HomeMy WebLinkAbout97-01951
.l,
"
(
~
t'
~
~
,
ct ~
....... \l
~ .~
. .. ;)
~~
~~
~ ~
.~ -
~J
'J
(
.~
:--..
..
.~
'-1
~
~
-....
.
t--
0'-
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO, 97- /fIs7 CIVIL TERM
You have been sued in court. If you wish to defend against the claims set forth in the
following pages, you must take action within twenty (20) days after this Complaint and Notice are
served, by entering a written appearance personally or by attorney and filing in writing with the court
your defenses or objections to the claims set forth against you. You are warned that if you fail to
do so, the case may proceed without you and a jUdgment may be entered against you by the court
without further notice for any money claimed in the Complaint or for any other claim or relief
requested by the Plaintiffs. You may lose money or property or other rights important to you.
,\FI1.U\DATAFJLE\HOS'ITALOOC\II9.coM 1\1.
c...d. OJJI4197 OJ 14 SUM
lniMd. OJll4l9704.9 21.,..
)0418119
CARLISLE HOSPITAL AND
HEALTH SERVICES,
Plaintiff
v.
ANTHONY H. SHUGHART,
Defenctant
JURY TRIAL DEMANDED
NOTICE
-
.,
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT
HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET
FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP:
Court Administrator
Fourth Floor
Cumberland County Courthouse
Carlisle, Pennsylvania 17013
Telephone (717) 240-6200
1." -,
~- ,~
\gt~
. t::i1~y.~
. ;;1:~Ji
':("4...~...,
MARTS ON, DEARDORFF, WILLIAMS & 011'0
By "'\
Georg . Faller, Jr" Es
I.D. No. 49813
Ten East High Street
Carlisle, PA 17013
(717) 243-3341
Attorneys for Plaintiff
Date: April lS, 1997
'._.'-~".'-
CARLISLE HOSPITAL AND
HEALTH SERVICES,
Plaintiff
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. 97- /1.{f CIVIL TERM
v.
ANTHONY H. SHUGHART,
Defendant
JURY TRIAL DEMANDED
COMPI.AINT
AND NOW, comes the Plaintiff, Carlisle Hospital and Health Services, by and through its
attorneys, Martson, Deardorff, WiIliwns & Otto, and hereby avers as follows:
1. Plaintiff is Carlisle Hospital and Health Services, a Pennsylvania non-profit
corpomtion with its principle place of business at 246 Parker Street, Carlisle, Cumberland County,
Pennsylvania 17013.
2. Defendant Anthony H. Shughart is an adult individual residing at ISI Old Gap Road,
Carlisle, Cumberland County, Pennsylvania 17013.
3. On or about November 30, 1995 through December 5, 1995, Defendant was provided
with reasonable and necessary medical care by the Plaintiff and the Plaintirrs agents, servants and
employees.
4. The reasonable and necessary value of the services provided to the Defendant totalled
$5,351.00 for which Defendant has yet to pay the remaining balance of$4,151.00. (A copy of the
printout of Defendant's account is attached hereto as Exhibit "A")
COUNT I
BRRACH OF CONTRACT FOR PROVIDING NRCESSARV CARR
5. Plaintiff hereby incorpomtes by reference the avennents contained in paragraphs I
through 4 ofthis Complaint.
6. Defendant has breached an expressed or implied agreement to pay the reasonable
value ofthe services rendered.
WHEREFORE, Plaintiff demands judgment against the Defendant in the wnount of
$4,151.00 plus pre-judgment and post-judgment interest and costs.
;
(~:~
>.;
",.,
;.i'
i;:
COUNT II
QUANTUM MRRIJIT
7. Plaintiff hereby incorporates by reference the avennents contained in paragraphs I
through 6 of this Complaint.
8. The Defendant is liable to the Plaintiff and/or have been unjustly enriched in the
amount of$4,151.00 plus pre-judgment and post-judgment interest and costs.
WHEREFORE, Plaintiff demands judgment against the Defendant in the amount of
$4,151.00 plus pre-judgment and post-judgment interest and costs,
MARTSON, DEARDORFF, WILLIAMS & OTTO
By
George B. Fal
1.0, No. 49813
Ten East High Street
Carlisle, PA 17013-3093
(717) 243-3341
Attorneys for Plaintiff
Date: April 15, 1997
Exhlb" A
::~~t
,i'. (
'~{J':.
~~k9
--~A"!14;i/l
~IQ ..lJlJ<l
.-....-
. .... p.
...~.....-._..-.._._.
. .
/
oiii7"i'91'
V."ij06IO.1
'ATl(~T NU 1053061
..1'..A 1 1..t..~J N I ~ C
SH~HAR1. ANTHONY H.
lOG Sit , l06JHO'S
CARLISLC HO~'ITAL
~HINT Pll teNT >UllR
FER 17. 1997 09iio
PAGE I
API QUE
4151.00
CHAQOES
PA.YKUHI .IlCJ..t.Hul rtOOL'...tH.liI.. .AFY "AL--llI.5 .IIIL._.
