Preview
(FILED: KINGS COUNTY CLERK 0372272022 07:05 PM
INDEX NO. 515167/2021
NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/22/2022
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
infants unde of 145 by the
Father and Natural Guardian IRAKLI SHARADZE, VERIFIED BILL OF
PARTICULARS
Index No.: 515167/2021
Plaintiff(s),
-against-
G.M.D. PROPERTIES
Plaintiff(s) N.S. and S.S., infants under the age of 14 years, by their father and natural
guardian IRAKLI SHARADZE, by their attorneys, LESCH & LESCH, P.C., responding to
Defendant(s) LAMI REALTY LLC’s, Demand for Bill of Particulars as follows:
1. Upon information and belief, infant Plaintiff(s) N.S. and $.S. were exposed to
lead from August 1, 2014 and continues until the present.
2. Upon information and belief, the location of occurrence was in Plaintiff(s)’
previous apartment located at EEE, Brooklyn, New York 11204 from August 01,
2014 up until December 30, 2015. Plaintiff(s) was further exposed at i’
Hg Brooklyn, New York 11223 from December 31, 2015 until the present.
3. See response to number 2 above.
A. Actual and Constructive notice are claimed.
3} Actual notice is claimed. Upon information and belief, the kind of paint used
in the building and the knowledge that same had high lead content was known to
Defendant(s). Person or persons to whom actual notice was given is within the purview of
Defendant(s)’ knowledge. The place where actual notice was given is within the purview of
Defendant(s)’ knowledge. The date and/or dates when actual notice was given are within the
purview of Defendant(s)’ knowledge. Furthermore, this information is within the exclusive
knowledge of Defendant(s) and will be purged and/or supplemented after depositions of the
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Defendant(s), its agents, servants and/or employees and after receipt of maintenance and
inspection records pursuant to Plaintiff(s)’ Demand for Discovery and Inspection.
6. Upon information and belief, infant Plaintiff N.S. suffered from elevated
blood lead levels; blood tests show the escalation of infant Plaintiff(s) Blood Lead Level as
follows:
a. 33 g/dl on December 12, 2014;
b. 32.5 g/dl on December 22, 2014;
c. 44 g/dl on January 9, 2015;
d. 36 g/dl on January 15, 2015;
e. 14.1 g/dl on December 14, 2015;
27 g/dl on April 14, 2016;
g. 24.1 g/dl on May 17, 2016;
h. 17.8 g/dl onJune 15, 2016;
i. 15.8 g/dl on August 15, 2016;
j. 14.5 ° g/dl on December 13, 2016;
4.8 g/dl on April 25, 2017;
8.4. g/dl on November 22, 2017;
m. 9.2 g/dl on April 21, 2018;
n. 11 g/dl on April 13, 2019;
o. 13.1 g/dl on January 24, 2020;
p. 11.6. g/dl on April 22, 2020;
q. 8.7. g/dl November 7, 2020; and
r. 6.9 g/dl on January 22, 2021.
Upon information and belief, infant Plaintiff S.S. suffered from elevated blood lead
levels; blood tests show the escalation of infant Plaintiff(s) Blood Lead Level as follows:
a. 14.2. g/dl on January 15, 2015;
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b. 10.1 g/dl on April 26, 2016;
c. 8.4. g/dl on May 16, 2016;
d. 6.0. g/dl on June 14, 2016;
e. 5.8 g/dl on August 12, 2016;
f. 5.1 g/dl on October 04, 2019;
g. 8.9 g/dl on January 25, 2021;
Blood lead levels in the range of 5-9 ug/dL have been associated with adverse health
effects in children aged six years and younger. As a result of the lead poisoning and/or
exposure, Infant Plaintiff(s) may suffer some or all the following sequelae which has been
linked to plumbism; regression; damage to the brain; behavioral difficulties; attention deficit
disorder; loss of 1.Q. d hemoglobin
levelopmental toxicity; decreased growth; decre:
synthesis; problems with red blood cells synthesis; effects on the central nervous system;
effects on the kidneys; effects on hematopoietic system; decreased intelligence; impaired
neuro- behavioral development; deficits in reading; deficits in writing; deficits in math; deficits
in abstract thinking; deficits in blood pressure associated with an increased risk of
cardiovascular disease; detrimental effects to the heart and blood vessels; damage to the
reproductive organ and systems; decreased conic disability; adverse neuro-psychological
development; adverse neuro-behavioral development; decreased ferreting level; muscle
weakness; abdominal cramping; negative effect on short term memory; decreased reaction
time; decreased hearing acute; decreased Vitamin D metabolism; problems with attention;
d risk of
problems with fine motor coordination; dec d cognitive performance; incr
anti-social and delinquent behavior; increased likelihood of behavior difficulties; poor
academic performance; decreased likelihood of the education and employment progress that
would have occurred if not subject to lead poisoning; diminishing level of understanding and
fund of information.
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Plaintiff(s) reserves the right to amend and/or supplement this portion of the Bill of
Particulars until discovery is completed.
7. Upon information and belief, Plaintiff(s) were not confined to bed, home and
hospital, but aforesaid injuries prevented them from performing their usual or customary
daily activities.
8. Upon information and belief, infant Plaintiff(s) did not lose time from school.
Plaintiff(s) reserves the right to amend and/or supplement this portion of the Bill of
Particulars until discovery is completed.
9. Special damages are unknown at this time and shall be provided upon receipt
of estimates. See Plaintiff(s) Reply to Defendant(s)’ Demand for Discovery and Inspection
below for the names and addresses of all physicians Plaintiff(s) received treatment from.
10. Please see responses to paragraphs 2 above.
11. a-b) Infant Plaintiff N.S. was born on 2018 in the country of Georgia. Infant
S.S. was born in 2014 in Brooklyn, New York; ¢) Infant Plaintiff(s) $.S. was born at Coney
Island Hospital; d-e) Infant Plaintiff(s)’ mother is Nato Shavishvili and father is Irakli
Sharadze both residing at ES. Brooklyn, New York 11230.
Plaintiff(s) reserves the right to amend and/or supplement this portion of the Bill of
Particulars until discovery is completed.
12. Infant Plaintiff N.S.’ Social Security number is XXX-XX-1902. Infant Plaintiff
S.S.’ Social Security number is XXX-XX-4349.
13. See Plaintiff(s) Reply to Defendant(s)’ Demand for Discovery and Inspection
below for the names and addresses of all physicians Plaintiff(s) received treatment from.
14. Claim for personal injury occurred when infant Plaintiff(s) ingested, breathed
and/or were exposed to lead due to the high lead-content of the paint used by Defendant(s)
to coat infant Plaintiff(s)’ apartment. See also response to number 2 above.
