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CAUSE NO. 23-05-06300
MARIA ORR IN THE DISTRICT COURT OF
MONTGOMERYCOUNTY, TEXAS
WENDY ANNE SMITH COUNTY COURT AT LAW #6
PLAINTIFF'S FIRST NOTICE OF FILING AFFIDAVITS
COMES NOW, MARIA ORR Plaintiff in the above entitled and numbered cause,
and files the following medical records and expense affidavits, as follows:
BILLINGRECORDAFFIDAVITS FOR PLAINTIFF
MCHD EMS $ 964.12
HCA Houston Conroe $ 40,617.00
Compass Pont Emergency, PLLC (NEED) $ 2,055.00
Singleton Associates, PA $ 1,773.00
Minivasive Pain & Orthopedics $ 4,475.00
UT Ortho $ 617.00
Integrative Spine & Sports $ 1,865.00
Townsen Memorial Imaging $ 650.00
Brain
and Spine Center $ 1,623.00
Origin Spine Institute $ 2,700.00
Origin MRI & Diagnostics $ 7,125.00
Jesse Schneringer, DC $ 4,520.00
Total: $68,984.12
laintiff’ s FirstNotice of Filing Affidavits
MEDICAL RECORD AFFIDAVITS FOR PLAINTIFF
MCHD EMS
HCA Houston Conroe
Minivasive Pain & Orthopedics
UT Ortho
Integrative Spine and Sports
Townsen Memorial Imaging
Brain and Spine Center
Origin Spine Institute
Origin MRI & Diagnostics
Jesse Schneringer, DC
The Court
and all parties are advised that said Affidavits are filed with the Court for
the purpose of admission into evidence at the time of trial pursuantto 18.001 of the Texas Civil
Practice and Remedies Code and the applicable sections of Rule 803(6), 803(7) and 902(10),
Texas Rules of Civil Evidence.
A copy of the items described above have been previously produced to all counsel of record.
or are being produced along with this Notic
Respectfully submitted,
CRIM & VILLALPANDO, PC
Is): Eduardo Domenech
EduardoJ. Domenech
Texas Bar No. 24107118
2122 E Govemors Circle
Houston, Texas 77092
(713) 807 7800 Telephone
(713) 807 8434 Facsimile
LitTeamB@CVInjuryLawyers.com service)
ATTORNEYS FOR PLAINTIFF
laintiff’ s FirstNotice of Filing Affidavits
From: Alicia Tatakis Fax: 17639332598 To: Fax: (986) 539-1163 Page: 4 of S 95103/2023 3:27 PM
MEDICAL EXPENSE AFFIDAVIT
BEFORE the undersign' authority, personally appeared no \ + who after
being by me duly swor> n oath said:
"My name is , 1 am over eighteen (18) years of age, of sound
mind, capable of making this affidavit.
Tam the person in charge of the billing records of Mm Che . Attached to this
ffi davit billing records that provide am itemize: tement offservices and the charg ‘or the services that
Weis
ar ae. provided to
The attached billing records a part of this affidavit.
dor after
The attached billing records are kept by me in the regular course of busine: information contained in
the billing records was transmitted to me il
employee or representative of fos
¢ regular course of business by oran
who has personal knowledge of the information, The
billing records were made at or near the time or reasonably soon after the time that the service was provided. These
billing records are the original or an exact duplicate of the original.
+ Thgvotal anpount ile “Gs HD in connection with treatment received by
The amount paid by insurance was §.
The amount paid by Medicare/Medicaid $. 5
The amoy ictually paid by patient, the patient's family or the patient's representative
was $.
x
An agysunen (wri ff) based on this provider's agreement with private and public health insurance in
the amount of $, was made,
Outstanding balarice owed by the patient or patient's representative is sGoy.l2,
The service provided was necessary and the amount charged for the service was rei at the time and
place that the service was provided.
Custodian of Patient A\ Ls
SWORN TO AND SUBSCRIBED BEFORE ME on the CS) day of Qe 20. RW
Cake
NOTARY PUBLIC IN AND FOR
THE STATE OF TEXAS
on NF
#
St pe ‘Walker
osit
res Name Printed: Diba Lelilkear
ID No, 130632421 My Commission Expires: 3/ iil24
STATE OF TEXAS
COUNTY OF HARRIS
AFFIDAVIT OF RECORDS CUSTODIAN
Before me, the undersigned authority, personally appeared JENNIFER SALASwho, being by me duly
sworn, deposed as follows:
My name is JENNIFER SALAS, | am of sound mind and capable of making this
affidavit, and personally acquainted with the facts herein stated.
Iam a custodian of records for HCA HOUSTON HEALTHCARE CONROE
_Hospital”). Attached to this affidavit are records that provide an itemized statement of the
service and the charge for the service that Hospital provided to MARIA TWOFATHERS
06/02/2021-06/02/2021. The attached records are a part of this affidavit.
The attached records are kept by Hospital in the regular course of business, and it was the
regular course of business of Hospital for an employee or representative of Hospital, with
knowledge of the service provided, to make the record or to transmit information to be included
in the record. The records were made in the regular course of business at or near the time or
reasonably soon after the time the service was provided. The records are the original or a
duplicate of the original.
Pursuant to Texas Civil Practice & Remedies Code § 18.002(b-1), the services provided
were necessary and the amount charged for the services was reasonable at the time and place that
the services were provided.
The total amount paid for the services was $2,50L00and the amount currently unpaid but
which Hospital has a right to be paid after any adjustments or credits i $0.00.
** The amount paid and the amount the Hospital has a right to be paid may change pending
potential payment from the patient’s health insurance.
of Sahee
LSA EOE
Afiant
SWORN TO AND SUBSCRIBED before me on this aa
77H day of fo
JULY 2023,
My commission expires: <+ ao aa.
No} Pub! State of T
10-14-2023
U-16-£025 0
Printed NameFooRANCISCA CASTILLO
CISCA LLO
lie joxas|
2023
Notary 0 132208412
MEDICAL EXPENSE AFFIDAVIT.
RE: Plaintiff, (patient)
BEFORE ME, the undersigned authority, personally appeared ; who after
being by me duly sworn, upon oath said:
"My name is , Lam over eighteen (18) years of age, of sound
mind, capable of making this affidavit.
I am the person in charge of the billing records of . Attached to this
affidavit are billing records that provide am itemized statement of services and the charge for the services that
provided to on and/or after
. The attached billing records are a part of this affidavit.
The attached billing records are kept by me in the regular course of business. The information contained in
the billing records was transmitted to me in the regular course of business by or an
employee or representative of who has personal knowledge of the information. The
billing records were made at or near the time or reasonably soon after the time that the service was provided. These
billing records are the original or an exact duplicate of the original.
The total amount billed by in connection with treatment received by
was $.
The amount paid by insurance was $
The amount paid by Medicare/Medicaid $
The amount actually paid by patient, the patient’s family or the patient’s representative
was $
An adjustment (write-off) based on this provider’s agreement with private and public health insurance in
the amount of $ was made.
