FILED
`3/19/2021 2:30 PM
`FELICIA PITRE
`DISTRICT CLERK
`DALLAS CO., TEXAS
`Miranda Lynch DEPUTY
`
`CAUSE NO. DC—l9—06515
`
`PEDRO CEREZO,
`
`IN THE DISTRICT COURT
`
`Plaintiff,
`
`vs.
`
`RODRIGO MIRANDA AND
`
`ADELAIDO MIRANDA,
`
`Defendants.
`
`134TH JUDICIAL DISTRICT
`
`DALLAS COUNTY, TEXAS
`
`DEFENDANT'S RESPONSE TO PLAINTIFF'S MOTION TO STRIKE DEFENDANT'S
`
`COUNTER-AFFIDAVIT PURSUANT TO SECTION 18.001 OF THE TEXAS CIVIL
`
`PRACTICE AND REMEDIES CODE
`
`RODRIGO MIRANDA AND ADELAIDO MIRANDA, hereinafter referred to as
`
`Defendants, files this Response to Plaintiff’s Motion to Strike the Counter-Affidavit of Ryan
`
`Robinson, D.C., CCSP and respectfully shows the Court the following:
`
`Section 18.001 of the Texas Civil Practice and Remedies Code serves as a notice provision
`
`establishing the basis for any dispute as to the reasonableness or necessity of Plaintiffs treatment.
`
`To give proper notice when disclosing a counter—affidavit, defense is guided by the following
`
`instruction under Sec. 18.001(e)(1) for cases filed prior to September 1, 2019:
`
`(e) A party intending to controvert a claim reflected by the affidavit must serve a copy of the
`counteraffidavit on each party or the other party’s attorney of record:
`(1) not later than:
`(A) 30 days after the day the party receives a copy of the affidavit; and
`(B) at least 14 days before the day on which evidence is first presented at the trial
`of the case; or
`
`(2)
`
`with leave of the court, at any time before the commencement of evidence at trial.
`
`Plaintiff contends that because Defendant filed its counter-affidavit well in advance of the
`
`30-day window, this renders Defenant’s counter-affidavit procedurally improper, and it therefore
`
`must be struck because failing to do so would constitute harmful error. Plaintiff does not allege
`
`Cerezo vs. Miranda, et al.
`DEFENDANT’S [ENTER NAME OF MOTION]
`04612655141
`
`PAGE 1
`
`

`

`the counter—affidavit is defective as to substance. However, the language of the statute does not
`
`have any mandatory language as to contravention in advance of disclosure of Plaintiff s affidavits.
`
`The statute simply says Defendant must controvert not later than 30 days after Defendant receives
`
`a copy of Plaintiff‘s affidavits. Here, Plaintiff had notice well in advance of that 30—day minimum
`
`notice required by statute if Defendant controverted August 6, 2019, but Plaintiff did not serve
`
`Defendants with those affidavits until March 10, 2020. Moreover, not only was all of Plaintiff’s
`
`treatment complete prior to the filing date of the counter—affidavit, but also,
`
`the affidavits
`
`themselves pre-date the filing date of the counteraffidavit. The affidavits provided to Defendant
`
`are all dated from the month of June 2019. See Exhibit A with affidavits containing services dates
`
`and charges for services rendered. Therefore, Defendant contends its counter—affidavit is not
`
`procedurally defective and that Plaintiff was helped, not harmed by its disclosure in advance of
`
`the 30-day minimum.
`
`To the extent that Plaintiff’ s counsel argues it has been harmed because Sec.18.001 is a
`
`cost savings statute and that “section 18.001 places a greater burden of proof on counter affidavits
`
`to discourage their misuse in a manner that frustrates the intended savings.” Turner v. Peril, 50
`
`S.W3d 742, 747 (Tex. App. 2001). Defendant completely agrees and understands Plaintiff’s
`
`concerns regard cost-savings. Therefore, Defendant hereby waives the reguirement by
`
`Plaintiff that she provide live testimony to prove up reasonableness of charges or necessig
`
`of treatment in the past from any of the medical providers controverted by the two above-
`
`referenced counter-affidavits. This allows Plaintiff to save costs by no longer being obliged to
`
`call their experts live, and it allows Defendant to still call his experts testify live or through their
`
`depositions on the topics of reasonableness of charges and necessity of treatment within their
`
`specialties. Furthermore, this stipulation removes any argument by Plaintiff” s counsel that there is
`
`a great burden ofproof on Defendant’s counter-affidavits. Therefore, due to this waiver, Defendant
`
`Cerezo vs. Miranda, et al.
`DEFENDANT’S [ENTER NAME OF MOTION]
`04612655141
`
`PAGE 2
`
`

