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Home My WebLink About98-00776 ~ '( ~ ~ ~ ~ >' ~ .tl - ':) \. ~\ ~ ..... ~ '-.. it .. .' Cl... lit , !ill ~ ..t .\1 I ~/ <:..J. ~ " ~ " :- . .::> - ~ ~ t' ~ ~ F\J'ILE""nATAnI.F.\JIO!\PrTAI.lxK.'I.NlI-CUM l~'ntll Rn1Wd Ffhnwy 9. 19'~ lO'-lIlhl CARLISLE HOSPITAL AND HEALTH SERVICES. Plaintiff IN THE COURT or COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO, 98- TllP CIVIL TERM v. HARRY T. BAUGHMAN, Defendant JURY TRIAL DEMANDED NOTICE 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, YOU SHOULD TAKE THlS 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: Cumberland County Bar Association 2 Liberty Avenue Carlisle, Pennsylvania 170 I 3 Telephone (717) 249-3166 By Attorneys for Plaintiff Date: February 9, 1998 " . ~ - .", CARLISLE HOSPITAL AND HEALTH SERVICES, Plaintiff IN THE COURT OF COMMON PLEAS or CUMBERLAND COUNTY, PENNSYL VANIA CIVIL ACTION - LA W NO. 98- '7 '7 (p CIVIL TERM v, HARRY T. BAUGHMAN, Defendant JURY TRIAL DEMANDED COMPI.AINT AND NOW, comes the Plaintiff, Carlisle Hospital and Health Services, by and through its attorneys, Mnrtson, Deardorff, Williams & Otto, and hereby avers as follows: 1. 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 Harry T, Baughman is an adult individual residing at Rural Route #2, Box 288, Landisburg, Pennsylvania 17040, 3, On or about February 24, 1997 through May I, 1997 Defendant was provided with reasonable and necessary medical care by the Plaintiff and the Plaintiffs agents, servants and employees, 4, The outstanding balance of$18, 769.50 represents the reasonable and necessary value of the services provided to the Defendant and which Defendant has yet to pay, (A copy of the printout summary is attached hereto as Exhibit "An), 5. Despite repeated demand for payment, Defendant has failed to pay for the services provided, COUNT I BREACH OF CONTRACT FOR PROVIDING NECESSARY CARE 6, Plaintiff hereby incorporates by reference the avennents 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, '"' , ' WHEREFORE, Pluintiff demunds judgment uguinst the Defendant in the amount of $18,769.50 plus pre-judgment und post-judgment interest und costs. COUNT II OUANTUM MERUIT 8, Plaintiff hereby incorporutes by reference the uvennenls contained in parugruphs I through 7 of this Compluint. 9. The Defendunt is liuble to the Plaintiff und/or hus been unjustly enriched in the amount of $18,769,50 plus pre-judgment and post-judgment interest and costs, WHEREFORE, Plaintiff demands judgment against the Defendant in the amount of $18,769.50 plus pre-judgment and post-judgment interest and costs. MARTSON, DEARDORFF, WILLIAMS & OTTO By Ge r , Fuller, Jr., EsqUlr I.D. No, 49813 Ten East High Street Carlisle, PA 17013-3093 (717) 243-3341 Attorneys for Plaintiff Date: February 9, /Cf}Y' ," '" ~"'I U"" ",";"'.' ",n(t1u 0 " '.""';';". , 'n" " .' ',' " Exhibit A lI- ,- I "" f-""'twl.