COUNSEL FOR SANDRA YVONNE BROWN IN THE UNITED …

Susan C. Mathews State Bar No. 05060650 Baker, Donelson, Bearman, Caldwell & Berkowitz, P.C. 1301 McKinney, Suite 3700 Houston, Texas 77010 Telephone: (713) 650-9700 Facsimile: (713) 650-9701 Email: [email protected] COUNSEL FOR SANDRA YVONNE BROWN

RESPONSE TO TORT CLAIMANT’S TRUSTEE’S OBJECTION Page 1 of 4 TO CLAIM OF SANDRA YVONNE BROWN 4830-7577-2330v1 9990010-ADM001 10/18/2019

IN THE UNITED STATES BANKRUPTCY COURT FOR THE NORTHERN DISTRICT OF TEXAS

DALLAS DIVISION

In re: 4 WEST HOLDINGS, INC., et al. Reorganized Debtors.

§ § § § §

Case No. 18-30777 (HDH)

(Jointly Administered)

RESPONSE TO TORT CLAIMANT TRUSTEE’S OBJECTION

TO CLAIM OF SANDRA YVONNE BROWN

Sandra Yvonne Brown (“Brown”) files her Response to the Objection to Claim of Sandra

Yvonne Brown (Doc. No. 1672), filed by Millenia Claims Management, LLC, as Trustee for the

4 West Tort Claimants Trust (“Trustee”), and respectfully states as follows:

1. On March 6, 2018 (the "Petition Date"), each of the Debtors filed a voluntary

petition for bankruptcy relief under Chapter 11 of Title 11 of the United States Code (the

"Bankruptcy Code").

2. Debtors' plan and confirmation order [Doc. Nos. 615, 1314, 1361 and 1386]

provided for the establishment of the Tort Claimants Trust, which was settled pursuant to the

Tort Claimants Trust Agreement between the Debtors and its affiliates (as settlors) and the

Trustee.

3. On or about March 15, 2018, Brown filed a lawsuit in the Circuit Court of the

Thirteenth Judicial District in Shelby County, Tennessee against Poplar Oaks Rehabilitation and

Case 18-30777-hdh11 Doc 1785 Filed 10/18/19 Entered 10/18/19 18:50:32 Page 1 of 4


Healthcare Center, LLC; New Ark Investments, Inc.; Orianna Holding Company, LLC; and

Orianna Health Systems, LLC as Cause No. CT-001205-18 in an unknown amount (the

"Claim"). A copy of the Complaint outlining Brown's Claim is attached hereto as Exhibit "1"

and incorporated herein. The Claim asserts an unsecured claim for negligence.

4. On or about September 18, 2019, Millenia Claims Management, LLC, as Trustee

for the 4 West Tort Claimants Trust (“Trustee”) filed the Objection to Claim of Sandra Yvonne

Brown.

5. Brown's Claim is brought pursuant to Tennessee law. As specifically enumerated

in the Complaint, Brown complied with the provisions of Tenn. Code Ann. § 29-26-121(a) by

properly serving Debtor with written notice of its negligence claim at least sixty (60) days before

filing the Complaint. Copies of the affidavit of service and written notices were attached to the

Complaint as Exhibit A. Further, Brown fully complied with the provisions of Tenn. Code Ann.

§ 29-26-122 by filing a Certificate of Good Faith in the Tennessee action. A copy of which is

attached as Exhibit "2" and incorporated herein.

6. Procedurally, the Trustee’s objection does not comply with L.B.R. 3007-1 of the

Local Rules of the United States Bankruptcy Court for the Northern District of Texas.

Specifically, it may not be filed on “negative notice.”

7. Substantively, the Trustee's objection misinterprets the requirements under

Tennessee law (the state law which governs the allegations alleged in the Complaint and the

basis of the Claim). Brown's Complaint is in full compliance with the statutory requirements of

Tennessee; and therefore, Brown has a valid negligence claim against Debtors' estate and

Brown's Claim should be allowed, after it is liquidated.



WHEREFORE, Sandra Yvonne Brown respectfully requests that the Court deny the

Millenia Claims Management, LLC's (as Trustee for the 4 West Tort Claimants Trust) Objection

to Claim of Sandra Yvonne Brown (Doc. No. 1672), and grant Brown such other, additional and

further relief as the Court deems appropriate under the circumstances.

RESPECTFULLY SUBMITTED this 18th day of October 2019.

BAKER DONELSON BEARMAN, CALDWELL, & BERKOWITZ, P.C. By: /s/ Susan C. Mathews SUSAN C. MATHEWS State Bar No. 05060650) 1301 McKinney Street, Suite 3700 Houston, Texas 77010 Telephone: 713-650-9700 Facsimile: 713-650-9701 Email: [email protected] Attorneys for Sandra Yvonne Brown



CERTIFICATE OF SERVICE

The undersigned hereby certifies that on the 18th day of October 2019, she caused a true

and correct copy of the foregoing document to be served via the Court’s CM/ECF Notification

system on the parties who have so subscribed and via first class mail upon the parties listed

below.

/s/ Susan C. Mathews Susan C. Mathews Counsel for Movant Dante M. Skourello 2002 N. Lois Avenue Suite 610 Tampa, FL 33607 U.S. Trustee United States Trustee 1100 Commerce Street Room 976 Dallas, TX 75202


EXHIBIT 1

Case 18-30777-hdh11 Doc 1785-1 Filed 10/18/19 Entered 10/18/19 18:50:32 Page 1 of 75

IN THE CIRCUIT COURT OF TENNESSEE FOR THETHIRTIETH JUDICIAL DISTRICT AT MEMPHIS, SHELBY COUNTY

SANDRA YVONNE BROWN,

Plaintiff,

V.

POPLAR OAKS REHABILITATION ANDHEALTHCARE CENTER, LLC, NEW ARKINVESTMENTS, INC., ORIANNA HOLDINGCOMPANY, LLC, ORIANNA HEALTHSYSTEMS, LLC, and DANA NASH, M.D.,and.

Defendants.

DIV.DOCKET NO. CT- (.0 049 s- -18JURY DEMANDED

I i if

COMPLAINT FOR HEALTH CARE LIABILITY

Plaintiff Sandra Yvonne Brown brings this action against the Defendants Poplar OaksRehabilitation and Healthcare Center, LLC, New Ark Investments, Inc., Orianna HoldingCompany, LLC, Orianna Health Systems, LLC, and Dana Nash, M.D. For her cause of action,Plaintiff asserts the following:

PARTIES AND VENUE

1. At all times relevant to this Complaint, Plaintiff Sandra Brown was a resident and citizenof Memphis, Shelby County, Tennessee.

2. Ms. Brown received care and treatment at Poplar Oaks Rehabilitation and HealthcareCenter beginning from November 11, 2016 to November 22, 2016.


3. Defendant Poplar Oaks Rehabilitation and Healthcare Center, LLC ("Poplar Oaks") is anactive Tennessee corporation licensed to and doing business in Shelby County, Tennesseein January of 2016.

4. Poplar Oaks can be served with process upon its registered agent for service of processCorporation Service Company, 2908 Poston Avenue Nashville, Tennessee 37203-1312.

5. Poplar Oaks provided professional healthcare services to Ms. Brown through its agents,servants, and/or employees.

6. Defendant New Ark Investments, Inc. ("New Ark") is an active Tennessee corporationlicensed to and doing business in Shelby County, Tennessee in January of 2016.

7. New Ark can be served with process upon its registered agent for service of processCorporation Service Company, 2908 Poston Avenue Nashville, Tennessee 37203-1312.

8. Upon information and belief, New Ark owns and/or operates Poplar Oaks.

9. New Ark provided professional healthcare services to Ms. Brown through its agents,

servants, and/or employees.

10. Defendant Orianna Holding Company, LLC is an active Tennessee corporation licensed toand doing business in Shelby County, Tennessee in January of 2016.

1 1. Orianna Holding Company, LLC can be served with process upon its registered agent forservice of process Corporation Service Company, 2908 Poston Avenue, Nashville,

Tennessee 37203-1312.

12. Upon information and belief, Orianna Holding Company, LLC owns and/or operates

Poplar Oaks.

13. Orianna Holding Company, LLC provided professional healthcare services to Ms. Brownthrough its agents, servants, and/or employees.


14. Defendant Orianna Health Systems, LLC is an active Tennessee corporation licensed to

and doing business in Shelby County, Tennessee in January of 2016.

15. Orianna Health Systems, LLC can be served with process upon its registered agent for

service of process Corporation Service Company, 2908 Poston Avenue Nashville,

Tennessee 37203-1312.

16. Upon information and belief, Orianna Health Systems, LLC owns and/or operates Poplar

Oaks.

17, Orianna Health Systems, LLC provided professional healthcare services to Ms. Brown

through its agents, servants, and/or employees.

18. Defendant Dana Nash, M.D. is an adult resident of Shelby County, Tennessee and can be

served with service of process at 490 W. Poplar Avenue, Collierville, Tennessee 38017-

2538.

19. Dr. Nash provided professional medical services to Ms. Brown from November 11, 2016

to November 22, 2016.

20. Dr. Nash was acting as an employee, servant, or agent (ostensible, apparent, or otherwise)

of Poplar Oaks when she provided medical services to Ms. Brown.

21. This cause of action arises in tort and as a result of injuries and damages proximately

caused in Memphis, Shelby County, Tennessee by the negligence of the Defendants.

22. This is a proper venue to assert Plaintiffs' claims against Defendant.

23. This Court has jurisdiction over the parties and the subject matter involved.

COMPLIANCE WITH TENN CODE ANN. 29-26-121.

24. Plaintiffs fully complied with the provisions of Tenn. Code Ann. § 29-26-121(a) by

properly serving Defendant with written notice of this claim at least sixty (60) days before


filing this complaint.

25. Copies of the affidavit of service and written notices are attached as Exhibit A.

26. Plaintiffs fully complied with the provisions of Tenn. Code Ann. § 29-26-122 by filing a

Certificate of Good Faith ("Certificate") simultaneously with the filing of this complaint.

27. Plaintiff's Certificate is also attached as Exhibit B.

28. This cause of action was properly commenced within the time required by law.

FACTUAL SUMMARY

29. Ms. Brown was admitted to Poplar Oaks on November 11, 2016.

30. Dr. Nash was the attending physician.

31. When Ms. Brown was admitted to Poplar Oaks on November 11, 2016, the agents and

employees of Poplar Oaks, including Dr. Nash, knew Ms. Brown had a diagnosis of

diabetes mellitus type 2.

32. When Ms. Brown was admitted to Poplar Oaks on November 11, 2016, the agents and

employees of Poplar Oaks, including Dr. Nash, knew or should have known that Ms.

Brown took or needed to take, or needed to be given insulin.

33. Poplar Oaks agents and/or employees created a Care Plan for Ms. Brown.

34. That Care Plan included both an acknowledgement that Ms. Brown was at risk for

hyper/hypoglycemia and a plan that Plaintiff be watched for signs or symptoms of

hyper/hypoglycemia.

35. The Care Plan did not include giving Plaintiff insulin.

36. Dr. Nash never ordered insulin for Ms. Brown.

37. Dr. Nash never ordered that Ms. Brown's blood glucose level be regularly checked and

documented.


