`INDEX NO. 61345/2016
`FILED: WESTCHESTER COUNTY CLERK 10/05/2017 04:51 PM
`INDEX \10' “345/2016
`FILED: WESTCHESTER COUNTY CLERK 10w2017 04:51 PM
`
`
`
`
`
`NYSCEF DOC. NO. 63
`RaCaIVaD NYSCEF: 10/05/2017
`NYSCEF DOC. NO. 63
`RECEIVED NYSCEF: 10/05/2017
`
`SUPREME COURT OF THE STATE OF NEW YORK
`
`COUNTY OF WESTCHESTER
`_________________________________________________________X
`
`ANTHONY GIRARDI and CAROL GIRARDI,
`
`Index N0.: 61345/2016
`
`Plaintiffs,
`
`- against -
`
`DAVID YASGUR, M.D., MT. KISCO
`
`MEDICAL GROUP, RC, and NORTHERN
`
`WESTCHESTER HOSPITAL,
`
`Defendant(s).
`_________________________________________________________X
`
`EXHIBIT R
`
`V SHAUB, AHMUTY, CITRIN& SPRATT, LLP
`Attorneys for Defendant
`NORTHERN WESTCHESTER HOSPITAL
`
`1983 Marcus Avenue
`
`Lake Success, New York 11042—1056
`
`(516) 488—3300
`OUR FILE NO.: 1008-00006
`
`0093 9743. I
`
`

`

`
`INDEX NO. 61345/2016
`FILED: WESTCHESTER COUNTY CLERK 10/05/2017 04:51 PM
`
`INDEX VO~ 61345/2016
`FILED: WESTCHESTER COUNTY CLERK 10w2017 04:51 PM
`
`
`
`
`
`NYSCEF DOC. NO. 63
`RaCaIVaD NYSCEF: 10/05/20i7
`NYSCEF DOC. NO. 63
`RECEIVED NYSCEF: 10/05/2017
`
`CAREMQU‘NT“
`
`MEDICAL
`
`ELECTRONIC HEALTH RECORD
`
`FOR
`
`ANTHONY GIRARDI
`
`DOB:_
`
`
`
`amnxmrmmmwxmawmmmwwwxv-WKA5351”:
`
`
`

`

`
`61345/2
`INDEX NO. 61345/2016
`FILED: WESTCHESTER COUNTY CLERK 10/05/2017 04:51 PM
`FILED: WESTCHESTER COUNTY CLERK 10m2017 04:51 PM
`INDEX NO'
`
`NYSCEF DOC. NO. 63
`0l7
`NYSCEF DOC. NO. 63
`RECEIVED NYSCEF: 10/05/2017
`
`i
`b
`
`l'..t
`
`sqsssr‘i
`
`DANKNER MILSTEIN, P.C.
`Attorneys At Law
`
`Q1 E 57‘“ Street 0 36‘” Floor ) BIA/S” ”7
`
`ew York, New York 10022
`Telephone: 212-751—8000
`Facsimile: 212-751-8091
`
`no IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
`
`111 Bedford Road
`
`tin-coups
`
`“IIIIIOOIIII
`
`'IIIIIIIIIII
`
`luly 27,:62
`éCOPlEfiEY '
`Dr. David Yasgur
`AND BILLS
`Katonah, New York 10536
`Att: Medical Records DepartmentHEALTHPom ‘--
`Re: (“than Girardi
`YT
`BECENED BY
`DID/B:
`1;
`AUG 02 ms
`Social Security No:-
`HEALTHPORT
`
`l r
`
`«nwmcmrmesmmmmmfianmnm-s‘“he“1,:.,_.
`
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`
`i
`2
`1
`
`3
`
`3
`?
`
`Dear Sir/Madam:
`
`i
`
`“We represent Anthony Girardi. We are enclosing a HlPAA-compliant medical
`authorization allowing us to obtain the medical records of this patient.
`R
`
`the com lete medical record/chart of the
`Please provide us with a photocopy of
`above-named patient and all materials or information including, but not limited to, all
`medical records, hospital records, physicians' records, surgeons‘ records, consultation
`records, operative reports, physical therapy and other therapy records; x—ray, CT scan,
`MR1, PET scan and reports or other diagnostic studies; laboratory reports; patient
`information and history questionnaire; physicals and history; discharge summary;
`progress notes; prescriptions and medication records; nurses' notes; psychotherapy
`notes, correspondence; consent for treatment; statements for services rendered; or any
`other materials (whether written or stored, created or maintained in any other form)
`relating or pertaining to this patient, including documents and records received from
`or that were created by another provider.
`
`HiPAA permits you, as a "covered entity", to impose reasonable, cost-based fees for
`providing the requested medical records. The fee may include only the cost of copying
`(including supplies and labor) and postage, if the patient requests that the copy be
`mailedii). The fee may not include costs associated with searching for and retrieving
`the requested information(2). As part of the Medicare program, the United States
`Department of Health 8: Human Services has established a rule for determining cost-
`based fees
`for photocopying medical
`records. Pursuant
`to that "Photocopy
`
`I’ll 031%?)
`
`«an....'-WH-...W._-........,....
`
`
`
`-fiwmw.....,
`
`..”spy—1,...www.—
`
`i
`
`Name: GlRARDl. ANTHONY
`
`DOB:
`
`Date: 07/27/2016
`
`
`
`