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15. Statutes, regulations, ordinances or rules are within the exclusive province of
the court and Plaintiff begs leave to refer to same at the time of trial, or after Defendant(s)’
depositions. Notwithstanding the aforementioned, Infant Plaintff(s) will align the following
statutes at time of trial; Multiple Dwelling Law Section 78; 80 and 210; New York City Health
Code Sections 173.13; 173.13(c); New York Administrative Code Sections 26-1201 (a)(3), 27-
2013, 27-2013(g), 27-2014, 27-2016, 27-2126, 27-2127, 27-2128; Public Health Law Sections
1370-1376; LONYCRR 67.1 - 67.13; Local Law 1 of 2004.
16. Unknown at this time and will be provided upon completion of discovery.
17. Defendant(s) G.M.D. PROPERTIES, INC. and LAMI REALTY LLC, their
agents, servants, and/or employees were reckless, careless, negligent in the ownership,
operation, maintenance and control of the aforesaid premises and that they caused, created
and/or failed to cure or rectify dangerous condition, to wit: paint used in the aforementioned
apartment had a greater lead toxicity level that is allowed by law and such paint was allowed to
chip, peel, and disintegrate from the walls and ceilings creating paint chips and paint dust
where lead was present; the Defendant(s) knew or had reason to know that the paint on the
walls and ceilings of the apartment was peeling and flaking and that such condition would
create an unreasonable risk of injury; Defendant(s) knew that an infant under the age of 7 was
in the apartment; Defendant(s) failed to warn the Plaintiff(s) of the dangerous condition of the
apartment and failed to remove the flaking and peeling paint from the premises all which
caused the infant Plaintiff(s) to become sick and disabled when they ingested, breathed or
were exposed to lead paint, paint chips and paint dust all of which had emanated from the
walls, ceilings, cabinets, radiators and pipes. As a result of the Defendant(s)’ negligence the
infant Plaintiff(s) were caused to ingest, breath and or was exposed to lead tainted chips,
peelings and dust and suffered lead paint poisoning.
18. Upon information and belief, Plaintiff(s) N.S. is covered by Emblem Health
under ID No. jggggwhile infant Plaintiff(s) S.S. is covered by UnitedHealthcare of New
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York under ID No. J. Plaintiff(s) reserves the right to amend this portion of the Bill
of Particulars until discovery is completed.
19. a. - c. Please see response to paragraph 2 above.
d. Unknown at this time and will be provided upon completion of discovery.
e. Upon information and belief, New York City Department of Health and
Mental Hygiene took samplings at the premises on March 20, 2015, April 26,
2016, June 17, 2016, and June 24, 2016. Plaintiff(s) reserves their right to
amend and/or supplement this portion of the Bill of Particulars upon
completion of discovery.
20. Unknown at this time and will be provided upon completion of discovery.
21. Unknown at this time and will be provided upon completion of discovery.
Dated: Bronx, New York
March 22, 2022
Yours, etc.
Lescu & Lescu, P.C.
By: _LA
GARY E.
Attorneys for Plaintiff(s)
860 Grand Concourse, Suite 2M
Bronx, New York 10451
(718) 292-1131
TO:
LITCHFIELD CAVO LLP
By: Andrew Sapon, Esq.
Attorneys for Defendant(s)
LAMI REALTY LLC
420 Lexington Avenue, Suite 2104
New York, New York 10170
(212) 434-0100
sapon@litchfieldcavo.com
6 of 15(FILED: KINGS COUNTY CLERK 0372272022 07:05 PM INDEX NO. 515167/2021
NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/22/2022
SUPREME COURT OF THE
COUNTY OF KINGS
TE OF NEW YORK
Father and Natural Guardian IRAKLI SHARADZE, VERIFICATION
Plaintiff(s),
Index No.: 515167/2021
-against-
G.M.D. PROPERTIES, INC. and LAMI REALTY LLC,
Defendant(s).
COUNTY OF BRONX }
GARY E. LESCH, ESQ., under the penalty of perjury and pursuant to CPLR, hereby
affirms the truth of the following statements:
Tam the attorney for the Plaintiff(s) in the within action and have read the foregoing BILL
OF PARTICULARS. That the same is true to my knowledge, except as to those matters
therein stated to be alleged upon information and belief, and as to those matters, I believe
them to be true.
This verification is made by deponent and not by the Plaintiff(s) since the Plaintiff(s) is not a
resident of the County where deponent maintains his office.
The grounds of deponent’s belief as to all matters not stated to be alleged upon information
and belief are as follows:
COMMUNICATIONS AND CONVERSATIONS HAD WITH PLAINTIFF(S) AND
UPON DOCUMENTS AND INFORMATION CONTAINED IN DEPONENT?’S FILE.
Dated: Bronx, New York
March 22, 2022
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SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
of 14y
Father and Natural Guardian IRAKLI SHARADZE, REPLY TO DEFENDANTS’
DEMAND FOR DISCOVERY
AND INSPECTION
Plaintiff(s), Index No.: 515167/2021
-against-
G.M.D. PROPERT:
2S,
INC. and LAMI REALTY LLC,
Defendant(s).
Plaintiff, N.S. and S.S., infants under the age of 14 years, by their Father and Natural
Guardian IRAKLI SHARADZE, by his attorneys, LESCH & LESCH, P.C., responding to
Defendant(s) LAMI REALTY LLC’s, Demand for Discovery and Inspection as follows:
1. NOTICE FOR DISCOVERY AND INSPECTION:
a. Demand for School Records: Not applicable. Upon information and belief,
Plaintiff(s) did not miss time from school. Plaintiff(s) reserves the right to
amend and/or supplement this portion of the reply until discovery is
completed.
b. Demand for Photographs/Videos of subject premise: None at this time and
will be provided upon completion of discovery.
c. Demand for Photographs/Videos of the defective condition: None at this time
and will be provided upon completion of discovery.
d. Demand for Collateral Source:
i. Upon information and belief, infant Plaintiff N.S. is covered by
Emblem Health. Served simultaneously with this reply is an
authorization authorizing release of same.
8 of 15(FILED: KINGS COUNTY CLERK 0372272022 07:05 PM INDEX NO. 515167/2021
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ii. Upon information and belief, infant Plainuff S.S. is covered by
UnitedHealthcare of New York. Served simultaneously with this reply
is an authorization authorizing release of same.
e. Demand for Statements: Plaintiff(s) do not have in their possession any
statements of the Defendant, its servants, agents and/or employees.
f. Infant Plaintiff(s)’ Birth Certificate: Served simultaneously with this reply are
copies of infant Plaintiff(s) N.S. and S.S. birth certificates.
g. Demand for any and all records from government agencies: Objection. Said
documents are public records.
2. DEMAND FOR MEDICAL INFORMATION:
a. Served simultaneously with this reply is an authorization for release of medical
records from BioReference Laboratories Inc. located at 481 Edward H. Ross
Dr., Elmwood Park, NJ 07407 for treatments rendered to Infant Plaintiff(s),
N.S., including diagnostic studies if any;
b. Served simultaneously with this reply is an authorization for release of medical
records from BioReference Laboratories Inc. located at 481 Edward H. Ross
Dr., Elmwood Park, NJ 07407 for treatments rendered to Infant Plaintiff(s),
S.S., including diagnostic studies if any;
3. DEMAND FOR HOSPITAL AUTHORIZATIONS: Upon information
and belief, Plaintiff(s) did not receive medical treatments from a hospital and Plaintiff(s)
reserve the right to amend this portion of the reply until discovery is completed.
