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Filing # 108154207 E-Filed 05/29/2020 05:36:34 PM
RETURN OF SERVICE
State of Florida County of Broward Circuit Court
MJD2020003341
33.
Case Number: 19-21435 CACE 08 |
Plaintiff:
JOYCE CLAXTON as parent and/or natural guardian for ATTICUS ROSA, a
minor
vs.
Defendant:
SCHOOL BOARD OF BROWARD COUNTY, a Florida political subdivision
For:
Edwina V. Kessler, Esq.
Catri, Holton, Kessler & Kessler, P.A.
633 S. Andrews Ave.
Third Floor
Fort Lauderdale, FL 33301
Received by Process Services, Inc. on the 27th day of April, 2020 at 2:45 pm to be served on Pill Box Pharmacy &
Medical Supply /RC, 7701 Nova Drive, Davie, FL 33324.
|, Murray Deal, do hereby affirm that on the 29th day of April, 2020 at 10:50 am, I:
SUBSTITUTE - BUSINESS: served by delivering a true copy of the Subpoena Duces Tecum (Mail-In Only);
Letter; Certificate of Compliance with HIPAA; Certification of Custodian of Records of Regularly Conducted
Business Activity; Notice of Production From Non-Party with the date and hour of service endorsed thereon by
me, to: Tom Boham as Pharmacist, a person employed therein and authorized to accept service for Pill Box
Pharmacy & Medical Supply at the address of: 7701 Nova Drive, Davie, FL 33324 and informing said person of
the contents thereof.
Additional Information pertaining to this Service:
Re: Atticus Rosa
(954) 475-7455
Under penalty of perjury, | declare that | have read the foregoing and that the facts stated in it are true and correct,
that | am a Sheriff's Appointed process server in the county in which service was effected in accordance with Florida
Statutes and | have no interest in the above action.
nO
Murray Dea J
SPS 109
Process Services, Inc.
8382 State Road 84
Fort Lauderdale, FL 33324
(954) 474-4867
Our Job Serial Number: MJD-2020003341
Ref: BL-34892-PK
Copyright © 1892-2020 Database Services, Inc. - Process Server's Toolbox VB.1g
*** FILED: BROWARD COUNTY, FL BRENDA D. FORMAN, CLERK 05/29/2020 05:36:33 PM.****S34
EVK/aa IN THE CIRCUIT COURT OF THE 17TH
BL-34892-PK JUDICIAL CIRCUIT IN AND FOR
BROWARD COUNTY, FLORIDA
JOYCE CLAXTON as parent and/or CASE NO.: CACE19021435
natural guardian for ATTICUS ROSA, a Division: 08
minor,
Plaintiff,
Vv.
SCHOOL BOARD OF BROWARD
COUNTY, a Florida political
subdivision,
Defendant.
/
SUBPOENA DUCES TECUM
(Mail-In Only)
TO: Record Custodian, Pill Box Pharmacy & Medical Supply
7701 Nova Drive
Davie, FL 33324
(954) 475-7455
YOU ARE COMMANDED to comply with the terms of this Subpoena Duces Tecum by
sending the documents identified herein to CATRI, HOLTON, KESSLER & KESSLER, P.A., 633
South Andrews Avenue, Third Floor, Ft. Lauderdale FL 33301, WITHIN TEN (10) DAYS
AFTER SERVICE OF THIS SUBPOENA DUCES TECUM.
Pursuant to 45 C.F.R. 164.512, “A covered entity may use or disclose protected
health information without the written consent or authorization of the
individual...to the extent that such use or disclosure is required by law and the
use or disclosure complied with and is limited to the relevant requirements of
such law.” Pursuant to 45 C.F.R. 164.501, “Required by law includes, but it not
limited to, court orders and court-ordered warrants; subpoenas or summons...a
civil or an authorized investigative demand.” (emphasis added) Further, in
compliance with the Health Insurance Portability Act of 1996, Section 164,510,
the undersigned certifies that written notice was given to the patient or his/her
attorney in the form of a Notice of Production from Non-Party which provided
the patient with pertinent information regarding the case and medical records
requested. The patient was given adequate time to object and no objection was
made. This subpoena was issued only after expiration of the requisite time for
said objection.
yfCASE NO.:CACE19021435
Division: 08
Page 2
ANY AND ALL INFORMATION REGARDING ATTICUS ROSA; DATE OF
BIRTH: ER; SOCIAL SECURITY +E «(See attached Records
Custodian letter for DOB & SSN) ; INCLUDING BUT NOT LIMITED TO:
. A COMPUTER PRINTOUT OF ALL PRESCRIPTIONS FILLED
DURING THE LAST SEVEN (7) YEARS, INCLUDING DATE,
DOCTOR, AND MEDICATION.
. ANY CHARGE ACCOUNT RECORDS.
THIS REQUEST IS A SEARCH OF ALL DRUG STORES.
If the cost of these records will exceed Fifty Dollars ($50.00), please contact the
undersigned for authorization before photocopying. PLEASE FURNISH A FORM W-9
“REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION”
WHEN SUBMITTING AN INVOICE FOR DUPLICATION OF RECORDS.
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 this 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 this 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.
If you fail to:
1. appear as specified or;
2. furnish the records instead of appearing as provided above; or
3. object to this subpoena;
you may be in contempt of Court. You are subpoenaed by the following attorney, and unless
excused from this subpoena by this attorney or the Court, you shall respond to this subpoena as
directed.DATED ON: April 27, 2020
EDWINA V. KESSLER, ESQUIRE
FOR THE COURT
\ fr
Catri, Holton, Kessler & Kessler, P.A.
