FOR PRODUCTION OF DOCUMENTS
THE STATE OF FLORIDA:
TO: RECORDS CUSTODIAN FOR
STUMPFF CHIROPRACTIC 954-368-4054
7860 PETERS RD. SUITE F-111
PLANTATION, FL 33324
YOU ARE COMMANDED to produce without depositionand deliver by mail or fax do Compex
Legal Services, Inc. located at,5481 W. Waters Ave. Suite 108, Tampa, Florida, 33634, Fax:
888-531-2922, after ten (10) days from the date of service of this subpoena, and to have with
you at that time and place the following:
INCLUDE RECORDS OF TREATMENT RENDERED BY: ERIC STUMPFF, DC
ALL DOCUMENTS AND RECORDS STORED IN ANY FORMAT OR 1METHOD
INCLUDING, BUT NOT LIMITED TO, ALL 1MEDICAL RECORDS, INTAKE FORMS,
PATIENT COMPLETED FORMS AND/OR DOCUMENTS, CORRESPONDENCE, ALL
OFFICE RECORDS, EMERGENCY ROOM RECORDS OR REPORTS, INPATIENT AND
OUTPATIENT CHARTS AND RECORDS, LIEN FILES, SOAP NOTES, PATHOLOGY
RECORDS AND REPORTS, LAB REPORTS, PHARMACY AND PRESCRIPTION
RECORDS, PHYSICAL THERAPY RECORDS, SIGN-IN SHEETS, ALL DESCRIPTIONS
OF EXERCISES PRESCRIBED, DOCUMENTATION WHICH INDICATE DATE AND
TIME OF PATIENT'S APPOINTMENTS, INSURANCE DOCUMENTS, ALL
RADIOLOGY REPORTS AND READINGS, AND ANY OTHER DOCUMENTS
MAINTAINED PERTAINING TO THE CARE, TREATMENT AND EXAMINATION OF
THE PATIENT; AND
Page 1 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-003
TOTAL PAGES: 3
ALL ITEMIZED STATEMENTS OF THE BILLING CHARGES AND/OR
CONSOLIDATED STATEMENT OF BENEFITS, WITH DIAGNOSTIC AND
PROCEDURE CODES INCLUDING ALL CPT AND ICD-9/ICD-10 CODING AND ALL
HCFA, UB04 AND UB92 BILLS, TO INCLUDE THE TOTAL CHARGES PRIVATE OR
GOVERNMENTAL; ANY AMOUNTS WRITTEN OFF BY THE PROVIDER, AND ANY
AMOUNTS THAT ARE THE PATIENT'S RESPONSIBILITY AND EXPLANATION OF
BENEFITS, PAYMENT HISTORY, RECORDS OF ANY LIENS, ANY INSURANCE
BILLING OR PAYMENTS INFORMATION, EMERGENCY ROOM PIIYSICIANS BILLS
AND RADIOLOGY BILLING FROM ALL SOURCES, TO INCLUDE ANY COMPUTER
GENERATED BILLING OR BILLING STORED IN ANY FORMAT AND PAYMENT
SOFTWARE THAT CONTAINS SAID INFORMATION; AND
COPIES OF ALL ORIGINAL X-RAYS FILMS, CT SCANS, MRIS AND ANY OTHER
SCANS ORIMAGES TAKEN AND/OR MAINTAINED, INCLUDING A
COMPREHENSIVE LIST OF ALL DATES AND BODY PARTS OF ALL FILMS, CT
SCANS, MRIS AND ALL OTHER IMAGES OR SCANS PROVIDED. ALL IMAGES AND
FILMS MUST BE PROVIDED ON CD IF AVAILABLE. NADIA SOOKLAL ; DOB:
SSN:
IFCOPY CHARGES EXCEED $500.00 FOR THIS PATIENT, PLEASE CONTACT
COMPEX LEGAL SERVICES, INC. AT 888-531-2919 WITH A LIST OF THE
CHARGES INVOLVED IN OBTAINING THESE RECORDS BEFORE CREATING
COPIES.
These items will be inspectedand may be copied at that time. You will not be requiredto
surrender the originalitems. You mav comply with this subpoena bv providing legible
copies of the items to be produced to COMPEX LEGAL SERVICES, INC., the agent of
the attornev whose name appears on this subpoena, on or before the scheduled date of
production. "The records requested will be used for this litigation onlv and will be
returned or destroved after litigation is complete.'" Please contact Compex Legal Services,
Inc. directlyand send all Medical Records, Bills,Films, and all other items necessary for
compliance to:
COMPEX LEGAL SERVICES, INC.
5481 W. WATERS AVE. SUITE 108, TAMPA, FLORIDA, 33634
Tel: 888-531-2919, Fax: 888-531-2922
You may condition the preparationof the copies upon the payment in advance of the reasonable
cost ofpreparation.You have the rightto objectto the production pursuant to this subpoena at
any time before productionby givingwritten notice to the attorney whose name appears on this
subpoena.
THIS WILL NOT BE A DEPOSITION, NO TESTIMONY WILL BE TAKEN.
If you fail to: (1) appear as specified;or (2) furnish the records instead of appearing as provided
above; or (3) object to this subpoena, you may be in contempt of court. You are subpoenaed by
the attorney whose name appears on this subpoena and unless excused from this subpoena by the
attorney or the Court, you shall respond to this subpoena as directed.
Page 2 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-003
TOTAL PAGES: 3
CERTIFICATE OF NOTICE
Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45
CFR Parts 160 and 164, I hereby certify that I have complied with the regulations and
requirements to obtain patient health information and that the representations below are true
and correct:
1. I have made
a good faith attempt to provide written notice to the above-named patient,
through counsel, of intent to obtain the patient's health information pursuant to this
subpoena;
2. The written or proceeding in which
notice provided sufficient information about this litigation
the protected health information is requested to permit the patient to raise an objection to
the court or administrative tribunal; and
3. The time of the patient to raise objections to the court or administrative tribunal has elapsed
and (check one)
No objections were filed;or
All objections filed by the patient were resolved by the court or administrative
tribunal and the disclosures being sought are consistent with such resolutions.
Objection was filed but per agreement of counsel, objection has been resolved.
ALEXANDRA M. DE MAIO, ESQ. Dated:
Attorney for Defendant(s)
LM General Insurance Company
FL Bar No. 0048429
LAW OFFICE OF ROBERT P. KELLY
P.O. BOX 7217 By:
LONDON, KY 40742 For the Court
Telephone: 813-868-8121
Page 3 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-004
TOTAL PAGES: 3
IN THE CIRCUIT COURT OF THE
SEVENTEENTH JUDICIAL CIRCUIT
IN AND FOR BROWARD COUNTY,
FLORIDA
NADIA SOOKLAL
CASE NO. CACE-21-007718
Plaintiff(s),
VS.
LM GENERAL INSURANCE COMPANY
Defendant(s),
'
SUBPOENA DUCES TECUM FOR PRODUCTION OF DOCUMENTS
THE STATE OF FLORIDA:
TO: RECORDS CUSTODIAN FOR
STAND UP MRI OF BOCA RATON, P.A. MAIN: 561-470-1890
9080 KIMBERLY BOULEVARD, SUITE 14
BOCA RATON, FL 33434
YOU ARE COMMANDED to produce without depositionand deliver by mail or fax do Compex
Legal Services, Inc. located at,5481 W. Waters Ave. Suite 108, Tampa, Florida, 33634, Fax:
888-531-2922, after ten (10) days from the date of service of this subpoena, and to have with
you at that time and place the following:
ALL DOCUMENTS AND RECORDS STORED IN ANY FORMAT OR 1METHOD
INCLUDING, BUT NOT LIMITED TO, ALL 1MEDICAL RECORDS, INTAKE FORMS,
PATIENT COMPLETED FORMS AND/OR DOCUMENTS, CORRESPONDENCE, ALL
OFFICE RECORDS, EMERGENCY ROOM RECORDS OR REPORTS, INPATIENT AND
OUTPATIENT CHARTS AND RECORDS, LIEN FILES, SOAP NOTES, PATHOLOGY
RECORDS AND REPORTS, LAB REPORTS, PHARMACY AND PRESCRIPTION
RECORDS, PHYSICAL THERAPY RECORDS, SIGN-IN SHEETS, ALL DESCRIPTIONS
OF EXERCISES PRESCRIBED, DOCUMENTATION WHICH INDICATE DATE AND
TIME OF PATIENT'S APPOINTMENTS, INSURANCE DOCUMENTS, ALL
RADIOLOGY REPORTS AND READINGS, AND ANY OTHER DOCUMENTS
MAINTAINED PERTAINING TO THE CARE, TREATMENT AND EXAMINATION OF
THE PATIENT; AND
ALL ITEMIZED STATEMENTS OF THE BILLING CHARGES AND/OR
CONSOLIDATED STATEMENT OF BENEFITS, WITH DIAGNOSTIC AND
Page 1 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-004
TOTAL PAGES: 3
PROCEDURE CODES INCLUDING ALL CPT AND ICI)-9/ICD-10 CODING AND ALL
HCFA, UB04 AND UB92 BILLS, TO INCLUDE THE TOTAL CHARGES PRIVATE OR
GOVERNMENTAL; ANY AMOUNTS WRITTEN OFF BY THE PROVIDER, AND ANY
AMOUNTS THAT ARE THE PATIENT'S RESPONSIBILITY AND EXPLANATION OF
BENEFITS, PAYMENT HISTORY, RECORDS OF ANY LIENS, ANY INSURANCE
BILLING OR PAYMENTS INFORMATION, EMERGENCY ROOM PIIYSICIANS BILLS
AND RADIOLOGY BILLING FROM ALL SOURCES, TO INCLUDE ANY COMPUTER
GENERATED BILLING OR BILLING STORED IN ANY FORMAT AND PAYMENT
SOFTWARE THAT CONTAINS SAID INFORMATION; AND
COPIES OF ALL ORIGINAL X-RAYS FILMS, CT SCANS, MRIS AND ANY OTHER
SCANS ORIMAGES TAKEN AND/OR MAINTAINED, INCLUDING A
COMPREHENSIVE LIST OF ALL DATES AND BODY PARTS OF ALL FILMS, CT
SCANS, MRIS AND ALL OTHER IMAGES OR SCANS PROVIDED. ALL IMAGES AND
FILMS MUST BE PROVIDED ON CD IF AVAILABLE. NADIA SOOKLAL ; DOB:
SSN:
IFCOPY CHARGES EXCEED $500.00 FOR THIS PATIENT, PLEASE CONTACT
COMPEX LEGAL SERVICES, INC. AT 888-531-2919 WITH A LIST OF THE
CHARGES INVOLVED IN OBTAINING THESE RECORDS BEFORE CREATING
COPIES.