Notwithstanding said assertion, see response to number 2 above.
A. DEMAND FOR NAMES AND ADDRESSES OF WITNESSES: None at
this time and will be provided upon completion of discovery, if any.
jy NOTICE PURSUANT TO 3101 (d):
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a. Dr. James Weisberger, M.D., a board certified pathologist associated with
BioReference Laboratories Inc.
The aforesaid expert is duly licensed to practice Medicine within the State of
New York and will testify that the injuries sustained by Plaintiff(s) as a result of the
lead exposure that occurred on or about August 01, 2014 until the present are
permanent in nature and duration. The physician will rely on his physical
examination of the Plaintiff(s) and on the medical records of the aforementioned
institutions. His testimony can be found in the reports/records attached hereto,
including history, diagnosis, prognosis and treatment.
The Plaintiff(s) refers the Defendant(s) to the Medical Directory of the State
of New York Volumes 2014-2022 for a detailed list of the physicians’ educational
background, licenses, publications, and hospital affiliations.
Curriculum vitae will be exchanged upon receipt of same.
Dated: Bronx, New York
March 22, 2022
Yours, etc.
Lescu & Lescu, P.C.
By: _LA
GARY E.
Attorneys for Plaintiff(s)
860 Grand Concourse, Suite 2M
Bronx, New York 10451
(718) 292-1131
TO:
LITCHFIELD CAVO LLP
By: Andrew Sapon, Esq.
Attorneys for Defendant(s)
LAMI REALTY LLC
420 Lexington Avenue, Suite 2104
New York, New York 10170
(212) 434-0100
sapon' chfieldcavo.com
10 of 15(FILED: KINGS COUNTY CLERK 0 U 07:05 PP INDEX NO. 515167/2021
NYSCEF DOC. NO. 4 RECEIVED NYSCEF:
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF BROOKLYN
N.S. and S.S., infants under the age of 14 years, by their
Father and Natural Guardian IRAKLI SHARADZE, Index No.: 515167/2021
Plaintiff(s),
-against-
G.M.D. PROPERTIES, INC. and LAMI REALTY LLC,
Defendant(s).
03/22/2022
VERIFIED BILL OF PARTICULARS and REPLY TO
DEFENDANT(S)’ DEMAND FOR DISCOVERY AND INSPECTION
Lescu & LEscu, P.C.
Attorneys for Plaintif(s)
Office & P.O. Address
860 Grand Concourse, Suite 2M
Bronx, New York 10451
(718) 292-1131
TO: LITCHFIELD CAVO LLP
11 of 15INDEX NO. 515167/2021
RECEIVED NYSCEF: 03/22/2022
\ OCA Official Form 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 Social Security Number
Ma 2013 a
Patient Address
, BROOKLYN, NEW YORK 11230
I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form:
In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996
(HIPAA), [understand that:
1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH
TREATMENT, except psychotherapy notes, and CONFIDENTIAL HIV* RELATED INFORMATION only if I place my initials on
the appropriate line in Item 9(a). In the event the health information described below includes any of these types of information, and I
initial the line on the box in Item 9(a), I specifically authorize release of such information to the person(s) indicated in Item 8.
2. If I am 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 authorization unless permitted to do so under federal or state law. I
understand that I have the right to request a list of people who may receive or use my HIV-related information without authorization. If
I experience discrimination because of the release or disclosure of HIV-related information, I may contact the New York State Division
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 right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may
revoke this authorization except to the extent that action has already been taken based on this authorization.
4. I understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for
benefits will not be conditioned upon my authorization of this disclosure.
5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this
redisclosure may no longer be protected by federal or state law.
6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL
CARE WITH ANYONE OTHER THAN THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9 (b).
7. Name and address of health provider or entity to release this information:
BIOREFERENCE LABORATORIES INC.; 481 Edward H. Ross Dr., Elmwood Park, NJ 07407
8. Name and address of person(s) or category of person to whom this information will be sent:
LITCHFIELD CAVO LLP; 420 Lexington Avenue, Suite 2104, New York, New York 10170
9(a). Specific information to be released:
Medical Record from (insert date) August 1,2044 to (insert date) present
U Entire Medical Record, including patient histories, office notes (except psychotherapy notes), test results, radiology studies, films,
referrals, consults, billing records, insurance records, and records sent to you by other health care providers.
@ Other: _including diagnostic reports Include: (Indicate by Initialing)
Alcohol/Drug Treatment
Mental Health Information
Authorization to Discuss Health Information HIV-Related Information
(b) O By initialing here I authorize
Tnitials ‘Name of individual health care provider
to discuss my health information with my attorney, or a governmental agency, listed here:
(Attomey/Firm Name or Governmental Agency Name)
10. Reason for release of information: 11. Date or event on which this authorization will expire:
QO At request of individual
@ Other; Litigation Purposes Upon Completion of Litigation
12. If not the patient, name of person signing form: 13. Authority to sign on behalf of patient:
IRAKLI SHARADZE. FATHER OF Na
‘All items on this my questions about this form have been answered. In addition, I have been provided a
copy of the form.
vv Qa . Date: _3.22.2022
Signature of patjent or Tepes SH i: BY law.
* Human Immunodeficiency Virus that causes AIDS. The New York State Public Health Law protects information which reasonably could
identify someone as having HIV symptoms or infection and information regarding a person’s contacts.
12 of 15INDEX NO. 515167/2021
RECEIVED NYSCEF: 03/22/2022
\ OCA Official Form 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 Social Security Number
| a MS 2014 a
Patient Address
BROOKLYN, NEW YORK 11230
I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form:
In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996
(HIPAA), [understand that:
1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH
TREATMENT, except psychotherapy notes, and CONFIDENTIAL HIV* RELATED INFORMATION only if I place my initials on
the appropriate line in Item 9(a). In the event the health information described below includes any of these types of information, and I
initial the line on the box in Item 9(a), I specifically authorize release of such information to the person(s) indicated in Item 8.
2. If I am 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 authorization unless permitted to do so under federal or state law. I
understand that I have the right to request a list of people who may receive or use my HIV-related information without authorization. If
I experience discrimination because of the release or disclosure of HIV-related information, I may contact the New York State Division
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 right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may
revoke this authorization except to the extent that action has already been taken based on this authorization.
4. I understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for
benefits will not be conditioned upon my authorization of this disclosure.
5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this
redisclosure may no longer be protected by federal or state law.
6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL
CARE WITH ANYONE OTHER THAN THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9 (b).
