On December 17, 2013 a
Motion-Secondary
was filed
involving a dispute between
Nathaniel Grayton,
Sherri Skidmore,
and
Calixto Cazano Md,
Fernando Ginebra Md,
Rajendra Bhayani Md,
Sony Loiseau Md,
Vasudha Viswanathan Md,
Wyckoff Heights Medical Center,
for Medical Malpractice
in the District Court of Kings County.
Preview
FILED: KINGS COUNTY CLERK 03/15/2021 12:18 PM INDEX NO. 508009/2013
NYSCEF DOC. NO. 135 RECEIVED NYSCEF: 03/15/2021
EXHIBIT I
FILED: KINGS COUNTY CLERK 03/15/2021 12:18 PM INDEX NO. 508009/2013
NYSCEF DOC. NO. 135 RECEIVED NYSCEF: 03/15/2021
MICHAEL'B. GROSSMAN WILLIAM T. BURDO
SCOTT D. RUBIN*
WALTER F. WORTMAN
LAW OFFICEs PERRYT. CRISCITELLI
COUNSEL
STEVEN SACHS LEVINE AND GROSSMAN
BRIAN C. LOCKHART 114 OLD COUNTRY ROAD
STACEY HASKEL + SUlTE 46o WILLIAM F. LEVINE
MINEOLA, NEW YORK 11501 (1935-2014)
* (N.Y. & MASS. BAR)
(516)248-7575
+ (N.Y., N.J. BAR)
(516)294-O066
FAX: (516)294-O645
EMAIL: LEVINENGROSSMANSAOL.COM
October 22, 2018
Costello, Shea & Gaffney LLP Arshack, Hajek & Lehrman, PLLC
11th 7th
44 Wall Street, FlOOr 1790 Broadway,
New York, NY 10005 New York, NY 10019
Brown Gruttadaro Gaujean & Prato, LLC Schiavetti, Corgan, DiEdwards,
White Plains Plaza Weinberg & Nicholson, LLP
- 14th
One North Broadway, Suite 1010 575 Eighth Avenue FlOOr
10018'
White Plains, NY 10601 New York, NY
Re: Grayton/Skidmore v. Viswanathan, et al.
Index No.: 508009/13
Counselors:
In response to Arshack, Hajek & Lehrman, PLLC's letter dated October 12, 2018 in
connection with the above referenced matter, enclosed please find a duly executed FDNY
authorization on their form.
Thank you for your attention to the foregoing.
Very truly yours,
BRIAN C. LOCKHART
BCL/vab
Encl.
FILED: KINGS COUNTY CLERK 03/15/2021 12:18 PM INDEX NO. 508009/2013
NYSCEF DOC. NO. 135 RECEIVED NYSCEF: 03/15/2021
FIRE DEPARTMENT - CITY OF NEW YORK
e
Public Records Unit / ACR Section
9 MetroTech Center
Brooklyn, New York 11201-3857
(718) 999-1998 or 1999
Ambulance Call Report/
Prehospital Care Report
Request Form
SECTION A CUSTOMER INFORMATION
Pleasegrint the required below.
infüiiñation
Name Telephone Number
State Zip Code
Note: Pleasemake sure you completethis form
and attach de===h
all required Enclose a checkor money order made payableto
the NYC FireDepartment and a stamped self-addressed enve!cpe (withpostage). Mailchecks or money orders to the
directly
address and unit listed
above. Only money ordersor checkswill be accepted
for Requests(no excepUens).DO NOT MAIL CASH.
SECTION B PATIENT INFORMATION
Please carefullyread the instructions
below and prinnt the
required patient's
information.
Name of Patient: _ GS 0Á\ R. S/ 0
bvi
Incident / Date: / /
Incident / Time: : AM PM
Incident / Location:
Incident / Borough:
Hospital taken to:
Is the patient a minor (please check onjy one box)? YES NO
Date of Birth ,
Last 4 digits of Social Security Number: I 0 W
Ifyou have the ACR/PCR, please provids ACR/PCR number:
What is the requester's raiatiêñship to the patient (please check only one box below)?
Self/ Patient Parent / Cs:r-':añ Executor / Ahinidr*r of Estate Other bÚ 't(
CUSTOMER - PLEASE READ AND SUBMIT THE REQUIRED BELOW
ITEM(S)
• An original notarized letter
from the patient authorizing the release of thisinformation.
