On February 20, 2020 a
Request,Application
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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ATTORNEY (Name, Slate San number, and address) POR COURt IJSE ONLY
Law Offices of Bruce G. Fagel and Associates
100 North Cresaent Drive Suite 360
Beverly Hills, California 90210
TELEPHONENO,. (310) 281-8700 FAX NO, (Op(Iona(i;
'310) 281-5656
plain tif f s Camille Jacobsen
E-MAIL ADDRESS (Opffonatt;
At(DRNEYFDR Namet;
e UPERIOR COURT OF CALIFORNiA, COUNTY OF LOS ANGELE S
BTREETADDREssr
111 North Hil 1 Street
MAILINQADDREssr Los Angeles, Cali fornia 90012
CITY AND ZIP CODE;
BRANOHNAME: Srtanley Mosk Courthouse
CAMILLE JACOBSEN/ a minor by and,
through her guard.ian ad litem, STACXE JACOBSEN
DEFFNDANTIREBPONDENTI ZHXEM P, V, NGUYEN ( M. D ~
CASE NUMBER;
APPLICATION AND ORDER FOR APPOINTIIEhIT
GF GUARDIAN AD LITEM— CML
EX PARTE
frfOTE: Thisform is for use in civil proceedfngs in which a party is a minor, an incapacitated person, or a person for
whom a conservator has been appointed. A party who seeks the appointment of a guardian ad lftem ln a family law or
Juvenile proceeding should use form FL-935. rfi party who seeks the appointment of a guardian ad litem in a probate
proceeding should use form OE-360/GC-f00. An indfvidual, cannot act as a guardian ad litem unless he or she is
Electronically Received 02/20/2020 10:35 AM
represented by an attorney or fs an attorney.
1. Applicant (name): St.acie Jacobsen ia
K] Camille Jacobsen
a.
b. ~
~
the parent of (name):
the guardian of,(name);
the conservator of (name):
c.
d,
e,
~
~ apartyto the suit.
the minor to be represented (if the mfnoris $ 4years ofage orolder).
f, ~ another interested person (spec('fy capacity):
2, This application seeks the appointment of the following person as guardian ad litem (state name,'ddress, and telephone number),"
Stacie, Jacobsen
1171 Shelley Street,
Manhattan Beach„ California 90266 Telephone 'No. .(310) 292-6227
3. The guardian ad litem is to represent the interests of the following person (state name, address, and teJephone number):
Camille Jacobsen
1171 Shelley Street
Manhattan Beach',. California 90266 Telephone No. (310) 292-6227
4. The person to be represented ts:
a. ~
~ a minor (date ofbirth):
an incompetent person.
August
b.
c, ~ a person for whom a conservator has been appointed.
~Medical malpractice resulting in the death of tne minor
5. The court should appoint a guardian ad liters because„
the person named in item 3 has a cause or causes of action on which suit shou]d be brought (daycqgek'I
'-father.
'age
a,
ariz.
~ Continued on Attachment Ga.
1 rd2
Form Adopled for Mandatory Use Code of Cfvfl Procedrrre,
APPLICATION AND GRIPER FOR APPOINTMENT $ 872 sI seq,
Judicial Council ol Cellfomla
OF GUARDIAN AD LITEMCIVIL SO u Ona
CIVIC [Rsv. January I, 2008I IQB
Document Filed Date
March 27, 2020
Case Filing Date
February 20, 2020
Category
Medical Malpractice - Physicians & Surgeons (General Jurisdiction)
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ATTORNEY (Name, Slate San number, and address) POR COURt IJSE ONLY Law Offices of Bruce G. Fagel and Associates 100 North Cresaent Drive Suite 360 Beverly Hills, California 90210 TELEPHONENO,. (310) 281-8700 FAX NO, (Op(Iona(i; '310) 281-5656 plain tif f s Camille Jacobsen E-MAIL ADDRESS (Opffonatt; At(DRNEYFDR Namet; e UPERIOR COURT OF CALIFORNiA, COUNTY OF LOS ANGELE S BTREETADDREssr 111 North Hil 1 Street MAILINQADDREssr Los Angeles, Cali fornia 90012 CITY AND ZIP CODE; BRANOHNAME: Srtanley Mosk Courthouse CAMILLE JACOBSEN/ a minor by and, through her guard.ian ad litem, STACXE JACOBSEN DEFFNDANTIREBPONDENTI ZHXEM P, V, NGUYEN ( M. D ~ CASE NUMBER; APPLICATION AND ORDER FOR APPOINTIIEhIT GF GUARDIAN AD LITEM— CML EX PARTE frfOTE: Thisform is for use in civil proceedfngs in which a party is a minor, an incapacitated person, or a person for whom a conservator has been appointed. A party who seeks the appointment of a guardian ad lftem ln a family law or Juvenile proceeding should use form FL-935. rfi party who seeks the appointment of a guardian ad litem in a probate proceeding should use form OE-360/GC-f00. An indfvidual, cannot act as a guardian ad litem unless he or she is Electronically Received 02/20/2020 10:35 AM represented by an attorney or fs an attorney. 1. Applicant (name): St.acie Jacobsen ia K] Camille Jacobsen a. b. ~ ~ the parent of (name): the guardian of,(name); the conservator of (name): c. d, e, ~ ~ apartyto the suit. the minor to be represented (if the mfnoris $ 4years ofage orolder). f, ~ another interested person (spec('fy capacity): 2, This application seeks the appointment of the following person as guardian ad litem (state name,'ddress, and telephone number)," Stacie, Jacobsen 1171 Shelley Street, Manhattan Beach„ California 90266 Telephone 'No. .(310) 292-6227 3. The guardian ad litem is to represent the interests of the following person (state name, address, and teJephone number): Camille Jacobsen 1171 Shelley Street Manhattan Beach',. California 90266 Telephone No. (310) 292-6227 4. The person to be represented ts: a. ~ ~ a minor (date ofbirth): an incompetent person. August b. c, ~ a person for whom a conservator has been appointed. ~Medical malpractice resulting in the death of tne minor 5. The court should appoint a guardian ad liters because„ the person named in item 3 has a cause or causes of action on which suit shou]d be brought (daycqgek'I '-father. 'age a, ariz. ~ Continued on Attachment Ga. 1 rd2 Form Adopled for Mandatory Use Code of Cfvfl Procedrrre, APPLICATION AND GRIPER FOR APPOINTMENT $ 872 sI seq, Judicial Council ol Cellfomla OF GUARDIAN AD LITEMCIVIL SO u Ona CIVIC [Rsv. January I, 2008I IQB