Preview
FILED: CHEMUNG COUNTY CLERK 11/09/2022 11:32 AM INDEX NO. 2021-5041
NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 11/09/2022
UCS-840
REQUEST FOR JUDICIAL INTERVENTION (rev. 02/01/2022)
Supreme COURT, COUNTY OF Chemung
Index No: 2021-5041 Date Index Issued: 01/13/2021 For Court Use Only:
CAPTION Enter the complete case caption. Do not use et al or et ano. If more space is needed, attach a caption rider sheet.
IAS Entry Date
Donna J. Kobbe
Judge Assigned
Plaintiff(s)/Petitioner(s)
-against-
Subramaniam Sadhasivam MD, Arnot Ogden Medical Center, Arnot Health, Inc.
RJI Filed Date
Defendant(s)/Respondent(s)
NATURE OF ACTION OR PROCEEDING: Check only one box and specify where indicated.
COMMERCIAL MATRIMONIAL
☐ ☐
Business Entity (includes corporations, partnerships, LLCs, LLPs, etc.) Contested
☐ Contract NOTE: If there are children under the age of 18, complete and attach the
MATRIMONIAL RJI Addendum (UCS-840M).
☐ Insurance (where insurance company is a party, except arbitration)
☐ UCC (includes sales and negotiable instruments) For Uncontested Matrimonial actions, use the Uncontested Divorce RJI (UD-13).
☐ Other Commercial (specify): REAL PROPERTY Specify how many properties the application includes:
☐ Condemnation
NOTE: For Commercial Division assignment requests pursuant to 22 NYCRR 202.70(d),
complete and attach the COMMERCIAL DIVISION RJI ADDENDUM (UCS-840C).
☐ ☐
Mortgage Foreclosure (specify):
Residential ☐ Commercial
TORTS Property Address:
☐ Asbestos NOTE: For Mortgage Foreclosure actions involving a one to four-family, owner-
☐ Child Victims Act occupied residential property or owner-occupied condominium, complete and
attach the FORECLOSURE RJI ADDENDUM (UCS-840F).
☐ Environmental (specify):
☒ Medical, Dental or Podiatric Malpractice ☐ Partition
☐ Motor Vehicle NOTE: Complete and attach the PARTITION RJI ADDENDUM (UCS-840P).
☐ Products Liability (specify): ☐ Tax Certiorari (specify):
Section: Block: Lot:
☐ Other Negligence (specify): ☐ Tax Foreclosure
☐ Other Professional Malpractice (specify): ☐ Other Real Property (specify):
☐ Other Tort (specify): OTHER MATTERS
SPECIAL PROCEEDINGS ☐ Certificate of Incorporation/Dissolution
[see NOTE in COMMERCIAL section]
☐ Child-Parent Security Act (specify): ☐ Assisted Reproduction ☐ Surrogacy Agreement
☐ Emergency Medical Treatment
☐ CPLR Article 75 - Arbitration
[see NOTE in COMMERCIAL section] ☐ Habeas Corpus
☐ CPLR Article 78 - Proceeding against a Body or Officer ☐ Local Court Appeal
☐ Election Law ☐ Mechanic's Lien
☐ Extreme Risk Protection Order ☐ Name Change/Sex Designation Change
☐ MHL Article 9.60 - Kendra's Law ☐ Pistol Permit Revocation Hearing
☐ ☐
MHL Article 10 - Sex Offender Confinement (specify):
Initial ☐ Review ☐ Sale or Finance of Religious/Not-for-Profit Property
☐ MHL Article 81 (Guardianship) ☐ Other (specify):
☐ Other Mental Hygiene (specify):
☐ Other Special Proceeding (specify):
STATUS OF ACTION OR PROCEEDING Answer YES or NO for every question and enter additional information where indicated.
YES NO
Has a summons and complaint or summons with notice been filed? ☒ ☐ If yes, date filed: 01/13/2021
Has a summons and complaint or summons with notice been served?☒ ☐ If yes, date served: 01/13/2021
Is this action/proceeding being filed post-judgment? ☐ ☒ If yes, judgment date:
NATURE OF JUDICIAL INTERVENTION Check one box only and enter additional information where indicated.
