Preview
FILED: KINGS COUNTY CLERK 09/13/2021 04:32 PM INDEX NO. 508009/2013
NYSCEF DOC. NO. 149 RECEIVED NYSCEF: 09/13/2021
EXHIBIT A
FILED: KINGS COUNTY CLERK 09/13/2021 04:32 PM INDEX NO. 508009/2013
NYSCEF DOC. NO. 149 RECEIVED NYSCEF: 09/13/2021
Re: G 2/Skidmore v. Viswanathan, M.D., et al (Index No.: 508009/2013)
Victoria Bruno
Fri 9/10/2021 6:08 PM
To: eetheridge@csgilplaw.com
Cc: Brian Lockhart ; lynn@lawahl.com <|ynn@Iawahl.com>; g.portera@sbs-law.com
; jdainow@schiavetti.com
(lÌJ 1 attachments(3 MB)
G Itr9.10.2021.pdf;
Counselor,
Please see the attached response. The original authorizations are being sent via regular mail. Thank
you.
Sincerely,
Victoria A. Bruno
Paralegal
Levine & Grossman
114 Old Country Road, Suite 460
Mineola, NY 11501
(516) 248-7575
NOTICE OF PRIVILEGE & CONFIDENTIALITY
This e-mail transmission (including any attachments) may contain confidential and/or privileged
Information or protected health infonnation subject to privacy regulations such as the Health Insurance
Portability and Accountability Act of 1996 (HIPAA). This transmission is intended only for the use of the
recipient(s) named above. If you are not the intended recipient, or a person responsible for delivering the
message to the intended recipient, you are hereby notified that any disclosure, printing, copying,
distribution, retention, publication or use of any of the information contained in this transmission is
STRICTLY PROHIBITED. If you are not the intended recipient or if you have received this transmission
in error, please immediately notify the sender by telephone and/or reply e-mail and permanently delete
this e-mail from your computer system without saving or copying itin any manner. Thank you.
From: Emmarie Etheridge
Sent: Friday,August20,2021 12:27:39 PM
To: Brian Lockhart
Cc: Michelle Genetempo
Subject: G _ /Skidmore v. Viswanathan, M.D., et al (Index No.: 508009/2013)
Dear Brian:
I am associate working with Steven Garry on the Grayton matter wherein we represent defendant, Dr.
Viswanathan.
FILED: KINGS COUNTY CLERK 09/13/2021 04:32 PM INDEX NO. 508009/2013
NYSCEF DOC. NO. 149 RECEIVED NYSCEF: 09/13/2021
I calledyou earlier this week and left a voicemail on your machine. We are preparing our standard report for the
carrier and need to include any updated lieninformation. Would you be able to provide same at your earliest
convenience?
Also, I noticed that the February 3, 2021 discovery response, including the authorizations for Dr. Sherri Singh,
P.S./l.S.384 Frances E. Carter and Medicaid/Empire Blue Cross, have the incorrect address for our firm. We are no
longer located at 44 Wall Street. Our new address is:
100 Merrick Road, Suite 218E
Rockville Centre, New York 11570
Could you please provide the updated authorizations to our new address so that they may be processed?
Thank you for your prompt attention to the above. Have a lovely weekend!
Very truly yours,
Emmarie A. Etheridge
Associate
CosteWo, Shea et gaffney
LLCP
100 Merrick Road East BIdg. Suite 218
Rockville Centre, New York 11570
Tel (212) 413-8912
Fax (516) 764-9104
eetheridgg@c_sgilplaw.com
FILED: KINGS COUNTY CLERK 09/13/2021 04:32 PM INDEX NO. 508009/2013
NYSCEF DOC. NO. 149 RECEIVED NYSCEF: 09/13/2021
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
WILLIAM F. LEVINE
STACEY HASKEL + SUITE 460
(1935-2014)
MINEOLA, NEW YORK 1 1501
JEFFREY D. HUMMEL
(516) 248-7575
* (N.Y. & MASS. BAR)
(516) 294-O066
+ (N.Y., N.J. BAR) FAX: (516)294-0645
EMAIL: LEVINENGROSSMAN@AOL.COM
September 10, 2021
Costello, Shea & Gaffney LLP
100 Merrick Road East, Suite 218
Rockville Centre, NY 11570
Re: G /Skidmore v. Viswanathan, et al.
Index No.: 508009/2013
Counselor:
In response to your email dated August 20, 2021 and your Motion filed on August 24, 2021,
enclosed please find duly executed authorizations with your new address that were previously
provided:
• Sherri M.D.
Singh,
• P.S. /I.S. 384 Frances E. Carter
• Medicaid
• Empire Blue Cross Blue Shield
V truly yours,
Brian C. Lockhart
BCL/vab
Encl.
cc:
Benvenuto & Slattery Schiavetti, Corgan, DiEdwards, Weinberg
1800 Northern Blvd. & Nicholson, LLP
- 14th
Roslyn, NY 11576 575 Eighth Avenue FlOOr
New York, NY 10018
Arshack, Hajek & Lehrman, PLLC
7th
1790 Broadway, FlOOr
New York, NY 10019
FILED: KINGS COUNTY CLERK 09/13/2021 04:32 PM INDEX NO. 508009/2013
NYSCEF DOC. NO. 149 RECEIVED NYSCEF: 09/13/2021
OCA officialForm No.: 960
AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA
IThis form has heertupproved by the New York State Departmen t ofIIealthI
PatientName- Date of Birth: SocialSecurityNumber:
N '
__ G J/09
PatientAddress: 228 Moffat StreetApt 3L, Brooklyn,New York 11207
I, or myauthorized request
representative, that healthiñfarmationregardingmy care and treatment
be released on this form.