Outstanding balance owed by the patient or patient’s representative is $,
The service provided was necessary and the amount charged for the service was reasonable at the time and
place that the service was provided. ax
44
Custodian of Patient/Account
SWORN TO AND SUBSCRIBED BEFORE ME on the day of 2021.
AT,
= se64Notary 4, SEAN DOUGLAS HAMMERLE
Public, State of Texas Nal
NOTARY PUBLIC IN AND FOR
% %,a “eS = = Comm. Expires 06-02-2024
THE STATE OF TEXAS
Ww Notary ID 130686186
Name Printed:
My Commission Expires:
AFFIDAVIT CONCERNING COST AND NECESSITY OF SERVICES
(Pursuant to Tex, Civ. Prac. & Rem. Code §§18.001 & 18.002)
Affidavit of Records Custodian of
MINIVASIVE PAIN AND ORTHOPEDICS
STATE OF TEXAS §
COUNTY OF Harris §
Before me, the undersigned authority, personally appeared Luis Oropeza, who, being by
me duly sworn, deposed as follows:
My name is Luis Oropeza. | am of sound mind and capable of making this affidavit, and
personally acquainted with the facts herein stated.
Tam a custodian of records for MINIVASIVE PAIN AND ORTHOPEDICS. Attached
to this affidavit are records that provide an itemized statement of the service and the charge for the
service that MINIVASIVE PAIN AND ORTHOPEDICS provided to MARIA ORR on
06/08/2021 - 08/24 /2021. The attached records are a part ofthis affidavit.
The attached records are kept by MINIVASIVE PAIN AND ORTHOPEDICS in the
regular course of business, and it was the regular course of business of MINIVASIVE PAIN AND
ORTHOPEDICS for an employee or representative of MINIVASIVE PAIN AND
ORTHOPEDICS, with knowledge of the service provided, to make the record or to transmit
information to be included in the record. The records were made in the regular course of business
at or near the time or reasonably soon after the time the service was provided. The records are the
original or a duplicate of the original.
The services provided were necessary and the amount charged for the services was
reasonable at the time and place that the services were provided.
The total amount paid for the services was $0.00 and the amount currently unpaid but
which MINIVASIVE PAIN AND ORTHOPEDICS has a right to be paid after any adjustments
LF—
or credits is $4,475.00.
Alfiant v
SWORN TO AND SUBSCRIBED before me on the 27th day of August, 2021.
we
wn, JAZMIN RODRIGUEZ
Notary Public, State of Texas Notary Publié, Sfate of Téas
Comm. Expires 02-24-2025
Gi
Notary (D. 132941325 Notary's printed name: Jazmin Rodriguez
My commission expires: 02/24/2025
MEDICAL EXPENSE AFFIDAVIT
RE: Plaintiff, Maria Orr (patient)
BEFORE ME, the undersigned authority, personally appeared Jdohya Bastidas
\
who after being by me d, ly sworn, upon oath said:
"My name is OCW Pas as ; |. am over eighteen (18) years of age,
of sound mind, capable of making this affidavit.
Tam the person in charge of the billing records of INteqrariye Spine % Sports
Attached to this affidavit are billing records that provide am itemized statement of services and the charge
for the services that | eavan Ve Spine 4 Spor provided to Maria Orr on and/or after
June 2, 2021. The attached billing records are a part of this affidavit.
The attached billing records are kept by me in the regular course of business. The information
contained in the billing records was transmitted to me in the regular course of business by Inegrative
Spine 4 Sports or an employee or representative of (WAZAANVE Spine a
Sports who has personal knowledge of the information. The billing records were made at or near
the time or reasonably soon after the time that the service was provided, These billing records are the
original or an exact duplicate of the original.
The total amount billed by \ Vy ee ee 4 Sports — in connection with
treatment received by Maria Orr was §,
The amount paid by insurance was $__@& x
The amount paid by Medicare/Medicaid $__& f
The amount actually paid by patient, the patient’s family or the patient's representative
was$_ pf.
An adjustment (write-off) based on this provider’s agreement with private and public health
insurance in the amount of $__ was made.
Outstanding balance owed by the patient or patient’s representative is $, $5.9.
The service provided was necessary and the amount charged for the service was reasonable at the
Ce
time and place that the service was provided.
aoa
Custodian ient Aecounis —~
SWORN TO AND SUBSCRIBED BEFORE ME on the \ day of il 2022.
Of
NOTARY PUBLIC IN AND FOR
teem - THE STATE OF TEXAS
Name Printed: WIC ‘Bu
My Commission Expires: 2 ‘| 2 p>
BILLING RECORDS AFFIDAVIT
(Pursuant to Tex. R. Evid. 902)
PATIENT’S NAME Maria Orr
DATE OF BIRTH 02/22/1957
STATE OF TEXAS
COUNTY OF Harris
Before me, the undersigned authority, personally appeared Bianca Arellano ’
who, being by me duly swom, deposed as follows
My name is Bianca Arellano I am of sound mind and capable of
making this affidavit, and personally acquainted with the facts herein stated:
Tam the custodian of billing records for Townsen Memorial Imaging-Spring
Tam familiar with the manner in which the facility’s billing records are created and maintained by
virtue of my duties and responsibilities. Attached hereto are 2 pages of billing records
from Townsen Memorial Imaging-Spring . These billing records are kept in the
regular course of business, and it was the regular course of business for an employee or
representative of Townsen Memorial Imaging-Spring , with knowledge of the act,
event, condition, opinion, or diagnosis, recorded to make the billing records or to transmit
information thereof to be included in such records; and the billing records were made at or near
the time or reasonably soon thereafter. The billing records attached hereto are the original or exact
duplicates of the original
| Total charges for the services rendered: $ 650.00
2 The amount actually paid by the patient or % aghe patient’ 's behalf: __ $0.00
2 Amount, if any, adjusted or written off:
4 Any amount currently unpaid but hich the esi has a right to be paid after any
adjustments or credits:
WL
Affiant
SWORN TO AND SUBSCRIBED before me on the 18 day of August 2022.
en, MELISSAS. MATTHEWS
jotary Public, State of Texas
Comm. Expires 02-02-2028 Notary Public, State of Texas
Notary ID 191434492
To: +17138078434 Paie: 04 of 22 2022-05-26 21:34:15 GMT 8447783046 From: 15034367151
MEDICAL EXPENSE AUDAVIE
RE: Plaintiff, Marla Orr (patient)
Zachary Gardner
BEFORE ME, the undersigned authority, personally appeared
who after belng by me duly # upon oath said:
"My name is 2 achary Gardner Tam over.eighteen (18) years of age,
of souad mind, capable of making this affidavit.
i am the person in charge of the billing records of Splnetech Neurosurgery, Attached to this
affidavit are bling eeoords that provide am itemized atarement of services and the charge for the services
that Spinetech Neurosurgery provided to Mula Orr on and/or after June 2, 2021. The attached billing
records are a part of this affidavit,
The attached billing records are kept by me in the regular course of business. The information
contained in the billing records was transmitted to ms in the regular course of business by Spinetech
Neurosurgery or an employee or representative of Spinetech Neurosurgery who has personal knowledge
of the information. The billing records were made at or near the tite or reasonably soon after the time that
the service was provided. These billing records ara the original or an exact duplicate of the original.
