v ••••-• I RECEIVED GCT26 2M5 NO. 2014-004069-2 COURT OF APPEALS SFCOND DISTRICT OF TEXAS SEDEBRASPISAK, CLERK IN THE COURT OF APPEALS TARRANT COUNTY, TEXAS SUNOSKY v. ALLEN A. RAD LAW FIRM Original Proceeding from the Court of Appeals, The Honorable Vince Sprinkle, Presiding The appeal is from Second District of Texas of Court of Appeals in cause number 2014-004069-2. The judgment was signed on September 23, 2015. Thuy Sunosky desire to appeal to the Second Court of Appeals and, hereby, give notice of appeal. ORAL ARGUMENT REQUESTED Thuy Sunosky 5932 Broadway Avenue Haltom City, Texas 76117 (832)423-1344 Pro Se Litigant T CAUSE No. 2014-004069-2 THUY SUNOSKY, APPELLANT IN THE JUDICIAL DISTRICT COURT vs. TARRANT COUNTY, TEXAS ALLEN A. RAD LAW FIRM, APPELLEE SECOND DISTRICT OF TEXAS This Notice of Appeal is filed by Thuy Sunosky, Appellant, a party to this proceeding who seeks to alter the trial court's decision of September 23, 2015. 1. The trial court, cause number, and style of this case are shown in the caption above. 2. The motion for an appeal was signed on September 23, 2015. 3. Thuy Sunosky desires to appeal all portions of the judgment. 4. This appeal is being taken to the Court of Appeals, Tarrant County, Texas. 5. This notice of appeal is being filed by Thuy Sunosky. Respectfully submitted, Thuy Sunosky 5932 Broadway Avenue Haltom City, Texas 76117 (832)423-1344 %' - f RECEIVED W OCT 16 2015 COURT C£o§tt^fes|j|fs SECOND DEPICT"oWeXAS FORT WORTH PLAINTIFF —r- THUY SUNOSKY VS. DEFENDANT — ALLEN A. RAD LAW FIRMS THUY SUNOSKY, AND NOW APPELLANT IN THE JUDICIAL DISTRICT COURT, TARRANT COUNTY, TEXAS RESPECTFULLY SUBMITTED, THUY SUNOSKY - I SUE MR. A RAD FOR $200,000 THUY'S ADDRESS THUY'S PHONE # 832-423-1344 MRS. THUY SUNOSKY LIVES AT: 5932 BROADWAY AVENUE HALTOM CITY, TX 76117 HER SOCIAL SECURITY NUMBER IS: 3197 HER DRIVER'S LICENSE NUMBER IS: 853 2) IN THE COURT TARRANT COUNTY, TEXAS JUDICIAL DISTRICT THUY SUNOSKY APPELLANT V. ALLEN A. RAD LAW FIRM APPELLEE REQUEST FOR PREPARATION OF THE RECORD FOR AN APPEAL Thuy Sunosky, and now Appellant in the above entitled and numbered cause, requests the Court Reporter of the Judicial District Court, Tarrant County, Texas, to prepare a record for appeal in the above entitled and numbered cause No. 2014-004069-2,1 sue Mr. A. Rad for $200,000. 1. Appellant further requests that the testimony included in the record be in question and answer form. 2. Appellant requests the court reporter to include the following portion of the evidence and other proceedings to be included in the record: I appeared before the Judge at Court at Law No. 2 on September 23, 2015 at 9:30 a.m. and was granted a motion for an appeal of which the deadline date is November 2, 2015. 1) Because Mr. ARad don't want to pay $200,000 from Memorandum Opinion No. 02-13-00032-CV at Court at Law No. 2, cause No. 2014-004069-2. 2) I still hurt in my knee and my doctor says that I need to have surgery now. And my back still hurt. 3) I'm handicapped now from car accident that I was a victim of in 2001. 4) I have skills and business as atailor and designer of clothes. Now I still hurt and Social Security pays me, but if I can work I can make more money. 5) In 2014 I was treated by the following doctors: William G. Coleman, M.D. for knee surgery Ved Aggarwal, M.D. for back pain Terri Allen, M.D. took x-rays for back pain Richard Jensen, M.D. did MRI for back pain 6) Dr. Joseph G. Carter, M.D. gave me a handicap card for four years now. 7) On June 25, 2015,1 went to see Dr. Carter for my back and knee and I've lost a lot of weight b 8) Because of the pain from the accident. 9) I have a new doctor and new information from 2015. Dr. Coleman says that I need a right knee replacement surgery and motion for $200,000.1 go to Trinity Pain Medicine and they want to do a procedure on me to show me where my pain in my lower back is. 10) Dr. Carter shows that I've lost alot ofweight because ofthe pain in my right knee and lower back from not eating and sleeping well. 11) Dr. Carter gave me ahandicap tag for four years now. 12) Motion shows that Ishould get paid $200,000. 13) Inever signed paper before. Icashed check for $3,685.68 to pay Dr. Jeffrey McGowen, M.D., to give me a shot because I was in a lot of pain in my right knee. Mr. A Rad sent me a paper to sign up for Medicare on September 18, 2005, so Mr. A Rad don't have to pay bill and he could keep the money from both sides' insurance. 14) Ilose my job that I went to school for. I have skills to design clothes and I lose my business, tailor too from car accident in 2001.1 can't work. \T 15) Ihurt for whole time. For 15 years now I still hurt and my court document shows I sue Mr. A Rad for $200,000, too. My case document is #2014-004069-2. 16) I need go now. I need surgery soon. 17) Isend #2) Court ofAppeals Memorandum Motion, #3) Court at Law No. 2 cause # 2014-004069-2, Selection of Discovery Level, #4), Medicare and check, #5) Dr. Coleman's records, #6), Dr. Carter's records, #7), copy of handicap tag, #8), Medial Branch Block, #9), Fashion Design circular. Respectfully submitted, Thuy Sunosk; 5932 Broadway Avenue Haltom City, TX 76117 (832)423-1344 (5) Respectfully submitted, Thuy Sunosky 5932 Broadway Avenue Haltom City, TX 76117 (832)423-1344 SIGNATURE Date:^/ifl_/20ii Signature:^^ucr J^LLfiiQ PrintName:7X^r Sg^/jl^^U^ Street Address: City: tffrLJ^ rjty State: 4 5e^<^ Htf-kr^lS REPT. UP. DCT. 12 3 4 TIMES P.R.N- O NON-REP. • ~s_ IVtaY "W 5ols<\4u )Y*$ s *i i^d 0V iU COURT OF APPEALS SECOND DISTRICT OF TEXAS FORT WORTH " NO. 02-13-00032-CV THUY SUNOSKY APPELLANT OCT 2 6 2015 V. SECa«||f DEBRASPISAK, CLERK LAW FIRM APPELLEE FROM COUNTY COURT AT LAW NO. 3 OF TARRANT COUNTY MEMORANDUM OPINION Appellant Thuy Sunosky, pro se, appeals from the trial court's order dismissing her claims against Appellee Allen A. Rad Law Firm (Rad) for lack of jurisdiction. Because Sunosky does not challenge the only basis for the trial court's order, we affirm. 1SeeTex. R. App. P. 47.4, Sunosky, acting pro se, sued Rad in statutory county court based on Allen Rad's representation of her in a previous matter relating to a car accident. She asserted that Rad agreed to represent her in the matter but then failed to communicate with her about the status of her case and failed to file suit until after the limitation period had passed. She sought damages "aggregating $50,000 or less" excluding costs and attorney's fees. Rad filed a general denial and asserted the affirmative defense of limitation and that Rad was not an appropriate party to the lawsuit. The case was called for trial on January 10, 2013. Sunosky appeared pro se. Rad did not appear. Sunosky testified along with two other witnesses. Sunosky testified that before the car accident giving rise to the claim for which Rad was to represent her, she had earned $2,000 a month, and in the eleven years after the accident, she could not work. At the conclusion of evidence, Sunosky asked the court to award her $314,000 in damages—her lost wages for eleven years plus interest. The trial court informed Sunosky that it was a court of limited jurisdiction, that it could not award her more than $200,000, and that she needed to file her claim in a district court.2 He then stated that it would "have to dismiss [her] case 2See Tex. Gov't Code Ann. § 25.0003 (West Supp. 2013) (providing that a statutory county court has jurisdiction in civil cases in which the matter in controversy exceeds $500 but does not exceed $200,000); § 25.2221(a) (West 2004) (stating that County Court at Law No. 3 of Tarrant County is a county court at law). for want of jurisdiction, because [she] ha[s] pled for an amount that is outside the amount in controversy [for] which this court is allowed to award." After the conclusion of the trial, the trial court signed an order of dismissal, stating that "[a]fter considering the matter, the Court finds that this matter should be dismissed for want of jurisdiction" and ordering that the case be dismissed without prejudice. Sunosky now appeals. In the "Issues Presented" section of her brief, Sunosky sets out fourteen numbered paragraphs that contain assertions of fact rather than legal issues. But in her summary of her argument, she makes the following statement, which we construe as her issue on appeal: "The Rad Law Firm put their desires ahead of their client, by failing to represent her in a timely manner, and by allowing the testimony of a doctor who never met nor examined her." In order for a trial court to decide a case, it must have the power to do so; in other words, it must have jurisdiction over the case.3 Not every court in Texas is authorized to try every claim. Under Texas law, statutory county courts (also referred to as "county courts at law"), like the trial court in this case, may only hear cases in which the amount in controversy is within a specified range.4 3Black's Law Dictionary 927 (9th ed. 2009) (defining "jurisdiction" as "[a] court's power to decide a case or issue a decree"). 