Superior Court of Washington, County of King

No.25-2-11308-6

Mathew Ralidak 06/12/86
Petitioner DOB Declaration of
Veronika Goodnight (Name)
v. (DCLR)
Veronika Goodnight 02/15/82
Respondent DOB

 

This declaration is made by:

Name:

Veronika Goodnight

Age: 43
Relationship to the parties in this action: Past Committed Intimate Relationship

| declare,

‘ts

2.

| am the respondent in this case and the biological mother of the protected person’s
three children.

| am submitting this supplemental declaration to bring to the Courts attention of ongoing
violations of our parenting plan and controlling behavior by Mathew Ralidak, which
directly relate to the nature of this protection order case.

On April 10", 2025, Mathew scheduled a medical appointment for Elora without
informing me. | was not told of the change in provider or time. | canceled a day of work
and when | arrived early, | was denied entry by the provider since Mathew earlier made
false claims that | was an alcoholic, drug addict and had mental illness. He created a
scene and my daughter looked coerced so | made another appointment with L. Miller
the following week to create peace and | left quietly. The provider L. Miller listed her
psychiatric behavior as “nervous/anxious” on 4/10/25 appointment and at the following
appointment L. Miller removed the false medical family history. See exhibit B.

Following the April 10", 2025 medical appointment, where | was denied entry and
witnessed my daughter Elora exhibiting signs of distress and coercion, | had a follow-up
discussion with Lisa Miller, ARNP. Cassidy Derieg was present with me at this
appointment as L. Miller is Cassidy's nurse practitioner as well. Ms. Miller noted that
Elora’s psychiatric presentation was anxious and nervous, and it became clear that
Elora needed a supportive adult presence to feel safe during future appointments. After
consultation with Ms. Miller, we mutually agreed that a “Consent to Treat a Minor without

RCW 7.105.200, .235, .500 Declaration (DCLR)
(07/2022) p. 1 of 2

PO 018

Parent or Guardian Present” form would be signed to allow Cassidy Derieg—Colin
Derieg’s daughter, and step sister to Elora—to attend the next appointment on May 7.
However, Mat rescheduled the appointment for May 22" without informing me, and
again failed to coordinate. Cassidy is fearful of Mathew’s behavior and radical false
accusations and is uncomfortable at appointments without me being present. This
protection order is inhibiting our children care they need. This pattern of scheduling
without notice and cancelling appointments after | have already communicated with him
on TalkingParents further demonstrates Mathew’s continued interference with my
parental role and the court-ordered joint medical authority. Please see Exhibit C.

5. In addition, | scheduled Elora for allergy testing per L. Miller's recommendation, on
August 13", their ONLY available time, during my 2 week uninterrupted summer time.
Mathew then contacted NW Allergy and Asthma Center, canceled the appointment
without my consent, and demanded to reschedule, falsely accusing me of “contempt’.
Screenshots are attached as Exhibit D. This demonstrates a repeated pattern of
interference and misrepresentation of the court orders.

6. These incidents reflect a continued misuse of authority and legal process to exclude me
from our children’s medical care and violate our parenting plan. This behavior is not
consistent with someone needing protection; it is consistent with someone exerting
control and undermining the court's intent for shared parenting. This pattern that
undermines the court's intention for cooperative, joint parenting has been aggressive for
5 years.

7. The protection order entered against me stated that Mathew Ralidak was to immediately
file a family law motion to resolve the parenting issues raised. He failed to do so. |
complied and filed the appropriate family law motions, which Commissioner Marianne
Jones acknowledged during the Ex Parte Adequate Cause hearing. My sincere hope is
that by following the directive of the protection order and utilizing the proper legal
channels, this pattern of aggressive behavior—which has actively undermined the
court’s intention for cooperative joint parenting for over five years- will finally be
addressed and ended. | have taken all steps required of me and ask the Court to
recognize that this misuse of the legal process must be stopped. | and especially our
children deserve peace.