• Proof of parental status or auardiañship. if thepatientisa minor. Acceptable proof isa copy of the patient'sbirth
certificate or a court document showing custody / guardianship.
• Proof that a court has appciated you executor or adrainistrator of the patient's estate, ifthe patient is deceased
(Letters testamentary or lettersof administration).
• Payrñêñt in the form of a check or money order inthe amount of $2.25 for each report.
FILED: KINGS COUNTY CLERK 03/15/2021 12:18 PM INDEX NO. 508009/2013
NYSCEF DOC. NO. 135 RECEIVED NYSCEF: 03/15/2021
FIRE DEPARTMENT - CITY OF NEW YORK
Public Records Unit / ACR Section
9 MetroTech Center
Brooklyn, New York 11201-3857
(718) 999-1998 or 1999
Ambulance Call Report/
Prehospital Care Report
Request Form
SECTION A CUSTOMER INFORMATION
Please ginntthe required informationbelow.
Name , .. Telephone Number
Address -
State Zip Code
Note: Pleasemake sure you complete and
this form attachall required
documents. Enclose a check or moneyorder made payableto
the NYC FireDepartment and a stamped ::5 :f-'r::::edenvelope (withpostage). Mailchecks or money orders to the
directly
address and unit listed
above. Only money ordersor checkswill be accepted
for Requests DO NOT MAll
(no exceptions). CASH.
SECTION B PATIENT INFORMATION
Please read,the instructicasbelow and the requiredpatient'sinfe= tion.
carefully gid
Name of Patient: CÓh CL O CC UA
Incident / Date: / /
Incident / Time: : AM PM
Incident / Location: __
Incident / Borough:
Hospital taken to:
Is the patient a minor (please check o_nly one box)? YES NO
Date of Birth: - ,_-_y_/ Û 00
Last 4 digits of Social Security Numbar:
Ifyou have the ACR/PCR, please provide ACR/PCR ñümbar:
What is the requester's re!etionship to the pat|ant (please check onjy one box below)?
Self/ Patient Parent / Guardian Executor / Afri!:trator of Estate Other O 1
CUSTOMER - PLEASE READ AND SUBMIT THE REQUIRED BELOW
ITEM(S)
• An originalnotarized letterfrom the patient authorizing the re:ease of thisinformatics.
• Proof of pareñta: status or auardianship. if thepatient isa minor. Acceptable proof isa copy of the patient'sbirth
certificateor a court document showing custody / guardianship.
• Proof that a court has appciated you executor or administrator of the patient's estate, ifthe patient is deceased
(Letters testamentary or lettersof administration).
• Payment in the form of a check or money order in the amount of $2.25 for each report.
FILED: KINGS COUNTY CLERK 03/15/2021 12:18 PM INDEX NO. 508009/2013
NYSCEF DOC. NO. 135 RECEIVED NYSCEF: 03/15/2021
FIRE DEPARTMENT - CITY OF NEW YORK
Public Records Unit / ACR Section
Wee
9 MetroTech Center
Brooklyn, New York 11201-3857
6H T (718) 999-1998 or 1999
Ambulance Call Report/
Prehospital Care Report
Request Form
SECTION A CUSTOMER INFORMATION
Please pri_nt the
requiredinfamaticñ below.
Name Telephone Number
Address .
_Na 4. M 00 i01
State { Zip Code
Note: Pleasemake sure you comp!etethis formand attach
all required
documents. Enclose a check or money ordermade payableto
the NYC FireDepartment and a stamped ::c!f
:dd-sssad envelope (with postage). Mailchecks or money orders to the
dj[ectly
address and unit listed
above. Only money ordersor checkswill be accepted
for Requests(no excepUens).DO NOT MAIL CASH.
SECTION B PATIENT INFORMATION
Please read
carefully the instructions
below and printthe required patient'sbfes#Gñ.
Name of Patient: f\ ifGil Y\
Incident / Date: / /
Incident / Time: : AM PM
Incident / Location:
Incident / Borough:
Hospital taken to:
Is the patient a minor (please check o_njy one box)? YES NO
Date of Birth: - - ,
Last 4 digits of Social Security Numbar: 10
Ifyou have the ACR/PCR, please provide ACR/PCR numbêr:
What is the requester's relationship to the patient (please check onjy one box below)?
Self/ Patient Parent / Guardian O Executor / .^'-""etor ofEstate Other ÛYkh nÎÓÓ
CUSTOMER - PLEASE READ AND SUBMIT THE REQUIRED BELOW
ITEM(S)
• An originainotarized letterfrom the patient authorizing the release of thisinformation.