38. On November 15, 2016, Plaintiff's serum glucose level was measured at 336, which is

abnormal.

39. No action was taken as a result of that abnormal serum glucose level.

40. During her stay at Poplar Oaks, Mrs. Brown's glucose levels were not being regularly

monitored and recorded.

41. At no time during her stay at Poplar Oaks was Mrs. Brown given insulin or another

medication to address her diagnosis of diabetes mellitus type 2.

42. Ms. Brown suffered a mental status change on November 22, 2016.

43. Mrs. Brown was transferred to Methodist North.

44. At the hospital, Ms. Brown's glucose level was 1472.

45. Plaintiff's diagnoses on admission included hyperglycemia hyperosmolar syndrome,

hyperkalemia, hypernatremia, and acute kidney injury.

46. She remained hospitalized until November 5, 2016, when she was transferred to an

outside facility for further care.

COUNT I - NEGLIGENCE

47. During Ms. Brown's stay at Poplar Oaks, Poplar Oaks, New Ark, Orianna Holdings, and

Orianna Health (the "Nursing Home defendants") owed a duty to provide professional

health care services to her in accordance with the recognized standard of acceptable

professional practice in the Memphis, Shelby County, Tennessee, and similar

communities.

48. The Nursing Home defendants acted with less than and/or failed to act with ordinary and

reasonable care in accordance with the recognized standard of acceptable professional

practice in the care and treatment provided to Ms. Brown.


49. The employees, servants, and agents of the Nursing Home defendants committed one or

more of the following acts of negligence and breach of duty, all pled in the alternative, and

each and every such act being a direct and proximate cause of the Ms. Brown's harms and

losses:

a. Negligently failed to assess or evaluate her upon admission;

b. Negligently failed to prepare the care plan for Ms. Brown;

c. Negligently failed to follow the care plan prepared for Ms. Brown;

d. Negligently failed to regularly check and document Ms. Brown's blood glucose

levels;

e. Negligently failed to provide medically necessary treatment and/or medication to

Ms. Brown;

f. Negligently failed to recognize signs and symptoms of hyperglycemia or other

conditions;

g. Negligently failed to provide Ms. Brown with necessary medical treatment or

interventions; and

h. Otherwise deviated from the recognized standard of acceptable professional

practice.

50. The Nursing Home defendants are vicariously liable for the acts and/or omissions of all its

employees, servants and agents (actual and/or apparent), including Dr. Nash, and every

member of its nursing and other staff who provided care and treatment to Ms. Brown.

51. During Ms. Brown's stay at Poplar Oaks, Dr. Nash owed a duty to provide professional

services to her in accordance with the recognized standard of acceptable professional

practice in the Memphis, Shelby County, Tennessee, and similar communities.


52. Dr. Nash acted with less than and/or failed to act with ordinary and reasonable care in

accordance with the recognized standard of acceptable professional practice in the care

and treatment provided to Ms. Brown.

53. Dr. Nash committed one or more of the following acts of negligence and breach of duty,

all pled in the alternative, each and every such act being a direct and proximate cause of

the Ms. Brown's harms and losses:

a. Negligently failed to assess or evaluate her upon admission;

b. Negligently failed to prepare the care plan for Ms. Brown;

c. Negligently failed to order the administration of insulin or other necessary

medications for Ms. Brown; Negligently failed to order the regular evaluation and

documentation Ms. Brown's blood glucose levels;

d. Negligently failed to provide or order necessary medical treatment or

interventions; and

e. Otherwise deviated from the recognized standard of acceptable professional

practice.

54. Ms. Brown suffered injuries which would not have otherwise occurred as a proximate

result of the negligent acts and omissions of the Defendants.

55. As a direct and proximate cause of the Defendants' negligence, Ms. Brown is entitled to

recover damages including, but not limited to, the following specific items of damage:

a. The mental and physical pain and suffering actually endured by Ms.

Brown;

b. Past and future medical expenses necessitated by the Defendant's

negligence;


i

c. Other out of pocket expenses incurred as a result of Defendants' negligence;

d. Other damages allowed by law.

WHEREFORE, Plaintiff sues the Defendant for the following:

1. Compensatory damages in an amount to be determined by the jury;

2. Costs herein;

3. Trial by jury; and

4. For all such other and further relief, general and specific, legal and equitable, to

which the Plaintiff is entitled.


Respectfully submitted,

MORGAN & MORGAN — MEMPHIS, LLC

Chad I5. Graddy (TNBPR No. 23196)One Commerce Square, Suite 2600Memphis, Tennessee 38103(901) 217-7000 -- telephone(901) 333-1897 — facsimile


NITED STATES

POSTAL SERVICE

Name and Address of Sender

Chad D. Graddy, Esq.

Morgan & Morgan - M

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One Commerce Square, Suite 2

600

Memphis, TN 38103

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MOQC-A MC.tne/t) 62SUITE 2600

ONE COMMERCE SQUAREMEMPHIS. TN 38103(901) 217.7000

FAX: (901) 333.1897

November 2, 2017

CERTIFIED MAIL — RETURN RECEIPT REDUESTEIIIIIll,itjii

* TN 7 36 9 t

Methodist Healthcare Memphis Hospitals1265 Union AvenueMemphis, TN 38104-3415

RE: Patient: Sandra Yvonne BrownNotice Required by T.C.A. § 29-26-121(a)

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I am the attorney representing Sandra Yvonne Brown. Through me and my firm, SandraYvonne Brown is asserting potential claims for medical malpractice against MethodistHealthcare Memphis Hospitals. This claim arises out of care provided by employees and/oragents of Methodist Healthcare Memphis Hospitals to your patient Sandra Yvonne Brown.

The full name and date of birth of the patient is:

Sandra Yvonne BrownDate of Birth: March 2, 1950

The name and address of the claimant authorizing this notice and relationship to thepatient are:

Sandra Yvonne Brown, patient3088 LynchburgMemphis, TN 38134

The name and address of the attorney sending this notice are:

Chad D. GraddyMorgan & Morgan Memphis, 1,LCOne Commerce Square40 S. Main, Suite 2600Memphis, TN 38103

Enclosed herein is a list of the names and addresses of all providers being sent a notice,

wwwforthepeople.ComA-LANTk GA * a;RANGHANI SchVoNG GREEN KY • COLUMBUS GA • DAYTONA BEACH FL • OELAND FL • F1 MYERS FL • JACKSON. MS • JACKSONVILLEKis.Sa.r.IEE FL • LAKELAND. FL • LEXtIGTCP: KY • LOUISVILLE KY • MELBOURNE. FL ♦ MEMPHIS TN • MOSti.E. AL • NAPLES. FL • NASHVILLE. NEw YORK. rORLANDO Ft. • pAOkiCA.4, KY + PENSACOLA Ft. • PLANTA':ON FL • PRESTONSBURG. KY • ST ALIGuSTINE, FL • ST PETERSBURG. FL • S.40.30 1-A. FLSAUANNAH GA • TALLAHASSEE. FL • TAMPA. FL • TAVARES FL • WEST PALM BEACH. FL ♦ WIrITER HAVEN. FL


Methodist Healthcare Memphis HospitalsNovember 2,2017Page 2

Enclosed is a HIPAA compliant medical authorization permitting Methodist HealthcareMemphis Hospitals to obtain complete medical records from each other provider being sent anotice.

Please forward this correspondence to the appropriate individual at your company arid/orto your professional liability insurance carrier and/or legal counsel. Please ask a representativeof the professional liability insurance carrier, and/or legal counsel, to contact me.

Sincerely,

MORGAN 43: MORGAN — MEMPHIS, LLC

Chad U. Graddy, Esq

CDG/sawEnclosures


LIST OF HEALTHCARE PROVIDERS TO WHOM NOTICE IS BEING GIVENPURSUANT TO T.C.A. § 29-26-121(A)

RE: Patient: Sandra Yvonne Brown

Below is a list of all healthcare providers to whom notice is being given, pursuant T.C.A. § 29-26-121(a), of a potential claim for medical malpractice:

1. Methodist Healthcare Memphis Hospitals1265 Union AvenueMemphis, TN 38104-3415

Methodist Healthcare Memphis Hospitalsc/o Monica Washington, Registered Agent121 1 Union Avenue, Ste. 700Memphis. TN 38104-6600

3. Oluwatoyin Jimmy Agbaosi. MD1300 Wesley DriveMemphis, TN 38116

4. Oluwatoyin Jimmy Agbaosi, MD1264 Wesley Drive, Ste. 601Memphis, TN 38116

5. Poplar Oaks Rehabilitation and Healthcare Center, LLC490 W. Poplar AvenueCollierville, TN 38017-2538

6. Poplar Oaks Rehabilitation and Healthcare Center, LLCclo Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312

7. Poplar Oaks Rehabilitation and Healthcare Center, LLC1001 Hawkins StreetNashville, TN 37203-4758

8. Orianna Health Systems, LLC1001 Hawkins StreetNashville, TN 37203-4758

9. Orianna Health Systems, LLCc/o Corporation Service Company, Registered Agent2908 Poston Avenue


Nashville, TN 37203-1312

1 0, Orianna Holding Company, LLC1001 Hawkins StreetNashville, TN 37203-4758

1 1. Orianna Holding Company, LLCc/o Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312

12. New Ark Investment, Inc.1001 Hawkins StreetNashville, TN 37203-4758

1 3. New Ark Investment, Inc.do Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312

14. Dana Nash, M.D.490 West Poplar AvenueCollierville, TN 38017-2538

1 5. Dana Nash, M.D.Allenbrooke Nursing and Rehabilitation

3933 Allenbrooke CoveMemphis, TN 381 18


Section A; This section must be completed for all Authorizations

Patient;Sandra Yvonne Brown

Birth Date;

March 2, 1950

Social Security No. (optional):

413-88-1209

Provider's Name:

*See below

Recipient's Name;

Methodist Healthcare Memphis Hospitals_

Provider's/Health Plan's Address;*Pursuant to 45 CFR 164.508(c){1)(11), thoseindividuals identified in the attached list ofproviders are authorized to release completecopies of their medical records.