(Attach additional single-sided pages if necessary and number them. Use form PO 010,
Statement.)

| certify under penalty of perjury under the laws of the state of Washington that the foregoing is
true and correct. )<|| have attached (number of pages). pages.

Signed at (City) DuwatA statey May. on (Date) S/a (26

Print or Type Name

   
 

Signature of Deck

 

RCW 7.105.200, .235, .500 Declaration (DCLR)
(07/2022) p. 2 of 2
PO 018

Supplemental Declaration in case number 25-2-11308-6 SEA.

EXHIBIT B

April 10, 2025 — Medical Appointment Access Denial and Communication

This exhibit includes:
. Screenshots of TalkingParents messages showing Mathew Ralidak failed to
coordinate Elora’s April 10 appointment.
Evidence that Veronika Goodnight was denied entry to the appointment.
Context surrounding Elora's emotional distress and the provider's concern about
her anxious and nervous behavior.

Submitted in support of the Supplemental Declaration of Veronika Goodnight for the May
14, 2025 hearing.

 

e alking
oe PARENTS

< _ Elora Doctors Appointment 4/10 & O

Mat,

Per our parenting plan, | was
entitled to coordination for Elora’s
appointment and the opportunity
to attend. | was not informed of
the change in provider or date. |
showed up early, respectfully. You
folg-y-1cre Re MXeX-1aC MOUNT MUTA]
room and | was denied entry by

the provider.

tio) ce komol-ar-\V olen eM ATC ATI
unusual and concerning. | will be
documenting this appointment
through the appropriate legal and
medical channels.

Veronika

4/9/2025, 12:40 PM

 

Max 50,000 characters

 

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2:03

< Mail

 

Elora

STW Col ain

 

Review of Systems

Constitutional: Negative for fever.

HENT: Negative for sore throat.

Gastrointestinal: Positive for abdominal pain and
diarrhea. Negative for constipation, nausea and
vomiting.

Genitourinary: Negative for dysuria, frequency
and hematuria.

Muscul ias and

  
    
   

in: Negative for rash.
Neurological: Negative for headaches.
Psychiatric/Behavioral: The patient is
nervous/anxious.

 
     
   

Past Medical/Surgical History
Patient Active Problem List
Diagnosis

+ Adjustment disorder, unspecified
+ Adenoidal hypertrophy

History reviewed. No pertinent past medical
history.

Outpatient Medications
No current outpatient medications on file prior to

visit.

No current facility-administered medications on
file prior to visit.

Vital Signs
BP 106/64 (BP Location: Left arm, upper, Patient

@ mychart.et1270.epichosted.com
RINE AN RANT BNE ANE NST

Supplemental Declaration in case number 25-2-11308-6 SEA.
EXHIBIT C
Consent to Treat Minor Without Parent Present — Cassidy Derieg

This exhibit includes:

Screenshots of the Consent to Treat a Minor Without Parent or Guardian Present
form.

Documentation that Cassidy Derieg, the adult daughter of Veronika's partner Colir
Derieg, was permitted to attend Elora’s appointment for emotional support.

Explanation that this arrangement was agreed upon by Lisa Miller, ARNP, and
Veronika for Elora’s well-being, not as a replacement of parental rights.

Submitted in support of the Supplemental Declaration of Veronika Goodnight for the May
14, 2025 hearing.

CONSENT TO TREAT A MINOR WITHOUT A PARENT/GUARDIAN PRESENT

arent or legal guardian before providing treatment for an injury or illness
reat your child in case you cannot accompany him/her to
child (babysitter, friend, relative, etc.) does not present
child.

EvergreenHealth needs consent from a child's p:

that is non-life threatening This form gives legal permission tot
EvergreenHealth for treatment. If the party accompanying your
this form, EvergreenHealth will contact you to request permission to treat your

NOTE:
+ Aparent/legal guardian must attend a minor's first visit.
+ Incertain circumstances, in accordance with State and Federal laws,
required for adolescents seen for certain conditions: sexually transmitted disease,

illness.
Patient's Name: 7 | DA Good igfet = dole atient's Date of own 3/iloote
'
4 m grant permission for. n adult into whose care, the inor has been entrusted) to
‘arrange for and authorize treatment at ergreenHegih\ for the period eginning (date).
- 2o3o[ Mer, 2)

This consent is valid until

parent/legal guardian consent may not be
family planning, or mental

 
 
 

Oo Please initial in this box if you are authorizing the minor to seek and consent to treatment with no adult present.