• Proof of parental status or quard|anship, if thepatient isa minor. Acceptable proof isa copy of the patient'sbirth
certificateor a court document showing custody / guardianship.
• Proof that a court has appointed you executor or administrator of the patient'sestate, if thepatient isdeceased
(Letters testamentary or lettersof administration).
• Payment in the form of a check or money order inthe amount of $2.25 for each report.
FILED: KINGS COUNTY CLERK 03/15/2021 12:18 PM INDEX NO. 508009/2013
NYSCEF DOC. NO. 135 RECEIVED NYSCEF: 03/15/2021
FIRE DEPARTMENT - CITY OF NEW YORK
Public Records Unit / ACR Section
9 MetroTech Center
Brooklyn, New York 11201-3857
(718) 999-1998 or 1999
Ambulance Call Report/
Prehospital Care Report
Request Form
SECTION A CUSTOMER INFORMATION
Please p.ri!g the
requiredinforrñaticñbelow.
. h btVem CD( S e-i CÂ V‰'T Û
Name .. -·
Telephone Number
Address
State Zip Code
N_ote: Pleasemake sure you enmpletethis formand attach
all required
dacümsñts. Enclose a check or money ordermade payableto
the NYC FireDepartment and a eMmped self-addressed cr.vsisps(with postage). Mail checksor money orders to
dj!ectly the
address and unit listed
above. Only money ordersor checkswill be accepted
for Requests DO NOT MAIL CASH.
(no exceptions).
SECTION B PATIENT INFORMATION
Please read the below
instructicñs and printthe required inferrnatinn
patient's
carefully
Name of Patient: / C\ \4\Ó COl t()vQ
Incident / Date: / /
Incident / Time: : AM PM
!ncident / Location:
Incident / Borough:
Hospital taken to: _
Is the patient a minor (please check only one box)?
Date of Birth:
Last 4 digits of Social Security Number: 0
Ifyou have the ACR/PCR, please provide ACR/PCR number: __
What is the requester's re!etionship to the patient (please check o_!gy one box below)?
O Self/ Patient O Parent / Guardian O Executor / AA.-M""atOr Of Estate Othe
CUSTOMER - PLEASE READ AND SUBMIT THE REQUIRED ITEM(S) BELOW
• An original notarized letterfrom the patient authorizing the release of this information.
• Proof of parental status or auardianship, if thepatient isa minor. Acceptâble proof isa copy of the patient'sbirth
certificatsor a court document showing custody / guardianship.
• Proof that a court has appciñted you executor or administrator of the patient'sestate, ifthe patientisdeceased
(Letters testamentary or lettersof administration).
• Payment in the form of a check or money order in the amount of $2.25 for each report.
Document Filed Date
March 15, 2021
Case Filing Date
December 17, 2013
Category
Medical Malpractice
For full print and download access, please subscribe at https://www.trellis.law/.
Preview
FILED: KINGS COUNTY CLERK 03/15/2021 12:18 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 135 RECEIVED NYSCEF: 03/15/2021 EXHIBIT I FILED: KINGS COUNTY CLERK 03/15/2021 12:18 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 135 RECEIVED NYSCEF: 03/15/2021 MICHAEL'B. GROSSMAN WILLIAM T. BURDO SCOTT D. RUBIN* WALTER F. WORTMAN LAW OFFICEs PERRYT. CRISCITELLI COUNSEL STEVEN SACHS LEVINE AND GROSSMAN BRIAN C. LOCKHART 114 OLD COUNTRY ROAD STACEY HASKEL + SUlTE 46o WILLIAM F. LEVINE MINEOLA, NEW YORK 11501 (1935-2014) * (N.Y. & MASS. BAR) (516)248-7575 + (N.Y., N.J. BAR) (516)294-O066 FAX: (516)294-O645 EMAIL: LEVINENGROSSMANSAOL.COM October 22, 2018 Costello, Shea & Gaffney LLP Arshack, Hajek & Lehrman, PLLC 11th 7th 44 Wall Street, FlOOr 1790 Broadway, New York, NY 10005 New York, NY 10019 Brown Gruttadaro Gaujean & Prato, LLC Schiavetti, Corgan, DiEdwards, White Plains Plaza Weinberg & Nicholson, LLP - 14th One North Broadway, Suite 1010 575 Eighth Avenue FlOOr 10018' White Plains, NY 10601 New York, NY Re: Grayton/Skidmore v. Viswanathan, et al. Index No.: 508009/13 Counselors: In response to Arshack, Hajek & Lehrman, PLLC's letter dated October 12, 2018 in connection with the above referenced matter, enclosed please find a duly executed FDNY authorization on their form. Thank you for your attention to the foregoing. Very truly yours, BRIAN C. LOCKHART BCL/vab