Preview
FILED: KINGS COUNTY CLERK 10/13/2020 05:55 PM INDEX NO. 514351/2019
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 10/13/2020
EXHIBIT A
FILED: KINGS COUNTY CLERK 10/13/2020 05:55 PM INDEX NO. 514351/2019
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 10/13/2020
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
-------------------------------------------------------------------X
ARIADN1 CORDERO,
Plaintiff, Index No.: 514351/2019
-against- SUPPLEMENTAL
RESPONSE TO
HP MARCUS GARVEY PRESERVATION PRELIMINARY
HOUSING COMPANY, INC. and C&C CONFERENCE ORDER
APARTMENT MANAGEMENT, LLC,
Defendants.
___.-----------------------------------------------------------------X
Plaintiff, ARIADNI CORDERO, by her attorneys, ELEFTERAKIS, ELEFTERAKlS &
PANEK, as and for a response to the Preliminary Conference Order, sets forth:
IX. OTHER DISCLOSURE
Gynecology/Pregnancy records: Enclosed herein is a duly executed authorization to
obtain Plaintiff's gynecology/pregnancy records from Dr. Shawn I.Yunaev.
PLEASE TAKE FURTHER NOTICE that Plaintiff reserves her right to amend and/or
supplement the above responses, up to and including the time of trial, ifand when additional
information becomes available
Dated: New York, New York
October 13, 2020
Yours, etc.,
ELEFTERAKIS, ELEFTERAKIS & PANEK
Aika Danayeva, Esq.
Attorneys for Plaintrff
380'
80 Pine Street, Floor
New York, New York 10005
FILED: KINGS COUNTY CLERK 10/13/2020 05:55 PM INDEX NO. 514351/2019
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 10/13/2020
TO: GOLDBERG SEGALIA LLP
Attorneys for Defendants,
HP MARCUS GARVEY PRESERVATION
HOUSING COMPANY, INC. and
C&C APARTMENT MANAGEMENT, LLC
200 Garden City Plaza, Suite 520
Garden City, NY I1530
FILED: KINGS COUNTY CLERK 10/13/2020 05:55 PM INDEX NO. 514351/2019
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 10/13/2020
OCA OfficialForm No.:960
AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA
[This form has been approved by the New York State Department of Health]
Patient Name Date of Birth umber
Patient Address
Elefterakis & Street 38* New New York 10005
c/o Elefterakis, Panek, 80 Pine Floor, York,
I,or my authorized representative,request that healthinformation regarding my care and treatment be released as set forthon thisform:
In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996
(HIPAA), I understand that:
1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH
except and CONFIDENTIAL HIV* RELATED INFORMATION ifI place initials
on
TREATMENT. psychotherapy notes, only my
the appropriate linein Item 9(a). In theevent the health information described below includes any of these types ofinformation, and 1
initial
the lineon the box in Item 9(a),I authorize
specifically release of such information tothe person(s) indicated in Item 8.
2. If Iam authorizing the release of HIV-related, alcohol or drug treatment, or mental health treatment information, the recipient is
prohibited from redisclosing such information without my authorizationunless permitted todo so under federalor statelaw. I understand
that I have theright torequest a listofpeople who may receive or use my HIV-related information without authorization. IfI experience
discrimination because of the release or disclosure of HIV-related information, I may contact the New York StateDivision of Human
Rights at (212) 480-2493 or the New York City Commission of Human Rights at(212) 306-7450. These agencies are responsible for
protecting my rights.
3. Ihave the rightto revoke thisauthorization atany time by writing to the health care provider listed below. I understand that Imay
revoke thisauthorization except to theextent thataction has already been taken based on thisauthorization.
4. Iunderstand thatsigning thisauthorization isvoluntary. My treatment, payment, enrollment ina health plan,or eligibilityforbenefits
willnot be conditioned upon my authorization of thisdisclosure.
5. Infounation disclosed under this authorization might be redisclosed by the recipient(except as noted above in Item 2), and this
redisclosuremay no longer be protected by federal orstate law.
6. THIS AUTHOR1ZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL
CARE WITH ANYONE OTHER THEN THE ATTORNEY OR GOVERNMENTAL AGENCY SPEIFIED IN ITEM 9 (b).