as set forth
In accordancewithNew York State Law and the Privacy
Rule of the Health
Iñërmcc and Acceüñtsility
Portability Act of 1996 (HIPAA),I.understand
that:
1. Thisauthorization
may include disclosureofinformation to ALCOHOL
relating and DRUG ABUSE, MENTAL HEALTH TREATMENT, except
psycheh==py notes,and CONFIDENTIAL HIV*RELATED INFORMATION onlyif I place
my initials line in Item
on the appropriate 9(a).In the
event thehealthinfnrmntion descdoed below includesany ofthese typesof information,and I initial
the lineon thebox in Item 9(a),
I specifically
authorizereleaseof suchinformation to theperson(s)indicated
in Item8.
2. IfI am authorizingthe releaseofHIV-related, alcoholor drugtreatment,or mentalhealthticatmcat information,the recipient
is prohibited
from
redisclosingsuchinformation withoutmy authorization
unlesspermittedto do so under
federalor state law. that I have the right
I understand to request
a list
of peoplewho may receiveor use myHIV-related irfGrmatics,I maycontactthe New York State Division
of Human Rightsat (212)
480-2493 or
the New York CityC÷ssion of Human Rights at(212)306-7450. These agenciesareresponsibleforprotectingmy rights.
3. I have therightto revoke thisauthorizationat anytime by writingto theheath careproviderlistedbelow. I understandthat I mayrevoke this
authorizationexceptto theextentthataction been taken
has already based on this
authorization.
4. I understandthatsigning thisautharimiionis voluntary.My treatment,payment, enro!!mentin a health
plan,or cligibility will
for benefits not be
conditioned upon my authorizationof this
disclosure.
5. Iñfematiêñ disclasedunder thisauthorizationmight by the recipient
be redisclosed (exceptas noted in Item redisclosure
2), and this may no longer
be protectedby federalor state
law.
6. THIS AUTHORIZATION DOES NOT AuïnüRiZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAT THE
TTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9(bi
.. - _ _....
7. Narne and address of health care provider or entityto releaseiñformation:
Sherri Singh, M.D., 1623 Weirfield Street, Ridgewood, NY 11385
8. Name and address Of person(s) or category of person to whorn thisiñfairnatics willbe sent:
CoStello, Shea & Gaffney LLP, 100 Merrick Road EaSt, Suite 218, RockVille Centre, NY 11570
9(a). pecificinformationtobe released:
Entire Medical Records, im'"'s patient office
histories, notes(excepts psycliathcrapynotes),testresults,
radiology studies,
films,referrals,consults,billingrecords,insurance records,and records sent to youby.other healthcare prsviders.
O Medical Record from(insertdate) to Present
OOther:
Include:(Indicate
by Ó
Init!:!!:;;) Alcohol/Drug TraatmanÓ Mental Health Informatic IV-Related Iñfarmatisa
Authorization to DiscussHealth Information
(b) By here
laitialing I authorize
Initials Name of individualhealthcare provider
to discussmy healthinformation with my or gaveraracatal
attorney, agency listed
here:
(Attorney/FirmName or Go v-enta! Agency Name)
10. Reason forreleaseofinformation: 11. Dateor eventon which thisauthorization
willexpire:
ofindividual AT THE END OF COURT CASE **
OAt request
X Other:LEGAL MATTER
12. Ifnotthe patient,
name ofperson signingform: 13. Authorityto sign
on behalfof patient
LEVINE & GROSSMAN ATTORNEYS-IN-FACT
All itemson thisform have been completed and my questionsabout thisform havebeen answered. In I have
addition, been provideda copyof
the fo .
Date: September 10. 2021
LEVINE & GROSSMAN by Brian C. Lockhart
Signatureof patientor representative
authorizedby law.
* Human !r2 ::f:f The New York
that causes AIDS.
ciency Virus State Public Health Law protects st!::which r=cnablycould identify someone as
having HIV and infe-±r
symptoms or infection regarding a person's contacts.
** If threeyearshaselapsedsince the datethis ruibi=ib
was signed,pleasecall Levine& Grossmanat (516) 248-7575to determineif thecasehasbeenconcluded.
FILED: KINGS COUNTY CLERK 09/13/2021 04:32 PM INDEX NO. 508009/2013
NYSCEF DOC. NO. 149 RECEIVED NYSCEF: 09/13/2021
oCA Official
Form No,: 960
AUTHORI7JTION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA
This fornihas heen apprured by the New York State Department of IIealth|
PatientName: Date ofBirth: SocialSecurityNumber:
N, G) /09 -1028
PatientAddress: 228 Moffat StreetApt 3L, Brooklyn,New York 11207
I, or myauthorized request
representative, thathealth informaticñscgeding my care and treatment
be released on this form.
as set forth
In acccidancewithNew York State Law and the Privacy
Rule of the Health
Insurance and Accüüñtability
Pertability Act of 1996(HIPAA), I understan
that:
1. Thiseuthorization
may includedisclosureofinfermatics to ALCOHOL
relating and DRUG ABUSE, MENTAL HEALTH TREATMENT, excep
psychotheepy notes,andCONFIDENTIAL HIV*RELATED INFORMATION only if I place
my on the appropriate
initials line in Item
9(a).In th
event thehealthinformation describedbelow includesany ofthese typesof information,and I initial
the lineon the boxin Item 9(a),
I specificall
authorizereleaseof suchinformation to the person(s)
indicated
in Item8.
