On February 06, 2020 a
Party Statement
was filed
involving a dispute between
Mobley, Jacqueline,
and
Ortiz, Maria,
for MOTOR VEHICLE ACCIDENT
in the District Court of Dallas County.
Preview
FILED
6/12/2020 12:29 PM
FELICIA PITRE
DISTRICT CLERK
DALLAS CO., TEXAS
Treva Parker—Ayodele DEPUTY
DC-20-02088
JACQUELINE MOBLEY IN THE DISTRICT COURT
vs. WWWWW
14TH JUDICIAL DISTRICT
MARIA ORTIz DALLAS COUNTY, TEXAS
Affidavit ofMedicaI Records
from
Texas Health care
STATE
STATE 00
COUNTY OF
0F
/”MM 6-4 §
§
§
§
§
AFFIDAVIT OF
AFFIDAVIT or MEDICAL RECORDS
§
‘Z
Before me,the
Before me, theundersigned
undersignedauthority,
authority,personally appeared, ),\‘w Li
personallyappeared, £152; ,.who,
who,
being by me
being by me duly
duly sworn.
sworn, deposed
deposed and said:
said:
"My
“My name Se., t.- 4-y;
nameisisSaw» {2453 . Ilam
. am over
over the
the age ofof eighteen
eighteen (18)
(18) years,
years, of
sound mind,
mind, capable of making
capable of making this
this affidavit,
affidavit,and
and personally
personally acquainted
acquainted with
with the
the facts stated in
facts stated in
it.
it. I am the
l the custodian
custodian of records for
of records for Texas Healthcare
Healthcare NeckNeck && Back Clinics
Clinics and asas such I am
I
qualified
qualified toto testify
testify about
about the
the records
records attached
attached to
to this
this affidavit, for the
affidavit, for the treatment
treatment of Jacqueline
of Jacqueline
Mobley.
Mobley.
The records
The records attached
attached toto this
this affidavit,
affidavit, consisting
consisting ofoffI30
- 0 pages
pages areare kept
kept byby Texas
Healthcare
Healthcare Neck
Neck & & Back Clinics
Clinics in the regular
in the regular course
course of its business.
of its business. It the regular
lt was the regular course
course
of the medical
of the medical provider
provider for
for an
an employee
employee or or representative
representative or or said
said provider
provider with
with knowledge
knowledge ofof
the act,
the event, condition,
act, event, condition, opinion
opinionor or diagnosis
diagnosisrecorded
recordedto to make
makethethe report
report or or to
to transmit
transmit the
the
information thereof
information thereof to
to be
be included
included in
in such
such record.
record. The
The report
report was made at
at or near the time
time of
the
the act,
act, event, condition, opinion
event, condition, opinion or or diagnosis
diagnosis recorded,
recorded, oror reasonably
reasonably soon
soon thereafter.
thereafter. The
records attached
records attached hereto
hereto are
are the
the originals
originals or or exact
exact duplicates
duplicates ofof the originals.
originals.
•
Swim;
*".••7"-te..
SWORN TO
SWORN 'ro
,
,A-
.‘1
AND
AND SUBSCRIBED
SUBSCRIBED
AFFIANT/CUSTODIAN
me on
before
before me the
on the c fl
AFFIANT/CUSTODMN OF
0F RECORDS
RECORDS
day
day of MMOE -
/
NOTI4RY
NOT PUBLIC, ST TEEOF
YPUBLIC,ST OF
Document Filed Date
June 12, 2020
Case Filing Date
February 06, 2020
Category
MOTOR VEHICLE ACCIDENT
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FILED 6/12/2020 12:29 PM FELICIA PITRE DISTRICT CLERK DALLAS CO., TEXAS Treva Parker—Ayodele DEPUTY DC-20-02088 JACQUELINE MOBLEY IN THE DISTRICT COURT vs. WWWWW 14TH JUDICIAL DISTRICT MARIA ORTIz DALLAS COUNTY, TEXAS Affidavit ofMedicaI Records from Texas Health care STATE STATE 00 COUNTY OF 0F /”MM 6-4 § § § § § AFFIDAVIT OF AFFIDAVIT or MEDICAL RECORDS § ‘Z Before me,the Before me, theundersigned undersignedauthority, authority,personally appeared, ),\‘w Li personallyappeared, £152; ,.who, who, being by me being by me duly duly sworn. sworn, deposed deposed and said: said: "My “My name Se., t.- 4-y; nameisisSaw» {2453 . Ilam . am over over the the age ofof eighteen eighteen (18) (18) years, years, of sound mind, mind, capable of making capable of making this this affidavit, affidavit,and and personally personally acquainted acquainted with with the the facts stated in facts stated in it. it. I am the l the custodian custodian of records for of records for Texas Healthcare Healthcare NeckNeck && Back Clinics Clinics and asas such I am I qualified qualified toto testify testify about about the the records records attached attached to to this this affidavit, for the affidavit, for the treatment treatment of Jacqueline of Jacqueline Mobley. Mobley. The records The records attached attached toto this this affidavit, affidavit, consisting consisting ofoffI30 - 0 pages pages areare kept kept byby Texas Healthcare Healthcare Neck Neck & & Back Clinics Clinics in the regular in the regular course course of its business. of its business. It the regular lt was the regular course course of the medical of the medical provider provider for for an an employee employee or or representative representative or or said said provider provider with with knowledge knowledge ofof the act, the event, condition, act, event, condition, opinion opinionor or diagnosis diagnosisrecorded recordedto to make makethethe report report or or to to transmit transmit the the information thereof information thereof to to be be included included in in such such record. record. The The report report was made at at or near the time time of the the act, act, event, condition, opinion event, condition, opinion or or diagnosis diagnosis recorded, recorded, oror reasonably reasonably soon soon thereafter. thereafter. The records attached records attached hereto hereto are are the the originals originals or or exact exact duplicates duplicates ofof the originals. originals. • Swim; *".••7"-te.. SWORN TO SWORN 'ro , ,A- .‘1 AND AND SUBSCRIBED SUBSCRIBED AFFIANT/CUSTODIAN me on before before me the on the c fl AFFIANT/CUSTODMN OF 0F RECORDS RECORDS day day of MMOE - / NOTI4RY NOT PUBLIC, ST TEEOF YPUBLIC,ST OF