☐ Infant's Compromise
☐ Extreme Risk Protection Order Application
☐ Note of Issue/Certificate of Readiness
☐ Notice of Medical, Dental or Podiatric Malpractice
Date Issue Joined:
☐ Notice of Motion Relief Requested: Return Date:
☐ Notice of Petition Relief Requested: Return Date:
☐ Order to Show Cause Relief Requested: Return Date:
☐ Other Ex Parte Application Relief Requested:
☐ Partition Settlement Conference
☐ Poor Person Application
☒ Request for Preliminary Conference
☐ Residential Mortgage Foreclosure Settlement Conference
☐ Writ of Habeas Corpus
☐ Other (specify):
1 of 2
FILED: CHEMUNG COUNTY CLERK 11/09/2022 11:32 AM INDEX NO. 2021-5041
NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 11/09/2022
RELATED CASES List any related actions. For Matrimonial cases, list any related criminal or Family Court cases. If none, leave blank.
If additional space is required, complete and attach the RJI Addendum (UCS-840A).
Case Title Index/Case Number Court Judge (if assigned) Relationship to instant case
PARTIES For parties without an attorney, check the "Un-Rep" box and enter the party's address, phone number and email in the space
provided. If additional space is required, complete and attach the RJI Addendum (UCS-840A).
Un- Parties Attorneys and Unrepresented Litigants Issue Joined Insurance Carriers
Rep List parties in same order as listed in the
For represented parties, provide attorney's name, firm name, address, phone
For each defendant,
For each defendant,
caption and indicate roles (e.g., plaintiff,
and email. For unrepresented parties, provide party's address, phone and
indicate if issue has
indicate insurance
defendant, 3rd party plaintiff, etc.)email. been joined. carrier, if applicable.
Name: Kobbe, Donna J. DIANA HUGHES, Diana L. Hughes & Associates, PLLC, 100
☐ W. Water Street, Suite 103B , Elmira, NY 14901, (607) ☒ YES ☐ NO
Role(s): Plaintiff/Petitioner 735-2888, dhughes@hugheslaw.org
Name: Sadhasivam, Subramaniam TOMAS CALLOCCHIA, Ricotta, Mattrey, Callocchia, Markel
☐ & Cassert, 496 MAIN STREET , BUFFALO, NY 14202, ☒ YES ☐ NO
Role(s): Defendant/Respondent 7168546424, tjc@ricottalaw.com
Name: Arnot Ogden Medical Center TOMAS CALLOCCHIA, Ricotta, Mattrey, Callocchia, Markel
☐ & Cassert, 496 MAIN STREET , BUFFALO, NY 14202, ☒ YES ☐ NO
Role(s): Defendant/Respondent 7168546424, tjc@ricottalaw.com
Name: Arnot Health, Inc. TOMAS CALLOCCHIA, Ricotta, Mattrey, Callocchia, Markel
☐ & Cassert, 496 MAIN STREET , BUFFALO, NY 14202, ☒ YES ☐ NO
Role(s): Defendant/Respondent 7168546424, tjc@ricottalaw.com
Name:
☐ ☐ YES ☐ NO
Role(s):
Name:
☐ ☐ YES ☐ NO
Role(s):
Name:
☐ ☐ YES ☐ NO
Role(s):
Name:
☐ ☐ YES ☐ NO
Role(s):
Name:
☐ ☐ YES ☐ NO
Role(s):
Name:
☐ ☐ YES ☐ NO
Role(s):
I AFFIRM UNDER THE PENALTY OF PERJURY THAT, UPON INFORMATION AND BELIEF, THERE ARE NO OTHER RELATED ACTIONS OR
PROCEEDINGS, EXCEPT AS NOTED ABOVE, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION BEEN PREVIOUSLY FILED IN THIS
ACTION OR PROCEEDING.