2. IfI am authorizingtherelease ofHIV-related,alcohol or drugtreatment,or mentalhealthtreatment the recipient
information, is prohibited
froo
redisclosingsuch informationwithoutmy authorizationunlesspermittedto do so under
federalor state law. that I have the right
I understand to reques
a list
ofpeople who may receiveor use myHIV-related I may contact
information, the New York State Division
of Human Rightsat (212)480-2493 o
the New York City Commission of Human Rightsat (212)306-7450. Theseagencies are responsible
forprotectingmy rights.
3. I have therightto revoke thisauthorizationat anytime by writingto theheath care provider
listedbelow. that I may
I understand revoke thi
authorizationexceptto theextentthataction has already
been taken based on this
authorization.
4..I understandthatsigning thisauthorization
is voluntary.My trcatmcat,payment, enrollmentin a health
plan, for benefits
or eligibility willnot b
conditioned upon my authorizationof this
disclosure.
5. Infüimatiandisclosedunder thisauthorizationmightbe redisclosedby the recipient
(exceptas notedin Item2),and this redisclosure
may no longe
be protectedby federalorstatelaw.
6. THIS AUTHORiZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAT THI
ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9(b). ..
7. Name and address Of health care provider or entityto releaseinformation:
P.S. /I.S. 384 FranceS E. Carter, 242 Cooper Street, Brooldyn, NY 11207
....
8. Name and address Of person(s) or categüry of person to whom thisinformation willbe sent:
CoStello, Shea & Gaffney LLP, 100 Merrick Road EaSt, Suite 218, Rockville Centre, NY 11570
9(a).Specificinformationto be released:
O Entire Medical Records, Mch patient office
histories, notes(exceptspsychotherapy notes),testresults,
radiologystudies,
films,referisis,consults,billingrecords,insurance records,and records sentto you by other healthcare prüviders.
O Medical Record from(insertdate) to Present
ther: schoolrecords
Include:(Indicate
by ½½!ing) Ó Icohol/Drug Treatment 6 Mental Health InfGrmatis HIV-Related Information
Authorization to Discuss Health Information
(b) By here
initiating I authorize
Initials Name of individual
healthcare provider
todiscuss my healthinfermaticñwith my attorney,orr,vvw umentalagency listedhere:
(Attorney/Firm Name or Governmental Agency Name)
10. Reasonfor releaseofinformation: 11. Dateor eventon which this will
authorization expire:
requestofindividual AT THE END OF COURT CASE **
OAt
X Other:LEGAL MATTER
12. Ifnotthe patient,
name ofperson signingform: 13. Authority
to signon behalfof patient
LEVINE & GROSSMAN ATTORNEYS-IN-FACT
All itemson thisform have been compktcd and my qüesticasabout thisform havebeen answered. In I have
eddition, been provideda copyof
the fo
Date: September 10. 2021
LEVINE & GROSSMAN by Brian C. Lockhart
Signatureof patientor representative
authorizedby law.
* Human !ss:::ff:::ñcy Virus The New York State Public Health Law protects
that causes AIDS. which reasonably could identify someone as
having HIVsymptoms or infection
and "-" regarding a person's contacts.
** If threeyearshaselapsedsincethe datethis =&·
he was signed,pleasecall Levine& Grossmanat (516) 248-7575to determineif thecasehasbeenconcluded.
FILED: KINGS COUNTY CLERK 09/13/2021 04:32 PM INDEX NO. 508009/2013
NYSCEF DOC. NO. 149 RECEIVED NYSCEF: 09/13/2021
OC A Ollicial
Form No,:960
AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA
|This foritiliasheel1approved by the New York State Departmelit of IIealtli|
PatientName: Date ofBirth: SocialSecurityNumber:
N, G: :/09 ' -1028
PatientAddress: 228 Moffat StreetApt 3L,Brooklyn, New York 11207
I, or myauthorized request
representative, thathealth infarmaticñregardingmy care and treatment
be releasedas set forth
on this form.
In accordancewithNew York State Law and the Privacy
Rule of the Health
Insurance and Accountability
Portability Act of1996 (HIPAA), I üñderstec
that:
1. Thi=*h~·izationmay includedisclosureof information to ALCOHOL
relating and DRUG ABUSE, MENTAL HEALTH TREATMENT, excepi
psychotherapy and
notes, CONFIDENTIAL HIV*RELATED INFORMATION only ifIplacemy on
initials theappropriate in
line Item 9(a).In the
event thehealthinfGrmatian describedbelow includesany ofthese typesof information,and I initial
the lineon the box I specificall)
in Item 9(a),
authorizereleaseof suchinformation to the person(s)
indicatedin Item
8.
2. IfI am authorizingtherelease ofHIV-related,alcohol or drug or mental
treatment, healthtreatment the recipient
infcrmation, frorr
is prohibited
redisclosingsuch informationwithoutmy authorizationunlesspermittedto do so under
federalor state law. to reques1
that I have the right
I understand
a list
of peoplewho may receiveor use myHIV-related information,I may contact
the New York State Division
of Human Rights at (212)
480-2493 or
the New York CityCommission of Human Rights at (212)
306-7450. These agenciesare responsible
forprotectingmy rights.