'1100.00 .00 IILO.OO Illl.OO .00'
rLEtr90hlC AL~Y...DILLEO ....._.
..-.---...-.-.......... "--"" .
...
HRY CHG an
AHOUNI IXI AHT SAV 01 1'\1 01 ~AT .rrlRlNef OtICRIPIIO~
no IIfoo...T...J10.DO.......310.Uc..rii09) Jj"309l'R~U olO5o"iloOROOii:;ei'o/ilHI'-" .---. ..-...-, ....-.
110 11100 1 370.00 370.00120191 HOJH RRO OHIO 1100 ROO.'BCO/HSlI
-lZQ..llll1I_1 H.Q.J.O.. 31.0.00 UH-iLlHH1..Jlll...OlnD..illo.HDO.,.atD/JlUI ... ________
110 AIHOo I 61.00 65.00 111091 IIS00) ~HO AtRlCURIUH IHJEtr10~ saKO
no unl 1 H,OO 19.001130'11 115091 PHO LIBEIOLOL 51RIN~E 10.0/1HL
110 HFlSO I I~._. Lo.tt-U500t..I.u,g,u HI\9__ --lit TOCL\l!'.!WlllIE IHJEcrlON
ISO CHOOl I 133.00 IlS.OO I1S091 113095 PHO ANESTHESIA'PHARH. ChlRGE
ISO A1RS4 I l.OO 1.00 11500' 11S0H PHO AtROPIHE .INJF.tflOH I.IHO/3:
1\0 NEOll _.1____ ...00_._.... 4.0.~.095 J.1)lli.PHO.__u. _.Aq}JI~.IH! IP.ROSIIGHlll' .1'
110 ACEU l 1.00 2.00 111091 110101 PIa tN1FCl r.HG ACEIAHI~OPpEN IUPPOUTOAY
ISO CFl07 I lZ.OO 12.00 IUOO\ 11019\ PIO IN'rt( t~G CIForlllN I GK INJ/YIAL IN
-m ~:m 'l-'---it:a---"-it:~.mm a:l:;{:~ +;jtfH'~~~ ~~~~~~~ffi-H\%r'-' '-.-"- .
ISO FENU I \.00 S.OO 11109S HOUI PU INIFtF C,,~ FFNIAHYL IHJECIlON .,
.llL.!C!ll._I... ..!...I!l. .!tl.Q..113.091 1I00.L!~..!_LHlfCr ~~PO.T1~SIU" ~LO"IDE~1!!1Ui~.;.. '.
ISO "O~lo I 1.00 1.00 1110~1 110191 HID IN,,'tECHr. HUHPHTNE INJEtTlON
ISO HORSO 1 1.00 1.00 IIJOH 1101011'10 IN'Ftl Cllr, HORPHINE INJHTlOH
I~O 1IE100 ....1-_. 10.0.L......IO. 0_0_Ul.IJ5 l.l!.liLcIO..'-'ill:tl C~G .!!UHONl.DUQIJ.. INJECTION..RT .
ho OENSS 1 l.OO 1.00 113091 1~0T9lr.10 INIFCE t,,1;"~!NTA"ltIH INJlClIOH
ISO Cf161 I lZ.IO H.OO luon 11011\ CIO INIFC! ChO CHOXITlN INJ lOll AOD.~AHT
.ill-OJ}95 I ll....!~._ . .1..I....!~.1.1l091_!.B.1...~ .c~J.r~E..5.!!!LQ(X.'RO~.Ll NJ ADD.mu!L.._.
110 .Cllijll~ I J.OO 1.00 llSO~ Ilol'/~ CIO INTFtr C.5 PIIAIiiiiCYCII.~Gl IV SmICE
lID .EI09 I 10.00 10.00115095 1l01.5 CH IHIFCE CHG HCIRONIDAlOLE INJECTION RT
110 CHOOo ..._L.._ J.Oo .......3.0.Q..U..tOH 11.!l..L~. CI.LU!.lE.CE ~H.U!LAHHA.9:...i!I.Al!ij~~Rtlll-_ .._.
llO GENIS I 10.00 10.00 1l10YS Iltl.5 tlO IHTFCE c~r. GtHfAHICIN 90H~ PRf.U . , .-....-.. -
ISO tHGOO 1 l.OO 1.00 113095 IIOl.5 CIO TNTFCE CHG PilAR HAC' CHARGE IV StRVICt: .