-.-i '...., ';-...........,.... " ~, FB,3.J.2 . " '\ , -"., i:"patie~t ':1 , BAUGHMAN, HARRY T. :' , BAUGHMAN, HARRY T. .'. BAUGHMAN, HARRY T. BAUGHMAN, HARRYT. BAUGHMAN, HARRY T. BAUGHMAN, HARRY T. .. End of List .* '"' CARLISLE HOSPITAL 11/19/1997 PATIENT MANAGEMENT " Pat # ST Soc Sec Num Dis Dt T FC R Amount Due 2763977 AR 186-30-7301 02/24/97 2 65 460.00 2823854 AR 186-30-7301 03/28/97 4 60 9,320.00 2866663 BD 186-30-7301 03/18/97 2 60 107.00 2902211 AR 186-30-7301 03/26/97 2 60 138.00 2943819 AR 186-30-7301 04/29/97 1 60 8,456.50 2944064 AR 186-30-7301 04/14/97 2 60 288.00 ~ If; ~f.S() EXHIBIT "A" " 08/28/97 251 ACCOUNT TRANSFER~TO BAD DEBTS DATE 8/28/9,7 PATIENT PAT CRD STMT NUM DISCHARGE B/D NUMBER PATIENT NAME TYPE F/C CD GRP STMTS DATE AGENT 286666-3 HARRY T. BAUGHMAN 2 60 4 27 5 03/18/97 E087 rJ" RESPONSIBLE PARTY INFORMATION HARRY T. BAUGHMAN RD 2 BOX 288 LANDISBURG, PA 17040 (717) 789-3928 PATIENT INFORMATION: ADM FC 60 SEX M RACE W MAR ST M SNN 186-30-7301 DIS ST 01 CNTY 196 ACCT REP M/R# 057740 DR# 60009 CAMPBELL, JOSEPH J MD DOB 03/18/39 R&B DAYS 0000 ADM DT 03/18/97 LST STMT DT 07/28/97 *** CHARGES *** POSTING DATE CHARGE SERVICE CODE DATE TECHNICAL DESCRIPTION AMOUNT 03/19/97 CIO 55000 03/19/97 CIO 55035 03/19/97 CIO 55028 03/19/97 CIO 55034 03/19/97 CIO 55283 FINAL BILL AMOUNT 03/18/97 PHLEBOTOMY FEE 03/18/97 CBC 03/18/97 PROTHROMBIN TIME 03/18/97 APTT 03/18/97 METABOLIC PROFILE NET CHARGES/CREDITS NOT DETAILED 107.00 8.00 28.00 18.00 24.00 29.00 107.00- *** CREDIT NOTES *** BAD DEBT AMOUNT : 107.00 . . _ . ".....' .' ':_'-.;. ~ MESSAGE FINAL BILL 107.00 0092 CREATED FRM BLR WRKBNCH STMT/SG27/CC1/MS#OS/ST# 1/ STMT/SG27/CC2/MS#06/ST# 2/ REVD ACCT, CLD HOME # N/A MANY ACCTS, FU TO C/B STMT/SG27/CC3/MS#07/ST# 3/ 107.00/P=Y CLD PAT BOWERS REF CLAIMS & CONCERNS FROM PATIENT, COMPLAINT ABOVE BEING GIVEN WRONG ESTIMATE FOR OPS 2823854 WAS TOLD BY DR NO COMPLICATIONS, WHY IS PRICE SO HIGH. ALSO UPSET ABT ICU RATE ON ADM 2943819 WAS TOLD NO AVAILABLE BED & THAT IS WHY HE WAS KEPT THERE, PER PAT SHE WILL HANDLE, FILE TO HER CLD COMBINED INS 1800-544-5531 PER MARY PT DOES HAVE COV ID#G2528878 REVIEWED WITH PATS, NOTES, FU 30 DAYS TO PENDING CCHH PAPERWORK, IF NO RESPONSE REVIEW WITH FRANK, POTENTIAL PROBLM HERE. REVD W/CR NOTE. CLD N/A REVD ACCTS/ CLD & SP/W MR BAUGHMAN, I ASK ABT CCHH PAPERWORK, STILL HASN,T 107.00/P=Y 107.00/P=Y C/B PT ENTRY DATE 03/24/97 03/26/97 04/14/97 05/19/97 06/04/97 06/04/97 06/09/97 06/09/97 06/09/97 06/09/97 06/09/97 06/09/97 06/09/97 06/09/97 06/09/97 06/16/97 06/16/97 06/26/97 06/26/97 06/26/97 06/26/97 07/14/97 07/17/97 07/17/97 ACTION DATE ,> . 