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VERIFIED RETURN OF SERVICE
State of Florida
Case Number: 50-2013CA004965XXXXMBAA.
County of Palm Beach Circuit Court
Plaintiff:
ROSA DESINORD
vs.
Defendant:
CYNTHIA TURBEVILLE
For:
Patrick Flanagan
FLANAGAN MANIOTIS, P.A.
2586 Forest Hill Boulevard
West Palm Beach, FL 33406
Received by LEGAL ADVOCATE SERVICES, INC. on the 14th day of May, 2013 at 9:57 am to be served on
RECORDS CUSTODIAN: CHRIS THOMPSON, D.C., 1200 South Main Street, Suite 202, Belle Glade, FL 33430.
|, Marion Toro, being duly sworn, depose and say that on the 17th day of May, 2013 at 11:50 am, I:
served an AUTHORIZED entity by delivering a true copy of the SUBPOENA DUCES TECUM WITHOUT
DEPOSITION (Mail-In Only), FILM REQUEST and CERTIFICATE OF NO OBJECTION AND COMPLIANCE
WITH C.F.R. 164.512, F.R.C.P. 1.351 AND HIPAA REGULATIONS with the date and hour of service endorsed
thereon by me, to: LAVITA GREEN as RECEPTIONIST at the address of: 1200 South Main Street, Suite 202,
Belle Glade, FL 33430, who stated they are authorized to accept service for CHRIS THOMPSON, D.C., and
informed said person of the contents therein, in compliance with state statutes.
| certify that | am over the age of 18, have no interest in the above action, and am a Process Server, in good
standing, in the judicial circuit in which the process was served. Pursuant to Florida Statutes 92.525, and under the
penalty of perjury, | declare that the facts set forth in the foregoing affidavit are true and correct.
we
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Marlon Toro
Subscribed and Sworn to before me on the 21st day of
License No. 1387
May, 2013 by the affiant who is personally known to
me.
LEGAL ADVOCATE SERVICES, INC.
P.O. Box 15598
NOTARYPUBLI : : West Palm Beach, FL 33416-5598
(561) 686-8828
; ANGELA OLSON Our Job Serial Number: LAS-2013007124
Commission # EE 069258
Expires March 1, 2015
Borde Tu Toy Fain sconce 8203857019
Copyright © 1992-2011 Database Servicas, Inc. - Process Server's Toolbox V6.5h7 : IN THE CIRCUIT COURT OF THE 15™
JUDICIAL CIRCUIT, IN AND FOR PALM
BEACH COUNTY, FLORIDA.
CASE NO: 50-2013 CA 004965 XXXX MBAA
ROSA DESINORD,
Plaintiff,
vs.
CYNTHIA TURBEVILLE,
Defendant.
/
SUBPOENA DUCES TECUM WITHOUT DEPOSITION
(MAIL-IN-ONLY)
THE STATE OF FLORIDA:
TO: Records Custodian
Chris Thompson, DC
1200 South Main Street, Suite 202
Belle Glade, FL 33430
YOU ARE COMMANDED to appear at the law offices of FLANAGAN &
MANIOTIS, P.A., 2586 Forest Hill Boulevard, West Palm Beach, Florida 33406, within
fifteen (15) days from the service hereof, and to have with you at that time and place, the
following:
DUCES TECUM: ROSA DESINORD ~ DOB: 03/30/1958; SSN:
TO THEN AND THERE BRING AND PRODUCE a copy of your entire file
related to the above-referenced individual, including, but not limited to, all medical records,
admission reports, initial evaluations, consultation reports, interim evaluations, final
evaluations, discharge summaries, clinical charts, clinical records, medical histories,
chiropractic histories, patient questionnaire forms, reports of physical examinations, reports
of mental examinations, narrative reports, x-rays, x-ray reports, thermograms, CT scans, CT-
scan reports, MRI films, MRI reports, notes on attendance, charts, complete bills with records
of payments, either partial or complete payment, in any form such records are kept including,
but not limited to, Financial Transaction Listings, records of assignments of money owed for
treatment, either full or partial, including names and identity of the assignee of such, all
correspondence, letters, telephone messages, notes, claim forms, lien letters, letters of
protection signed by the patient and/or the patient’s attorney, and diagnostic test results and
studies. This subpoena is in no way limited to any particular accident or condition.