These items will be inspectedand may be copied at that time. You will not be requiredto
surrender the originalitems. You mav comply with this subpoena bv providing legible
copies of the items to be produced to COMPEX LEGAL SERVICES, INC., the agent of
the attornev whose name appears on this subpoena, on or before the scheduled date of
production. "The records requested will be used for this litigation onlv and will be
returned or destroved after litigation is complete.'" Please contact Compex Legal Services,
Inc. directlyand send all Medical Records, Bills,Films, and all other items necessary for
compliance to:
COMPEX LEGAL SERVICES, INC.
5481 W. WATERS AVE. SUITE 108, TAMPA, FLORIDA, 33634
Tel: 888-531-2919, Fax: 888-531-2922
You may condition the preparationof the copiesupon the payment in advance of the reasonable
cost ofpreparation.You have the rightto objectto the production pursuant to this subpoena at
any time before production by giving written notice to the attorney whose name appears on this
subpoena.
THIS WILL NOT BE A DEPOSITION, NO TESTIMONY WILL BE TAKEN.
If you fail to: (1) appear as specified;or (2) furnish the records instead of appearing as provided
above; or (3) object to this subpoena, you may be in contempt of court. You are subpoenaed by
the attorney whose name appears on this subpoena and unless excused from this subpoena by the
attorney or the Court, you shall respond to this subpoena as directed.
Page 2 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-004
TOTAL PAGES: 3
CERTIFICATE OF NOTICE
Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45
CFR Parts 160 and 164, I hereby certify that I have complied with the regulations and
requirements to obtain patient health information and that the representations below are true
and correct:
1. I have made
a good faith attempt to provide written notice to the above-named patient,
through counsel, of intent to obtain the patient's health information pursuant to this
subpoena;
2. The written or proceeding in which
notice provided sufficient information about this litigation
the protected health information is requested to permit the patient to raise an objection to
the court or administrative tribunal; and
3. The time of the patient to raise objections to the court or administrative tribunal has elapsed
and (check one)
No objections were filed;or
All objections filed by the patient were resolved by the court or administrative
tribunal and the disclosures being sought are consistent with such resolutions.
Objection was filed but per agreement of counsel, objection has been resolved.
ALEXANDRA M. DE MAIO, ESQ. Dated:
Attorney for Defendant(s)
LM General Insurance Company
FL Bar No. 0048429
LAW OFFICE OF ROBERT P. KELLY
P.O. BOX 7217 By:
LONDON, KY 40742 For the Court
Telephone: 813-868-8121
Page 3 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-005
TOTAL PAGES: 3
IN THE CIRCUIT COURT OF THE
SEVENTEENTH JUDICIAL CIRCUIT
IN AND FOR BROWARD COUNTY,
FLORIDA
NADIA SOOKLAL
CASE NO. CACE-21-007718
Plaintiff(s),
VS.
LM GENERAL INSURANCE COMPANY
Defendant(s),
'
SUBPOENA DUCES TECUM FOR PRODUCTION OF DOCUMENTS
THE STATE OF FLORIDA:
TO: RECORDS CUSTODIAN FOR
INTERVENTIONAL PAIN PHYSICIANS OF SOUTH FLORIDA MAIN: 954-722-6200
7447 NORTH UNIVERSITY DRIVE
TAMARAC, FL 33321
YOU ARE COMMANDED to produce without depositionand deliver by mail or fax do Compex
Legal Services, Inc. located at,5481 W. Waters Ave. Suite 108, Tampa, Florida, 33634, Fax:
888-531-2922, after ten (10) days from the date of service of this subpoena, and to have with
you at that time and place the following:
INCLUDE RECORDS OF TREATMENT RENDERED BY: ALAN SIEGEL, MD
ALL DOCUMENTS AND RECORDS STORED IN ANY FORMAT OR 1METHOD
INCLUDING, BUT NOT LIMITED TO, ALL 1MEDICAL RECORDS, INTAKE FORMS,
PATIENT COMPLETED FORMS AND/OR DOCUMENTS, CORRESPONDENCE, ALL
OFFICE RECORDS, EMERGENCY ROOM RECORDS OR REPORTS, INPATIENT AND
OUTPATIENT CHARTS AND RECORDS, LIEN FILES, SOAP NOTES, PATHOLOGY
RECORDS AND REPORTS, LAB REPORTS, PHARMACY AND PRESCRIPTION
RECORDS, PHYSICAL THERAPY RECORDS, SIGN-IN SHEETS, ALL DESCRIPTIONS
OF EXERCISES PRESCRIBED, DOCUMENTATION WHICH INDICATE DATE AND
TIME OF PATIENT'S APPOINTMENTS, INSURANCE DOCUMENTS, ALL
RADIOLOGY REPORTS AND READINGS, AND ANY OTHER DOCUMENTS
MAINTAINED PERTAINING TO THE CARE, TREATMENT AND EXAMINATION OF
THE PATIENT; AND
Page 1 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-005
TOTAL PAGES: 3
ALL ITEMIZED STATEMENTS OF THE BILLING CHARGES AND/OR
CONSOLIDATED STATEMENT OF BENEFITS, WITH DIAGNOSTIC AND
PROCEDURE CODES INCLUDING ALL CPT AND ICD-9/ICD-10 CODING AND ALL
HCFA, UB04 AND UB92 BILLS, TO INCLUDE THE TOTAL CHARGES PRIVATE OR
GOVERNMENTAL; ANY AMOUNTS WRITTEN OFF BY THE PROVIDER, AND ANY
AMOUNTS THAT ARE THE PATIENT'S RESPONSIBILITY AND EXPLANATION OF
BENEFITS, PAYMENT HISTORY, RECORDS OF ANY LIENS, ANY INSURANCE
BILLING OR PAYMENTS INFORMATION, EMERGENCY ROOM PIIYSICIANS BILLS
AND RADIOLOGY BILLING FROM ALL SOURCES, TO INCLUDE ANY COMPUTER
GENERATED BILLING OR BILLING STORED IN ANY FORMAT AND PAYMENT
SOFTWARE THAT CONTAINS SAID INFORMATION; AND
COPIES OF ALL ORIGINAL X-RAYS FILMS, CT SCANS, MRIS AND ANY OTHER
SCANS ORIMAGES TAKEN AND/OR MAINTAINED, INCLUDING A
COMPREHENSIVE LIST OF ALL DATES AND BODY PARTS OF ALL FILMS, CT
SCANS, MRIS AND ALL OTHER IMAGES OR SCANS PROVIDED. ALL IMAGES AND
FILMS MUST BE PROVIDED ON CD IF AVAILABLE. NADIA SOOKLAL ; DOB:
SSN:
IFCOPY CHARGES EXCEED $500.00 FOR THIS PATIENT, PLEASE CONTACT
COMPEX LEGAL SERVICES, INC. AT 888-531-2919 WITH A LIST OF THE
CHARGES INVOLVED IN OBTAINING THESE RECORDS BEFORE CREATING
COPIES.
These items will be inspectedand may be copied at that time. You will not be requiredto
surrender the originalitems. You mav comply with this subpoena bv providing legible
copies of the items to be produced to COMPEX LEGAL SERVICES, INC., the agent of
the attornev whose name appears on this subpoena, on or before the scheduled date of
production. "The records requested will be used for this litigation onlv and will be
returned or destroved after litigation is complete.'" Please contact Compex Legal Services,
Inc. directlyand send all Medical Records, Bills,Films, and all other items necessary for
compliance to:
COMPEX LEGAL SERVICES, INC.
5481 W. WATERS AVE. SUITE 108, TAMPA, FLORIDA, 33634
Tel: 888-531-2919, Fax: 888-531-2922
You may condition the preparationof the copies upon the payment in advance of the reasonable
cost ofpreparation.You have the rightto objectto the production pursuant to this subpoena at
any time before productionby givingwritten notice to the attorney whose name appears on this
subpoena.
THIS WILL NOT BE A DEPOSITION, NO TESTIMONY WILL BE TAKEN.
If you fail to: (1) appear as specified;or (2) furnish the records instead of appearing as provided
above; or (3) object to this subpoena, you may be in contempt of court. You are subpoenaed by
the attorney whose name appears on this subpoena and unless excused from this subpoena by the
attorney or the Court, you shall respond to this subpoena as directed.
Page 2 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-005
TOTAL PAGES: 3
CERTIFICATE OF NOTICE
Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45
CFR Parts 160 and 164, I hereby certify that I have complied with the regulations and
requirements to obtain patient health information and that the representations below are true
and correct:
1. I have made
a good faith attempt to provide written notice to the above-named patient,
through counsel, of intent to obtain the patient's health information pursuant to this
subpoena;
2. The written or proceeding in which
notice provided sufficient information about this litigation
the protected health information is requested to permit the patient to raise an objection to
the court or administrative tribunal; and
3. The time of the patient to raise objections to the court or administrative tribunal has elapsed
and (check one)
No objections were filed;or
All objections filed by the patient were resolved by the court or administrative
tribunal and the disclosures being sought are consistent with such resolutions.
Objection was filed but per agreement of counsel, objection has been resolved.
ALEXANDRA M. DE MAIO, ESQ. Dated:
Attorney for Defendant(s)
LM General Insurance Company
FL Bar No. 0048429
LAW OFFICE OF ROBERT P. KELLY
P.O. BOX 7217 By:
LONDON, KY 40742 For the Court
Telephone: 813-868-8121
Page 3 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-006
TOTAL PAGES: 3
IN THE CIRCUIT COURT OF THE
SEVENTEENTH JUDICIAL CIRCUIT
IN AND FOR BROWARD COUNTY,
FLORIDA
NADIA SOOKLAL
CASE NO. CACE-21-007718
Plaintiff(s),
VS.