03/24/97 03/26/97 04/14/97 05/19/97 06/04/97 06/04/97 06/09/97 06/09/97 06/09/97 06/09/97 06/09/97 06/09/97 06/09/97 06/09/97 06/09/97 06/16/97 06/16/97 07/26/97 07/26/97 07/26/97 07/26/97 07/14/97 07/17/97 07/17/97 "I I ! \ \ ,,",, ~.. " " ,PB.1,.1 CARLISLE HOSPITAL 11/19/97 PATIENT ,MAST~R INQUIRY CHARGES " .... Number 2902211 Name BAUGHMAN, HARRY T. Amt Due 138.00 FC 60 Nrv Chg. Qty Amount Date Bat Reference Description Post Dt 305 55035 1 28.00 032697 CIO INTFCE CHG CBC 032797 305 55027 1 12.00 032697 CIO INTFCE CHG DIFFERENTIAL WBC 032797 301 56084 1 37.00 032697 CIO INTFCE CHG GLYCOSLYATED HEMOGLOB 032797 301 55255 1 27.00 032697 CIO INTFCE CHG T4 032797 301 55244 1 34.00 032697 CIO INTFCE CHG CHEMISTRY PROFILE 032797 ** End of List ** ENTER Continue F2 Credit Notes N Nxt Patient F3 Insur Estmts S Chg Inquiry F4 Insur Plans F1 Charges F5 Stmt Data 11/19/1997 FINA~ BILL .... PiT 2 F/C 60 04/14/97 C/C 3 S/G 27 04/14/97 Sex M SRV 38 03/18/39 Race W DRG 04/21/97 Amt 288.00 Amt .00 10/13/97 Amt 288.00 Due 288.00 PB.3,.12.1 CARLISLE HOSPITAL PATIENT 2944064 'Pat Name BAUGHMAN, HARRY T. Rsp prty BAUGHMAN, HARRY T. Address RD 2 BOX 288 Adm Dt Dis Dt Brth Dt Bill Dt Pymt Dt Stmt Dt LANDISBURG, PA 17040 Phone (717)789-3928 M/R # 057740 Soc Sec 186-30-7301 Credit Note Messages Act Dt By SMOKER DM 04/11/9'1 DH FINAL BILL 288.00 04/21/97 FB STMT/SG27/CC1/MS#05/ST# 1/ 288.00/P=Y 05/12/97 SM REVD ACCT, CLD HOME # N/A C/B PT 06/04/97 SS MANY ACCTS, FU TO C/B 06/04/97 SS CLD PAT BOWERS REF CLAIMS & CONCERNS 06/09/97 SS FROM PATIENT, COMPLAINT ABOVE BEING 06/09/97 SS GIVEN WRONG ESTIMATE FOR OPS 2823854 06/09/97 SS WAS TOLD BY DR NO COMPLICATIONS, WHY IS 06/09/97 SS PRICE SO HIGH. ALSO UPSET ABT ICU RATE 06/09/97 SS Enter Function Key, 'F1' for Help, or ENTER to Exit. ** Registration ** ** Credit Notes ** PB . 1. 1 CARLISLE HOSPITAL 11/19/97 PATIENT ,MASTER INQUIRY CHARGES ., '. HARRY T. number 2944064 Name BAUGHMAN, Amt Due 288.00 FC 60 Nrv Chg. Qty Amount Date Bat Reference Description Post Dt 320 60055 1 116.00 041497 PHO 71020 CHEST ROUTINE 2V 041497 730 76001 1 81. 00 041497 PHO 93005 EKG 041497 301 55000 1 8.00 041497 CIO INTFCE CHG PHLEBOTOMY FEE 041597 301 55283 1 29.00 041497 CIO INTFCE CHG METABOLIC PROFILE 041597 302 55889 1 12.00 041497 CIO INTFCE CHG BLOOD TYPE 041597 302 55879 1 30.00 041497 CIO INTFCE CHG ANTI BODY SCREEN 041597 302 55890 1 12.00 041497 CIO INTFCE CHG BLOOD RH 041597 ** End of List ** ENTER Continue F2 Credit Notes N Nxt Patient F3 Insur Estmts S Chg