Loading...
HomeMy WebLinkAbout97-03069 ~ i .. ~ \l ., ~ """ -) .-;. - I I "I I > I ~ I .-\- q: - \/I " cl - :> ~ 0 ~ ::t ., l.I? ~ .1 - ~ ~ '" ... . - - - cJ. '" -, / - . . :) , - 0"'" ...., <:) :1 ~: . ~ ..,' i 0 , , '"4 () n ~ If) a- 3 a- 0 ~ 0- -:t- (f) i! l!) - 11': .., 1\- ..) -{ cL C) ~ fuod; '0 ~ OH C U1~ ClI .\) >0\.1 " ~~3 :~ ....0 ~ :s ~ .........c ... z... 0 gJ c8l ... 0 < t-- ~ ~i2~~ iffi:S ~ .:!l.a ~ .':':: 010 ?i! ll<~ ~i > '0 0 ~ ~g ~ 'M L.I~ H 'OClI od; 8z-~ -H C G ' ~ :Hi ~~~ 13U1 , ...:l > H I") ~ " :;!8i:z :C:c -.... 3 iZo~~ WE-< 9z c.. ~~ ffi ~..... ~ ~<zul ~~5 U1::>1Il ~ ~ ~ ~~ !l!"'1Il ~:c ClI Ql OZI") _<0 \S fllffi I") III ~ l: WClI ~ < ~~ H 'l: :l ~ I") "= ) CARLISLE HOSPITAL AND HEALTH SERVICES, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v, CIVIL ACTION - LAW NO. 97- 30'.,/ CIVIL TERM JULIE JOHNSEN, Individually and as Natural Guardian for Jessica J. Johnsen, Defendant JURY TRIAL DEMANDED COMPLAINT AND NOW, comes the Plaintiff, Carlisle Hospital, by and through its attomeys, Martson, Deardorff, Williams & Otto, and hereby avers as follows: I. Plaintiff is Carlisle Hospital and Health Services. a Pennsylvania non-profit corporation with its principle place of business at 246 Parker Street, Carlisle, Cumberland County, Pennsylvania 17013. 2, Defendant Julie Johnsen is an adult individual residing at 22 South Letort Drive, Carlisle, Cumberland County, Pennsylvania and is the natural and legal guardian for Jessica J. Johnsen. 4. On or about July 15, 1996 through August I, 1996, Defendant's daughter, Jessica 1. Johnsen. was provided with reasonable and necessary medical care by the Plaintiff and the Plaintiff's agents, servants and employees, 5. The outstanding balance of $9,763.00 represents the reasonable and necessary value of the services provided to Jessica Johnsen for which Defendant has yet to pay. (A copy of the printout summary is attached hereto as Exhibit" An). COUNT I BREACH OF CONTRACT FOR PROVIDING NECESSARY CARE AND SIIPPORT 6. Plaintiff hereby incorporates by reference the averments contained in paragraphs I through 5 of this Complaint. 