`

`
`INDEX NO. 61345/2016
`FILED: WESTCHESTER COUNTY CLERK 10/05/2017 04:51 PM
`FILED: WESTCHESTER COUNTY CLERK 10m2017 04:51 PM
`INDEX NO~ 61345/2016
`
`NYSCEF DOC. NO. 63
`RECEIVED NYSCEF: 10/05/2017
`NYSCEF DOC. NO. 63
`W20?
`\
`
`3
`é
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`l
`'
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`
`Reimbursement Methodology", Health & Human Services established 7 cents per page
`as the appropriate rate in 1992 (3).
`in November, 2002, Health & Human Services
`proposed a rule to increase cost—based fees for photocopying medical records from 7
`cents per page to 12 cents per page, to reflect inflationary changes in the labor and
`supply cost components of the formula (4).
`
`Although the new rule has not yet been adopted, we believe that it accurately reflects
`those inflationary changes.
`
`As you are aware, before the effective date of HIPAA, New York State law permitted
`you to charge a fee of up to 75 cents per page for providing photocopies of medical
`records. Our research has revealed no provisions of HiPAA that prevent us from
`offering to pay you a fee greater than 12 cents per page,
`if we request special
`"expedited service".
`.
`
`Accordingly, we are offering to pay you a fee of 75 cents per page (including postage),
`if you send us all of the records that we are requesting within 10 days of the date of this
`letter.
`if you do not send us all of the records that we are requesting within 10 days of
`the date of this letter, we will pay you 12 cents per page, plus the cost of postage, as
`7 set forthin HlPAAand the proposed federal rule;
`’
`'
`‘
`'
`
`Thank you for your courtesy and cooperation in this matter.
`
`Very truly yours,
`
`DANKNER MlLSTElN, P.C.
`
`EPA/Via
`
`lliana Alvarado
`By:
`lliana Alvarado, Legal Assistant
`
`Name: GIRARDI, ANTHONY
`
`'
`DOB.
`
`Date: 07/27/2016
`
`
`
`
`
`
`
`Mame—4m.mmh.”new”
`
`,1
`
`fi
`
`‘
`
`l
`
`

`

`
`16
`INDEX NO. 61345/2016
`FILED: WESTCHESTER COUNTY CLERK 10/05/2017 04:51 PM
`
`FILED: WESTCHESTER COUNTY CLERK 10m2017 04:51 PM
`INDEX W 613453:
`
`
`
`
`‘17
`NYSCI
`NYSCEF DOC. NO. 63
`RECEIVED NYSCEF: 10/05/2017
`SF DOC. no. 63 W
`'J
`
`
`
`
`OCA Official Form No: 960
`AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA
`[This form has been approved by the New York State Department of Health}
`Date ofBirth
`Social Security Number
`
`‘71,..."
`Patient Name
`Anthony Girardi
`Patient Address
`
`
`
`
`7965 Baypointe Drive, Denver, North Carolina 28037
`
`
`
`I understand that I may
`
`
`
`I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form:
`In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996
`(HIPAA),
`I understand that:
`‘
`I. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH
`TREATMENT, except psychotherapy notes, and CONFIDENTIAL HIV“ RELATED INFORMATION only ifI place my initials on
`the appropriate line in Item 9(a).
`In the event the health information described below includes any ofthese types of information. and I
`initial the line on the box in Item 9(a), I specifically authorize release of such information to the person(s) indicated in Item 8.
`2. If i am authorizing the release of HIV-related, alcohol or drug treatment, or mental health treatment information, the recipient is
`prohibited from redisclosing such information without my authorization unless permitted to do so under federal or state law.
`I
`understand that l have the right to request a list of people who may receive or use my HIV-related information without authorization. If
`I experience discrimination because of the release or disclosure of HIV-related information, I may contact the New York State Division
`of Human Rights at (2l2) 480-2493 or the New York City Commission of Human Rights at (212) 3064450. These agencies are
`responsible for protecting my rights.
`3.
`lhavethe right to revoke this authorization‘atnny time by writing to the health care provider listed below.
`revoke this authorization except to the extent that action has already been taken based on this authorization.
`4.
`I understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for
`benefits will not be conditioned upon my authorization of this disclosure.
`5. Information disclosed under this authorization might be redisclosed by the recipient (except as noted above in Item 2), and this
`rcdisclosure may no longer be protected by federal or state law.
`6. THIS AUTIIQEIEAEO§_DQESWNOT AUTHORIZE YOUTO DISCUSS MY- HEALTH INFORMATION OR ‘MEDICAL
`CARE WITH ANYONE OTHER THAN THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9 b .
`7. Name and address of health provider or entity to release this infonnation:
`Dr. David Yasgur - 111 Bedford Road, Katonah, New York 10536
`8. Name and address ofperso
`gory
`11(5) or cute
`of person to whom this information will be sent:
`Dankner Milstein P.
`., 41 East 57th Street, 3661 FL, New York, New York 10022
`9(a). Specific information to be released:
`
`to (insert date)
`D Medical Record from (insert date)
`[2 Entire Medical Record, including patient histories, office notes (except psychotherapy notes), test results, radiology studies, films,
`referrals. consults, billing records. insurance records, and records sent to you by other health care providers.
`
`D Other:
`Incl do: (Indicate by Initialing)
`
`Alcohol/Drug Treatment
`Mental Health Information
`HIV-Related Information
`
`
`
`
`
`
`
`
`Name of individual health care provider
`Initials
`
`to discuss my health information with my attorney, or a governmental agency, listed here:
`
`
`
`
` Attome /Firm Name or Governmental
`~ ;
`
`IO. Reason for release of information:
`
`l I; Date or event on which this authorization will expire:
`
`
`Cl At request of individual
`
`One year from signature date
`Other: Litigation
`
`
`i2. If not the patient. name of person signing form:
`13. Authority to sign on behalfof patient:
`
`
`
`
`
`
`All items on this form have been completed and my questions about this form have been answered. In addition, I have been provided a
`copy of the form.
`
`
`
` v.-~—wv4.u-”may...Mtg—cu...“—.............i-~-s.,.....-...~n~<mW—~'u..W.l....V.
`
`
`
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`
`
`
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`
`
`
`
`
`
`
`
`
`
`Authorization to Discuss Health Information
`(bl D By initialing here
`I authorize
`
`
`
`
`
`
`
`
`
`" Human Immunodeficiency Virus that causes AIDS. The New York State Public Health Law protects information which reasonably could
`identify someone as having HIV symptoms or infection and information regarding a person‘s contacts.
`
`m 2%! le-
`
`Name: GlRARD l, ANTHONY
`
`DOB:
`
`Date: 07/27/2016
`
`