Address 1: 1265 Union Avenue

Address 2:

City: MemphisState: Zip:

TN 38104.3415

This authorization will expire on the following: (Fill In the Date or the Event but not both.)Date: 11-02-2018 Event:

Purpose of disclosure; COMPLIANCE WITH T,C.A. § 79.26-171

Description of Information to be used or d sclosed

Is this request for psychotherapy notes? Yes, then this is ti-e only Item you may request on this authorization, You rn.st submit

another authorization for other Items below. X No, then you may check as many Items below as you need,

Description: Date(s): Description: Date(s) Description: Date(s)

EX All PHI In medicalrecord

ci Admission form0 Dictation reports0 Physician orders0 Intake/outtakeCI Clinical TestCI Medication Sheets

Q Operative Information0 Cath tabCI Special testitnerapyCl Rhythm StepsCl Nursing Information0 Transfer forms

0 ER Information

0 Labor/delivery sum,C3 06 nursing assesscl Postpartum flow sheet0 Itemized bill:Cl UB 92:Cl Other: all diaglostic (Urns,

x-rays, MR1s, CAT scans,

etc.Cl Other;

I acknowledge, and hereby consent to such, that he released Information may contain alcohol, drug abuse, psychiatric, HIV testing, HIVresults or AIDS Information. (Initial) Ir not apptcable, check here, d(

1 understand that:1. I may refuse to sign this authorization and that It Is strictly voluntary.2, If do not sign this form, my health care and the payment for my health care will not be affected unless stated otherwise.3. 1 may revoke this authorization at any time in writing, but If I do, It will not have any affect on any actions taken prior to

receiving the revocation. Further details may be found In the Notice of Privacy Practices.4. if the requester or receiver Is not a health plan or health care provider, the released Information may no longer be protected by

federal privacy regulations and maybe redisclosed.S. I understand that I my attorney will receive copies of all records received through this authorization.6, I, through my attorney, will get a copy of this form after I sign it,

section B; The pumose of the release of my recordsAlT(HORIYATION DOES NOT

is for review by not applicable fcc vd-:.ch I am granting my authortsaton. TiusMEDICAL EROVIDER OR THEIRPEBMI'( YOU TO OISCUSITHESE MATTERS WITH 14Y

REPRESENTATIVES OUTSIDE THE PRESENCE OF MY ATTORNEYS. You may furnish Uis law firma Bates-numbered copy(5) days aRer the records

by this office.

of this

NA medical recasts oiabln rsuant to this authorization shall be copied by their office andChael ID. Ora y, within five

'mud:, that are requestedshall be famished to my court*am obtained through the use

authorization.

Section C: atures'-. .----

auth I f t tested healt2ItgformatIon as stated,_..t.

lure or pane n e

Cl cird, ,)j) ,-/Patlept/Plan Mem er epresentative:. Date:

10',;21e- 1tiPrint Name of Patient/Plan Member's ReprESeatative:

_ ......

Relatluship to Pattent/Plan Member:self

Revised 3/2003





2.


Methodist Healthcare Memphis Hospitalsc/o Monica Washington, Registered Agent121 1 Union Avenue, Ste. 700Memphis, TN 38104-6600

3. Oluwatoyin Jimmy Agbaosi, MD1300 Wesley DriveMemphis, TN 381 16

Oluwatoyin Jimmy Agbaosi, MD1264 Wesley Drive, Ste. 601Memphis, TN 38116


6. Poplar Oaks Rehabilitation and Healthcare Center, LLCcfo Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312



9. Orianna Health Systems, LLCclo Corporation Service Company, Registered Agent2908 Poston Avenue



10. Orianna Holding Company, LLC1001 Hawkins StreetNashville, TN 37203-4758

1 1. Orianna Holding Company, 1_,LCc/o Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312


1 3. New Ark Investment, Inc.c/o Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312


1 5. Dana Nash, M.D.cio Allenbrooke Nursing and Rehabilitation3933 Allenbrooke CoveMemphis, TN 38118


MOQGAN7017-) Cl!

SUITE 2600ONE COMMERCE SQUARE

MEMPHIS, TN 381031901) 217-7000

FAX (901) 333-1897

November 2, 2017

CERTIFIED MAIL— RETURN RECEIPT REQUESTED1111111111111111N11111[1* TN 7 3 6 9 0 7 1

Methodist Healthcare Memphis Hospitalsc/o Monica Wharton, Registered Agent1211 Union Avenue, Ste. 700Memphis, TN 38104-6600


Dear Sir or Madam:

CERTIFIED .MAOPEC

Domestic Mail Only

Far delivery information, visit ourNvebsite at

wwrif.usps.core.• e

rri Gerbil-(d 1,.. Ise

I-1 -).' rl S

In

la Services & Fees (chack to4 adaltutirT4ite)

fiatum Friccalpt (1-itudeoPY,

Tj

to 1 Raturn ReCtipl (CIECUOT.1) $

0 i 0 Gsitfitxl t.iait Res041*ININere $ --_....f.:..._

ED 0 mutt Signature Requved 5 ...------1 :

0 Adt.11 Signature Res*Ictad 0..... ..Lnr S ___........-I-L-•!:

No I.$:, 4 ' 1 _. ____ , •ED IPostage ,...% ------ --- ' —

rl TAB! Poo aele Ad Fees

S t - 1 I 1r,- Serq 0r—i (.4 NSF- ilea-Ware iiiillACVQN Piefiiri. Apt7F,6.: Vi Is 4 fj '''' ' ''''''

211 tkot (,Y N. Sk 700bii.. 5i . ir. tTp+:4,. ' ' -

t. '-' — - ' " '"•

Dili (De- .(..). •`Reverieloi lestri

V

I am the attorney representing Sandra Yvonne Brown. Through me and my firm, SandraYvonne Brown is asserting potential claims for medical malpractice against MethodistHealthcare Memphis Hospitals. This claim arises out of care provided by employees and/oragents of Methodist Healthcare Memphis Hospitals to your patient Sandra Yvonne Brown.






Chad D. GraddyMorgan & Morgan - Memphis, LLCOne Commerce Square40 S. Main, Suite 2600Memphis, TN 38103

www.forthepeopie.com

PostmarkHere 1

•-

0 fV1441(C

ATLANTA, GA 4. R;RMINGRANI. AL ♦ BOWLING GREEN KY 4 COLUMBUS. GA 4 DAYTONA BEACH. FL 4 DELAND, FL. 4 FT MYERS FL 4 JACKSON. MS S JACKSDA12-FKISSIMMEE. Ft. • LAKELAND. FL 4 LEXINGTON. KY 4 LOUISVILLE KY 4 MELBOURNE. FL t MEMPHIS, TN * MOW. FI AL 4 NAPLES. FL 4 FIASHVILLE. TR * NEI/ YORK. N?

OFIL.37100. FL * PADLICAH KY • PENSAGGIA FL 4 PLANTATION FL 4 PRESTONSBURG KY * ST AuGusi-T,E. FL * ST PETERSBURG. FL • SARASOTA. FLSNANNAH GA t TALLAHASSEE. FL 4 TAMPA, FL 4 TAVARES FL 4 WEST PALM BEACti. FL 4 NTER HAVEN. FL


Methodist Healthcare Memphis HospitalsNovember 2, 2017Page 2

Enclosed herein is a list of the names and addresses of all providers being sent a notice.

Enclosed is a HEPAA compliant medical authorization permitting Methodist HealthcareMemphis Hospitals to obtain complete medical records from each other provider being sent anotice.

Please forward this correspondence to the appropriate individual at your company and/orto your professional liability insurance carrier and/or legal counsel. Please ask a representativeof the professional liability insurance carrier, and/or legal counsel, to contact me.

Sincerely,

MORGAN & MORCAN — MEMPHIS, LLC

Chad D. Graddy, Esquire

CDG/sawEnclosures






2. Methodist I lealthcare Memphis Hospitalsc/o Monica Washington, Registered Agent1211 Union Avenue, Ste. 700Memphis, TN 38104-6600




6. Poplar Oaks Rehabilitation and Healthcare Center, LLCCo Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312







Orianna 1-bolding Company, LLCc/o Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312


11 New Ark Investment, Inc.c/o Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312


15. Dana Nash, M.D.c/o Allenbrooke Nursing and Rehabilitation3933 Allenbrooke CoveMemphis, TN 38118


•AZigaillil.-

Section A: This section must be completed for all Authorizations

.1101

Patient:Sandra Yvonne Brown

Birth Date:

March 2, 1950

Soda! Security NO. (optional):413-88-1209

Provider's Name:

*See belowRecipient's Name:

Methodist Healthcare Memphis Hospitals

Provider's/Health Plan's Address:*Pursuant to 45 CFR 164.508(c)(1){ii), thoseindividuals identified in the attached list ofproviders are authorized to release completecopies of their medical records.

Address l! c/o Monica Wharton, Registered Agent

Address 2: 1211 Union Avenue, Ste. 700


TN 38104-6600

This authorization will expire on the following: (Fill in the Date or the Event but not both.)

Date: 11-02-2018 Event:

Purpose of disclosure: COMPLIANCE WITH T.C.A. § 29-26-121

Description of information to be used or cfsclosed

Is this request fur psychotherapy notes? Yes then this is the only item you may request on Vas authorization. You must submit

another authorization for other Items below. X No, then you may check as many items beow as you need,


CX All PHI In medicalrecord

Si Admission form0 Dictation reports0 Physician Orders0 Intake/outtakeC1 Clinical Test0 Medication Sheets

0 Operative informationq Cath tabCI Special test/therapy0 Rhythm Stl4pS0 Nursing Informal:on0 Transfer forms

CI ER Information

D Labor/delivery sum.0 OB nursing assess0 Postpartum flow sheetq Itemized bill:0 U8 92:0 Other: all d agnostic films,

x-rays, Milts, CAT scans,etc.0 Other:

1 acknowledge, and hereby consent to such, that the released Information may contain alcohol, drug abuse, psychiatric, HIV testing, thy

results or AIDS Information. (initial) If not applicable, check here. C?(

1 understand that:1. I may refuse to sign this authorization and that It Is strictly voluntary.

2. If do not sign this form, my health care and the payment for my health care will not be affected unless stated otherwise.3. I may revoke this authorization at any time in writing, but If I do, it will not have any affect on any actions taken prior to

receiving the revocation, Further details may be fOund in the Notice of Privacy Practices,

4. If the requester or receiver is not a health plan or health care provider, the released Information may no longer be protected byfederal privacy regulations and maybe redisciosed.

5. I understand that I my attorney will receive copies of all records received through this authorization,6, I, through my attorney, will get a copy of this form after I sign it.

Section 0:The purpose of the release of my records is for rev'ew byALPIEOREIATION DOES Nor PEWIT_ YOU

not applicable for wtech I are granting my authortzation. THisMEDICAL PROVIDER OR THEIRTO_DISCSISS THESE MATTERS WITH ANY

REPRISENTATIVES OUTSIDE ME pEESENCE OF MYATTORNEYS. You may furnish th:s law Arm records that are requested Ly des ofece.a Bates-numbered copy shall be furnished to my counsel,(5) days after the records are obtained through the use d' this

Xi medicaIrecotettobben rsuant to this authorlzaton shall be copied by their °Mee andcnaa u. Ura y, t-sq. within Ave

authertzabon.

Section C• atures,..--- ----

t' .

g°41a13 I f t elected health i . lion as stated.

ture Or Patle n e

' CI 0.4--,6- S

G /Patient/Plan Mem er epresentative:_ Date:

--J1g- P71-0,--2---.