Dated: 11/09/2022 DIANA L. HUGHES
Signature
2453744 DIANA L. HUGHES
Attorney Registration Number Print Name
This form was generated by NYSCEF
2 of 2
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FILED: CHEMUNG COUNTY CLERK 11/09/2022 11:32 AM INDEX NO. 2021-5041 NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 11/09/2022 UCS-840 REQUEST FOR JUDICIAL INTERVENTION (rev. 02/01/2022) Supreme COURT, COUNTY OF Chemung Index No: 2021-5041 Date Index Issued: 01/13/2021 For Court Use Only: CAPTION Enter the complete case caption. Do not use et al or et ano. If more space is needed, attach a caption rider sheet. IAS Entry Date Donna J. Kobbe Judge Assigned Plaintiff(s)/Petitioner(s) -against- Subramaniam Sadhasivam MD, Arnot Ogden Medical Center, Arnot Health, Inc. RJI Filed Date Defendant(s)/Respondent(s) NATURE OF ACTION OR PROCEEDING: Check only one box and specify where indicated. COMMERCIAL MATRIMONIAL ☐ ☐ Business Entity (includes corporations, partnerships, LLCs, LLPs, etc.) Contested ☐ Contract NOTE: If there are children under the age of 18, complete and attach the MATRIMONIAL RJI Addendum (UCS-840M). ☐ Insurance (where insurance company is a party, except arbitration) ☐ UCC (includes sales and negotiable instruments) For Uncontested Matrimonial actions, use the Uncontested Divorce RJI (UD-13). ☐ Other Commercial (specify): REAL PROPERTY Specify how many properties the application includes: ☐ Condemnation NOTE: For Commercial Division assignment requests pursuant to 22 NYCRR 202.70(d), complete and attach the COMMERCIAL DIVISION RJI ADDENDUM (UCS-840C). ☐ ☐ Mortgage Foreclosure (specify): Residential ☐ Commercial TORTS Property Address: ☐ Asbestos NOTE: For Mortgage Foreclosure actions involving a one to four-family, owner- ☐ Child Victims Act occupied residential property or owner-occupied condominium, complete and attach the FORECLOSURE RJI ADDENDUM (UCS-840F). ☐ Environmental (specify): ☒ Medical, Dental or Podiatric Malpractice ☐ Partition ☐ Motor Vehicle NOTE: Complete and attach the PARTITION RJI ADDENDUM (UCS-840P). ☐ Products Liability (specify): ☐ Tax Certiorari (specify): Section: Block: Lot: ☐ Other Negligence (specify): ☐ Tax Foreclosure ☐ Other Professional Malpractice (specify): ☐ Other Real Property (specify): ☐ Other Tort (specify): OTHER MATTERS SPECIAL PROCEEDINGS ☐ Certificate of Incorporation/Dissolution [see NOTE in COMMERCIAL section] ☐ Child-Parent Security Act (specify): ☐ Assisted Reproduction ☐ Surrogacy Agreement ☐ Emergency Medical Treatment ☐ CPLR Article 75 - Arbitration [see NOTE in COMMERCIAL section] ☐ Habeas Corpus ☐ CPLR Article 78 - Proceeding against a Body or Officer ☐ Local Court Appeal ☐ Election Law ☐ Mechanic's Lien ☐ Extreme Risk Protection Order ☐ Name Change/Sex Designation Change ☐ MHL Article 9.60 - Kendra's Law ☐ Pistol Permit Revocation Hearing ☐ ☐ MHL Article 10 - Sex Offender Confinement (specify): Initial ☐ Review ☐ Sale or Finance of Religious/Not-for-Profit Property ☐ MHL Article 81 (Guardianship) ☐ Other (specify): ☐ Other Mental Hygiene (specify): ☐ Other Special Proceeding (specify): STATUS OF ACTION OR PROCEEDING Answer YES or NO for every question and enter additional information where indicated. YES NO Has a summons and complaint or summons with notice been filed? ☒ ☐ If yes, date filed: 01/13/2021 Has a summons and complaint or summons with notice been served?