`

`
`INDEX NO. 61345/2016
`FILED: WESTCHESTER COUNTY CLERK 10/05/2017 04:51 PM
`FILED: WESTCHESTER COUNTY CLERK 10w2017 04:51 PM
`INDEX \lO~ 61345/2016
`
`
`
`
`
`NYSCEF DOC. NO. 63
`RECEIVED NYSCEF: 10/05/2017
`fl
`
`
`RaCaIVaD NYSCEF: 10/05/20f7
`$988 349
`
`NYSCEF DOC. NO. 63
`‘
`
`1 l
`
`gi
`I
`
`i lt
`
`l
`
`'
`
`f
`
`i li
`
`DANKNER MltSTElN, P.C.
`
`(41 assistant,” ) Bill/SHIP
`
`New York, New York 10022
`Telephone: 212-75 1.8000
`Facsimile: 21 2-751-8091
`
`’é'éisis’BBv ,
`
`.
`
`I I I I I I I I l l I I I I I I I I I I I I l l I I l I I I I I I I I I I I .-
`
`RECORDS
`
`Mt. Kisco Medical Group
`110 5 Bedford Rd #2,
`Mt Kisco, NY 10549
`Att: Medical Records Department
`
`AND BILLS
`III-IIlI-IIUUIUI lllll Dillon-IIIO'IIII
`
`“IIDIIIIIII.
`loco-II-IIII
`.......................................
`PT
`Re: Anthony Girardi
`RECENEDBY
`ocial Security No:_
`ӣ21szng
`
`D/OIB:
`
`2
`
`Dear Sir/Madam:
`
`we represent—Anthony Girardi. We are enclosing a HlPAA—compliant medical
`authorization allowing us to obtain the medical records of this patient.
`
`Please provide us with a photocopy of
`
`the complete medical record/chart of the
`
`above—named patient and all materials or information Including, but not limited to, all
`medical records, hospital records, physiciansl records, surgeons’ records, consultation
`records, operative reports, physical therapy and other therapy records; x~ray, CT scan,
`MRI, PET scan and reports or other diagnostic studies; laboratory reports; patient
`information and history questionnaire; physicals and history; discharge summary;
`progress notes; prescriptions and medication records; nurses' notes; psychotherapy
`notes, correspondence; consent for treatment; statements for services rendered; or any
`other materials (whether written or stored, create or maintained in any 0 er form)
`relating or pertaining to this patient, including documents and records received from
`or that were created by another provider.
`
`HIPAA permits you, as a "covered entity", to impose reasonable, cost-based fees for
`providing the requested medical records. The fee may include only the cost of copying
`(including supplies and labor) and postage, if the patient requests that the copy be
`mailed(i ). The fee may not include costs associated with searching for and retrieving
`the requested information(2). As part of the Medicare program, the United States
`Department of Health & Human Services has established a rule for determining cost-
`based fees
`for photocopying medical
`records. Pursuant
`to that "Photocopy
`
`Name: GlRARDl, ANTHONY
`
`DOB:
`
`Date: 07/27/2016
`
`{Mott/0i
`
`