633 South Andrews Avenue -Third Floor
Ft. Lauderdale, FL 33301/(954) 463-8593
Florida Bar #: 016209
CASE NO.;CACE19021435
Division: 08
Page 3
Preview
Filing # 108154207 E-Filed 05/29/2020 05:36:34 PM RETURN OF SERVICE State of Florida County of Broward Circuit Court MJD2020003341 33. Case Number: 19-21435 CACE 08 | Plaintiff: JOYCE CLAXTON as parent and/or natural guardian for ATTICUS ROSA, a minor vs. Defendant: SCHOOL BOARD OF BROWARD COUNTY, a Florida political subdivision For: Edwina V. Kessler, Esq. Catri, Holton, Kessler & Kessler, P.A. 633 S. Andrews Ave. Third Floor Fort Lauderdale, FL 33301 Received by Process Services, Inc. on the 27th day of April, 2020 at 2:45 pm to be served on Pill Box Pharmacy & Medical Supply /RC, 7701 Nova Drive, Davie, FL 33324. |, Murray Deal, do hereby affirm that on the 29th day of April, 2020 at 10:50 am, I: SUBSTITUTE - BUSINESS: served by delivering a true copy of the Subpoena Duces Tecum (Mail-In Only); Letter; Certificate of Compliance with HIPAA; Certification of Custodian of Records of Regularly Conducted Business Activity; Notice of Production From Non-Party with the date and hour of service endorsed thereon by me, to: Tom Boham as Pharmacist, a person employed therein and authorized to accept service for Pill Box Pharmacy & Medical Supply at the address of: 7701 Nova Drive, Davie, FL 33324 and informing said person of the contents thereof. Additional Information pertaining to this Service: Re: Atticus Rosa (954) 475-7455 Under penalty of perjury, | declare that | have read the foregoing and that the facts stated in it are true and correct, that | am a Sheriff's Appointed process server in the county in which service was effected in accordance with Florida Statutes and | have no interest in the above action. nO Murray Dea J SPS 109 Process Services, Inc. 8382 State Road 84 Fort Lauderdale, FL 33324 (954) 474-4867 Our Job Serial Number: MJD-2020003341 Ref: BL-34892-PK Copyright © 1892-2020 Database Services, Inc. - Process Server's Toolbox VB.1g *** FILED: BROWARD COUNTY, FL BRENDA D. FORMAN, CLERK 05/29/2020 05:36:33 PM.****S34 EVK/aa IN THE CIRCUIT COURT OF THE 17TH BL-34892-PK JUDICIAL CIRCUIT IN AND FOR BROWARD COUNTY, FLORIDA JOYCE CLAXTON as parent and/or CASE NO.: CACE19021435 natural guardian for ATTICUS ROSA, a Division: 08 minor, Plaintiff, Vv. SCHOOL BOARD OF BROWARD COUNTY, a Florida political subdivision, Defendant. / SUBPOENA DUCES TECUM (Mail-In Only) TO: Record Custodian, Pill Box Pharmacy & Medical Supply 7701 Nova Drive Davie, FL 33324 (954) 475-7455 YOU ARE COMMANDED to comply with the terms of this Subpoena Duces Tecum by sending the documents identified herein to CATRI, HOLTON, KESSLER & KESSLER, P.A., 633 South Andrews Avenue, Third Floor, Ft. Lauderdale FL 33301, WITHIN TEN (10) DAYS AFTER SERVICE OF THIS SUBPOENA DUCES TECUM. Pursuant to 45 C.F.R. 164.512, “A covered entity may use or disclose protected health information without the written consent or authorization of the individual...to the extent that such use or disclosure is required by law and the use or disclosure complied with and is limited to the relevant requirements of such law.” Pursuant to 45 C.F.R. 164.501, “Required by law includes, but it not limited to, court orders and court-ordered warrants; subpoenas or summons...a civil or an authorized investigative demand.” (emphasis added) Further, in compliance with the Health Insurance Portability Act of 1996, Section 164,510, the undersigned certifies that written notice was given to the patient or his/her attorney in the form of a Notice of Production from Non-Party which provided the patient with pertinent information regarding the case and medical records requested. The patient was given adequate time to object and no objection was made. This subpoena was issued only after expiration of the requisite time for said objection. yfCASE NO.:CACE19021435 Division: 08 Page 2 ANY AND ALL INFORMATION REGARDING ATTICUS ROSA; DATE OF BIRTH: ER; SOCIAL SECURITY +E «(See attached Records Custodian letter for DOB & SSN) ; INCLUDING BUT NOT LIMITED TO: . A COMPUTER PRINTOUT OF ALL PRESCRIPTIONS FILLED DURING THE LAST SEVEN (7) YEARS, INCLUDING DATE, DOCTOR, AND MEDICATION. . ANY CHARGE ACCOUNT RECORDS. THIS REQUEST IS A SEARCH OF ALL DRUG STORES. If the cost of these records will exceed Fifty Dollars ($50.00), please contact the undersigned for authorization before photocopying. PLEASE FURNISH A FORM W-9 “REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION” WHEN SUBMITTING AN INVOICE FOR DUPLICATION OF RECORDS. 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 this 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 this 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. If you fail to: 1. appear as specified or; 2. furnish the records instead of appearing as provided above; or 3. object to this subpoena; you may be in contempt of Court. You are subpoenaed by the following attorney, and unless excused from this subpoena by this attorney or the Court, you shall respond to this subpoena as directed.DATED ON: April 27, 2020 EDWINA V. KESSLER, ESQUIRE FOR THE COURT \ fr Catri, Holton, Kessler & Kessler, P.A. 633 South Andrews Avenue -Third Floor Ft. Lauderdale, FL 33301/(954) 463-8593 Florida Bar #: 016209 CASE NO.;CACE19021435 Division: 08 Page 3