On August 01, 2018 a
Exhibit,Appendix
was filed
involving a dispute between
Amanda Dillon,
Valerie Austin,
and
Brian Changlai Md,
Jeanne Bishop Md,
Ovid Neulander Md,
Pawan K Rao Md,
for Torts - Medical, Dental, or Podiatrist Malpractice
in the District Court of Onondaga County.
Preview
FILED: ONONDAGA COUNTY CLERK 08/11/2022 03:29 PM INDEX NO. 007476/2018
NYSCEF DOC. NO. 196 RECEIVED NYSCEF: 08/11/2022
EXHIBIT “A”
FILED: ONONDAGA COUNTY CLERK 08/11/2022 03:29 PM INDEX NO. 007476/2018
ET
NYSCEF DOC.0011-19H
NO.(W 196
I NEWYORKSTATE
DEPARTMENTOFHEALTH
RECEIVED NYSCEF: 08/11/2022
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Document Filed Date
August 11, 2022
Case Filing Date
August 01, 2018
Category
Torts - Medical, Dental, or Podiatrist Malpractice
For full print and download access, please subscribe at https://www.trellis.law/.
Preview
FILED: ONONDAGA COUNTY CLERK 08/11/2022 03:29 PM INDEX NO. 007476/2018 NYSCEF DOC. NO. 196 RECEIVED NYSCEF: 08/11/2022 EXHIBIT “A” FILED: ONONDAGA COUNTY CLERK 08/11/2022 03:29 PM INDEX NO. 007476/2018 ET NYSCEF DOC.0011-19H NO.(W 196 I NEWYORKSTATE DEPARTMENTOFHEALTH RECEIVED NYSCEF: 08/11/2022 LOCALRÉej8TRARCOPY ' Rs c C CERTIFICATE OF DEATH 1.M071231 JA0lrLE 2SE iaE FmE 3ASA110FDEATlt man m = <38LHOUlt 3 USCIA/ J¾ O2 of |20No O(.o$o em Ne,s AfW C of | o o o a o a o a e 4e.mswractnysdunwamw pat0cauiv: aw, ro |4s.coum0FDEat , enY vs Tom 10426 State Route 38 | O O E Conquestr Cayuqa 46 4ENEU|¬ALillCORONO.|46.WASSFCEDENTTitANSFERREDfROMANOTliERINSTEM10N? FptspeogrMMor|Nmeeyortmetw6md$Wd KO YES &9ATE0FBiRTft SC.HNDER10AY47ACITVANDSTATE0F$iGBt#difUe 5AAGEGI 66.tFiJhl0ER1YEM yW 78.1FAGEUNDER1YEAR,NAME0FHOSPfIMG MONTH 00 WAR (as as e:iums 61 feks;iertevékridainsutmetoft . 9.0fCECBIT0FFBSiW000REU? B.SERVEDINUS.ARIAED 10.0ECE0$NT$RAlf e:tteBoatWtesrçimateth©erg4the$tar@eihWemAmu &cter4aronssbtrda"tm . actspar sputMo B Ws.UE6rñNedaiAmriraciano 808báerNitmAv#r,atCOArimladiam m½ DOCWress FFçire F rest GO1torfam H ½!:urmsa E YI0 stSpchitivarMEiroMyo9) N $gscan GeavimerDamstro ag enwifet¼rsorburetshicthfggskvdh il0GMNT5t0vCM)0tounctbatstesrdso eth iFedt 2 -1 gsk.Ndi'lM2 3 Ni idud0rda:astEl 4 5 AHocit:tidegree 6 Swecclagecredthtrodatoe fL"celerideyte s00 a=w F ElasMdegee GederMrclesto-gderia 6 12.50CIALSECURllV BEft 13.UAMALSTATUS: 14.5tiRVMNGSPoostearair NEVERDJAR:EDNARRˆ4W)0WED DMEC¬DEEPARATED mig 29!dt$ N$f Di m2 02 04 as * =* Valerie L. Coffey 