Inquiry F4 Insur Plans F1 Charges F5 Stmt Data ..:' NOV 19, 1997 10:18 PAGE 1 11/19/97 CF .P8 0610.1 PATIENT NO 2943819 PAT I E N T N A H E BAUGHHAN, HARRY T. SOC SEC I 186307301 CARLISLE HOSPITAL PRINT PATIENT HASTER CHARGES NET CHGS ROOH CHGS PREV BAL .00 840.00 8456.50 0/5 INS .00 PAYHENTS .00 AHT DUE B456.50 000 ELECTRONICALLY BILLED 000 AHOUNT EXT AHT SRV DT PST DT BAT REFERENCE DESCRIPTION NRV CHG QTY 200 19500 1 250 A TR60 2 250 EPH50 I 250 HEP55 2 250 HEP68 I 250 LlD42 1 250 KET50 1 250 CHGOl 1 250 ATR54 1 250 NE052 1 250 CFlOl 1 250 CHG09 1 250 CFI0l 1 250 CFlOl 1 250 CHG09 1 250 CHG09 1 250 HEP56 1 250 8AC50 1 250 LID55 1 250 KID50 1 250 FEN50 2 250 FEN51 2 250 KOR50 1 250 DOP50 2 250 CFI01 1 250 CHG09 1 250 KOR50 1 HO OXY02 2 250 GLI03 1 250 GLI03 -1 250 GLI03 1 250 GLI03 1 255 82448 1 270 80081 1 270 80299 1 270 79026 1 270 79892 1 270 78204 1 270 80092 1 270 79125 1 270 79845 1 270 78542 1 270 79885 1 270 79280 1 270 79913 1 270 78570 1 270 82511 1 0005A 2000 ROOH-8ED/ICU ATRACURIUH INJECTION 50HG EPHEDRINE SULFATE INJ. HEPARIN INJECTION HEPARIN INFUSION iOOOUNITS LIDOCAINE 4~ DUO-TRACH KIT KETOCLOPRAKIDE INJECTION ANESTHESIA-PHARH. CHARGE ATROPINE INJECTION 1.2HG/3 NEOSTIGHINE /PRDSTIGHIN I INTFCE CHG CEFAZDLIN IN D5W PREKIX 1 INTFCE CHG PHARKACY CHARGE IV SERVICE INTFCE CHG CEFAZOLIN IN D5W PREHIX 1 INTFCE CHG CEFAZOLIN IN D5W PREKIX 1 INTFCE CHG PHARHACY CHARGE IV SERVICE INTFCE CHG PHARKACY CHARGE IV SERVICE INTFCE CHG HEPARIN INJECTION INTFCE CHG BACITRACIN INJECTION 5000 INTFCE CHG LIDOCAINE 1~ INJECTION INTFCE CHG HIDAZOLAK INJECTION INTFCE CHG FENTANYL INJECTION INTFCE CHG FENTANYL INJECTION INTFCE CHG KORPHINE INJECTION INTFCE CHG DDPAKINE VIAL INJECTN 400 INTFCE CHG CEFAZOLIN IN D5W PREHIX 1 I NTFCE CHG PHARKACY CHARGE IV SERVICE' INTFCE CHG HORPHINE INJECTION I NTFC E CHG OX YCODONE/ACETAKINOPHEN INTFCE CHG GLIPIZIDE EXTENDED RELEASE INTFCE CHG GLIPI2IDE EXTENDED RELEASE INTFCE CHG GLIPI2IDE EXTENDED RELEASE INTFCE CHG GLIPI2IDE EXTENDED RELEASE OPTIRAY 240 50HL VIAL FINGER STIX BLOOD SUGAR SE INTFCE CHG I.V. THERAPY SERVICE CUFF ADULT DISP SENSOR OXYGEN ADH OXYTIP NSS IRRIG. BOTTLE 250 HL 2 KIT STARTER ONE TOUCH PAD ELECTRODE PATIENT RETU PACK BASIC Al14T DRESSING TELFA 8- X 3" STE PEN ELECTROSURGICAL -BOVIE SYRINGE IRRIGATING BULB TY SPONGE LAPAROTDKY 4 x 18 4 CLOSER STERI-STRIP SKIN EXTENSION TUBING 20- K50 042897 RBO 042B97 PHO 042897 PHO 042B97 PHO 042897 PHO 04U97 PHO 042897 PHO 042897 PHO 042897 PHO 042897 PHO 042997 C 10 042997 C 10 042997 C 10 042997 CIO 042997 C 10 042997 CIO 043097 P 10 043097 PIO 043097 P 10 043097 PIO 043097 PIO 043097 PIO 043097 PIO 043097 PIO 042997 C 10 042997 CIO 043097 PIl 043097 P Il 