10Print Name of Patient/Pan Member's Reprosensative: Relatupship to Patient/Plan Member:

self

Revised 3/2003




Below is a list of all healthcare providers to whom notice is being given, pursuant T.C.A, § 29-26-121(a), of a potential claim for medical malpractice:

1 Methodist Healthcare Memphis Hospitals1265 Union AvenueMemphis, TN 38104-3415

2. Methodist Healthcare Memphis Hospitalsc/o Monica Washington, Registered Agent121 1 Union Avenue, Ste. 700Memphis, TN 38104-6600

3. Oluwatoyin Jimmy Agbaosi, MI)1300 Wesley DriveMemphis, TN 381 16



6. Poplar Oaks Rehabilitation and Healthcare Center, LI.,Ccio Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312

7 Poplar Oaks Rehabilitation and Healthcare Center, LLC1001 Hawkins StreetNashville, TN 37203-4758


9. Orianna Health Systems, LLCcio Corporation Service Company, Registered Agent2908 Poston Avenue




I I. Orianna Holding Company, LLCc/o Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312




1 5. Dana Nash, M.D.e/o Allenbrooke Nursing and Rehabilitation3933 Allenbrooke CoveMemphis, TN 38118


MOQGN

CERTIFIED MAIL — RETURNIlls 911

Oluwatoyin Jimmy Agbaosi, M.D.1300 Wesley DriveMemphis, TN 38116

cn MCeltNe», '

SUITE 2600ONE COMMERCE SQUAREMEMPHIS, TN 38103

(901) 217-7000

FAX: (901) 3334897

November 2, 2017

RECEIPT REQUESTEL

RE: Patient: Sandra Yvonne BrownNotice Required by T.C.A. § 29-26121(a)

Dear Sir or Madam:

ru,..na

1-9

ti

O

to

ci

Nr4

N

' o r delivery Information; idsIt our website'er www.usOicome. 1

certified Mail Fee

C Services & Fees (crag: box, eed rturn riefisipt rhardtCpy) $ „_ '

Orin Reraiira (elacti4n1c) S

°Certified Mail Flostritted Deivrery 5 ' .."°Adult Signature RaguVed

°Adult Signature Asslricted Delivery S _

!Postage

1:1'sta •PostaR 11 Foes

IS,e/1176

';,•;?6 kr,rfo baosi , M

traetand t.

'21W I 63 Ur" 3614 tofits

I am the attorney representing Sandra Yvonne Brown. Through me and my firm, SandraYvonne Brown is asserting potential claims for medical malpractice against Oluwatoyin JimmyAgbaosi, M.D. This claim arises out of care provided by you to your patient Sandra YvonneBrown.






Chad D. GraddyMorgan & Morgan Memphis, LLCOne Commerce Square40 S. Main, Suite 2600Memphis, TN 38103


www.forthepeople.comA7(,,.,;(FA, GA • BIRMINGHAM A, • 1:304'/UNO GREEN. KY * COLUMBUS, GA • DAYTONA BEACH. FL • DELANO, FL • FT. MYERS FL • JACKSON. MS • JACKSONVILLE FLo:(....i.S4,11,IEE, FL • LAKELAND, FL • LEXINGTON. KY • LOUISVILLE KY • MELBOURNE. FL • MEMPHIS. TN • MOBILE. AL • NAPLES. FL • NASHVILLE. TN • NEW YORK NV

GBLA!i100. FL • PADUCAH. KY 4 PENSACOLA. FL • PL4ITAWN FL • PRESTONSBURG. KY # ST AUGUSTINE FL • ST PETERSBURG, cL • $,s.aASOrts. PLSAVANNAH. GA • TALLAHASSEE. FL + TAMPA FL # 'AVARES. FL 4, VEST PALM BEACH P„, • WINTER HAVEN. FL


Oluwatoyin Jimmy Agbaosi, M.D.November 2, 2017Page 2

Enclosed is a HIPAA compliant medical authorization permitting Dr. Agbaosi to obtaincomplete medical records from each other provider being sent a notice.

Please forward this correspondence to the appropriate individual at your company and/orto your professional liability ins►ranee carrier and/or legal counsel. Please ask a representativeof the professional liability insurance carrier, and/or legal counsel, to contact me.

Sincerely,



CDG/sawEnclosures



RE; Patient: Sandra Yvonne Brown

Below is a list of all healthcare providers to whom notice is being given, pursuant T,C.A. § 29-26-121(a), of a potential claim for medical malpractice:


2. Methodist Healthcare Memphis Hospitalsc/o Monica Washington, Registered Agent1211 Union Avenue, Ste. 700Memphis, TN 38104-6600

3. Oluwatoyin Jimmy Agbaosi, MD1300 Wesley DriveMemphis, TN 38116


5. Poplar Oaks Rehabilitation and I lealthcare Center, LLC490 W. Poplar AvenueCollierville, TN 38017-2538

6. Poplar Oaks Rehabilitation and Healthcare Center, LLCdo Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312







1 1. Orianna Holding Company, LLCdo Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312

1 2. New Ark Investment, Inc.1001 Hawkins StreetNashville, TN 37203-4758

1 3. New Ark Investment, Inc.cio Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312


1 5. Dana Nash, M.D.c/a Allenbrooke Nursing and Rehabilitation3933 Allenbrooke CoveMemphis, TN 381 18


4



Birth Date:

March 2, 1950

Social Security NO. (optional):

413-88.1209

Provider's Name:

*See below

Recipient's Name:

Oluwatoyin Jimmy Agbaosi, MD

Provider's/Health Plan's Address:Pursuant to 45 CFR 164.508(0(1R, those

individuals identified in the attached list ofproviders are authorized to release completecopies of their medical records.

Address 1; 1300 Wesley Drive

Address 2;

City: MemphisState: zip:

TN 38116

This authorization wild expire on the follow:rig: (Fih in the Date or the Event but not both.)Date: 11-02-2018 Event:

Purpose of disdosure: COMPLIANCE WITH T.C.A. § 29-26-121

Description of information to be used or dsclosed

Is this request for psychotherapy notes"? ___Yes then this Is the only Item you may request on th's authorization. You must submt

another authorization for othe Items below. X No, then you may check as maw Items below as you need,


CX All PHI in medicalrecord

a Admission form0 Dictation reports0 Physician ordersCI Intake/outtake0 anical Test0 Medicaton Sheets

0 Operative Information0 Cath labCl Special test/therapy0 Rhythm Str'pSCI Nursing Information0 Transfer formsa ER Informabon

0 Labor/delivery sum.0 08 nursing assess0 Postpartum flow sheet0 Itemized bill:0 UB 92:0 Other: all clacmost.t films

x-rays, MR1s, CAT scans,etc.0 Other:

I acknowledge, and hereby consent to such, that the released Information may contain alcohol, drug abuse, psychiatric, NW testing, HIVresults or AIDS Information. (initial) If not applicable, check here. 1214

1 understand that:1. I may refuse to sign this authorization and that it is strictly voluntary.2. If do not sign this form, my health care and the payment for my health care will not be affected unless stated otherwise.3. I may revoke this authorization at any time In writing, but If I do, It will not have any affect on any actions taken prior to

receiving the revocation. Further details may be found in the Notice of Privacy Practices.4. If the requester or receiver Is not a health plan or health care provider, the released Information may no longer be protected by

federal privacy regulations and maybe redisciosed.5, I understand that I my attorney will receive copies of all records received through this authorization.6. I, through my attorney, will get a copy of this form after I sign It.

' Section 8:The purpose of the release of my reoxds Is for relew byAUTHORIZATION DOES NO TPERMIX Y.QU

flat aPPilcable for v,Nch I am granting my authorbation. gusMEDICAL PROYID_ER OR TH_EIRTO DISCUSS THESE MATTERS WITH ANY

REPReSENT6TIYES OUISIOEJJIE PRESENCE OF MY A' You may furnish tfis law Aml records that are requested by tt: °free.and a Bates-numbered copy shall be furnished to my counsel,(5) days after the records are obtained through the use cf tills

M medicalrecotdsdatitin • • • Isuant to this authorization shall be copied by their °freeChad U. ura. i y, Esq. within rue

aultertzation. .,

5.ection C: 5 tures'N6̀

I f t otected healtt_llgfor-rnatton as stated.

'. • tore or Patl n e

....› a oird_ -6----6

/Patient/Plan Mem er (representative:_ Date:

10 rlIQ-d - iit) ,-.Print Name of Patient/Plan Member's Representative: Relationship to Patient/Plan Member:

self

Revised 3/2003




Below is a list of all healthcare providers to whom notice is being given, pursuant T.C.A. § 29-26-12 i (a), of a potential claim for medical malpractice:


Methodist Healthcare Memphis Hospitalsc/o Monica Washington, Registered Agent1211 Union Avenue, Ste. 700Memphis, TN 38104-6600


4. Oluwatoyin Jimmy Agbaosi, MD1264 Wesley Drive, Ste. 601Memphis, TN 381 16

Poplar Oaks Rehabilitation and I lealthcare Center, LLC490 W. Poplar AvenueCollierville, TN 38017-2538

6. Poplar Oaks Rehabilitation and Healthcare Center, LLCc10 Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312

7 Poplar Oaks Rehabilitation and Ilealthcare Center, LLC1001 Hawkins StreetNashville, TN 37203-4758








13. New Ark Investment, Inc.do Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312


1 5. Dana Nash, M.D.cio Allenbrooke Nursing and Rehabilitation3933 Allenbrooke CoveMemphis, TN 38118


Oluwatoyin Jimmy Agbaosi, M.D.November 2, 2017Page 2

Enclosed is a H1PAA compliant medical authorization permitting Dr. Agbaosi to obtaincomplete medical records from each other provider being sent a notice.


Sincerely,


)//)ki/


CDGisawEnclosures


vOQC-A

ONE COMMERCE SQUARE Untitled Mai Restricted DOW, S

MEMPHIS, TN 38103 Signature Required $(901) 217.7000

FAX: (001) (101) 3:33.1997 lF . ;

November 2, 2017

rr

CS MOM

rq S-Eit!fa ,,ervices F' ees Ida p

Fitcetpt tharticertilSUITE 2600

(:) •.rn Receipt .;elecotool S

CERTIEJE.D MAIL(' RECEIPTDomestic Mail Only ,• •

FM' delivery information, visit our webs ite•at www.us. -,00rno:•

0 &gnature Restricted Der .itiey S

"Fcsluzo

r•-•

CERTIFIED MAIL —RETURN RECEIPT REDUESTEI1111111111i11111111111i111111111111111

T N 7 3 6 9 0 7 1 *

Oluwatoyin Jimmy Agbaosi, M.D.1264 Wesley Drive, Ste. 601Memphis, TN 38116


Dear Sir or Madam:

..-art,had MOiI Fee

Toots oslagpQnd Fees

S SJritTo

u kA)Ck+D t.rri riNra(6 oz k 61.%R at and Apt N or

512 LP' -2iP+ - - ‘../

t S I sg1

baQS.I OIU Sic. 6701

I am the attorney representing Sandra Yvonne Brown. Through me and my firm, SandraYvonne Brown is asserting potential claims for medical malpractice against Oluwatoyin JimmyAgbaosi, M.D. This claim arises out of care provided by you to your patient Sandra YvonneBrown.