1siosm0ccumon:penw am00FSUSNESSCAMOUSTRY: 150MEMt0¢MY0FCOWW08RRt Camillus Cutlery, Camillus m Line Sucervisor Manufacturing ERES R ch 1 loCN dpy 'T" sg North NY Onondaga ORoa$1CSyracuse 6 OND IFN,$1 10H: a a mSustameEn0Faesi0øice jaze0002 25 5548 Bear Apt. 6E 13212 Rd, - nma smsT LAsT tem0amus fiRST m tm ª"" 0FMDMR as Carl Austin ass0mome mumm6 RESS Valerie Austin 5548 Bear Rd Apt 6E Syracuse, N013212 8' a10s=$gnam so metacE0FeeRtat.camTi0um0a0RoTHeRaispostriON. |20c.tocATi0Neoaretta..ases) *°"" mg mg . n | 2016 oakwedd Crematorium |Syracuse, NY | 08| 21AMEMDADDRESS0FfUNERAtlf0ME· 31g j MREGGIBAt0NAMR Funeral Home N.Nain North 13212 01252 7 New Comer 705 St. Syracuse, j 228.SiGNA E0FfUNERALD]REC10ft 220.REGISTRAT10NkWNA . 2&MEOFFllNEM01RECT01t °" 2R6. Jamie E0F LSildt Smith ... E2330ATERLE[t u b12 ' ORS. UITI Day: . 14094 ' 249.DATE1$$U m 2.d/ , I 2 Y/s ITEMS251HRUSSCOMPLETEOBYCERT1FYlNGPHYSICIAN-- On"" 00R0ta/C R'SPHV$1CIANORME040ALEXAMINER 25A.CERTIFICATFON: TDthebestof mykrmwledge, atthetime,dateandpaceasidduetothecetisesstated. deathDocurred 0co0 cerstetsnarre ticenseNo.: VonGs 0· Year M \q,ut> .2 AD |o9 | to |2cWe coc£a cerwswe a sea oDP macfmm0fMAR&g tim 20MadicalExanú¤lidDegutfMedicalfxamirar C CWit5¬¢ (C t¤0ncer a marmp¥m emerAcest¥cartsnarce umrarismot atoo mesAte 4øms - 26Aannere Wan up on nar u:m crr Yrar a esceass tutsenarrra IAd 266.ermal P* I =m.aª* wanassa to ""' o 2 Ko ap2 |26 Zos agg |o9 pog, |W |~2o6 I m|og |u| de 27.MANNER0FDEAT@t Ul ETERMiNEDPEAIDms 28,WASCASEREFERREDTO 29AAUTOPSY7 29illFVE$,WEREflNONGSUSE9100ETEA EVESIlGATl0.4 COROhiEit0RMSICALeULMiME97 If0VIC40E$U:CiBI CFRCWSTANCES 0 YiS fitFUSED CAUSE0FDEAm? NATUCAUSE ACC10ENT 1 O2 OS 04 05 08 No (OYES 0 Of O2 00N 1 YE$ CONT1DENTIAL SERINSTMCTIONSHEETFORCOMPLETINGCAUSE0FDEATH CGNF[DENTIAL 310EATNWASCAU$MSY: 0NTER0NLY0NECAUSEFERLINEFOR(A7ÇS),ANO(C)) m PallTLIMMEDCAUSE" (A) +4^c A«6t DUEI008ASA 0F 00tr00RASA OF g -- PETit0Ititit$iGhflCANTC0h0Ill0NSCONTIUBUTi!iGTO . , 0|0TOBACCOUSECO'•IMUTET00fATH7 0EATH8UTK0TAELA1£0TGCAUSEGMNINPMT)(A) 41 Q ff d 0 NO1 YES PR0SAM 300M 8 3 liffURY,0ATE HOUit AtañJstet) 31LDESCitiSEHOWIWURYCCCURSEd310.PIACE0FIN2RY SillNJURYATWOM 31B.1NMlYtCCALIf)0tforttmand 0 t ° E5 $1F.IFTRANSP0RTATl0NW3tlRY,SFECIFY: 31YCLSDECEDENT 33A.lffUJALE 33iLDATEUF0ELIVER½ a ¾r£purar2 Plueytr3 N5psKgn dGat| 2 MWint t.âGmr23 4Nhitif&r3 M WS G Myrpt sTh122gar1 freyrlgtline 4Ûename On On aOmayw.wgw ensem, e Oswarirge,a