***THIS SUBPOENA CONTEMPLATES THE PRODUCTION OF EACH AND
EVERY PIECE OF PAPER IN YOUR FILE REGARDLESS OF CONTENT,
INCLUDING HAND WRITTEN NOTES, WHETHER PHYSICALLY OR
ELECTRONICALLY MAINTAINED.
Pursuant to Florida law, this subpoena was issued only after notice of an intent to
serve it was given to the individual whose records are being subpoenaed through his/her
attorney, and the individual has consented, either expressly or by his/her failure to object, to
THthe issuance of the subpoena, and therefore, your compliance with it. If you are subject to
the requirements of 45 CFR 164(HIPAA), you are advised that the records requested,
pursuant to 45 CFR 164.512(e)(1)(ii), should be produced in response to this subpoena.
Pursuant to Florida Administrative Code 21M-26.003, a fee of $1.00 per page for
the first twenty-five (25) pages and 25¢ per page for each additional page will be paid for
the photocopying of said records. IF THE FEE FOR PHOTOCOPYING EXCEEDS
FIFTY ($50.00) DOLLARS, PLEASE CONTACT THE UNDERSIGNED IN ADVANCE
OF THE COPYING FOR AUTHORIZATION TO DO SO. If it is necessary to have the
fee paid in advance, or if the records cannot be gathered by the appointed date, please
contact the undersigned on or before the date on the subpoena and arrangements will be
made,
These items will be inspected and may be copied at that time. You will not be
required to surrender the original items. You may comply with this Subpoena by providing
legible copies of the items to be produced to the attorney whose name appears on the
subpoena on or before the scheduled date of production. You may condition the preparation
of the copies upon the payment in advance of the reasonable cost of preparation. You may
mail or deliver the copies to the attorney whose name appears on the Subpoena and
thereby eliminate your appearance at the time and place specified above. You have the
right to object to the production pursuant to this Subpoena at any time before production by
giving written notice to the attorney whose name appears on this Subpoena. THIS WILL
NOT BE A DEPOSITION; NO TESTIMONY WILL BE TAKEN.
MAIL RECORDS TO THE LAW OFFICE OF FLANAGAN & MANIOTIS, P.A.
If you fail to: (1) Appear as specified; (2) Furnish the records instead of appearing as
provided above; or (3) Object to the Subpoena, you may be in contempt of Court. You are
subpoenaed by the attorney whose name appears on this Subpoena and, unless excused from this
Subpoena by the attorney or the Court, you shall respond to this Subpoena as directed ed-Fai
you.
FLANAGAN & MANIOTIS, P.A.
Attorneys for Defendant
2586 Forest Hill Boulevard
West Palm Beach, Florida 33406
561-964-7501/FAX: 561-964-8025. oo FILM REQUEST
To: Chris Thompson, DC ;
1200 South Main Street; Suite 202
Belle Glade, FL 33430
Your Tax ID No.: (necessary to issue check)
Your Phone No.:
Patient: ROSA DESINORD - DOB: 03/30/1958; SSN:
This subpoena requests any and all films, x-rays, MRI, CT Scans, etc., however, a
complete breakdown/description of film dates and views is required PRIOR TO
DUPLICATION. If you have no films please return this form indicating no films. If the
films have been checked out by another facility/provider or the patient, please provide
the sign out sheet.
Please complete this form and fax or mail to the address below prior to the
compliance date specified on the Subpoena.
Film Date View/Description No. of films Duplication Cost
Total Cost
Patrick B. Flanagan, Esq.
FLANAGAN & MANIOTIS, P.A.