7. Name and address of healthprovider or entityto releasethis information:
Shawn I Yanayev MD., 6410 Veteran Ave, Suite 103 Brooklyn, NY 11234
8.Name and address of person(s) or category of person to whom thisinformation willbe sent:
Goldberg Segalla LLP, 200 Garden City Plaza, Suite 520, Garden City, New York 11530
9(a). Specificinformation to be released:
Medical Record from (2/7/2014) to(Present)
Entire Medical Record, including patient office
histories, notes (except psychotherapy notes),testresults,radiology studies,films,
referrals,consults,billingrecords, insurance records, and records sent toyou by other healthcare providers.
. Include: (Indicateby Initialing)
Other: also include any diagnostic film(s)and report(s), any
billingrecords from 2/7/2014 topresent
Mental Health Information
HIV-Related Information
Authorization to Discuss Health Information
O By here
initialing I authorize
Initials
to discussmy health information with my attorney,or a governmental agency, listhere:
10. Reason for releaseof infonnation: 11. Date or event on which thisauthorization will expire:
At request of individual End of Litigation
Other: Litigation
13. on patient·
12.Ifnot the patient,name of pe)son signing fonn: Authority tosign behalf of
Aika Danayeva, Esq. y Power of Attorney
All items on thisform have been completed and my questions about thisform have b n an tered.In addition,I have been provided a
copy ofthe form.
Date:
Signature of patien r representative authorized by law.
* Human Virus thatcauses AIDS. The New York State Public Health Law protects information which
Immunodgfipfency reasonably
could identifysomeoñe as havinp,HIV symptoms or infectionand information regarding a person'scontacts.
FILED: KINGS COUNTY CLERK 10/13/2020 05:55 PM INDEX NO. 514351/2019
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 10/13/2020
To Execute lHPAA Medical Record Authorizedon Forms Pesenat to NY Pablic¥rmalth Imw Seedon
Do hereby appointy
38° ELE3TERAKIS, EI2FTERAIDS & PA EE, P.C. with ofBoes
Street, New at80 Pine
Floor, York, NY 10005, my attomeys-in-fact io act (cach agent
my name, place sad may act in
stead in any which I sepmately)
way myself could do, ifI were
HIPAA medical record personally present to execute
suthorization forms pursuant to NY Public WeaNh
amended 03/0649.
Law Section 18 as
(1)(G)
ELEBTERAIGS, ELEFTERAKIB & PANEK, P.C. is also auf borize
written request for to eseenge a
my bealth infoonation under NY PabBe Washh Imw Section 18. This
Attomeymay be revoked me Power of
by at any tima This Power
or ofAttomey shellnotbe affected
disability incompetence. bymy subsequent
To induce thhd
any party to act I
hereunder, hereby agree that any third
executed copy orfacrimile of party receiving a daly
thisinstrument act hereunder,
may and that levocation or
shallbe ineffbetive as fanninarian hereof
to such third unless and
party untilactusi notice or knowledge
ennninavian of such revocation er
shallhave been received such third
by party,and I formyself and for
reprnaantatives, and my heirs,executors, legal
assigns, hereby agree to and hold
insannify harmless any such thhd
against any and allclaims party fmm and
thatmay ariseapinst such third
on partyby reason of such third
the provisions of thisinstrmnane party having relied
In Witness Whereof Ihave herenato signed a
my name of
day
13
(Patient'sSignature)
. Esq.
ACENOWLEDGEMENT
State ofNew York
)
Comuty of
)ss:
On of .
day 201 bedbre me
|‰dn t und au> .
came
thenndersigned, personally appeared
evÈence to be the kno.m.b.,r-dame-thebasisorsadarammy
indi-ddaal whose name is subsodbed to the within instrument and
f buthe she exeonted the acknowledged to me
same in his/her
individual, or the person who acted
capacity, and that by hia%cr alW on the
instrument, the
on behalf of the the instrument and that
individual-mado ch appearance such
before thenndersigned at , New York.
P3b][c
J ANICE 0.RODRIGUEZ
NOTARYPUBLIC-STATEOF
NEW YORK
No. 01 R06301849
Qualified
m Richmond
County
My CommesesonExpkes
04-28-2022
FILED: KINGS COUNTY CLERK 10/13/2020 05:55 PM INDEX NO. 514351/2019
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 10/13/2020
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
___..____ ___--------------------------------------X
ARIADNI CORDERO,
Plaintiff, Index No.: 514351/2019
-against- AFFIRMATION OF
SERVICE
HP MARCUS GARVEY PRESERVATION
HOUSING COMPANY, INC. and C&C
APARTMENT MANAGEMENT, LLC,
Defendants.