7. Name and address of health provider or entity to release this information:
BIOREFERENCE LABORATORIES INC.; 481 Edward H. Ross Dr., Elmwood Park, NJ 07407
8. Name and address of person(s) or category of person to whom this information will be sent:
LITCHFIELD CAVO LLP; 420 Lexington Avenue, Suite 2104, New York, New York 10170
9(a). Specific information to be released:
Medical Record from (insert date) August 1,2044 to (insert date) present
U Entire Medical Record, including patient histories, office notes (except psychotherapy notes), test results, radiology studies, films,
referrals, consults, billing records, insurance records, and records sent to you by other health care providers.
@ Other: _including diagnostic reports Include: (Indicate by Initialing)
Alcohol/Drug Treatment
Mental Health Information
Authorization to Discuss Health Information HIV-Related Information
(b) O By initialing here I authorize
Tnitials ‘Name of individual health care provider
to discuss my health information with my attorney, or a governmental agency, listed here:
(Attomey/Firm Name or Governmental Agency Name)
10. Reason for release of information: 11. Date or event on which this authorization will expire:
QO At request of individual
@ Other; Litigation Purposes Upon Completion of Litigation
12. If not the patient, name of person signing form: 13. Authority to sign on behalf of patient:
IRAKLI SHARADZE FATHER OF Sa
All items on this my questions about this form have been answered. In addition, I have been provided a
copy of the form.
vv Qa . Date: _3.22.2022
Signature of patjent or Tepes SH i: BY law.
* Human Immunodeficiency Virus that causes AIDS. The New York State Public Health Law protects information which reasonably could
identify someone as having HIV symptoms or infection and information regarding a person’s contacts.
13 of 15INDEX NO. 515167/2021
RECEIVED NYSCEF: 03/22/2022
\ OCA Official Form 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 Social Security Number
| a MS 2014 a
Patient Address
, BROOKLYN, NEW YORK 11230
I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form:
In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996
(HIPAA), [understand that:
1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH
TREATMENT, except psychotherapy notes, and CONFIDENTIAL HIV* RELATED INFORMATION only if I place my initials on
the appropriate line in Item 9(a). In the event the health information described below includes any of these types of information, and I
initial the line on the box in Item 9(a), I specifically authorize release of such information to the person(s) indicated in Item 8.
2. If I am 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 authorization unless permitted to do so under federal or state law. I
understand that I have the right to request a list of people who may receive or use my HIV-related information without authorization. If
I experience discrimination because of the release or disclosure of HIV-related information, I may contact the New York State Division
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 right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may
revoke this authorization except to the extent that action has already been taken based on this authorization.
4. I understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for
benefits will not be conditioned upon my authorization of this disclosure.
5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this
redisclosure may no longer be protected by federal or state law.
6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL
CARE WITH ANYONE OTHER THAN THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9 (b).
7. Name and address of health provider or entity to release this information:
UNITEDHEALTHCARE OF NEW YORK; 35 E Broadway, First Floor, New York, NY 10002
8. Name and address of person(s) or category of person to whom this information will be sent:
LITCHFIELD CAVO LLP; 420 Lexington Avenue, Suite 2104, New York, New York 10170
9(a). Specific information to be released:
Medical Record from (insert date) August 1,2044 to (insert date) present
U Entire Medical Record, including patient histories, office notes (except psychotherapy notes), test results, radiology studies, films,
referrals, consults, billing records, insurance records, and records sent to you by other health care providers.
@ Other: _under 1D No: Include: (Indicate by Initialing)
Alcohol/Drug Treatment
Mental Health Information
Authorization to Discuss Health Information HIV-Related Information
(b) O By initiating here I authorize
Tnitials ‘Name of individual health care provider
to discuss my health information with my attorney, or a governmental agency, listed here:
(Attomey/Firm Name or Governmental Agency Name)
10. Reason for release of information: 11. Date or event on which this authorization will expire:
QO At request of individual
@ Other; Litigation Purposes Upon Completion of Litigation
12. If not the patient, name of person signing form: 13. Authority to sign on behalf of patient:
IRAKLI SHARADZE. FATHER OF Sa
‘All items on this my questions about this form have been answered. In addition, I have been provided a
copy of the form.
vv Qa . Date: _3.22.2022
Signature of patjent or Tepes SH i: BY law.
* Human Immunodeficiency Virus that causes AIDS. The New York State Public Health Law protects information which reasonably could
identify someone as having HIV symptoms or infection and information regarding a person’s contacts.
14 of 15INDEX NO. 515167/2021
RECEIVED NYSCEF: 03/22/2022
\ OCA Official Form 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 Social Security Number
Ma 2013 a
Patient Address
, BROOKLYN, NEW YORK 11230
I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form:
In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996
(HIPAA), [understand that:
1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH
TREATMENT, except psychotherapy notes, and CONFIDENTIAL HIV* RELATED INFORMATION only if I place my initials on
the appropriate line in Item 9(a). In the event the health information described below includes any of these types of information, and I
initial the line on the box in Item 9(a), I specifically authorize release of such information to the person(s) indicated in Item 8.
2. If I am 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 authorization unless permitted to do so under federal or state law. I
understand that I have the right to request a list of people who may receive or use my HIV-related information without authorization. If
I experience discrimination because of the release or disclosure of HIV-related information, I may contact the New York State Division
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 right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may
revoke this authorization except to the extent that action has already been taken based on this authorization.
4. I understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for
benefits will not be conditioned upon my authorization of this disclosure.
5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this
redisclosure may no longer be protected by federal or state law.
6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL
CARE WITH ANYONE OTHER THAN THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9 (b).
7. Name and address of health provider or entity to release this information:
EMBLEM HEALTH; P.O. Box 2845, NY, NY 10116-2845
8. Name and address of person(s) or category of person to whom this information will be sent:
LITCHFIELD CAVO LLP; 420 Lexington Avenue, Suite 2104, New York, New York 10170
9(a). Specific information to be released:
Medical Record from (insert date) August 1,2044 to (insert date) present
U Entire Medical Record, including patient histories, office notes (except psychotherapy notes), test results, radiology studies, films,
referrals, consults, billing records, insurance records, and records sent to you by other health care providers.
@ Other: _under 1D No: Include: (Indicate by Initialing)
Alcohol/Drug Treatment
Mental Health Information
Authorization to Discuss Health Information HIV-Related Information
(b) O By initiating here I authorize
Tnitials ‘Name of individual health care provider
to discuss my health information with my attorney, or a governmental agency, listed here:
(Attomey/Firm Name or Governmental Agency Name)
10. Reason for release of information: 11. Date or event on which this authorization will expire:
QO At request of individual
@ Other; Litigation Purposes Upon Completion of Litigation
12. If not the patient, name of person signing form: 13. Authority to sign on behalf of patient:
IRAKLI SHARADZE. FATHER OF Na
‘All items on this my questions about this form have been answered. In addition, I have been provided a
copy of the form.
vv Qa . Date: _3.22.2022
Signature of patjent or Tepes SH i: BY law.
* Human Immunodeficiency Virus that causes AIDS. The New York State Public Health Law protects information which reasonably could
identify someone as having HIV symptoms or infection and information regarding a person’s contacts.