.150 CF 164 ..1... _lL.oQ . .lll,jJ ..I..Ull~.I.1 0.1'lLU.0..1 II!!tLCHLllEW lLIj I NJ- JO~ ADO-Y~NT
250 OIX91. 15.00 hl.OO 111091 II0J9) (f0 IHIFCE CHG OCArRDSf 5~ INJ ADO'VANTAG
ISO tHOOo. 1.00 11.00 113091 1I01H cia INIFCC lHG p".~~'eY ChARGE IV SERVICE
150 1IE100 . ... 1.0.,'.9..... '0 ..0.UllOO ~.J..I..W) .~lLl1!IF.r.LOiLNEl~O'l DA lQl..t I NJEtTlON IlT
110 CHOO,. 1.00 11.60 11109\ T2Tfo\ CIO IN!FCE CHij P".RIIACY t~IOOE IV SfRVICE
ISO GENIS' I~.OO 30.00 IlJOOI lIQ191 CIO IN1FCE CH. Gl'llIHICIN ~OHO'PRE.IX .
lU. tHOOO 5. .u_~..9.Q ._~..0~.I.U.tll..110"'U...~.10 1."lllJ CH!!....!:IWMCY Ci"I'~PU.'lV"UIl.YIC[
2)0 HORIO 1 ~.OO 1.00 113001 120191 HIO l"frCE CHO pOR~hlNl INJEtIlO~
250 KeLSO I 10.00 10.00 IllDOI Sl0191 PIO INlfCE C"O POTA~SIUII CtlLORIDE 2OHU/0
110 HQJl~O I,. __h.o.L.. ...1....H..J!...l9li...ll.U..I~JNT''-LCJlO ~lUleJIl~LI!!1ECllON
ISO .ORIO I 5.00 1.~0 113095 1101111>10 IN1FtE CHO HORPHINl.l~ECllOH. .,--,.....,.--,.,.
HO AC.E02 J .00 .03 113001 110191 PIO INTFtE CHO ACErAHINOPijEN IAft~ET 610~G'\ :'
no SALlI..-L.. a.o~._..H..iL\ISOOI..illW..c.lO INTFCE.1!!L$OUIUH CHLO~ .' '. :,'
llO CflU -8 12.00 '156,00 11309\ 120191 CIl INIICE C',O CEFOlllIN INJ IG" AOO'YANI
110 DEx93 -8 15.00 '120.00 JIJ011 11049) CII INlrCE eHO DEATQ05E l~ INJ ICO'VANTAO
210..~_ ;.L.__ l,OO . .:l.!.OUP~'5 I..l.ll.9U/l. Will. C~.P".~Il1lA'-'Ln~Il.GUV. $[RVIeE ..~ ,..,.........,_..
no oE169 -0 10.00 '60.00 11J09~ 12049\ CIl INIHE rHG K!lRQNIOHO~E. INJEctION.RI
110 tHG09 -6 1.00 -18.00 llJOOS 120491 Cll INTFCE CIlO H"AAHACY.CHARD['"IY SERViCE..... "''':' ..- .....
llO GENII .~.l_ _10.. 00. ...._~B.oLHSO'S .WUI .~U..lllllif...t!IU[HlIHlClH 90HO' PRl~IX. :.".'" :1 ".' . .'. .' .:..... ,'; .
110 CH009 -J 1.00 .V.OO 113093 120491 tl1 INIFCF ttlO PUR",CY tHAROE IY SERVICE
110 AlBIZ I 1.00 8.00 11300' Il0405 PHO A~BUIEROL NEI. SOLN O.OB"
..--
......-
"
--
..----:-
.' .
,.:
. -
I
I
r
r
-.. --:.-
. EXHIBIT ,,'A"
"_'" _".._n
... . ..:~~~~~~t~:~~.~.T: ..:}!~. .~.,.:;~'.;':~?~~:~~~fti:W~~.I;i.{.~.:~. :.:~:~~
.' .<f .. ~; .. ._~._.:.-' ....,.. .;.~.=JJ:"I~.4~t.,.~......I.~:,~.l.i.
Feb 17.97
10:34 No,004 P,03
I
Zi17/01
F.P&06IO.1
PArUNI NO IOSJ06S
..~ 1 .1 t NT. N A ~ t
lliiiHART. AHTHOHY H,
IX $[C , 1063546"
'[1 17, 1917 OOISO
PUE l
CAALISL~ H05PITA~
P~IHT 'ATII~T PASIER
APT nur PAlHENIS
4iH:o'o-::j200.00
CHARr.ES
~H Q!H..'!!.Q!l.t<..CHOS ...~,RtY..llL. . .O/Ll~l.__._~.~.___
.00 IIIO.OU 'Ul.OO .00 "
...__...___.___...... . ..~...Jg.~!~QNICAlLY eILL~.!l_!!~_.. ._....._
AY CHO OTV ANOUNt HT ANI SUY OT PST OT RAI RrrENt'C. Of SCRIPIION
~'. .AO~lIf.--r----y:-6!. .. S.OO 1I3'ffi TH,9> ")4"6 ""1Ill1llli1fNE" INJ(cHOlf-....