LM GENERAL INSURANCE COMPANY
Defendant(s),
'
SUBPOENA DUCES TECUM FOR PRODUCTION OF DOCUMENTS
THE STATE OF FLORIDA:
TO: RECORDS CUSTODIAN FOR
ORTHOPAEDIC CENTER OF SOUTH FLORIDA MAIN: 954-473-6344, B: 954-473-9779,
F:954-473-6344
600 SOUTH PINE ISLAND ROAD, SUITE 300
PLANTATION, FL 33324
YOU ARE COMMANDED to produce without depositionand deliver by mail or fax do Compex
Legal Services, Inc. located at, 5481 W. Waters Ave. Suite 108, Tampa, Florida, 33634, Fax:
888-531-2922, after ten (10) days from the date of service of this subpoena, and to have with
you at that time and place the following:
ALL DOCUMENTS AND RECORDS STORED IN ANY FORMAT OR 1METHOD
INCLUDING, BUT NOT LIMITED TO, ALL 1MEDICAL RECORDS, INTAKE FORMS,
PATIENT COMPLETED FORMS AND/OR DOCUMENTS, CORRESPONDENCE, ALL
OFFICE RECORDS, EMERGENCY ROOM RECORDS OR REPORTS, INPATIENT AND
OUTPATIENT CHARTS AND RECORDS, LIEN FILES, SOAP NOTES, PATHOLOGY
RECORDS AND REPORTS, LAB REPORTS, PHARMACY AND PRESCRIPTION
RECORDS, PHYSICAL THERAPY RECORDS, SIGN-IN SHEETS, ALL DESCRIPTIONS
OF EXERCISES PRESCRIBED, DOCUMENTATION WHICH INDICATE DATE AND
TIME OF PATIENT'S APPOINTMENTS, INSURANCE DOCUMENTS, ALL
RADIOLOGY REPORTS AND READINGS, AND ANY OTHER DOCUMENTS
MAINTAINED PERTAINING TO THE CARE, TREATMENT AND EXAMINATION OF
THE PATIENT; AND
ALL ITEMIZED STATEMENTS OF THE BILLING CHARGES AND/OR
Page 1 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-006
TOTAL PAGES: 3
CONSOLIDATED STATEMENT OF BENEFITS, WITH DIAGNOSTIC AND
PROCEDURE CODES INCLUDING ALL CPT AND ICD-9/ICD-10 CODING AND ALL
HCFA, UB04 AND UB92 BILLS, TO INCLUDE THE TOTAL CHARGES PRIVATE OR
GOVERNMENTAL; ANY AMOUNTS WRITTEN OFF BY THE PROVIDER, AND ANY
AMOUNTS THAT ARE THE PATIENT'S RESPONSIBILITY AND EXPLANATION OF
BENEFITS, PAYMENT HISTORY, RECORDS OF ANY LIENS, ANY INSURANCE
BILLING OR PAYMENTS INFORMATION, EMERGENCY ROOM PIIYSICIANS BILLS
AND RADIOLOGY BILLING FROM ALL SOURCES, TO INCLUDE ANY COMPUTER
GENERATED BILLING OR BILLING STORED IN ANY FORMAT AND PAYMENT
SOFTWARE THAT CONTAINS SAID INFORMATION; AND
COPIES OF ALL ORIGINAL X-RAYS FILMS, CT SCANS, MRIS AND ANY OTHER
SCANS ORIMAGES TAKEN AND/OR MAINTAINED, INCLUDING A
COMPREHENSIVE LIST OF ALL DATES AND BODY PARTS OF ALL FILMS, CT
SCANS, MRIS AND ALL OTHER IMAGES OR SCANS PROVIDED. ALL IMAGES AND
FILMS MUST BE PROVIDED ON CD IF AVAILABLE. NADIA SOOKLAL ; DOB:
SSN:
IFCOPY CHARGES EXCEED $500.00 FOR THIS PATIENT, PLEASE CONTACT
COMPEX LEGAL SERVICES, INC. AT 888-531-2919 WITH A LIST OF THE
CHARGES INVOLVED IN OBTAINING THESE RECORDS BEFORE CREATING
COPIES.
These items will be inspectedand may be copied at that time. You will not be requiredto
surrender the originalitems. You mav comply with this subpoena bv providing legible
copies of the items to be produced to COMPEX LEGAL SERVICES, INC., the agent of
the attornev whose name appears on this subpoena, on or before the scheduled date of
production. "The records requested will be used for this litigation onlv and will be
"
returned or destroved after litigation is complete.' Please contact Compex Legal Services,
Inc. directlyand send all Medical Records, Bills,Films, and all other items necessary for
compliance to:
COMPEX LEGAL SERVICES, INC.
5481 W. WATERS AVE. SUITE 108, TAMPA, FLORIDA, 33634
Tel: 888-531-2919, Fax: 888-531-2922
You may condition the preparationof the copiesupon the payment in advance of the reasonable
cost ofpreparation.You have the rightto objectto the production pursuant to this subpoena at
any time before production by giving written notice to the attorney whose name appears on this
subpoena.
THIS WILL NOT BE A DEPOSITION, NO TESTIMONY WILL BE TAKEN.
or (2) furnish the records instead of appearing as provided
If you fail to: (1) appear as specified;
above; or (3) objectto this subpoena, you may be in contempt of court. You are subpoenaed by
the attorney whose name appears on this subpoena and unless excused from this subpoena by the
attorney or the Court, you shall respond to this subpoena as directed.
Page 2 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-006
TOTAL PAGES: 3
CERTIFICATE OF NOTICE
Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45
CFR Parts 160 and 164, I hereby certify that I have complied with the regulations and
requirements to obtain patient health information and that the representations below are true
and correct:
1. I have made
a good faith attempt to provide written notice to the above-named patient,
through counsel, of intent to obtain the patient's health information pursuant to this
subpoena;
2. The written or proceeding in which
notice provided sufficient information about this litigation
the protected health information is requested to permit the patient to raise an objection to
the court or administrative tribunal; and
3. The time of the patient to raise objections to the court or administrative tribunal has elapsed
and (check one)
No objections were filed;or
All objections filed by the patient were resolved by the court or administrative
tribunal and the disclosures being sought are consistent with such resolutions.
Objection was filed but per agreement of counsel, objection has been resolved.
ALEXANDRA M. DE MAIO, ESQ. Dated:
Attorney for Defendant(s)
LM General Insurance Company
FL Bar No. 0048429
LAW OFFICE OF ROBERT P. KELLY
P.O. BOX 7217 By:
LONDON, KY 40742 For the Court
Telephone: 813-868-8121
Page 3 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-007
TOTAL PAGES: 3
IN THE CIRCUIT COURT OF THE
SEVENTEENTH JUDICIAL CIRCUIT
IN AND FOR BROWARD COUNTY,
FLORIDA
NADIA SOOKLAL
CASE NO. CACE-21-007718
Plaintiff(s),
VS.
LM GENERAL INSURANCE COMPANY
Defendant(s),
'
SUBPOENA DUCES TECUM FOR PRODUCTION OF DOCUMENTS
THE STATE OF FLORIDA:
TO: RECORDS CUSTODIAN FOR
ALEYDA M. BORGE, MD 954-252-8797
9710 STIRLING RD
HOLLYWOOD, FL 33024
YOU ARE COMMANDED to produce without depositionand deliver by mail or fax do Compex
Legal Services, Inc. located at,5481 W. Waters Ave. Suite 108, Tampa, Florida, 33634, Fax:
888-531-2922, after ten (10) days from the date of service of this subpoena, and to have with
you at that time and place the following:
ALL DOCUMENTS AND RECORDS STORED IN ANY FORMAT OR 1METHOD
INCLUDING, BUT NOT LIMITED TO, ALL 1MEDICAL RECORDS, INTAKE FORMS,
PATIENT COMPLETED FORMS AND/OR DOCUMENTS, CORRESPONDENCE, ALL
OFFICE RECORDS, EMERGENCY ROOM RECORDS OR REPORTS, INPATIENT AND
OUTPATIENT CHARTS AND RECORDS, LIEN FILES, SOAP NOTES, PATHOLOGY
RECORDS AND REPORTS, LAB REPORTS, PHARMACY AND PRESCRIPTION
RECORDS, PHYSICAL THERAPY RECORDS, SIGN-IN SHEETS, ALL DESCRIPTIONS
OF EXERCISES PRESCRIBED, DOCUMENTATION WHICH INDICATE DATE AND
TIME OF PATIENT'S APPOINTMENTS, INSURANCE DOCUMENTS, ALL
RADIOLOGY REPORTS AND READINGS, AND ANY OTHER DOCUMENTS
MAINTAINED PERTAINING TO THE CARE, TREATMENT AND EXAMINATION OF
THE PATIENT; AND
ALL ITEMIZED STATEMENTS OF THE BILLING CHARGES AND/OR
CONSOLIDATED STATEMENT OF BENEFITS, WITH DIAGNOSTIC AND
Page 1 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-007
TOTAL PAGES: 3
PROCEDURE CODES INCLUDING ALL CPT AND ICI)-9/ICD-10 CODING AND ALL
HCFA, UB04 AND UB92 BILLS, TO INCLUDE THE TOTAL CHARGES PRIVATE OR
GOVERNMENTAL; ANY AMOUNTS WRITTEN OFF BY THE PROVIDER, AND ANY
AMOUNTS THAT ARE THE PATIENT'S RESPONSIBILITY AND EXPLANATION OF
BENEFITS, PAYMENT HISTORY, RECORDS OF ANY LIENS, ANY INSURANCE
BILLING OR PAYMENTS INFORMATION, EMERGENCY ROOM PIIYSICIANS BILLS
AND RADIOLOGY BILLING FROM ALL SOURCES, TO INCLUDE ANY COMPUTER
GENERATED BILLING OR BILLING STORED IN ANY FORMAT AND PAYMENT
SOFTWARE THAT CONTAINS SAID INFORMATION; AND
COPIES OF ALL ORIGINAL X-RAYS FILMS, CT SCANS, MRIS AND ANY OTHER
SCANS ORIMAGES TAKEN AND/OR MAINTAINED, INCLUDING A
COMPREHENSIVE LIST OF ALL DATES AND BODY PARTS OF ALL FILMS, CT
SCANS, MRIS AND ALL OTHER IMAGES OR SCANS PROVIDED. ALL IMAGES AND
FILMS MUST BE PROVIDED ON CD IF AVAILABLE. NADIA SOOKLAL ; DOB:
SSN:
IFCOPY CHARGES EXCEED $500.00 FOR THIS PATIENT, PLEASE CONTACT
COMPEX LEGAL SERVICES, INC. AT 888-531-2919 WITH A LIST OF THE
CHARGES INVOLVED IN OBTAINING THESE RECORDS BEFORE CREATING
COPIES.