Chad D. GraddyMorgan & Morgan — Memphis, LLCOne Commerce Square40 S. Main, Suite 2600Memphis, TN 38103


www.farthepeopie.cornATLXITA. GA ♦ BIRMINGHAM AL + 60V/LING GREEN, KY ♦ COLUMBUS GA • DAYTONA BEACH. FL • DELAND FL O FT MYERS. FL ♦ JACKSON. MS • JACK.SOF PRLLE FLKISSIMMEE FL • LAKELAND FL ♦ LEXINGTON. KY • LOuisvi_LE. KY • MELBOURNE FL It MEMPHIS: TN • MOBILE. AL • NAPLES. FL • NASHVILLE. TN • NEW YORK NY

ORLANDO FL • PADUCAH. KY • PENSACOLA. FL • PLANTATION. FL • PRESTONSBURG KY • ST. AUGUSTINE. FL • ST. PETERSBURG FL • SARASOnt. FLSAVANNAH GA • TALLAHASSEE FL • TAMPA. FL • TAVARES. FL • )85ST PALM BEACH, FL + WINTER HAVEN. FL


LIST OF HEALTHCARE PROVIDERS TO WHOM NOTICE IS BEING GIVENPURSUANT TO T.C.A. § 29-26-12I(A)




2. Methodist Healthcare Memphis HospitalsOo Monica Washington, Registered Agent1211 Union Avenue, Ste. 700Memphis, TN 38104-6600




6. Poplar Oaks Rehabilitation and Healthcare Center, LLCc/o Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312






1 0. Orianna Holding Company. LLC1001 Hawkins StreetNashville, TN 37203-4758



13. New Ark Investment, Inc.c/o Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312


15. Dana Nash, M.D.clo Allenbrooke Nursing and Rehabilitation3933 Allenbrooke CoveMemphis, TN 38118




Birth Date:

March 2, 1950

Social Security NO. (optional):413-88-1209

Provider's Name:

*See below

Recipient's Name:

Oluwatoyin Jimmy Agbaosi, MD

Provider's/Health Plan's Address:*Pursuant to 45 CFR 164.508(c)(1}(ii), thoseindividuals identified in the attached list ofproviders are authorized to release complete

copies of their medical records.

Address 1: 1264 Wesley Drive, Ste. 601

Address 2:


TN 38116

This authorization will expire on the following; (Fill in the Date or the Event but not both.)

Date: 11-02.2018 Event;

Purpose of disclosure: COMPLIANCE WITH T.C.A. § 29.26-121

Description of Information to be used or disclosed

is this request for psychotherapy notes? Yes then this Is the only Item you may request on this authorization. You nvJst submit



CX Ali PHI In medicalrecord

CI Admission form0 Dictation reportsO Physician ordersCI IntakefouttakeO Clinical Test0 Medication Sheets

01 Operative informationCI Cath lab0 Spedal test/therapyD Rhythm Steps0 Nursing Information0 Transfer forms0 ER Information

C labor/del very sum.0 08 nursing assessCI Postpartum flow sheet0 Itemized bill:0 U8.92:0 Other: all diaglost'c films,

X-rays, MR1s, CAT scans,etc.

Ci Other:

I acknowledge, and hereby consent to such, that he released Information may contain alcohol, d ug abuse, psychiatric, HIV testing, HIV

results or AIDS information. (nItial) tr not appi cable, check here. 1:1

I understand that:S. I may refuse to sign this authorization and that it is str'ctly voluntary.

2. If do not sign this form, my health care and the payment for my health care will not be affected unless stated otherwise.

3. I may revoke this authorization at any time in writing, but If I do, it will not have any affect on any actions taken prior to

receiving the revocation. Further details may be found In the Notice of Privacy Practices.

4. If the requester or receiver Is note health plan or health care provider, the released Information may no longer be protected byfederal privacy regulations and maybe redisclosed.

5. 1 understand that 1 my attorney wilt receive copies of all records received through this authorization.6. 1, through my attorney, will get a copy of this form after I sign It.

Section B:The purpose of the release ct my reoards Is for review by nOt aPPliCatple for virkil I am granting my autorizaton. IHIS

AUTHORIZATION DOES NOT PERMIT YOU TO QJSCUSS THESE MATTERS WITH ANY MEDICAL PRO_VIDER OR THEIR,REPRESENTATIVES OUTSIDE THE PRESENCE OF MY ATTORNEYS, You may fumIsh MI.% law firm records that are reqt sted by this °free_

Al medical recoMsoban ursuant to this authorization shall be coped by their onice and a Dates-numbered copy shall be furnished to my counsel,Laid U. tlfa y, t sq. , within ftve (5) days after the records em obta'ned through die use no tits

authorization.

Section C: atures-----

I f t otected health 0er-illation as stated.

00,04

ture Or Pad n e Plan /Patient/ Mem er Representative:

./...> 0 0,4--.4.- prtle),-3,.

Date:

.1Q.ID ';? - iriPrint (lame of Patient/Plan Member's Represzatative: Relatlopship to Patient/Plan Member;

self

Revised 3/2003






2. Methodist Healthcare Memphis Hospitalscto Monica Washington, Registered Agent121 1 Union Avenue, Ste. 700Memphis, TN 38104-6600




6. Poplar Oaks Rehabilitation and Healthcare Center, LLCcio Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312







1 1. Orianna Holding Company, LLCc/o Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 3 7203 -1312


1 3. New Ark Investment, Inc.cto Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312


15. Dana Nash, M.D.Allenbrooke Nursing and Rehabilitation

3933 Allenbrooke CoveMemphis, TN 38118


MOQGIV\ MOI1=IM 7;ertpild

CA-It Rep s 2'SUITE 2600

ONE COMMERCE SQUAREMEMPHIS, TN 38103(901) 217-7000

FAX: (901) 333-1897

November 2, 2017

O

a Services & Fees (check txu. add S1eunkcPY)

Ko.1 ,11 Ree.*I (I/fact/so/40 Oen?Sae A1aA I.c.ste,s, 3 Nweri 5El 'Asher SIcytn, I• s0 ASO Signals, r!, :coave.y

C.1 Postage

rz) $,Tota

rg

CERTIFIED MAIL — RETURN RECEIPT REQUESTED r-1119111)ImutitjupTill'

Poplar Oaks Rehabilitation and Healthcare Center, LLC490 W. Poplar Ave.Collierville, TN 38017-2538


Dear Sir or Madam:

T

s apeHate)t: ,v,lf1•?

Fk";11'00tk

3100Ai nd Peesg to.rr alie-S hat) f,

Silo and Apt. 'if0 it) •'

Psfiiiniso00A'

I am the attorney representing Sandra Yvonne Brown. Through me and my firm, SandraYvonne Brown is asserting potential claims for medical malpractice against Poplar OaksRehabilitation and Healthcare Center, LLC. This claim arises out of care provided by employeesand/or agents of Poplar Oaks Rehabilitation and Healthcare Center, LLC to your patient SandraYvonne Brown.







www forthepeople cornAT.A7.TA GA * EERMP,GHAhl AL 46 BOVLINGSREEN KY * COLUMBV, rA 0 OAYTONA BEACH FL O DELAND.ft 4 FT MYERS FL 4 JACKSON MS • ,jADKSONVILLEKISVAMEE FL • LAKELAND. FL • LEXINGTON. KY KY ♦ MELBOURNE FL ♦ MEMPHIS TN • MOBILE. AL ♦ NAPLES. FL • NASHVILLE TN 0 NEW YORK HY

ORLANDO EL • PADUCAH. KY • PENSACOLA FL • PLANTATION. FL • PRESTONSBURG. KY • ST AUGUSTINE, FL 4 ST PETERSBURG FL • SARASOTA. FLSAVA/ INI,1)-3, GA 4 TALLAHA(;:',"E FL 4 TAMPA. FL • TAVARES FL • ifW,S1' PALM BEACH. FL ♦ WINTER HAVEN. F1


Poplar Oaks Rehabilitation and Healthcare Center, LLCNovember 2, 2017Page 2


Enclosed is a HIPAA compliant medical authorization permitting Poplar OaksRehabilitation and Healthcare Center, LLC to obtain complete medical records from each otherprovider being sent a notice.


Sincerely,

MORGAN & NIORGAN — MEMPHIS, LLC


CDG/sawEnclosures









D. Poplar Oaks Rehabilitation and Healthcare Center, LLC490 W. Poplar AvenueCollierville, TN 38017-2538

6. Poplar Oaks Rehabilitation and Healthcare Center, LLCdo Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312







1 1 . Orianna Holding Company, LLCcto Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312




15. Dana Nash, M.D.cio Allenbrooke Nursing and Rehabilitation3933 Allenbrooke CoveMemphis, TN 381 18




Birth Date:

March 2, 1950Social Security No. (optional):

413-88-1209

Provider's Name:


Poplar Oaks Rehabilitation and Healthcare Center, L1C

Provider's/Health Plan's Address:*Pursuant to 45 CFR 164.508(0040i), thoseindividuals identified in the attached list ofproviders are authorized to release completecopies of their medical records.

AddreSS 1: 490 W. Poplar Avenue

Address 2:

City: ColliervilleState: Zip:

TN 38017-2538

This authorization will expire on the following; (Fill In the Date or the Event but not both.)Date: 11-02-2018 Event:


Description of Information to be used or d sciosed

Is this request for psychotherapy notes? _Yes then this is the only Item you may request on this authorzation. You mk.st subm t


Description: Date(s): Description: Dates) Description: Date(s)

CY All PHI in medicalrecord

0 Admission form0 Dictation reports0 Physician orders0 Intake/outtake10 Clinical TestCl Medication Sheets

0 Operative informationf3 Cath lab0 Spode! test/therapy0 Rhythm Strips0 Nursing Information0 Transfer forms

(3 ER Information

CI Labor/delivery sum.0 08 nursing assess0 Postpartum flow sheet0 Itemized bill:0 UB.92;0 Other: all diagnostic films,

x•rays, MR1s, CAT scans,

etc.0 Other:

I acknowledge, and hereby consent to such, that the released Information may contain alcohol, drug abuse, psychiatric, HIV testing, HIV

results or AIDS information. (initial) It not appl cable, check here, d(

1 understand that:1. I may refuse to sign this authorization and that it is strictly voluntary.

2. if do not sign this form, my health care and the payment for my health care wIl not be affected unless stated otherwise.3. I may revoke this authorization at any time In writing, but If 1 do, It will not have any affect on any actions taken prior to

receiving the revocation. Further details may be found In the Notice of Privacy Practices.

4. if the requester or receiver is not a health plan or health care provider, the released information may no longer be protected byfederal privacy regulations and maybe redIstiosed.

5. 1 understand that 1 my attorney will receive copies of all records received through this authorization.6. I, through my attorney, will get a copy of this form after I sign It.

is:_SectionThe purpose of the release of my recc.r-ds is for review by not aPPlicable for vklch lam granting my authorization. THIS

AUTHORIZATION bogs NOr PERMIT YQj. TO DISCUSS THESE MATTERS WITH ANY MEDICAL PROVIDER OR THEIRREPRESENTATIVES OUTSIDE THE PRESENCE OP MY ATTORNEYS. You may furnish th:s law flan records that are requested by this offce.M medical reconots.obbln uant to this authorization shall be copied by their office and a Bates-numbered copy shall be furnished to my counsel,

LtIa0 1.). ura y, t sq. within five (S) days after the ,words are obtained through the use of this

aLlhertnition.

C: atures.5ection.'