Well acknowledge that we are responsible for all reasonable charges in connection with the care and treatment rendered.

(if applicable) to the appointment.

may contact me at the following telephone
ly on the proxy decision-maker named above

Please send the insurance card and co-pay

he health of my minor child, you

If you need to contact me (us) regarding t
(us) for any reason, you may rel

numbers. If you are unable to contact me
for consent.

Parent Name: Vb COndwalit— ' Parent Name:
Daytime Phone #: G05 22 S oS be Daytime Phone #:

Evening Phone #:

 

 

 

 

 

 

Evening Phone #:

 

 

Other Phone #:

 

 

 

 

 

Other Phone #:

Signature of Parent/Legal union Date: 45, L: ZS

Cerca W124.

 

 

 

 

 

 

Relation to patient (documentation may

 

 

EvergreenHealth kinins, wa:sox
CONSENT TO TREAT A MINOR WITHOUT A APPLY PATIENT LABEL HERE
PARENT/GUARDIAN PRESENT
FORM ID ADM 810 Original - EMG Clinic Record Copy - Parent
wn

Approved 04/24

 

 

9:46 ea

Elora

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Appointment
Rescheduled (Elora) a
Participants

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fa EvergreenHealth
9:23 AM

  

 

Appointment Information:

Visit Type: Brief Office Visit

Date: 5/22/2025

Dept: EvergreenHealth Primary Care,
Monroe

Provider: Lisa M Miller, ARNP

Time: 8:45 AM PDT

Length: 15 mins

Appt Status: Scheduled

Appointment Instructions: In Person Visit:
Bring driver's license or government

 

 

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Appointment a
Canceled (Elora) ) a
Participants

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EvergreenHealth
10:10 AM

Appointment Information:

Visit Type: Brief Office Visit

Date: 5/22/2025

Dept: EvergreenHealth Primary Care,
Monroe

Provider: Lisa M Miller, ARNP

Time: 8:45 AM PDT

Length: 15 mins

Appt Status: Canceled

Appointment Instructions: In Person Visit:
Bring driver's license or government
issued Photo ID, Insurance card,
medication list, and copay (if applicable).

Video Visit:

During e-Check-in, please remember to

complete all reauested fields. upload vour
mychart.et1270.epichosted.com

10:17 al > a

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10:17 AM
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' Dear Lisa,

I'm confirming the cancellation of |
| Elora’s May 22 appointment. Mathew
| and | share joint medical decision-
| making. He may only schedule
annual exams with coordination. This —
_ appointment was not agreed upon or
| coordinated with me and violates our
_ court order. Please pause all non- |
| emergency appointments until after
| our custody trial.

_ Thank you for your understanding.

_ — Veronika Goodnight

 

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1:06
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Fa] McKenzie, MA
eo 12:05 PM

Hi Veronika,

Please work with all necessary parties to try
and get a follow up scheduled for Elora as
Lisa did need to see her back in a month in
order to review her food diary, symptoms,
etc.. It is important for her to have follow up
care if she is still having symptoms.

Take care,

McKenzie Radcliff, CMA

Clinic Manager

Evergreen Health Primary Care Monroe and
Sultan

\

 

 

| After May 14th I'll have more |
_ information and can work out with |
_ Mathew a follow up appointment.

| :

| Thank you for your patience and care

| during this sensitive time. )

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Supplemental Declaration in case number 25-2-11308-6 SEA.
EXHIBIT D
Northwest Allergy and Asthma Appointment Conflict - August 2023

This exhibit includes:
Screenshots of TalkingParents messages showing Veronika Goodnight scheduled
a summer allergy appointment during her court-ordered uninterrupted time.
Mathew Ralidak’s cancellation of the appointment without consent and attempt to
override her parenting time.
False accusations of contempt made by Mathew, despite clear parenting plan
protections.