7. Defendant has breached an expressed or implied agreement to pay the reasonable value of the services rendered. exhibit A / TEL;1-717-249-9346 Her 26,97 0)126/91 ".Pb0610.1 PAllEN' NO U014?7 ~AlIE'l NA~E JOH..SE~, JESSICA J. ...,oe-sce , ll+9M-l-ilD CA~LJ~Ll ~O~Pl'~I, ,'~lhl ~.Tlf'~T ~A~lr~ .4..1/, 1007 Il:B ~4~1 I CII4ROE5 .-...-...,.P..... 'M Ilur "AV"LNTS NeT (,..t.~ ~n~. CHOS PPfV SAl Y763.00 .00 .00 .llS.OO 9TU.00 ~.. EL~CT~C~tCALLY ~ILL~O ~~y 015 I NI .00 .------.- "'frif".-c-tt~'''..n'.' ..It~ellr.T ',M' lllf--5RY O'F- ;':'.T AT ~I"" ftt...k.PE"/C[ ersr.~lnl0H. IH 16100 I '15.00 HS.OO o 11>~0 071196 ,eo o S040 1210 ROO~-O~D/IS 1t1. loH6 1 -6!l".Ot' J.BS.U nrl.:....O-.ON~( ~-,: r )l'''.HI,O' '186"1 B~8/)S -- .. ,..-- IH 10500 I 11I.00 401.00 0717.0 071796 neo o 101~ 1210 ROOO-~~D/IS 114 16S00 I 'IU.OO '40S.00 071&96 071!9/, neo bSHO HIO ~oc~-eEO/15 114 16HO I HSioOO- 48$.18 171 'J H '07 LCJ96' RIU . SI'B 17.+t',"$Ofl SlOtH -, IU L6S00 I 4H.00 '!I.OO 072006 012006 WOo 05010 1?10 ROOM-BEO/55 IH 16100 ' I 415.00 UI.OO 071196 bHI76 RltO o SOlO 1?10 OOO~-OEO/IS 11'" H.H8 I '.-"'lll.U t8S.DO 07HO:. B:rz1~ R38 H6!0 I ZU RAllfHlEO/5S'-' 114 16500 I 411.00 "5.00 07B9~ 07?l?6 HPO 05060 Ill0 RnOM-IED/IS IH 16100 I u~.oo IoIS.OO 07H'11 072496 rf~O o 101~ ':l"O ~~0'-RFOI\5 114 16~" I !a~.aob- .../1,$. 88 e1l~~'6"-OiZS1b Flf.e , H~b H4rO lIeBr. Rre/S:. 114 16S00 'I 4U.00 AH,OO 072696 07l69b 000 o 10lw 1240 HOCR-RFO/IS 114 16100 I 415.00 415.00 OH796 Oll1h RAO OIOl" HIO ROOK-BfOIlS U... 161~' I us.oo 4A'.'OO '1ZB')~ e. lB'i6'.Cf;\B 1)9J.4 lZ~OM gee:S& IH 16100 1 ~6S.00 4a,.00 OH096 012.00 K.O 0'50 SW 1'10 ROO.-lfO/55 1l~ 16100 I 4\1.00 ',6~. 00 07lHO nllOH ROO o lOlW 1Z10 ROO'-8CD/IS It.lo 1611I6 I 4~~.Q" 4aS../ID \l':H'i~ erH1~ k811 "8 ~w llU ReSl1 OfO'H 250 VAlU 1 4.00 8.00 011090 071790 GIO I'UCE CKG OIV4lP~OE' TA9IFl ?SOMn 250 VAtOZ I 4.00 0.00 o 71IV6 0'l8~6 (Jo I"f~l C"G CIVllPAOEI lUlH HOOO UO .uoz l ~ . eo ~.OO O.lf );, OH'!"9/t fJ3 111H:' 'C"'Ic,'OJ'.'lll'fl8CI( TAbLEr 2~ar6 -----... 210 VAl02 1 4.00 0.00 071&.0 07l0~6 (,10 INlrn C"G 0IV4.PROEI T49lET 250~G llO HYOOT l '2'.00 11.00 U7I OYO O'll~b ell l'trCE C"G "YOOOJYZ1.C ORH UO/CAP O. II.GOT 6 ....."