The total amount billed by Spinetech Neurosurgery in connection with treatment received by
Maria Orr was $1,623.00
‘The amount paid by insurance was 319.92
‘The amount pald by Medteare/Madicaid §,
The amount actually paid by patient, the putient's family or the patient's representative
an aqjusimen (walte-off) based on this provider's agreement with private and public health
Inpurance in the amount of §, was made,
Outstanding balance owed by the patient or patlont's representative fs $1,303.08,
Zo
‘The service provided was necessary and the ammount charged for the service was reasonable at the
tine and placs that the service was provided.
Custodian of Patent Accounts
SWORN TO AND SUBSCRIBED BEFORE MEon the 28th day of _ May: 90.22
5
A
JENNIFER GNEILL AND FOR
Gfficfal Seal IB STATE OF ‘AS
Notary Public - State of Hlinois
@ ty Commission Expires Aug #8, 2025 Rare Printeds Jennifer O'Neill
My Commission Expires; 08/18/2025
MEDICAL EXPENSE AFFIDAVIT
RE Plaintiff, Orr, Maria Delores
BEFORE ME, the undersigned authority, personally appeared ALI MAZLOOM, MD » who
after being by me duly sworn, upon oath said:
"My name is ALI MAZLOOM, MD , lam over eighteen (18) years of age, of sound
mind, capable of making this affidavit.
I am the erson in charge of the billing records of
ORIGIN SPINE INSTITUTE
Attached to this affidavit are billing records that provide an itemized statement of services and the charge for
the services that ORIGIN SPINE INSTITUTE provided to Orr, Maria Delores on 08/17/2021
and/or after 02/10/2022. The attached billing records are a part of this affidavit.
The attached billing records are kept by me in the regular course of business. The information
contained in the billing records was transmitted to me in the regular course of business
by ORIGIN SPINE INSTITUTE or an employee or representative of ORIGIN SPINE
INSTITUTE who has personal knowledge of the information. The billing records were made at or near the
time or reasonably soon after the time that the service was provided. These billing records are the original
or an exact duplicate of the original.
The total amount billed by ORIGIN SPINE INSTITUTE in
connection with treatment received
ORIGIN SPINE INSTITUTE was $ 2,700.00
The amount paid by insurance was $0.00
The amount paid by Medicare/Medicaid $_0.00
The amount actually paid by patient, the patient’s family or the patient’s representative
was $_0.00
An adjustment (write-off) based on this provider’s agreement with private and public health insurance
in the amount of $_0.00 was made.
Outstanding balance owed by the patient or patient’s representative is $ 2,700.00 .
The service provided was necessary and the amount charged for the service was reasonable at the time
and place that the service was provided.
LA p>
Custodian of Patient Avesints
SWORN TO AND SUBSCRIBED BEFORE ME on the _\_ day of Popa \ 5207227
NOTARY PUBLIC IN AND FOR
KS EAU. a> JEANNE THAO TRAN
A\ Notary iD #13252655ire0s THE STATE OF _\-
who after being by me duly sworn, upon oath said:
"My name is nr SCO , Lam over eighteen (18) years of age,
of sound mind, capable of making this affidavit. oO
Iam the person in charge of the billing records of Schneringer Chiropractic-. Attached to this
services
affidavit are billing records that provide am itemized statement of services and the charge for the
and/or after June 2, 2021. The attached billing
that Schneringer Chiropractic- provided to Maria Orr on
records are a part of this affidavit.
information
The attached billing records are kept by me in the regular course of business. The
business by Schnerin ger
contained in the billing records was transmitted to me in the regular course of
tic- who has personal
Chiropractic- or an employee or representative of Schneringer Chiroprac
reasonably soon after
knowledge of the information. The billing records were made at or near the time or
or an exact duplicate of the
the time that the service was provided. These billing records are the original
original.
by
billed by Schneringer Chiropractic in connection with treatment received
The total amount
Maria Orr was $, . 0
ax
The amount paid by insurance was $
The amount paid by Medicare/Medi icaid $aid
$_ representative
The amount actually paid by patient, the patient’s fa mi nily or the patient’s
was $
An adjustment (write-off) bas: edgph ‘is provider’s agreement with private and public health
insurance in the amount of $__
Outstanding balance owed by the patient
was made.
or patient’s representative is 4,500.0
service was reasonab! le at the
The service provided was necessary and the amount charged for the
time and place that the service was provided.
W O SteM Ve
an of Patient Accounts
Cufddi
SWORN TO AND SUBSCRIBED BEFORE ME on the _14_ day of _ Jud 4 , 20D
LAA $
NO’ TAR ARON AN IDFOR J
‘ATE OF TEXAS
Name Printed: yende Sadr
My Commission Expires: _ 1 )a
Lucinda Sanchez
2 My Commission Expires
2 1017/2022
ID No 124026357
From: Alicia Tatakis Fax: 17633332598 To: Fax: (936) $39-1163 Page: 4 of 5 05/03/2023 3:32 PM
MEDICAL RECORDS AFFIDAVIT
BEFORE ME, the undersi;
who being by me dul sworn, deposi
ed authority, personally appeared
as follows:
Staal.
"My name is Iam of sound mind, capable of
making this affidavit, and personally acquainted with the facts herein stated:
Ta the custodian of the records for Cet Attached
hereto are pages of recor from These said
pages are kept by vyY\ in the regular course of business, and it
was the regular course of busi WNCHHS or an employee or
representative of with personal knowledge of the act,
event, condition, opinion, or diagnosis, recorded to make the record or to transmit information thereof to
be included in such record; and the record was made at or near the time or reasonably soon thereafter. The
records attached hereto are the original or exact duplicates of the original."
Custodian of Ree
SWORN TO AND SUBSCRIBED BEFORE ME on the CQ. _ day of Buk 209A. Ad
THE STATE OF TEXAS
Name Printed: Baba Leblketir-
My Commission Expires: SHid/34
EPP
PPPPL
PLL PPO
Debra Walker
My Commission Expres
Oe (3 IDND. 130632421
1306
Patient: TWOFEATHERS, MARIA Medical Record Number: BHO0510682 eRequest 10; 144017690
Facility: HCA Houston Healthcare Conroe Phone Number: 936-539-7425
Address: _504 Medical Center Blvd City/State:_Conroe, TX Zip: 77304
AFFIDAVIT OF MEDICAL RECORDS:
‘Gunna Johnson
Before me, the undersigned authority, personally appeared
Who, being by me duly sworn, deposed as follows:
My name is _Le‘Quona Johnson fam of sound mind, capable of making this affidavit and
personally acquainted with the facts herein stated:
tam the custodian of the medical records for HCA Houston Healthcare Conroe.
Attached hereto are "> pages of medical records.
