On April 08, 2020 a
EX 9 BRA NATURAL HEALTH FIVE STAR PERSONAL INJURY
was filed
involving a dispute between
and
for INJURY OR DAMAGE, INVOLVING MOTOR VEHICLE
in the District Court of Tarrant County.
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RELCIVED UIs Vos cel Yor oorM Ol fal f-oo3d OMITH & SMITH
01/03/2020 03:54PM 8177353837 LMS CHIRO INC PAGE 03/03
RECEIVED 12/30/2019 11:37AM 8177353897 LMS CHIRO INC
12/30/2019 14:37AM 817-877-8899 SMITH & SMITH PAGE 04/05
352-316364-20
AFFIDAVIT FOR BILLING RECORDS AND OF
REASONABLENESS AND NECESSITY OF SERVICES
RECORDS PERTAINING TO: David Padilla
s for dates of services April 26, 2018 to present.
RECORDS REQUESTED: Billing and payment record
FIVE STAR PERSONAL INJURY
MEDICAL PROVIDER: NATURAL HEALTH
the undersigned authority, personally appeared
l Air Sout
AFFIANT (Custodian of Records)
who, ing by me duly sworn, deposed and said:
of sound mind, capable of making
this affidavit, and
J, the undersigned, am over 18 years of age,
n stated:
personally acquainted with the facts herei
‘SR PERSON,
J am the CUSTODIAN OF RECORDS for NA’ eC tement of the sctvices and
s that proviide ap.
INJURY _. Attached to this affidavit are record NAL, LY provided
the charges for such services that _NA’
d Padilla. The attached records
are 2 part of this affidavit.
46 _Davi
course of business, and it was the regular
The attached records are kept by me in the regui far SON: JURY for an employee or
course of business of
representative of
NA’
TURAL E RPE) INAL | with knowledge of the
inf formal tion to be includ ed in the records. The
services provided, to make the records or to transmit the time or reasona bly soon after the time
records were made in the regular course Of f business at Of near
duplicate of the original s.
that the services were provided. The records are the originals or an exact
for the. services was reasonable at
The services provided were necessary and the amount charged
the time and place that the services were provided.
The total amount PAID for services was $ oe , and the amount currently UNPAID but
which TURAL, IVE STAR Pj SONAL IN. sight to be. id after any
a—
adjustments or credits is §,
AFFIANT (Custodian of Records)
SWORN TO AND SUBSCRIBED before me. on the 4 day of. < an 2020,
a
oa,
HG, State of Texas
ca vison Expires: i2{ib(22.
SHELLY ADKINS
Notary (D #130042407 EXHIBIT
My Commnission Expi res
December 18, 2022
Document Filed Date
June 09, 2020
Case Filing Date
April 08, 2020
Category
INJURY OR DAMAGE, INVOLVING MOTOR VEHICLE
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RELCIVED UIs Vos cel Yor oorM Ol fal f-oo3d OMITH & SMITH 01/03/2020 03:54PM 8177353837 LMS CHIRO INC PAGE 03/03 RECEIVED 12/30/2019 11:37AM 8177353897 LMS CHIRO INC 12/30/2019 14:37AM 817-877-8899 SMITH & SMITH PAGE 04/05 352-316364-20 AFFIDAVIT FOR BILLING RECORDS AND OF REASONABLENESS AND NECESSITY OF SERVICES RECORDS PERTAINING TO: David Padilla s for dates of services April 26, 2018 to present. RECORDS REQUESTED: Billing and payment record FIVE STAR PERSONAL INJURY MEDICAL PROVIDER: NATURAL HEALTH the undersigned authority, personally appeared l Air Sout AFFIANT (Custodian of Records) who, ing by me duly sworn, deposed and said: of sound mind, capable of making this affidavit, and J, the undersigned, am over 18 years of age, n stated: personally acquainted with the facts herei ‘SR PERSON, J am the CUSTODIAN OF RECORDS for NA’ eC tement of the sctvices and s that proviide ap. INJURY _. Attached to this affidavit are record NAL, LY provided the charges for such services that _NA’ d Padilla. The attached records are 2 part of this affidavit. 46 _Davi course of business, and it was the regular The attached records are kept by me in the regui far SON: JURY for an employee or course of business of representative of NA’ TURAL E RPE) INAL | with knowledge of the inf formal tion to be includ ed in the records. The services provided, to make the records or to transmit the time or reasona bly soon after the time records were made in the regular course Of f business at Of near duplicate of the original s. that the services were provided. The records are the originals or an exact for the. services was reasonable at The services provided were necessary and the amount charged the time and place that the services were provided. The total amount PAID for services was $ oe , and the amount currently UNPAID but which TURAL, IVE STAR Pj SONAL IN. sight to be. id after any a— adjustments or credits is §, AFFIANT (Custodian of Records) SWORN TO AND SUBSCRIBED before me. on the 4 day of. < an 2020, a oa, HG, State of Texas ca vison Expires: i2{ib(22. SHELLY ADKINS Notary (D #130042407 EXHIBIT My Commnission Expi res December 18, 2022