`

`
`INDEX NO. 61345/2016
`FILED: WESTCHESTER COUNTY CLERK 10/05/2017 04:51 PM
`
`FILED: WESTCHESTER COUNTY CLERK 10w2017 04:51 PM
`INDEX \lO~ 61345/2016
`
`
`
`
`
`NYSCEF DOC. NO. 63
`RaCaIVaD NYSCEF: 10/05/20?7
`NYSCEF DOC. NO. 63
`RECEIVED NYSCEF: 10/05/2017
`i
`z
`‘
`i
`i
`l
`
`3
`
`.
`
`~
`
`
`
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`
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`
`;
`
`i
`
`
`
`l l l
`
`i l
`
`’_
`
`g
`i
`
`Reimbursement Methodology", Health 8: Human Services established 7 cents per page
`as the appropriate rate in 1992 (3).
`In November, 2002, Health & Human Services
`proposed a rule to increase cost—based fees for photocopying medical records from 7
`cents per page to 12 cents per page, to reflect inflationary changes in the labor and
`supply cost components of the formula (4).
`
`Although the new rule has not yet been adopted, we believe that it accurately reflects
`those inflationary changes»
`
`As you are aware, before the effective date of HIPAA, New York State law permitted
`you to charge a fee of up to 75 cents per page for providing photocopies of medical
`records. Our research has revealed no provisions of HiPAA that prevent us from
`offering to pay you a fee greater than 12 cents per page,
`if we request special
`"expedited service".
`
`Accordingly, we are offering to pay you a fee of 75 cents per page (including postage),
`if you send us all of the records that we are requesting within 10 days of the date of this
`letter if you do not send us all of the records that we are requesting within 10 days of
`the date of this letter, we will pay you 12 cents per page, plus the cost of postage, as
`set forth in HIPAA and the proposed federal rule.
`
`Thank you for your courtesy and cooperation in this matter.
`
`Very truly yours,
`
`DANKNER, MlLSTElN, RC.
`
`EPM/ia
`
`lliana Alvarado
`By:
`Iliana Alvarado, Legal Assistant
`
`Name: GIRARDI, ANTHONY
`
`DOB:
`
`,
`
`Date: 07/27/2016
`
`

`

`
`INDEX NO. 61345/2016
`FILED: WESTCHESTER COUNTY CLERK 10/05/2017 04:51 PM
`INDEX \10' “345/2016
` FILED: WESTCHESTER COUNTY CLERK 10w2017 04:51 PM
`
`
`
`
`
`NYSCEF DOC. NO. 63
`RaCaIVaD NYSCEF: 10/05/20 7
`NYSCEF DOC. NO. 63
`RECEIVED NYSCEF: 10/05/2017
`I
`‘ ‘
`I;
`
`
`
`I l I
`
`Name: GlRARDl. ANTHONY
`
`DOB:
`
`Date: 07/27/2016
`
`anaauarwxmmwmmmwmnmflmwmmunwwmnwmnmwmmnMfl—‘W
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`
`
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`
`\
`
`OCA Official Form NIL: 960
`AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA
`[This form has been approved by the New York State Department of Health]
`
`
`7965 Bay . inte Drive, Denver, North Carolina 28037
`
`Patient Name
`
`Author! Girardi
`Patient Address
`
`.
`
`I understand that I may
`
`I, or my authorized representative, request that health information regarding my care and treatment he released as set forth on this form:
`In accordance with New York State Law and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996
`(HIPAA),
`I understand that:
`l. This authorization may include disclosure of information relating to ALCOHOL and DRUG ABUSE, MENTAL HEALTH
`TREATMENT, except psychotherapy notes, and CONFIDENTIAL HIV“ RELATED INFORMATION only if I place my initials on
`the appropriate line in Item 9(a).
`In the event the health information described below includes any of these types of information, and I
`initial the line on the box in Item 9(a), I specifically authorize release of such information to the pcrson(s) indicated in [tan 8.
`2. If I am authorizing the release of HIV~related. alcohol or drug treatment. or mental health treatment information, the recipient is
`prohibited from redisclosing such information without my authorization unless permitted to do so under federal or state law.
`I
`understand that l have the right to request a list of people who may receive or use my HIV-related information without authorization. If
`I experience discrimination because of the release or disclosure of HIV'related information, I may contact the New York State Division
`of Human Rights at (212) 480-2493 or the New York City Commission of Human Rights at (212) 306—7450. These agencies are
`responsible for protecting my rights.
`3.
`i have the right to revoke this authorization at any time by writing to the health care provider listed below.
`revoke this authorization except to the extent that action has already been taken based on this authorization.
`4.
`I understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for
`benefits will not be conditioned upon my authorization of this disclosure.
`5. Infomation disclosed under this authorization might be rcdisclosed by the recipient (except as noted above in Item 2), and this
`redisclosure may no longer be protected by federal or state law.
`.6“ THIS AUTHORIZATION DOES NOT AUTHORIZE YOU TO DISCUSS MY HEALTHINFORMATION OR" MEDICAL
`CARE WITH ANYONE OTHER THAN THE ATTORNEY OR GOVERNMENTAL AGENCY SPECIFIED IN ITEM 9 .
`.
`
`
`7. Name and address of health provider or entity to release this information:
`
`
`Mt. Kisco Medical Group — 110 S Redford Rd, #2, Mt Khoo, NY 10549
`
`
`8. Name and address of person(s) or category of person to whom this information will be sent:
`Dankner Milstein P.C., 41 East 57th Street, 36th FL, New York, New York 10022
`
`
`9(a). Specific information to be released:
`
`to (insert date)
`D Medical Record from (insert date)
`
`.
`« .,
`eept psychotherapy notes), test results, radiology studies, films,
`» ’
`{23 Entire Medical Record, including patient r
`i
`.
`
`referrals, consults billing records, ins
`;
`i ‘ sent to you by other health care providers.
`D Other:
`0 2 2016
`Include: (Indicate by Initialing)
`Alcohol/DrugTreatment
`5'
`HEALTHPORT
`Mental Health Information
`HIV-Related Information
`Authorization to Discuss Health Information
`
`
`
`
`
`
`
`
`
`Initials
`Name of individual health care provider
`to discuss my health information with my attorney, or a governmental agency, listed here:
`
`
`10. Reason for release of information:
`
`
`(b) Cl 8y initialing here
`
`I authorize
`
`CI At request of individual
`El Other: Litigation
`12. If not the patient, name of person signing form:
`
`
`
`One year from signature date
`13 Authority to sign on behalf of patient:
`
`
`
`All items on this form have been completed and my questions about this form have been answered. In addition, I have been provided a
`copy of the form.
`
`Signature of potion
`
`resen tive authorized by law.
`
`' Maw
`
`‘ Human Immunodeficiency Virus that causes AIDS. The New York State Public Health Law protect: information which reasonably could
`identify someone as having HIV symptoms or Infection and information regarding a person's contacts.
`
`

