FREEDOM OF INFORMATION ACT REQUEST

July 6, 2016
VIA FACSIMILE (443) 380-7260
CMS FOIA Officer
Centers for Medicare & Medicaid Services
Mailstop N2-20-16
7500 Security Boulevard
Baltimore, MD 21244

VIA FACSIMILE (215) 861-4240

CMS, Philadelphia Regional Office
Attn: Constance Smalls
Suite 216, The Public Ledger Building
150 South Independence Mall West
Philadelphia, PA 19106

Dear Sir/Madam:
Under the Freedom of Information Act, 5 U.S.C. subsection 552, I am requesting
access to any and all documents, memorandums, notes or similar such materials
related, in any way, to the following individual:
NAME:
DOB:
SS#:
HICN:
ADDRESS:

DOLORES C. MCNALLY
1/21/1938
201-30-1809
201301809A
24 S. SYLVANIA AVENUE
ROCKLEDGE, PA 19046

or any other individual related or residing in the same household, entity or

organization with whom said individual was associated to, connected to, related
to, or which maintains any type of relationship with said individual. Please
include in your response (but do not consider this portion to limit, in any way,
the information requested) applications, examinations, examination results,
claims made, claims presented, claims honored, claims denied, payment records
made, payments requested, payments made, benefits requested, benefits paid,
records reflecting accidents, injuries, health care treatment or claims for
compensation or benefits, declaration sheets, and policies of insurance issued at
any point in time and the itemized total CMS lien regarding the above
individual.

In order to help you determine my status for the purpose of assessing fees, you
should know that I am affiliated with a private business (law firm) and am
seeking information for use in the pending litigation surrounding the abovenamed individual.
I request a waiver of all fees for this request. However, if there is a fee, an invoice
can be sent along with the requested records for payment.
I request that the information I seek be provided in electronic format, and I
would like to receive it on a CD-ROM or emailed to pleadings@Fernandeztl.com.
If you have any questions about handling this request, you may telephone me at
(904) 398-8008 or emailing me at JSleweon@FernandezTL.com.
Sincerely,

Julia B. Sleweon, Paralegal to

John M. Howell, Esquire
FERNANDEZ TRIAL LAWYERS, P.A.
8780-200 Perimeter Park Court
Jacksonville, FL 32216