`

`respectfully requests that the Court deny Plaintiff” s Motion to Strike the Counter—Affidavit of Ryan
`
`Robinson, D.C., CCSP.
`
`Respectfully submitted,
`
`SUSAN L. FLORENCE & ASSOCIATES
`
`“Warwick/{fig
`
`
`
`KATE GARDNER
`
`TBN: 24101788
`
`1201 Elm Street, Suite 5050
`
`Dallas, TX 75270
`
`E-SerVice Only: DallasLega1@allstate.com
`(214) 676-8026
`(877) 678-4763 (fax)
`
`ATTORNEY FOR DEFENDANT(S)
`RODRIGO MIRANDA AND ADELAIDO
`
`MIRANDA
`
`Cerezo vs. Miranda, et al.
`DEFENDANT’S [ENTER NAME OF MOTION]
`04612655141
`
`PAGE 3
`
`

`

`CERTIFICATE OF SERVICE
`
`I hereby certify that a true and correct copy of the foregoing has been served in compliance
`
`with Rules 21 and 21a of the Texas Rules of Civil Procedure on the _19_ day of March, 2021,
`
`to:
`
`Larry Rolle
`Rolle Law
`
`2030 Main St Ste 200
`
`Dallas, TX 75201
`
`'WML/gMAQQ
`
`
`
`KATE GARDNER
`
`Cerezo vs. Miranda, et al.
`DEFENDANT’S [ENTER NAME OF MOTION]
`04612655141
`
`PAGE 4
`
`

`

`EXHIBIT “A”
`
`

`

`FILED
`3/9/2020 12:00 AM
`FELICIA PITRE
`DISTRICT CLERK
`DALLAS CO., TEXAS
`Miranda Lynch DEPUTY
`
`DC-19-065 15
`
`§
`§
`
`§
`§
`§
`§
`
`§
`§
`§
`§
`
`IN THE DISTRICT COURT
`
`134m IUDICIAL DISTRICT
`
`DALLAS COUNTY, TEXAS
`
`AFFIDAVIT OF MEDICAL CHARGES
`i
`..
`
`PEDRO CEREZO
`
`vs.
`
`RODRIGO MIRANDA AND
`ADELAIDo MIRAN
`
`STATE or
`
`’1 ,
`
`.1
`
`
`
`COUNTY or 7 7
`
`q
`
`'
`
`.
`
`’ /
`
`Before me, the undersigned authority, personally appeared,
`me duly sworn, deposed and said:
`
`who, being by
`
`I am of sound mind and capable of making this
`.
`"My name is erg; £11.33
`affidavit, and personally acquainted with the facts herein stated.
`
`I am the custodian of records for Texas Healthcare. Attached to this affidavit are records that
`
`provide an itemized statement of the service and the charge for the service that Texas Healthcare
`provided to Pedro Cerezo from (Siam! {7 to 13,5 ”if E
`. The attached records are a part of this
`affidavit
`
`The attached records are kept by Texas Healthcare in the regular course of its business, and it
`was the regular course of business of Texas Healthcare for an employee or representative Of Texas
`Healthcare, with knowledge of the service provided, to make the record or to transmit information to
`be included in the record. The records were made in the regular course of business at or near the time
`or reasonably soon after the time the service was provided. The records are the original or a duplicate
`of the original.
`
`The services provided were necessary and the amount charged for the services was reasonable
`at the time and place that the services were provided.
`
`and the amount currentl unpaid but which
`The amount paid for the services was $ 0
`Texas Healthcare has a right to be paid after any adjustments or credits is $ 33 0g. ‘73 .
`50.
`2.
`/,
`AFFIANT/CUSTODIAN OF RECORDS
`
`SWORN TOAND SUBSCRIBED before me o glue 4 0 day of
`
`
`NOTA
`PUBLIC, STATE OF
`
`
`MY COMMISSION EXPIRES
`
`DEBRA H. HENDRIX
`
`

`

`Balance Inquiry
`
`
`OUR CLIENT:
`
`PROVIDER:
`
`Pedro Cerezo
`
`Texas Healthcare
`
`DATE OF ACCIDENT:
`June 20, 2017
`
`
`TOTAL CHARGES INCURRED:
`
`% -
`
`r‘3‘ 00
`
`PATIENT PAYMENT(S):
`INSURANCE PAYMENT(S):
`MEDICAID/MEDICARE PAYMENT(s]:
`
`AD]U5TMENT(S] [if any):
`
`TOTALBALANCE:
`
`O
`D
`O 7
`
`O
`
`7
`
`.
`
`LI
`
`, of)
`E3.
`
` E
`
`INFORMATION PROVIDED BY:
`
`TODAY'S DATE:
`
`2 OJ C;\ Q {03
`
`Lot (01 / 7
`
`CONTACT NUMBER: M
`_—__..
`
`
`INSURANCE COMPANY:
`
`

