On February 20, 2020 a
Proof of Service
was filed
involving a dispute between
Camille Jacobsen A Minor Maeve Jacobsen A Minor Luke Jacobsen A Minor Through Their Guardian Ad Litem Stacie Jacobsen,
Jacobsen Stacie,
and
Bhandari M.D. Anil Kumar,
Cardiology Associates Medical Group Dba Los Angeles Cardiology Associates A Medical Group,
Cedars Sinai Medical Care Foundation Doe 141,
Cedars Sinai Medical Group,
Keck Medical Center Of Usc Doe 101,
Keck Medicine Of Usc Doe 104,
Khiem P.V. Nyguen M.D. Cardiology Associates Medical Group Inc A California Corporation Dba Los Angeles Cardiology Associates A Medical Group,
Usc Care Medical Group Inc. Doe 103,
Usc Care Medical Group Keck Usc Hospital Doe 102,
for Medical Malpractice - Physicians & Surgeons (General Jurisdiction)
in the District Court of Los Angeles County.
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Electronically FILED by Superior Court of California, County of Los Angeles on 12/17/2020 10:11 AM Sherri R. Carter, Executive Officer/Clerk of Court, by S. Lopez,Deputy Clerk
POS-010
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address). FOR COURT USE ONLY
Devon Fagel SBN 235228
BRUCE G. FAGEL & ASSOCIATES
9200 W Sunset Blvd 670
West Hollywood, CA 90069
TELEPHONE NOJ (310) 281-8700 FAX ND /Oprione0:
E-MAIL ADDRESS /Op¹onai): devonfagelefagellaw.corn
ATTORNEY FOR /Name): Plaintiff
SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES
STREET ADDRESS; 111 N Hill St.
MAILING ADDRESS: 111 N Hill St.
CITY AND ZIP CODE: Los Angeles, CA 90012
BRANCH NAME: SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES
PLAINTIFF/PETITIONER: Camille Jacobsen CASE NUMBER;
20STCV07221
DEFENDANT/RESPONDENT: KHIEM P.V. NGUYEN, M.D.
Ref, Nc. Or File No..
PROOF OF SERVICE OF SUMMONS JACOBBEN
(Separate proof of service is required for each party served.)
At the time of service was at least 18 years of age and not 8 party to this action.
I
BY FAX
2. I served copies of; Summons and Complaint) Amendment to Complaint; Civil Case Cover Sheet; Civil Case Cover Sheet
Addendum and Statement of Location; Notice of Cas» Assignment;;
3. a. Party served (speci/y name of parly as shown on documents served): Cedars Sinai I/led/ca/ Care Foundation- Doe 14f
b.
~st Person (other than the party in item 3a) served on behalf of an entity or as an authorized agent (and not a person under
item 5b on whom substituted service was made) /speci/y name and relationship to the party named in item 3a);
By Serving Terri W. Cammarano, Agent for Service
4. Address where the party was served: 200 N Robertson Blvd, 101 Beverly Hills, CA 90211
a.
b
I
~
served the party /check proper box)
by personal service. personally delivered the documents listed in item 2 to the party or person authorized to receive
I
service of process for the party (1) on: (2) at:
~st by substituted service. On:12/11/2020indicatedinat: 01:37 PM I left the documents listed in item 2 with or in the presence of
(name and title or relationship lo person item 3):
Irma Parros (Gender: F Age: 50 Height: 5'7n Weight: 180 Race: Hispanic Hair: gray Other: brown eyes)
Assistant Manager
(1) ~& (business) a person at least 18 years of age apparently in charge at the office or usual place of business of
(2) ~—
I I
the person to be served. I informed him or her of the general nature of the papers.
(home) a competent member of the household (at least 18 years of age) at the dweling house or usual
place of abode of the party. I informed him or her of the general nature of the papers.
(3) (physical address unknown) a person of at least 18 years of age apparently in charge at the usual
mailing address of the person to be served, other than a United States Postal Service post office box. I
informed him or her of the general nature of the papers.