4Tex. Gov't Code Ann. § 25.0003; see also Tejas Toyota, Inc. v. Griffin, 587 S.W.2d 775, 776 (Tex. Civ. App.—Waco 1979, writ refd n.r.e.) (stating that "the amount in controversy is the amount of damages claimed in the pleading"). 3 Currently, that range is between $500 and $200,000.5 That is, the trial court in this case did not have the power to hear the case if the amount of damages claimed was less than $500 or if the amount of damages claimed was more than $200,000.6 In her petition, Sunosky stated that she'was seeking to recover not more than $50,000. The trial court had the power to hear a case involving that amount in damages.7 But at trial, Sunosky introduced evidence that her damages were over $200,000, and she asked the trial court to award her more than $200,000. The trial court concluded that because Sunosky sought to recover more than $200,000, it did not have jurisdiction over her claim. Sunosky's brief alleges that Rad failed to keep her updated on her case, failed to file her case before the limitation period had passed, and kept money that the insurance company had paid out on her claim. Nothing in her brief, however, addresses whether the trial court had jurisdiction over her claims, which was the sole ground on which the trial courtordered the dismissal of her claims.8 Although we are mindful of the difficulty that pro se litigants face, we may not 5Tex. Gov't Code Ann. § 25.0003. 6td 7See id. 8See Tex. R. App. P. 44.1; Britton v. Tex. Dep't of Criminal Justice, 95 S.W.3d 676, 682 (Tex. App.—Houston [1st Dist.] 2002, no pet.) (affirming the trial court's grant of a plea to the jurisdiction because the appellant failed to challenge on appeal all of the grounds that were included in the plea). make Sunosky's arguments for her.9 Accordingly, we overrule Sunosky's sole issue on appeal. Having overruled Sunosky's sole issue on appeal, we affirm the trial court's order of dismissal. /s/ Lee Ann Dauphinot LEEANNDAUPHINOT JUSTICE PANEL: DAUPHINOT, MEIER, and GABRIEL, JJ. GABRIEL, J., concurs without opinion. DELIVERED: March 20, 2014 9Strange v. Cont'l Cas. Co., 126 S.W.3d 676, 677-78 (Tex. App—Dallas 2004, pet. denied), cert, denied, 543 U.S. 1076, 125 S. Ct. 928 (2005). // o .>-•#•. .-Li'-AiiGM rufi CIS A3 LED ,-H=SCM iDENTIHCATSON ;CA = D AMD ,• CR CiSASLH- P£=SON LICENSE PLATE iSFCRTATiCN CCDE. .C'V!l ==THAT "ALSSr ONG !NFORMA7:GM CM ANY REQUIRED STATEMENT OR APPLICATION '3 - :.C-DE'3r.EE FELONY. Blue placards may be issued for disabilities (permanent or temporary) In which the person cannot walk THIS 3LOCX FOR TAX ASS55SCR- COLLECTOR USE ONLY •.vi theLit the use of or assistance from an assisianca device, including a brace, cane, crutch, another person or a prosthetic device, or who cannot ambulate without a wheelchair cr-similar device. Red placards ~ mayy be issued for any other type of disability (permanent or temporary). Disacled Person License Plates may be issued only to persons with permanent disabilities. •-CS.NS5 ?JT= NUMBERS) IS3UEC In icccrcar.ee witn Iran secnation Cede, Chapters 502 and/crSat, application is hereby made fen n (1) Red Placard or Q (2) Red Placards (Temporary Disaoility) {"} Red Placard or Q [2) Red Placards (Permanent Disability) (") clue Placard or Q (2) Slue Placards (Tampcrary Disacilityj PLACARD FEE: 55.00 each ZI3A3LS3 PSSSGN Z!SA3L£3 PSSSGM P'^C*«p(S) iSSL'SO P',AC*«p<5) ;S5LEQ j (1/ 3iue Placard or Q (2) BluePlacards (PermanentDisability) ICrcfe One) i 3lue \ Pel Disabled Person License Plate LICENSE PLATE FEE: .Regular Reg. Fee RECEIPT OF STATUTORY FEE HE.RE3Y 1 Cisabied Person License Plate and ACKNOWLEDGED 5 Q Red Placard (Permanent Disability); or CD 3!ue Placard (PermanentDisability) U Additional Set(s) cf Disabled Person License Plates forspecially equipped vehicles (see back formors information) TAX CCU.EC7Crt.Ji Disabled PersonPersonalized License Plates (Complete Form VTR-35A inaddition to this form) I. the undersigned, certify that I am Q disabled Q making application on behalf of a disabled person and have read the instructions on the reverse side of this application and fully understand the provisions ofTransportation Code, Chapters 502 and 581. _\£_Vs £x APPLICANTS NAME/INSTITU1 T IGN NAME ;AN^SSIGNATURE/ ADMINISTprftOR'S^NA.TURE (RIVEH'S LICENSE or I.O. or OHS NUMBER OATS 5°I^Z 5toAPw*Y AOfaJOF. UAiTnAr.-rV Tf-YA^ iyi6\\r-\ APPLICANTSOR INSTITUTION'S STHEET ADDRESS, CITY, STATS. AND ZIP CODE INFORMATION REQUIRED FOR ISSUANCE OF DISABLED PERSON LICENSE PLATES \°iin YEAR MODEL TOYOTA lNXAE£2G,Sk:ZM3^7-/- VEHICLE MAKE VEHICLE IDENTIF!CA TK5j NUMBER LICENSE PLATE NUMBE? 2. YEAR MODEL VEHICLE MAKE VEHICLE IDENTIFICATION NUMBER LICENSE PLATE NUMEEP, I, ;he undersigned, certify that I am the owner of the above described .vehicie(s) or that the vehide(s) is / are owned by an institution that qualifies for disabiec person license plates. I further certify that the vehicle's) is / are regularly, operated by or for the transportation of the disabled person named in the Disability Statement below or operated by the qualified institution fortranspojSatan ofa disabled resident of_suqh institution. VEHICLE OWNER'S NAME OR tflSTIT •ISTITUTiCN NAME fS SIGNATURE t/W?jrt4 1I GATE l DISABILITY STATEMENT /] TO BE COMPLETED 3Y APHYSICIAN: LICENSED BY THE TEXAS STATE BOARD OF MEDICO/EXAMINERS, APHYSICIAN LICENSED TO PRACTIC! .MEDICINE IN ARKANSAS, LOUISIANA, NEW MEXICO, OR OKLAHOMA, A PHYSICIAN PRACTICING MEDICINE IN THE U.S. MILITARY ON A MILITARY INSTALLATION IN TEXAS, OR A PHYSICIAN PRACTICING MEDICINE IN A HOSPITAL OR OTHER HEALTH FACILITY OF THE DEPARTMENT OF VETERANS AFFAIRS, OR A PODIATRIST LICENSED BY THE TEXAS STATE BOARD OF PODIATRIC MEDICAL EXAMINERS |See Back Of Application For Disability Definitions And Additional Information) ;see oacx ur Mppncauor i hereby certify that has (checkone): HTa disability defined by Transportation Code, ^_J NAME OF DISABLED P_3flSON §681.001 (51(B) or (C), or Q any other disability. The person's disability is (check one): "^permanent or Q temoorary in nature. la->1- fa- __Mlla LV.J-4V HAMS Of(fHYSJCIAN CR PODIATR1SJ -__j_j_. 3R0FE5SI0NAC LICENSE NUMSER CF PHYSIC!AN OR PODIATRIST 34(4 ^Vk-vu JV 4%f- U3ar4J\ 5TPEET ADDRESS STATE i!P COOS ^rgudiun^fpfivswmrui Huuimm,! V,«„4^.h^ On this oate. , the abov earned physician or podiatrist, GATE NAME CF PHYSICIAN OR PODIATRIST 3opeared before me so that! couid witness his / her signature. SIGNATURE OF NOTARY SEAL . PRINTEO NAME OF NOTARY sreby certify that! am a notar/ in the State cf T,=xas. t* Count/. Mv commission exoires IMPORTANT! PHYSICIAN'S OR PODIATRIST'S SIGNATURE MUST BE NOTARIZED UNLESS ASEPARATE WRITTSN ORIGINAL PRESCRIPTION IS SueMITTEC \ **"\ "" Submit both ccoies of this aoclication with acolicable fees to the Cauntv T.