3. I have therightto revoke thisauthorizationat anytime by writingtothe heathcare providerlistedbelow. I understand
that I mayrevoke this
authorizationexceptto theextentthataction been taken
has already based on this
authorization.
4. I understandthatsigningthis authorization
is voluntary.My treatment,payment, enro!!mentin a health
plan,or eligibility
for benefits
willnot be
conditionedupon my authorizationof this
disclosure.
5. InfGrmaticñdisclosedunder thisauthorizationmightbe redisclosedby the recipient
(exceptas notedin Item2), redisclosure
and this may no longer
be protectedby federal
or statelaw.
6. THIS AUTHORIZATION DOES NOT AUTiiOitiZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAT THE
ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9(b).
7.Name and address Of health care provider or entityto releaseinfarrsation:
Medicaid Data WarehouSe -
CDRS, NYSDOH -
MISCNY, ESP P1-11 S Dock J, Albany, NY 12237
8. Name and address Of person(s) or category of person to whom thisinformation will be sent:
CoStello, Shea & Gaffney LLP, 100 Merrick Road EaSt, Suite 218, RockVille Centre, NY 11570
9(a).Specific
information tobe released:
O Entire Medical Records, != 'ingpatient office
histGries, notes(exceptspsychotherapy notes),testresults,
radiologystudies,
films,referrals,
consults, billingrecords,insurance records,and records sentto you by otherhealth care providers.
. Medical R ordfr;m(inse date . to resent
Other: CO / (Av ( th, ÔÛ
Include:(Indicate
by Initialing) Alcohol/Drug TreatmenÔ entalHealth Information IV-Related InfGrmatiGñ
Authorization to DiscussHealth Information
(b) By here
initialing I authorize
Initials Name of individualhealthcare provider
to discussmy healthinformation with my attorney,or govcmmcatal agency listed
here:
(Attorney/Firm Name or Governmental Agency Name)
10. Reason forreleaseofinformation: 11. Dateor eventon which thisauthorization
willexpire:
OAt requestofindividual AT THE END OF COURT CASE **
X Other:LEGAL MATTER
12. Ifnotthe patient,
name ofperson signingform: 13. Authority on behalf
to sign of patient
LEVINE & GROSSMAN ATTORNEYS-IN-FACT
All itemson thisform have been cGmpleted and my questionsabout thisform have been answered.In addition,I havebeen provideda copyof
the form.
Date:_ Scatem'uer 10. 2021
LEVINE & GROSSMAN by Brian C. Lockhart
Signatureof patientor representative
authorizedby law.
* Human !:::::±±dency Virus The New York
that causes AIDS. State Public Health Law protects :which reasonably could identify someone as
having HIVsymp:c=: or infection regarding a person's contacts.
and infen-.::tian
"-"
** If threeyearshaselapsedsincethe datethis was signed,pleasecall Levine& Grossmanat (516) 248-7575to detennineif thecasehasbeenconcluded.
FILED: KINGS COUNTY CLERK 09/13/2021 04:32 PM INDEX NO. 508009/2013
NYSCEF DOC. NO. 149 RECEIVED NYSCEF: 09/13/2021
OCA Of fidal
Form No.:98
AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA
This form has heest upproved by the New York State Department of IIeu1th|
PatientName: Date of Birth: SocialSecurityNumber:
N GT /09 1-1028
PatientAddress: 228 Moffat StreetApt 3L, Brooklyn,New York 11207
I, or myauthorized request
representative, thathealth infGrmaticaregazdingmy care and trcstment
be released on this form.
as set forth
In eccordancewithNew York State Law Rule
and the Privacy of the Health
Insumce and Acceent±b!!!iy
Pertability Act of1996 (HIPAA), I understand
that:
1. Thisauthorization
may includedisclosureof information to ALCOHOL
relating and DRUG ABUSE, MENTAL HEALTH TREATMENT, except
psyphntherapy notes, and CONFIDENTIAL HIV*RELATED INFORMATION onlyifIplacemy initials line in Item
on the appropriate 9(a).In the
event the health
informatics describedbelow includesany ofthese typesof information,and Iinitial
the lineonthe box inItem9(a),I specifically
authorizereleaseof suchinformation to the person(s)
indicatedin Item
8.
2. IfI am authorizingtherelease ofHIV-related,alcohol or drugtreatment,ormental healthtreatment is prohibited
the recipient
information, from
redisclosingsuch infe=etionwithout my autherization
unlesspermittedtodo so underfederalorstatelaw. IunderstandthatIhavethe right
to request
a list
of peoplewho may receiveor use myHIV-related I may contact
information, the New York State Division
of Human 480-2493
Rights at (212) or
the New York CityCommission of Human Rights at (212)
306-7450. These agenciesare responsible
forprotectingmy rights.
3. I have therightto revoke thisauthorizationat anytime by writingtothe heath careproviderlistedbelow. that I may
I understand revoke this
authorizationexceptto theextentthataction been taken
has already based on this
authorization..
4. I understandthatsigningthis authorization
is voluntary.My payment,
treatment, carcilmcatin a health
plan,or eligibility will
for benefits not be
conditionedupon my authorizationofthisdisclosure.