`

`A
`
`0. 61345/20u6
`INDEX NO. 61345/2016
`FILED: WESTCHESTER COUNTY CLERK 10/05/2017 04:51 PM
`
`INDEX
`FILED: WESTCHESTER COUNTY CLERK 10m2017 04:51 PM
`
`
`
`
`NYSCEF DOC. NO. 63
`RfiCfiIVfiD NYSCEF:
`NYSCEF DOC. NO. 63
`RECEIVED NYSCEF: 10/05/2017
`
`10/05/2017
`.nmwmm,mmmwmmmnmm."
`
`KATONAH
`KATONAH OFFICE
`DOB:
`'
`ANTHONY GIRARDI
`Date 0
`Healthcare Professional: DAVID YASGUR MD
`Referring Healthcare Professional: David Yasgur MD
`
`111 BEDFORD ROAD
`
`05236—2115
`
`. 7/22/2015
`
`(914)232-3135
`Patient 10*: 5955399
`
`REASON FOR VISIT:
`OFFICE VISIT, FOLLOWUP SCANS
`
`The patient returns with continued complaints of left knee pain. He has had
`intermittent pain just about once a day, which is a sharp pain with a
`sensation of near buckling, which generally is much better if he wears a knee
`sleeve. He is here now to review the 2 bone scans that were done as the last
`x—ray revealed possible subtle tibial loosening.
`
`On exam, knees without particular change. Still with well—healed incisions.
`Stiffnese is noted with range of motion without change over prior,
`0 to 120 on
`the right,
`5 to 105 on the left.
`
`A 3~phase regional bone scan is reviewed and is noted to have only late
`pooling and isotope uptake in the delayed phase at the medial tibial plateau.
`Possibility of loosening was suggested although not definitive. Labeled white
`blood cell scan is reviewed showing no evidence of infection.
`
`IMPRESSION:
`
`Possible failing left tibial component.
`
`PLAN:
`
`I
`The patient was counseled at length. Since he is moving to North Carolina,
`recommended_that he immediately.connectuwith a orthopedist.down therem,I think
`he should have a followup x-ray in 3 months. If this does prove to be early
`loosening of the tibial component, he should consider revision TKA of the left
`knee. The patient was counseled at great length. Full
`informed consent
`disclosed. Total time spent face—to‘face with this patient was 15 minutes with
`greater than 50% of the time dedicated to discussion of informed consent.
`
`DAVID YASGUR/lZ/lZ/1953/18790454/18790454/0
`Dictated —07/22/2015 22218:22
`Transcribed — 07/23/2015 02:47:42
`58692491/528l9383
`
`Electronically signed by David Yasgur MD on 07/23/2015 10:57 AM
`
`
`
`
`
`
`

`

`
`INDEX NO. 61345/2016
`FILED: WESTCHESTER COUNTY CLERK 10/05/2017 04:51 PM
`FILED: WESTCHESTER COUNTY CLERK 10w2017 04:51 PM
`INDEX VO~ 61345/2016
`
`
`
`
`
`
`NYSCEF DOC. NO. 63
`RaCaIVaD NYSCEF: 10/05/20?7
`NYSCEF DOC. NO. 63
`RECEIVED NYSCEF: 10/05/2017
`li
`
`
`
`MOUNTWMEQIGALGRDUPPC
`aMeningeal“ @WW»
`4%!"le 'WJW
`W
`
`VISIT SUMMARY
`
`ANTHONY GIRARDI
`
`ID: 5955399 DOB.*
`07/22/2015 02215 P
`Visit Type: Office Visit
`
`Thank you for choosing us for your healthcare needs. The following is a summary of the outcome of today's visit
`and other instructions and information we hope you find helpful.
`
`‘
`
`‘.
`.
`
`i
`
`i
`
`i
`
`i E
`
`I E
`
`iii i
`
`E
`
`Reason(s) for Visit:
`bilateral knee scan review.
`
`Assessment/Flaw
`
`
`
`Fish on
`
`Other Health Information:
`Former smoker.
`
`
`
`NO KNOWN DRUG ALLERGIES
`
`Problem List:
`
`History of total lcnee replacement
`11/03/2014
`i
`H
`
`Demographics:
`Sex: Male
`
`Ethnicity: Non—Hispanic
`Preferred Language: English
`This is a visit of 15 minutes.
`
`Sincerely,
`
`.
`
`GIRARDI, ANTHONY 001566023599 -7/22/2015 02:15 PM Page: 1/2
`
`