These items will be inspectedand may be copied at that time. You will not be requiredto
surrender the originalitems. You mav comply with this subpoena bv providing legible
copies of the items to be produced to COMPEX LEGAL SERVICES, INC., the agent of
the attornev whose name appears on this subpoena, on or before the scheduled date of
production. "The records requested will be used for this litigation onlv and will be
returned or destroved after litigation is complete.'" Please contact Compex Legal Services,
Inc. directlyand send all Medical Records, Bills,Films, and all other items necessary for
compliance to:
COMPEX LEGAL SERVICES, INC.
5481 W. WATERS AVE. SUITE 108, TAMPA, FLORIDA, 33634
Tel: 888-531-2919, Fax: 888-531-2922
You may condition the preparationof the copiesupon the payment in advance of the reasonable
cost ofpreparation.You have the rightto objectto the production pursuant to this subpoena at
any time before production by giving written notice to the attorney whose name appears on this
subpoena.
THIS WILL NOT BE A DEPOSITION, NO TESTIMONY WILL BE TAKEN.
If you fail to: (1) appear as specified;or (2) furnish the records instead of appearing as provided
above; or (3) object to this subpoena, you may be in contempt of court. You are subpoenaed by
the attorney whose name appears on this subpoena and unless excused from this subpoena by the
attorney or the Court, you shall respond to this subpoena as directed.
Page 2 of 3
CLAIM NO.: 043927022-0007
ORDER #: FL0171978-007
TOTAL PAGES: 3
CERTIFICATE OF NOTICE
Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45
CFR Parts 160 and 164, I hereby certify that I have complied with the regulations and
requirements to obtain patient health information and that the representations below are true
and correct:
1. I have made
a good faith attempt to provide written notice to the above-named patient,
through counsel, of intent to obtain the patient's health information pursuant to this
subpoena;
2. The written or proceeding in which
notice provided sufficient information about this litigation
the protected health information is requested to permit the patient to raise an objection to
the court or administrative tribunal; and
3. The time of the patient to raise objections to the court or administrative tribunal has elapsed
and (check one)
No objections were filed;or
Preview
Filing# 144263555 E-Filed 02/21/2022 09:12:29 AM ORDER #: FL0171978 TOTAL PAGES: 4 IN THE CIRCUIT COURT OF THE SEVENTEENTH JUDICIAL CIRCUIT IN AND FOR BROWARD COUNTY, FLORIDA NADIA SOOKLAL CASE NO. CACE-21-007718 Plaintiff(s), VS. LM GENERAL INSURANCE COMPANY Defendant(s), DEFENDANT(S) NOTICE OF PRODUCTION OF DOCUMENTS FROM NON-PARTY YOU ARE HEREBY NOTIFIED that after ten (10) days from the date of service of this Notice, service is by email, and if no objectionis received from any party, the undersigned will issue or apply to the Clerk of this court for the issuance of the attached Subpoena(s) directed to the following: Medical Records Custodian for THE EYE CENTER 1732 NORTH UNIVERSITY DRIVE PEMBROKE PINES, FL 33024 Medical Records Custodian for CLEVELAND CLINIC FLORIDA, WESTON 3100 WESTON ROAD WESTON, FL 33331 Medical Records Custodian for STUMPFF CHIROPRACTIC 7860PETERS RD. SUITE F-111 PLANTATION, FL 33324 Medical Records Custodian for STAND UP MRI OF BOCA RATON, P.A. KIMBERLY BOULEVARD, SUITE 14 9080 BOCA RATON, FL 33434 Page 1 of 4 *** FILED: BROWARD COUNTY, FL BRENDA D. FORMAN, CLERK 02/21/2022 09:12:29 AM.**** CLAIM NO.: 043927022-0007 ORDER #: FL0171978 TOTAL PAGES: 4 Medical Records Custodian for INTERVENTIONAL PAIN PHYSICIANS OF SOUTH FLORIDA 7447 NORTH UNIVERSITY DRIVE TAMARAC, FL 33321 Medical Records Custodian for ORTHOPAEDIC CENTER OF SOUTH FLORIDA 600 SOUTH PINE ISLAND ROAD, SUITE 300 PLANTATION, FL 33324 Medical Records Custodian for ALEYDA M. BORGE, MD 9710 STIRLING RD HOLLYWOOD, FL 33024 Medical Records Custodian for ANGELICA RODRIGUEZ, DO 1825 NORTH CORPORATE LAKES BOULEVARD WESTON, FL 33326 Medical Records Custodian for PRIYANKA GROVER, MD 8397 WEST OAKLAND PARK BOULEVARD SUNRISE, FL 33351 Medical Records Custodian for SRINIVAS TUMMALA, MD 1400 NORTHWEST 12TH AVENUE MIAMI, FL 33136 Medical Records Custodian for IHOR PIDHORECKY, MD 2301 NORTH UNIVERSITY DRIVE, SUITE 204 PEMBROKE PINES, FL 33024 Medical Records Custodian for RYAN GREENE, M.D. 2731EXECUTIVE PARK DRIVE, SUITE 1 WESTON, FL 33331 Medical Records Custodian for SHERMAN SILBER, MD 224 SOUTH WOODS MILL ROAD, SUITE 730 CHESTERFIELD, MO 63017 Page 2 of 4 CLAIM NO.: 043927022-0007 ORDER #: FL0171978 TOTAL PAGES: 4 BillingRecords Custodian for CCF ITEMIZATION P.O.BOX 932294 CLEVELAND, OH 44193 Radiology Records Custodian for CLEVELAND CLINIC FLORIDA, ATTN: RADIOLOGY 3100 WESTON ROAD WESTON, FL 33331 The above listed are not a party to this lawsuit and are requestedto produce the items listed at the time and place specifiedin the attached Subpoena(s). If you wish to receive copies o f these documents, please advise the undersigned,in writing, and same will be provided, at a cost for photocopies,upon receipt. COPY CHARGES EXCEED $500.00 FOR THIS PATIENT, PLEASE CONTACT IF COMPEX LEGAL SERVICES, INC. AT 888-531-2919 WITH A LIST OF THE CHARGES INVOLVED IN OBTAINING THESE RECORDS BEFORE CREATING COPIES. PLEASE BE GOVERNED ACCORDINGLY. I HEREBY CERTIFY that on the -21-stlay of February , 20 -22[ true and correct copy of the foregoing Defendant(s) Notice of Production of Documents from Non Party has been furnished by email to: STEVEN S. FARBMAN, ESQ. LAW OFFICES OF STEVEN S. FARBMAN, PA 7805 SOUTHWEST 6TH COURT PLANTATION, FL 33324 Page 3 of 4 CLAIM NO.: 043927022-0007 ORDER #: FL0171978 TOTAL PAGES: 4 LAW OFFICE OF ROBERT P. KELLY PO BOX 7217 LONDON, KY 40742 Telephone: 813-286-0068 Fax: 603-334-7774 Aeysndram.De7,na.co By: ALEXANDRA M. DE MAIO, ESQ. FL BAR NO.: 0048429 PRINCIPLE EMAIL FOR SERVICE OF PLEADINGS: PLGMAIL@LIBERTYMUTUAL.COM ALEXANDRA.DEMAIO@LIBERTYMUTUAL.COM Page 4 of 4 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-001 TOTAL PAGES: 3 IN THE CIRCUIT COURT OF THE SEVENTEENTH JUDICIAL CIRCUIT IN AND FOR BROWARD COUNTY, FLORIDA NADIA SOOKLAL CASE NO. CACE-21-007718 Plaintiff(s), VS. LM GENERAL INSURANCE COMPANY Defendant(s), ' SUBPOENA DUCES TECUM FOR PRODUCTION OF DOCUMENTS THE STATE OF FLORIDA: TO: RECORDS CUSTODIAN FOR THE EYE CENTER MAIN: 954-432-7711 1732 NORTH UNIVERSITY DRIVE PEMBROKE PINES, FL 33024 YOU ARE COMMANDED to produce without depositionand deliver by mail or fax do Compex Legal Services, Inc. located at,5481 W. Waters Ave. Suite 108, Tampa, Florida, 33634, Fax: 888-531-2922, after ten (10) days from the date of service of this subpoena, and to have with you at that time and place the following: INCLUDE RECORDS OF TREATMENT RENDERED BY: STEPHANIE DAVIS, OD ALL DOCUMENTS AND RECORDS STORED IN ANY FORMAT OR 1METHOD INCLUDING, BUT NOT LIMITED TO, ALL 1MEDICAL RECORDS, INTAKE FORMS, PATIENT COMPLETED FORMS AND/OR DOCUMENTS, CORRESPONDENCE, ALL OFFICE RECORDS, EMERGENCY ROOM RECORDS OR REPORTS, INPATIENT AND OUTPATIENT CHARTS AND RECORDS, LIEN FILES, SOAP NOTES, PATHOLOGY RECORDS AND REPORTS, LAB REPORTS, PHARMACY AND PRESCRIPTION RECORDS, PHYSICAL THERAPY RECORDS, SIGN-IN SHEETS, ALL DESCRIPTIONS OF EXERCISES PRESCRIBED, DOCUMENTATION WHICH INDICATE DATE AND TIME OF PATIENT'S APPOINTMENTS, INSURANCE DOCUMENTS, ALL RADIOLOGY REPORTS AND READINGS, AND ANY OTHER DOCUMENTS MAINTAINED PERTAINING TO THE CARE, TREATMENT AND EXAMINATION OF THE PATIENT; AND Page 1 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-001 TOTAL PAGES: 3 ALL ITEMIZED STATEMENTS OF THE BILLING CHARGES AND/OR CONSOLIDATED STATEMENT OF BENEFITS, WITH DIAGNOSTIC AND PROCEDURE CODES INCLUDING ALL CPT AND ICD-9/ICD-10 CODING AND ALL HCFA, UB04 AND UB92 BILLS, TO INCLUDE THE TOTAL CHARGES PRIVATE OR GOVERNMENTAL; ANY AMOUNTS WRITTEN OFF BY THE PROVIDER, AND ANY AMOUNTS THAT ARE THE PATIENT'S RESPONSIBILITY AND EXPLANATION OF BENEFITS, PAYMENT HISTORY, RECORDS OF ANY LIENS, ANY INSURANCE BILLING OR PAYMENTS INFORMATION, EMERGENCY ROOM PIIYSICIANS BILLS AND RADIOLOGY BILLING FROM ALL SOURCES, TO INCLUDE ANY COMPUTER GENERATED BILLING OR BILLING STORED IN ANY FORMAT AND PAYMENT SOFTWARE THAT CONTAINS SAID INFORMATION; AND COPIES OF ALL ORIGINAL X-RAYS FILMS, CT SCANS, MRIS AND ANY OTHER SCANS ORIMAGES TAKEN AND/OR MAINTAINED, INCLUDING A COMPREHENSIVE LIST OF ALL DATES AND BODY PARTS OF ALL FILMS, CT SCANS, MRIS AND ALL OTHER IMAGES OR SCANS PROVIDED. ALL IMAGES AND FILMS MUST BE PROVIDED ON CD IF AVAILABLE. NADIA SOOKLAL ; DOB: SSN: IFCOPY CHARGES EXCEED $500.00 FOR THIS PATIENT, PLEASE CONTACT COMPEX LEGAL SERVICES, INC. AT 888-531-2919 WITH A LIST OF THE CHARGES INVOLVED IN OBTAINING