5. I#=a66n disclosedunder thisauthorizationmightbe redisclosedby the recipient
(exceptas notedin Item2), and this redisclosure
may no longer
be protectedby federal
or statelaw.
6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAT THE
ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9(b).
7. Name and address Of health care provider or entityto releaseinf0rrsaticn:
Empire Blue Cross Blue Shield, 15 Metrotech Center, Brooklyn, NY 11201
8. Name and address Of person(s) or category of person to whom thisinformation willbe sent:
CoStello, Shea & Gaffney LLP, 100 Merrick Road EaSt, Suite 218, Rockville Centre, NY 11570
9(a).Specificinformationtobe released:
O EntireMedical Records, patient
inc:üdia¡;; office
histories, notes(excep
Preview
FILED: KINGS COUNTY CLERK 09/13/2021 04:32 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 149 RECEIVED NYSCEF: 09/13/2021 EXHIBIT A FILED: KINGS COUNTY CLERK 09/13/2021 04:32 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 149 RECEIVED NYSCEF: 09/13/2021 Re: G 2/Skidmore v. Viswanathan, M.D., et al (Index No.: 508009/2013) Victoria Bruno Fri 9/10/2021 6:08 PM To: eetheridge@csgilplaw.com Cc: Brian Lockhart ; lynn@lawahl.com <|ynn@Iawahl.com>; g.portera@sbs-law.com ; jdainow@schiavetti.com (lÌJ 1 attachments(3 MB) G Itr9.10.2021.pdf; Counselor, Please see the attached response. The original authorizations are being sent via regular mail. Thank you. Sincerely, Victoria A. Bruno Paralegal Levine & Grossman 114 Old Country Road, Suite 460 Mineola, NY 11501 (516) 248-7575 NOTICE OF PRIVILEGE & CONFIDENTIALITY This e-mail transmission (including any attachments) may contain confidential and/or privileged Information or protected health infonnation subject to privacy regulations such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This transmission is intended only for the use of the recipient(s) named above. If you are not the intended recipient, or a person responsible for delivering the message to the intended recipient, you are hereby notified that any disclosure, printing, copying, distribution, retention, publication or use of any of the information contained in this transmission is STRICTLY PROHIBITED. If you are not the intended recipient or if you have received this transmission in error, please immediately notify the sender by telephone and/or reply e-mail and permanently delete this e-mail from your computer system without saving or copying itin any manner. Thank you. From: Emmarie Etheridge Sent: Friday,August20,2021 12:27:39 PM To: Brian Lockhart Cc: Michelle Genetempo Subject: G _ /Skidmore v. Viswanathan, M.D., et al (Index No.: 508009/2013) Dear Brian: I am associate working with Steven Garry on the Grayton matter wherein we represent defendant, Dr. Viswanathan. FILED: KINGS COUNTY CLERK 09/13/2021 04:32 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 149 RECEIVED NYSCEF: 09/13/2021 I calledyou earlier this week and left a voicemail on your machine. We are preparing our standard report for the carrier and need to include any updated lieninformation. Would you be able to provide same at your earliest convenience? Also, I noticed that the February 3, 2021 discovery response, including the authorizations for Dr. Sherri Singh, P.S./l.S.384 Frances E. Carter and Medicaid/Empire Blue Cross, have the incorrect address for our firm. We are no longer located at 44 Wall Street. Our new address is: 100 Merrick Road, Suite 218E Rockville Centre, New York 11570 Could you please provide the updated authorizations to our new address so that they may be processed? Thank you for your prompt attention to the above. Have a lovely weekend! Very truly yours, Emmarie A. Etheridge Associate CosteWo, Shea et gaffney LLCP 100 Merrick Road East BIdg. Suite 218 Rockville Centre, New York 11570 Tel (212) 413-8912 Fax (516) 764-9104 eetheridgg@c_sgilplaw.com FILED: KINGS COUNTY CLERK 09/13/2021 04:32 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 149 RECEIVED NYSCEF: 09/13/2021 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 WILLIAM F. LEVINE STACEY HASKEL + SUITE 460 (1935-2014) MINEOLA, NEW YORK 1 1501 JEFFREY D. HUMMEL (516) 248-7575 * (N.Y. & MASS. BAR) (516) 294-O066 + (N.Y., N.J. BAR) FAX: (516)294-0645 EMAIL: LEVINENGROSSMAN@AOL.COM September 10, 2021 Costello, Shea & Gaffney LLP 100 Merrick Road East, Suite 218 Rockville Centre, NY 11570 Re: G /Skidmore v. Viswanathan, et al. Index No.: 508009/2013 Counselor: In response to your email dated August 20, 2021 and your Motion filed on August 24, 2021, enclosed please find duly executed authorizations with your new address that were previously provided: • Sherri M.D. Singh, • P.S. /I.S. 384 Frances E. Carter • Medicaid • Empire Blue Cross Blue Shield V truly yours, Brian C. Lockhart BCL/vab Encl. cc: Benvenuto & Slattery Schiavetti, Corgan, DiEdwards, Weinberg 1800 Northern Blvd. & Nicholson, LLP - 14th Roslyn, NY 11576 575 Eighth Avenue FlOOr New York, NY 10018 Arshack, Hajek & Lehrman, PLLC 7th 1790 Broadway, FlOOr New York, NY 10019 FILED: KINGS COUNTY CLERK 09/13/2021 04:32 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 149 RECEIVED NYSCEF: 09/13/2021 OCA officialForm No.: 960 AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA IThis form has heertupproved by the New York State Departmen