-ix A«Msor-Gi-)l!t»*:ror "*-* '*.. (T) PR. JOSEPH S. OBneil/w.T). CA^e ME A"RED JUAK)PlCA? CAPX) T^AT WAS GooT> R>fc_. oMuy !SlX MOVJTV4S, AM"D \JOuJ I'vjE TOLD \\\M -7IAAT X MAP AJO AUTOMOBILE ACoDEioT \w ^ol A^t> X^€ Uutrr ft>^ \M YEAes mou)( s At MY MCfcaCAL, A>Jp poc-rtrtLS RE^o^DS AkiP kjouj I'M WAmu6 ?t>12.5c42.Gee.Y o^ ^Y i03E€ AND "8Ac<. !06io v*6 WAJ-rrs TO Gwi me A "BcoE I (aJAS l^u'^r (M A CXSL Accipe^JT \u 1l, AMD MY VocxoZ- 5AVS THA-r TW€ ISAcvc $o££e£-Y uiU T56 v/BfcY PiFBcoLT APP TVAAT VT'S MOT GvA0 ME "pAiJO MQMCapE AMP X AM TAv^mG VT U^TlUX cSE:T ;T«& $ui2_SQ^Y, 1?UT pOH'T ^?Oolu t^ATWLC UAPP&J M<&- SWGQZ-Y IfCAuSE THE l>AC£l SoftGtW t>0cTOE_ 5AY? tHsAt THE T^CEP^^L iS WOT 6O'A^Ai0TeeP vCO/o, u fr.'S (Jp X Aaa i^eallv healtt-iy ^cepT Edu-aay j^mEe Amp ^cC wi'Hal: stilc v-Hj£x frfe>M nrft X caajmot \jocmL the ^i -rHArx i^Emtc to SCHOOL- "^(2^ foU_ Tl^& TAST ^ YEA^S >JCXJ UOlM THE ALLENJ A. VAO LAW FtJIM UAS TO ?AY ME ^33S(ooo Tlos ^^ooo ^o(LT6o?oe To U^ure Pd^-mE dj Bn^lis^I AMP S YEAizjc; fb£- Tl^E 57ATE 13AR-. oP TEXAS \M V26>\&&&> LETTERS Plus ivoTE^eST P^£v\tHE ^^3S(ooO Avv "TMc JUP6E W IUC DEtUPE V+oIaJ MucH tHE ^2_AP LMjO n^AA u;ilu ?AY ME 'Hd(Z_TH€ TZ-6ST OP mV UE£. Ht\Nh\c/\p - 2-o /y Doctors' KecoKDS 1401 Henderson Street • Fort Worth, TX 76102 X17-332-3664 • Fax SI7 SX2-W88 \ ililfi'YM <• mi iitiiHiwnr. «i V. \_i 0_3 Sr- *£ fe-n ALLEN A. RAD LAW FIRM -< , o O TO THE HONORABLE COURT: MRS. THUY SUNOSKY-lives at 5932 Broadway Avenue, Haltom City, Texas 76117. Her Social Security number is XXX-XX-X197 and her driver's license number is XXXXX853, issued in the state of Texas. MRS. THUY SUNOSKY (the "plaintiff") complains of MR. ALLEN A. RAD (the "defendant"), and for cause of action shows: 1. SELECTION OF DISCOVERY LEVEL The plaintiff affirmatively pleads that she seeks only monetary T" relief aggregating $200,000 and no more; excluding cost, prejudgment interest, and attorney's fees under Civil Procedure Rule 190.2. 2. PARTIES AND SERVICE OF CITATION \ - = WjOT.f. W»a«sa63!«4it*"*:»3J 'JliUbi! | \ wa:W.,5-t«jti«Ks3-t«tw»a»aasW5e*;s»- iiciniiihauas OAUK a inui, cn i UA1.I.AS. IX7S2.JU RAD LAvT^OUNT UNDER IOLTA" "TRUST A,.. no.siriTb-900 32 -!16'IMO <|'MH-2limi 4& (''|l«/ ftl / «? 12!JO0 »11ESTI «H DALLAS. TEX AS75;, p.i(0/2)«gi 11 ii.t l-AX (il/L') 601-;j!i37 \3t>-J325 .,.,*?,-"»!r^Pi»S^f?^^-, '-':r?|||# :'"'-'•'%'K - I •*' ":j.ot*.fifl I ih«rTi.«H«...JSi«ii....^v!!KiR!!!£!^?^''Jf/!,-,fr-»- I "/ V , 5932 Hmailway Ave 11 siHoi n City, T> 7iili7-3307 mi Full &llnnl SeflletiWit 202(108 ^^ ^ . ^ |, 5 2 L ill* iJBrets»^»-"*pe!Kn:ri^ 0 ^^^^^.^^^^^^^«*» • 3605 2 nAi pLAW FIRM. PC /"TRUST ACl'-OUNT UNDI :R',olta- 100G ct^ecj^: x t^a^up *"~ H'MM-200cf Date Signed Date of Injury Social Security Number Or Health Insurance Claim Number MSP90767:RELEOF:09/09/2005 MEDICARE centersfvrMmcAEE® medicaid services I Pm Aintermediary Part B Carrier January 10,2006 Kim Wong R.ad Law Firm /#' -4.2900 Preston Rd.. Ste. 900 Dallas. TX 75230-1325 RJE: Thuy Sunosky HIC: -166-31-3197A DATE OF ACCIDENT: 2/9/01 Dear Sir or Madam: This letter follows our earlier communication in which we advised you of the applicability of the Medicare Secondary Payer Program. Medicare has paid S3,1.71.73 to date. This amount represents the total medical payments made to date; however, this amount will change if additional claims are paid after the date of this letter or if we become aware of related claims paid by another Medicare contractor. Please be advised, this is not the final interest amount. DX^Q^SEND-A CHEGK-A3^THIS4TME., Upon settlement, please send a copy of the signed settlement/release agreementalong with an itemizationof attorney's fees and costs. Clearly state how much of settlement is Personal Injury Protection (PIP) and how much is Medical Payments (Med-Pay). Reduction on settlement DOES NOT APPLY to PIP or MED-PAY. Medicare's reimbursement will be deducted from these recoveries first. Medicare will then calculate the final interest amount after any reduction for procurement costs in accordance with 42 CFR 411.37 and 411.51. If you have anyquestions regarding the current list, or if you become aware of future payments, please send your inquiry in writing to the address listed above, or you may call our office at 903-463-0641. We appreciate your cooperation and look forward to hearing from you. Sincerelv. •iracy 'Jtoncysucaje Liability Member Service Representative cc: Thuv Sunoskv TrailBlazer Health Enterprises. L.L.C. P.O. Box 9020, Denison. Texas 75021 Liability Subrogation Printed On: 1/10/2006 MEDICARE Part A Intermediary Part B Carrier gjBliftta cifflK Letter Number: 340893 Date: 02/28/2006 RAD LAW FIRM & 12900 PRESTON RD SUITE 900 DALLAS, TX 752301325 RE: Name: THUY T SUNOSKY HIC* 466313197A Date of Incident: 02/09/2001 Debt Identification No.: 200524109000018 Demand Amount: $2,893.85 Dear Sir/Madam: We are writing to you because we recently learned that you made aliability claim relating to an illness, injury or incident occurring on or about 02/09/2001 and obtained a recovery We have determined that you are required to repay the Medicare program $2,893.85 for the cost of medical care it paid relating to your liability recovery. (The term "recovery includes a settlement, judgment, award or any other type of recovery.) We hope that you will find answers to some of the questions you may have about this letter below Parts I and II of this letter explain the federal law that requires you to pay Medicare back and the way we determined the amount you are required to repay. We have provided instructions for repaying Medicare in Part 111 of this letter. You have the right to appeal our determination if you disagree with it, and you also have the right to request that the Medicare program waive recovery of the amount you owe in full or in part. Instructions for requesting waiver of recovery and appeal are provided in Part IV of this letter. Finally, Part Vof this letter exolains the interest charges that apply if you do not repay Medicare withm sixty (60 days from the date of this letter and tells you about certain actions Medicare may decide to take it you fail to repay the amount you owe. I. Why am I required to repay Medicare? You are required to repay Medicare because Medicare paid for medical care you received related to your liability recovery. The Medicare Secondary Payer (MSP) law allows Medicare to pay for medical care received by aMedicare beneficiary who has or may have aLability dam. However the law also requires Medicare to recover those payments if payment of a liability settlement, judgment, recovery, or award has been or could be made. Congress passed the TrailBlazer Health Enterprises; LLC Executive Center III, 8330 LBJ Freeway, Dallas, TX 75243-121S wvm-trailblazertieaith.com Date: 02/28/200ic TrailBlazer Health Enterprises, LLC Page 2 —-———- To Date Total le.mbureed Conditional Provider Name Diagnosis Code From Date TOS ICN Line* Processing Charges Amount Payment Contractor Amount 73300 10/30/2003 10/30/2003 $20.00 $14.80 $14.80 JPS HEALTH NETWORK V0481 SMI-20332302913601 28 00400 0 07/27/2004 07/27/2004 $3,026.00 $337.19 $337.19 00400 JPS HEALTH NETWORK V7651 0 SMIr20421801487101 1 12/27/2001 12/27/2001 $150.50 $120.40 $120.40 00900 RICHARDSON, KENNETH W 7175 SMI-451502011040580-000000001 27 P 12/03/2001 $190.00 $92.74 $92.74 71516 12/03/2001 SMI-451502154417600-000000001 26 00900 PROTZMAN, ROBERT R P 12/03/2001 12/03/2001 $120.00 $26.58 $26.58 00900 PROTZMAN, ROBERT R 71516 SMI-451502154417800-000000002 25 P 12/03/2001 $145.00 $76,33 $76.33 71516 12/03/2001 24 00900 PROTZMAN, ROBERT R P SMI-451502154417800-000000003 12/03/2001 $8.00 $3.56 $3.56 71516 12/03/2001 SMI-451502154417800-000000004 23 00900 PROTZMAN, ROBERT R P 09/24/2001 $34,00 $9.90 $9.90 7245 09/24/2001 SMI-452201284198630-000000001 22 00900 MILLER, ALAN P 09/24/2001 $30.00 $7.79 $7.79 71946 09/24/2001 SMI-452201284198630-000000002 21 00900 MILLER. ALAN P $67.00 $27.97 $27.97 7840 09/24/2001 09/24/2001 SMI-452201288108920-000000001 20 00900 LUM, DANIEL C P 11/07/2001 $155.00 $62.13 $62.13 4556 11/07/2001 SMI-452201324489560-000000001 19 00900 TRUONG, HOA L P 11/07/2001 $45.00 $16.88 $16.88 V762 11/07/2001 SMI-452201324489560-000000002 18 00900 TRUONG, HOA L P 11/26/2001 $67.00 $27.97 $27.97 71946 11/26/2001 SMI -452201346438960-000000001 17 00900 LUM. DANIEL C P 12/12/2001 $100.00 $61.85 $61.85 12/12/2001 SMI-452201362542810-000000001 16 00900 PROTZMAN, ROBERT R P 12/27/2001 $3,735.00 $513.08 $513.0B 7172 12/27/2001 SMI-452202010695880-000000001 15 00900 PROTZMAN, ROBERT R P 05/06/2002 $67.00 $16.74 $16.74 311 05/06/2002 SMI-452202134227960-000000001 14 00900 LUM, DANIEL C P 04/23/2002 04/23/2002 $33.0C $26.4C $26.40' STRATEN, SUSAN M V7612 SMI-452202140485090-000000001 13 00900 P 07/18/2002 $67.00 $16.7^ $16.74 311 07/18/2002 