THESE RECORDS BEFORE CREATING COPIES. These items will be inspectedand may be copied at that time. You will not be requiredto surrender the originalitems. You mav comply with this subpoena bv providing legible copies of the items to be produced to COMPEX LEGAL SERVICES, INC., the agent of the attornev whose name appears on this subpoena, on or before the scheduled date of production. "The records requested will be used for this litigation onlv and will be returned or destroved after litigation is complete.'" Please contact Compex Legal Services, Inc. directlyand send all Medical Records, Bills,Films, and all other items necessary for compliance to: COMPEX LEGAL SERVICES, INC. 5481 W. WATERS AVE. SUITE 108, TAMPA, FLORIDA, 33634 Tel: 888-531-2919, Fax: 888-531-2922 You may condition the preparationof the copies upon the payment in advance of the reasonable cost ofpreparation.You have the rightto objectto the production pursuant to this subpoena at any time before productionby givingwritten notice to the attorney whose name appears on this subpoena. THIS WILL NOT BE A DEPOSITION, NO TESTIMONY WILL BE TAKEN. If you fail to: (1) appear as specified;or (2) furnish the records instead of appearing as provided above; or (3) object to this subpoena, you may be in contempt of court. You are subpoenaed by the attorney whose name appears on this subpoena and unless excused from this subpoena by the attorney or the Court, you shall respond to this subpoena as directed. Page 2 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-001 TOTAL PAGES: 3 CERTIFICATE OF NOTICE Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 CFR Parts 160 and 164, I hereby certify that I have complied with the regulations and requirements to obtain patient health information and that the representations below are true and correct: 1. I have made a good faith attempt to provide written notice to the above-named patient, through counsel, of intent to obtain the patient's health information pursuant to this subpoena; 2. The written or proceeding in which notice provided sufficient information about this litigation the protected health information is requested to permit the patient to raise an objection to the court or administrative tribunal; and 3. The time of the patient to raise objections to the court or administrative tribunal has elapsed and (check one) No objections were filed;or All objections filed by the patient were resolved by the court or administrative tribunal and the disclosures being sought are consistent with such resolutions. Objection was filed but per agreement of counsel, objection has been resolved. ALEXANDRA M. DE MAIO, ESQ. Dated: Attorney for Defendant(s) LM General Insurance Company FL Bar No. 0048429 LAW OFFICE OF ROBERT P. KELLY P.O. BOX 7217 By: LONDON, KY 40742 For the Court Telephone: 813-868-8121 Page 3 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-002 TOTAL PAGES: 3 IN THE CIRCUIT COURT OF THE SEVENTEENTH JUDICIAL CIRCUIT IN AND FOR BROWARD COUNTY, FLORIDA NADIA SOOKLAL CASE NO. CACE-21-007718 Plaintiff(s), VS. LM GENERAL INSURANCE COMPANY Defendant(s), ' SUBPOENA DUCES TECUM FOR PRODUCTION OF DOCUMENTS THE STATE OF FLORIDA: TO: RECORDS CUSTODIAN FOR CLEVELAND CLINIC FLORIDA, WESTON MAIN: 954-689-5000, B: 866-621-6385, F: 954-689-5110 3100 WESTON ROAD WESTON, FL 33331 YOU ARE COMMANDED to produce without depositionand deliver by mail or fax do Compex Legal Services, Inc. located at, 5481 W. Waters Ave. Suite 108, Tampa, Florida, 33634, Fax: 888-531-2922, after ten (10) days from the date of service of this subpoena, and to have with you at that time and place the following: ALL DOCUMENTS AND RECORDS STORED IN ANY FORMAT OR 1METHOD INCLUDING, BUT NOT LIMITED TO, ALL 1MEDICAL RECORDS, INTAKE FORMS, PATIENT COMPLETED FORMS AND/OR DOCUMENTS, CORRESPONDENCE, ALL OFFICE RECORDS, EMERGENCY ROOM RECORDS OR REPORTS, INPATIENT AND OUTPATIENT CHARTS AND RECORDS, LIEN FILES, SOAP NOTES, PATHOLOGY RECORDS AND REPORTS, LAB REPORTS, PHARMACY AND PRESCRIPTION RECORDS, PHYSICAL THERAPY RECORDS, SIGN-IN SHEETS, ALL DESCRIPTIONS OF EXERCISES PRESCRIBED, DOCUMENTATION WHICH INDICATE DATE AND TIME OF PATIENT'S APPOINTMENTS, INSURANCE DOCUMENTS, ALL RADIOLOGY REPORTS AND READINGS, AND ANY OTHER DOCUMENTS 1MAINTAINED PERTAINING TO THE CARE, TREATMENT AND EXAMINATION OF THE PATIENT. NADIA SOOKLAL ; DOB: SSN: Page 1 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-002 TOTAL PAGES: 3 IFCOPY CHARGES EXCEED $500.00 FOR THIS PATIENT, PLEASE CONTACT COMPEX LEGAL SERVICES, INC. AT 888-531-2919 WITH A LIST OF THE CHARGES INVOLVED IN OBTAINING THESE RECORDS BEFORE CREATING COPIES. These items will be inspectedand may be copied at that time. You will not be requiredto surrender the originalitems. You mav comply with this subpoena bv providing legible copies of the items to be produced to COMPEX LEGAL SERVICES, INC., the agent of the attornev whose name appears on this subpoena, on or before the scheduled date of production. "The records requested will be used for this litigation onlv and will be returned or destroved after litigation is complete.'" Please contact Compex Legal Services, Inc. directlyand send all Medical Records, Bills,Films, and all other items necessary for compliance to: COMPEX LEGAL SERVICES, INC. 5481 W. WATERS AVE. SUITE 108, TAMPA, FLORIDA, 33634 Tel: 888-531-2919, Fax: 888-531-2922 You may condition the preparationof the copiesupon the payment in advance of the reasonable cost ofpreparation.You have the rightto objectto the production pursuant to this subpoena at any time before production by giving written notice to the attorney whose name appears on this subpoena. THIS WILL NOT BE A DEPOSITION, NO TESTIMONY WILL BE TAKEN. or (2) furnish the records instead of appearing as provided If you fail to: (1) appear as specified; above; or (3) objectto this subpoena, you may be in contempt of court. You are subpoenaed by the attorney whose name appears on this subpoena and unless excused from this subpoena by the attorney or the Court, you shall respond to this subpoena as directed. Page 2 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-002 TOTAL PAGES: 3 CERTIFICATE OF NOTICE Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 CFR Parts 160 and 164, I hereby certify that I have complied with the regulations and requirements to obtain patient health information and that the representations below are true and correct: 1. I have made a good faith attempt to provide written notice to the above-named patient, through counsel, of intent to obtain the patient's health information pursuant to this subpoena; 2. The written or proceeding in which notice provided sufficient information about this litigation the protected health information is requested to permit the patient to raise an objection to the court or administrative tribunal; and 3. The time of the patient to raise objections to the court or administrative tribunal has elapsed and (check one) No objections were filed;or All objections filed by the patient were resolved by the court or administrative tribunal and the disclosures being sought are consistent with such resolutions. Objection was filed but per agreement of counsel, objection has been resolved. ALEXANDRA M. DE MAIO, ESQ. Dated: Attorney for Defendant(s) LM General Insurance Company FL Bar No. 0048429 LAW OFFICE OF ROBERT P. KELLY P.O. BOX 7217 By: LONDON, KY 40742 For the Court Telephone: 813-868-8121 Page 3 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-003 TOTAL PAGES: 3 IN THE CIRCUIT COURT OF THE SEVENTEENTH JUDICIAL CIRCUIT IN AND FOR BROWARD COUNTY, FLORIDA NADIA SOOKLAL CASE NO. CACE-21-007718 Plaintiff(s), VS. LM GENERAL INSURANCE COMPANY Defendant(s), ' SUBPOENA DUCES TECUM FOR PRODUCTION OF DOCUMENTS THE STATE OF FLORIDA: TO: RECORDS CUSTODIAN FOR STUMPFF CHIROPRACTIC 954-368-4054 7860 PETERS RD. SUITE F-111 PLANTATION, FL 33324 YOU ARE COMMANDED to produce without depositionand deliver by mail or fax do Compex Legal Services, Inc. located at,5481 W. Waters Ave. Suite 108, Tampa, Florida, 33634, Fax: 888-531-2922, after ten (10) days from the date of service of this subpoena, and to have with you at that time and place the following: INCLUDE RECORDS OF TREATMENT RENDERED BY: ERIC STUMPFF, DC ALL DOCUMENTS AND RECORDS STORED IN ANY FORMAT OR 1METHOD INCLUDING, BUT NOT LIMITED TO, ALL 1MEDICAL RECORDS, INTAKE FORMS, PATIENT COMPLETED FORMS AND/OR DOCUMENTS, CORRESPONDENCE, ALL OFFICE RECORDS, EMERGENCY ROOM RECORDS OR REPORTS, INPATIENT AND OUTPATIENT CHARTS AND RECORDS, LIEN FILES, SOAP NOTES, PATHOLOGY RECORDS AND REPORTS, LAB REPORTS, PHARMACY AND PRESCRIPTION RECORDS, PHYSICAL THERAPY RECORDS, SIGN-IN SHEETS, ALL DESCRIPTIONS OF