50 CF1U 4 H.OO 118.00 120105 1l040S CIO IHIFCf. CHO CHOXI1IN INJ ION AOD-YANI
~~tJ!05 4 15.00 00,00 120195 IlD4Y.l Cl0 INTF~~ CHO OEHNOS' n IHJ AOO.<4UTAO
ff~of'-T" I. DO" . -Yz;oi liol" 110(9S 'OoCNik. 'c'HO .H,;ilmTcHIRb~-rv1ERVm . .... -.-
50 N[169' 10.00 40.00 1201.5 IlO"S CIO INTrCE CHO HUOONIOUOLf INJECTION AT
50 CN009 4 3,00 12.00 UOlYI 11040S CIO INTFC. CHO PHARHACY CHAROE IV SERYlCE
50 oeHSI 5 . 10;00 ._.JO'~OrrOnr120(6\-croTliTrrrlHO OF-HIAttICIH OONo'p!F.R1X _._._~
50 CHOOO 5' 5,00 0.00 120191 120'05 C10 INIFC[ CHO PHARM'CY CHARGE'IV SEAYICE
"5A.I"!L 2 1,00 10.00 12019S 110'91 CIl INIFCE CHO 5001~H CHLORIDE IU'JECTION
,,'H"lilllo" 1 -f'"oo 1;6fnorrr-il0491 pl1'1NTFCE CHti' HO~~kINE INJECTm---
"/lOR" I 5.00 5.00 110105 12040~ '11 INTrcr WG M~~HINF INJECTION
\0 HDR~I ..J S.OO 1,00 110105 110491 PII IUTHF CHG 'URPHINE INJECTION
30 /lORH' C' -'''':00---'1.00 \loHT 110.95 PU INmr ClOG HORPHIHi:.~tlJECTlON
SO KCLS6 1 A.OO 1.00 H010S 110405 PIl lUTfeE CHO r~TASSluH CN~O~IOE llHEl/O
SG CF161 4 'l.OO 12&.00 11010S 1l04H CII INTftE CHO C(FOXlIIH INl .IOH AOD'YANl
Sa OtxO) -'-"'15.00 . '6'..'b6'if0295 lZOA9St"fIlNfKf tNO i\lJilim"fi"lAr~on'YANlMi
50 CHGOO' 5,00 11.00 1l0I., 110495 ell INlrec CHO 'H,nHACY CHARGE IV SERYICE
to /lEl60 4 10.DO 40.00 120295 1/0495 CII INlrCE ehO HiTnONIOAlOlE INJW1DN AT
50-tlllfoo 4 3.1'0.... li;'ob"i-rrmlZo49~ tll ("HTFCE CHG PHlu"Hlty CH'RGE fv~I.~VICE
500ENSI 3 10.00 H.OO 1202H H04.5 ell IhlFCC CHO OFhlA"ICIN 90HO PREHIX
SO CHOOl 5 3.00 0,00 17010\ lID.., III IhlFCE CHO PHARHACr CHAROE I'L~HE
sa CIPO! 1-' 11.-rr'-'-IS.oo lZOIOS"mr19nTn'u'l,ef C"i1"rCT1'ROIi"niItW'TATiL1T-
50 HUll 1 1.00 2.01 110101 110'0\ CII INIFef C,'O HEIRONI04Z0LF. 1A8LEI
50 [IPOl 2 \l.00 10.00 11on5 110495 CII INI<Cf CHr, CIPROI'LOHCIN TA~LET
fi'tlprr--"'l--rr;'oo lO;0'O-lTnlrflo(05 ClnmrrnHO cf~noFLO"C ;i"l'Afin"
IO.NETIl 5 1.00 6.00 12029) 110491 CIl INIHF. CHO H~I~ONI04Z0LE IAOLeT
10".HElIl I 1,00 6.00 1l0lOS H040S ell INIFCE CHI, H(lRONIOAIOlE lAaLEI .
~l'" 2.00'" 'l;ornoiYI"lI011fS"nTTNTH~"c'HG OXYCODONOACElAHIHCPHCij-'''-
so OXYOI 1 2.00 2.00110195 110491 PIl l"tFCE CHO OXYCODONI/ACElAoINOPHEU
I LOX/O I 1 2.00 1.01 lIOIO\ 129495 PIl !HlrCC eHO O'YCOOONCI'.CElAHINOPHEN
wmllr-:-'--T~oT . 36;""OlI\"I011r'ltbl'D5 .tl"fTl;"IRreHG-CI pnorlOAAC IllfDttT
SO'HETlI.I l.OO -6.00 110191 1I0'Y5 CII IHTrCE CHO HnRONIDAlOLE lAa~ET
~YOI 1 1.00 2.00 11030\ 110'"1 ~14 INTFCE ClIO oXYcon.ONf/ACE1AHIHnp~~N ,. . .. .....