45
These said — pages of medical records are kept by HCA Houston Healthcare Conroe in the regular course of
business, and it was in the regular course of business of HCA Houston Healthcare Conroe for an employee or
representative of HCA Houston Healthcare Conroe with knowledge of the act, event, condition, opinion or
diagnosis, was ordered to make the record or to transmit information thereof to be included in such records;
and the records were made at or near the time of reasonably soon thereafter. The records attached hereto are
the original or exact duplicates of the original,
AFFIDAVIT OF NO RECORDS
© A thorough search of requested information carried out under my direction and control revealed that this facility does
not have the records described in the patient authorization or the subpoena duces tecum.
DECLARATION OF CUSTODIAN OF RECORDS
4, Le'Qunna Johnson: am the duly authorized Custodian of Records of the above named facility. | am familiar with
the mode of preparation of, and have the authority to certify, the facility record. | dectare under penalty of perjury under
thy the of Texas, ity of Montgomery that the "Si is true and correct.
Signa Date
SAHOO
S UREN OONEGEROAROR ERAN OU eRN ERR OONNERMAS ERONENOENAMERSERE
ANE OKERa AND
ny 0 iF,
oh, I “Uc public in and for said county, wrisLO pay of ieBy, in,
$s “
o%%,
tary Public
My commission expires: WL. Mn,
Be «et
=
In states where 2 Notary is not required, this form will only include signature and date of rep)
Araya
MEDICAL RECORDS AFFIDAVIT
(Pursuant to Tex. R. Evid. 902)
PATIENT’S NAME: MARIA ORR
PATIENT’S DATE OF BIRTH: 02/22/1957
STATE OF TEXAS
COUNTY OF Harris
Before me, the undersigned authority, personally appeared Luis Oropeza, who, being by
me duly sworn, deposed as follows:
My naine is Luis Oropeza. | am of sound mind and capable of making this affidavit, and
personally acquainted with the facts herein stated:
I am the custodian of the records of MINIVASIVE PAIN AND ORTHOPEDICS
Attached hereto are 52 pages of records from MINIVASIVE PAIN AND ORTHOPEDICS
These said 52 pages of records are kept by MINIVASIVE PAIN AND ORTHOPEDICS in the
regular course of business, and it was the regular course of business of MINIVASIVE PAIN AND
ORTHOPEDICS for an employee or representative of MINIVASIVE PAIN AND
ORTHOPEDICS, with knowledge of the act, event, condition, opinion, or diagnosis, recorded to
make the record or to transmit information thereof to be included in such record; and the record
was made at or near the time or reasonably soon thereafter. The records attached hereto are the
original or exact duplicates of the original.
Affiant
LP-
SWORN TO AND SUBSCRIBED before me on the 27th day of August, 2021.
tay, JAZMIN RODRIGUEZ
oe Notary Public, (State of Tog)
Notary Public, State of Texas)
Comm. Expires 02-24-2025
Notary ID 132941325 Notary's printed name: Jazmin Rodrigue:
as
My commission expires; 02/24/2025
MEDICAL RECORDS AFFIDAVIT
RE Plaintiff, Maria Orr
BEFORE ME, the undersigned authority, personally appeared
who being by me duly sworn, deposed as follows:
Jaclyn Pashdas —
"My name is \aclun Bastidas I am of sound mind, capable of
making this affidavit, and personilly acquainted with the facts herein stated
are
1am the custodian of the records for | me
D__ pages of records from Wnteay rahve ofative
ine
Spine 2 Sports
4 Sports
1. Attached hereto
These said__\D__ pages
are kept by \wteorative Spine 4, Yeas in the regular course of business, and it was the
regular course of business Integrative Spine 4 Sports or an employee or representative
of \Inyearatve Spine 4 Sports with personal knowledge of the act, event, condition,
opinion, or diagnosis, recorded to make the record or to transmit informution thereofto be included in such
record; and the record was made at or near the time or reasonably soon thereafter. The records attached
hereto are the original or exact duplicates of the original."
=.
Custodi
SWORN TO AND SUBSCRIBED BEFORE ME on the \ day of Joly 2022 |
NOTARY PUBLIC IN AND FOR
THE STATE OF TEXAS
Sy Liz
Notary iD
Name Printed: ie Du
My Commission Expires Zz | 22>
SSE 2025
MEDICAL RECORDS AFFIDAVIT
(Pursuantto Tex. R. Evid. 902)
Maria Orr
PATIENT’S NAME;
DATE OF BIRTH: 02/22/1957
STATE OF TEXAS §
COUNTY OF HARRIS
Before me, the undersigned authority, personally appeared Nandi Vazquez-Rojas
who, being by me duly sworn, deposed as follows
My name is. Nandi Vazquez-Rojas 1 am of sound mind and capable of making
this affidavit, and personally acquainted with the facts herein stated
I am the custodian of the records of Townsen Memorial Imaging-Spring. Attached
hereto are _8 pages of records from Townsen Memorial Imaging-Spring. These said_8
pages of records are kept by Townsen Memorial Imaging-Spring in the regular course of
business, and it was the regular course of business of Townsen Memorial Imaging-Spring for
an employee or representative of Townsen Memorial Imaging-Spring, with knowledge of the
act, event, condition, opinion, or diagnosis. recorded to make the record or to transmit information
thereof to be included in such record; and the record was made at or near the time or reasonably
soon thereafter. The records attached hereto are the original or exact duplicates of the original.
SWORN TO AND SUBSCRIBED before me on the 18 day of August 20 22
ae
Notary Public, State of Texas|
Comm. Expires 02-02-2026
Notary ID 131434492 Notary's printed name: i
My commission expires: 2-2-2 le
To: +17138078434 Page: 03 of 22 2022-05-26 21:34:15 GMT 8447783046 From: 15034367151
MEDICAL RECORDS AFFIDAVIT
RE: Plaintiff, Maria Orr
BEFORE MB, the undersigned authority, personally appeared, Zachary Gardner
who being by me duly swore, deposed as follows:
"My nams is Zachary Gardner Tem of sound mind, capable of
making thls affidavit, and personally acquainted with the facts herein stated:
Tam the custodian of the records for Spinetech Neurosurgery. Attached hereto are pages
of records from Spinetech Neurosurgery. These sald. poges are kept by Spinatech Neurosurgery
In the regular course of business, and it was the regular course of business Spinatech Neurosurgery or an
employes or representative of Spinotech Neurosurgery with personal knowledge of the act, event,
condition, opinion, or diagnosis, recorded to make the record of to transmit information thereof to ba
included in such revord; and the record was made at or near the time or reasonably soon thereafter, The
records attached hereto are the original or exact duplicates of the original,”
Bo
Oustodian of Records
SWORN TO AND SUBSCRIBED BEFORE ME on the 26th day of __ May 20,22
JENNIFER ONEILL.
Official Sea!