☒ ☐ If yes, date served: 01/13/2021 Is this action/proceeding being filed post-judgment? ☐ ☒ If yes, judgment date: NATURE OF JUDICIAL INTERVENTION Check one box only and enter additional information where indicated. ☐ Infant's Compromise ☐ Extreme Risk Protection Order Application ☐ Note of Issue/Certificate of Readiness ☐ Notice of Medical, Dental or Podiatric Malpractice Date Issue Joined: ☐ Notice of Motion Relief Requested: Return Date: ☐ Notice of Petition Relief Requested: Return Date: ☐ Order to Show Cause Relief Requested: Return Date: ☐ Other Ex Parte Application Relief Requested: ☐ Partition Settlement Conference ☐ Poor Person Application ☒ Request for Preliminary Conference ☐ Residential Mortgage Foreclosure Settlement Conference ☐ Writ of Habeas Corpus ☐ Other (specify): 1 of 2 FILED: CHEMUNG COUNTY CLERK 11/09/2022 11:32 AM INDEX NO. 2021-5041 NYSCEF DOC. NO. 6 RECEIVED NYSCEF: 11/09/2022 RELATED CASES List any related actions. For Matrimonial cases, list any related criminal or Family Court cases. If none, leave blank. If additional space is required, complete and attach the RJI Addendum (UCS-840A). Case Title Index/Case Number Court Judge (if assigned) Relationship to instant case PARTIES For parties without an attorney, check the "Un-Rep" box and enter the party's address, phone number and email in the space provided. If additional space is required, complete and attach the RJI Addendum (UCS-840A). Un- Parties Attorneys and Unrepresented Litigants Issue Joined Insurance Carriers Rep List parties in same order as listed in the For represented parties, provide attorney's name, firm name, address, phone For each defendant, For each defendant, caption and indicate roles (e.g., plaintiff, and email. For unrepresented parties, provide party's address, phone and indicate if issue has indicate insurance defendant, 3rd party plaintiff, etc.)email. been joined. carrier, if applicable. Name: Kobbe, Donna J. DIANA HUGHES, Diana L. Hughes & Associates, PLLC, 100 ☐ W. Water Street, Suite 103B , Elmira, NY 14901, (607) ☒ YES ☐ NO Role(s): Plaintiff/Petitioner 735-2888, dhughes@hugheslaw.org Name: Sadhasivam, Subramaniam TOMAS CALLOCCHIA, Ricotta, Mattrey, Callocchia, Markel ☐ & Cassert, 496 MAIN STREET , BUFFALO, NY 14202, ☒ YES ☐ NO Role(s): Defendant/Respondent 7168546424, tjc@ricottalaw.com Name: Arnot Ogden Medical Center TOMAS CALLOCCHIA, Ricotta, Mattrey, Callocchia, Markel ☐ & Cassert, 496 MAIN STREET , BUFFALO, NY 14202, ☒ YES ☐ NO Role(s): Defendant/Respondent 7168546424, tjc@ricottalaw.com Name: Arnot Health, Inc. TOMAS CALLOCCHIA, Ricotta, Mattrey, Callocchia, Markel ☐ & Cassert, 496 MAIN STREET , BUFFALO, NY 14202, ☒ YES ☐ NO Role(s): Defendant/Respondent 7168546424, tjc@ricottalaw.com Name: ☐ ☐ YES ☐ NO Role(s): Name: ☐ ☐ YES ☐ NO Role(s): Name: ☐ ☐ YES ☐ NO Role(s): Name: ☐ ☐ YES ☐ NO Role(s): Name: ☐ ☐ YES ☐ NO Role(s): Name: ☐ ☐ YES ☐ NO Role(s): I AFFIRM UNDER THE PENALTY OF PERJURY THAT, UPON INFORMATION AND BELIEF, THERE ARE NO OTHER RELATED ACTIONS OR PROCEEDINGS, EXCEPT AS NOTED ABOVE, NOR HAS A REQUEST FOR JUDICIAL INTERVENTION BEEN PREVIOUSLY FILED IN THIS ACTION OR PROCEEDING. Dated: 11/09/2022 DIANA L. HUGHES Signature 2453744 DIANA L. HUGHES Attorney Registration Number Print Name This form was generated by NYSCEF 2 of 2