WALlifr- j ....'T.-n........../.ou irOl-rrrlDTif~HO. ... 'LUU'fI'oor NE~. sIiL~..r.G1Tr._-
II 10"1 I H.OO 31.00 110195 110'"1 HII IV 5CL SOD CHL o.a HD HL
l07Uza 1 10.00 20.00 L1Z9.5 1IS09S HOD IY ADHIN CHEce VALVC HT
'079001 1 . 8;'00-- '-f:-ooriTWrUIToI RAO" BAO rtTl'All~E.OJ6P"- . ...,.
'OIU51 I 1'.10 24.00 L110H 11]095 nn .1000 HL.IV SOLUTlOH'ANESIH .'.' ;;. ..... :..-:.'....
'0.70S01 1 11.00 11.00 lH005 IIl105 HU 'UHfHOO 7,0:"" CU~'ED .' . ....... ..
ro-.7'1l"....T.. H.~-Tr.ilo.mO"Vrrnm 08'---' SIY[f.ln 14'FR.'- ..---
'080501 I 15.00 IS.OI IUODS 11]005 HIl ClncUII ADULT
'081106 1 11.00 11.00 11300S llJDOS R~5 HA~( ANESTHBIA 51 6 LO AD
'a 'DUD -1''' 5,or.... ;."lrllH~nrrn"Hj cAl\lnER 5V~llcl/"n"FR:
'0 80011 1 ..00 0.01113095 lJ)oH Rn IUOI NON.eOHDUCIIYE.U'..
'0'79401 1 8.00 1.01113005113095 nIl CANNISIER'su~nOH noo/IL'.. .1. ;.'\'.::'" '''0
rrn.1l1......r...--B';"~-..-a-.oo J1UY) lrnVS"~HU .< - 'Iv f'u"r IN~U!lOH \I:HVIt.f:. 1 ..
'0 ,un I 1.00 1.00 113OY5 12049\ RI3 SET IV SOL SECONOARY nEO
'..; "
~
-.0_-'.
.---
'., .'~t.--
, .',
;.,;.'
.....
. ,
.'
,I. :
'. '. .. . ,.... . .... C'
. ...' ~. . . ....... I't.- ~. ..... .. I .' I". ,.
:; .."';....~; '.1 .~._:"1';'~':-"":l!'!!\:'":'''''!''':'''' .",L <.,
. ".n., ..;....-. ..I..f..;.:i.j........ ..~::;t~..:
. --..... .'. 'of.... ' . ,. ". t \>1.'
~. _.:-": ',_" 1;;'1.l',~ ~..._....'.:(.,.~.........'.......l ..
,_' ' , , .,. '~I ~J~"..... '.
-
-.---- ......
P,04
I
J
, .,
Fee 11, IV91 0,.50
,.G! 3
ii/i ,-",
cr.P~OUO.1
PUIEHT HO 1013065
P A T-'- E ~ T H A ~ F
iif~"Alrf; ANTit6W h.
soe SEC. 10031'015
CAPL l!,l.C 1.;)~rUAL
pnl~1 .'llfNI ~.~Ten
CIIANGES
AhT OU~ PA,,'NT5 NFT r.G~ AO~" e"~5 PHEI GAL OIS INS
Ull.0D -IZ00.00 ,00 1110:0.b..-''.lllT:06----.:n..-.~--
_'_U'__'''_' ,... ...._.. ....... ELi.eIHONle'LLY RIlLFO ............