`

`
`
`
`
`
`
`Patient Name
`
`Chart No
`
`Service Date CPT
`
`Texas Healthcare-Irving
`800 W. Airport Freeway, Suite 810
`Irving, TX 750626285
`Phone: (972) 812-0020 Fax: (972) 312-0021
`Patient Statement
`
`GAH1 703080
`GAR1 703080
`GAFl1 703080
`GAR1 703080
`GAR1 703080
`GAFH 703080
`GAFl1 703080
`GAH1 703080
`GAR1 703080
`GAR1 703080
`GAR1703080
`GAFH 703080
`GAH1703080
`GAR1 703080
`GAR1703080
`GAFH 703080
`GAFl1 703080
`GAR1703080
`GAR1 703080
`GAR1703080
`GAFH 703080
`GARI 703080
`
`GAR1 703080
`GAH1703080
`GAFH 703080
`GAFH 703080
`GAH1703080
`
`GAFH 703080
`GARt 703080
`
`GAR1 703080
`GAR1 703080
`GAFH 703080
`GAR1 703080
`
`60283
`06/26/2017
`99202
`06/26/2017
`A4456
`06/26/2017
`9701 0
`06/26/2017
`99070
`06/26/2017
`97018
`06/27/2017
`98941
`06/27/2017
`06/27/2017 G0283
`06/27/2017
`97010
`06/28/201 7
`98941
`06/28/2017
`97010
`06/28/2017
`60283
`07/19/2017
`G0283
`07/1 91201 7
`72100
`
`{17/19/2017
`07/19/2017
`07119/2017
`07/24/201 7
`07/24/201 7
`(17/24/2017
`08/21 /2017
`08/21/2017
`08/21/2017
`08/25I2017
`08/25/201 7
`08/25/2017
`08/28/2017
`08/28/2017
`08/28/201 7
`09/01/2017
`(19/01/2017
`09/01/2017
`09/08/201 7
`
`98941
`72040
`72070
`98941
`60283
`97010
`99213
`97012
`98941
`97012
`98941
`97110
`97012
`97110
`98941
`97012
`98941
`97110
`97110
`
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz, Pedro
`
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`CerezoNilchiz. Pedro
`
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo—VilchizI Pedro
`Cerezo—Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Gerezo-Vilchiz, Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`
`Page 1 013
`
`Mod 1 W10 2 Cit—0;:
`(60283) Electrical Muscle Stimulation
`(99202) New Patient Exam Limited
`(A4456) Electrical Pads
`(97010) Ice and/or Heat Pack (applied)
`(99070) Ice Pack (Take Home)
`(97018) Paraffin
`(98941) Chiro Manipulative Treatment 3-4 Regions
`(G0283) Electrical Muscle Stimulation
`(97010) Ice and/or Heat Pack (applied)
`(98941) Chiro Manipulative Treatment 3-4 Regions
`(97010) Ice and/or Heat Pack (applied)
`(G0283) Electrical Muscle Stimulation
`(G0283) Electrical Muscle Stimulation
`
`(72100) Lumbar (2 or 3 views)
`(98941) Chiro Manipulative Treatment 3—4 Regions
`(72040) Cervical (2 or 3 views)
`(72070) Thoracic (2 views)
`(98941) Chiro Manipulative Treatment 3-4 Regions
`(G0283) Electrical Muscle Stimulation
`
`(97010) Ice and/0r Heat Pack (applied)
`(99213) Established PT Fla-Evaluation
`(97012) Intersegmental Traction
`
`(98941) Chiro Manipulative Treatment 3-4 Regions
`
`(97012) lntersegmental Traction
`(98941) Chiro Manipulative Treatment 3-4 Regions
`(971 10) Therapeutic Exercises
`(97012) Intersegmental Traction
`
`(97110) Therapeutic Exercises
`
`(98941) Chiro Manipulative Treatment 3-4 Regions
`(97012) lntersegmental Traction
`(98941) Chiro Manipulative Treatment 3-4 Regions
`(97110) Therapeutic Exercises
`(97110) Therapeutic Exercises
`
`25
`
`GO
`
`GO
`
`GO
`G0
`
`Provider
`
`Nguyen, Nhuyen
`Nguyen, Nhuyen
`Nguyen, Nhuyen
`Nguyen. Nhuyen
`
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`Nguyen, Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`
`Nguyen. Nhuyen
`
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`
`
`
`
`Charge
`55.00
`225.00
`
`26.00
`45.00
`
`1 1 .00
`
`65.00
`105.00
`
`55.00
`45.00
`
`105.00
`45.00
`55.00
`55.00
`220.00
`1 05.00
`205.00
`218.00
`105.00
`55.00
`45.00
`200.00
`55.00
`105.00
`55.00
`105.00
`95.00
`55.00
`
`95.00
`105.00
`55.00
`105.00
`95.00
`95.00
`
`vUnits
`1.00
`1.00
`1 .00
`1.00
`1.00
`
`1.00
`1.00
`
`1.00
`1.00
`
`1.00
`1.00
`1.00
`1.00
`1.00
`1.00
`1.00
`1.00
`1.00
`1.00
`1.00
`1.00
`1.00
`1.00
`
`1.00
`1.00
`1 .00
`1 .00
`1.00
`
`1.00
`1.00
`1.00
`1.00
`1.00
`
`Report Id: C4
`
`Print Date: 12/28/2017 09:16 am
`
`