`

`
`INDEX NO. 61345/2016
`FILED: WESTCHESTER COUNTY CLERK 10/05/2017 04:51 PM
`
`INDEX VO~ “345/2016
`FILED: WESTCHESTER COUNTY CLERK 10w2017 04:51 PM
`
`
`
`
`
`NYSCEF DOC. NO. 63
`RaCaIVaD NYSCEF: 10/05/2017
`
`NYSCEF DOC. NO. 63
`RECEIVED NYSCEF: 10/05/2017
`
`Provider: David Yasgur MD 07/22/2015 02:55 PM
`Document generated by: David Yasgur 07/22/2015
`
`MKMG
`111 Bedford Road
`
`Katonah, NY 10536—2115
`(914)232-3135
`
`GIRARDI, ANTHONY 001566023599 -07/22/2015 02:15 PM Page: 2/2
`
`
`
`mm..9-wmnwmwm
`
`
`
`mm»
`
`,mama‘OMWMVWWmu.mmmm-mu
`
`
`
`

`

`Home phone
`Day phone
`Alternate phone
`
`(914)603-3566
`
`wnmmmmm
`
`
`
`l
`
`
`INDEX NO. 61345/2016
`FILED: WESTCHESTER COUNTY CLERK 10/05/2017 04:51 PM
`INDEX \10' “345/2016
` FILED: WESTCHESTER COUNTY CLERK 10w2017 04:51 PM
`
`
`
`
`
`NYSCEF DOC. NO. 63
`RaCaIVaD NYSCEF: 10/05/20,7
`NYSCEF DOC. NO. 63
`RECEIVED NYSCEF: 10/05/2017
`
`
`
`i§ TELEPHONE MESSAGE
`
`
`
`Patient Name ANTHONY GlRARDI
`Date of Birth
`
`Date of Call
`
`07/21/2015
`
`Spoke with: patient
`Time of call: 3:45 PM
`
`Call taken by: Maureen E. Dubiel
`Contact type: outgoing call
`Call type: outgoing
`
`
`Telephone Contact Detail
`
`
`
`
`
`tam
`
`
`fi.‘
`£111
`1151‘
`My ,5 g r
`r 5‘
`
`
`07/21/2015 3:47 PM
`Maureen E. Dublel
`per DJY - pt notified results are negative for Infection or
`loosening - pt verbalized understanding of above as well
`as he has further questions which he will review with DJY
`tomorrow when sees him for flu appt .
`
`Provider: David Yasgur MD 07/21/2015 03:47 PM
`
`Document generated by: Maureen E. Dubiel
`
`GIRARDI, ANTHONY 001566023599_07/21/2015 03:45 PM Page: 1/1
`
`

`

`
`INDEX NO. 61345/2016
`FILED: WESTCHESTER COUNTY CLERK 10/05/2017 04:51 PM
`FILED: WESTCHESTER COUNTY CLERK 10w2017 04:51 PM
`INDEX VO~ 61345/2016
`
`
`
`
`
`NYSCEF DOC. NO. 63
`RECEIVED NYSCEF: 10/05/2017
`NYSCEF DOC. NO. 63
`RaCaIVaD NYSCEF: 10/05/2OF7
`
`
`
`-
`
`
`MOUNT KISCO MEDICAL GROUP PC
`
`
`.1 my
`‘
`~
`90 SOUTH BEDFORD RD
`Order Status: Results Complete
`MOUNT KISCO, NY 10549-3412
`07/14/2015 4:00 Pm
`
`
`(914) 241-1050
`
`Gender Male
`
`IRARDI, ANTHONY
`Patient ID # 5955399 % Age '
`
`
`SS
`1617 MOGUL DRIVE
`
`
`
`E OHEGAN LAKE, NY 10547 Home Phone
`
`
`Work Phone
`I rdcrln DAVID YASGUR
`
`
`
`
`I rder all PRO9864927
`0 rder Comments
`est Ordered NM BONE SCAN 3 PHASE STUDY OSTEOMYELITIS
`
`
`Date of Service 07/14/2015 2:31 in
`
`RIS Order Accession # 10491727
`
`l
`
`' BONE SCAN 3 PHASE STUDY OSTEOMYELITIS
`
`Result Status: FINAL
`
`Performing Location: MRAD Verified By: Marc Hertz 07/ 14/2015 3:59 pm
`
`Result Date: 07/14/2015 3:59 pm
`Test Status: Complete
`Test Accession #: 10491727
`
`NM BONE SCAN 3 PHASE STUDY OSTEOMYELI’I‘IS
`
`Three-phase pone seem attention lower extremities
`
`Clinical history: previous knee joint replacement.
`
`The patient received bolus administration of 24.0 11101 of technetium 99-MDP.
`Triple phase bone scan was performed. There is prompt uptake of isotope on the
`arterial phase in the left and right lower extremity. Blood pool imaging
`demonstrates symmetric normal isotope uptake surrounding the lefl and right knee
`joint.
`
`Imaging delayed until 3 hours demonstrates asymmetry in uptake of isotope at the
`level of the medial tibial plateau, left knee. There is no other focal area of
`abnormal or asymmetric isotope.
`
`IMPRESSION: Asymmetric isotope uptake only seen in the delayed phase, at the
`medial tibial plateau left knee. This does not represent evidence for
`osteomyelitis. The possibility of loosening is suggested. Correlation with
`symptoms or signs at the level of the medial left tibial plateau recommended.
`
`Electronically Signed in Powerscribe By Dr. Marc Hertz MD on 7/14/2015 3:59 PM
`
`est Performed at MRAD
`
`MKMG RADIOLOGY
`90 SOUTH BEDFORD ROAD
`
`MOUNT KJSCO NY 10549-3412
`
`Ph: (914) 242-4395
`
`Electronically signed by David Yasgur MD 011 07/15/2015 05:59 PM
`
`m-mmwmmw._.._.mmm=maw»,mummmmyummum-am.mumwmwmmkmmmmwwmGWWW—Wumum
`
`kamMmz-s
`
`