t ofIIealthI PatientName- Date of Birth: SocialSecurityNumber: N ' __ G J/09 PatientAddress: 228 Moffat StreetApt 3L, Brooklyn,New York 11207 I, or myauthorized request representative, that healthiñfarmationregardingmy care and treatment be released on this form. as set forth In accordancewithNew York State Law and the Privacy Rule of the Health Iñërmcc and Acceüñtsility Portability Act of 1996 (HIPAA),I.understand that: 1. Thisauthorization may include disclosureofinformation to ALCOHOL relating and DRUG ABUSE, MENTAL HEALTH TREATMENT, except psycheh==py notes,and CONFIDENTIAL HIV*RELATED INFORMATION onlyif I place my initials line in Item on the appropriate 9(a).In the event thehealthinfnrmntion descdoed below includesany ofthese typesof information,and I initial the lineon thebox in Item 9(a), I specifically authorizereleaseof suchinformation to theperson(s)indicated in Item8. 2. IfI am authorizingthe releaseofHIV-related, alcoholor drugtreatment,or mentalhealthticatmcat information,the recipient is prohibited from redisclosingsuchinformation withoutmy authorization unlesspermittedto do so under federalor state law. that I have the right I understand to request a list of peoplewho may receiveor use myHIV-related irfGrmatics,I maycontactthe New York State Division of Human Rightsat (212) 480-2493 or the New York CityC÷ssion of Human Rights at(212)306-7450. These agenciesareresponsibleforprotectingmy rights. 3. I have therightto revoke thisauthorizationat anytime by writingto theheath careproviderlistedbelow. I understandthat I mayrevoke this authorizationexceptto theextentthataction been taken has already based on this authorization. 4. I understandthatsigning thisautharimiionis voluntary.My treatment,payment, enro!!mentin a health plan,or cligibility will for benefits not be conditioned upon my authorizationof this disclosure. 5. Iñfematiêñ disclasedunder thisauthorizationmight by the recipient be redisclosed (exceptas noted in Item redisclosure 2), and this may no longer be protectedby federalor state law. 6. THIS AUTHORIZATION DOES NOT AuïnüRiZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAT THE TTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9(bi .. - _ _.... 7. Narne and address of health care provider or entityto releaseiñformation: Sherri Singh, M.D., 1623 Weirfield Street, Ridgewood, NY 11385 8. Name and address Of person(s) or category of person to whorn thisiñfairnatics willbe sent: CoStello, Shea & Gaffney LLP, 100 Merrick Road EaSt, Suite 218, RockVille Centre, NY 11570 9(a). pecificinformationtobe released: Entire Medical Records, im'"'s patient office histories, notes(excepts psycliathcrapynotes),testresults, radiology studies, films,referrals,consults,billingrecords,insurance records,and records sent to youby.other healthcare prsviders. O Medical Record from(insertdate) to Present OOther: Include:(Indicate by Ó Init!:!!:;;) Alcohol/Drug TraatmanÓ Mental Health Informatic IV-Related Iñfarmatisa Authorization to DiscussHealth Information (b) By here laitialing I authorize Initials Name of individualhealthcare provider to discussmy healthinformation with my or gaveraracatal attorney, agency listed here: (Attorney/FirmName or Go v-enta! Agency Name) 10. Reason forreleaseofinformation: 11. Dateor eventon which thisauthorization willexpire: ofindividual AT THE END OF COURT CASE ** OAt request X Other:LEGAL MATTER 12. Ifnotthe patient, name ofperson signingform: 13. Authorityto sign on behalfof patient LEVINE & GROSSMAN ATTORNEYS-IN-FACT All itemson thisform have been completed and my questionsabout thisform havebeen answered. In I have addition, been provideda copyof the fo . Date: September 10. 2021 LEVINE & GROSSMAN by Brian C. Lockhart Signatureof patientor representative authorizedby law. * Human !r2 ::f:f The New York that causes AIDS. ciency Virus State Public Health Law protects st!::which r=cnablycould identify someone as having HIV and infe-±r symptoms or infection regarding a person's contacts. ** If threeyearshaselapsedsince the datethis ruibi=ib was signed,pleasecall Levine& Grossmanat (516) 248-7575to determineif thecasehasbeenconcluded. FILED: KINGS COUNTY CLERK 09/13/2021 04:32 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 149 RECEIVED NYSCEF: 09/13/2021 oCA Official Form No,: 960 AUTHORI7JTION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA This fornihas heen apprured by the New York State Department of IIealth| PatientName: Date ofBirth: SocialSecurityNumber: N, G) /09 -1028 PatientAddress: 228 Moffat StreetApt 3L, Brooklyn,New York 11207 I, or myauthorized request representative, thathealth informaticñscgeding my care and treatment be released on this form. as set forth In acccidancewithNew York State Law and the Privacy Rule of the Health Insurance and Accüüñtability Pertability Act of 1996(HIPAA), I understan that: 1. Thiseuthorization may includedisclosureofinfermatics to ALCOHOL relating and DRUG ABUSE, MENTAL HEALTH TREATMENT, excep psychotheepy notes,andCONFIDENTIAL HIV*RELATED INFORMATION only if I place my on the appropriate initials line in Item 9(a).In th event thehealthinformation describedbelow includesany ofthese typesof information,and I initial the lineon the boxin Item 9(a), I specificall authorizereleaseof suchinformation to the person(s) indicated in Item8. 