`

`Texas Healthcare-Irving
`800 w. Airport Freeway, Suite 810
`Irving, TX 750626285
`Phone: {9721312410er Fax: (972) 312-0021
`Patient Statement
`
`cit—an No
`GAR1 703080
`
`GA R1 703080
`GAR1 703080
`GAR1 703080
`
`GAR1 703080
`GAR1703080
`GAR1 703080
`GAR1703080
`GAR1 703080
`GAR1 703080
`GAR1703080
`GAR1 703080
`GAR 1 703080
`GAR1 703080
`GAR1703080
`GAR1 703080
`GAR1 703080
`
`GAH1703080
`GAR1 703080
`GAR1 703080
`GAR1 703030
`GAR1 703080
`GAR1 703080
`GA R1 703080
`GAR1 703080
`GAR1 703080
`GAR1 703080
`GAR1 703080
`GAR1 703030
`GAR1 703080
`GAR1 703080
`GAR1 703080
`
`GAR1 703080
`
`Service Date
`09/08/2017
`09/08/2017
`09/11/2017
`09/11/2017
`
`09/11/2017
`09/15/2017
`09/15/2017
`09/15/2017
`09/18/2017
`09/18/2017
`09/18/2017
`09/22/2017
`09/22/2017
`09/22/2017
`09/25/2017
`09/25/2017
`09/25/2017
`09/29/2017
`09/29/2017
`09/29/2017
`10/02/2017
`10/02/2017
`10/02/2017
`10/06/2017
`
`10/06/2017
`10/06/2017
`10/09/2017
`10/09/2017
`10/09/2017
`10/13/2017
`1 0/13/2017
`10/16/2017
`10/16/2017
`
`CPT
`
`97012
`
`98941
`97012
`98941
`
`97110
`97012
`98941
`97110
`97012
`98940
`97110
`97012
`98940
`97110
`97012
`98940
`97110
`
`98940
`97012
`97110
`98940
`97012
`
`97110
`97012
`97110
`98940
`98940
`97012
`97110
`98940
`97110
`98940
`97110
`
`
`Mod1 M6112 cpt Desc
`
`(97012) lntersegmental Traction
`(98941) Chiro Manipulative Treatment 3-4 Regions
`(97012) lntersegmental Traction
`(98941) Chiro Manipulative Treatment 3-4 Regions
`(97110) Therapeutic Exercises
`(97012) lntersegmental Traction
`(98941) Chiro Manipulative Treatment 3-4 Regions
`(97110) Therapeutic Exercises
`(97012) lntersegmental Traction
`
`(98940) Chiro Manipulative Treatment 1-2 Regions
`(97110) Therapeutic Exercises
`(97012) lntersegmental Traction
`(98940) Chiro Manipulative Treatment 1-2 Regions
`(97110) Therapeutic Exercises
`(97012) lntersegmental Traction
`
`(98940) Chiro Manipulative Treatment 1 -2 Regions
`(97110) Therapeutic Exercises
`(98940) Chiro Manipulative Treatment 1-2 Regions
`(97012) lntersegmental Traction
`(971 10) Therapeutic Exercises
`
`(98940) Chiro Manipulative Treatment 1-2 Regions
`(97012) lntersegmental Traction
`(97110) Therapeutic Exercises
`(97012) lntersegmental Traction
`(97110) Therapeutic Exercises
`
`(98940) Chiro Manipulative Treatment 1—2 Regions
`(98940) Chiro Manipulative Treatment 1-2 Regions
`(97012) lntersegmental Traction
`
`(97110) Therapeutic Exercises
`(98940) Chiro Manipulative Treatment 1-2 Regions
`(97110) Therapeutic Exercises
`(98940) Chiro Manipulative Treatment 1—2 Regions
`(97110) Therapeutic Exercises
`
`GO
`
`GO
`
`GO
`
`GO
`
`GO
`
`GO
`
`GO
`
`GO
`
`GO
`
`GO
`
`GO
`
`Provider
`
`Nguyen, Nhuyen
`Nguyen, Nhuyen
`Nguyen, Nhuyen
`Nguyen, Nhuyen
`
`Nguyen. Nhuyen
`Nguyen, Nhuyen
`Nguyen, Nhuyen
`Nguyen, Nhuyen
`Nguyen, Nhuyen
`Nguyen. Nhuyen
`Nguyen, Nhuyen
`Nguyen, Nhuyen
`Nguyen, Nhuyen
`Nguyen, Nhuyen
`
`Nguyen, Nhuyen
`Nguyen, Nhuyen
`Nguyen, Nhuyen
`Nguyen. Nhuyen
`Nguyen, Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`Nguyen, Nhuyen
`
`Nguyen, Nhuyen
`Nguyen, Nhuyen
`Nguyen, Nhuyen
`Nguyen, Nhuyen
`Nguyen, Nhuyen
`
`Nguyen. Nhuyen
`Nguyen, Nhuyen
`Nguyen, Nhuyen
`Nguyen. Nhuyen
`Nguyen, Nhuyen
`
`Nguyen, Nhuyen
`
`Unlts
`
`
`Charge
`
`1.00
`1.00
`1.00
`1.00
`
`1.00
`1.00
`1.00
`1.00
`1.00
`1.00
`1.00
`1.00
`1.00
`1.00
`
`1.00
`1.00
`1.00
`1.00
`1.00
`1.00
`1.00
`1.00
`
`1.00
`1.00
`100
`1.00
`1.00
`
`1.00
`1.00
`1.00
`2.00
`1.00
`
`2.00
`
`55.00
`105.00
`55.00
`105.00
`
`95.00
`55.00
`105.00
`95.00
`55.00
`95.00
`95.00
`55.00
`95.00
`95.00
`
`55.00
`95.00
`95.00
`95.00
`55.00
`95.00
`95.00
`55.00
`
`95.00
`55.00
`95.00
`95.00
`95.00
`
`55.00
`95.00
`95.00
`190.00
`95.00
`
`190.00
`
`Reporlld: C4
`
`Prlnt Date: 12/28/2017 09:16 am
`
`Patient Name
`
`Cerezo—Vilchiz, Pedro
`
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo—Vilchiz, Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo-Viichiz, Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz. Pedro
`
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo—Vilchiz, Pedro
`Cerezo—Vilchiz, Pedro
`
`Cerezo-Vilchiz, Pedro
`Cerezo—Vilchiz, Pedro
`Cerezo—Vilchiz, Pedro
`Cerezo-Vilchiz, Pedro
`
`Page 2 01 3
`
`