(4) Ithereafter mailed (by first-class, postage prepaid) copies of the documents to the person to be served at
the place where the copies were left (Code Civ. Proc., 0 415.20). mailed the documents:
I
on: from: or ~24 a declaration of mailing is attached.
(5)
~ I attach a declaration of diligence stating actions taken first to attempt personal service.
Pa 11 of 2
PROOF OF SERVICE OF SUMMONS
POSJJ10 iaav January 1, 200yi Invoice ¹ 4088884-02
Document Filed Date
December 17, 2020
Case Filing Date
February 20, 2020
Category
Medical Malpractice - Physicians & Surgeons (General Jurisdiction)
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Electronically FILED by Superior Court of California, County of Los Angeles on 12/17/2020 10:11 AM Sherri R. Carter, Executive Officer/Clerk of Court, by S. Lopez,Deputy Clerk POS-010 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address). FOR COURT USE ONLY Devon Fagel SBN 235228 BRUCE G. FAGEL & ASSOCIATES 9200 W Sunset Blvd 670 West Hollywood, CA 90069 TELEPHONE NOJ (310) 281-8700 FAX ND /Oprione0: E-MAIL ADDRESS /Op¹onai): devonfagelefagellaw.corn ATTORNEY FOR /Name): Plaintiff SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES STREET ADDRESS; 111 N Hill St. MAILING ADDRESS: 111 N Hill St. CITY AND ZIP CODE: Los Angeles, CA 90012 BRANCH NAME: SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES PLAINTIFF/PETITIONER: Camille Jacobsen CASE NUMBER; 20STCV07221 DEFENDANT/RESPONDENT: KHIEM P.V. NGUYEN, M.D. Ref, Nc. Or File No.. PROOF OF SERVICE OF SUMMONS JACOBBEN (Separate proof of service is required for each party served.) At the time of service was at least 18 years of age and not 8 party to this action. I BY FAX 2. I served copies of; Summons and Complaint) Amendment to Complaint; Civil Case Cover Sheet; Civil Case Cover Sheet Addendum and Statement of Location; Notice of Cas» Assignment;; 3. a. Party served (speci/y name of parly as shown on documents served): Cedars Sinai I/led/ca/ Care Foundation- Doe 14f b. ~st Person (other than the party in item 3a) served on behalf of an entity or as an authorized agent (and not a person under item 5b on whom substituted service was made) /speci/y name and relationship to the party named in item 3a); By Serving Terri W. Cammarano, Agent for Service 4. Address where the party was served: 200 N Robertson Blvd, 101 Beverly Hills, CA 90211 a. b I ~ served the party /check proper box) by personal service. personally delivered the documents listed in item 2 to the party or person authorized to receive I service of process for the party (1) on: (2) at: ~st by substituted service. On:12/11/2020indicatedinat: 01:37 PM I left the documents listed in item 2 with or in the presence of (name and title or relationship lo person item 3): Irma Parros (Gender: F Age: 50 Height: 5'7n Weight: 180 Race: Hispanic Hair: gray Other: brown eyes) Assistant Manager (1) ~& (business) a person at least 18 years of age apparently in charge at the office or usual place of business of (2) ~— I I the person to be served. I informed him or her of the general nature of the papers. (home) a competent member of the household (at least 18 years of age) at the dweling house or usual place of abode of the party. I informed him or her of the general nature of the papers. (3) (physical address unknown) a person of at least 18 years of age apparently in charge at the usual mailing address of the person to be served, other than a United States Postal Service post office box. I informed him or her of the general nature of the papers. (4) Ithereafter mailed (by first-class, postage prepaid) copies of the documents to the person to be served at the place where the copies were left (Code Civ. Proc., 0 415.20). mailed the documents: I on: from: or ~24 a declaration of mailing is attached. (5) ~ I attach a declaration of diligence stating actions taken first to attempt personal service. Pa 11 of 2 PROOF OF SERVICE OF SUMMONS POSJJ10 iaav January 1, 200yi Invoice ¹ 4088884-02