..08 Il..aa 4'tlW~1~... ((I 1 ..,1f( C ( 11 ,1, e~8)1Yi"'IJt eft 1L T Atl/GAP'-- . . ,_.,.,- BO .AtU 2 4.00 8,00 0110'/6 012190 C/ 0 lNl~(( CKU OlY4LPROU TAOLET 2IO"G no HYOOI l 2.00 b.OO 071996 012Z06 CIl l'l~CF CKO IIvMCIYZlNf OAH TA9/CAP O~ ""1.41. I .10.68 ~fl. 8 0 fJrUJ~':' )f Zt'+6 U 1 JI.Hn ("6"01 V,l.LP AeCl! 14!ltt' t>'118 2S0 /lY007 l 2.00 ..00 072006 OlllH CIO l'IFC F tHG lIYO~OIV/lNf 004l HB/CAP ISO V4l0! 2 4.00 8.00 O'/IH 072196 C 12 Isner Ctlr, 01 '4l~RO~' uaLET 250"0 130 V"b~l I .I..U ...8.80 \HLlJA 811)96 elO IIHf([ CH(~ ~1~~Lr~e[~ Tl9ttT tSu & .....-...- no VAtU 2 4.00 8.00 071396 071.~90 clO lNl~CE CHO OIV4LPAOU l4alE! HONG no HY007 1 2.00 0.00 01lJYh 0116.6 no I NI~C! CHG KVn~OlYZ1NE ORAL H8/C AP IH .~LU I ..., '4-..ee a.aG 01L.l.1a OTl3 )~ U~ 1.HrfC e 16 ,tvllPlte'=R ''''!UT''~6 250 HLOl 2 4.00 8.00 07H/6 Ol2b.0 Pl. I Hlrcr. t"G 01 V'LPROB T49LET 250MG 250 VALOI -l 4.00 -8.00 07259^ 0'Z6~6 GIO I NTHF CliO 01 VALPROEl UBlE! 2SO~0 lS' '.M.H. 1 ".06 6:.00 ar[!>'~ 8T16'~ tlO IU11'tf fll& 81 )"AL'R5t:~"T~Blcr ~.aeIlB ----..-- ISO VAtU l A.oo 12.00 072S~6 012606 C 10 IN1fCE CHG OIVAlPROEI TABLET 100"~ 250 YAlOI 2 6.00 11. DO 071S~6 011696 t 10 (N!fer CHG OlV4lpnon IABLET HO"G f)lJ w,I.LU--t---.. .~'.'OO ~. ft n Df!3u.erz<.H. C 10 ~~CE (18 6t ....LIIR,QtK l,l.SltT 3(8"6- ISO yAtU ! 6.00 11.00 o 1109 6 072091 ClO I HHCl CNG 01 VALPROEl U 9lE! 100NG 110 Ht007 6 2.0~ 1(\.00 072696 07290e Cll lNlFn CNI, HYOROUlINf ORAL HO/C.. ZSI \....LO~ I ,~. 86 11.09 e7~7?~ 01i1~~ tl1 tl,H(t'~r~ B1VAlDR9t-*-T'RL[l )'.nc;--. no VAL 01 1 ~. bO 12.0. 072696 .,299b C n 1 HIre E CHG OIVAL"ROEX TABLET SOONG l}O YAL04 2 0.00 12.00 07109 b 071096 C/O '~IFCE CHG UIVAIPROH UOLET 'OOMO nl UC02--t-.. ._" 108 ..00" 0 15090 '.3IV6 I'll Itl Ire ( tll8 ...foeT fl.fHIIBPl1C'J U91:€T 4SIl1e-'~, l50 VAlO. 2 6.00 12.0. 07)OU 071190 G I 0 l~l~CE CHG 01 VALPROEI IAOLll SOOMG llO VAl04 l 6.00 12.00 011106 0&0106 GIO INI~CE CHG 0lV4lPROEl TA8LfT 500~0 nl, ....r.\.u I 6.18 -l2~" '''11 '0 oeOZ~t tit IIIHC( &11& 81 VA\'~[M TABLeT $OOM& (.,.....,..;, . :.