`

`Patlentilame
`
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo—Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz, Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz, Pedro
`
`Cerezo-Vilchiz. Pedro
`Cerezo-Vilchiz. Pedro
`Cerezc-Vilchiz. Pedro
`
`
`
`Chart No
`
`Service Date
`
`CPT
`
`GAR1 703080
`GAR1 703080
`GAR1 703080
`GAR 1 703080
`GAR1 703080
`GAR1 703080
`GAR1703080
`
`GAR1 703080
`GAR1 703080
`GAR1 703080
`GAFH 703080
`GAR1 703080
`
`GAFH 703080
`GAR1703080
`
`GAFI1 703080
`GAFI1 703080
`GAR1703080
`
`10/20/2017
`10/20/2017
`10/23/2017
`10/23/2017
`10/30/2017
`10/30/2017
`11/06/2017
`
`11/08/2017
`11/13/2017
`1 1/13/2017
`11/20/2017
`11/20/2017
`11/27/2017
`11/27/2017
`
`12/11/2017
`12/11/2017
`12/11/2017
`
`97110
`98940
`97110
`
`98940
`97110
`98940
`98940
`97110
`97110
`98940
`97110
`98940
`97110
`98940
`
`99213
`97110
`98940
`
`Texas Healthcare-lrving
`800 W. Airport Freeway, Suite 810
`lrvlng, TX 7506262135
`Phone: (972) 812-0020 Fax: (972) 812-0021
`Patient Statement
`
`
`
`Mod 1 Mod 2 Opt Deec
`GO
`
`GO
`
`GO
`
`GO
`GO
`
`GO
`
`G0
`
`25
`GO
`
`(97110) Therapeutic Exercises
`(98940) Chiro Manipulative Treatment 1-2 Regions
`(97110) Therapeutic Exercises
`(98940) Chiro Manipulative Treatment 1 -2 Regions
`(97110) Therapeutic Exercises
`(98940) Chiro Manipulative Treatment 1-2 Regions
`(98940) Chiro Manipulative Treatment 1-2 Regions
`
`(97110) Therapeutic Exercises
`(97110) Therapeutic Exercises
`(98940) Chiro Manipulative Treatment 1-2 Regions
`
`(97110) Therapeutic Exercises
`(98940) Chiro Manipulative Treatment 1-2 Regions
`(97110) Therapeutic Exercises
`(98940) Chiro Manipulative Treatment 1—2 Regions
`(99213) Established Patient Final Exam
`
`(97110) Therapeutic Exercises
`(98940) Chiro Manipulative Treatment 1-2 Regions
`
`Provider
`
`Units
`
`Nguyen. Nhuyen
`Nguyen, Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`
`Nguyen. Nhuyen
`Nguyen, Nhuyen
`Nguyen. Nhuyen
`
`Nguyen, Nhuyen
`Nguyen. Nhuyen
`Nguyen, Nhuyen
`Nguyen, Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`
`Nguyen. Nhuyen
`Nguyen. Nhuyen
`
`200
`1.00
`2.00
`1.00
`
`2.00
`1.00
`1.00
`
`2.00
`2.00
`1.00
`1.00
`1.00
`2.00
`1.00
`1.00
`2.00
`1.00
`
`Charge
`190.00
`95.00
`
`190.00
`95.00
`190.00
`95.00
`95.00
`190.00
`190.00
`95.00
`95.00
`95.00
`1 90.00
`95.00
`
`200.00
`190.00
`95.00
`
`
`8405.00
`
`Page 3 at 3
`
`Report Id: 04
`
`Print Date: 1212812017 09:16 am
`
`