15 of 15
Preview
(FILED: KINGS COUNTY CLERK 0372272022 07:05 PM INDEX NO. 515167/2021 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/22/2022 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS infants unde of 145 by the Father and Natural Guardian IRAKLI SHARADZE, VERIFIED BILL OF PARTICULARS Index No.: 515167/2021 Plaintiff(s), -against- G.M.D. PROPERTIES Plaintiff(s) N.S. and S.S., infants under the age of 14 years, by their father and natural guardian IRAKLI SHARADZE, by their attorneys, LESCH & LESCH, P.C., responding to Defendant(s) LAMI REALTY LLC’s, Demand for Bill of Particulars as follows: 1. Upon information and belief, infant Plaintiff(s) N.S. and $.S. were exposed to lead from August 1, 2014 and continues until the present. 2. Upon information and belief, the location of occurrence was in Plaintiff(s)’ previous apartment located at EEE, Brooklyn, New York 11204 from August 01, 2014 up until December 30, 2015. Plaintiff(s) was further exposed at i’ Hg Brooklyn, New York 11223 from December 31, 2015 until the present. 3. See response to number 2 above. A. Actual and Constructive notice are claimed. 3} Actual notice is claimed. Upon information and belief, the kind of paint used in the building and the knowledge that same had high lead content was known to Defendant(s). Person or persons to whom actual notice was given is within the purview of Defendant(s)’ knowledge. The place where actual notice was given is within the purview of Defendant(s)’ knowledge. The date and/or dates when actual notice was given are within the purview of Defendant(s)’ knowledge. Furthermore, this information is within the exclusive knowledge of Defendant(s) and will be purged and/or supplemented after depositions of the 1 of 15(FILED: KINGS COUNTY CLERK 0372272022 07:05 PM INDEX NO. 515167/2021 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/22/2022 Defendant(s), its agents, servants and/or employees and after receipt of maintenance and inspection records pursuant to Plaintiff(s)’ Demand for Discovery and Inspection. 6. Upon information and belief, infant Plaintiff N.S. suffered from elevated blood lead levels; blood tests show the escalation of infant Plaintiff(s) Blood Lead Level as follows: a. 33 g/dl on December 12, 2014; b. 32.5 g/dl on December 22, 2014; c. 44 g/dl on January 9, 2015; d. 36 g/dl on January 15, 2015; e. 14.1 g/dl on December 14, 2015; 27 g/dl on April 14, 2016; g. 24.1 g/dl on May 17, 2016; h. 17.8 g/dl onJune 15, 2016; i. 15.8 g/dl on August 15, 2016; j. 14.5 ° g/dl on December 13, 2016; 4.8 g/dl on April 25, 2017; 8.4. g/dl on November 22, 2017; m. 9.2 g/dl on April 21, 2018; n. 11 g/dl on April 13, 2019; o. 13.1 g/dl on January 24, 2020; p. 11.6. g/dl on April 22, 2020; q. 8.7. g/dl November 7, 2020; and r. 6.9 g/dl on January 22, 2021. Upon information and belief, infant Plaintiff S.S. suffered from elevated blood lead levels; blood tests show the escalation of infant Plaintiff(s) Blood Lead Level as follows: a. 14.2. g/dl on January 15, 2015; 2 of 15(FILED: KINGS COUNTY CLERK 0372272022 07:05 PM INDEX NO. 515167/2021 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/22/2022 b. 10.1 g/dl on April 26, 2016; c. 8.4. g/dl on May 16, 2016; d. 6.0. g/dl on June 14, 2016; e. 5.8 g/dl on August 12, 2016; f. 5.1 g/dl on October 04, 2019; g. 8.9 g/dl on January 25, 2021; Blood lead levels in the range of 5-9 ug/dL have been associated with adverse health effects in children aged six years and younger. As a result of the lead poisoning and/or exposure, Infant Plaintiff(s) may suffer some or all the following sequelae which has been linked to plumbism; regression; damage to the brain; behavioral difficulties; attention deficit disorder; loss of 1.Q. d hemoglobin levelopmental toxicity; decreased growth; decre: synthesis; problems with red blood cells synthesis; effects on the central nervous system; effects on the kidneys; effects on hematopoietic system; decreased intelligence; impaired neuro- behavioral development; deficits in reading; deficits in writing; deficits in math; deficits in abstract thinking; deficits in blood pressure associated with an increased risk of cardiovascular disease; detrimental effects to the heart and blood vessels; damage to the reproductive organ and systems; decreased conic disability; adverse neuro-psychological development; adverse neuro-behavioral development; decreased ferreting level; muscle weakness; abdominal cramping; negative effect on short term memory; decreased reaction time; decreased hearing acute; decreased Vitamin D metabolism; problems with attention; d risk of problems with fine motor coordination; dec d cognitive performance; incr anti-social and delinquent behavior; increased likelihood of behavior difficulties; poor academic performance; decreased likelihood of the education and employment progress that would have occurred if not subject to lead poisoning; diminishing level of understanding and fund of information. 3 of 15(FILED: KINGS COUNTY CLERK 0372272022 07:05 PM INDEX NO. 515167/2021 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/22/2022 Plaintiff(s) reserves the right to amend and/or supplement this portion of the Bill of Particulars until discovery is completed. 7. Upon information and belief, Plaintiff(s) were not confined to bed, home and hospital, but aforesaid injuries prevented them from performing their usual or customary daily activities. 8. Upon information and belief, infant Plaintiff(s) did not lose time from school. Plaintiff(s) reserves the right to amend and/or supplement this portion of the Bill of Particulars until discovery is completed. 9. Special damages are unknown at this time and shall be provided upon receipt of estimates. See Plaintiff(s) Reply to Defendant(s)’ Demand for Discovery and Inspection below for the names and addresses of all physicians Plaintiff(s) received treatment from. 10. Please see responses to paragraphs 2 above. 11. a-b) Infant Plaintiff N.S. was born on 2018 in the country of Georgia. Infant S.S. was born in 2014 in Brooklyn, New York; ¢) Infant Plaintiff(s) $.S. was born at Coney Island Hospital; d-e) Infant Plaintiff(s)’ mother is Nato Shavishvili and father is Irakli Sharadze both residing at ES. Brooklyn, New York 11230. Plaintiff(s) reserves the right to amend and/or supplement this portion of the Bill of Particulars until discovery is completed. 12. Infant Plaintiff N.S.’ Social Security number is XXX-XX-1902. Infant Plaintiff S.S.’ Social Security number is XXX-XX-4349. 13. See Plaintiff(s) Reply to Defendant(s)’ Demand for Discovery and Inspection below for the names and addresses of all physicians Plaintiff(s) received treatment from. 14. Claim for personal injury occurred when infant Plaintiff(s) ingested, breathed and/or were exposed to lead due to the high lead-content of the paint used by Defendant(s) to coat infant Plaintiff(s)’ apartment. See also response to number 2 above. 4 of 15(FILED: KINGS COUNTY CLERK 0372272022 07:05 PM INDEX NO. 515167/2021 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/22/2022 15. Statutes, regulations, ordinances or rules are within the exclusive province of the court and Plaintiff begs leave to refer to same at the time of trial, or after Defendant(s)’ depositions. Notwithstanding the aforementioned, Infant Plaintff(s) will align the following statutes at time of trial; Multiple Dwelling Law Section 78; 80 and 210; New York City Health Code Sections 173.13; 173.13(c); New York Administrative Code Sections 26-1201 (a)(3), 27- 2013, 27-2013(g), 27-2014, 27-2016, 27-2126, 27-2127, 27-2128; Public Health Law Sections 1370-1376; LONYCRR 67.1 - 67.13; Local Law 1 of 2004. 16. Unknown at this time and will be provided upon completion of discovery. 