                                                         FILED
                                               2025 MAY 12 11:28 AM
                                                   KING COUNTY
                                              SUPERIOR COURT CLERK
                                                      E-FILED
                                              CASE #: 25-2-11308-6 SEA




                           Superior Court of Washington, County of King

                                                             No. 25-2-11308-6

    Matthew W Ralidak                       6/12/1986        Sealed Cover Sheet- Confidential:
    Petitioner                            Date of Birth      [ ] Sealed Financial Source Documents
    Vs                                                           (SEALFN)
    Veronika E. Goodnight                   2/15/1982        [X] Sealed Personal Health Care Records
    Respondent                            Date of Birth          (SEALPHC)
                                                             [ ] Sealed Confidential Report (SEALRPT)
                                                             Court Clerk: This is a Restricted Access
                                                             Document. Do not file in a ublic access file.

                                Sealed Cover Sheet - Confidential
Important! Use this cover sheet as page 1 of a separate filing. Check documentls below. Write "Confidential" at
least one inch from the top of the first page of each attached document. For use only in family law, guardianship,
and protection order cases.
[X]          Health Care Records (SEALPHC)
[        ]      Medical/Psychological Report (SEALRPT)
[ ]          Court Visitor/Guardian ad Litem Report (SEALRPT)
[ ]          Social Security Representative Payee Report (SEALRPT)




Submitted by:


► /s/ Mathew Ralidak                               Mathew Ralidak
Signature                                          Print Name                                [ JWSBA [ JCPG#

    Privacy Notice! All parties, court staff, and authorized volunteers may have access to these documents.




    GR22                                   Sealed Cover Sheet - Confidential
    (07/2023)                                             p.1
    All Civil 040
4/24/25, 4:57 PM                                After document loads, press CTRL+P to print --- Then hit the 'X' in the corner to close.




      Billing Name:         Elora Goodnight-Ralidak                           Name                        Elora Goodnight-Ralidak
      Pronouns              She/Her                                           Gender                      Female
      Client ID:            153056                                            DOB:
      Employee Name: Anjali DSouza , LMHCA , MA , MHP Date/Time - Duration: 4/23/2025 4:00 PM to 4:00 PM - 0
      Service Type:         Special Occurrence

          Supervisor/Manager yes

          Supervisor/Manager: Program Supervisor Linda Lasz

          Date and Time: 04/22/2025 at 3:00 PM
          Supervisor was: Consulted (document recommendations)
          Consulted with Linda Lasz and was advised to make a CPS report and continue to reach out to client's mother.
          Law Enforcement (includes making a police report) yes

          Law enforcement: Will fax to Carnation PD

          Law enforcement was: Notified
          CPS or APS yes

          CPS/APS: CPS intake line, intake number: 5688548, spoke with Paul De La Cuasta

          Date and Time: 04/24/2025 at 2:00 PM
          CPS/APS was: : Notified
      ACTION PLAN
          Please indicate which actions have been taken, and which are planned for the future.

          Review risk issues in the near future (specify when) yes
          Clinician will continue to be in contact with client's parents to assess for ongoing risk.

          Other actions yes
          Therapist will continue working with client in therapy to address safety issues.

                             Employee Signature                                                       Supervisor Signature




                               4/24/2025 2 58 PM                                                       4/24/2025 4 30 PM
                              Anjali DSouza 2827                                                        Linda Lasz 2877
                              LMHCA , MA , MHP                                                        MHP, MS, LMFT, CMHS




                                                                                                                         Supervisor's Signature
                                                                                                               Approved by LLASZ on 4/24/2025
                                                                                                     Linda Lasz, 2877, MHP , MS , LMFT , CMHS




https://www.cbh3.crediblebh.com/visit/clientvisit_printout_multi.asp?multi=1&clientvisit_ids=4786095,&useSelected=1                               2/2