050197 C Il 050197 CIl 050197 CIl 050197 C Il 043097 R68 042897 PHO 042997 CIO 043097 R71 043097 R71 043097 R71 043097 R71 043097 R68 043097 R68 043097 R68 043097 R68 043097 R68 043097 R68 043097 R68 043097 R68 840.00 042897 134.00 042897 2.00 042897 8.00 042B97 15.00 042B97 34.00 042B97 2.00 042897 IB.OO 042897 2.00 042897 4.00 042897 21.00 042897 3.00 042897 21.00 042897 H.OO 042897 3.00 042897 3.00 042897 8.00 042897 15.00 042897 2.00 042897 H.OO 042897 10.00 042897 10.00 042897 5.00 042897 8.00 042897 H.OO 042997 3.00 042997 5.00 042997 4.00 042997 4.00 042997 -4.00 042997 4.00 043097 4.00 050197 60.00 042897 3.00 042897 90.00 042897 20.00 042897 60.00 042897 3.00 042897 90.00 042897 14.00042897 11.00 042897 3.00 042897 11.00 042897 3.00 042897 8.00 042897 3.00 042897 3.00 042897 840.00 67.00 2.00 4.00 15.00 34.00 2.00 133.00 2.00 4.00 H.OO 3.00 H.OO 21.00 3.00 3.00 8.00 15.00 2.00 H.OO 5.00 5.00 5.00 4.00 21.00 3.00 5~ 00 2.00 4.00 4.00 4.00 4.00 60.00 3.00 90.00 20.00 60.00 3.00 90.00 14.00 11.00 3.00 11.00 3.00 8.00 3.00 3.00 .: NOV 19, 1991 10:18 PAGE 2 11/19/91 CF.PB0610.1 PATIENT NO 2943819 PAT I E N T N A H E BAUGHHAN, HARRY T. SOC SEC , 186301301 CARLISLE HOSPITAL PRINT PATIENT HASTER CHARGES NET CHGS ROOH CHGS PRE V BAL .00 840.00 B456.50 OIS INS .00 A~T DUE PAYHENTS 8456.50 .00 ~.. ELECTRONICALLY BILLED ~~~ AHOUNT EXT AHT SRV DT PST DT 8AT REFERENCE DESCRIPTION NRV CHG IlTY SURGICAL 4X8 S NEEDLE GUARD COUNT 1200 STAPLER SKIN 25W SPONGE LAPAROTOHY 4 . IB 4 COVER HAYO . SURG ICAL 4X8 S PAD PREPPING SU RG ICAL 4X8 S BAG-A-JET CLEANER BOVIE TIP SPONGE LAPAROTOHY 4 . 18 4 STERILE H20 BOTTLE 1500HL RAZOR DISP SCHICK CANNISTER SUCTION 1500HL SPONGE LAPAROTOHY 4 . 18 4 IV START ANESTHESIA DEPT I.V. THERAPY SERVICE ELECTRODC PNS DUAL ELEHENT SENSOR ESOPHAGEAL TEHPATUR TUBE ENDO 1.0 HH CUFFED ST YLETTE 14 FR. CI RCUIT ADULT EXCHANGE HEAT HOIST PALL CANNULA NASAL OXYGEN HASK ANESTHESIA SZ 6 LG AD YANKAUER SUCTICN INSTRUHEN TUBE NON-CONDUCTIVE 12' CANNISTER SUCTION 1500HL KIT HONITORING 4255B-Ol KIT ARTERIAL/RADIAL AK-040 CATH SET RADIAL ARTERY RA INTFCE CHG I.V. THERAPY SERVICE IV PUHP INFUSION SERVICE I PUHP PLEXIPULSE IW PADS STAPLE REHOVER DISP INTFCE CHG I.V. THERAPY SERVICE NSS IRRIG. BOTTLE 1000 HL INTFCE CHG PHLEBOTDHY FEE INTFCE CHG PHLE80TOHY FEE INTFCE CHG PHLEBOTOHY FEE INTFCE CHG HETABOllC PROFILE INTFCE CHG BLOOD TYPE INTFCE CHG ANTI BODY SCREEN INTFCE CHG BLOOD RH INTFCE CHG ST AT INTFCE CHG HEHOGLOBIN INTFCE CHG HEHATOCRIT 60.00 042891 8.00 042891 120.00 042891 8.00 042891 8.00 042891 60.00 042897 3.00 042897 60.00 042897 15.00 042897 3_00 042897 8.00 042897 8.00 042897 3.00 042897 8.00 042897 8.00 042897 18.00 042897 90.00 