RESPONSE TO DEMAND Medical Authorizations - Medical Authorizations Possible SSN Administratively Redacted - Kimberlee J Harman, Kevin D Harman v. Karen A Ballantine, Roger D Ballantine

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On July 28, 2021 a case was filed by Kevin D Harman, and Kimberlee J Harman, represented by Howard, Michael C., against Karen A Ballantine, and Roger D Ballantine, represented by Kagan, Scott Daniel, and Perley, Michael Francis, in the jurisdiction of Greene County. Judge Adam W Silverman presiding.

                        
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                          (CN tHORIZAHION-FO-DISELOSE MEDICAL INFORMATION

 

PROVIDER: Catskill Ambulance Services 82 W Bridge St. Catskill, NY 12414
Name Address

CLIENT/PATIENT NAME: Kimberlee Harman DATE OF BIRTH: _ 3/6/72

ACCIDENT DATE: 9-3-2018 SSN: {|__|

Kindly furnish to: Michael F. Perley, Esq.,

HURWITZ & FINE, P.C

1300 Liberty Building

424 Main Street

Buffalo, New York 12402
A copy of the following records pertaining to me :
____ Narrative medical report.
__X_ Medical records (include all bills, charts, and reports prepared for any insurance company).
____ Hospital records (pursuant to Public Health Law Section 18).
__X_ Copies of X-rays, Ct. Scan, MRI films and reports. (LIMITED TO:
__X_ Copies of films and reports of other diagnostic testing i.e.:
__X_ Entire Medical Record (LIMITED TO:
____ No-fault file: Claim #
____Compensation/Disability records: File #

Other:

 

 

 

 

Information regarding my heath care, in…