`

`
`INDEX NO. 61345/2016
`FILED: WESTCHESTER COUNTY CLERK 10/05/2017 04:51 PM
`
`FILED: WESTCHESTER COUNTY CLERK 10w2017 04:51 PM
`INDEX \10' “345/2016
`
`
`
`
`
`NYSCEF DOC. NO. 63
`RECEIVED NYSCEF: 10/05/2017
`NYSCEF DOC. NO. 63
`RaCaIVaD NYSCEF: 10/05/20?7
`
`MOUNT KISCO NIEDICAL GROUP PC
`
`90 SOUTH BEDFORD RD
`
`Order Status: Results Complete
`
`.
`
`MOUNT KISCO, NY10549~3412
`241-1050
`
`07/17/2015 4:22 Pm
`
`GIRARDI, ANTHONY
`
`Patient 1]) # 5955399
`
`DOB
`
`Age
`
`Gender Male
`
`1617MOGULDRIVE
`
`SSNF -
`
`1 OHEGAN LAKE,NY 10547 Home Phone 914) 603-3566
`Work Phone
`
`est Ordered NM WBC INDIUM SCAN
`
`0 rderin_ DAVID YASGUR
`0 rder # PR09864927
`0 rder Comments
`
`Date of Service 07/17/2015 3:11 in
`
`RIS Order Accession # 10495813
`
`
`
` i ‘ WBC INDIUM SCAN Result Status: FINAL
`
`
`
`Performing Location: MRAD Verified By: John Chen 07/ 17/2015 4:21 pm
`
`Result Date: 07/17/2015 4:21 pm
`Test Status: Complete
`Test Accession #: 10495813
`
`NM WBC INDIUM SCAN
`
`.,.Indiun?-111WBC$csn..,,
`
`History: Lefi knee pain, status post left knee replacement.
`
`Technique: 485 uCi indium-111 antelogous WBC was administered intravenously via
`the right wrist injection. 24 hour delayed imaging ofthe bilateral knee regions
`performed in multiple projections were obtained.
`
`Findings:
`
`Correlation is made with three~phase bone scan 7/14/2015, and bilateral knee
`radiographs 6/25/2015.
`
`There is minimal asymmetric faint uptake around the left knee prosthesis seen
`only on the fijontal View, felt to be of doubtful clinical significance. There is
`certainly no intense uptake.
`
`IMPRESSION:
`
`No significant uptake. No scintigraphic evidence of infection/osteomyelitis.
`
`Electronically Signed in Powerscribe By Dr. John Chen MD on 7/17/2015 4:21 PM
`
`est Perfumed at MRAD
`
`MKMG RADIOLOGY
`90 SOUTH BEDFORD ROAD
`MOUNT KISCO NY 10549-3412
`
`Ph: (914) 242-1395
`
`Electronically signed by David Yasgur MD on 07/21/2015 12:00 PM
`
`WWWW.WWmmemymy.“wugmm.mmmwmwmmwmxw«www-mnmmsmwmmwwrtummymom-"mew“.W-MEWAWWMWWmwvmmum.mmwm~m.mem
`
`

`

`
`INDEX NO. 61345/2016
`FILED: WESTCHESTER COUNTY CLERK 10/05/2017 04:51 PM
`
`FILED: WESTCHESTER COUNTY CLERK 10 @2017 04:51 PM
`INDEX VO~ 61345/20--
`
`
`
`
`
`NYSCEF DOC. NO. 63
`RaCaIVaD NYSCEF: 10/05/20i
`NYSCEF DOC. NO. 63
`RECEIVED NYSCEF: 10/05/2017
`
`90 some women ROAD MOUNT xxsco NY 10549—3412
`some KISCO OFFICE
`nomw
`ANTHONY GXRARDI
`Date 0
`. 6/25/2015
`Healthcare Professional: DAVID YASGUR MD
`Referring Healthcare Professional: David Yasgur MD
`
`(914)241-1050
`patient 191;: 5955399
`
`REASON FOR VISIT:
`OFFICE VISIT, BILATERAL KNEES
`
`The patient returns for re-evaluation of bilateral TKA. He has had trouble
`with the left one recently in terms of swelling,
`tightening and stiffening. He
`wakes up screaming in pain on some days. He used ice for a week at a time,
`which helped tremendously and then he stopped icing.
`
`On exam, right knee with no effusion. Range of motion 0 to 120. Left knee with
`range of motion 5 to 105. No effusion. No laxity. Neutral patellar tracking.
`
`X—rays reveal satisfactory alignment and fixation following bilateral TKA
`without gross loosening.
`
`IMPRESSION:
`
`Status post bilateral TKA.
`
`PEAN:
`
`I recommended nuclear magnetic resonance
`The patient was counseled at length.
`scans worthwhile to assess for subtle lucency about the left knee tibial
`component.
`If he has loosening of the tibial component, he will likely
`require a revision TKA.
`
`,Follownp will be after nuclear medicine scant,"
`
`time spent face—to~face with this patient was 15 minutes with greater
`Total
`than 50% of the time dedicated to discussion of his condition and its
`treatment.
`
`DAVID YASGUR/lZ/12/l953/18790196/18790139/1
`Dictated ~06/26/2015 22:10:13
`Transcribed - 06/27/2015 09:46:08
`58453323/52626231
`
`Electronically signed by David Yasgur MD on 06/29/2015 05:51 PM
`
`
`
`.
`i
`
`
`mmmrfimmmmwmmmmm
`
`