17. Defendant(s) G.M.D. PROPERTIES, INC. and LAMI REALTY LLC, their agents, servants, and/or employees were reckless, careless, negligent in the ownership, operation, maintenance and control of the aforesaid premises and that they caused, created and/or failed to cure or rectify dangerous condition, to wit: paint used in the aforementioned apartment had a greater lead toxicity level that is allowed by law and such paint was allowed to chip, peel, and disintegrate from the walls and ceilings creating paint chips and paint dust where lead was present; the Defendant(s) knew or had reason to know that the paint on the walls and ceilings of the apartment was peeling and flaking and that such condition would create an unreasonable risk of injury; Defendant(s) knew that an infant under the age of 7 was in the apartment; Defendant(s) failed to warn the Plaintiff(s) of the dangerous condition of the apartment and failed to remove the flaking and peeling paint from the premises all which caused the infant Plaintiff(s) to become sick and disabled when they ingested, breathed or were exposed to lead paint, paint chips and paint dust all of which had emanated from the walls, ceilings, cabinets, radiators and pipes. As a result of the Defendant(s)’ negligence the infant Plaintiff(s) were caused to ingest, breath and or was exposed to lead tainted chips, peelings and dust and suffered lead paint poisoning. 18. Upon information and belief, Plaintiff(s) N.S. is covered by Emblem Health under ID No. jggggwhile infant Plaintiff(s) S.S. is covered by UnitedHealthcare of New 5 of 15(FILED: KINGS COUNTY CLERK 0372272022 07:05 PM INDEX NO. 515167/2021 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/22/2022 York under ID No. J. Plaintiff(s) reserves the right to amend this portion of the Bill of Particulars until discovery is completed. 19. a. - c. Please see response to paragraph 2 above. d. Unknown at this time and will be provided upon completion of discovery. e. Upon information and belief, New York City Department of Health and Mental Hygiene took samplings at the premises on March 20, 2015, April 26, 2016, June 17, 2016, and June 24, 2016. Plaintiff(s) reserves their right to amend and/or supplement this portion of the Bill of Particulars upon completion of discovery. 20. Unknown at this time and will be provided upon completion of discovery. 21. Unknown at this time and will be provided upon completion of discovery. Dated: Bronx, New York March 22, 2022 Yours, etc. Lescu & Lescu, P.C. By: _LA GARY E. Attorneys for Plaintiff(s) 860 Grand Concourse, Suite 2M Bronx, New York 10451 (718) 292-1131 TO: LITCHFIELD CAVO LLP By: Andrew Sapon, Esq. Attorneys for Defendant(s) LAMI REALTY LLC 420 Lexington Avenue, Suite 2104 New York, New York 10170 (212) 434-0100 sapon@litchfieldcavo.com 6 of 15(FILED: KINGS COUNTY CLERK 0372272022 07:05 PM INDEX NO. 515167/2021 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/22/2022 SUPREME COURT OF THE COUNTY OF KINGS TE OF NEW YORK Father and Natural Guardian IRAKLI SHARADZE, VERIFICATION Plaintiff(s), Index No.: 515167/2021 -against- G.M.D. PROPERTIES, INC. and LAMI REALTY LLC, Defendant(s). COUNTY OF BRONX } GARY E. LESCH, ESQ., under the penalty of perjury and pursuant to CPLR, hereby affirms the truth of the following statements: Tam the attorney for the Plaintiff(s) in the within action and have read the foregoing BILL OF PARTICULARS. That the same is true to my knowledge, except as to those matters therein stated to be alleged upon information and belief, and as to those matters, I believe them to be true. This verification is made by deponent and not by the Plaintiff(s) since the Plaintiff(s) is not a resident of the County where deponent maintains his office. The grounds of deponent’s belief as to all matters not stated to be alleged upon information and belief are as follows: COMMUNICATIONS AND CONVERSATIONS HAD WITH PLAINTIFF(S) AND UPON DOCUMENTS AND INFORMATION CONTAINED IN DEPONENT?’S FILE. Dated: Bronx, New York March 22, 2022 7 of 15(FILED: KINGS COUNTY CLERK 0372272022 07:05 PM INDEX NO. 515167/2021 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/22/2022 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS of 14y Father and Natural Guardian IRAKLI SHARADZE, REPLY TO DEFENDANTS’ DEMAND FOR DISCOVERY AND INSPECTION Plaintiff(s), Index No.: 515167/2021 -against- G.M.D. PROPERT: 2S, INC. and LAMI REALTY LLC, Defendant(s). Plaintiff, N.S. and S.S., infants under the age of 14 years, by their Father and Natural Guardian IRAKLI SHARADZE, by his attorneys, LESCH & LESCH, P.C., responding to Defendant(s) LAMI REALTY LLC’s, Demand for Discovery and Inspection as follows: 1. NOTICE FOR DISCOVERY AND INSPECTION: a. Demand for School Records: Not applicable. Upon information and belief, Plaintiff(s) did not miss time from school. Plaintiff(s) reserves the right to amend and/or supplement this portion of the reply until discovery is completed. b. Demand for Photographs/Videos of subject premise: None at this time and will be provided upon completion of discovery. c. Demand for Photographs/Videos of the defective condition: None at this time and will be provided upon completion of discovery. d. Demand for Collateral Source: i. Upon information and belief, infant Plaintiff N.S. is covered by Emblem Health. Served simultaneously with this reply is an authorization authorizing release of same. 8 of 15(FILED: KINGS COUNTY CLERK 0372272022 07:05 PM INDEX NO. 515167/2021 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/22/2022 ii. Upon information and belief, infant Plainuff S.S. is covered by UnitedHealthcare of New York. Served simultaneously with this reply is an authorization authorizing release of same. e. Demand for Statements: Plaintiff(s) do not have in their possession any statements of the Defendant, its servants, agents and/or employees. f. Infant Plaintiff(s)’ Birth Certificate: Served simultaneously with this reply are copies of infant Plaintiff(s) N.S. and S.S. birth certificates. g. Demand for any and all records from government agencies: Objection. Said documents are public records. 2. DEMAND FOR MEDICAL INFORMATION: a. Served simultaneously with this reply is an authorization for release of medical records from BioReference Laboratories Inc. located at 481 Edward H. Ross Dr., Elmwood Park, NJ 07407 for treatments rendered to Infant Plaintiff(s), N.S., including diagnostic studies if any; b. Served simultaneously with this reply is an authorization for release of medical records from BioReference Laboratories Inc. located at 481 Edward H. Ross Dr., Elmwood Park, NJ 07407 for treatments rendered to Infant Plaintiff(s), S.S., including diagnostic studies if any; 3. DEMAND FOR HOSPITAL AUTHORIZATIONS: Upon information and belief, Plaintiff(s) did not receive medical treatments from a hospital and Plaintiff(s) reserve the right to amend this portion of the reply until discovery is completed. Notwithstanding said assertion, see response to number 2 above. A. DEMAND FOR NAMES AND ADDRESSES OF WITNESSES: None at this time and will be provided upon completion of discovery, if any. jy NOTICE PURSUANT TO 3101 (d): 9 of 15(FILED: KINGS COUNTY CLERK 0372272022 07:05 PM INDEX NO. 515167/2021 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: 03/22/2022 a. Dr. James Weisberger, M.D., a board certified pathologist associated with BioReference Laboratories Inc. The aforesaid expert is duly licensed to practice Medicine within the State of New York and will testify that the injuries sustained by Plaintiff(s) as a result of the lead exposure that occurred on or about August 01, 2014 until the present are permanent in nature and duration. The physician will rely on his physical examination of the Plaintiff(s) and on the medical records of the aforementioned institutions. His testimony can be found in the reports/records attached hereto, including history, diagnosis, prognosis and treatment. The Plaintiff(s) refers the Defendant(s) to the Medical Directory of the State of New York Volumes 2014-2022 for a detailed list of the physicians’ educational background, licenses, publications, and hospital affiliations. Curriculum vitae will be exchanged upon receipt of same. Dated: Bronx, New York March 22, 2022 Yours, etc. Lescu & Lescu, P.C. By: _LA GARY E. Attorneys for Plaintiff(s) 860 Grand Concourse, Suite 2M Bronx, New York 10451 (718) 292-1131 TO: LITCHFIELD CAVO LLP By: Andrew Sapon, Esq. Attorneys for Defendant(s) LAMI REALTY LLC 420 Lexington Avenue, Suite 2104 New York, New York 10170 (212) 434-0100 sapon' chfieldcavo.com 10 of 15(FILED: KINGS COUNTY CLERK 0 U 07:05 PP INDEX NO. 515167/2021 NYSCEF DOC. NO. 4 RECEIVED NYSCEF: SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF BROOKLYN N.S. and S.S., infants under the age of 14 years, by their Father and Natural Guardian IRAKLI SHARADZE, Index No.: 515167/2021 Plaintiff(s), -against- G.M.D. PROPERTIES, INC. and LAMI REALTY LLC, Defendant(s). 