SMI-452202217224220-000000001 12 00900 LUM, DANIEL C P •^ Date: 02/28/200.; TrailBlazer Health Enterprises, LLC Page 2 Diagnosis Code From Date To Date Total Reimbursed Conditional Llne# Processing Provider Name TOS ICN Charges Amount Payment Contractor Amount 73300 10/30/2003 10/30/2003 $20.00 $14.80 $14.80 JPS HEALTH NETWORK V0481 0 SMI-20332302913601 28 00400 07/27/2004 07/27/2004 $3,026.00 $337.19 $337.19 00400 JPS HEALTH NETWORK V7651 0 SMI-20421801487101 1 12/27/2001 12/27/2001 $150.50 $120.40 $120.40 SM1-451502011040580-000000001 27 00900 ' RICHARDSON, KENNETH W 7175 p 12/03/2001 $190.00 $92.74 $92.74 PROTZMAN, ROBERT R 71516 12/03/2001 SMI-451502154417800-000000001 26 00900 p 12/03/2001 12/03/2001 $120.00 $26.58 $26.58 00900 PROTZMAN, ROBERTR 71516 p SMI-451502154417800-000000002 26 12/03/2001 12/03/2001 $145.00 $76.33 $76.33 PROTZMAN, ROBERT R 71516 SMI-451502154417800-000000003 24 00900 p 12/03/2001 12/03/2001 $8.00 $3.56 $3.56 00900 PROTZMAN, ROBERT R 71516 p SMI-451602154417800-000000004 23 09/24/2001 09/24/2001 $34.00 $9.90 $9.90 00900 MILLER, ALAN 7245 p SMI-452201284198630-000000001 22 09/24/2001 $30.00 $7.79 $7.79 71946 09/24/2001 SMI-452201284198630-000000002 21 00900 MILLER. ALAN p 09/24/2001 $67.00 $27.97 $27,97 7840 09/24/2001 SMI-452201288108920 -000000001 20 00900 LUM, DANIEL C p 11/07/2001 $155.00 $62.13 $62.13 4556 11/07/2001 SMI-452201324489560-000000001 19 00900 TRUONG, HOA L p 11/07/2001 $45.00 $16.88 $16.88 V762 11/07/2001 SMI-452201324489560-000000002 18 00900 TRUONG.HOA L p 11/28/2001 $67.00 $27.97 $27.97 71946 11/26/2001 SMI-452201346438960-000000001 17 00900 LUM. DANIEL C p 12/12/2001 $100.00 $61.85 $61.85 7175 12/12/2001 SM1-4522O1362542810-O00O00OO1 16 00900 PROTZMAN, ROBERT R p 7172 12/27/2001 12/27/2001 $3,735.00 I $513.08 $513.08 SMI-452202010695880-000000001 15 00900 PROTZMAN, ROBERT R p 05/06/2002 $67.00 $16.74 $16.74 311 05/06/2002 SMI-452202134227960-000000001 14 00900 LUM, DANIELC p 04/23/2002 $33.00 $26.40 $26.40 V7612 04/23/2002 SMI-452202140485090-000000001 13 00900 STRATEN,SUSAN M p 07/18/2002 $67.00 $16.74 $16.74 311 07/18/2002 SMI-452202217224220-000000001 12 00900 LUM, DANIEL C • p ^ Date: 02/28/2001* TrailBlazer Health Enterprises, LLC Page 3 From Date To Date Total Reimbursed Conditional Provider Name Diagnosis Code ICN Line* Processing Charges Amount Payment TOS Contractor Amount 12/19/2002 $67,00 $16.74 $16.74 311 12/19/2002 SMI-452203015133080-000000001 11 00900 LUM. DANIEL C P 06/26/2003 $47.00 $18.24 $18.24 73300 06/26/2003 SMI-452203204254410-000000001 10 00900 LUM, DANIEL C P 08/29/2003 $67.00 $27.21 $27.21 73300 08/29/2003 SMI-452203268183490-000000001 9 00900 LUM, DANIEL C P 10/08/2003 $82.00 $49.16 $49.16 V7651 10/08/2003 SM1-452203295123740-000000001 8 00900 ZIEGLER, DANIELW P 12/06/2001 $1,216.00 $391.78 $391.78 7172 12/06/2001 SM 1*452801355268270-000000001 7 00900 SCHULTZ, STEVEN P 12/27/2001 $5,854.75 $479,38 $479.38 8361 12/27/2001 SMI-452802009268000-000000001 6 00900 451011 P 06/16/2003 $245.00 $104.92 $104.92 73300 06/16/2003 SMI-452803199767370-000000001 5 00900 TAYLOR, DENISE J P 03/10/2004 $67.00 $28.23 $28.23 490 03/10/2004 SMi-452804146321680 -000000001 4 00900 LUM, DANIELC P 07/27/2004 $962.00 $163.66 $163.66 ZIEGLER, DANIEL W V1272 07/27/2004 SMI-452804222745350-000000001 3 00900 P 07/07/2004 $47.00 $31.35 $31.35 V7651 07/07/2004 SMI-452904194189130-000000001 2 00900 ZIEGLER, DANIEL W P Total Conditional Payment: $3,171.73 "->} w '-tf CONSENT TO RELEASE FORM The Privacy Act of 1974 (Public Law 93-579) prohibits the government from revealing information from personal files without the express writtenpermission of the person involved. Disclosure of personal records to an attorney or other representative who is acting on behalf of another person is prohibited, unless the individual to whomthe record pertains hasconsented. I* ihu-M S^rxoskn , hereby authorize the Centers for Medicare &Medicaid. Services (CMS), hs agents'and7or contractors to disclose, discuss, and/or release, orally orhi writing, information related to my injury andVor settlement to the indrvidual(s) andVor firm(s) listed'uStOW. . xiiis consent is-tor my current Ciairo anu is on an •ongoing basis. An additional "• consent to release form will not be necessary unless or untilI revokethis authorization (which must be in writing). PLEASE CHECK: H*) Beneficiary's attorney Rad -0\ \a) •RM (name and/or firm) • Other Party's attorney (name and/or firm) I I Workers' compensation carrier/Insurer (name and/or firm) Q . .Other. . (Forexample, personal representative (name and/or firm) or spouse) Beneficiary's Signature " ' /f a-IK- 9/^n^ Date Sisned %L-Z\-llcl7 fi- Date of Injury Social Security Number Or Health Insurance Claim Number MSP9D767:RELEDr:D9/09/20D5 Rad Law Firm ALIEN A. RAO. U.B.. U.M.. 1.0.'+ A pROFESS[oNAL CORPORATE OAUAS. IEXAS OFFICE: „4(. R. HARO.SON. Adam u nen< J.O.- ln m«»xu North n.-uc Dallas B*u» Bank Tnu/cn Tower NOS1M PR 0Atl*S BANK TOW" MACDALENA VlLLALOBOS. J.D. llQAA Dnt-r-rrtW Dnm CiiitC Q fl ft 12900 PRESTON ROAD, SUITE 9UU Dallas. Texas 75230-1325 WA0f a. barrow, j.d. Dallas, Texas 75230-1325 |972) „,.,„, Fax (972| 461.3537 donmo"?teller. J.D. TELEPHONE: (972) 661-0181 FACSIMILE: (972) 661-3537 »,»,«„, texas off.ce: E-mail Address: TheFirm@RadLawFirm.com Banj. ONE Buiioing • Also Licenseo in New York I 600 F.. Pioneer Parkway. Sujie 335 + ALSO LICENSED IN D.C. ARLINGION. TEXAS 76OT0-6562 - Board Certified Personal Injury MaV 26 2005 |8l7) $43-1999 Fax (817) 543-1993 Triai Law FORT WOIIH, TEXAS OFFICE: Banc One SuhOinc 2001 Beach Streei, Suite 600 Fi. Worn.. Texas 76103-2314 17] 543-1999 Fax {817| 543-1319 Ms. Thuy Sunosky 5932 Broadway Haltom City, Texas 76117 Re: Cause No. 2002-013404-1; Sunosky vs. Razo and Allstate Dear Ms. Sunosky: Please be advised the Court has reset this case for trial the week of July 25,2005. Also, please be advised we have rescheduled the arbitration for July 19,2005, at 1:30 p.m. at GammonMediations. I am enclosing a map with directions to Gammon Mediations. Thank you for your attention to this matter. Please do not hesitate to contact me should you have any questions. Sincerely yours, RAD LAW FIRM Kim Wong Litigation Manager /kw sr/^-c^o ^>, v. JA FLLEN A. RAO.lLlTB.. LL.M f^OAW R. Hardison. J.O.- J.D. Rad Law Firm a professional corporation DALLAS. 1*5CAS OFFICE: Norik Dallas Bank 1o«I« 12900 PRESTON Road. Suite 900 Dallas. Texas 75230-1325 (972) 661-1111 Fax (972) 661-3537 MaBia DEL Carmen MCCABE. J.D. North Dallas Bank Tower ARLINGTON. TEXAS OFFICE: Rat Galvan. JR.. J.D. 12900 preston road, suite 900 6 mi One Building MaGDALENA VlLLALOBOS. J.O. 1600 E. Pioneer Parkway. Suite 335 Dallas, Texas 7S230-132S Arlington, Texas 76010-6562 Wade a. Barrow. J.D. TELEPHONE: (972) 661-1111 FACSIMILE: (972) 661-3537 (617) 543-1999 Fax |817| 543-1993 ALBERTO POSADA. J. 0. E-MAIL ADDRESS: THEFIRM@RadLAWFIRM.COM FORT WORTH. TEXAS OFFICE: Banc One BbUO'Nu Shawn Thompson. J.D. 2001 Beach STREET. SuilE «00 of counsel. Ft. worim. Texas 76103-2314 donald e. teller. j.d. IB 171 54?-1999 F». IBl'l 5 4 3-1319 • also licensed in new york * also licensed in d.c. - board certified personal iniury Trial law Ms. Thuy Sunosky 5932 Broadway Haltom City,TX 76117 VIA CM/RRR: 7001 0320 0004 2121 8007 Re: PIP Check for Motor Vehicle Accident on6-24-03 Dear Ms. Sunosky: Enclosed please find check nunfeSaagg^35ffbm Allstate Insurance Company in the amount of$2,500.00 for your PIP claim forSie^ove-mentioned accident. The back ofthe check has been endorsed by the firm arid requires your signature on the back as well for you to deposit or cash. Thank you for choosing RAD LAW FIRM to assist you in this matter. We welcome »T~~-^ your comments, questions regarding handling ofyour case. Please do not hesitate to contact us should you need our services in the future. We, the attorneys &staff at this firm, greatly appreciate your recommendations of this firm to others. Should you have any questions or need further assistance, please do not hesitate to contact me at the number listed above. Yours Truly, RAD LAW FIRM j$7vn Ywv^ AnnTran Legal Assistant to Attorney Adam R. Hardison (972)331-5047 ARH/at 6 THUY NGUYEN. SUNOSKY' POLICY NUMBER eC £7 CLAIM NUMBER °^ /. -nft",AiA'-> ) SOUTHWEST ~ \ INSURED 5164-93658- * «4i£7 ° J ° 2° ' ^ ^TA CENTER, -7?7^ia»u......jkl,^.