- .,....-... . EXHIBIT t1A~..~ ... . . . ..~., ,h _. l~ -,- , I TEL:1-717-~4~-93J6 t1ar .if;,.j, '1/10/97 .r .P,0610.1 P~tlfNT NO Id9~'97 t.hH.:~"( .1(l!.f'IUl ...:,:,-, r,,' Inn t'AC',Tr.il NAn 16, 1907 14.1" ~AGl 1 c.""PGt~ -'-'---' '"'~._..- 'AIIE"IIA.E 10HN~EN. JFS'IC~ J. ;OC.-~~\o .. l1'796'lUIO' AN' OUE YHI.~) ~AY"!"S . ~'O 'lofT t~GS I'';OK Ctlc..~ yq(y GU .01'1 :H4~.O' 9163.00 o IS INS .00 ... ... ,....-.........--- .,.----,-..-....-.... ...-... -... ...' -~. ,... ,. ... n,Fc.TIlOk:Ci\LL.' 'ilt \,fO Uti ,,I... ..n~ nv' "K!'OUNr--'-r-rr-U~1 .4., VI r.1 .), .'''' "",,,~ll.':L. ~~3\,.AI'1IG" --------. 101 56060 110.00 119,00 0715Y6 071n! CIO INtF'E CH~ ORU~S Ale.OHOL CAN'AftlHOIOS lor~HO. t>.V," &:'O"O-rtl H~ U 11 ,~ ( 1~'1 NTrr r 'CNO I'Ht f1l0.0HY" ~~~-_. \01 ~SZ71 10S.00 10).0~ 071696 011796 ClO IIITH F ("~ THYOOIO 'BOFIU \01 S5H' S'.OO 54.00 071696 0711;! (10 T~TFC~ (N~ CHEHISUY P'lO~ IL~ ."'.1. ~ ""'",,, . _.'90-.-.... 1:";tO"'"O'M'I""-'" uU \0 I':' . nH.." L.,u 'n..d,~.J ..r , ,!! 101 56064 I 41.00 '7.00 07U?b 07129~ CU.INTfU CH~ OI~uENI nLrO~I( AtlO. 101 5 SODO I R.OO 1.00 07Z19b 0lC50b C Of. I HllCE CN~ ~HLEOuTOHY FCE ro-r-;;n Uo -- . 101.''';' .'-"'\1 w,,,' ,I) ,,,!...,.. " I ~ .I~ rh. { ... 'v .A.,,...! ,[ ......'1~H ~C1b \01 HOOO I 8.00 1.00 071996 0105.6 CIO INnCI C~~ '~LE001~.Y oee 102 H60' I l4.00 l'.OO ~716'lb 0717 96 Cl0 INHCL I'NG '^'~ ~UAL JII.l .J:'ilJj--t ,n."," ,..11"" VI L.!,.,,, VI.AI.,II .... l\ol U~ ,....l. ';'I~ ~...t \06 5SSIO I ~7. 00 47.00 0717'16 O'lIYb C 10 INHtC CNO (uLT URINf COLC"Y r.t 10fNI 107 S110Z I 1'.00 1S.DO 01 UOb 0717Yb CI~ T NHCE CNG ,of(, UBINE ;U'L )\1' ;J~Uol: . "'U,'fl' .....-. I ~'. OO'ell \9\- O'7'I"f11-..t!e-tNT1'Cr ~1J1t'N.W"!1""r~~1; ----.-..-... 107 HIO] I 11.00 31.00 071196 011990 C 10 I N,reo (NG He (. OU'L ;10 6640 I Sl.OO !l.00 07l6Y6 011796 .110 I/C~!7 (j=tOlJP \E5S10~ 4\.60 MIN. \10 B040] l ,lO' u~n I m-~ b.~~3......t .lO &bADl I ;lO 8b40 I I \U IUU3 1 \10 U4Cl ? 130 86.0) I Ht'tUJG 1 130 aool I . . . . '2.00 1U'.00 .071&9& o,uv,. D~O wct.~7 r,qcup ~ts~IO'" 'l-flC "I~. H.OO 51.00 Hll96 01B90 .