03/22/2022 VERIFIED BILL OF PARTICULARS and REPLY TO DEFENDANT(S)’ DEMAND FOR DISCOVERY AND INSPECTION Lescu & LEscu, P.C. Attorneys for Plaintif(s) Office & P.O. Address 860 Grand Concourse, Suite 2M Bronx, New York 10451 (718) 292-1131 TO: LITCHFIELD CAVO LLP 11 of 15INDEX NO. 515167/2021 RECEIVED NYSCEF: 03/22/2022 \ OCA Official Form 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 Social Security Number Ma 2013 a Patient Address , BROOKLYN, NEW YORK 11230 I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form: In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), [understand that: 1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH TREATMENT, except psychotherapy notes, and CONFIDENTIAL HIV* RELATED INFORMATION only if I place my initials on the appropriate line in Item 9(a). In the event the health information described below includes any of these types of information, and I initial the line on the box in Item 9(a), I specifically authorize release of such information to the person(s) indicated in Item 8. 2. If I am 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 authorization unless permitted to do so under federal or state law. I understand that I have the right to request a list of people who may receive or use my HIV-related information without authorization. If I experience discrimination because of the release or disclosure of HIV-related information, I may contact the New York State Division 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 right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may revoke this authorization except to the extent that action has already been taken based on this authorization. 4. I understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for benefits will not be conditioned upon my authorization of this disclosure. 5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this redisclosure may no longer be protected by federal or state law. 6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAN THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9 (b). 7. Name and address of health provider or entity to release this information: BIOREFERENCE LABORATORIES INC.; 481 Edward H. Ross Dr., Elmwood Park, NJ 07407 8. Name and address of person(s) or category of person to whom this information will be sent: LITCHFIELD CAVO LLP; 420 Lexington Avenue, Suite 2104, New York, New York 10170 9(a). Specific information to be released: Medical Record from (insert date) August 1,2044 to (insert date) present U Entire Medical Record, including patient histories, office notes (except psychotherapy notes), test results, radiology studies, films, referrals, consults, billing records, insurance records, and records sent to you by other health care providers. @ Other: _including diagnostic reports Include: (Indicate by Initialing) Alcohol/Drug Treatment Mental Health Information Authorization to Discuss Health Information HIV-Related Information (b) O By initialing here I authorize Tnitials ‘Name of individual health care provider to discuss my health information with my attorney, or a governmental agency, listed here: (Attomey/Firm Name or Governmental Agency Name) 10. Reason for release of information: 11. Date or event on which this authorization will expire: QO At request of individual @ Other; Litigation Purposes Upon Completion of Litigation 12. If not the patient, name of person signing form: 13. Authority to sign on behalf of patient: IRAKLI SHARADZE. FATHER OF Na ‘All items on this my questions about this form have been answered. In addition, I have been provided a copy of the form. vv Qa . Date: _3.22.2022 Signature of patjent or Tepes SH i: BY law. * Human Immunodeficiency Virus that causes AIDS. The New York State Public Health Law protects information which reasonably could identify someone as having HIV symptoms or infection and information regarding a person’s contacts. 12 of 15INDEX NO. 515167/2021 RECEIVED NYSCEF: 03/22/2022 \ OCA Official Form 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 Social Security Number | a MS 2014 a Patient Address BROOKLYN, NEW YORK 11230 I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form: In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), [understand that: 1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH TREATMENT, except psychotherapy notes, and CONFIDENTIAL HIV* RELATED INFORMATION only if I place my initials on the appropriate line in Item 9(a). In the event the health information described below includes any of these types of information, and I initial the line on the box in Item 9(a), I specifically authorize release of such information to the person(s) indicated in Item 8. 2. If I am 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 authorization unless permitted to do so under federal or state law. I understand that I have the right to request a list of people who may receive or use my HIV-related information without authorization. If I experience discrimination because of the release or disclosure of HIV-related information, I may contact the New York State Division 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 right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may revoke this authorization except to the extent that action has already been taken based on this authorization. 4. I understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for benefits will not be conditioned upon my authorization of this disclosure. 5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this redisclosure may no longer be protected by federal or state law. 6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAN THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9 (b). 7. Name and address of health provider or entity to release this information: BIOREFERENCE LABORATORIES INC.; 481 Edward H. Ross Dr., Elmwood Park, NJ 07407 8. Name and address of person(s) or category of person to whom this information will be sent: LITCHFIELD CAVO LLP; 420 Lexington Avenue, Suite 2104, New York, New York 10170 9(a). Specific information to be released: Medical Record from (insert date) August 1,2044 to (insert date) present U Entire Medical Record, including patient histories, office notes (except psychotherapy notes), test results, radiology studies, films, referrals, consults, billing records, insurance records, and records sent to you by other health care providers. @ Other: _including diagnostic reports Include: (Indicate by Initialing) Alcohol/Drug Treatment Mental Health Information Authorization to Discuss Health Information HIV-Related Information (b) O By initialing here I authorize Tnitials ‘Name of individual health care provider to discuss my health information with my attorney, or a governmental agency, listed here: (Attomey/Firm Name or Governmental Agency Name) 10. Reason for release of information: 11. Date or event on which this authorization will expire: QO At request of individual @ Other; Litigation Purposes Upon Completion of Litigation 12. If not the patient, name of person signing form: 13. Authority to sign on behalf of patient: IRAKLI SHARADZE FATHER OF Sa All items on this my questions about this form have been answered. In addition, I have been provided a copy of the form. vv Qa . Date: _3.22.2022 Signature of patjent or Tepes SH i: BY law. * Human Immunodeficiency Virus that causes AIDS. The New York State Public Health Law protects information which reasonably could identify someone as having HIV symptoms or infection and information regarding a person’s contacts. 