-""---
NAI eHO HI
'NOUN! EXI ANI SHY UT ~~T 01 UAI NHFHE~tF eF 5tAIPTlON
rr.nm--r 1.00 '"1706"-mOil\ no.91 Nl]Uh'Il.'TpIS"
270 70US 1 5.00 5.00 11309' 110'" AI3 II SIlAI XIT
lID 79145 1 11.00 !l.00 IIl095 170495 ACl p~e~ AAlle AIl41
rn-'rOlbT"'T"'."'1I"":l1"-"- 0.'0 IIJOrr-nm)~OI--" .. ---.-'.;..1 ~Y(lfmlo.. 1I00~L
710 79036 1 0.00 8.00 IllUI 116'95 AOl HHOlf GU'AO ceU~T I!OO
110 79115 + }',OO 1..00 I U095 120491 HOl PAO ELrcrRoDf .!'.!.I.llHT RlTU
270 19'11" -.- "l.00 o.oO'lf:1oH'Ho'491 AOl ~PONGE L'PARllT1IiW"'1l'. 18
270 79913 Z 0.00 16;00 113095 110'91 H03 SPOHGE lAPAAbTO~' , . 18 4
210 OOZI! 1 11.00 L1.00 lB095 120." AOl INSTRUNEHT"SUCflON POOLE
270 7fflr-r 1I.~r- 11.00 llJOOT-rzo';'~j it'li) -liEN ELEtTROSUR01CAL OOOYlE
270 79444 1 5.00 5.00 11]095 120495 nOl 'AHuueA SUeTlCN I"STRUNEN
270 OOOH 1 0.00 0.00 113095 LZ04V5 HOl TURE HOH'CONOUCTlVE lZ'
2ra ~.nS "'r'-"-'-';~-'o'--W.OO 120195 120191 pjjO---'" UpuiiP" fNTtJSIOH SERVICE
270 78UI 1 5.00 5.00'110195 120495 HIO IV SIART KIT ..,
210 18259 I 1.00 0.00 120195 120.91 Rift sn II SOL SECONJ,RY, ~EO
210 11J20 1 20:01-- "i'0'.0'5"rl6WYl.l,.-oTm-' I. AONIN CNECk .,lv! HT
270 01016 1 15.00 11.00 120'OS lZ0401 PHO SPIRONEIER INCENTIVE
l74 78100 I 5.00 5.00 1130Y5 12049S HOl NSS IRRIG. 80lTLE 1000 ~l
~D1 55000 '-r- t.OO -r.-ol'lTJOH"uoi~1 C10"11<TTeC eHG PHLEOOTO"' fEE ...., ..,--
lOI 15UI 1 43.00 4l.00 1130" LZOl95 elo INHef eRG L1ICR PROFIL~
lOI "Ul 1 77.00 H.OO llHOS 1201VI elo INneE tHG H,71~Olle PROfILE
JDI )'000 1 -''1;60--- 7.00-!"21fIVT"'rn401 ~10 I NI'(Cr.;~o"'PCFb(llaHrf'ot
301 5581Z 1 1'.00 14.00 110105 120491 elo IN5~eE (HG SPEelll HlNDLING
J01 SU20 1 ID.OO llJ.OO 1101?! 111'9\ CIO INIfCE C"G GENrlNyelN lEVEl
301'55283 'f,o,u'l'r.D' if." liom"11H91 CIO INtra CIl~'Ht 1l60LIC PRO>lL[
3015S000 1 7.00 7.00 120195 12HOI elo INneE eHO PHLfOOIONY FEl
301 BODO 1 7.00 7.00 120195 lZ040\ Cll IImeF. eHO PHlE80TONYFEE.
301 "20] 1'- '21;00 1r:uo~u)rZ"O"'9rllTTJllrct' (Hr, NFT.~Olle PNO' III
JIS sson 1 16.00 16.00 lIH9S lZH91 elo IHtrCf CHr, SIAl
J05 5S01S I l6.00. 20.00 111091 lZ0195 el0 INIFeF eHO e~e
]0) "OU I l~'''''-I..'Oo-[130VI lZCIOI elO INTFet'Clln"~rAl .--:"' ,', - ...
JIS 55035 1 H.OO H.00'120105 120401 elo INTFeF CHO CAe .....
305 "027 I 11.00 11.00 120195 120401 CIO IHHee eHO OJ'FEOFNTl'!;' HOC
!6"S"'Sn31"-r-.'16:00,-o-n:orrn?'1"n'aC'II'C'111J1TrCl CIIG COC - --....-.
JOS 15021 1 11.00 11.00 120295 lZ0491 ell INtreE CIIG DIFFERENTIAL WBe
]06 ISSOS I 40.00 40.00 l1J09S llO191 cIa INTreE CHO eUlIUHe ARHROUle
196 5556? s"--'1,o:n-'''''H~'~'nH~H'TTnol CIO I NtreE tHG CULTURt. WOUNO
lO6 55116 1 19.00 19.00111095 120101 elO IHTreE eHG O~AN STAIN'
306 HHl 1 21.00 Z1,00'1l1~Y~ 110491 elO INtfCE eHG AF.ROBIC:lor,jIIFltAlIO,,'
3H-n-s7T'-T---11~ 21.'0 IlHV~ IlO~95 'nO-THrFet lllG A,ROBle I o[~rITT'AIIO'"
50655507 1 ll.OO ll.OO 1201YS IZ0l91 CIO lNlFeF CIIG OAeTERIlL SEN511l11TIFS
306 H507 I '1.00 ".00 1I019S n0491 el0 INTFCE eND &AeHRlll SENSlllIlTlfS
In 55507 '1"'" "ll;Oo-,-,o'o,l:"" Il'lVrTflfffi ~lo'rNTrC1:C'R~"~A{lERIlL ~UlSrmlTlu
'" 15112 I 11.00 15.00 IIJOO) 120191 ere IHTree eHO OOl~Al1S1&'ROUTlNE
III 5571l I 2&.00 2&.00 1/1005 120591.N17 SURG P4TH"LE'IU,...IIl' ;',' .
fl969401' 1 6Z.90-'- 6l.00 l'lO"V),llo'1)lfl;o "000 ..... .\IOnAr~'.Qa I'
110 600H 1 100.00 108.00 111091 IlJOOI PII, "010 eHUI nOUTlNl: 2Y
---
. ". .