~O IIO^^, r,'o~p \'5S1~N 41-60 MIN. )!.O~~..""t'G-fft4'" (lr(J'~ -:--~Il^,T ~~-1~laI1 41 L6 111""""--- 51.00 51.00 07l69^ C7/996 olin IICM7 r,Rour SCHION 41-60 MTN, 51.00 51.00 071996 073096 PH" wC'(;~7 C;~DJP S~SSII'JN '1-60 "IH. 'I.U H.OO UJIH~ 86elt1J,;. P,lO 4t:~t ~HH1r ~:S~fl'\fj -"I U "Ill. 51,00 10'.00 C7ll~6 OU600 PliO "H^7 :'~CJP seSSION 41-60 MIN. 51.00 52.00 OaOLY6 OIOb;b '00 1/0'6' OQCUp SISSIOH '1-60 MIH. e.oo" . 8,Oo-ffT'J't'O. OflO'tt-lH'I"-'- ....--~1-~t~I"IH "IO-S1REM ~I.OO 81.00 07169b 071606 P.O 9100S ~(~ .. ('~l\ .4f ~II"HH-... - .-.-." .....-.-........,-.. ..-.....-.--'----- ---..- ---.-----...,--.--' --..- -.---.,--. ' -- .-.....- ..- _. ..,..........-.-...-,... ,.- --,-..--.- '. -. . .- ~ , - .,.-..... SHEIlIFF'S rlJ::TURN - Tl1::GU1.AH GASE NO: t~97-030~9 P Cl)MMllNW~:AI.TH l]V P~:NNSYLVANIA: COUNTY llF CUMIl~;RLAND CAm. J S.l.,~:_!!9?P 1T~.L... "...JJt:Al.:rH.. S~:R VS. .IDJ!.NSI'lLJJI!.U: ..F:T (\1,.__. MJf.-'1A f.L. BtoRRICK._ _ .' Sheriff or Deputy Sheriff of CUMnERI~ND County, Pennsylvania, vho being duly svorn according to lav, says, the vi thin GOMPI.AINT vas served upon J.llIlN.st:N JIlI.n: {NOIV (0 ". AS.. "liARD {AN m'. JI,SSICA ~ ..JOJlNS~aL the do{ondont, a t J5'\~: 00. HlJURS, on the t2tl1. day of June . . _u _. ___-' t 99". at __ .:?2_.S0IlTIl l.~:TORT .I)R (V~: CAIII,(SI.~:,I'.A t'/0ta , GIJMIl~:RI.AN(L____-, Coun~,y, Ponnsytvon;,o, hy honding to JlJl.U: JOIINSI':ll. o truo onoi att:ost>?d I:OPY of the COMPl.A (NT ond ot ~,hl' som>? timt:' l:lirrmt.ing lIer. ot.tention to thl? l:ontonts thereof. .....___.___ _.-J Shoriff's Costs: Docketing SC4rv'lce Affidavit Surcharge So onsve?~r...<:~ H. I homas KJ.1ne, ::;:er1 t8.00 a.10 .00 2.00 $7.3.10 ~ARTSON DEAHDORFF 06/13/1997 by Svorn and sub~cribeoi to hefore me this t3!!:: . doy of 9...-.- ._ t':l'17_A.D. n C. 11.-' (l...- ., AT: . yr-'Prot'honotaryr-' i.' , I,.'." , .',' \'- , , C. \. . ' t. ,. ~--' (~ ) ."'J r.' ",,;.' ~l~ ',.) ~ ~ lQ ~ ~..; ~',=> ~ ~ .:S ~ I :>.B ~ ~~ ~ ~ - M'M ~ ~l2t;~ Mill .~ O~~ ~~ ~~L:> iJ . ~~ ~ ~U~i3~ > ~ :o!8:EZ i ZO~~ ~ 2;<: c.. \: i1l~z5 .~ p. . _\< u" CJ ~ \n ~ ~B ~ ~1;! iil ~. '" ~ is ~Di " '" ~ ~ ~ ~ 3