EXERCISES PRESCRIBED, DOCUMENTATION WHICH INDICATE DATE AND TIME OF PATIENT'S APPOINTMENTS, INSURANCE DOCUMENTS, ALL RADIOLOGY REPORTS AND READINGS, AND ANY OTHER DOCUMENTS MAINTAINED PERTAINING TO THE CARE, TREATMENT AND EXAMINATION OF THE PATIENT; AND Page 1 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-003 TOTAL PAGES: 3 ALL ITEMIZED STATEMENTS OF THE BILLING CHARGES AND/OR CONSOLIDATED STATEMENT OF BENEFITS, WITH DIAGNOSTIC AND PROCEDURE CODES INCLUDING ALL CPT AND ICD-9/ICD-10 CODING AND ALL HCFA, UB04 AND UB92 BILLS, TO INCLUDE THE TOTAL CHARGES PRIVATE OR GOVERNMENTAL; ANY AMOUNTS WRITTEN OFF BY THE PROVIDER, AND ANY AMOUNTS THAT ARE THE PATIENT'S RESPONSIBILITY AND EXPLANATION OF BENEFITS, PAYMENT HISTORY, RECORDS OF ANY LIENS, ANY INSURANCE BILLING OR PAYMENTS INFORMATION, EMERGENCY ROOM PIIYSICIANS BILLS AND RADIOLOGY BILLING FROM ALL SOURCES, TO INCLUDE ANY COMPUTER GENERATED BILLING OR BILLING STORED IN ANY FORMAT AND PAYMENT SOFTWARE THAT CONTAINS SAID INFORMATION; AND COPIES OF ALL ORIGINAL X-RAYS FILMS, CT SCANS, MRIS AND ANY OTHER SCANS ORIMAGES TAKEN AND/OR MAINTAINED, INCLUDING A COMPREHENSIVE LIST OF ALL DATES AND BODY PARTS OF ALL FILMS, CT SCANS, MRIS AND ALL OTHER IMAGES OR SCANS PROVIDED. ALL IMAGES AND FILMS MUST BE PROVIDED ON CD IF AVAILABLE. NADIA SOOKLAL ; DOB: SSN: IFCOPY CHARGES EXCEED $500.00 FOR THIS PATIENT, PLEASE CONTACT COMPEX LEGAL SERVICES, INC. AT 888-531-2919 WITH A LIST OF THE CHARGES INVOLVED IN OBTAINING THESE RECORDS BEFORE CREATING COPIES. These items will be inspectedand may be copied at that time. You will not be requiredto surrender the originalitems. You mav comply with this subpoena bv providing legible copies of the items to be produced to COMPEX LEGAL SERVICES, INC., the agent of the attornev whose name appears on this subpoena, on or before the scheduled date of production. "The records requested will be used for this litigation onlv and will be returned or destroved after litigation is complete.'" Please contact Compex Legal Services, Inc. directlyand send all Medical Records, Bills,Films, and all other items necessary for compliance to: COMPEX LEGAL SERVICES, INC. 5481 W. WATERS AVE. SUITE 108, TAMPA, FLORIDA, 33634 Tel: 888-531-2919, Fax: 888-531-2922 You may condition the preparationof the copies upon the payment in advance of the reasonable cost ofpreparation.You have the rightto objectto the production pursuant to this subpoena at any time before productionby givingwritten notice to the attorney whose name appears on this subpoena. THIS WILL NOT BE A DEPOSITION, NO TESTIMONY WILL BE TAKEN. If you fail to: (1) appear as specified;or (2) furnish the records instead of appearing as provided above; or (3) object to this subpoena, you may be in contempt of court. You are subpoenaed by the attorney whose name appears on this subpoena and unless excused from this subpoena by the attorney or the Court, you shall respond to this subpoena as directed. Page 2 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-003 TOTAL PAGES: 3 CERTIFICATE OF NOTICE Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 CFR Parts 160 and 164, I hereby certify that I have complied with the regulations and requirements to obtain patient health information and that the representations below are true and correct: 1. I have made a good faith attempt to provide written notice to the above-named patient, through counsel, of intent to obtain the patient's health information pursuant to this subpoena; 2. The written or proceeding in which notice provided sufficient information about this litigation the protected health information is requested to permit the patient to raise an objection to the court or administrative tribunal; and 3. The time of the patient to raise objections to the court or administrative tribunal has elapsed and (check one) No objections were filed;or All objections filed by the patient were resolved by the court or administrative tribunal and the disclosures being sought are consistent with such resolutions. Objection was filed but per agreement of counsel, objection has been resolved. ALEXANDRA M. DE MAIO, ESQ. Dated: Attorney for Defendant(s) LM General Insurance Company FL Bar No. 0048429 LAW OFFICE OF ROBERT P. KELLY P.O. BOX 7217 By: LONDON, KY 40742 For the Court Telephone: 813-868-8121 Page 3 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-004 TOTAL PAGES: 3 IN THE CIRCUIT COURT OF THE SEVENTEENTH JUDICIAL CIRCUIT IN AND FOR BROWARD COUNTY, FLORIDA NADIA SOOKLAL CASE NO. CACE-21-007718 Plaintiff(s), VS. LM GENERAL INSURANCE COMPANY Defendant(s), ' SUBPOENA DUCES TECUM FOR PRODUCTION OF DOCUMENTS THE STATE OF FLORIDA: TO: RECORDS CUSTODIAN FOR STAND UP MRI OF BOCA RATON, P.A. MAIN: 561-470-1890 9080 KIMBERLY BOULEVARD, SUITE 14 BOCA RATON, FL 33434 YOU ARE COMMANDED to produce without depositionand deliver by mail or fax do Compex Legal Services, Inc. located at,5481 W. Waters Ave. Suite 108, Tampa, Florida, 33634, Fax: 888-531-2922, after ten (10) days from the date of service of this subpoena, and to have with you at that time and place the following: ALL DOCUMENTS AND RECORDS STORED IN ANY FORMAT OR 1METHOD INCLUDING, BUT NOT LIMITED TO, ALL 1MEDICAL RECORDS, INTAKE FORMS, PATIENT COMPLETED FORMS AND/OR DOCUMENTS, CORRESPONDENCE, ALL OFFICE RECORDS, EMERGENCY ROOM RECORDS OR REPORTS, INPATIENT AND OUTPATIENT CHARTS AND RECORDS, LIEN FILES, SOAP NOTES, PATHOLOGY RECORDS AND REPORTS, LAB REPORTS, PHARMACY AND PRESCRIPTION RECORDS, PHYSICAL THERAPY RECORDS, SIGN-IN SHEETS, ALL DESCRIPTIONS OF EXERCISES PRESCRIBED, DOCUMENTATION WHICH INDICATE DATE AND TIME OF PATIENT'S APPOINTMENTS, INSURANCE DOCUMENTS, ALL RADIOLOGY REPORTS AND READINGS, AND ANY OTHER DOCUMENTS MAINTAINED PERTAINING TO THE CARE, TREATMENT AND EXAMINATION OF THE PATIENT; AND ALL ITEMIZED STATEMENTS OF THE BILLING CHARGES AND/OR CONSOLIDATED STATEMENT OF BENEFITS, WITH DIAGNOSTIC AND Page 1 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-004 TOTAL PAGES: 3 PROCEDURE CODES INCLUDING ALL CPT AND ICI)-9/ICD-10 CODING AND ALL HCFA, UB04 AND UB92 BILLS, TO INCLUDE THE TOTAL CHARGES PRIVATE OR GOVERNMENTAL; ANY AMOUNTS WRITTEN OFF BY THE PROVIDER, AND ANY AMOUNTS THAT ARE THE PATIENT'S RESPONSIBILITY AND EXPLANATION OF BENEFITS, PAYMENT HISTORY, RECORDS OF ANY LIENS, ANY INSURANCE BILLING OR PAYMENTS INFORMATION, EMERGENCY ROOM PIIYSICIANS BILLS AND RADIOLOGY BILLING FROM ALL SOURCES, TO INCLUDE ANY COMPUTER GENERATED BILLING OR BILLING STORED IN ANY FORMAT AND PAYMENT SOFTWARE THAT CONTAINS SAID INFORMATION; AND COPIES OF ALL ORIGINAL X-RAYS FILMS, CT SCANS, MRIS AND ANY OTHER SCANS ORIMAGES TAKEN AND/OR MAINTAINED, INCLUDING A COMPREHENSIVE LIST OF ALL DATES AND BODY PARTS OF ALL FILMS, CT SCANS, MRIS AND ALL OTHER IMAGES OR SCANS PROVIDED. ALL IMAGES AND FILMS MUST BE PROVIDED ON CD IF AVAILABLE. NADIA SOOKLAL ; DOB: SSN: IFCOPY CHARGES EXCEED $500.00 FOR THIS PATIENT, PLEASE CONTACT COMPEX LEGAL SERVICES, INC. AT 888-531-2919 WITH A LIST OF THE CHARGES INVOLVED IN OBTAINING THESE RECORDS BEFORE CREATING COPIES. These items will be inspectedand may be copied at that time. You will not be requiredto surrender the originalitems. You mav comply with this subpoena bv providing legible copies of the items to be produced to COMPEX LEGAL SERVICES, INC., the agent of the attornev whose name appears on this subpoena, on or before the scheduled date of production. "The records requested will be used for this litigation onlv and will be returned or destroved after litigation is complete.'" Please contact Compex Legal Services, Inc. directlyand send all Medical Records, Bills,Films, and all other items necessary for compliance to: COMPEX LEGAL SERVICES, INC. 5481 W. WATERS AVE. SUITE 108, TAMPA, FLORIDA, 33634 Tel: 888-531-2919, Fax: 888-531-2922 You may condition the preparationof the copiesupon the payment in advance of the reasonable cost ofpreparation.You have the rightto objectto the production pursuant to this subpoena at any time before production by giving written notice to the attorney whose name appears on this subpoena. THIS WILL NOT BE A DEPOSITION, NO TESTIMONY WILL BE TAKEN. If you fail to: (1) appear as specified;or (2) furnish the records instead of appearing as provided above; or (3) object to this subpoena, you may be in contempt of court. You are subpoenaed by the attorney whose name appears on this subpoena and unless excused from this subpoena by the attorney or the Court, you shall respond to this subpoena as directed. Page 2 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-004 TOTAL PAGES: 3 CERTIFICATE OF NOTICE Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 CFR Parts 160 and 164, I hereby certify that I