-^ ;CLAIM CLAIM CHECK CHECK CLAIMANT OESKLOC EMPLOYEE 1.0 b L A1 ft I- 0 R Pfc. K&UNftL • 1 NJ UK.Y " " fipqUnqg .:• SSN/TIN ACCOUNT.. 75-2530225- RSK IP4B \>n01i:.(inun 13eni"h.a:i&,. ak:ts:rng Bank o! America, N.A. ... . .•• Bank of America 64-1276 Ailqnla.Dekalti County. Georgia j^j5iDrafli£onD£Oion- 611 "'•;. TUG"••TMOy^Nlf Fg^l^HiJ^ftRlD ffifes***** •'$*#** 2.500. 00 DATE ISSUED^ *" P*V" " . .". « : •""- - * -L» ,-ifv-" W"L jf. i „ LumromuBW. INVOICENUMBER' "!• :;1 •.PftftftMCQ-- I IRS I PAYgfcT 0742 S i'6 """Si: ..-1 OS: 07= KM J*Q:iito C Allstate IS . y • You're In good hands, r £•, Ne*ADAHE8«*NT8:PAyA9iJ!irDESII^AtaM«0»!AMEniCA.'(«VADAHX ALLSTATE INSURANCE COMPANY OR ONE OF113AFHUMES THUY NGUtSi^'ijLJNOSKY COMPANY NAME btcu^rifj'L'** • TOTHE^AWSM^^t^Wr-F^Mr © DMHonUA T™ 'n&R^vtwfiwev- ALLSTtfTR RRORBRTY AM) ^^SUAIiTY'^iNSLi RANGE7 CO HPANY • AUTHPRIZED SIGNATURES yQ'D g^OT ggf?f^Jffj^gJiiJiigg^JJ^PP^- SIXTY-FIVE DAYS OF THE DATE OFjSgjJE^ (•USqflfl&BSii- i:0£iil2?flfl'S 321 ^RU 07E.R«" Stephen L. Brotherton, MJ> ' / / DfS#Ft«»16S7 DPS*C0067039 ' ' pfA0BM1523U2 I* A 0 BM1523U2 * IT DEA#AB2130S7* B-^VuxiAM a Coleman, M.D. DPS * M0061416 Steven J. Meyers, MJ>. DPS # 40110956 ^ONE&JOIKTCLINIC DEA # BC0293465 Til** MMttll «»•• P««T ••«»»• a William H-Mitchell, MJX DEA # BM63080S8 MaRKW.WyiJE,MJ). DPS it K0010707 DEA#AM2212481 DPS # 30129234 1651 W. ROSEDALE, SUITE 200 O James Brezina, MJ>. DEA#BW76t9731 FORTWORTH, TEXAS 76104 DPS # N0159654 Donald Dolce, MJX 817-335-4316 DEA # FB0956358 DPS # 10198591 Q William Lowe, MJ>. fti?y JvJ/?_CL£k^ DEA # FD4374485 DPS #30095188 DEA0BL1O78129 For D.0.B.. Address. Date 34nLf a REFT.UP-OCT- 12 3 4 TOMES P.R.N.O NON-REP O iL^j^i M.D- ~~RECEIVED OCT 2 6 2015 COURT OF APPEALS SECOND DISTRICT OF TEXAS DEBRASPISAK. CLERK 0i»'." .00 Suncteky Thuy T texas health care, p.llc •imimmtrAtit'&l Birth: 12/10/1941 h Desc: RT KNEE, AP/OLV •H. LOW^EXM Exam Date: 7/9/2015 lyng&ky Thuy T TEXAS HEALTH CARE, P. Birth: 12/10/1941 Desc: RT KNEE, LATERAt / LOWJEXM Exam Date: 7/9/2015 OLE "^•.wsrs"'.'^' """"»" vr*': ~r:v:- v:-r%<- - * w — ^Bj" • T""V5W*-,'y • .*jp •TPr?f^.; ;•£" " r • -tU*. 5^ ft: William G. Coleman MD TEXAS HEALTH CARE, P.L.L.C. 1651 West Rosedale Suite 200 Fort Worth, TX 76104-7437 Phone: (817)335-4316 Fax: (817)338-0342 ent. Thuy Sunosky e of Birth: 12/10/1941 03/17/2014 10:30 AM ,t Type: Office Visit ; 72 year old female presents for Follow Up of right knee. story of Present Illness: Follow Up of right knee h bout ayear ag0 and she was going to get aknee some hritis and degenerative disc disease. jst Medical History: jviewed, no change. Jlergies: eviewed. no changes. :amily History: Reviewed, no changes. Social History: Tobacco use reviewed. Reviewed, no changes. VITAL SIGNS HEIGHT in cm Last Measured Height Position Time ft 10.00 147.32 09/22/2011 11:24 AM 4.0 BSAm2 WEIGHT/BSA/BMI °<- BMI kg/m2 kg Context Time lb oz 21.53 46.720 11:24 AM 103.00 Cuff Size BLCOD PRESSURE Site Method Position Side Time BP mm/Hg 11:24 AM 71/52 Sunosky, Thuy T . 000000240362 12/10/1941 03/17/201410:30 AM Pag* 1/2 "jsky Thuy T 0..34; .AS HEALTH CARE. P.L.L.C. .D: 46631319| >\.,*m iirth: 12/10/194l| Desc: RT KNEE,!, lIiIf;;LOW EXlVCi Exam Date: 1/1TlM i'-fr! DOVI W ?43? I -u??. Wiliiam G. Coleman MD TEXAS HEALTH CARE, P.L.L.C. 1651 West Rosedale Suite 200 Fort Worth, TX 76104-7437 Phone: (817)335-4316 Fax: (817)338-0342 Patient: Thuy Sunosky Date of Birth: 12/10/1941 Date: 03/27/2014 3:30 PM Visit Type: Office Visit H:5"orian: self This 72 yearold female presents for Back pain. History of Present Illness: 1. Back pain Patient f/u for her lower back. She is here with her MRI. MRI does show probably the most significant disc with acentral to the right side protrusion at 4-! Past Medical History: Reviewed, no change. Allergies: Ingredient Reaction Medication Name Comment NO KNOWN ALLERGIES Reviewed, no changes. Family History: Reviewed, no changes. Social History: Reviewed, no changes. VITAL SIGNS HEIGHT Time ft in cm Last Measured Height Position 2:51 PM 4.0 10.00 147.32 09/22/2011 WEIGHT/BSA/BMI Time lb oz kg Context % BMI kg/m2 BSAm2 2:51 PM 103.00 46.720 21.53 BLOOD PRESSURE Sunosky, Thuy T. 000000240362 12/10/1941 03/27/2014 03:30 PM Page: 1/2 From Envision Radiology 1.888.831.2485 Mon Mar 24 11:52:02 2014 MST Page 1 of 2 PATIENT NAME: BIRTH DATE: SUNOSKY, THUY 12/10/1941 Q ENVISION IMAGING MPW: PEN1634 DATE OF EXAM: 3/21/2014 REFERRED BY: William Coleman, MD 1651 West Rosedale, Ste 200 Fort Worth, TX 76104 EXAM: MR LUMBAR SPINE { HISTORY: MVA 2001. Lower back pain. TECHNIQUE: MR examination of the lumbar spine was performed using sagittal and axial images without contrast administration. Comparison: None FINDINGS: Rve lumbar vertebrae are assumed to be present for the purposes of this examination, but if intervention is planned plain film con-elation is recommended regarding the appropriate levels. There is a mild curvature of the lumbar spine with convexity tothe right. At the T12-L1 level degenerative disk desiccation is present without loss of height of the intervertebral diskspace. Mild posterior spondylosis is present. At the L1-2 level degenerative disk desiccation is present with loss of height of the intervertebral disk space. Signal changes adjacent to the endplates are compatible with degenerative disk disease, with subchondral edema suggesting this may be a pain generator. There is moderate posterior spondylosis and old in disk with mild effacement of anterior thecal sac. At the L2-3 level degenerative disk desiccation is present with mild loss of height of the intervertebral disk space. Signal changes adjacent to the endplates are compatible with degenerative disk disease. Posterolateral spondylosis is present with associated disk protrusion. At the L3-4 level degenerative disk desiccation is present without loss of height of the intervertebral disk space. There is moderate posterior disk protrusion which appears broad base with mild effacement and two thecal sac. At the L4-5 level degenerative disk desiccation is present with mild loss of height of the Page 1 of 2 815 Pennsylvania Ave. , FortWorth, TX 76104- Phone;8173210300 - Fax: 8173210399 Name: Sunosky, Thuy DOB: 12/10/1941 Date: Insight Diagnostic Center Fort Worth 1199 8th Ave Fort Worth, TX 76104 Phone: 817-335-9729 Fax: 888-854-1510 To: Joseph G Carter, MD Name: Thuy Sunosky 2919 Markum Dr CDI MRN: 97535847 Referring MRN: Fort Worth, TX 76117 Phone: - DOB: 12/10/1941 Gender: Female Phone: 817-831-0321 Exam Date: 01/31/2014 Fax: 817-831-3211 Referring Phys.: Joseph G Carter, MD EXAM: X-RAY LUMBAR SPINE 4+ VIEWS CLINICAL HISTORY: Back pain. FINDINGS: 5 views of the lumbar spine are provided. There is normal alignment of the lumbar vertebra. There is mild disc space narrowing and spondylosis at Ll-2. The disc spaces are otherwise maintained. There is no evidence of a compression fracture or bone destruction. The pedicles are intact. There is no spondylolysis or spondylolisthesis. There is mild facet joint osteoarthritis at L5-S1. The bones are diffusely osteopenic. IMPRESSION: 1. DEGENERATIVE CHANGES IN THE LUMBAR SPINE AS DESCRIBED. 2. DIFFUSE OSTEOPENIA. TA/pp Interpreting Physician ~~ Terri Allen, M.D. Electronically Signed: 1/31/14 2:43pm Printed: 3/12/2014 12:28 pm DIAGNOSTIC REPORT Page 1 of 1 From Envision Radiology 1.888.831.2485 Mon Mar 24 11:52:02 2014 MST Page 2 of 2 PATIENT NAME: SUNOSKY, THUY S) ENVISION IMAGING BIRTH DATE: 12/10/1941 !