Encl. FILED: KINGS COUNTY CLERK 03/15/2021 12:18 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 135 RECEIVED NYSCEF: 03/15/2021 FIRE DEPARTMENT - CITY OF NEW YORK e Public Records Unit / ACR Section 9 MetroTech Center Brooklyn, New York 11201-3857 (718) 999-1998 or 1999 Ambulance Call Report/ Prehospital Care Report Request Form SECTION A CUSTOMER INFORMATION Pleasegrint the required below. infüiiñation Name Telephone Number State Zip Code Note: Pleasemake sure you completethis form and attach de===h all required Enclose a checkor money order made payableto the NYC FireDepartment and a stamped self-addressed enve!cpe (withpostage). Mailchecks or money orders to the directly address and unit listed above. Only money ordersor checkswill be accepted for Requests(no excepUens).DO NOT MAIL CASH. SECTION B PATIENT INFORMATION Please carefullyread the instructions below and prinnt the required patient's information. Name of Patient: _ GS 0Á\ R. S/ 0 bvi Incident / Date: / / Incident / Time: : AM PM Incident / Location: Incident / Borough: Hospital taken to: Is the patient a minor (please check onjy one box)? YES NO Date of Birth , Last 4 digits of Social Security Number: I 0 W Ifyou have the ACR/PCR, please provids ACR/PCR number: What is the requester's raiatiêñship to the patient (please check only one box below)? Self/ Patient Parent / Cs:r-':añ Executor / Ahinidr*r of Estate Other bÚ 't( CUSTOMER - PLEASE READ AND SUBMIT THE REQUIRED BELOW ITEM(S) • An original notarized letter from the patient authorizing the release of thisinformation. • Proof of parental status or auardiañship. if thepatientisa minor. Acceptable proof isa copy of the patient'sbirth certificate or a court document showing custody / guardianship. • Proof that a court has appciated you executor or adrainistrator of the patient's estate, ifthe patient is deceased (Letters testamentary or lettersof administration). • Payrñêñt in the form of a check or money order inthe amount of $2.25 for each report. FILED: KINGS COUNTY CLERK 03/15/2021 12:18 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 135 RECEIVED NYSCEF: 03/15/2021 FIRE DEPARTMENT - CITY OF NEW YORK Public Records Unit / ACR Section 9 MetroTech Center Brooklyn, New York 11201-3857 (718) 999-1998 or 1999 Ambulance Call Report/ Prehospital Care Report Request Form SECTION A CUSTOMER INFORMATION Please ginntthe required informationbelow. Name , .. Telephone Number Address - State Zip Code Note: Pleasemake sure you complete and this form attachall required documents. Enclose a check or moneyorder made payableto the NYC FireDepartment and a stamped ::5 :f-'r::::edenvelope (withpostage). Mailchecks or money orders to the directly address and unit listed above. Only money ordersor checkswill be accepted for Requests DO NOT MAll (no exceptions). CASH. SECTION B PATIENT INFORMATION Please read,the instructicasbelow and the requiredpatient'sinfe= tion. carefully gid Name of Patient: CÓh CL O CC UA Incident / Date: / / Incident / Time: : AM PM Incident / Location: __ Incident / Borough: Hospital taken to: Is the patient a minor (please check o_nly one box)? YES NO Date of Birth: - ,_-_y_/ Û 00 Last 4 digits of Social Security Numbar: Ifyou have the ACR/PCR, please provide ACR/PCR ñümbar: What is the requester's re!etionship to the pat|ant (please check onjy one box below)? Self/ Patient Parent / Guardian Executor / Afri!:trator of Estate Other O 1 CUSTOMER - PLEASE READ AND SUBMIT THE REQUIRED BELOW ITEM(S) • An originalnotarized letterfrom the patient authorizing the re:ease of thisinformatics. • Proof of pareñta: status or auardianship. if thepatient isa minor. Acceptable proof isa copy of the patient'sbirth certificateor a court document showing custody / guardianship. • Proof that a court has appciated you executor or administrator of the patient's estate, ifthe patient is deceased (Letters testamentary or lettersof administration). • Payment in the form of a check or money order in the amount of $2.25 for each report. FILED: KINGS COUNTY