Notary Public - State Of
iftinots 8 STATE OF
ID FO)
ALO
My Commission Expires Aug 18, 202
5 Jennifer O'Neill
Name Printed:
My Commission Hupires: 08/18/2025
MEDICAL RECORDS AFFIDAVIT
RE: Plaintiff, Orr, Maria Delores
BEFORE ME, the undersigned authority, personally appeared _ ALI MAZ. OOM, MD j
who being by me duly sworn, deposed as follows:
"My name is ALI MAZLOOM, MD ; 1am of sound mind, capable of making this
affidavit, and personally acquainted with the facts herein stated:
the custodian of the records for
5 ORIGIN SPINE I NSTITUTE
Attached hereto are 41 pages of records from
ORIGIN SPINE INSTITUTE
These said
ORIGIN SPINE INSTITUTE
4l pages are kept by
in the regular course of business, and it was the regular course of business
ORIGIN SPINE INSTITUTE
or an employee or representative of
ORIGIN SPINE INSTITUTE
with personal knowledge of the act, event, condition, opinion, or diagnosis, recorded to make the record or
to transmit information thereof to be included in such record; and the record was made at or near the time
or reasonably soon thereafter. The records attached h
Preview
CAUSE NO. 23-05-06300 MARIA ORR IN THE DISTRICT COURT OF MONTGOMERYCOUNTY, TEXAS WENDY ANNE SMITH COUNTY COURT AT LAW #6 PLAINTIFF'S FIRST NOTICE OF FILING AFFIDAVITS COMES NOW, MARIA ORR Plaintiff in the above entitled and numbered cause, and files the following medical records and expense affidavits, as follows: BILLINGRECORDAFFIDAVITS FOR PLAINTIFF MCHD EMS $ 964.12 HCA Houston Conroe $ 40,617.00 Compass Pont Emergency, PLLC (NEED) $ 2,055.00 Singleton Associates, PA $ 1,773.00 Minivasive Pain & Orthopedics $ 4,475.00 UT Ortho $ 617.00 Integrative Spine & Sports $ 1,865.00 Townsen Memorial Imaging $ 650.00 Brain and Spine Center $ 1,623.00 Origin Spine Institute $ 2,700.00 Origin MRI & Diagnostics $ 7,125.00 Jesse Schneringer, DC $ 4,520.00 Total: $68,984.12 laintiff’ s FirstNotice of Filing Affidavits MEDICAL RECORD AFFIDAVITS FOR PLAINTIFF MCHD EMS HCA Houston Conroe Minivasive Pain & Orthopedics UT Ortho Integrative Spine and Sports Townsen Memorial Imaging Brain and Spine Center Origin Spine Institute Origin MRI & Diagnostics Jesse Schneringer, DC The Court and all parties are advised that said Affidavits are filed with the Court for the purpose of admission into evidence at the time of trial pursuantto 18.001 of the Texas Civil Practice and Remedies Code and the applicable sections of Rule 803(6), 803(7) and 902(10), Texas Rules of Civil Evidence. A copy of the items described above have been previously produced to all counsel of record. or are being produced along with this Notic Respectfully submitted, CRIM & VILLALPANDO, PC Is): Eduardo Domenech EduardoJ. Domenech Texas Bar No. 24107118 2122 E Govemors Circle Houston, Texas 77092 (713) 807 7800 Telephone (713) 807 8434 Facsimile LitTeamB@CVInjuryLawyers.com service) ATTORNEYS FOR PLAINTIFF laintiff’ s FirstNotice of Filing Affidavits From: Alicia Tatakis Fax: 17639332598 To: Fax: (986) 539-1163 Page: 4 of S 95103/2023 3:27 PM MEDICAL EXPENSE AFFIDAVIT BEFORE the undersign' authority, personally appeared no \ + who after being by me duly swor> n oath said: "My name is , 1 am over eighteen (18) years of age, of sound mind, capable of making this affidavit. Tam the person in charge of the billing records of Mm Che . Attached to this ffi davit billing records that provide am itemize: tement offservices and the charg ‘or the services that Weis ar ae. provided to The attached billing records a part of this affidavit. dor after The attached billing records are kept by me in the regular course of busine: information contained in the billing records was transmitted to me il employee or representative of fos ¢ regular course of business by oran who has personal knowledge of the information, The billing records were made at or near the time or reasonably soon after the time that the service was provided. These billing records are the original or an exact duplicate of the original. + Thgvotal anpount ile “Gs HD in connection with treatment received by The amount paid by insurance was §. The amount paid by Medicare/Medicaid $. 5 The amoy ictually paid by patient, the patient's family or the patient's representative was $. x An agysunen (wri ff) based on this provider's agreement with private and public health insurance in the amount of $, was made, Outstanding balarice owed by the patient or patient's representative is sGoy.l2, The service provided was necessary and the amount charged for the service was rei at the time and place that the service was provided. Custodian of Patient A\ Ls SWORN TO AND SUBSCRIBED BEFORE ME on the CS) day of Qe 20. RW Cake NOTARY PUBLIC IN AND FOR THE STATE OF TEXAS on NF # St pe ‘Walker osit res Name Printed: Diba Lelilkear ID No, 130632421 My Commission Expires: 3/ iil24 STATE OF TEXAS COUNTY OF HARRIS AFFIDAVIT OF RECORDS CUSTODIAN Before me, the undersigned authority, personally appeared JENNIFER SALASwho, being by me duly sworn, deposed as follows: My name is JENNIFER SALAS, | am of sound mind and capable of making this affidavit, and personally acquainted with the facts herein stated. Iam a custodian of records for HCA HOUSTON HEALTHCARE CONROE _Hospital”). Attached to this affidavit are records that provide an itemized statement of the service and the charge for the service that Hospital provided to MARIA TWOFATHERS 06/02/2021-06/02/2021. The attached records are a part of this affidavit. The attached records are kept by Hospital in the regular course of business, and it was the regular course of business of Hospital for an employee or representative of Hospital, with knowledge of the service provided, to make the record or to transmit information to be included in the record. The records were made in the regular course of business at or near the time or reasonably soon after the time the service was provided. The records are the original or a duplicate of the original. Pursuant to Texas Civil Practice & Remedies Code § 18.002(b-1), the services provided were necessary and the amount charged for the services was reasonable at the time and place that the services were provided. The total amount paid for the services was $2,50L00and the amount currently unpaid but which Hospital has a right to be paid after any adjustments or credits i $0.00. ** The amount paid and the amount the Hospital has a right to be paid may change pending potential payment from the patient’s health insurance. of Sahee LSA EOE Afiant SWORN TO AND SUBSCRIBED before me on this aa 77H day of fo JULY 2023, My commission expires: <+ ao aa. No} Pub! State of T 10-14-2023 U-16-£025 0 Printed NameFooRANCISCA CASTILLO CISCA LLO lie joxas| 2023 Notary 0 132208412 MEDICAL EXPENSE AFFIDAVIT. RE: Plaintiff, (patient) BEFORE ME, the undersigned authority, personally appeared ; who after being by me duly sworn, upon oath said: "My name is , Lam over eighteen (18) years of age, of sound mind, capable of making this affidavit. I am the person in charge of the billing records of . Attached to this affidavit are billing records that provide am itemized statement of services and the charge for the services that provided to on and/or after . The attached billing records are a part of this affidavit. The attached billing records are kept by me in the regular course of business. The information contained in the billing records was transmitted to me in the regular course of business by or an employee or representative of who has personal