^ MPI#: PEN1634 DATE OF EXAM: 3/21/2014 intervertebral disk space. There is a broad-based posterior disk protrusion extending 5-mm from the posterior vertebral margin and 17-mm from medial to lateral'with moderate effacement of the anterior thecal sac. The AP diameter of the sac measures 10 mm. Posterolateral spondylosis is present. At the L5-S1 level there is degenerative disk desiccation without loss of height of the intervertebral disk space. There is a moderate broad-based central posterior disk protrusion extending approximately 3mm from the posterior vertebral margin. Moderate facet arthropathy is present in the left with mild facet arthropathy on the right. There is mild encroachment left neural foramen. The vertebral alignment appears normal. No fracture or compression is seen. The conus medullaris lies in normal position. No other significant finding isseen. IMPRESSION: Large broad-based central posterior disk protrusion at L4-5. There is mild encroachment on the left L5-S1 neuraiforamen. Subchondral edema associated with degenerative disk disease at L1 -2 suggests this may be apain generator. Moderate multilevel degenerative changes of the lumbar spine otherwise as discussed above. Finalized BY: 79 UJENSEN, RICHARD MD 03/24/2014 12:4457 Report Ends Richard Jensen, This document was electronically signed by Richard Jensen, on 3/24/2014 Pa9® 2of * 815 Pennsylvania Ave. .Fori Worth. TX 76104 -Phone: 8173210300 •Fax: 8173210399 Name: Sunosky, Thuy DOB: 12/10/1941 Date: Summary View for Sunosky, Thuy T ' .-" .4• Page 1 of 2 Patient: Sunosky, Thuy T ^ It/JO £fjTL / Progress Notes provider: Joseph GCarter, MD Account Number: 118741 DOB: 12/10/1941 Age: 73 Y Sex: Female Date: 06/25/2015 Phone: 832-423-1344 Address: 5932 Broadway Ave, F«4»J«(e^|tffk/jftl7 Subjective: OCT 26 2015 Chief Complaints: COURT OF APPEALS 1. on labs results and Rt^^^caH^yg^^g HPI: DEBRASPISAK, CLERK Constitutional: Patient presents to clinic for FU and review of her recent labs. She is doing well over all but still having problems with right kne and lower back pain. She has had this for years and was told she needs knee surgery but she lives alone and has no transportation so she has been hesitant. Her labs are unremarkable and show excellent crontol of DM and lipids. ROS: FoIIqw-Ud Review of Systems: General: no fever, no chills, no fatigue. Cardiology: no leg swelling, no chest pain. Gastroenterology: no nausea, no vomiting, no diarrhea, no abdominal pain, no constipation. GU no dysuria, no frequency, no incontinence. Musculoskeletal knee pain, back pain. Neurology: no headaches, no dizziness. Pulmonology: no shortness of.breath, no cough. Medical History: Osteoarthrosis, unspecified whether generalized or localized, lower leg , Nuclear Sclerosis , Lower back pain/Lumbago . Surgical History: knee surgery , hysterectomy partial . Family History: Father: deceasedMother: deceased 1 brother(s) , 1 sister(s) - healthy. 2 son(s) , 1 daughter(s) - healthy. Social History: Tobacco Use: Smoking Are you a:: never smoker. Drug/Alcohol: Alcohol Points: 0. Medications: Taking Evista 60 MG Tablet 1 tablet Once a day, Taking Tramadol HCI 50 MG Tablet 1 tablet as needed BID, Medication List reviewed and reconciled with the patient Allergies: Fosamax. Objective: Vitals: Wt_99^.Ht 57, BMI 21.51, Temp 98.2, HR 83, BP 100/68, RR 17, HC n/a, Oxygen sat % n/a, LMP: n/a vitals by Et. Examination: General Examination: GENERAL APPEARANCE: in no acute distress, pleasant, well nourished. EYES: conjunctiva clear, PERRLA, sclera clear, no scleral icterus. ORAL CAVITY: clear, mucosa moist, moist tongue. CHEST: symmetrical respiration. EXTREMITIES: no clubbing, no edema. DIABETIC FOOT EXAM Circulation normal. PSYCH appropriate mood and affect. Assessment: Assessment: 1. Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled - 250.00 (Primary) 2. Degenerative arthritis of knee - 715.96 3. Chronic back pain - 724.5 4. Breast cancer screening - V76.10 5. Special screening for malignant neoplasms, colon - V76.51 https://txtrpaapp.eclinicalweb.eom/mobiledoc/jsp/catalog/xml/printChartOptions.jsp?enco... 6/25/2015 3* » «^_£ummary View for Sunosky, Thuy T -'•« Page 2 of2 Plan: 1. Degenerative arthritis of knee Referral To:William Cofeman Orthopedic Surgery Reason: 2. Chronic back pain Referral To:Ashley Classen Pain Management Reason: 3. Breast cancer screening Imaging: MAMMOGRAM, SCREENING 4. Special screening for malignant neoplasms, colon LAB: FOBT Occult Blood. Fecal. IA Follow Up: 6 Months Provider: Joseph G Carter, MD Patient: Sunosky, Thuy T DOB: 12/10/1941 Date: 06/25/2015 Electronically signed by Joseph Carter, MD on 06/25/2015 at 10:02 AM CDT Sign off status: Pending https://txtrpaapp.eclinicalweb.comVmobiledoc/jsp/catalog/xml/printChartOptions.jsp?enco... 6/25/2015 •i-'i. ± '.. Fashion Design RECEIVED DCTf 6 20 Custom Fine Tailoring COURT OF ^HtiTTS SECOND DISTRICT OF TEXAS DEBRA-P^ Alterations Patterns Designed For Men and Women Make Patterns For Sale « Call (817) 834-8404 or (817) 595-1579 Inexpensive Rates For Professional Services IHP If tSLWs .!'.: .to mi"-® Eashion Design Custom Fine Tailoring Alterations Patterns Designed For Men and Women Make Patterns For Sale S Call (817) 834-8404 or (817) 595-1579 Inexpensive Rates For Professional Services H-T^5fp&i5&; ^m^^^^^^^^^^m. f%% 1 "Ai^^^m^^^M ^^K.^ ^ ^fc |;tvS»H:-t|.Wl!MI--\l'liv.l'-'3'jlMJ-i 1Ji «»lM!ffil!SSW V'iVuUWU >,l! Hi 111 s .HffltllfllWIItWHIfflf inonviv?i"n p;iwii\]Viii\RMIBiin ?ii'll?ll«l1.1'WffllJ«KBl .i!iin\i\n?i«flafiJf «^ipflipr • 11 • M ' *Vf 111 <1W "O'F'r 4WK :Lip:7imil1|?|?l#;^ 111' ! I '• iI i i " MS • ' • h?i11?nino«»7\7«^3i?ntsif-fii7\i'}7{riifli?«iAfi?tim?iifimiwr«mw*mnnnfuauwuni VUH! !H7U\H?H \7WU Ul a*jtn»!i'.n»." \l\i IN" :U^h Ji|i?iK: Wl fn }-Ul1 r;; ?u AU'i: ;h nrurMV^ny! W(Ml v7?-^ U^ Ultn ;\i i^-Vj ^(?u rn?u tp .'* ..I'M1 ;: :->, ;." ; •• .,--, ,• . -n ••»- ,,,7-. -: =•.-•.. •ntl'li-,n iTii ii.iraivn ,-?n:-J ni 111 Hi =C P; '•' HI iff ririii CM '!• I \>.i • • • \a • i« •• Ji !• T;{VTj"Vj o copyii;>'"hi', iws, i'-.yes school pubushinc. co., ii-ic , Pittsburgh, pa t SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ONDELIVERY '. ". '"" - Complete items 1, 2, and 3. Also complete A. Signature item 4 if Restricted Delivery is desired. • Agent X • Addressee Print your name and address on the reverse so that we can return the card to you. B. Received by (Printed Name) C. Date of Delivery Attach this card to the back of the mailpiece, or on the front if space permits. D. Isdelivery address different from item 1? O Yes 1. Article Addressed to: IfYES, enter delivery address below: • No ALLE'ftA.rZAOLAIM FiM Moo PtelToNba&vz-s- nE_ _—» ,3. Service Type "TyO/lJ-K nCertifiedMaIi Certified rv C3 Express Man C / IIfZ 9/1 /> ICilAA- 9W• Registered Registered • Return Receipt F for Merchandise • Insured Mail D C.O.D. 4. Restricted Delivery? (Extra Fee) D Yes 2. Article Number (Transfer from service label) i PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 l u:Si Postal Service™ •• ^'; :: GERTIFIED MAIU RECEIPT^ UMMll aa O H p- p- Ln «-n Postage Certified Fee r-=l rl Postmark n o Return Receipt Fee o • (Endorsement Required) Here a o Restricted Delivery Fee (Endorsement Required) o • "HOC Total Postage &Fees $ _. / ,. . ru ru ru ru ru ru !-=* i-q a n- • p- or PO Box Wo. SS^EH United States Postal Service First-Class Mail Postage & Fees Paid USPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 In this box • Tf/au SuAtCSfcy SiZ&BROADWAV firlsET ~ •- Hal Tom culy / f£K/tS/ T-6trh Certified Mail Provides: • A mailing receipt • Aunique identifier for your maifpiece a Arecord of delivery kept by the Postal Service for two years Important Reminders: •I Certified SrtS u5may?NlV, ^ C°mbined Mail isnot available Wi*hofRfS,-ClaSS for any class Mai,«mailor Prio% Mai^. international IMPORTANT: Save this receipt and present it when making an inquiry. PSForm 3600, Augusl 2006 (Reverse) PSN 7530-02-000-9047 " RECEIVED ^rn^^1 ranQe 'S between $500 and $200>000-5 That is, the trial court In., cour^^^^Jaq376 the power t0 hear tne case if th© amount of damages C0NpDlSTRlCT0FTEXAi> rje@HweaSA^te^S'than $500 or if the amount of damages claimed was more than $200,000.6 In her petition, Sunosky stated that she was seeking to recover not more than $50,000. The trial court had the power to hear a case involving that amount in damages.7 But at trial, Sunosky introduced evidence that her damages were over $200,000, and she asked the trial court to award her more than $200,000. The trial court concluded that because Sunosky sought to recover more than $200,000, it did not have jurisdiction over her claim. Sunosky's brief alleges that Rad failed to keep her updated on her case, failed to file her case before the limitation period had passed, and kept money that the insurance company had paid out on her claim. Nothing in her brief, however, addresses whether the trial court had jurisdiction over her claims, which was the sole ground on which the trial court ordered the dismissal of her claims.8 Although we are mindful of the difficulty that pro se litigants face, we may not 5Tex. Gov't Code Ann. § 25.0003. 