`

`FILED
`3/9/2020 12:00 AM
`FELICIA PITRE
`DISTRICT CLERK
`DALLAS CO., TEXAS
`Miranda Lynch DEPUTY
`
`IN THE DISTRICT COURT
`
`134T}! JUDICIAL DISTRICT
`
`DALLAS COUNTY, TEXAS
`
`AFFIDAVIT OF MEDICAL CHARGES
`
`DC-19-065 15
`
`§
`§
`
`§
`§
`
`§
`§
`§
`
`§ §
`
`§
`
`PEDRO CEREZO
`
`vs.
`
`RODRIGO MIRANDA AND
`ADELAIDO MIRANDA
`
`STATE OF
`
`Iexas
`
`COUNTY or 7 Dallas
`
`Before me, the undersigned authority, personally appeared, Adriana Ledesma ,, .who, being by
`me duly sworn, deposed and said:
`
`I am of sound mind and capable of making this
`.
`“My name is Adriana Ledesma
`affidavit, and personally acquainted with the facts herein stated.
`
`I am the custodian of records for MRI Centers of Texas. Attached to this affidavit are records
`
`that provide an itemized statement of the service and the charge for the service that MRI Centers of
`Texas provided to Pedro Cerezo from 3/19/2017
`to 8/19/2017 . The attached records are a part of
`this affidavit.
`
`The attached records are kept by MRI Centers of Texas in the regular course of its business,
`and it was the regular course of business of MRI Centers of Texas for an employee or representative of
`MRI Centers of Texas, with knowledge of the service provided, to make the record or to transmit
`information to be included in the record. The records were made in the regular course of business at or
`near the time or reasonably soon after the time the service was provided. The records are the original
`or a duplicate of the original.
`
`The services provided were necessary and the amount charged for the services was reasonable
`at the time and place that the services were provided.
`
`and the amount currently unpaid but which
`_
`The amount paid for the services was $ 0
`MRI Centers of Texas has a right to be paid after any d' m ts or credits is $ 41390-00 ,,-
`
`
` AFFIANT UST IAN OF RECORDS
`
`
`SWORN TO AND SUBSCRIBED before me on the 12th
`
`
`
`da of June 20E
`
` ,
`m—
`
`NINA A. sum
`Notary Public. State of Texas
`‘ Comm. Expires‘os-M-Zozo
`Notary lD 130700473
`
`__
`NOTARY PUBLIC, STATE 0F_T_exa_s___
`
`

`

`Balance Inquiry
`
`
`OUR CLIENT:
`
`PROVIDER:
`
`Pedro Cerezo
`
`MRI Centers of Texas
`
`DATE OF ACCIDENT:
`June 20, 2017
`
`
`TOTAL CHARGES INCURRED:
`
`$439000
`
`PATIENT PAYMENT(S):
`
`INSURANCE PAYMENT[3):
`
`MEDICAID/MEDICARE PAYMENT(S]:
`
`ADJUSTMENT(S] (if any]:
`
`0
`
`0
`
`0
`
`0 7
`
`7
`
`TOTAL BALANCE:
`$439000
`
`
`INFORMATION PROVIDED BY:
`
`Adriana Ledesma
`
`TODAY’S DATE:
`
`CONTACT NUMBER:
`
`June 12: 2019
`
`972/498/19533
`
`INSURANCE COMPANY:
`
`N/A
`
`

`

`Patient Ledger - MRI Centers of Texas
`Patient: CEREZO-VILCHIZ, PEDRO
`
`CEREZO-VILCHIZ, PEDRO
`218 N FOREST CREST
`
`GARLAND, TX 75042
`Phone: 2148748542
`Acct: CERPEOOO
`
`MRI CENTERS OF TEXAS, LLC
`_ PRESTON SERIES
`PO. BOX 224852
`
`DALLAS, TX 75222 4852
`9724981963
`
`Date
`
`Code
`
`Description
`
`Provider
`
`Amount Running Bal
`
`08/19/2017
`08/19/2017
`
`72141
`72148
`
`Cervical MRI W/O Contrast
`Lumbar MRI W/O Contrast
`
`2195.00
`2195.00
`
`2,195.00
`4,390.00
`
`4,390.00
`
`06/12/19 4:14 PM
`
`1/1
`
`