have complied with the regulations and requirements to obtain patient health information and that the representations below are true and correct: 1. I have made a good faith attempt to provide written notice to the above-named patient, through counsel, of intent to obtain the patient's health information pursuant to this subpoena; 2. The written or proceeding in which notice provided sufficient information about this litigation the protected health information is requested to permit the patient to raise an objection to the court or administrative tribunal; and 3. The time of the patient to raise objections to the court or administrative tribunal has elapsed and (check one) No objections were filed;or All objections filed by the patient were resolved by the court or administrative tribunal and the disclosures being sought are consistent with such resolutions. Objection was filed but per agreement of counsel, objection has been resolved. ALEXANDRA M. DE MAIO, ESQ. Dated: Attorney for Defendant(s) LM General Insurance Company FL Bar No. 0048429 LAW OFFICE OF ROBERT P. KELLY P.O. BOX 7217 By: LONDON, KY 40742 For the Court Telephone: 813-868-8121 Page 3 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-005 TOTAL PAGES: 3 IN THE CIRCUIT COURT OF THE SEVENTEENTH JUDICIAL CIRCUIT IN AND FOR BROWARD COUNTY, FLORIDA NADIA SOOKLAL CASE NO. CACE-21-007718 Plaintiff(s), VS. LM GENERAL INSURANCE COMPANY Defendant(s), ' SUBPOENA DUCES TECUM FOR PRODUCTION OF DOCUMENTS THE STATE OF FLORIDA: TO: RECORDS CUSTODIAN FOR INTERVENTIONAL PAIN PHYSICIANS OF SOUTH FLORIDA MAIN: 954-722-6200 7447 NORTH UNIVERSITY DRIVE TAMARAC, FL 33321 YOU ARE COMMANDED to produce without depositionand deliver by mail or fax do Compex Legal Services, Inc. located at,5481 W. Waters Ave. Suite 108, Tampa, Florida, 33634, Fax: 888-531-2922, after ten (10) days from the date of service of this subpoena, and to have with you at that time and place the following: INCLUDE RECORDS OF TREATMENT RENDERED BY: ALAN SIEGEL, MD ALL DOCUMENTS AND RECORDS STORED IN ANY FORMAT OR 1METHOD INCLUDING, BUT NOT LIMITED TO, ALL 1MEDICAL RECORDS, INTAKE FORMS, PATIENT COMPLETED FORMS AND/OR DOCUMENTS, CORRESPONDENCE, ALL OFFICE RECORDS, EMERGENCY ROOM RECORDS OR REPORTS, INPATIENT AND OUTPATIENT CHARTS AND RECORDS, LIEN FILES, SOAP NOTES, PATHOLOGY RECORDS AND REPORTS, LAB REPORTS, PHARMACY AND PRESCRIPTION RECORDS, PHYSICAL THERAPY RECORDS, SIGN-IN SHEETS, ALL DESCRIPTIONS OF EXERCISES PRESCRIBED, DOCUMENTATION WHICH INDICATE DATE AND TIME OF PATIENT'S APPOINTMENTS, INSURANCE DOCUMENTS, ALL RADIOLOGY REPORTS AND READINGS, AND ANY OTHER DOCUMENTS MAINTAINED PERTAINING TO THE CARE, TREATMENT AND EXAMINATION OF THE PATIENT; AND Page 1 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-005 TOTAL PAGES: 3 ALL ITEMIZED STATEMENTS OF THE BILLING CHARGES AND/OR CONSOLIDATED STATEMENT OF BENEFITS, WITH DIAGNOSTIC AND PROCEDURE CODES INCLUDING ALL CPT AND ICD-9/ICD-10 CODING AND ALL HCFA, UB04 AND UB92 BILLS, TO INCLUDE THE TOTAL CHARGES PRIVATE OR GOVERNMENTAL; ANY AMOUNTS WRITTEN OFF BY THE PROVIDER, AND ANY AMOUNTS THAT ARE THE PATIENT'S RESPONSIBILITY AND EXPLANATION OF BENEFITS, PAYMENT HISTORY, RECORDS OF ANY LIENS, ANY INSURANCE BILLING OR PAYMENTS INFORMATION, EMERGENCY ROOM PIIYSICIANS BILLS AND RADIOLOGY BILLING FROM ALL SOURCES, TO INCLUDE ANY COMPUTER GENERATED BILLING OR BILLING STORED IN ANY FORMAT AND PAYMENT SOFTWARE THAT CONTAINS SAID INFORMATION; AND COPIES OF ALL ORIGINAL X-RAYS FILMS, CT SCANS, MRIS AND ANY OTHER SCANS ORIMAGES TAKEN AND/OR MAINTAINED, INCLUDING A COMPREHENSIVE LIST OF ALL DATES AND BODY PARTS OF ALL FILMS, CT SCANS, MRIS AND ALL OTHER IMAGES OR SCANS PROVIDED. ALL IMAGES AND FILMS MUST BE PROVIDED ON CD IF AVAILABLE. NADIA SOOKLAL ; DOB: SSN: IFCOPY CHARGES EXCEED $500.00 FOR THIS PATIENT, PLEASE CONTACT COMPEX LEGAL SERVICES, INC. AT 888-531-2919 WITH A LIST OF THE CHARGES INVOLVED IN OBTAINING THESE RECORDS BEFORE CREATING COPIES. These items will be inspectedand may be copied at that time. You will not be requiredto surrender the originalitems. You mav comply with this subpoena bv providing legible copies of the items to be produced to COMPEX LEGAL SERVICES, INC., the agent of the attornev whose name appears on this subpoena, on or before the scheduled date of production. "The records requested will be used for this litigation onlv and will be returned or destroved after litigation is complete.'" Please contact Compex Legal Services, Inc. directlyand send all Medical Records, Bills,Films, and all other items necessary for compliance to: COMPEX LEGAL SERVICES, INC. 5481 W. WATERS AVE. SUITE 108, TAMPA, FLORIDA, 33634 Tel: 888-531-2919, Fax: 888-531-2922 You may condition the preparationof the copies upon the payment in advance of the reasonable cost ofpreparation.You have the rightto objectto the production pursuant to this subpoena at any time before productionby givingwritten notice to the attorney whose name appears on this subpoena. THIS WILL NOT BE A DEPOSITION, NO TESTIMONY WILL BE TAKEN. If you fail to: (1) appear as specified;or (2) furnish the records instead of appearing as provided above; or (3) object to this subpoena, you may be in contempt of court. You are subpoenaed by the attorney whose name appears on this subpoena and unless excused from this subpoena by the attorney or the Court, you shall respond to this subpoena as directed. Page 2 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-005 TOTAL PAGES: 3 CERTIFICATE OF NOTICE Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 CFR Parts 160 and 164, I hereby certify that I have complied with the regulations and requirements to obtain patient health information and that the representations below are true and correct: 1. I have made a good faith attempt to provide written notice to the above-named patient, through counsel, of intent to obtain the patient's health information pursuant to this subpoena; 2. The written or proceeding in which notice provided sufficient information about this litigation the protected health information is requested to permit the patient to raise an objection to the court or administrative tribunal; and 3. The time of the patient to raise objections to the court or administrative tribunal has elapsed and (check one) No objections were filed;or All objections filed by the patient were resolved by the court or administrative tribunal and the disclosures being sought are consistent with such resolutions. Objection was filed but per agreement of counsel, objection has been resolved. ALEXANDRA M. DE MAIO, ESQ. Dated: Attorney for Defendant(s) LM General Insurance Company FL Bar No. 0048429 LAW OFFICE OF ROBERT P. KELLY P.O. BOX 7217 By: LONDON, KY 40742 For the Court Telephone: 813-868-8121 Page 3 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-006 TOTAL PAGES: 3 IN THE CIRCUIT COURT OF THE SEVENTEENTH JUDICIAL CIRCUIT IN AND FOR BROWARD COUNTY, FLORIDA NADIA SOOKLAL CASE NO. CACE-21-007718 Plaintiff(s), VS. LM GENERAL INSURANCE COMPANY Defendant(s), ' SUBPOENA DUCES TECUM FOR PRODUCTION OF DOCUMENTS THE STATE OF FLORIDA: TO: RECORDS CUSTODIAN FOR ORTHOPAEDIC CENTER OF SOUTH FLORIDA MAIN: 954-473-6344, B: 954-473-9779, F:954-473-6344 600 SOUTH PINE ISLAND ROAD, SUITE 300 PLANTATION, FL 33324 YOU ARE COMMANDED to produce without depositionand deliver by mail or fax do Compex Legal Services, Inc. located at, 5481 W. Waters Ave. Suite 108, Tampa, Florida, 33634, Fax: 888-531-2922, after ten (10) days from the date of service of this subpoena, and to have with you at that time and place the following: ALL DOCUMENTS AND RECORDS STORED IN ANY FORMAT OR 1METHOD INCLUDING, BUT NOT LIMITED TO, ALL 1MEDICAL RECORDS, INTAKE FORMS, PATIENT COMPLETED FORMS AND/OR DOCUMENTS, CORRESPONDENCE, ALL OFFICE RECORDS, EMERGENCY ROOM RECORDS OR REPORTS, INPATIENT AND OUTPATIENT CHARTS AND RECORDS, LIEN FILES, SOAP NOTES, PATHOLOGY RECORDS AND REPORTS, LAB REPORTS, PHARMACY AND PRESCRIPTION RECORDS, PHYSICAL THERAPY RECORDS, SIGN-IN SHEETS, ALL DESCRIPTIONS OF EXERCISES PRESCRIBED, DOCUMENTATION WHICH INDICATE DATE AND TIME OF PATIENT'S APPOINTMENTS, INSURANCE DOCUMENTS, ALL RADIOLOGY REPORTS AND READINGS, AND ANY OTHER DOCUMENTS MAINTAINED PERTAINING TO THE CARE, TREATMENT AND EXAMINATION OF THE PATIENT; AND ALL ITEMIZED STATEMENTS OF THE BILLING CHARGES AND/OR Page 1 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-006 TOTAL PAGES: 3 CONSOLIDATED STATEMENT OF BENEFITS, WITH DIAGNOSTIC AND PROCEDURE CODES INCLUDING ALL CPT AND ICD-9/ICD-10 CODING AND ALL HCFA, UB04 AND UB92 BILLS, TO INCLUDE THE TOTAL CHARGES PRIVATE OR GOVERNMENTAL; ANY AMOUNTS WRITTEN OFF BY THE PROVIDER, AND ANY AMOUNTS THAT ARE THE PATIENT'S