Free Affidavit - District Court of Arizona - Arizona

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I JOHN M. SCALES IN THE UNITED STATES DISTRICT COURT
P.O.BOX 24501 DISTRIC OF ARIZON*
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PHOENIX AZ 85074-4501 A FNED _—mLODGED
w__RECEVED ___COPY
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A SHANNON M. CLARK g APR 21 ZBB5
HAINTIFF , CASE NO_ CIV 03 ‘¥>Hm?H§¤ev§¤E?a¤E‘§T
I VS AFFIDAVIT BY JOH BM C LESFMLZBWQ
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I VALUE OPTIONS INC. )
A ETAL DEFENDANT g
STATE OF ARIZONA , , L ,__
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1.I, JOHN M. SCALES, FIRST BEING DULY SWORN SAY: MAKE THIS
AFFADAVIT AS A FRIEND OF THE COURT AND WITNESS READY AND WILLING
A TO TESTIFY IN THE ABOVE ENTITLED CASE.THE FACTS SET FORTH HEREIN
ARE BASED ON MY OWN PERSONAL EXPERIENCE AND ARE INTENDED TO
ASSIST THE COURT IN DECIDING THE ABOVE ENTITLED CASE.
A 2. AT THE REQUEST OF THE SOCIAL SECURITY ADMINISTRATION, GREGORY
, NOVIE,PH.D. ADMINISTERED A WECHLER ADULT INTELLIGENCE SCAE_III,
MILLON CLINICAL MULTIAXIAL INVENTORY_III, AND A CLINICAL INTERVIEW.
I 3.BASED ON THESE EVALUATIONS, DR. NOVIE CONCLUDED THAT I HAVE AN ~A -~
AFFECTIVE DISORDER SINCE OCTOBER OF 2001,THAT HAS CAUSED MORE
THAN A MINIMAL LIMITATION OF ABILITY TO DO BASIC WORK ACTIVITIES,
AND I HAVE A HISTORY OF MORE THAN A YEARS INABILITY TO FUNCTION
OUTSIDE A HIGHLY SUPPORTIVE SUPPORTIVE LIVING ARRANGMENT..
4. I WAS ACCEPTED FOR A YEAR IN A VETERANS ADMINISTRATION SPONSORED.
RESIDENTIAL PROGRAM FOR PEOPLE WITH SUBSTANCE ABUSE PROBLEMS,AS
WELL AS ATTENDED MEETINGS AT ALCOHOLICS ANONYMOUS AND A COPE GROUP
HELD THROUGH TERROS BEHAVIORAL HEALTH SERVICES.
5.0N NOVEMBER 3,2005 A VALUEOPTIONS, INC. EVALUATOR ASSESSED ME
A FOR SMI ELIGIBILITY, __ , ,__ M _, __ V ,N,,J,r_wW__ ,___, (“M__,_m,$r_
4 6. ON NOVEMBER 7,2005 VALUE OPTIONS,INC. NOTIFIED ME, VIA U.S. MAIL
A THAT A VALUE OPTIONS PSYCHOLOGIST HAD DETERMINED THAT THAT I WAS
I NOT ELIGIBLE FOR SMI BENEFITS BASED ON THE INFORMATION PROVIDED BY
A THE EVALUATOR. HOWEVER I WAS ELIGIBLE FOR ALTERNATIVE SERVICES. A
A REFERRAL TO TERROS FOR SUBSTANCE ABUSE TREATMENT.
7.AN ADMINISTRATIVE JUDGE, BASED ON THE TOTALITY OF THE EVIDENCE,
A SPECIFICALLY,DR. NOVIES EVALUATION, FOUND THAT I AM SERIOUSLY
, LIMITED IN MY ABILITY TO USE JUDGEMENT,FUNCTION INDEPENDANTLY AND
, TO BEHAVE IN AN EMOTINALLY STABLE MANNER AND I HAVE AN IMPAIRMENT
A THAT MEETS THE NECESSARY CRITERIA, WHICH VALUE OPTIONS TOTALLY
T DIREGARDED.
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Case 2:O3—cv—O1344-EHC-HCE Document 228 Filed O4/21/2006 ,*;Page 1 0f2

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8. I AM CURRENTLY IN THE APPEALS PROCESS REGARDING MY SMI
DETERMINATION AND NOT RECEIVING THE BENEFITS AND MENTAL HEALTH
CARE I AM ENTITLED TO.
9. VALUE OPTIONS EVALUATORS ASSESSMENT AND THE PSYCHOLOGISTS
DETERMINATION BASED ON THE ASSESSMENT ARE THE CAUSE OF MY NOT
RECEIVING THE MENTAL HEALTH CARE I NEED.
10. I AM PERSONALLY AWARE OF THE OTHER PEOPLE WHO RECEIVED SIMILAR
SMI DETERMINATIONS AND ASSESSMENTS AS I DID WITH THE SAME RESULTS.
NO SMI DETERMINATION PRIOR TO APPEALING.
AFFIANT SAY NOT:
DATED THISEQST DAY OF APRIL,2006
SIGNATURE
_ ,1%, __ ,,_, _ _ ,____ HNLHM,. .S,C,A.LES·.,- I A A- A-
SUBSCRIBED AND SWORN TO ME THIS_§$T DAY OF APRIL, 2006 BY
JOHN M. SCALES
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ORIGINAL AND COPY MAILED THIS 1ST DAY OF APRIL,2008 TO:
U CLERK U.S. DISTRICT COURT, SANDRA DAY OCONNER U-S. COURTHOUSE I .2. »
SUITE 130, 401 W. WASHINGTON ST., SPC -1,PHOENIX ARIZONA 85003-2118
ONE COPY MAILED THIS 1ST DAY OF APRIL,2006 TO:
HON. JUDGE EARL H. CARROLL, U.S. DISTRICT COURT, SANDRA DAY OCONNER
ONE COPY MAILED THIS 1ST DAY OF APRIL,2006 TO:
NORLING,KOLSRUD,SFFERMAN AND DAVIS,P.L.C.
16427 N. SCOTTDALE RD.SUITE 210 SCOTTSDALE ARIZONA 85254 , , , ,
ONE COPY MAILED THIS 1ST DAY OF APRIL,2006 TO:
SHANNON M. CLARK,#113372 ASPC—TUCSON-SANTA RITA,10012S. WILMOT RD.
P.O.BOX 24406 TUCSON ARIZONA 85734-4406
ONE COPY MAILED THIS 1ST DAY OF APRIL,2006 TO:
KATHLEEN MAXWELL REHABILITATION SERV. SPEC.
3839 N. 3RD ST. SUITE 303 PHOENIX ARIZONA 85012
2.
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Case 2:O3—cv—O1344-EHC-HCE Document 228 Filed O4/21/2006 Page 2 of 2

Case 2:03-cv-01344-EHC-HCE

Document 228

Filed 04/21/2006

Page 1 of 2

Case 2:03-cv-01344-EHC-HCE

Document 228

Filed 04/21/2006

Page 2 of 2