CLERK 03/15/2021 12:18 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 135 RECEIVED NYSCEF: 03/15/2021 FIRE DEPARTMENT - CITY OF NEW YORK Public Records Unit / ACR Section Wee 9 MetroTech Center Brooklyn, New York 11201-3857 6H T (718) 999-1998 or 1999 Ambulance Call Report/ Prehospital Care Report Request Form SECTION A CUSTOMER INFORMATION Please pri_nt the requiredinfamaticñ below. Name Telephone Number Address . _Na 4. M 00 i01 State { Zip Code Note: Pleasemake sure you comp!etethis formand attach all required documents. Enclose a check or money ordermade payableto the NYC FireDepartment and a stamped ::c!f :dd-sssad envelope (with postage). Mailchecks or money orders to the dj[ectly address and unit listed above. Only money ordersor checkswill be accepted for Requests(no excepUens).DO NOT MAIL CASH. SECTION B PATIENT INFORMATION Please read carefully the instructions below and printthe required patient'sbfes#Gñ. Name of Patient: f\ ifGil Y\ Incident / Date: / / Incident / Time: : AM PM Incident / Location: Incident / Borough: Hospital taken to: Is the patient a minor (please check o_njy one box)? YES NO Date of Birth: - - , Last 4 digits of Social Security Numbar: 10 Ifyou have the ACR/PCR, please provide ACR/PCR numbêr: What is the requester's relationship to the patient (please check onjy one box below)? Self/ Patient Parent / Guardian O Executor / .^'-""etor ofEstate Other ÛYkh nÎÓÓ CUSTOMER - PLEASE READ AND SUBMIT THE REQUIRED BELOW ITEM(S) • An originainotarized letterfrom the patient authorizing the release of thisinformation. • Proof of parental status or quard|anship, if thepatient isa minor. Acceptable proof isa copy of the patient'sbirth certificateor a court document showing custody / guardianship. • Proof that a court has appointed you executor or administrator of the patient'sestate, if thepatient isdeceased (Letters testamentary or lettersof administration). • Payment in the form of a check or money order inthe amount of $2.25 for each report. FILED: KINGS COUNTY CLERK 03/15/2021 12:18 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 135 RECEIVED NYSCEF: 03/15/2021 FIRE DEPARTMENT - CITY OF NEW YORK Public Records Unit / ACR Section 9 MetroTech Center Brooklyn, New York 11201-3857 (718) 999-1998 or 1999 Ambulance Call Report/ Prehospital Care Report Request Form SECTION A CUSTOMER INFORMATION Please p.ri!g the requiredinforrñaticñbelow. . h btVem CD( S e-i CÂ V‰'T Û Name .. -· Telephone Number Address State Zip Code N_ote: Pleasemake sure you enmpletethis formand attach all required dacümsñts. Enclose a check or money ordermade payableto the NYC FireDepartment and a eMmped self-addressed cr.vsisps(with postage). Mail checksor money orders to dj!ectly the address and unit listed above. Only money ordersor checkswill be accepted for Requests DO NOT MAIL CASH. (no exceptions). SECTION B PATIENT INFORMATION Please read the below instructicñs and printthe required inferrnatinn patient's carefully Name of Patient: / C\ \4\Ó COl t()vQ Incident / Date: / / Incident / Time: : AM PM !ncident / Location: Incident / Borough: Hospital taken to: _ Is the patient a minor (please check only one box)? Date of Birth: Last 4 digits of Social Security Number: 0 Ifyou have the ACR/PCR, please provide ACR/PCR number: __ What is the requester's re!etionship to the patient (please check o_!gy one box below)? O Self/ Patient O Parent / Guardian O Executor / AA.-M""atOr Of Estate Othe CUSTOMER - PLEASE READ AND SUBMIT THE REQUIRED ITEM(S) BELOW • An original notarized letterfrom the patient authorizing the release of this information. • Proof of parental status or auardianship, if thepatient isa minor. Acceptâble proof isa copy of the patient'sbirth certificatsor a court document showing custody / guardianship. • Proof that a court has appciñted you executor or administrator of the patient'sestate, ifthe patientisdeceased (Letters testamentary or lettersof administration). • Payment in the form of a check or money order in the amount of $2.25 for each report.