6ld. 7See id. 8See Tex. R. App. P. 44.1; Britf.on v. Tex. Dep't of Criminal Jutfirv P* S.W.3d 676, 682 (Tex. App.—Houston [1st Dist.] 2002,' no pet.) (affirming the trial court's grant of a plea to the jurisdiction because the appellant failed to challenge on appeaf all of the grounds that were included in the plea). / '3 Sunosky, acting pro se, sued Rad in statutory county court based on Allen Rad's representation of her in a previous matter relating to a car accident. She r asserted that Rad agreed to represent her in the matter but then failed to communicate with her about the status of her case and failed to file suit until after the limitation period had passed. She sought damages "aggregating $50,000 or less" excluding costs and attorney's fees. Rad filed a general denial and asserted the affirmative defense of limitation and that Rad was not an appropriate party to the lawsuit. The case was called for trial on January 10, 2013. Sunosky appeared pro se. Rad did not appear. Sunosky testified along with two other witnesses. Sunosky testified that before the car accident giving rise to the claim for which Rad was to represent her, she had earned $2,000 a month, and in the eleven years after the accident, she could not work. At the conclusion of evidence, Sunosky asked the court to award her $314,000 in damages—her lost wages for eleven years plus interest. The trial court informed Sunosky that it was a court of limited jurisdiction, that it could not award her more than $200,000, and that she needed to file her claim in a district court.2 He then stated that it would "have to dismiss [her] case 2, See Tex. Gov't Code Ann. § 25.0003 (West Supp. 2013) (providing that a statutory county court has jurisdiction in civil cases in which the matter in controversy exceeds $500 but does not exceed $200,000); § 25.2221(a) (West 2004) (stating that County Court at Law No. 3 of Tarrant County is a county court at law). r- i r . r ri_^/ -VED_AGGA-R.WAL, .M^.'.-_ B-^k..j^nxJ-/Y- Teegu >alleh-M-t>. = -X— My gA.CM-Pf^r j"pe. Joseph 6- L^BxefR7...M,ai.7 Gjve_ME A HAKjpicuxp ca-K£> ptsK Pour YEA?. |OouJ. Jojo£_^5.(_2DiS'/ 1 £o_5_BE_T>£, Cail-tG^ Po^l MY 'BAe^ AmX> i^toe& AtJD. TN£ LoST U- utt of iaj&ght. my "Back aka> tiM6S 5TI U_ 4-Io-ET" ^J% Svc^eti ^CR)gE me, f\ Notary Public it^ Tf\RRft»JT COUKTTV , STATE OF TEX/VS .3 this a-ci-i-v\ X)f\-y of 3Utoe, S-otS" $&/£> Commission Eapra >P% ^v 07-18-2017 -..2* / 4 Mcj'oiL.. i f XHAVE. WEW..DocroK:W^^r^-~ :j * kj^l H6Aes wow, "^ Mot, ok, Sttow s J- G6T P&IEJtZoQjDOQ -' .-*-«*«•\\^ "i. MEvEe. SiGioeD We^. Before, i EASEEP Cwecefofc. ^3,6^S16g "To ?ay DR. J6ff-£6Y MeGOvAt./vj to g^E me A fefJD jKE OjuCD t::5EP TAE MOmEy F£oaa rU S(DES jMSuRA»oG5 . X . LOSE Ms< J oT3 TEA" X U^^T To -32^-teoL ?aR. X KAv/E S*C((j_ to XXS\Gto ClotmES AED X Lose aay 'Hostess, TAilc^ TOO ff.OAA CM^ ACC-vDEMT "2o o LX-JlA:l/Jt-U/-0-lk. T Uu£r Ece WHOLE T(MEAA5\Y6*eS Haw X -Since .tkJ^T" Aml> avY Cou12te pbCUMENTT SE-ot/JS X SuE A^e. A.^XD po1^_4X2o_Qr.Oao_rroo. MY CAS£ X>oco^e,MT 3t l20E{-OOqcYAE2. - TMSBD-fo., A/mjJ ci-.i mzd s ^. y^2 *0f* 07-18-2017 •/°*v 1401 Henderson Street • Fort Worth. TX 76102 »17-332-3664 • Fax XI7 SX2-C>SKX \ iltlflit'ih e in in ntiiH'itt. iiilitfi'iviifi in Iiff Medial Branch Block You have been scheduled for this procedure as your next diagnostic nerve block. The nerves (medial branch of the dorsal ramus) which come from the primary nerve root at any given spinal level, supply the joint at that level as well as a portion of the muscle on either side of your neck, mid back or low back. This nerve block is intended to determine whether you have pain associated with the facet joints, the disks which are in between each of the spinal vertebrae, or a combination of both of these areas. This nerve block is purely diagnostic although some patients receive more than a few hours, and sometimes a few days relief, depending on several factors. This nerve block is not intended to cure your pain, rather it is only to determine where the pain is coming from. Procedure Date: w> ot ScXcMkJl Time of Arrival: ^- TRINITY PAIN MEDICINE ASSOCIATES, P.A. PRE-PROCEDURE INSTRUCTIONS Patient Name: PI LAB WORK APPOINTMENT WiKJSfs Date: Time: Location, „______ __ Thefollowing instructions must be followed prior to your procedure. Please keep this form for future reference. Q 5 DAYS PRIOR TO PRE-PROCEDURE LAB WORK STOP your ASA, aspirin. Coumadin^nd/an^type otblood thinners(Plavix, Warfarin, Effient, Xaretto.etc), anti-inflammatory medications (Naprosyn, ^6pfof0,-:'^\/^lt^ewe, Ibuprofen, Motrin.etc), vitamins, herbs, diet pills and energy drinks. Do nottake any ofthese medication's untiiafter-your procedure unless instructed by Dr. Classen. You are allowed to take Tylenol (over-the-counter) for pain control. Please remember that the use of the medications and supplements listed above can affect your lab work results and may result in cancellationof your procedure. PROCEDURE DATE: TIME:^ Thefollowing instructions must be followed priorto your procedure. Please keep this form for future reference. —> 12 HOURS PRIOR TO YOUR PROCEDURE REMOVE ALL PAIN PATCHES. -♦ 8 HOURS PRIOR TO YOUR PROCEDURE STOP TAKING ALL PAIN MEDICATIONS, INCLUDING OVER THE COUNTER PAIN MEDICATION. —•PLEASE DRINKWATER UP TO 2H0URS PRIOR TO PROCEDURE. —• DO NOT EAT ANYTHING 6 HOURS PRIOR TO YOUR PROCEDURE, INCLUDING GUM, CANDY, OR MINTS. -> DO NOT TAKE DIABETIC MEDICATION, INCLUDING INSULIN, AFTER MIDNIGHT BEFORE YOUR PROCEDURE. -» HOWEVER, IFYOU TAKE MEDICATION FOR SEIZURES, BLOOD PRESSURE, HEART, OR REFLUX, TAKE THESE MEDICATIONS AS SOON AS YOU GET OUT OF BED WITH A SMALL CUP OF WATER. -*• DO NOT TAKE DIURETICS, (WATER PILLS) THE MORNING OF YOUR PROCEDURE. IF YOU USE AN INHALER, PLEASE BRING IT WITH YOU TO YOUR PROCEDURE APPOINTMENT. NOTOBACCO PRODUCTS AFTER MIDNIGHT (CIGARETTES, CHEWING TOBACCO, E-CIGARETTES, SNUFF, ETC. I HAVE RECEIVED INSTRUCTION SHEETS CONCERNING MY NEXT PROCEDURE WHICH IS A -»IF YOU ARE FEELING ILL, HAVE A FEVER, OR ARE HAVING NO PAIN; PLEASE CALL OUR OFFICE PRIOR TO COMING IN. Q PROCEDURE PAY/POST PROCEDURE ©You must have someone drive you to our facility priorto your procedure and remain in the facility unless appropriate measures have been arranged with our staff. Aresponsible person must be able to be with youat home the day of yourprocedure. {fs If you are undergoing a discogram, your driver mustbe present throughout the procedure. If your driver is notpresent during the discogram, your procedure will not be performed. You wilt notbe permitted to drive for 24 hours following the procedure.* * 3. You mayhave increased discomfort forthefirst 48 hours post procedure. You maytake pain medications as prescribed by Dr. Classen for your discomfort. Please remember thatdepending on the typeof block and use for diagnostic purposes, the relief you may receive maybe immediate but not long lasting. It is important to remember this when the clinic performs its follow up call. 4. Phone calls will be returned the day of inquiry. Please be patient with a returncall as we address all matters after direct patientcare is completed in the office at the end of the day. 5. Prescriptions are filled Monday through Thursday only. Call pharmacy 72 hours beforeyouneed your prescription. 6. Our phones are answered 24 hours a day, 7 days a week. Specific instructions foremergencies are detailed on our automated voice . processing system. 7. OUR OFFICE HAS A "NO SHOW. NO MEDICATIONS" POLICY. FAILURE TO SHOW FOR APPOINTMENTS WILL RESULT IN A DENIAL FOR MEDICATION. 8. THERE WILL BE A CHARGE FOR A LESS THAN 24 HOUR NOTIFICATION OF CANCELLATION OF AN APPOINTMENT OR A NO SHOW. I hereby acknowledge receipt of these instructions and understand all of the above. PatientSignature/Representative Date/Time of All Signatures Trinity Pain Medicine Associates Staff Member WHITE COPY-OFFICE YELLOW COPY-PATIENT 1401 Henderson Street Fort Worth, TX 76102 Ph: 817-332-3664 Fax: 817-882-9888 APPLICATION FOR. DISABLED PEPS CM IDENTIFICATION PLACARD AND/ CF, DISABLED PERSON LICENSE PLATE WARMING! TRANSPORTATION CODe. §502.4". 