042897 3.00 042897 14.00 042897 11.00 042897 14.00 042897 25. DO 042897 14.00 042897 3.00 042897 11.00 042897 3.00 042897 8.00 042897 8.00 042897 45.00 042897 30.00 042897 20.00 042897 90.00 042997 9.00 042997 180.00 042997 14.00 042997 90.00 043097 3.00 042897 8.00 042897 8.00 042897 8.00 042997 29.00 042997 12.00 042897 30.00 042897 12.00 042897 17.00 042897 12.00 042897 12.00 042897 043097 R68 043097 R68 043097 R68 043097 R68 043097 R68 043091 R68 043097 R68 043097 R68 043097 R68 043097 R68 043097 R68 043097 R68 043097 R68 043097 R68 043097 R68 043097 R27 043097 R27 043097 R27 043097 R27 043097 R27 043097 R27 043097 R27 043097 R27 043097 R27 043097 R27 043097 R27 043097 R27 043097 R27 043097 R27 043097 R27 043097 R27 042997 CIO 042997 PHO 042997 PHO 043097 R35 042997 CIO 043097 R68 042997 CIO 050197 CIO 050197 CIl 050197 CIl 042997 C 10 042997 CIO 042997 C 10 042997 C 10 042997 C 10 042997 C 10 60.00 8.00 12 O. 00 8.00 8.00 6 0.00 3.00 60.00 15.00 3.00 8.00 8.00 3.00 8.00 8.00 18.00 9 O. 00 3.00 14.00 11.00 14.00 25.00 14.00 3.00 11. DO 3.00 8.00 8.00 45.00 30.00 20.00 90.00 9.00 180.00 14.00 90.00 3.00 8.00 8.00 8.00 29.00 12.00 30.00 12.00 17.00 12. DO 12.00 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 210 78545 210 79836 210 78318 270 79913 270 79710 210 78545 270 80048 270 78545 270 78282 270 80088 270 79913 270 '78200 210 79171 270 79403 210 79913 270 81250 210 80299 210 81234 210 80519 210 79500 210 79458 210 80502 210 80204 270 79404 270' 81206 270 79444 270 80082 210 79403 270 80040 210 80032 210 81226 270 80299 270 78113 210 78126 270 78298 210 80299 274 7820B 301 55000 301' 55000 301 55000 301 55283 302 55BB9 302 55B79 302 55B90 305 55032 305 55013 305 55012 -,' - 11/19/97 CF.PB0610.1 PATIENT NO 2943819 PATIENT NAHE BAUGHHAN, HARRY T. SOC SEC _ 186307301 NRV CHG OTY 305 55035 312 55710 320 60722 360 29006 360 30206 360 30400 360 30213 360 29185 360 29185 360 30237 360 29190 360 30400 360 30408 360 30234 360 30626 360 29185 360 30628 360 29235 360 29016 370 53017 370 53024 370 53032 490 34220 710 32001 940 19610 940 19615 CARLISLE HOSPITAL PRINT PATIENT ~ASTER NOV 19, 1997 10.18 PAGE 3 CHARGES PREV BAL 8456.5p AHT OUE PAYHENTS NET CHGS ROOH CHGS 8456.50 .00 .00 840.00 .00 ELECTRONICALLY BILLED ... AHOUNT EXT AHT SRV DT PST DT BAT REFERENCE DESCRIPTION 1 1 1 1 1 1 2 1 1 1 1 1 1 1 6 1 7 1 1 1 1 1 1 1 1 1 28.00 8.00 501.00 1458.00 150.00 23.00 45.00 8.00 8.00 8.00 14. 00 23.00 90.00 14.00 15.00 8.00 27.00 51.00 1198.50 1140.00 3.00 3.00 72. 00 270.00 17.00 13.00 .. END OF CHARGES .. 