'I f t tested healti or-ration as stated.

lure or Pati n e G /Patient/Plan Mem er epresentative:. Date:

ig

Print Name of Patient/Plan Member's Representative: Relationship to Patient/Plan Member:self

Revised 3/2003




Below is a list of all healthcare providers to whom notice is being given, pursuant T.C.A. § 29-26-121(a). of a potential claim for medical malpractice:








8. Orianna Flealth Systems, LLC1001 Hawkins StreetNashville, TN 37203-4758





I 1 . Orianna Holding Company, LLCc/o Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312


1 3. New Ark Investment, Inc.c/o Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312


1 5. Dana Nash, M.D.cvfo Allenbrooke Nursing and Rehabilitation3933 Allenbrooke CoveMemphis, TN 38118


MOQC-A:\ HCCjifforwey.)

SUITE 2600

ONE COMMERCE SQUAREMEMPHIS, TN 38103

(901) 217.7000FAX: (901) 333.1897

November 2, 2017

rncrO

'-9rg

1070 0000

N

CERTIFIED MAIL — RETURN RECEIPT REOUESTEI1111111 .3111

71111J1

61111411111'1,

714

* T N 3 9 1 *

Poplar Oaks Rehabilitation and Healthcare Center, LLCdo Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312


Dear Sir or Madam:

CERTIFIED MAIL? RECEDomestic Mail._ Only

Certified MAIIF‘ss

ra Return Receipt (saslcopy)Services (. Fes (cseck bat.. add lee a P. ^

S.Receipt (electronic)

Culf,ed Maii Rest/toted Delivery 3

o Adult Stgoaturd Reroo.Ored 3

Dikadt Signaturo Restricted Deltery $

Postage ri

,L„_ 4 'TOW Pos 51.1 Fees

S CP tq T CIOart-OYS Pkilia-Of gecti411 Ca, C— CCIYIIV.A5

Siie t a cfApt. r75 Pox filo.

i44. ,... ............. ,...., .............. .. .. ..... „.., ..........

'1 -M 3'7203 -6 Z.Rwi. .8e:tor 1 ei Via

.̀ " INOStem111:0 ,„

1

Zt;••

I am the attorney representing Sandra Yvonne Brown. Through me and my firm, SandraYvonne Brown is asserting potential claims for medical malpractice against Poplar OaksRehabilitation and Healthcare Center, LLC. This claim arises out of care provided by employeesand/or agents of Poplar Oaks Rehabilitation and Healthcare Center. LLC to your patient SandraYvonne Brown.







wOw.forthepeople cornAC'LANTA GA * BIRMINGHAM AL • SOVIUNG GREEN. KY • COLUMSUS.GA • DAYTONA BEACH. FL ♦ DELAND FL • Fr MYERS FL • JACKSON MS • JAGte60,41.1.E Ft‘

it1S$MMEE. F_ • LAK5.LAND, P. • LEXINGTON. KY • LioutSviLLE, KY ♦ MEt, BOURNE FL • MEMPH/S, TN • IslOatE. AL • NAPLES FL • NASHVILLE. ri • NEyivomcc,ORLANDO. FL + PADUCAH KY • PENSACOLA. FL • PLANTATION FL • PRESTONSBURG. KY • ST AUGUSTINE, Ft. • ST PETERSBURG. FL * SARASOTA.

SAVX•INAH GA • TALLAPASSEE. FL • TAMPA. FL ♦ TAVARES. FL ♦ WEST PALM ElEACH, FL ♦ WINTER HAVEN FL

L.4




Enclosed is a HIPAA compliant medical authorization permitting Poplar OaksRehabilitation and Healthcare Center, LLC to obtain complete medical records from each otherprovider being sent a notice.


Sincerely,


( •'


CDG/sawEnclosures






1

Methodist Healthcare Memphis Hospitalsc/o Monica Washington, Registered Agent1 21 1 Union Avenue, Ste. 700Memphis, TN 38104-6600

Oluwatoyin Jimmy Agbaosi, MD1300 Wesley DriveMemphis, TN 381 16


Poplar Oaks Rehabilitation and Healthcare Center, LLC490 W. Poplar AvenueCollierville, TN 38017-2538

6. Poplar Oaks Rehabilitation and Healthcare Center, LLCdio Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312

7. Poplar Oaks Rehabilitation and Healthcare Center, LIE1001 Hawkins StreetNashville, TN 37203-4758


9. Orianna Health Systems, LLCeto Corporation Service Company, Registered Agent2908 Poston Avenue




Orianna Holding Company, LLCc/o Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312


13. New Ark Investment, Inc.cio Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312


1 5. Dana Nash, M.D.c/o Allenbrooke Nursing and Rehabilitation3933 Allenbrooke CoveMemphis, TN 38118




Birth Date:

March 2, 1950Social Security No. (optional):413-88-1209

Provider's Name:

*See belowRecipient's Mame:

Poplar Oaks Rehabilitation and Healthcare Center, LLC

Provider's/Health Plan's Address:Pursuant to 45 CFR 164.508(c)(1)(ii), those


Address 1: c/o Corporation Service Company, Registered Agent

Address 2: 2908 Poston Avenue

City: NashvilleState: Zip:

TN 37203-1312

This authorization will expire on the following: (Fill In the Date or the Event but not both.)Date: 11-02.2018 Event:

Purpose of disclosure: COMPLIANCE WITH T,C.A. 5 29-26-121

Description of information to be used or d.sclosed

Is this request for psychotherapy notes? Yes, then this is the only Item you may request on th:s authorization, You must submit


Description: Date(s): Description: Dates) Description: Date(s)

.. All PHI In medicalrecord

0 Admission formU Dictation reports0 Physician ordersCl Intake/outtake0 Clinical Test0 Medication Sheets

0 Operative InformationCI Cath labCI Special tesptiterapy0 Rhythm Steps0 Nursing Information0 Transfer forms

ci ER Information

0 Labor/delivery sum.CI OB nursing assess0 Postpartum flow sheet0 Itemized bill:0 UB 92:0 Other: ail diagnostic films,

x-rays, MR1s, CAT scans,etc.0 Other:

I acknowledge, and hereby consent to such, that he released information may contain alcohol, d ug abuse, psychiatric, HIV testing, HIV

results or AIDS Information. (initial) if not applicable, check here. C.1

1 understand that:1. I may refuse to sign this authorization and that It Is strictly voluntary.

2. If do not sign this form, my health care and the payment for my health care will not be affected unless stated otherwise.3. I may revoke this authorization at any time In writing, but if I do, it will not have any affect on any actions taken prior to

receiving the revocation. Further details may be found In the Notice of Privacy Practices.4. If the requester or receiver Is not a health plan or health care provider, the released information may no longer be protected by

federal privacy regulations and maybe redisciosed.

5. I understand that I my attorney will receive copies of all records received through this authorization.6. I, through my attorney, will get a copy of this form after I sign it.

Section B:The purpose of the release of my records is for review byAUTHORIZATION DOES NOT PERtat YOU

not applicable for which I am granting my authortraon. 11LISMEDICAL PROUDER OR THEIRTO DISCUSS THFsy MATTERS WITH ANY

UPRESENTATIVES OUTSIDE flj PRESENCE OF MY_ATTORNEYS.You may furnish bis iaw flan reords that art requested by this offie.

a Ba -nurnbered copy shall be furnished to my counsel,(5) days after the reoords am obtained through the use efts

Ai medical recosdobleiln rstant to this authorization shall be copied by their office Batt andC ot u. ura y, t sq. within the

authorization.

Section C. atures' -\* Ampalmmle ..

f t tected health I rn atfon as stated,

Lure or Patle n e G /Patient/Pian Mem er epresentative:_ Date:

1Q 117Print Name of Patient/Plan Member's Representative:

. .

Relationship to Patient/Plan member;self

Revised 3/2003









5. Poplar Oaks Rehabilitation and I lealthcare Center, LLC490 W. Poplar AvenueCollierville, TN 38017-2538








Orianna Holding Company, LLCdo Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312


13. New Ark Investment, Inc.cjo Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312

14. Dana Nash, M.D.490 \Vest Poplar AvenueCollierville, TN 38017-2538

1 5. Dana Nash, M.D.coo Allenbrooke Nursing and Rehabilitation3933 Allenbrooke CoveMemphis, TN 38118


MOQGA\ 0 MCtr

• - - &e") C://'7 m

we

SUITE 2600ONE COMMERCE SQUAREMEMPHIS, TN 38103(901) 217.7000

FAX: (901) 333-1897

November 2, 2017

DD

Domestic Mail CInlyt, •

k'For delivery information ,,visitour.website at wivw.t.isp,4,e0m4,-....:

Certilled Mai

$ ';• Exiii iices 3 Pees (chock box,

Nilott:rn Ascelpt thefticcP0&axe Receipt (etiteeellid

DCeeefied Mail Restricted Derry I ❑Mutt Signature RatIVIPP

/WO Signature Restricted &Men" I—P Posta o

S •9 Total

P-

°;‘0,1 OCkr-S 2-0-10, 0A 4461_,(4.KcojCERTIFIED MAIL — RETURN RECEIPT REDUESTE1 4̀

-.tatT N / 3 6 9 o 7 -I .Poplar Oaks Rehabilitation and I Iealthcare Center, LLC1001 Hawkins St.Nashville, TN 37203-4758


Dear Sir or Madam:

tAira-1 LC-Nil.,or 74x At: st

I am the attorney representing Sandra Yvonne Brown. Through me and lily firm, SandraYvonne Brown is asserting potential claims for medical malpractice against Poplar OaksRehabilitation and Healthcare Center, LLC. This claim arises out of care provided by employeesand/or agents of Poplar Oaks Rehabilitation and Healthcare Center, LLC to your patient SandraYvonne Brown.





The name and address of the attorney sending this notice arc:


www.forthepeople.comATLANTA. GA 0 BRNINGHAM, AL + BOViLING GREEN KY • COLUMBUS GA • DAYTONA BEACH FL • DELAND. Pi, • FT MYERS, FL + JACKSON, MS f JACKSONVILLE FLKISSIiiMEE.FL • LAKELAND FL • LEXINGTON. KY 0 LOUISVILLE KY 4 MELBOURNE FL • MEMPHIS, TN 0 MOBILE. AL 8 NAPLES. FL 0 11A$H1A4LE TN • NEW YORK.NYORLANDO ♦ PADUCAH, KY + PENSACOLA. PLANTATION. FL ♦ PRESTONSBURG. KY 4 ST AUGUSTINE. FL • ST PETERSBUFG. FL • SARASOTA, FL

SAVANNAH. GA TALLAHASSEE FL 4. TAMPA. FL TAVARES. FL 0. WEST PALM BEACH. FL 0 WINTER HAVEN. FL




Enclosed is a HIPAA compliant medical authorization permitting Poplar OaksRehabilitation and Healthcare Center, 1.1,C to obtain complete medical records from each otherprovider being sent a notice.