`

`FILED
`3/9/2020 12:00 AM
`FELICIA PITRE
`DISTRICT CLERK
`DALLAS CO., TEXAS
`Miranda Lynch DEPUTY
`
`IN THE DISTRICT COURT
`
`134m JUDICIAL DISTRICT
`
`DALLAS COUNTY, TEXAS
`
`AFFIDAVIT or MEDICAL CHARGES
`
`' mg r6»
`‘
`la
`
`w
`54/? ho, being by
`
`DC- 19-065 1 5
`
`§
`
`§
`
`§
`
`§
`
`§
`
`§
`
`§
`
`§ §
`
`§
`
`PEDRO CEREZO
`
`vs.
`
`RODRIGO MIRANDA AND
`
`ADELAIDO MIRANDA
`
`STATE OF 7 TLXCTS ,
`
`,
`
`COUNTYOF
`
`i l] “[43
`
`Before me, the undersigned authority, personally appeared,
`me duly sworn, deposed and said:
`./"—
`
`"My name is
`
`i
`
`l L! I3!, [£5 KQCI '63 I am of sound mind and capable of making this
`
`affidavit, and personally acquainted with the facts herein stated.
`
`I am the custodian of records for Momentum Spine and Joint. Attached to this affidavit are
`records that provide an itemized statement of the ser ice and the cha go for the service that Momentum
`Spine and Joint provided to Pedro Cerezo from lOIQQJZDW to ii 2
`Di] The attached records are
`
`a part of this affidavit.
`
`The attached-records are kept by Momentum Spine and Joint in the regular course of its
`business, and it was the regular course of business of Momentum Spine and Joint for an employee or
`representative of Momentum Spine and Joint, with knowledge of the service provided, to make the
`record or to transmit information to be included in the record. The records were made in the regular
`course of business at or near the time or reasonably soon after the time the service was provided. The
`records are the original or a duplicate of the original.
`
`The services provided were necessary and the amount charged for the services was reasonable
`at the time and place that the services were provided.
`and the amount currently unpaid but which
`The amount paid for the services was $ (1)
`Momentum Spine and Joint has a right to be paid Wstments or credits is $ H; \D [54‘ X3
`
`
`SWORN TO AND SUBSCRIBED before me on the rl
`
`day of , QM , 20 l
`
`
`NOTARY PU
`
`
`
`
`
`

`

`Balance Inquiry
`
`
`OUR CLIENT:
`
`PROVIDER:
`
`Pedro Cerezo
`
`Momentum Spine and Joint
`
`DATE OF ACCIDENT:
`Iune 20, 2017
`
`
`TOTAL CHARGES INCURRED:
`
`\
`
`ll
`
`[[13 .
`
`PATIENT PAYMENT[S):
`
`INSURANCE PAYMENT(S):
`
`MEDICAID /MEDICARE PAYMENT(S):
`
`ADJUSTMENT(S) (if any):
`
`
`65
`
`£25
`
`
`03
`
`(23
`
`TOTAL BALANCE:
`
`$H,(07'S;Q_D_
`
`
`INFORMATION PROVIDED BY:
`
`TODAY'S DATE:
`
`CONTACT NUMBER:
`
`INSURANCE COMPANY:
`
`Inn/wig thles:
`
`001112019
`
`ZIH- 951;Jim I
`
`
`

`

`(2‘ {v131m:‘2‘5%)}!,U{‘4
`
`'
`
`,
`
`Please mail payment directly to:
`
`PO BOX 46123 HOUSTON, TX 77210—4603
`
`MOMENTUMSPINE&JOINT
`
`T: (214) 557-4111 | F: (972) 972-8660
`
`Date:06/10/2019
`
`ITEMZED STATED/IENT
`
`Patient Name: CEREZO— VILCHIZ, PEDRO
`
`DOB: 07/01/1971
`
`DATE OF SEWCE [0/09/2017, [0/31/20I7, [108/2017
`
`CODE
`
`DESCRIPTION
`
`99204
`
`ORTHO OFFICE CONSULTATION
`
`62321-C
`
`CHlVICAL E31 1 LEVEL
`
`01992
`
`99214
`
`ANESTHESIA
`
`ORTHO OFFICE FOLLOW-UP
`
`DATE
`
`10/09/2017
`
`10/31/2017
`
`10/31/2017
`
`1 1/28I‘2017
`
`QTY
`
`AMOUNT
`
`1
`
`1
`
`1
`
`1
`
`$ 1 ,250.00
`
`$8,525.00
`
`$1,000.00
`
`$900.00
`
`TOTAL AMOUNT OF INVOICE:
`
`$11,675.00
`
`For billing inquires please email, Billing@nmmntmmpine.com
`
`