13 of 15INDEX NO. 515167/2021 RECEIVED NYSCEF: 03/22/2022 \ OCA Official Form 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 Social Security Number | a MS 2014 a Patient Address , BROOKLYN, NEW YORK 11230 I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form: In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), [understand that: 1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH TREATMENT, except psychotherapy notes, and CONFIDENTIAL HIV* RELATED INFORMATION only if I place my initials on the appropriate line in Item 9(a). In the event the health information described below includes any of these types of information, and I initial the line on the box in Item 9(a), I specifically authorize release of such information to the person(s) indicated in Item 8. 2. If I am 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 authorization unless permitted to do so under federal or state law. I understand that I have the right to request a list of people who may receive or use my HIV-related information without authorization. If I experience discrimination because of the release or disclosure of HIV-related information, I may contact the New York State Division 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 right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may revoke this authorization except to the extent that action has already been taken based on this authorization. 4. I understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for benefits will not be conditioned upon my authorization of this disclosure. 5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this redisclosure may no longer be protected by federal or state law. 6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAN THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9 (b). 7. Name and address of health provider or entity to release this information: UNITEDHEALTHCARE OF NEW YORK; 35 E Broadway, First Floor, New York, NY 10002 8. Name and address of person(s) or category of person to whom this information will be sent: LITCHFIELD CAVO LLP; 420 Lexington Avenue, Suite 2104, New York, New York 10170 9(a). Specific information to be released: Medical Record from (insert date) August 1,2044 to (insert date) present U Entire Medical Record, including patient histories, office notes (except psychotherapy notes), test results, radiology studies, films, referrals, consults, billing records, insurance records, and records sent to you by other health care providers. @ Other: _under 1D No: Include: (Indicate by Initialing) Alcohol/Drug Treatment Mental Health Information Authorization to Discuss Health Information HIV-Related Information (b) O By initiating here I authorize Tnitials ‘Name of individual health care provider to discuss my health information with my attorney, or a governmental agency, listed here: (Attomey/Firm Name or Governmental Agency Name) 10. Reason for release of information: 11. Date or event on which this authorization will expire: QO At request of individual @ Other; Litigation Purposes Upon Completion of Litigation 12. If not the patient, name of person signing form: 13. Authority to sign on behalf of patient: IRAKLI SHARADZE. FATHER OF Sa ‘All items on this my questions about this form have been answered. In addition, I have been provided a copy of the form. vv Qa . Date: _3.22.2022 Signature of patjent or Tepes SH i: BY law. * Human Immunodeficiency Virus that causes AIDS. The New York State Public Health Law protects information which reasonably could identify someone as having HIV symptoms or infection and information regarding a person’s contacts. 14 of 15INDEX NO. 515167/2021 RECEIVED NYSCEF: 03/22/2022 \ OCA Official Form 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 Social Security Number Ma 2013 a Patient Address , BROOKLYN, NEW YORK 11230 I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form: In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), [understand that: 1. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH TREATMENT, except psychotherapy notes, and CONFIDENTIAL HIV* RELATED INFORMATION only if I place my initials on the appropriate line in Item 9(a). In the event the health information described below includes any of these types of information, and I initial the line on the box in Item 9(a), I specifically authorize release of such information to the person(s) indicated in Item 8. 2. If I am 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 authorization unless permitted to do so under federal or state law. I understand that I have the right to request a list of people who may receive or use my HIV-related information without authorization. If I experience discrimination because of the release or disclosure of HIV-related information, I may contact the New York State Division 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 right to revoke this authorization at any time by writing to the health care provider listed below. I understand that I may revoke this authorization except to the extent that action has already been taken based on this authorization. 4. I understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for benefits will not be conditioned upon my authorization of this disclosure. 5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this redisclosure may no longer be protected by federal or state law. 6. THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTH INFORMATION OR MEDICAL CARE WITH ANYONE OTHER THAN THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9 (b). 7. Name and address of health provider or entity to release this information: EMBLEM HEALTH; P.O. Box 2845, NY, NY 10116-2845 8. Name and address of person(s) or category of person to whom this information will be sent: LITCHFIELD CAVO LLP; 420 Lexington Avenue, Suite 2104, New York, New York 10170 9(a). Specific information to be released: Medical Record from (insert date) August 1,2044 to (insert date) present U Entire Medical Record, including patient histories, office notes (except psychotherapy notes), test results, radiology studies, films, referrals, consults, billing records, insurance records, and records sent to you by other health care providers. @ Other: _under 1D No: Include: (Indicate by Initialing) Alcohol/Drug Treatment Mental Health Information Authorization to Discuss Health Information HIV-Related Information (b) O By initiating here I authorize Tnitials ‘Name of individual health care provider to discuss my health information with my attorney, or a governmental agency, listed here: (Attomey/Firm Name or Governmental Agency Name) 10. Reason for release of information: 11. Date or event on which this authorization will expire: QO At request of individual @ Other; Litigation Purposes Upon Completion of Litigation 12. If not the patient, name of person signing form: 13. Authority to sign on behalf of patient: IRAKLI SHARADZE. FATHER OF Na ‘All items on this my questions about this form have been answered. In addition, I have been provided a copy of the form. vv Qa . Date: _3.22.2022 Signature of patjent or Tepes SH i: BY law. * Human Immunodeficiency Virus that causes AIDS. The New York State Public Health Law protects information which reasonably could identify someone as having HIV symptoms or infection and information regarding a person’s contacts. 15 of 15