Sincerely,

MORGAN & MORGAN MEMPHIS, LLC

1/1/


CDC-I,/sawEnclosures






Methodist Healthcare Memphis Hospitalscfo Monica Washington, Registered Agent1211 Union Avenue, Ste. 700Memphis, TN 38104-6600

Oluwatoyin Jimmy Agbaosi, MD1300 Wesley DriveMemphis, TN 38116




7, Poplar Oaks Rehabilitation and Healthcare Center, LLC1001 Hawkins StreetNashville, TN 37203-4758

Orianna Health Systems, LLC1001 Hawkins StreetNashville, TN 37203-4758

9. Orianna Health Systems, LLCcfo Corporation Service Company, Registered Agent2908 Poston Avenue




Orianna Holding Company, LLCclo Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312


1 3. New Ark Investment, Inc.clo Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312


1 5. Dana Nash, M.D.clo Allenbrooke Nursing and Rehabilitation3933 Allenbrooke CoveMemphis, TN 38118




Birth Date:

March 2, 1950


413-88.1209

Provider's Name:


Poplar Oaks Rehabilitation and Healthcare Center, LLC

Provider's/Health Plan's Address:Pursuant to 45 CFR 164.508(c}(1)(ii), those


Address 1: 1001 Hawkins Street

Address 2:


TN 37203.4758

This authorization will expire on the following: (Fill in the Date or the Event but not both.)Date: 11-02-2018 Event:

Purpose of dIstlosure: COMPLIANCE WITH T.C.A. § 29.26-121

Description of Information to be used or thsclosed

Is this request for psychotherapy notes? Yes then this Is the only item you may request on this authorization. You must subrmt

another authorization for other Items below. X No, then you may check as many items below as you need,

Description: Date(s): Description: Date(s) Description: Datets)

0( All PHI in medicalrecord

0 Admission form0 Dictation reports0 Physician orders0 Intake/outtake0 Clinical Test0 Medication Sheets

0 Operative information0 Cath labCI Special test/therapyCI Rhythm Str4ps0 Nursing Information0 Transfer forms

0 ER Information

0 Labor/delivery sum,CI OB nursing assess0 Postpartum flow sheet0 Itemized bl%:CI UB 92:0 Other: all ii.agiost.7c films,

x•rays, Mitts, CAT scans,etc.

0 Other:

I acknowledge, and hereby consent to such, that the released InfOrmaton may contain alcohol, d ug abuse, psychiatric, HIV testing, HIV

results or AIDS information. (Initial) If not applicable, check here, d(

1 understand that:I. I may refuse to sign this authorization and that it Is strictly voluntary.

2. If do not sign this form, my health care and the payment for my health care wil not be affected unless stated Otherwise.3. I may revoke this authorization at any time In writing, but If I do, It Minot have any affect on any actions taken prior to

receiving the revocation. Further details may be found In the Not:ce of Privacy Practices.4. if the requester or receiver is not a health plan or health care provider, the released ,nrormation may no longer be protected by

federal privacy regulations and maybe redisclosed.5. I understand that I my attorney will receive copies of all records received through this authorization.6. I, through my attorney, will get a copy of this form after I sign It.

section 8:The purpose of the re!ea.e of my records is for review try bat applicable forwh.ch I am granting my authorization. MS

DISCUSSREPRESENTATIVES OUTSIDE THE PRESENCE QF MY ATTORNEYS. You may furnish th:slaw fIrrn records that are requested by this circa.

a Bates-numbered copy shall be notched to my counsel,(5) days after the records are obtained through the u..e of this

Al mecilcinnetffn • . . rsuant to this authonzalon shall be copied by their office andra! • y, ksq. walla Me

authorization.

Section C:.„ ' aturesc"-.

}S4

I i t otected healtl,›formation as stated.

Cure or Patl t n f e G /Patient/Pian Mem er epresentative:. Date:

1Q.

Print Name of Patient/Plan Member's Representative: Relatioshlp to Patient/Plan Member:self

Revised 3/2003






2. Methodist Healthcare Memphis Ilospitalscio Monica Washington, Registered Agent1211 Union Avenue, Ste. 700Memphis, TN 38104-6600







9. Orianna Health Systems, LLCcio Corporation Service Company, Registered Agent2908 Poston Avenue




1 1. Orianna Holding Company, LLCdo Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312

P. New Ark Investment, Inc.1001 Hawkins StreetNashville, TN 37203-4758


14. Dana Nash, M.D.490 \Vest Poplar AvenueCollierville, TN 38017-2538

1 5. Dana Nash, M.D.cto Allenbrooke Nursing and Rehabilitation3933 Allenbrooke CoveMemphis, TN 38118


rlCEIRIZEU MAIL° RECErryDomestic Mail Only"

MOQGA cs roc0/be:Italy.)

SUITE 2600ONE COMMERCE SQUARE

MEMPHIS. TN 38103

(901(217.7000FAX: (901) 333-1897

November 2, 2017

a

CERTIFIED MAIL — RETURN RECEIPT REQUESTEJ1113113[1111111FIV1111111:111111IT 3'6 '9 0 7 1 *

Orianna Health Systems, LLC1001 Hawkins St.Nashville, TN 37203-4758

RE: Patient: Sandra Yvonne BrownNotice Required by 'F.C.A. § 29-26-121(a)

Dear Sir or Madam:

"'For delivery intaimation, visit our website at www.usps.cam°:1

CI I m (Certified Mgjl Feer-1 I ,/ri $

e2 . ; "

Extra Sery ces & Fees (check Mx, ea /sags ago)

C) ca ..g

fidt,rn Rk-eipt (hAretepy) I fi-, ' 1p 1-

1 liolum Receipt (electiente) 5

D 0 Cerklied Mall Rustrictid Dellgery S l. I /

CI ; 0 Adult Sittdatutts fleguatei 5 ____,I.

' 0 Adult Signature Restricted Reevety $ ' '1 postage$ t.

rl Total Poe rind Fees

sent

r)ann.Dr_ 'Wis.

PL}tth 0' —

I am the attorney representing Sandra Yvonne Brown. Through me and my firm, SandraYvonne Brown is asserting potential claims for medical malpractice against Orianna HealthSystems, LLC. This claim arises out of care provided by employees and/or agents of OriannaHealth Systems. LLC to your patient Sandra Yvonne Brown.








www.forthepeople.comATLANTA GA • BIRMINGHAM AL • BOWLING GREEN. KY • COLUMBUS GA + DAYTONA BEACH. Ft. 0 °ELAND. FL • Fr MYERS. FL ♦ JACKSON MS • JAcKS01.i.ILLE. FLKISStuk.IEE FL 4. tAK.ELAND FL • LEXINGTON KY ♦ LOVISV,LLE KY • MELBOURNE. FL • MEMPHIS TN • MOB LE, AL • NAPLES FL • NASHVILLE T% • HE:! 'fIRK

ODLAMDO FL ♦ PADUCAH KY 4- PENSACOLA FL • PLANTATION FL ♦ PRESTONSBURG KY * ST AUGUSTINE FL • ST PETERSBURG FL • SARASOTA- Ft..SAVANNAH. GA 4 TAL_AHASSEE FL • TAMPA. FL • TAVARES. FL 4 ViES7 PALM BEACH. FL ♦ WINTER HA/EN. FL


Orianna Health Systems, I ICNovember 2, 2017Page 2

Enclosed is a HIPAA compliant medical authorization permitting Orianna HealthSystem, LLC to obtain complete medical records from each other provider being sent a notice.


Sincerely,



CDG/sawEnclosures





2.


Methodist Healthcare Memphis Hospitalscio Monica Washington, Registered Agent1211 Union Avenue, Ste. 700Memphis, TN 38104-6600











1 1. Orianna Holding Company, LLCclo Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312

12, New Ark Investment, Inc.1001 Hawkins StreetNashville, TN 37203-4758

13. New Ark Investment, Inc.clo Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312

i 4. Dana Nash, M.D.490 West Poplar AvenueCollierville, TN 38017-2538

1 5. Dana Nash, M.D.c/o Allenbrooke Nursing and Rehabilitation3933 Allenbrooke CoveMemphis, TN 38118




Birth Date:

March 2, 1950

Social Security NO. (optional):413-88-1209

Provider's Name:

*See below

Recipient's Name:

Orianna Health Systems, LLC

Provider's/Health Plan's Address:*Pursuant to 45 CFR 164.508(c)(1)(ii), thoseindividuals identified in the attached list ofproviders are authorized to release completecopies of their medical records.

Address i: 1001 Hawkins Street

Address 2:


TN 37203-4758

This authorization will expire on the following: VIII In the Date or the Event but not both.)Date: 11-02-2018 Event:

Purpose of disclosure: COMPLIANCE WITH T,C.A. § 29-26-121

Description of information to be used or disclosed

Is this request for psychotherapy notes? Yes then this Is the only Um you may request on this authorization. You must submit

another authorization for othe Items below. X No, then you may check as many Items below as you need,


CX All PHI In medicalrecord

0 Admission form0 Dictation reports0 Physician orders0 Intake/outtake0 Clinical Test0 Medication Sheets

0 Operative Information0 Cad: lab0 special test/tnerePY0 Rhythm Str'psCI Nursing Information0 Transfer forms

0 ER Information

C3 Labor/delivery sum,

0 08 nursing assess

0 Postpartum flow sheet0 Itemized bill:0 MI 92:0 Other: all &agnostic films,

x-rays, MR1s, CAT scans,

etc.0 Other:

I acknowledge, and hereby Consent to such, that he releaSed Information may contain alcohol, drug abuse, psychiatric, HIV testing, HIVresults or AIDS Information. (initial) If not applicable, check here. (

1 understand that:1. I may refuse to sign this authorization and that It is strictly voluntary.

2, If do not sign this form, my health care and the payment for my health care will not be affected unless stated otherwise.

3. I may revoke this authorization at any time in writing, but if I do, it will not have any affect on any actions taken prior to

receiving the revocation. Further details may be found in the Notice of Privacy Practices.

4. if the requester or receiver is not a health plan or health care provider, the released Information may no longer be protected byfederal privacy regulations and maybe redisciosed.

5, 1 understand that I my attorney will receive copies of all records received through this authorization.6. I, through my attorney, will get a copy of this form after I sign It.

Section 8:The purpose of the release of IN records Is for review byAtITINORUATWN DOES NprpERturt YOU

not applicable for which tam granting my authortsalion. THISMEDICAL PROVIDER OR THEIRTO DISCOSS THESE MAILERS WITH ANY

REE.81,5ENTATIVES OULCIDLTIte PfillaNCE_OF MY AWORVEYL You may furnish ih:s law firm records that are requesrod by this eke.a Batarenumbeed Copy shall be kimisherd to my counsel,(5) days after the records are obtained through the use of thts

Al medicaLrecomtsobtaln rsuant to this authorization shall be copied by their ofrce andchael U. Lam y, Esq. , within the

authorization.