_____...---------------- -----¬-----------------X
I, Aika Danayeva, Esq., an attomey duly admitted to practice law in the State of New
York, do affirm under the penalty of perjury: I am not a party to the action, am over 18 years of
age and reside in Kings County, in the State of New York.
On October 13, 2020, I served a SUPPLEMENTAL RESPONSE TO PRELIMINARY
CONFERENCE ORDER, on Defendants true copies thereof enclosed in a post-
by depositing
paid wrapper, in an official depository under the exclusive care and custody of the U.S. Postal
Service within New York State, via regular mail, addressed to the following:
GOLDBERG SEGALIA LLP
Attorneys for Defendants,
HP MARCUS GARVEY PRESERVATION HOUSING COMPANY, INC. and C&C
APARTMENT MANAGEMENT, LLC
200 Garden City Plaza, Suite 520
Garden City, NY 11530
Aika Danayeva, Esq.
FILED: KINGS COUNTY CLERK 10/13/2020 05:55 PM INDEX NO. 514351/2019
NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 10/13/2020
Index No.: 514351 Year 2019
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
ARIADNI CORDERO,
Plaintiff,
-against-
HP MARCUS GARVEY PRESERVATION HOUSING COMPANY, INC. and C&C
APARTMENT MANAGEMENT, LLC,
Defendants.
SUPPLEMENTAL RESPONSE TO PRELIMINARY CONFERENCE ORDER
ELEFTERAKIS, ELEFTERAKIS & PANEK
Attorneys for Plaintsff
38*
80 Pine Street, Floor
New York, New York 10005
(212) 532-1116
To
Attorney(s) for
Service of a copy of the within is hereby admitted
Dated:
Attorney(s) for
DPLEASE TAKE NOTICE that the within is a true copy of an Order signed by
the Honorable
that was entered in the office of the clerk of the within named Court on
NOTICE OF ENTRY
O that an Order of which the within is a true copy will be presented for s ment to the
, one of the judges of the within named Court for signature
on
Dated: New York, NY
NOTICE OF SETTLEMENT
Preview
FILED: KINGS COUNTY CLERK 10/13/2020 05:55 PM INDEX NO. 514351/2019 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 10/13/2020 EXHIBIT A FILED: KINGS COUNTY CLERK 10/13/2020 05:55 PM INDEX NO. 514351/2019 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 10/13/2020 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS -------------------------------------------------------------------X ARIADN1 CORDERO, Plaintiff, Index No.: 514351/2019 -against- SUPPLEMENTAL RESPONSE TO HP MARCUS GARVEY PRESERVATION PRELIMINARY HOUSING COMPANY, INC. and C&C CONFERENCE ORDER APARTMENT MANAGEMENT, LLC, Defendants. ___.-----------------------------------------------------------------X Plaintiff, ARIADNI CORDERO, by her attorneys, ELEFTERAKIS, ELEFTERAKlS & PANEK, as and for a response to the Preliminary Conference Order, sets forth: IX. OTHER DISCLOSURE Gynecology/Pregnancy records: Enclosed herein is a duly executed authorization to obtain Plaintiff's gynecology/pregnancy records from Dr. Shawn I.Yunaev. PLEASE TAKE FURTHER NOTICE that Plaintiff reserves her right to amend and/or supplement the above responses, up to and including the time of trial, ifand when additional information becomes available Dated: New York, New York October 13, 2020 Yours, etc., ELEFTERAKIS, ELEFTERAKIS & PANEK Aika Danayeva, Esq. Attorneys for Plaintrff 380' 80 Pine Street, Floor New York, New York 10005 FILED: KINGS COUNTY CLERK 10/13/2020 05:55 PM INDEX NO. 514351/2019 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 10/13/2020 TO: GOLDBERG SEGALIA LLP Attorneys for Defendants, HP MARCUS GARVEY PRESERVATION HOUSING COMPANY, INC. and C&C APARTMENT MANAGEMENT, LLC 200 Garden City Plaza, Suite 520 Garden City, NY I1530 FILED: KINGS COUNTY CLERK 10/13/2020 05:55 PM INDEX NO. 514351/2019 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 10/13/2020 OCA OfficialForm No.:960 AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA [This form has been approved by the New York State Department of Health] Patient Name Date of Birth umber Patient Address Elefterakis & Street 38* New New York 10005 c/o Elefterakis, Panek, 80 Pine Floor, York, I,or my authorized representative,request that healthinformation regarding my care and treatment be released as set forthon thisform: In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), I understand that: 1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH except and CONFIDENTIAL HIV* RELATED INFORMATION ifI place initials on TREATMENT. psychotherapy notes, only my the appropriate linein Item 9(a). In theevent the health information described below includes any of these types ofinformation, and 1 initial the lineon the box in Item 9(a),I authorize specifically release of such information tothe person(s) indicated in Item 8. 