2. IfI am authorizingtherelease ofHIV-related,alcohol or drugtreatment,or mentalhealthtreatment the recipient information, is prohibited froo redisclosingsuch informationwithoutmy authorizationunlesspermittedto do so under federalor state law. that I have the right I understand to reques a list ofpeople who may receiveor use myHIV-related I may contact information, the New York State Division of Human Rightsat (212)480-2493 o the New York City Commission of Human Rightsat (212)306-7450. Theseagencies are responsible forprotectingmy rights. 3. I have therightto revoke thisauthorizationat anytime by writingto theheath care provider listedbelow. that I may I understand revoke thi authorizationexceptto theextentthataction has already been taken based on this authorization. 4..I understandthatsigning thisauthorization is voluntary.My trcatmcat,payment, enrollmentin a health plan, for benefits or eligibility willnot b conditioned upon my authorizationof this disclosure. 5. Infüimatiandisclosedunder thisauthorizationmightbe redisclosedby the recipient (exceptas notedin Item2),and this redisclosure may no longe be protectedby federalorstatelaw. 6. THIS AUTHORiZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAT THI ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9(b). .. 7. Name and address Of health care provider or entityto releaseinformation: P.S. /I.S. 384 FranceS E. Carter, 242 Cooper Street, Brooldyn, NY 11207 .... 8. Name and address Of person(s) or categüry of person to whom thisinformation willbe sent: CoStello, Shea & Gaffney LLP, 100 Merrick Road EaSt, Suite 218, Rockville Centre, NY 11570 9(a).Specificinformationto be released: O Entire Medical Records, Mch patient office histories, notes(exceptspsychotherapy notes),testresults, radiologystudies, films,referisis,consults,billingrecords,insurance records,and records sentto you by other healthcare prüviders. O Medical Record from(insertdate) to Present ther: schoolrecords Include:(Indicate by ½½!ing) Ó Icohol/Drug Treatment 6 Mental Health InfGrmatis HIV-Related Information Authorization to Discuss Health Information (b) By here initiating I authorize Initials Name of individual healthcare provider todiscuss my healthinfermaticñwith my attorney,orr,vvw umentalagency listedhere: (Attorney/Firm Name or Governmental Agency Name) 10. Reasonfor releaseofinformation: 11. Dateor eventon which this will authorization expire: requestofindividual AT THE END OF COURT CASE ** OAt X Other:LEGAL MATTER 12. Ifnotthe patient, name ofperson signingform: 13. Authority to signon behalfof patient LEVINE & GROSSMAN ATTORNEYS-IN-FACT All itemson thisform have been compktcd and my qüesticasabout thisform havebeen answered. In I have eddition, been provideda copyof the fo Date: September 10. 2021 LEVINE & GROSSMAN by Brian C. Lockhart Signatureof patientor representative authorizedby law. * Human !ss:::ff:::ñcy Virus The New York State Public Health Law protects that causes AIDS. which reasonably could identify someone as having HIVsymptoms or infection and "-" regarding a person's contacts. ** If threeyearshaselapsedsincethe datethis =&· he was signed,pleasecall Levine& Grossmanat (516) 248-7575to determineif thecasehasbeenconcluded. FILED: KINGS COUNTY CLERK 09/13/2021 04:32 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 149 RECEIVED NYSCEF: 09/13/2021 OC A Ollicial Form No,:960 AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA |This foritiliasheel1approved by the New York State Departmelit of IIealtli| PatientName: Date ofBirth: SocialSecurityNumber: N, G: :/09 ' -1028 PatientAddress: 228 Moffat StreetApt 3L,Brooklyn, New York 11207 I, or myauthorized request representative, thathealth infarmaticñregardingmy care and treatment be releasedas set forth on this form. In accordancewithNew York State Law and the Privacy Rule of the Health Insurance and Accountability Portability Act of1996 (HIPAA), I üñderstec that: 1. Thi=*h~·izationmay includedisclosureof information to ALCOHOL relating and DRUG ABUSE, MENTAL HEALTH TREATMENT, excepi psychotherapy and notes, CONFIDENTIAL HIV*RELATED INFORMATION only ifIplacemy on initials theappropriate in line Item 9(a).In the event thehealthinfGrmatian describedbelow includesany ofthese typesof information,and I initial the lineon the box I specificall) in Item 9(a), authorizereleaseof suchinformation to the person(s) indicatedin Item 8. 2. IfI am authorizingtherelease ofHIV-related,alcohol or drug or mental treatment, healthtreatment the recipient infcrmation, frorr is prohibited redisclosingsuch informationwithoutmy authorizationunlesspermittedto do so under federalor state law. to reques1 that I have the right I understand a list of peoplewho may receiveor use myHIV-related information,I may contact the New York State Division of Human Rights at (212) 480-2493 or the New York CityCommission of Human Rights at (212) 306-7450. These agenciesare responsible forprotectingmy rights. 3. I have therightto revoke thisauthorizationat anytime by writingtothe heathcare providerlistedbelow. I understand that I mayrevoke this authorizationexceptto theextentthataction been taken has already based on this authorization. 