0. PROVIDES iRAi FALSIFYING INFORMATION ON ANY REQUIRED 5 1A1EMEMT OR APPLICATION IS THIRD-DEGREE FELONY. THIS SLOCK FOR TAX ASSESSOR- Blue placards may be issued for disabilities (permanent or temporary) in which the person cannot walk COLLECTOR USE ONLY without the use of or assistance from an assistance device, including a brace, cane, crutch, another person cra prosthetic device, or who cannot ambulate without a wheelchair qr-similar device. Hed placards may be issued for any othertypeofdisability {permanent or temporary). Disabled Person License Plates may be issued only to persons with permanent disabilities. L.CSNSE PLATS NUMBEfi(S) ISSUED !n acccraance with Transportation Code, Chapters 502and/or 581, application is hereby made ion Q (1) Red Placard or Q (2) RedPlacards (Temporary Disability) Q (i) Red Placard Qi Q (2) RedPlacards (Permanent Disability) Q (-•) Slue Placard or Q (2) Blue Placards (Temporary Oisacility) PLACARD FEE: S5.00 each Ecn^Vc,^ 2SABLE0 PERSON PA&M=£(S) iSSL'ED (Circle One) (Blue v Reel gj (1) Slue Placard or D (2) Blue Placards (Permanent Disability) Q Disabled Person License Plate LICENSE PLATE FEE:..Regular Reg. Fee RECEIPT OF STATUTORY FEE HERE3Y ACKNOWLEDGED Q Disabled Person License Plate and Q Red Placard (Permanent Disability); or D Blue Placard (Permanent Disability) ^^-xv^e^vv , TAX COUECTCftO Q Additional Set(s) of Disabled Person License Plates for specially equipped vehicles (see back for more imormation) Q Disabled Person Personalized License Plates(Complete Form VTR-3SA in addition tothisform) r^CK^iNXKry^ l, the undersigned, certify that Iam Q disabled Q making application on behalf of adisabled person and have'read theinstructions onthe reverse sideofthis application and fully understand the provisions of Transportation Code, Chapters 502 and 681. 06PLTT7 _o^a APPUCANTS NAME / INSTITU"I TION NAME (ibn-s^fiNATURe DRIVER'STjCENSEpt 1.0. orOHS NUMBER -^ DATE 5°i^Z ^ Ul^ StoAPwAY r-Sr- w w -\ — A^-iJOF. UAuttmA u -ir:.y> 'r.-rY. . •' ' I . T^XA^ iDonriwrei Ofl APPUCANTS ' w ^ *-*-* OR INSTITOTJON'S INKTrrfmON-S STREET 7&UH 1 — ii STREET AODRESS, ADDRESS. CrTY. 1 . CfTY. STATE. S — — ANO ZIPCOOE INFORMATION REQUIRED FOR ISSUANCE OF DISABLED PERSON LICENSE PLATES 5m.YEAR MODEL VEHICLE MAKE 'VEHICLE lOENTlHICATlCV NUMBER LICENSE PLATE NUMHER 2. UCENSE PLATE NUMBER VEHICLE MAKE VEHICLE IDENTIFICATION NUMBER YEAR MOOEL 1, the undersigned, certify that Iam the owner of the above described vehicle(s) or that the vehicle(s) is / are owned by an institution that qualifies for disabied .oerson license plates. Ifurther certify that the-vehicles) is / are regularly, operated by or for the transportation of the disabled person named in .he Disability Statement below or operated by the qualified institution for transpMlSHon of a disced resident of such institution. ^ly^t/. . "iTEHiCLE QwftEflf'S'OR A[^t/MSTftAf&>rs SIGNATURE i/fr/zcH | / DATE l 'EH!CLE OWNER'S NAME OR IN;STITUTION NAA/lE DISABILITY STATEMENT , TO BE COMPLETED BY APHYSICIAN: LICENSED BY THE TEXAS STATE BOARD OF MEDICO/EXAMINERS APHYSICIAN' "CENSED T^PRACTCE MEDICINE IN ARKANSAS, LOUISIANA, NEW MEXICO, OR OKLAHOMA, APHYSICIAN PRACTICING M^^J"™^'*^*™^™^™ INSTALLATION IN TEXAS, OR APHYSICIAN PRACTICING MEDICINE IN AHOSPITAL OR OTHER HEALTH FACJUTY OF ™" °fPA«™EN» 0F VETERANS AFFAIRS, OR APODIATRIST LICENSED BY THE TEXAS STATE BOARD OF PODIATRIC MEDICAL EXAMINERS 'See BackOf Application For Disability Definitions And Additional Information] I hereby certify that has (check one): t^a disability defined by Transportation Code, ~~J NAME OF DISABLED P3fl£ §681.001 (5)(8) or (C), or Qany other disability. The person's disability is (check one): "^permanent or Q temporary in nature. NAME OFU>HYSiCI/»N OR PODIATRIST PROFESSIONAL LICENSE NUMBER OF PHYSICIAN OR PODIATRIST DATE 34(4 r-W-^A^ JV Air. Uk>r4i\ STATE ZIP COOE CITY STREET ADDRESS ,^tiatnre^rph^ferjhii^p»uiut>iai''E_____^--J %*^^6&>- On this oate. , the above^med physician orpodiatrist. NAME OF PHYSICIAN OR PODIATRIST DATE appeared before me so that I could witness his/her signature. SIGNATURE OF NOTARY SEAL . PRINTED NAME OF NOTAftY • ! hereby certify that! am a notary in the State cf Texas, in , Countv. Mv commission exoires IMPORTANT! PHYSICIAN'S OR PODIATRIST'S SIGNATURE MUST 3E NOTARIZED UNLESS ASEPARATE WRITTEN ORIGINAL PRESCRIPTION IS SUEMITT; \ ^> •— Submit both copies ofthis application with applicable fees to the County Tax Assessor-Collector "" \ Vn -7 CAS£# -Zoiq-OOLfO-6^-2. j (P -DR. JoSEpM G. Otttreii/A^.T). GAv/£ ME A12£T> !UAUPICA? CARD TUAT WAS GooT> pop-. oKJUf JSIX MoVJtMS, AmP MOW I'VE TOO) |4iM THAT jl.HAP Ai AUTOMO"BlUe ACciDrjoT \w 'lool AtfD £'v£ M-u2rr f*>^ \M V6Aes MOIa), S^ -t^6 Pocto^ i lj>o&5> AT MV M"6C>(CAC A>Jp Pbcrco^s £6<^>?-"DS i W MOW I'M WAmw6 ^O^L^J^CXXX O* ^Y £*)££ awp isac<. |06w v<6 wakjts to ewe Me a "fecoe IvAawpvca'? caCD Ft^ A LouG Loajo- 11 MB ! i |l l/JAS \MjiEX (M A CA1L ACC(P5>^T \w looI, AMD MV P .MY pooco^ v4AS mou) Gtwexj Mt TAiM Me&icu^E AMP 1 AM "lAv^MG H~ uUTtuI- 6t;T THf£ $u(IiSe^Y, tUT po^'T \^rOotu tv^ATMLC MAP-pe^ APtge- SM2-66ZY l^c-iusE TH6 "SACK! \$u%jG&l>( Doctor 5AY? ~cHAt Tf-£ Tfcocepu^, ts vjot 6uA(2AMreep \ooy0. c (9) :T Aaa 'V&uj* v^eal-ttiy -e^cepr f^^l/ay y^>E& A/op "TSAct uji^cX : Stilc rru?rr fiz^M nr€ Of-AcciD&JT" (K) "2-OOl- X CA/JrJOT .|a>ORV^ "TH& -icU T^AT Ju t^E^ TO ;ScHocc_ ^roR. FoT2- TW& PAST ^ YS^fcS >JOU) JMOIaJ TH6 ALLeo A. 'PAD LAW FH*-^ V4AS to ^ay m6 $3l%{ooo Tlos ^,ooo Fofc.T'EoPUE To U^Rrre f^^-AAe i>j En£uSt-I A*-^ 5 YBAgj^ ft*. Ti^6 STATE TSASL OP Tr3AS \M 1^i5>TgLgD uertvefcs ?tus \K)Te^£ST f^^ATKe $33s(ooo- AMP TWc J^PG6 UHLC PEofPE V+OUJ MUCV4 THE ^AP UHaJ fitZAA tOiLU ?AY M& '"Pttf-THrE '¥-sCSY OP mV UE6. i_) HANhlCAP =r 2-01if ?ouU RtfoKT Loot- MEDic-AL KECoR^S DdcToKf Records RECEIVED OCT 2 6 2015 COURT OF APPEALS SfcCOND DISTRICT OF TEXAS CASE & 7ot<-f-oo<4n<^-7 DEBRASPISAK, CLERK CouVrc OP AFPEAL5 SEsJD MY Go<3D CAUSE t^U E^mZX )JO. ~2L. THAT T1MF. AAV CA^F, 6ooD. August -7 7oH{ T Tufcxira? m.v <5?ui2x- PA?gg.lM. AAAMAaeg ASi^D OMf^nzi \M .U*?E- OPPtCfL TO TAKlC, A*€. TO GO TO M'g.'S .RAggY E AM C^nJ SEX UP ay r^on-r;, .ftuT E Tjo^'T VO I TRY TO To On PAvJQ?. So S^E could S £ t UE aav ^ t J g x :pAT-P. %U3i "SKS AlAlP T. f*a TO A\AkJA^-,RZ.,S OrF-tcE T_ ASVC pog. boi4Y •poi^E r^iof, /Ag r^o -rg> couT2rr A up AA-^-s. UA£ SAV ITS Too L6aj& <^ ^(L_C-A.5_E_AG?AiiJ, * ' - f • • s , ... ' '. \J> • <• > >• ,. « • • - • • • — * ' '.• . • > * • • t • . > • • • . • 1 1 - .. • . v . • ' • • mr . •. • • - .: ' . . - ' - '• ' . . . . J' •» \ > . - ' • . i • m .jQVGfr i(J AfP&M_ Coc/l£=r "Do You -rt-H^fc: M-e.5;. *RAggy Tg-v -ce> H6LP cAwv^_I>g>j! lUv/F, TO 'PAY ME aADaj€Y_, ^ fOOu) •APPEAL £g>c/i2T 1?CFASF__tiSLJrLAl£-.-jr-. =5T((-,L H-^Err MVTgAGEL AMD MY feCMfcfl "Doctt^e. <9T\LL^ SM T- frkWfe TO £So SugiSSgY /OCKaI Aiq-Q T_ UAffix OS* E<*R. ErjcJg- YFAffS mo,wj. j>OQ-<. )n& TMu/Z. AioE? ^oscaJ&SS Am"D H <^5> ScfcfQOL, Dr5(6M CLcrT^f^_jra-^._Jg;A'gT JZUaE. foS ••Si^U jo_A?.£S&L._.. Oiff T- TPM'T/066P LA\>JY£%,...^AMX>_jj£iuI ^QS.T^AgEy ME,^<; UP .A*Y_. CASE:._1_ " — gL£^^ajK*JrlA^ii...-TMAfJ^- YOO SO AAUCH •_ . /a^SalS X Ul<^-TD--^ .Lm^K4L rr^v^.eA^e o^JUAA^gg^-.-- c #••"*, T J? n * FILED TARRAHT COUNTY CLERK fro^Qom^ im AUG -7 PH h 05 IN THE L^gip^li^tOURT fr^yr COUNTY, TEXAS dYrapinAT.nTSTRTrr THUY SUNOSKY CD -< V. <$£ Ol ALLEN A. RAD LAW FIRM m ^3 -< o o r~ m TO PC TO THE HONORABLE COURT: MRS. THUY SUNOSKY lives at 5932 Broadway Avenue, Haltom City, Texas 76117. Her SocialSecurity number is XXX-XX-X197 and her driver's license niunber is XXXXX853, issued in the state of Texas. MRS, THUY SUNOSKY (the "plaintiff") complains of MR. ALLEN A. RAD (the "defendant"), and for cause of action shows: 1. SELECTION OF DISCOVERY LEVEL The plaintiff affirmatively pleads that she seeks only monetary relief aggregating $200,000 and no more, excluding cost, prejudgment interest, and attorney's fees under Civil Procedure Rule 190.2. 2. PARTIES AND SERVICE OF CITATION