Hitech Act Request.docx

YOUR NAME AND ADDRESS HERE

Department of Health and Human Services Centers for Medicare and Medicaid Services 7500 Security Boulevard, Mail Stop N2-20-16 Baltimore, MD 21244-1850 HITECH ACT REQUEST TO CDC; CMS and (any other agency you want records from) Appeal: March 31, 2019 Dear Principal Deputy Administrator, Pursuant to the HITECH Act Request and Privacy Act, this letter serves as a request for records and data your agency has regarding me whether under my name or associated identifiers. I did not ask in my original letter under the HITECH Act but am including this in the appeal in case I need to assert my rights in Federal Court for my records as my records have been withheld by your agency for over two years without cause. My procedures/services/organ donor was done on DATE, but the people involved have often backdated the records, so the consent/waiver or authorization would be DATE or thereabouts. But, please search DATE through DATE as the billing agency that has my records says that insurance can be billed before or after the procedures and that they can use multiple identifiers if you are a human subject, which they verified I am. I do not know my state/insurance/training/or any identifiers associated with my person, but These two numbers were on my operating report though. Xxxxxxxxxxx Xxxxxxxxxxxxx Please provide me with: State health identification numbers that CDC health and medical records, laboratory profiles, or any other data you have on me as a donor, or services, procedures and who conducted them on DATE and who paid for these procedures, if you have them under your control.

Please release to me any records of procedures and services performed on DATE at Lasky Clinic Surgical Center ---Whether under Leased or Subleased Spaces (The Tenants) Rented/Leased/Subleased space from University of Southern California’s ENT department of Otolarynology (Tina and Rick Caruso’s) University of Southern California’s Real Estate Asset Management Cedars Sinai Health System leased Spaces UC Regents (The Regents) leased spaces Roh’s Lab Leased or subleased spaces i-Corp Leased or subleased spaces Brentwood Biomedical leased or subleased spaces LA County’s leased or subleased spaces and or the VA’s subleased or leased spaces (Veteran’s Administration; Veteran’s Affairs) The County Counsel Association of Los Angeles County Los Angeles Memorial Coliseum Leased or Subleased Spaces University of Southern California’s Trustee’s Leased or Subleased Spaces Community Partners Leased or subleased spaces At: 201 S. Lasky Dr Beverly Hills, CA 90210 And 153 S. Lasky Dr. Beverly Hills CA 90210 CLV Holdings 201 S. Sycamore Av. #5 Los Angeles, CA 90036 The Plans/Programs to check for my records are including but not limited to:   

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California Oral Health Plan Chronic Disease Surveillance and Research Branch The Chronic Disease Prevention Framework developed by the California Conference of Local Health OfficersCounty Health Executives Association of California plan And OB/GYN cancer health plans and women’s health plans. Genetic Screening plans CCR CCCP CBRFSS CDOC

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CDER (Emergency Response) Genetic Disease Screening Program (GDSP) California Biobank Program California Birth Defects Monitoring program (CBDMP) Genetic Disease Laboratory Program Standards and Quality Assurance (PSQA) Program Development and Evaluation (PDE) SIS IRIS  Committee of Interns and Residents program And any other programs I was used in under your control that I have not listed. And an index of any and all registries my name, identifiers, or data is in under your control. Thank you for your help. I am willing to pay $6.25 for the records as this is allowable. If the amount goes over this, please let me know. Please provide me with the signed verification and affidavit of the completeness of these records provided to me. Statement of Verification: I declare, certify, verify and state that, under penalty of perjury under the laws of the United States of America, the foregoing is true and correct. My name is_________________________ and I do not know my identifiers only that I was used as a human subject. Best Wishes,

Xxxxxxxxxxxxx Phone number