Attorneys for Defendant
2586 Forest Hill Boulevard
West Palm Beach, Florida 33406
561-964-7501/FAX: 561-964-8025IN THE CIRCUIT COURT OF THE 15™
JUDICIAL CIRCUIT, IN AND FOR PALM
BEACH COUNTY, FLORIDA.
CASE NO: 50-2013 CA 004965 XXKX MBAA
ROSA DESINORD,
Plaintiff,
vs.
CYNTHIA TURBEVILLE,
Defendant.
CERTIFICATE OF NO OBJECTION AND COMPLIANCE WITH
164.512, 351 AND HIPAA REGULATIONS
As the attorney issuing the attached Subpoena Duces Tecum, I hereby certify that
I have complied with C.R.F.164.512, F.R.C.P. 1.351 and applicable HIPAA Regulations
and that the following statements are true:
Pursuant to C.F.R. 164.512 and/or F.R.C.P. 1.351:
1. Plaintiff, through Plaintiff's attorney, has been given written notice that
his/her protected health information has been subpoenaed.
2. Plaintiffs attorney has been furnished a copy of the Notice of Production
from Non-Party as well as a’copy of the Subpoena Duces Tecum.
3. The Notice of Production from Non-Party and Subpoena Duces Tecum
provided sufficient information about the litigation or proceeding, in which the protected
health information is requested, to permit the individual to raise objections to the court or
administrative tribunal.
4. The time for the individual to raise objections to the court or
administrative tribunal has elapsed.5. Either no objections were filed or all objections filed by the individual
have been resolved by the court or the administrative tribunal and the disclosures being
sought are consistent with such resolution.
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true copy of the foregoing has been sent, via email,
this 13 day of HAs 2013 -to: - Walter C. Jones,.IV, Esquire,.Freeman & Jones,
L.L.C., 3555 Northlake Boulevard, Suite C, Palm Beach Gardens, FL 33403 at
wjories@gardenslaw.com.
FLANAGAN & MANIOTIS, P.A.
Attomeys for Defendant
2586 Forest Hill Blvd.
West Palm’Beach, FL 33401
(561) 964-7501
Preview
VERIFIED RETURN OF SERVICE State of Florida Case Number: 50-2013CA004965XXXXMBAA. County of Palm Beach Circuit Court Plaintiff: ROSA DESINORD vs. Defendant: CYNTHIA TURBEVILLE For: Patrick Flanagan FLANAGAN MANIOTIS, P.A. 2586 Forest Hill Boulevard West Palm Beach, FL 33406 Received by LEGAL ADVOCATE SERVICES, INC. on the 14th day of May, 2013 at 9:57 am to be served on RECORDS CUSTODIAN: CHRIS THOMPSON, D.C., 1200 South Main Street, Suite 202, Belle Glade, FL 33430. |, Marion Toro, being duly sworn, depose and say that on the 17th day of May, 2013 at 11:50 am, I: served an AUTHORIZED entity by delivering a true copy of the SUBPOENA DUCES TECUM WITHOUT DEPOSITION (Mail-In Only), FILM REQUEST and CERTIFICATE OF NO OBJECTION AND COMPLIANCE WITH C.F.R. 164.512, F.R.C.P. 1.351 AND HIPAA REGULATIONS with the date and hour of service endorsed thereon by me, to: LAVITA GREEN as RECEPTIONIST at the address of: 1200 South Main Street, Suite 202, Belle Glade, FL 33430, who stated they are authorized to accept service for CHRIS THOMPSON, D.C., and informed said person of the contents therein, in compliance with state statutes. | certify that | am over the age of 18, have no interest in the above action, and am a Process Server, in good standing, in the judicial circuit in which the process was served. Pursuant to Florida Statutes 92.525, and under the penalty of perjury, | declare that the facts set forth in the foregoing affidavit are true and correct. we BY ws Ss Crp —_ 228 2 => So Bre = Cran < 1 325 @' = ole 208 ral =32 2 Tj Hom = oD zy oi ee wi LO ~ ; rR ON Marlon Toro Subscribed and Sworn to before me on the 21st day of License No. 1387 May, 2013 by the affiant who is personally known to me. LEGAL ADVOCATE SERVICES, INC. P.O. Box 15598 NOTARYPUBLI : : West Palm Beach, FL 33416-5598 (561) 686-8828 ; ANGELA OLSON Our Job Serial Number: LAS-2013007124 Commission # EE 069258 Expires March 1, 2015 Borde Tu Toy Fain sconce 8203857019 Copyright © 1992-2011 Database Servicas, Inc. - Process Server's Toolbox V6.5h7 : IN THE CIRCUIT COURT OF THE 15™ JUDICIAL CIRCUIT, IN AND FOR PALM BEACH COUNTY, FLORIDA. CASE NO: 50-2013 CA 004965 XXXX MBAA ROSA DESINORD, Plaintiff, vs. CYNTHIA TURBEVILLE, Defendant. / SUBPOENA DUCES TECUM WITHOUT DEPOSITION (MAIL-IN-ONLY) THE STATE OF FLORIDA: TO: Records Custodian Chris Thompson, DC 1200 South Main Street, Suite 202 Belle Glade, FL 33430 YOU ARE COMMANDED to appear at the law offices of FLANAGAN & MANIOTIS, P.A., 2586 Forest Hill Boulevard, West Palm Beach, Florida 33406, within fifteen (15) days from the service hereof, and to have with you at that time and place, the following: DUCES TECUM: ROSA DESINORD ~ DOB: 03/30/1958; SSN: TO THEN AND THERE BRING AND PRODUCE a copy of your entire file related to the above-referenced individual, including, but not limited to, all medical records, admission reports, initial evaluations, consultation reports, interim evaluations, final evaluations, discharge summaries, clinical charts, clinical records, medical histories, chiropractic histories, patient questionnaire forms, reports of physical examinations, reports of mental examinations, narrative reports, x-rays, x-ray reports, thermograms, CT scans, CT- scan reports, MRI films, MRI reports, notes on attendance, charts, complete bills with records of payments, either partial or complete payment, in any form such records are kept including, but not limited to, Financial Transaction Listings, records of assignments of money owed for treatment, either full or partial, including names and identity of the assignee of such, all correspondence, letters, telephone messages, notes, claim forms, lien letters, letters of protection signed by the patient and/or the patient’s attorney, and diagnostic test results and studies. This subpoena is in no way limited to any particular accident or condition. ***THIS SUBPOENA CONTEMPLATES THE PRODUCTION OF EACH AND EVERY PIECE OF PAPER IN YOUR FILE REGARDLESS OF CONTENT, INCLUDING HAND WRITTEN NOTES, WHETHER PHYSICALLY OR ELECTRONICALLY MAINTAINED. Pursuant to Florida law, this subpoena was issued only after notice of an intent to serve it was given to the individual whose records are being subpoenaed through his/her attorney, and the individual has consented, either expressly or by his/her failure to object, to THthe issuance of the subpoena, and therefore, your compliance with it. If you are subject to the requirements of 45 CFR 164(HIPAA), you are advised that the records requested, pursuant to 45 CFR 164.512(e)(1)(ii), should be produced in response to this subpoena. Pursuant to Florida Administrative Code 21M-26.003, a fee of $1.00 per page for the first twenty-five (25) pages and 25¢ per page for each additional page will be paid for the photocopying of said records. IF THE FEE FOR PHOTOCOPYING EXCEEDS FIFTY ($50.00) DOLLARS, PLEASE CONTACT THE UNDERSIGNED IN ADVANCE OF THE COPYING FOR AUTHORIZATION TO DO SO. If it is necessary to have the fee paid in advance, or if the records cannot be gathered by the appointed date, please contact the undersigned on or before the date on the subpoena and arrangements will be made, These items will be inspected and may be copied at that time. You will not be required to surrender the original items. You may comply with this Subpoena by providing legible copies of the items to be produced to the attorney whose name appears on the subpoena on or before the scheduled date of production. You may condition the preparation of the copies upon the payment