28.00 042997 050197 Cll 8.00 042897 043097 H07 501.00 042897 042897 PHO 1458.00 042897 042897 PHO 150.00 042897 043097 R68 23.00 042897 043097 R68 90.00 042897 043097 R68 8.00 042897 043097 R68 8.00 042897 043097 R68 8.00 042B97 043097 R68 14.00 042897 043097 R68 23.00 042897 043097 R68 90.00 042897 043097 R68 14.00 042897 043097 R68 90.00 042897 043097 R68 8.00 042897 043097 R68 189.00 042897 043097 R68 51.00 042897 043097 R68 1198.50 042B97 043097 R68 1140.00 042897 042897 PHO 3.00 042897 043097 R27 3.00 042897 043097 R27 72.00 042897 042897 PHO 270.00 042897 042897 PHO 17.00 042997 042997 PHO 13.00 042997 042997 PHO 0/5 INS . DO I NTFC E CHG CBC SURG PATH LEVEL I OR ARTERIOGRAH EXTREHITY 8 OR TIHE 181-210 HIN SKIN STAPLER AUTOSUTURE 12 ARTERIAL CLAHP JAW INSERT HE HOCLlP PACK VASCULAR TILES 4001-W VASCULAR TILES 4001-W DONUT POSITIONING ANT CHAHBER WASHOUT CANNUL ARTERIAL CLAHP JAW INSERT CAROTID SHUNT IN STRUHENT HA T SUTURE CHARGE CLASS I VASCULAR TILES 400I-W SU TURE CHARGE CLASS II ELECTROSURGICAL UNIT HEADOX HEHASHIELD PATCH ANES 181-210 HINS ELECTRODE TEHPA STRIP OUTPATIENT SET-UP CHARGE REC RH 61-120 INVASIVE LINE HONITORING CONTINUOUS EKG HONITORING . VERIFICATION Patrick R. Richards, who is Sr. Vicc President/CEO of Carlisle Hospital and Health Services and acknowledges that he has the authority to execute this Verification in behal f of Carlisle Hospital and Health Services certifies that the foregoing Complaint is based upon infomlation which has been gathered by my counsel in the preparation of the lawsuit. TIle language of this Complaint is that of counsel and not my own. I have 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 ,-', 7 <<;-- / r-' ---; /' / .!4Ut-ttk t--, (t~).iulk/' Patrick R. Richards f.U:ILES\D^TAFILE\lIOSPITAL,~6I-COM.I"bl\mad !~ I I I I , I I I ! , if, l.., CARLISLE HOSPITAL AND HEALTH SERVICES, Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA v. CIVIL ACTION - LAW HARRY T. BAUGHMAN, Defendant 98-776 CIVIL TERM ORDER OF COURT AND NOW, this 30th day of October, 2001, in the case of Carlisle Hospital and Health Service versus Baughman at No. 98-776 Civil Term, and it appearing that an objection has been filed by Plaintiff's counsel to dismissal of the case, the case is stricken from the purge list and shall remain active for a period of 6 months. In the event that no action on the docket appears within that period, the case shall be deemed automatically dismissed and purged. By the Court, George B. Faller, Jr" 10 East High Street Carlisle, PA 17013 For the Plaintiff g} Esquire . ~ Defend~' p<~~ofL~ Harry T. Baughman, Box 288 Landisburg, PA,17040 (") c, "' C 'II ~.. =-"= :...,;j "UlT <::> >: ?:1 n)!.1~ ..:.: ._o_L r:; ::::::c- ),::) U.J .,- lD -:; ~~ . ,) , t::"CI -~I() ,- :s ~~~, .:.::.; 2;(") ," ':;;() 09 ~ t')rn --c -'-I Z 0 ;c- ~ .;;- ~ pcb