. "'''''' ..
. : "" '. -".: ~ "..!
....: Il,~;~, '..
.:....;..:;..~
.'.. _.
.-
.' ."
--.....
,.
.......,;.: ;"
'I '" ..
:.. .. ..1._
--........-
-.'" :"":.~ '.. Ok I .
. " . '.. .. ~ :=~ '!:
..~-;. -'
': '..; :~'~~. ';f~: . ~~. :~~~~.}:?~.; ;j:.~~~.;.~:t~~/J~1~~~~,:
, ." . ... :;:".""" 1,'~I. .'.to . .,..... :""
TEL:I-717-249-9345
!'eb 17,~i
10:37 Hc.a04 P,OS
'CUlII'I
CF.~U0I10.1
PArrlNr NO 1051065
~ A r .1 t ~ r N A H C.
SKU.HANr. ANrHONY 1',
soe SEe, 200"401'
I
CAHLISLF HOSPITAl
.~rHI PATlI~1 HA~TFR
,., 11. 1191 09.50
-'OE 4
t:1I4~GES
.'.....
--..........
ANI DUE PAYHEI/IS. NU CHijS ROOH CtlCS .. .eI!LY..~AL
4111.00 -1100.00 .00 1110.00 1151,00
. . -. ... ~tt .~L(CINONlt4LLL'JLlJD ".. ,.. .__.___.
EXT ANI lAY Dr rsr 01 U4T AEFFAF.NCE OCSCA1~1I0N
OlS.,W._..._ ... ,
.00
-AY CHO try
AI'OUHr
. ....----.--.. .
360 2000r'-'r' S9;O.00 .'S'91:'oi-iTi"'OQ's'ii309s P..u,.....-..-....-...oit..iiMf :n:."60.1ITN..--...... '''_'_
360 HilS I 41.00 41.00 IU095 HOHI nOJ [UCTROSURGICAL UNIT
360. H20..,... L . .n9.~0__....~I!.00 u 191LJ1R.ULlUL_.. ......JlLAlliJUJO..,\\ITUIli 55
160 JO016 6 14.00 84.00 llJOOS Il0491 AO' SUTUAE CHAAGI CLASS I
160 JOllO I S.OO 1.00 1\J09S 1l049\ HO, aOYI[ TIP CLIANER
510 5]011_.1. "'60'_ I.OLlllRnIU.2.9S AI) fLU!!l!!.P.t-.._.,. ......_
110 Hon I 6. 0 0.00 1l309S USo" AU T"HPA 51AIP
170 51017 I 4".00 '24.00 111095 111005 PHO ANES 11-00 HINS'
ULl.Alll' 4.... v.OO... 104.00 11l.tl.\..ll04.i'_?l1R.__._.... AF.'p'O~Al. 'SU8SU!IUI.r _,__
110 7Ul6 l 114.00 2G'.00 IUOos HO'" PHO OHOIN SEAYICE OAllY
410 14210 I 10.00 30.00 1l0.91 H0491 PHO AEROS'L, IHlTlAl
UP 74ZS0 f----!I1JRJ,.. _~1~00 1l049! .Ll.O.+.OI.nO___._,__ J.'Cf~TJXf,J!>JR.QIlUJ!L .I.'!I.L
160 74390 56.00 ".00 113095 HalOS PHO 94760 OXrHfTRY lifASUREH[NI
III llOll I 1.00 5.00 I~O'" 12049! PHO N[BUlIlE~ HAND IIHO "'. '.; :>;..~.,
rID H09L..J, lZl.q,_ 214.00 IJ,U9J....Uill.Lt.llL... .. .Fu....lllLQ1JL1(,V.__..____~~_:._,',:~.,i.::. ..
101 01010 -I 100.00 -lOO.oo OUY96 031096 CIS " PATIe" ~AYNINT
101 01010'1 JOO.OO "00.00 047696 042606 ClI P PAl/CNI PAY"ENT
I~LllU.2_~L--'U.l.9 -l.9,~,.2.!_060S06 060~~6 .cll-f-__.. P'T/FN.I)!11.&lil._..
10101010.1 JOO.OO .;00.00001000091196 CIl P ""ENT P'YNENT
-.. ......-
........--
"
---
u END OF [HAk.liJ.$. ~.'.._.___ ___
-.-.-
. .
-----.............
., ~~~\'~:.'
"
-.~.
---
---.......-.
--............
.....---....
-.--.......-
" -
..................--
;....
.---..--. ....-
.-.--.---..--- . -.--...-... "_0'_.
--..-.. .
-.----,....
..-.....-... ...
- ..
:("'i;~\ ,\;':.)~.:~f:.J"li :~:..< ".