knowledge of the information. The billing records were made at or near the time or reasonably soon after the time that the service was provided. These billing records are the original or an exact duplicate of the original. The total amount billed by in connection with treatment received by was $. The amount paid by insurance was $ The amount paid by Medicare/Medicaid $ The amount actually paid by patient, the patient’s family or the patient’s representative was $ An adjustment (write-off) based on this provider’s agreement with private and public health insurance in the amount of $ was made. Outstanding balance owed by the patient or patient’s representative is $, The service provided was necessary and the amount charged for the service was reasonable at the time and place that the service was provided. ax 44 Custodian of Patient/Account SWORN TO AND SUBSCRIBED BEFORE ME on the day of 2021. AT, = se64Notary 4, SEAN DOUGLAS HAMMERLE Public, State of Texas Nal NOTARY PUBLIC IN AND FOR % %,a “eS = = Comm. Expires 06-02-2024 THE STATE OF TEXAS Ww Notary ID 130686186 Name Printed: My Commission Expires: AFFIDAVIT CONCERNING COST AND NECESSITY OF SERVICES (Pursuant to Tex, Civ. Prac. & Rem. Code §§18.001 & 18.002) Affidavit of Records Custodian of MINIVASIVE PAIN AND ORTHOPEDICS STATE OF TEXAS § COUNTY OF Harris § Before me, the undersigned authority, personally appeared Luis Oropeza, who, being by me duly sworn, deposed as follows: My name is Luis Oropeza. | am of sound mind and capable of making this affidavit, and personally acquainted with the facts herein stated. Tam a custodian of records for MINIVASIVE PAIN AND ORTHOPEDICS. Attached to this affidavit are records that provide an itemized statement of the service and the charge for the service that MINIVASIVE PAIN AND ORTHOPEDICS provided to MARIA ORR on 06/08/2021 - 08/24 /2021. The attached records are a part ofthis affidavit. The attached records are kept by MINIVASIVE PAIN AND ORTHOPEDICS in the regular course of business, and it was the regular course of business of MINIVASIVE PAIN AND ORTHOPEDICS for an employee or representative of MINIVASIVE PAIN AND ORTHOPEDICS, with knowledge of the service provided, to make the record or to transmit information to be included in the record. The records were made in the regular course of business at or near the time or reasonably soon after the time the service was provided. The records are the original or a duplicate of the original. The services provided were necessary and the amount charged for the services was reasonable at the time and place that the services were provided. The total amount paid for the services was $0.00 and the amount currently unpaid but which MINIVASIVE PAIN AND ORTHOPEDICS has a right to be paid after any adjustments LF— or credits is $4,475.00. Alfiant v SWORN TO AND SUBSCRIBED before me on the 27th day of August, 2021. we wn, JAZMIN RODRIGUEZ Notary Public, State of Texas Notary Publié, Sfate of Téas Comm. Expires 02-24-2025 Gi Notary (D. 132941325 Notary's printed name: Jazmin Rodriguez My commission expires: 02/24/2025 MEDICAL EXPENSE AFFIDAVIT RE: Plaintiff, Maria Orr (patient) BEFORE ME, the undersigned authority, personally appeared Jdohya Bastidas \ who after being by me d, ly sworn, upon oath said: "My name is OCW Pas as ; |. am over eighteen (18) years of age, of sound mind, capable of making this affidavit. Tam the person in charge of the billing records of INteqrariye Spine % Sports Attached to this affidavit are billing records that provide am itemized statement of services and the charge for the services that | eavan Ve Spine 4 Spor provided to Maria Orr on and/or after June 2, 2021. The attached billing records are a part of this affidavit. The attached billing records are kept by me in the regular course of business. The information contained in the billing records was transmitted to me in the regular course of business by Inegrative Spine 4 Sports or an employee or representative of (WAZAANVE Spine a Sports who has personal knowledge of the information. The billing records were made at or near the time or reasonably soon after the time that the service was provided, These billing records are the original or an exact duplicate of the original. The total amount billed by \ Vy ee ee 4 Sports — in connection with treatment received by Maria Orr was §, The amount paid by insurance was $__@& x The amount paid by Medicare/Medicaid $__& f The amount actually paid by patient, the patient’s family or the patient's representative was$_ pf. An adjustment (write-off) based on this provider’s agreement with private and public health insurance in the amount of $__ was made. Outstanding balance owed by the patient or patient’s representative is $, $5.9. The service provided was necessary and the amount charged for the service was reasonable at the Ce time and place that the service was provided. aoa Custodian ient Aecounis —~ SWORN TO AND SUBSCRIBED BEFORE ME on the \ day of il 2022. Of NOTARY PUBLIC IN AND FOR teem - THE STATE OF TEXAS Name Printed: WIC ‘Bu My Commission Expires: 2 ‘| 2 p> BILLING RECORDS AFFIDAVIT (Pursuant to Tex. R. Evid. 902) PATIENT’S NAME Maria Orr DATE OF BIRTH 02/22/1957 STATE OF TEXAS COUNTY OF Harris Before me, the undersigned authority, personally appeared Bianca Arellano ’ who, being by me duly swom, deposed as follows My name is Bianca Arellano I am of sound mind and capable of making this affidavit, and personally acquainted with the facts herein stated: Tam the custodian of billing records for Townsen Memorial Imaging-Spring Tam familiar with the manner in which the facility’s billing records are created and maintained by virtue of my duties and responsibilities. Attached hereto are 2 pages of billing records from Townsen Memorial Imaging-Spring . These billing records are kept in the regular course of business, and it was the regular course of business for an employee or representative of Townsen Memorial Imaging-Spring , with knowledge of the act, event, condition, opinion, or diagnosis, recorded to make the billing records or to transmit information thereof to be included in such records; and the billing records were made at or near the time or reasonably soon thereafter. The billing records attached hereto are the original or exact duplicates of the original | Total charges for the services rendered: $ 650.00 2 The amount actually paid by the patient or % aghe patient’ 's behalf: __ $0.00 2 Amount, if any, adjusted or written off: 4 Any amount currently unpaid but hich the esi has a right to be paid after any adjustments or credits: WL Affiant SWORN TO AND SUBSCRIBED before me on the 18 day of August 2022. en, MELISSAS. MATTHEWS jotary Public, State of Texas Comm. Expires 02-02-2028 Notary Public, State of Texas Notary ID 191434492 To: +17138078434 Paie: 04 of 22 2022-05-26 21:34:15 GMT 8447783046 From: 15034367151 MEDICAL EXPENSE AUDAVIE RE: Plaintiff, Marla Orr (patient) Zachary Gardner BEFORE ME, the undersigned authority, personally appeared who after belng by me duly # upon oath said: "My name is 2 achary Gardner Tam over.eighteen (18) years of age, of souad mind, capable of making this affidavit. i am the person in charge of the billing records of Splnetech Neurosurgery, Attached to this affidavit are bling eeoords that provide am itemized atarement of services and the charge for the services that Spinetech Neurosurgery provided to Mula Orr on and/or after June 2, 2021. The attached billing records