)e.ction C: atures...-- ‘,..

r44,/,#114 I ( t tested health irlferelation as stated,

Cure or Patie n erneerZ

Cl f,lc-.4... r.7)

/Patient/Plan Mem er epresentative:. Date:

iti '. 1Q .- irl_11)fe7,"--

Print Name of Patient/Plan Member's Represp_atative: Relationship to Patient/Plan Member;self

Revised 3/2003


LIST OF HEALTIICARE PROVIDERS TO WHOM NOTICE IS BEING GIVENPURSUANT TO T.C.A, § 29-26-121(A)


Below is a list of all healthcare providers to whom notice is being given. pursuant T.C.A. § 29-26-121(a), of a potential claim for medical malpractice:


2. Methodist Healthcare Memphis Hospitalsc/o Monica Washington, Registered Agent121 1 Union Avenue, Ste. 700Memphis, TN 38104-6600




6. Poplar Oaks Rehabilitation and Healthcare Center, LLCc/o Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203.1312


8. Orianna Health Systems, LI C1001 Hawkins StreetNashville, TN 37203-4758

9. Orianna Health Systems, LLCdo Corporation Service Company, Registered Agent2908 Poston Avenue




1 1. Orianna Holding Company, LLCclo Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312




1 5. Dana Nash, M.D.do Allenbrooke Nursing and Rehabilitation3933 Allenbrooke CoveMemphis, TN 38118


vIOQC-A\ 0 MC( fge--tNej,i)

SUITE 2600

ONE COMMERCE SQUARE

MEMPHIS, TN 38103

(901) 217-7000

FAX: (901) 333-1897

November 2, 2017

rnru

Omrl

La

O

Or-9

C:1CERTIFIED MAIL — RETURN RECEIPT REQUESTE P-11111111111111111 -HIllt111311111111* TN7 36 90 7 1 *

Orianna Health Systems, LLCc/o Corporation Service Company, Registered Agent2908 Poston Ave.Nashville, TN 37203-1312


Dear Sir or Madam:

• -CERTIFIED !..Dometic Maif.Only - •

For delivery iorormatioiWisiFturvrebsite at wry w trapa.cOmt

Certiri al 'ee

$tia n6t,etrrvRiceeis

Receipt 0.,,,...dFeetotteph.r tte,Scte,j41.ys Re2p.

etetetn Receipt (eitictront1/4) 9C t eta Mail Restricted Cerively $

o Adult SigAstuts K4ceaea S

Omen Sig Mute ReslActod D ie try 5

Postage

STotal P sta Fees

Po4markHbre

FiTeprOvWfla,WiTki no- StitS(ow.5

0,5 tio tufAN ax 0ofi, Star

At LIPA F5rra,3800;Aciiii 2016 P

1 am the attorney representing Sandra Yvonne Brown. Through me and my firm, SandraYvonne Brown is asserting potential claims for medical malpractice against Orianna HealthSystems, LLC. This claim arises out of care provided by employees and/or agents of OriannaHealth Systems, LLC to your patient Sandra Yvonne Brown.






Chad D. GraddyMorgan & Morgan - Memphis. LLCOne Commerce Square40 S. Main, Suite 2600Memphis, TN 38103

www.forthepeople.comATLANTA. GA 4. BIRMNGHAGI AL ♦ 130M KG GREEN KY • COLUMBUS, GA ♦ DAYTONA BEACH FL ♦ DELAND FL 4, FT. MYERS. FL • JACKSON MS ♦ JACKSONTI LE FKISSik.IMEE, FL • LAKEUV ID. FL ♦ LEXINGTON. KY • LOUISVILLE- KY • MELBOURNE FL ♦ MEMPHIS TN • MOBILE. AL ♦ NAPLES FL ♦ NASHVILLE TNI • NEW YORK sa'?

ORLAN00 R., • PADUCAP.rl ♦ PENSACOLA. FL • PLANTATION. PRESTONSBURG. KY ♦ ST AUGUSTINE. FL • ST PETERSBURG. FL • SARASOTA. FLSAVANNAH GA • TALLAHASSEE. FL ♦ TAMPA. FL • TA'JARES. FL • WEST PALM BEACH. FL • WINTER HAVEN FL


Orianna Health Systems, LLCNovember 2, 2017Page 2


Enclosed is a HIPAA compliant medical authorization permitting Orianna HealthSystem, LLC to obtain complete medical records from each other provider being sent a notice.


Sincerely,

MORGAN & MORGAN MEMPHIS, LLC


CDGIsawEnclosures





2.





5. Poplar Oaks Rehabilitation and Healthcare Center, LI.,C490 W. Poplar AvenueCollierville, TN 38017-2538








1 1. Orianna Holding Company, LLCcio Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312




15. Dana Nash, M.D.coo Allenbrooke Nursing and Rehabilitation3933 Allenbrooke CoveMemphis, TN 38118




Birth Date:

March 2, 1950


413-88-1209

Provider's Name:

*See below

Recipient's Name:

(Manna Health Systems, LIC

Provider's/Health Plan's Address:*Pursuant to 45 CFR 164.508(c)(1)(ii), those

individuals identified in the attached list of

providers are authorized to release complete

copies of their medical records.

Address 1: c/o Corporation Service Company, Registered Agent

Address 2: 2908 Poston Avenue

City: NashvilleState:

TN 37203-1312

This authorization will expire on the following: (Fill in the Date or the Event but not both.)

Date: 11-02.2018 Event:


Description of Information to be used or disclosed

Is this request for psychotherapy notes? Yes then this is the only Item you may request on this authorization. You must submit

another authorization for other Items below. X No, then you may check as many Items below as you need,,

Description: Oat*); Description: Date(s) Description: Date(s)

cx All PHI in medicalreccrd

0 Admission form0 Dictation reports0 Physician orders0 Intake/outtakea Clinical Test0 Medication Sheets

0 Operative Information0 Cath lab0 Spedal test/tnerapy0 Rhythm Strips0 Nursing Information0 Transfer forms

0 ER Information

0 Labor/delivery sum.0 05 nursing assess0 Postpartum flow sheet0 Itemized bill:CI U5 92:0 Other: all diagiostfc films,

x-rays, Mills, CAT scans,

etc.0 Other:

I acknowledge, and hereby consent to such, that he released Information may contain alcohol, d ug abuse, psychiatric, HIV testing, HIV

results or AIDS Information. (Initial If not applicable, check here. CS

1 understand that:I. I may refuse to sign this authorization and that It is strictly voluntary.

2. If do not sign this form, my health care and the payment for my health care will not be affected unless stated otherwise.

3. 1 may revoke this authorization at any time in writing, but If I do, it will not have any affect on any actions taken prior to

receiving the revocation. Further details may be found in the Notice of Privacy Practices.

q. If the requester or receiver Is note health plan or health care provider, the released Information may no longer be protected by

federal privacy regulations and maybe redisclosed.

5. I understand that I my attorney will receive copies of all records received through this authorization.6. I, through my attorney, will get a copy of this form after I sign it.

Section B:The purpose of the release of my records Is for review by =applicable for which I am granting my authortzabon. THIS

AUTHORIZATION DOES NOT PERMIT YOIL TO DISCUSS THESE MATTERS WITH ANY MEDICAL PROVIDER OR THEN

REEReSENTATIVES OUTSIDE nig PRESENCEQF MY ATTORNEYS, You may furnIsh ths law rtma records that are requestmi by tills orece.

M medicalrecord.s.obm

ialn rsuant to this authorization shall be copied by their °Moe and a Babes-numbered copy shall be famished to my counsel,Inad IL ta y, tsq. within nve (5) days after the records are obtained through the use of this

authorization.

Section C: atures

I f t otected health I . lion as stated._..t.

' ture or Patl n e G i /Patlept/Plan Mem er epresentatIve:.. Thate:

l0 ) Pi1 c> 0 ‘71)C75- ICA I.1)...--,.. ;Print Name of Patient/Plan Member's Representative:

- -

Relationship to Patient/Plan Member;self

Revised 3/2003


LIST OF HEALTHCARE PROVIDERS TO WHOM NOTICE IS BEING GIVENPURSUANT TO T.C.A. § 29-26-I21(A)




2. Methodist Healthcare Memphis Hospitalsc/o Monica Washington, Registered Agent1211 Union Avenue, Ste. 700Memphis, TN 38104-6600

3. Oluwatoyin Jimmy Agbaosi, MD1 300 Wesley DriveMemphis, TN 381 16






9. Orianna Health Systems, LLCdo Corporation Service Company, Registered Agent2908 Poston Avenue




1 1. Orianna Holding Company, LLCcio Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312


13. New Ark Investment, Inc.c/o Corporation Service Company, Registered Agent2908 Poston AvenueNashville, TN 37203-1312


1 5. Dana Nash, M.D.Allenbrooke Nursing and Rehabilitation

3933 Allenbrooke CoveMemphis, TN 38118


EXHIBIT 2


IN THE CIRCUIT COURT OF SHELBY COUNTY TENNESSEE

FOR THE THIRTIETH JUDICIAL DISTRICT AT MEMPHIS

SANDRA YVONNE BROWN,

Plaintiff,

v.

POPLAR OAKS REHABILITATION AND

HEALTHCARE CENTER, LLC, NEW ARK

INVESTMENTS, INC., ORIANNA

HOLDING COMPANY, LLC, ORIANNA

HEALTH SYSTEMS, LLC, and DANA

NASH, M.D.

Defendants.

NO. CT-ts6 IoU) -

JURY DEMAND

Judge D;v

CERTIFICATE OF GOOD FAITH

Medical Malpractice Case

PLAINTIFFS FORM

A. In accordance with T.C.A. § 29-26-122, I hereby state the following: (Check item

1 or 2 below and sign your name beneath the item you have checked, verifying the

information you have checked. Failure to check item 1 or 2 and/or not signing

item 1 or 2 will make this case subject to dismissal with prejudice.)

1. The Plaintiff or Plaintiff's counsel has consulted with one (1) or more

experts who have provided a signed written statement confirming that upon

information and belief they:

(A) Are competent under § 29-26-115 to express opinion(s) in the case;

and

(B) Believe, based on the information available from the medical records

concerning the care and treatment of the Plaintiff for the incident(s)

at issue, that there is a good faith basis to maintain the

action consistent with the requirements of § 29-26-115.

Signature of Plaintiff if not represented, or Signature

of Plaintiff's Counsel


Or

El 2. The Plaintiff or Plaintiff's counsel has consulted with one (1) or moreexperts who have provided a signed written statement confirming that uponinformation and belief they:

(A) Are competent under § 29-26-115 to express opinion(s) in the case;and

(B) Believe, based on the information available from the medical recordsreviewed concerning the care and treatment of the Plaintiff for theincident(s) at issue and, as appropriate, information from thePlaintiff or others with knowledge of the incident(s) at issue, thatthere are facts material to the resolution of the case that cannot bereasonably ascertained from the medical records or information

reasonably available to the Plaintiff or Plaintiff's counsel; and that

despite the absence of this information there is a good faith basis formaintaining the action as to each Defendant consistent with therequirements of § 29-26-115. Refusal of the defendant to release

the medical records in a timely fashion, or where it is impossible forthe plaintiff to obtain the medical records shall waive therequirement that the expert review the medical records prior to

expert certification.

.75Signature of Plaintiff if of presented, or Signature ofPlaintiff's Counsel

B. You MUST complete the information below and sign:

I have been found in violation of T.C.A. § 29-26-122 0 prior times. (Insert

number of prior violations by you.)

Signature of Person Executing This Document Date


Documents

COUNSEL FOR SANDRA YVONNE BROWN IN THE UNITED …