RESPONSIBILITY AND EXPLANATION OF BENEFITS, PAYMENT HISTORY, RECORDS OF ANY LIENS, ANY INSURANCE BILLING OR PAYMENTS INFORMATION, EMERGENCY ROOM PIIYSICIANS BILLS AND RADIOLOGY BILLING FROM ALL SOURCES, TO INCLUDE ANY COMPUTER GENERATED BILLING OR BILLING STORED IN ANY FORMAT AND PAYMENT SOFTWARE THAT CONTAINS SAID INFORMATION; AND COPIES OF ALL ORIGINAL X-RAYS FILMS, CT SCANS, MRIS AND ANY OTHER SCANS ORIMAGES TAKEN AND/OR MAINTAINED, INCLUDING A COMPREHENSIVE LIST OF ALL DATES AND BODY PARTS OF ALL FILMS, CT SCANS, MRIS AND ALL OTHER IMAGES OR SCANS PROVIDED. ALL IMAGES AND FILMS MUST BE PROVIDED ON CD IF AVAILABLE. NADIA SOOKLAL ; DOB: SSN: IFCOPY CHARGES EXCEED $500.00 FOR THIS PATIENT, PLEASE CONTACT COMPEX LEGAL SERVICES, INC. AT 888-531-2919 WITH A LIST OF THE CHARGES INVOLVED IN OBTAINING THESE RECORDS BEFORE CREATING COPIES. These items will be inspectedand may be copied at that time. You will not be requiredto surrender the originalitems. You mav comply with this subpoena bv providing legible copies of the items to be produced to COMPEX LEGAL SERVICES, INC., the agent of the attornev whose name appears on this subpoena, on or before the scheduled date of production. "The records requested will be used for this litigation onlv and will be " returned or destroved after litigation is complete.' Please contact Compex Legal Services, Inc. directlyand send all Medical Records, Bills,Films, and all other items necessary for compliance to: COMPEX LEGAL SERVICES, INC. 5481 W. WATERS AVE. SUITE 108, TAMPA, FLORIDA, 33634 Tel: 888-531-2919, Fax: 888-531-2922 You may condition the preparationof the copiesupon the payment in advance of the reasonable cost ofpreparation.You have the rightto objectto the production pursuant to this subpoena at any time before production by giving written notice to the attorney whose name appears on this subpoena. THIS WILL NOT BE A DEPOSITION, NO TESTIMONY WILL BE TAKEN. or (2) furnish the records instead of appearing as provided If you fail to: (1) appear as specified; above; or (3) objectto this subpoena, you may be in contempt of court. You are subpoenaed by the attorney whose name appears on this subpoena and unless excused from this subpoena by the attorney or the Court, you shall respond to this subpoena as directed. Page 2 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-006 TOTAL PAGES: 3 CERTIFICATE OF NOTICE Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 CFR Parts 160 and 164, I hereby certify that I have complied with the regulations and requirements to obtain patient health information and that the representations below are true and correct: 1. I have made a good faith attempt to provide written notice to the above-named patient, through counsel, of intent to obtain the patient's health information pursuant to this subpoena; 2. The written or proceeding in which notice provided sufficient information about this litigation the protected health information is requested to permit the patient to raise an objection to the court or administrative tribunal; and 3. The time of the patient to raise objections to the court or administrative tribunal has elapsed and (check one) No objections were filed;or All objections filed by the patient were resolved by the court or administrative tribunal and the disclosures being sought are consistent with such resolutions. Objection was filed but per agreement of counsel, objection has been resolved. ALEXANDRA M. DE MAIO, ESQ. Dated: Attorney for Defendant(s) LM General Insurance Company FL Bar No. 0048429 LAW OFFICE OF ROBERT P. KELLY P.O. BOX 7217 By: LONDON, KY 40742 For the Court Telephone: 813-868-8121 Page 3 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-007 TOTAL PAGES: 3 IN THE CIRCUIT COURT OF THE SEVENTEENTH JUDICIAL CIRCUIT IN AND FOR BROWARD COUNTY, FLORIDA NADIA SOOKLAL CASE NO. CACE-21-007718 Plaintiff(s), VS. LM GENERAL INSURANCE COMPANY Defendant(s), ' SUBPOENA DUCES TECUM FOR PRODUCTION OF DOCUMENTS THE STATE OF FLORIDA: TO: RECORDS CUSTODIAN FOR ALEYDA M. BORGE, MD 954-252-8797 9710 STIRLING RD HOLLYWOOD, FL 33024 YOU ARE COMMANDED to produce without depositionand deliver by mail or fax do Compex Legal Services, Inc. located at,5481 W. Waters Ave. Suite 108, Tampa, Florida, 33634, Fax: 888-531-2922, after ten (10) days from the date of service of this subpoena, and to have with you at that time and place the following: ALL DOCUMENTS AND RECORDS STORED IN ANY FORMAT OR 1METHOD INCLUDING, BUT NOT LIMITED TO, ALL 1MEDICAL RECORDS, INTAKE FORMS, PATIENT COMPLETED FORMS AND/OR DOCUMENTS, CORRESPONDENCE, ALL OFFICE RECORDS, EMERGENCY ROOM RECORDS OR REPORTS, INPATIENT AND OUTPATIENT CHARTS AND RECORDS, LIEN FILES, SOAP NOTES, PATHOLOGY RECORDS AND REPORTS, LAB REPORTS, PHARMACY AND PRESCRIPTION RECORDS, PHYSICAL THERAPY RECORDS, SIGN-IN SHEETS, ALL DESCRIPTIONS OF EXERCISES PRESCRIBED, DOCUMENTATION WHICH INDICATE DATE AND TIME OF PATIENT'S APPOINTMENTS, INSURANCE DOCUMENTS, ALL RADIOLOGY REPORTS AND READINGS, AND ANY OTHER DOCUMENTS MAINTAINED PERTAINING TO THE CARE, TREATMENT AND EXAMINATION OF THE PATIENT; AND ALL ITEMIZED STATEMENTS OF THE BILLING CHARGES AND/OR CONSOLIDATED STATEMENT OF BENEFITS, WITH DIAGNOSTIC AND Page 1 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-007 TOTAL PAGES: 3 PROCEDURE CODES INCLUDING ALL CPT AND ICI)-9/ICD-10 CODING AND ALL HCFA, UB04 AND UB92 BILLS, TO INCLUDE THE TOTAL CHARGES PRIVATE OR GOVERNMENTAL; ANY AMOUNTS WRITTEN OFF BY THE PROVIDER, AND ANY AMOUNTS THAT ARE THE PATIENT'S RESPONSIBILITY AND EXPLANATION OF BENEFITS, PAYMENT HISTORY, RECORDS OF ANY LIENS, ANY INSURANCE BILLING OR PAYMENTS INFORMATION, EMERGENCY ROOM PIIYSICIANS BILLS AND RADIOLOGY BILLING FROM ALL SOURCES, TO INCLUDE ANY COMPUTER GENERATED BILLING OR BILLING STORED IN ANY FORMAT AND PAYMENT SOFTWARE THAT CONTAINS SAID INFORMATION; AND COPIES OF ALL ORIGINAL X-RAYS FILMS, CT SCANS, MRIS AND ANY OTHER SCANS ORIMAGES TAKEN AND/OR MAINTAINED, INCLUDING A COMPREHENSIVE LIST OF ALL DATES AND BODY PARTS OF ALL FILMS, CT SCANS, MRIS AND ALL OTHER IMAGES OR SCANS PROVIDED. ALL IMAGES AND FILMS MUST BE PROVIDED ON CD IF AVAILABLE. NADIA SOOKLAL ; DOB: SSN: IFCOPY CHARGES EXCEED $500.00 FOR THIS PATIENT, PLEASE CONTACT COMPEX LEGAL SERVICES, INC. AT 888-531-2919 WITH A LIST OF THE CHARGES INVOLVED IN OBTAINING THESE RECORDS BEFORE CREATING COPIES. These items will be inspectedand may be copied at that time. You will not be requiredto surrender the originalitems. You mav comply with this subpoena bv providing legible copies of the items to be produced to COMPEX LEGAL SERVICES, INC., the agent of the attornev whose name appears on this subpoena, on or before the scheduled date of production. "The records requested will be used for this litigation onlv and will be returned or destroved after litigation is complete.'" Please contact Compex Legal Services, Inc. directlyand send all Medical Records, Bills,Films, and all other items necessary for compliance to: COMPEX LEGAL SERVICES, INC. 5481 W. WATERS AVE. SUITE 108, TAMPA, FLORIDA, 33634 Tel: 888-531-2919, Fax: 888-531-2922 You may condition the preparationof the copiesupon the payment in advance of the reasonable cost ofpreparation.You have the rightto objectto the production pursuant to this subpoena at any time before production by giving written notice to the attorney whose name appears on this subpoena. THIS WILL NOT BE A DEPOSITION, NO TESTIMONY WILL BE TAKEN. If you fail to: (1) appear as specified;or (2) furnish the records instead of appearing as provided above; or (3) object to this subpoena, you may be in contempt of court. You are subpoenaed by the attorney whose name appears on this subpoena and unless excused from this subpoena by the attorney or the Court, you shall respond to this subpoena as directed. Page 2 of 3 CLAIM NO.: 043927022-0007 ORDER #: FL0171978-007 TOTAL PAGES: 3 CERTIFICATE OF NOTICE Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 CFR Parts 160 and 164, I hereby certify that I have complied with the regulations and requirements to obtain patient health information and that the representations below are true and correct: 1. I have made a good faith attempt to provide written notice to the above-named patient, through counsel, of intent to obtain the patient's health information pursuant to this subpoena; 2. The written or proceeding in which notice provided sufficient information about this litigation the protected health information is requested to permit the patient to raise an objection to the court or administrative tribunal; and 3. The time of the patient to raise objections to the court or administrative tribunal has elapsed and (check one) No objections were filed;or