are a part of this affidavit, The attached billing records are kept by me in the regular course of business. The information contained in the billing records was transmitted to ms in the regular course of business by Spinetech Neurosurgery or an employee or representative of Spinetech Neurosurgery who has personal knowledge of the information. The billing records were made at or near the tite or reasonably soon after the time that the service was provided. These billing records ara the original or an exact duplicate of the original. The total amount billed by Spinetech Neurosurgery in connection with treatment received by Maria Orr was $1,623.00 ‘The amount paid by insurance was 319.92 ‘The amount pald by Medteare/Madicaid §, The amount actually paid by patient, the putient's family or the patient's representative an aqjusimen (walte-off) based on this provider's agreement with private and public health Inpurance in the amount of §, was made, Outstanding balance owed by the patient or patlont's representative fs $1,303.08, Zo ‘The service provided was necessary and the ammount charged for the service was reasonable at the tine and placs that the service was provided. Custodian of Patent Accounts SWORN TO AND SUBSCRIBED BEFORE MEon the 28th day of _ May: 90.22 5 A JENNIFER GNEILL AND FOR Gfficfal Seal IB STATE OF ‘AS Notary Public - State of Hlinois @ ty Commission Expires Aug #8, 2025 Rare Printeds Jennifer O'Neill My Commission Expires; 08/18/2025 MEDICAL EXPENSE AFFIDAVIT RE Plaintiff, Orr, Maria Delores BEFORE ME, the undersigned authority, personally appeared ALI MAZLOOM, MD » who after being by me duly sworn, upon oath said: "My name is ALI MAZLOOM, MD , lam over eighteen (18) years of age, of sound mind, capable of making this affidavit. I am the erson in charge of the billing records of ORIGIN SPINE INSTITUTE Attached to this affidavit are billing records that provide an itemized statement of services and the charge for the services that ORIGIN SPINE INSTITUTE provided to Orr, Maria Delores on 08/17/2021 and/or after 02/10/2022. The attached billing records are a part of this affidavit. The attached billing records are kept by me in the regular course of business. The information contained in the billing records was transmitted to me in the regular course of business by ORIGIN SPINE INSTITUTE or an employee or representative of ORIGIN SPINE INSTITUTE who has personal knowledge of the information. The billing records were made at or near the time or reasonably soon after the time that the service was provided. These billing records are the original or an exact duplicate of the original. The total amount billed by ORIGIN SPINE INSTITUTE in connection with treatment received ORIGIN SPINE INSTITUTE was $ 2,700.00 The amount paid by insurance was $0.00 The amount paid by Medicare/Medicaid $_0.00 The amount actually paid by patient, the patient’s family or the patient’s representative was $_0.00 An adjustment (write-off) based on this provider’s agreement with private and public health insurance in the amount of $_0.00 was made. Outstanding balance owed by the patient or patient’s representative is $ 2,700.00 . The service provided was necessary and the amount charged for the service was reasonable at the time and place that the service was provided. LA p> Custodian of Patient Avesints SWORN TO AND SUBSCRIBED BEFORE ME on the _\_ day of Popa \ 5207227 NOTARY PUBLIC IN AND FOR KS EAU. a> JEANNE THAO TRAN A\ Notary iD #13252655ire0s THE STATE OF _\- who after being by me duly sworn, upon oath said: "My name is nr SCO , Lam over eighteen (18) years of age, of sound mind, capable of making this affidavit. oO Iam the person in charge of the billing records of Schneringer Chiropractic-. Attached to this services affidavit are billing records that provide am itemized statement of services and the charge for the and/or after June 2, 2021. The attached billing that Schneringer Chiropractic- provided to Maria Orr on records are a part of this affidavit. information The attached billing records are kept by me in the regular course of business. The business by Schnerin ger contained in the billing records was transmitted to me in the regular course of tic- who has personal Chiropractic- or an employee or representative of Schneringer Chiroprac reasonably soon after knowledge of the information. The billing records were made at or near the time or or an exact duplicate of the the time that the service was provided. These billing records are the original original. by billed by Schneringer Chiropractic in connection with treatment received The total amount Maria Orr was $, . 0 ax The amount paid by insurance was $ The amount paid by Medicare/Medi icaid $aid $_ representative The amount actually paid by patient, the patient’s fa mi nily or the patient’s was $ An adjustment (write-off) bas: edgph ‘is provider’s agreement with private and public health insurance in the amount of $__ Outstanding balance owed by the patient was made. or patient’s representative is 4,500.0 service was reasonab! le at the The service provided was necessary and the amount charged for the time and place that the service was provided. W O SteM Ve an of Patient Accounts Cufddi SWORN TO AND SUBSCRIBED BEFORE ME on the _14_ day of _ Jud 4 , 20D LAA $ NO’ TAR ARON AN IDFOR J ‘ATE OF TEXAS Name Printed: yende Sadr My Commission Expires: _ 1 )a Lucinda Sanchez 2 My Commission Expires 2 1017/2022 ID No 124026357 From: Alicia Tatakis Fax: 17633332598 To: Fax: (936) $39-1163 Page: 4 of 5 05/03/2023 3:32 PM MEDICAL RECORDS AFFIDAVIT BEFORE ME, the undersi; who being by me dul sworn, deposi ed authority, personally appeared as follows: Staal. "My name is Iam of sound mind, capable of making this affidavit, and personally acquainted with the facts herein stated: Ta the custodian of the records for Cet Attached hereto are pages of recor from These said pages are kept by vyY\ in the regular course of business, and it was the regular course of busi WNCHHS or an employee or representative of with personal knowledge of the act, event, condition, opinion, or diagnosis, recorded to make the record or to transmit information thereof to be included in such record; and the record was made at or near the time or reasonably soon thereafter. The records attached hereto are the original or exact duplicates of the original." Custodian of Ree SWORN TO AND SUBSCRIBED BEFORE ME on the CQ. _ day of Buk 209A. Ad THE STATE OF TEXAS Name Printed: Baba Leblketir- My Commission Expires: SHid/34 EPP PPPPL PLL PPO Debra Walker My Commission Expres Oe (3 IDND. 130632421 1306 Patient: TWOFEATHERS, MARIA Medical Record Number: BHO0510682 eRequest 10; 144017690 Facility: HCA Houston Healthcare Conroe Phone Number: 936-539-7425 Address: _504 Medical Center Blvd City/State:_Conroe, TX Zip: 77304 AFFIDAVIT OF MEDICAL RECORDS: ‘Gunna Johnson Before me, the undersigned authority, personally appeared Who, being by me duly sworn, deposed as follows: My name is _Le‘Quona Johnson fam of sound mind, capable of making this affidavit and personally acquainted with the facts herein stated: tam the custodian of the medical records for HCA Houston Healthcare Conroe. Attached hereto are "> pages of medical records. 