`

`
`INDEX NO. 61345/2016
`FILED: WESTCHESTER COUNTY CLERK 10/05/2017 04:51 PM
`
`FILED: WESTCHESTER COUNTY CLERK 10w2017 04:51 PM
`INDEX VO~ 61345/2016
`
`
`
`
`
`NYSCEF DOC. NO. 63
`RaCaIVaD NYSCEF: 10/05/20?7
`NYSCEF DOC. NO. 63
`RECEIVED NYSCEF: 10/05/2017
`
`
`
`QWMW gm“
`AWJWWWW‘WW
`
`VISIT SUMMARY
`
`ANTHONY GIRARDI
`ID: 5955399 DOB.
`
`06/25/2015 04:00 PM
`Visit Type: Office Visit
`
`Thank you for choosing us for your heaithcare needs. The foilowing is a summary of the outcome of today's visit
`and other instructions and information we hope you find helpful.
`
`Future Appointment Date:
`07/17/2015
`
`Reason(s) for Visit:
`f/u left knee.
`
`” “Assessment/055;“ "
`
`
`
`
`
`
`10,5
`,5
`.
`..
`.pp,
`.
`
`XR KNEE BILATERAL3 V4355
`05/25/2015
`VIEWS
`NM BONE SCAN 3
`PHASE
`STUDY—OSTEOMYELITIS
`NM wac INDIUM
`SCAN
`
`V4355
`
`V4355
`
`06/25/2015
`
`06/25/2015
`
`Other Health Information:
`Former smoker.
`
`Aiiergies:
`
`£15.95.
`NO KNOWN DRUG ALLERGIES
`
`GIRARDI, ANTHONY 001566023599 -06/25/2015 04:00 PM Page: 1/2
`
`,.m...”
`
`
`
`2
`5
`
`g
`;
`i
`
`
`
`

`

`
`INDEX NO. 61345/2016
`FILED: WESTCHESTER COUNTY CLERK 10/05/2017 04:51 PM
`
`FILED: WESTCHESTER COUNTY CLERK 10w2017 04:51 PM
`INDEX VO~ 61345/2016
`
`
`
`
`
`
`NYSCEF DOC. NO. 63
`RaCaIVaD NYSCEF: 10/05/2017
`NYSCEF DOC. NO. 63
`RECEIVED NYSCEF: 10/05/2017
`
`
` .3 $.51
`
`
`11/03/2014
`
`
`Demographics:
`Sex: Male
`
`Ethnicity Non~Hispanic
`Preferred Language: English
`This is a visit of 15 minutes.
`
`Sincerely,
`
`Provider: David Yasgur MD 06/25/2015 05:47 PM
`Document generated by: David Yasgur 06/25/2015
`
`MKMG
`
`90 South Bedford Road
`Mount Kisco, NY 10549~3412
`(914)241-1050
`
`GIRARDI, ANTHONY 001566023599_O6/25/2015 04:00 PM Page: 2/2
`
`Nwmmasmmmwmwwmvm
`
`‘
`'
`‘
`
`mum—«mumw
`
`
`

`

`
`INDEX NO. 61345/2016
`FILED: WESTCHESTER COUNTY CLERK 10/05/2017 04:51 PM
`FILED: WESTCHESTER COUNTY CLERK 10m2017 04:51 PM
`INDEX \IO~ 61345/2016
`
`
`
`
`
`
`3
`R
`NYSCEF DOC. NO.
`6
`aCfiIVaD NYSCEF: 10/05/2017
`NYSCEF DOC. NO. 63
`RECEIVED NYSCEF: 10/05/2017
`
` mwmfimw.._~m.mnm
`
`
`Order Status: Results Complete
`
`05/25/2015 5:53 1"“
`
`
` Gender Male
`
`
`
`MOUNT KISCO NIEDICAL GROUP PC
`90 SOUTH BEDFORD RD
`
`MOUNT KISCO, NY 10549-3412
`
`914 241-1050
`
`
`GIRARDI, ANTHONY
`Patient ID # 5955399 k Age
`SSPP
`1617 MOGUL DRIVE
`
`
`1 OHEGAN LAKE, NY 10547 Home Phone
`Work Phone
`
`
`
`
`
`4) 603-3566
`
`0 rderin DAVID YASGUR
`fi rder # PR09864792
`
`Date of Service 06/25/2015 5:28 In
`
`est Ordered XR KNEE BILATERAL 3 VIEWS
`
`‘
`RIS Order Accession # 10475517
`