2. If Iam authorizing the release of HIV-related, alcohol or drug treatment, or mental health treatment information, the recipient is prohibited from redisclosing such information without my authorizationunless permitted todo so under federalor statelaw. I understand that I have theright torequest a listofpeople who may receive or use my HIV-related information without authorization. IfI experience discrimination because of the release or disclosure of HIV-related information, I may contact the New York StateDivision of Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at(212) 306-7450. These agencies are responsible for protecting my rights. 3. Ihave the rightto revoke thisauthorization atany time by writing to the health care provider listed below. I understand that Imay revoke thisauthorization except to theextent thataction has already been taken based on thisauthorization. 4. Iunderstand thatsigning thisauthorization isvoluntary. My treatment, payment, enrollment ina health plan,or eligibilityforbenefits willnot be conditioned upon my authorization of thisdisclosure. 5. Infounation disclosed under this authorization might be redisclosed by the recipient(except as noted above in Item 2), and this redisclosuremay no longer be protected by federal orstate law. 6. THIS AUTHOR1ZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THEN THE ATTORNEY OR GOVERNMENTAL AGENCY SPEIFIED IN ITEM 9 (b). 7. Name and address of healthprovider or entityto releasethis information: Shawn I Yanayev MD., 6410 Veteran Ave, Suite 103 Brooklyn, NY 11234 8.Name and address of person(s) or category of person to whom thisinformation willbe sent: Goldberg Segalla LLP, 200 Garden City Plaza, Suite 520, Garden City, New York 11530 9(a). Specificinformation to be released: Medical Record from (2/7/2014) to(Present) Entire Medical Record, including patient office histories, notes (except psychotherapy notes),testresults,radiology studies,films, referrals,consults,billingrecords, insurance records, and records sent toyou by other healthcare providers. . Include: (Indicateby Initialing) Other: also include any diagnostic film(s)and report(s), any billingrecords from 2/7/2014 topresent Mental Health Information HIV-Related Information Authorization to Discuss Health Information O By here initialing I authorize Initials to discussmy health information with my attorney,or a governmental agency, listhere: 10. Reason for releaseof infonnation: 11. Date or event on which thisauthorization will expire: At request of individual End of Litigation Other: Litigation 13. on patient· 12.Ifnot the patient,name of pe)son signing fonn: Authority tosign behalf of Aika Danayeva, Esq. y Power of Attorney All items on thisform have been completed and my questions about thisform have b n an tered.In addition,I have been provided a copy ofthe form. Date: Signature of patien r representative authorized by law. * Human Virus thatcauses AIDS. The New York State Public Health Law protects information which Immunodgfipfency reasonably could identifysomeoñe as havinp,HIV symptoms or infectionand information regarding a person'scontacts. FILED: KINGS COUNTY CLERK 10/13/2020 05:55 PM INDEX NO. 514351/2019 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 10/13/2020 To Execute lHPAA Medical Record Authorizedon Forms Pesenat to NY Pablic¥rmalth Imw Seedon Do hereby appointy 38° ELE3TERAKIS, EI2FTERAIDS & PA EE, P.C. with ofBoes Street, New at80 Pine Floor, York, NY 10005, my attomeys-in-fact io act (cach agent my name, place sad may act in stead in any which