`

`FILED
`3/9/2020 12:00 AM
`FELICIA PITRE
`DISTRICT CLERK
`DALLAS CO., TEXAS
`Miranda Lynch DEPUTY
`
`PEDRO CEREzo
`
`vs.
`
`RODRIGO MIRANDA AND
`
`ADELAIDO MIRANDA
`
`STATE 0F
`
`3 12)! AS
`
`COUNTY 0F
`
`‘
`1? r
`
`DC-19-065 15
`
`§
`
`§
`§
`§
`§
`
`§
`§
`§
`§
`§
`
`IN THE DISTRICT COURT
`
`134TI-I IUDICIAL DISTRICT
`
`DALLAS COUNTY, TEXAS
`
`AFFIDAVIT OF MEDICAL CHARGES
`
`Before me, the undersigned authority, personally appeared,
`me duly sworn, deposed and said:
`
`who, being by
`
`
`I am of sound mind and capable of making this
`
`"My name is
`
`EmEa {gigE:
`
`.
`
`affidavit, and personally acquainte with the facts herein stated.
`
`I am the custodian of records for Salient Radiology Associates. Attached to this affidavit are
`records that provide an itemized statement of the service and the charge for the service that Salient
`Radiology Associates provided to Pedro Cerezo from
`Jail? to 9.14.! l
`. The attached
`records are a part of this affidavit
`
`The attached records are kept by Salient Radiology Associates in the regular course of its
`business, and it was the regular course of business of Salient Radiology Associates for an employee or
`representative of Salient Radiology Associates, with knowledge of the service provided, to make the
`record or to transmit information to be included in the record. The records were made in the regular
`course of business at or near the time or reasonably soon after the time the service was provided. The
`records are the original or a duplicate of the original.
`
`The services provided were necessary and the amount charged for the services was reasonable
`at the time and place that the services were provided.
`
`and the amount currently unpaid but which
`JG
`The amount paid for the services was $
`Salient Radiology Associates has a right to be paid after any adjustments or credits is $ QED 00::
`.
`[Al/Llama) (2%
`
`AFFIANT/CUSTO AN OF RECORDS
`
`SWORN To AND SUBSCRIBED before me on the
`
`H! j day of4L 20fl
`
` NOTARY PUBLIC TATE C
`
`
`
`

`

`Balance Inquiry
`
`
`OUR CLIENT:
`
`PROVIDER:
`
`Pedro Cerezo
`
`Salient Radiology Associates
`
`DATE OF ACCIDENT:
`June 20, 2017
`
`
`TOTAL CHARGES INCURRED: ma __
`
`PATIENT PAYMENT[S]:
`
`‘U/
`
`INSURANCE PAYMENT(S):
`
`_J1—_____
`
`MEDICAID/MEDICARE PAYMENT(S):
`_i7;______~
`ADIUSTMENT[S) [if any): L __
`
`_ __ __
`$? 291; ‘3’
`TOTAL BALANCE:
`
`
`INFORMATION PROVIDED BY:
`
`TODAY’S DATE:
`
`CONTACT NUMBER:
`
`INSURANCE COMPANY:
`
`N?_~\\’ WL— _ __ __
`
`
`
`

`

`is Salient Radiology
`
`Bill To:
`
`CEREZO— VILCHIZ, PEDRO
`218 N FOREST CREST,
`GARLAND, TEXAS 75042
`
`INVOICE
`
`:
`06/11/2019
`Patient Account #: 04951 Paynbnt Due:
`
`Make (heck Payalie and Renit to:
`
`Salient Radiology Associates
`PO Box 66430
`Houston, TX 77266
`
`Professional Radiology Service Bill Summary
`*Facility component is billed separately.
`
`Date of Service
`
`Description
`
`Clmges
`
`Crecfits
`
`Patient Balance
`
`08/19/2017
`
`72141 MRI CERVICAL SPINE
`
`08/19/2017
`
`72148 MRI LUMBAR SPINE
`
`$625.00
`
`$625.00
`
`$625.00
`
`$625.00
`
`Account Gin-rent Balance:
`
`$1,250.00
`
`Please make all checks payable to Salient Radiology Associates
`
`Thank you for your business!
`
`Should you have any inquiries concerning this statement, please contact 832-930-4181
`
`P.O. Box 66430, Houston, TX 77266
`
`Tel: 832-930-4181 Fax: 832—615-0881 E—mail: Billing@SalientRadiology.com
`
`

`

`Automated Certificate of eService
`This automated certificate of service was created by the efiling system.
`The filer served this document via email generated by the efiling system
`on the date and to the persons listed below. The rules governing
`certificates of service have not changed. Filers must still provide a
`certificate of service that complies with all applicable rules.
`
`Kate Gardner on behalf of Kate Gardner
`
`Bar No. 24101788
`kate.gardner@allstate.com
`Envelope ID: 51648353
`Status as of 3/19/2021 3:18 PM CST
`
`Associated Case Party: PEDRO CEREZO
`
` Lawrence F. Rolle
`
`larryr@rbrl.com 3/19/2021 2:30:05 PM SENT
`
`17212600
`
`Associated Case Party: RODRIGO MIRANDA
`
`
`
`Kate Gardner- DallasLegal@allstate.com 3/19/2021 2:30:05 PM SENT
`
`Case Contacts
`
`ANGELA CONEJO
`
`angela.conejo@dallascounty.org
`
`3/19/2021 2:30:05 PM SENT
`
` —- fly@dallascourts.org
`
`Claudia Jackson
`
`claudiaj@rbrl.com
`
`3/19/2021 2:30:05 PM SENT
`3/19/2021 2:30:05 PM SENT
`
`