in advance of the reasonable cost of preparation. You may mail or deliver the copies to the attorney whose name appears on the Subpoena and thereby eliminate your appearance at the time and place specified above. You have the right to object to the production pursuant to this Subpoena at any time before production by giving written notice to the attorney whose name appears on this Subpoena. THIS WILL NOT BE A DEPOSITION; NO TESTIMONY WILL BE TAKEN. MAIL RECORDS TO THE LAW OFFICE OF FLANAGAN & MANIOTIS, P.A. If you fail to: (1) Appear as specified; (2) Furnish the records instead of appearing as provided above; or (3) Object to the Subpoena, you may be in contempt of Court. You are subpoenaed by the attorney whose name appears on this Subpoena and, unless excused from this Subpoena by the attorney or the Court, you shall respond to this Subpoena as directed ed-Fai you. FLANAGAN & MANIOTIS, P.A. Attorneys for Defendant 2586 Forest Hill Boulevard West Palm Beach, Florida 33406 561-964-7501/FAX: 561-964-8025. oo FILM REQUEST To: Chris Thompson, DC ; 1200 South Main Street; Suite 202 Belle Glade, FL 33430 Your Tax ID No.: (necessary to issue check) Your Phone No.: Patient: ROSA DESINORD - DOB: 03/30/1958; SSN: This subpoena requests any and all films, x-rays, MRI, CT Scans, etc., however, a complete breakdown/description of film dates and views is required PRIOR TO DUPLICATION. If you have no films please return this form indicating no films. If the films have been checked out by another facility/provider or the patient, please provide the sign out sheet. Please complete this form and fax or mail to the address below prior to the compliance date specified on the Subpoena. Film Date View/Description No. of films Duplication Cost Total Cost Patrick B. Flanagan, Esq. FLANAGAN & MANIOTIS, P.A. Attorneys for Defendant 2586 Forest Hill Boulevard West Palm Beach, Florida 33406 561-964-7501/FAX: 561-964-8025IN THE CIRCUIT COURT OF THE 15™ JUDICIAL CIRCUIT, IN AND FOR PALM BEACH COUNTY, FLORIDA. CASE NO: 50-2013 CA 004965 XXKX MBAA ROSA DESINORD, Plaintiff, vs. CYNTHIA TURBEVILLE, Defendant. CERTIFICATE OF NO OBJECTION AND COMPLIANCE WITH 164.512, 351 AND HIPAA REGULATIONS As the attorney issuing the attached Subpoena Duces Tecum, I hereby certify that I have complied with C.R.F.164.512, F.R.C.P. 1.351 and applicable HIPAA Regulations and that the following statements are true: Pursuant to C.F.R. 164.512 and/or F.R.C.P. 1.351: 1. Plaintiff, through Plaintiff's attorney, has been given written notice that his/her protected health information has been subpoenaed. 2. Plaintiffs attorney has been furnished a copy of the Notice of Production from Non-Party as well as a’copy of the Subpoena Duces Tecum. 3. The Notice of Production from Non-Party and Subpoena Duces Tecum provided sufficient information about the litigation or proceeding, in which the protected health information is requested, to permit the individual to raise objections to the court or administrative tribunal. 4. The time for the individual to raise objections to the court or administrative tribunal has elapsed.5. Either no objections were filed or all objections filed by the individual have been resolved by the court or the administrative tribunal and the disclosures being sought are consistent with such resolution. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true copy of the foregoing has been sent, via email, this 13 day of HAs 2013 -to: - Walter C. Jones,.IV, Esquire,.Freeman & Jones, L.L.C., 3555 Northlake Boulevard, Suite C, Palm Beach Gardens, FL 33403 at wjories@gardenslaw.com. FLANAGAN & MANIOTIS, P.A. Attomeys for Defendant 2586 Forest Hill Blvd. West Palm’Beach, FL 33401 (561) 964-7501