I sepmately) way myself could do, ifI were HIPAA medical record personally present to execute suthorization forms pursuant to NY Public WeaNh amended 03/0649. Law Section 18 as (1)(G) ELEBTERAIGS, ELEFTERAKIB & PANEK, P.C. is also auf borize written request for to eseenge a my bealth infoonation under NY PabBe Washh Imw Section 18. This Attomeymay be revoked me Power of by at any tima This Power or ofAttomey shellnotbe affected disability incompetence. bymy subsequent To induce thhd any party to act I hereunder, hereby agree that any third executed copy orfacrimile of party receiving a daly thisinstrument act hereunder, may and that levocation or shallbe ineffbetive as fanninarian hereof to such third unless and party untilactusi notice or knowledge ennninavian of such revocation er shallhave been received such third by party,and I formyself and for reprnaantatives, and my heirs,executors, legal assigns, hereby agree to and hold insannify harmless any such thhd against any and allclaims party fmm and thatmay ariseapinst such third on partyby reason of such third the provisions of thisinstrmnane party having relied In Witness Whereof Ihave herenato signed a my name of day 13 (Patient'sSignature) . Esq. ACENOWLEDGEMENT State ofNew York ) Comuty of )ss: On of . day 201 bedbre me |‰dn t und au> . came thenndersigned, personally appeared evÈence to be the kno.m.b.,r-dame-thebasisorsadarammy indi-ddaal whose name is subsodbed to the within instrument and f buthe she exeonted the acknowledged to me same in his/her individual, or the person who acted capacity, and that by hia%cr alW on the instrument, the on behalf of the the instrument and that individual-mado ch appearance such before thenndersigned at , New York. P3b][c J ANICE 0.RODRIGUEZ NOTARYPUBLIC-STATEOF NEW YORK No. 01 R06301849 Qualified m Richmond County My CommesesonExpkes 04-28-2022 FILED: KINGS COUNTY CLERK 10/13/2020 05:55 PM INDEX NO. 514351/2019 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 10/13/2020 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS ___..____ ___--------------------------------------X ARIADNI CORDERO, Plaintiff, Index No.: 514351/2019 -against- AFFIRMATION OF SERVICE HP MARCUS GARVEY PRESERVATION HOUSING COMPANY, INC. and C&C APARTMENT MANAGEMENT, LLC, Defendants. _____...---------------- -----¬-----------------X I, Aika Danayeva, Esq., an attomey duly admitted to practice law in the State of New York, do affirm under the penalty of perjury: I am not a party to the action, am over 18 years of age and reside in Kings County, in the State of New York. On October 13, 2020, I served a SUPPLEMENTAL RESPONSE TO PRELIMINARY CONFERENCE ORDER, on Defendants true copies thereof enclosed in a post- by depositing paid wrapper, in an official depository under the exclusive care and custody of the U.S. Postal Service within New York State, via regular mail, addressed to the following: GOLDBERG SEGALIA LLP Attorneys for Defendants, HP MARCUS GARVEY PRESERVATION HOUSING COMPANY, INC. and C&C APARTMENT MANAGEMENT, LLC 200 Garden City Plaza, Suite 520 Garden City, NY 11530 Aika Danayeva, Esq. FILED: KINGS COUNTY CLERK 10/13/2020 05:55 PM INDEX NO. 514351/2019 NYSCEF DOC. NO. 53 RECEIVED NYSCEF: 10/13/2020 Index No.: 514351 Year 2019 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS ARIADNI CORDERO, Plaintiff, -against- HP MARCUS GARVEY PRESERVATION HOUSING COMPANY, INC. and C&C APARTMENT MANAGEMENT, LLC, Defendants. SUPPLEMENTAL RESPONSE TO PRELIMINARY CONFERENCE ORDER ELEFTERAKIS, ELEFTERAKIS & PANEK Attorneys for Plaintsff 38* 80 Pine Street, Floor New York, New York 10005 (212) 532-1116 To Attorney(s) for Service of a copy of the within is hereby admitted Dated: Attorney(s) for DPLEASE TAKE NOTICE that the within is a true copy of an Order signed by the Honorable that was entered in the office of the clerk of the within named Court on NOTICE OF ENTRY O that an Order of which the within is a true copy will be presented for s ment to the , one of the judges of the within named Court for signature on Dated: New York, NY NOTICE OF SETTLEMENT