4. I understandthatsigningthis authorization is voluntary.My treatment,payment, enro!!mentin a health plan,or eligibility for benefits willnot be conditionedupon my authorizationof this disclosure. 5. InfGrmaticñdisclosedunder thisauthorizationmightbe redisclosedby the recipient (exceptas notedin Item2), redisclosure and this may no longer be protectedby federal or statelaw. 6. THIS AUTHORIZATION DOES NOT AUTiiOitiZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAT THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9(b). 7.Name and address Of health care provider or entityto releaseinfarrsation: Medicaid Data WarehouSe - CDRS, NYSDOH - MISCNY, ESP P1-11 S Dock J, Albany, NY 12237 8. Name and address Of person(s) or category of person to whom thisinformation will be sent: CoStello, Shea & Gaffney LLP, 100 Merrick Road EaSt, Suite 218, RockVille Centre, NY 11570 9(a).Specific information tobe released: O Entire Medical Records, != 'ingpatient office histGries, notes(exceptspsychotherapy notes),testresults, radiologystudies, films,referrals, consults, billingrecords,insurance records,and records sentto you by otherhealth care providers. . Medical R ordfr;m(inse date . to resent Other: CO / (Av ( th, ÔÛ Include:(Indicate by Initialing) Alcohol/Drug TreatmenÔ entalHealth Information IV-Related InfGrmatiGñ Authorization to DiscussHealth Information (b) By here initialing I authorize Initials Name of individualhealthcare provider to discussmy healthinformation with my attorney,or govcmmcatal agency listed here: (Attorney/Firm Name or Governmental Agency Name) 10. Reason forreleaseofinformation: 11. Dateor eventon which thisauthorization willexpire: OAt requestofindividual AT THE END OF COURT CASE ** X Other:LEGAL MATTER 12. Ifnotthe patient, name ofperson signingform: 13. Authority on behalf to sign of patient LEVINE & GROSSMAN ATTORNEYS-IN-FACT All itemson thisform have been cGmpleted and my questionsabout thisform have been answered.In addition,I havebeen provideda copyof the form. Date:_ Scatem'uer 10. 2021 LEVINE & GROSSMAN by Brian C. Lockhart Signatureof patientor representative authorizedby law. * Human !:::::±±dency Virus The New York that causes AIDS. State Public Health Law protects :which reasonably could identify someone as having HIVsymp:c=: or infection regarding a person's contacts. and infen-.::tian "-" ** If threeyearshaselapsedsincethe datethis was signed,pleasecall Levine& Grossmanat (516) 248-7575to detennineif thecasehasbeenconcluded. FILED: KINGS COUNTY CLERK 09/13/2021 04:32 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 149 RECEIVED NYSCEF: 09/13/2021 OCA Of fidal Form No.:98 AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA This form has heest upproved by the New York State Department of IIeu1th| PatientName: Date of Birth: SocialSecurityNumber: N GT /09 1-1028 PatientAddress: 228 Moffat StreetApt 3L, Brooklyn,New York 11207 I, or myauthorized request representative, thathealth infGrmaticaregazdingmy care and trcstment be released on this form. as set forth In eccordancewithNew York State Law Rule and the Privacy of the Health Insumce and Acceent±b!!!iy Pertability Act of1996 (HIPAA), I understand that: 1. Thisauthorization may includedisclosureof information to ALCOHOL relating and DRUG ABUSE, MENTAL HEALTH TREATMENT, except psyphntherapy notes, and CONFIDENTIAL HIV*RELATED INFORMATION onlyifIplacemy initials line in Item on the appropriate 9(a).In the event the health informatics describedbelow includesany ofthese typesof information,and Iinitial the lineonthe box inItem9(a),I specifically authorizereleaseof suchinformation to the person(s) indicatedin Item 8. 2. IfI am authorizingtherelease ofHIV-related,alcohol or drugtreatment,ormental healthtreatment is prohibited the recipient information, from redisclosingsuch infe=etionwithout my autherization unlesspermittedtodo so underfederalorstatelaw. IunderstandthatIhavethe right to request a list of peoplewho may receiveor use myHIV-related I may contact information, the New York State Division of Human 480-2493 Rights at (212) or the New York CityCommission of Human Rights at (212) 306-7450. These agenciesare responsible forprotectingmy rights. 3. I have therightto revoke thisauthorizationat anytime by writingtothe heath careproviderlistedbelow. that I may I understand revoke this authorizationexceptto theextentthataction been taken has already based on this authorization.. 4. I understandthatsigningthis authorization is voluntary.My payment, treatment, carcilmcatin a health plan,or eligibility will for benefits not be conditionedupon my authorizationofthisdisclosure. 5. I#=a66n disclosedunder thisauthorizationmightbe redisclosedby the recipient (exceptas notedin Item2), and this redisclosure may no longer be protectedby federal or statelaw. 6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAT THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9(b). 7. Name and address Of health care provider or entityto releaseinf0rrsaticn: Empire Blue Cross Blue Shield, 15 Metrotech Center, Brooklyn, NY 11201 8. Name and address Of person(s) or category of person to whom thisinformation willbe sent: CoStello, Shea & Gaffney LLP, 100 Merrick Road EaSt, Suite 218, Rockville Centre, NY 11570 9(a).Specificinformationtobe released: O EntireMedical Records, patient inc:üdia¡;; office histories, notes(excep