-...-...............-
.... ...-----. .-------..
-"---..-
". .:.
.....--
-..---- .. '. .--------... .-
---... "
-.
....:
'-.
-..-.......-..
. -.-.-- _.
.....--........ .
.--. .._-
....,:--
~ . .
-.......-........-
....---. -- -..--.----.
.'; ~
. :.::~ :' .~:: ...~.~:
. :... .~
"'" -'-..-----..-.. ........,--
....
""--
.. ,
:1 ,~.. ......--:::. '.' ..~....'.l..~.. :,"'.J.,",~. L,_
." :.. ':1:'..;:~' .:~.i:" :,~,i'~;'t:~~;~,:,,:~~.~t;. ;~.;~\:~;. t:
VERIFICATION
~Jt e: ~~ , who is'Se' VJt6 ~lWPLlfmofcarlisle
Hospital and Health Services and acknowledges that he has the authority to execute this Verification
in behalf of Carlisle Hospital and Health Services certifies that the foregoing Complaint is based
upon information which has been gathered by my counsel in the preparation of the lawsuit. The
language of this Complaint is that of counsel and not my own, I havc read the document and to the
extent that the Complaint is based upon information which I have given to my counsel, it is true and
correct to the best of my knowledge, information and belief. To the extent that the content of the
Complaint is that of counsel, I have relied upon counsel in making this Verification.
This statement and Verification are made subject to the penalties of 18 Pa. C,S. Section 4904
relating to unsworn falsification to authorities, which provides that if I make knowingly false
averments, I may be subject to criminal penalties.
Carlisle Hospital and Health Services
~e~
F.\fILES\DA T AFlLE\HOS'1T ALIXJC.I19-COM, l'cbNal
11 ..r:
_ I..~/:...;.-
~,~,' . ",':
-.....___'..__ .~:., I ,'~.'.\
!. ....'t..;
, ,.,
SH~RI~~'S RE1URN - REGULAR
CA~j~: 111.1: 1':1'9"1-01951 P
ClJl'IMUNW.:AI.TII IJF r~:IHlSYLV AN I A:
CIJlJNTY llF CUMHI.:llLAI/D
CAllI. [SU: HUSP IrAI. MID IWAI.'I1L-
VS.
SHIJlillAllT MlTHIJNY H
S'I'I':V~: WII (STU:H
, Shoriff or lIC'puty Sheri.if at
Cll~J/I[-:III.ANIl County, I'ennsylvaniil, whc, be1ng duly sworn ilccord1ng
to J all, says, the with1n CUMI'I.AItIT
upon SHI)liIlART ANTHIJNY H
rlefC'ndant, at 1031 :00 HOURS, on the Ibth day of April
was served
the
lY"]"/ at
18\ OLD GAP RUM)
CAllllSI.l:.. PA 17013 .CUMEJEHLAllD
County, Pennsylvania, by h'lnding to NEI.SUN r. SIlUGHART, FATIlER
OF DI':FT.
a true and attested copy of the CUMPLAINT
together with NOTICE
and ilt the same time direct1ng His attent10n to the contents thereof.
Shl?J"iIf.::.; Cost.s:
Do<::ketinCl
~3erv tct.1 ~
Aff1davlt
Surcharge
111.00
:1.Hl
.00
2.00
So iln;:;lIers: ../'?./~.
r):ftf.""v..,,-<. ~
R. I homas 1\11ne, ~her1
<,.'3. 110 11AlllSlIN lll.:AHDOIWF WILLIAMS
04/17/1997
b y.\c-\-- iRJ~
~~l"",,-, L. L -t'J4.
De pu y er1:11
;)Wllr-n ilr..t suh8cri bed tr) befof\? me
thi:: /1 E:- ,j.Jy 01 ~W
1',1 q 1 A. D.
- (\...Vo-()l~l ,~t,........,~.q,oWi~--
!'1- ~ 100(;; .dry :"'7
. \fll.fS\.DATAflU!\JIOSPITAL 00C\I19.UA 1\1.
0-.4 04/291910] JI OJ PM
lniMd 04IJW910] U 09 PM
)0418119
v.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. 97-1951 CIVIL TERM
CARLISLE HOSPITAL AND
HEALTH SERVICES,
Plaintiff
.....
ANTHONY H. SHUGHART,
Defendant
JURY TRIAL DEMANDED
PRAECIPF.
TO THE CUMBERLAND COUNTY PROTHONOTARY:
,
Please mark the above captioned case settled and discontinued and issue a certificate
reflecting same,
By
Ge r
J.D. No, 4 13
Ten East High Street
Carlisle, PA 17013
(717) 243-3341
..
~
..;
Attorneys for Plaintiff
Date: April 29, 1997
i
i
I
,
l
I
f
I
,- '.,'
I.
f-,;'
:~..r~.
1~::i~
, ;:."ol.