Submitted in support of the Supplemental Declaration of Veronika Goodnight for the May
14, 2025 hearing.

 

— e®@ talking
= Oo PARENTS

< NWaAllergy And Asthma Center & O

Created by Veronika Goodnight on 4/10/2025 at 11:40 AM

altel a

Elora’s allergy testing appointment
has been scheduled for August 13,
which falls within my two weeks of
uninterrupted summer vacation
time as outlined in Section 9 of our
parenting plan. This appointment
was arranged following a referral |
received, and | will be taking her to
it as part of her routine care.

Given that this is my uninterrupted
time, | am requesting that you do
not appear at this appointment. If
you choose to disregard this
request, | will view it as
interference with my court-ordered

 

residential time and will contact

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ELTA SEAL CAEL CT I

 

28 PARENTS

<  NWaAllergy And Asthma Center & OO

Given that this is my uninterrupted
time, | am requesting that you do
not appear at this appointment. If
you choose to disregard this
request, | will view it as
interference with my court-ordered
residential time and will contact
the authorities as needed to
enforce the boundaries of the plan.

Please respect the terms we both
agreed to and allow Elora the
peace and consistency she
deserves during this time.

ronika

4/10/2025, 11:40 AM

 

© Mathew viewed on 4/10/2025, 2:46 PM

This would be in contempt.
| will be scheduling with the NW

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e alking
O28 PARENTS

<  NWaAllergy And Asthma Center & ON

This would be in contempt.

| will be scheduling with the NW
Asthma team and will work with
you on a date that works for both
of us. Should you choose not to
work with me, | will attend with

Elora.

4/10/2025, 3:12 PM

© You viewed on 4/10/2025, 3:17 PM

 

Elora’s allergy testing appointment
has been scheduled for August 13
— the only available date
provided, and it happens to fall
within my court-ordered two
weeks of uninterrupted summer
vacation time. Per Section 9 of our
Parenting Plan, | am under no
obligation to coordinate this time
with you, and | will not allow you to
Tal colaciee

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< NWaAllergy And Asthma Center & On

 

Elora’s allergy testing appointment
has been scheduled for August 13
— the only available date
provided, and it happens to fall
within my court-ordered two
weeks of uninterrupted summer
vacation time. Per Section 9 of our
Parenting Plan, | am under no
obligation to coordinate this time
with you, and | will not allow you to
interfere.

Your behavior at Elora’s recent
medical appointment was

inappropriate and a violation of the

Parenting Plan. That type of
interference is not in our
daughter's best interest, and | will
not subject either myself or Elora
to it again.

The appointment is set. | will take

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< NWaAllergy And Asthma Center & OI

The appointment is set. | will take
her. | will update you via this app
afterward and you can access her
records through the patient portal
as always. You are not to attend.
Should you show up, | will involve
law enforcement to ensure my
rights — and Elora’s peace — are
protected.

This is not negotiable. | will not
continue to tolerate controlling or
abusive behavior under the guise

of co-parenting. Respect the
Parenting Plan, respect my time,
and most importantly, respect

Elora’s well-being.

- Veronika

4/10/2025, 3:23 PM

 

| was contacted today b

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@c® talking
N= PARENTS
< NWaAllergy And Asthma Center & Oo

| was contacted today by
Northwest Asthma Center.
Michaela informed me that you
canceled Elora’s scheduled
appointment and asked them to
have me reschedule. | was not
notified, nor was this decision
coordinated with me, which is
required under Section 5(a) of our
parenting plan.

The appointment on August 13
had already been scheduled, and

your unilateral cancellation
without my knowledge is another

documented violation. I’ve
requested that your actions and
the lack of coordination be noted
in Elora’s chart.

4/11/2025, 12:05 PM

 

© Mathew viewed on 4/12/2025, 9:21 AM

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