45 These said — pages of medical records are kept by HCA Houston Healthcare Conroe in the regular course of business, and it was in the regular course of business of HCA Houston Healthcare Conroe for an employee or representative of HCA Houston Healthcare Conroe with knowledge of the act, event, condition, opinion or diagnosis, was ordered to make the record or to transmit information thereof to be included in such records; and the records were made at or near the time of reasonably soon thereafter. The records attached hereto are the original or exact duplicates of the original, AFFIDAVIT OF NO RECORDS © A thorough search of requested information carried out under my direction and control revealed that this facility does not have the records described in the patient authorization or the subpoena duces tecum. DECLARATION OF CUSTODIAN OF RECORDS 4, Le'Qunna Johnson: am the duly authorized Custodian of Records of the above named facility. | am familiar with the mode of preparation of, and have the authority to certify, the facility record. | dectare under penalty of perjury under thy the of Texas, ity of Montgomery that the "Si is true and correct. Signa Date SAHOO S UREN OONEGEROAROR ERAN OU eRN ERR OONNERMAS ERONENOENAMERSERE ANE OKERa AND ny 0 iF, oh, I “Uc public in and for said county, wrisLO pay of ieBy, in, $s “ o%%, tary Public My commission expires: WL. Mn, Be «et = In states where 2 Notary is not required, this form will only include signature and date of rep) Araya MEDICAL RECORDS AFFIDAVIT (Pursuant to Tex. R. Evid. 902) PATIENT’S NAME: MARIA ORR PATIENT’S DATE OF BIRTH: 02/22/1957 STATE OF TEXAS COUNTY OF Harris Before me, the undersigned authority, personally appeared Luis Oropeza, who, being by me duly sworn, deposed as follows: My naine is Luis Oropeza. | am of sound mind and capable of making this affidavit, and personally acquainted with the facts herein stated: I am the custodian of the records of MINIVASIVE PAIN AND ORTHOPEDICS Attached hereto are 52 pages of records from MINIVASIVE PAIN AND ORTHOPEDICS These said 52 pages of records are kept by MINIVASIVE PAIN AND ORTHOPEDICS in the regular course of business, and it was the regular course of business of MINIVASIVE PAIN AND ORTHOPEDICS for an employee or representative of MINIVASIVE PAIN AND ORTHOPEDICS, with knowledge of the act, event, condition, opinion, or diagnosis, recorded to make the record or to transmit information thereof to be included in such record; and the record was made at or near the time or reasonably soon thereafter. The records attached hereto are the original or exact duplicates of the original. Affiant LP- SWORN TO AND SUBSCRIBED before me on the 27th day of August, 2021. tay, JAZMIN RODRIGUEZ oe Notary Public, (State of Tog) Notary Public, State of Texas) Comm. Expires 02-24-2025 Notary ID 132941325 Notary's printed name: Jazmin Rodrigue: as My commission expires; 02/24/2025 MEDICAL RECORDS AFFIDAVIT RE Plaintiff, Maria Orr BEFORE ME, the undersigned authority, personally appeared who being by me duly sworn, deposed as follows: Jaclyn Pashdas — "My name is \aclun Bastidas I am of sound mind, capable of making this affidavit, and personilly acquainted with the facts herein stated are 1am the custodian of the records for | me D__ pages of records from Wnteay rahve ofative ine Spine 2 Sports 4 Sports 1. Attached hereto These said__\D__ pages are kept by \wteorative Spine 4, Yeas in the regular course of business, and it was the regular course of business Integrative Spine 4 Sports or an employee or representative of \Inyearatve Spine 4 Sports with personal knowledge of the act, event, condition, opinion, or diagnosis, recorded to make the record or to transmit informution thereofto be included in such record; and the record was made at or near the time or reasonably soon thereafter. The records attached hereto are the original or exact duplicates of the original." =. Custodi SWORN TO AND SUBSCRIBED BEFORE ME on the \ day of Joly 2022 | NOTARY PUBLIC IN AND FOR THE STATE OF TEXAS Sy Liz Notary iD Name Printed: ie Du My Commission Expires Zz | 22> SSE 2025 MEDICAL RECORDS AFFIDAVIT (Pursuantto Tex. R. Evid. 902) Maria Orr PATIENT’S NAME; DATE OF BIRTH: 02/22/1957 STATE OF TEXAS § COUNTY OF HARRIS Before me, the undersigned authority, personally appeared Nandi Vazquez-Rojas who, being by me duly sworn, deposed as follows My name is. Nandi Vazquez-Rojas 1 am of sound mind and capable of making this affidavit, and personally acquainted with the facts herein stated I am the custodian of the records of Townsen Memorial Imaging-Spring. Attached hereto are _8 pages of records from Townsen Memorial Imaging-Spring. These said_8 pages of records are kept by Townsen Memorial Imaging-Spring in the regular course of business, and it was the regular course of business of Townsen Memorial Imaging-Spring for an employee or representative of Townsen Memorial Imaging-Spring, with knowledge of the act, event, condition, opinion, or diagnosis. recorded to make the record or to transmit information thereof to be included in such record; and the record was made at or near the time or reasonably soon thereafter. The records attached hereto are the original or exact duplicates of the original. SWORN TO AND SUBSCRIBED before me on the 18 day of August 20 22 ae Notary Public, State of Texas| Comm. Expires 02-02-2026 Notary ID 131434492 Notary's printed name: i My commission expires: 2-2-2 le To: +17138078434 Page: 03 of 22 2022-05-26 21:34:15 GMT 8447783046 From: 15034367151 MEDICAL RECORDS AFFIDAVIT RE: Plaintiff, Maria Orr BEFORE MB, the undersigned authority, personally appeared, Zachary Gardner who being by me duly swore, deposed as follows: "My nams is Zachary Gardner Tem of sound mind, capable of making thls affidavit, and personally acquainted with the facts herein stated: Tam the custodian of the records for Spinetech Neurosurgery. Attached hereto are pages of records from Spinetech Neurosurgery. These sald. poges are kept by Spinatech Neurosurgery In the regular course of business, and it was the regular course of business Spinatech Neurosurgery or an employes or representative of Spinotech Neurosurgery with personal knowledge of the act, event, condition, opinion, or diagnosis, recorded to make the record of to transmit information thereof to ba included in such revord; and the record was made at or near the time or reasonably soon thereafter, The records attached hereto are the original or exact duplicates of the original,” Bo Oustodian of Records SWORN TO AND SUBSCRIBED BEFORE ME on the 26th day of __ May 20,22 JENNIFER ONEILL. Official Sea! Notary Public - State Of iftinots 8 STATE OF ID FO) ALO My Commission Expires Aug 18, 202 5 Jennifer O'Neill Name Printed: My Commission Hupires: 08/18/2025 MEDICAL RECORDS AFFIDAVIT RE: Plaintiff, Orr, Maria Delores BEFORE ME, the undersigned authority, personally appeared _ ALI MAZ. OOM, MD j who being by me duly sworn, deposed as follows: "My name is ALI MAZLOOM, MD ; 1am of sound mind, capable of making this affidavit, and personally acquainted with the facts herein stated: the custodian of the records for 5 ORIGIN SPINE I NSTITUTE Attached hereto are 41 pages of records from ORIGIN SPINE INSTITUTE These said ORIGIN SPINE INSTITUTE 4l pages are kept by in the regular course of business, and it was the regular course of business ORIGIN SPINE INSTITUTE or an employee or representative of ORIGIN SPINE INSTITUTE with personal knowledge of the act, event, condition, opinion, or diagnosis, recorded to make the record or to transmit information thereof to be included in such record; and the record was made at or near the time or reasonably soon thereafter. The records attached h