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cARLISLE HOSPITAL AND
IIEALTlI SERVICES,
Plaintiff
IN TIlE COURT OF COMMON PLEAS OF
CUMBERlAND COUNTY, PENNSYLVANIA
v,
CIVIL ACTION - LAW
NO.9X- 3/ i L~ CIVIL TERM
DANIEL BURGE,
Defendunt.
JURY TRIAL DEMANDED
.C!)MPLAlli1
AND NOW, comes the Plaintiff, Carlisle Hospital and Health Serviecs, hy und through its
attorneys, Martson, Deardorff, Williams & Olio, and hcrehy avcrs as t()lIows:
1, Plaintiff is Carlisle Hospital and Health Services, a Pennsylvania non-profit
eorporution with its principle place of business at 246 Parker Street, Carlislc, Cumbcrland County,
Pcnnsylvaniu 17013.
2. Defendant Daniel Burge is an adult individual residing at 619R Manehestcr,
Alexand1'ia, Fuirfax County, Virginia 22310.
3, On or about Scptember 25, 1997 Dcfcndant was a paticnt at Carlisle Hospital and
Hcalth Services for treatmcnt.
4, On or about Septcmhcr 25, 1997 through Octobcr 2. 1997 Defendant was provided
with reusonable and necessary care by the Plaintiff and the Plaintiffs agents, servants and
employees. Such care constituted wus rcasonably necessary I(lr the health and well heing of the
Defendant.
5. Thc outstanding balance of $4,309 represents the rcasonable and nceessary vaJue of
the serviccs providcd to the Defendant und which Defendant has yet to pay, (A copy of the printout
summary is attach cd hereto as Exhihit "A").
6, Despite repeatcd demand I()r paymcnt, Defcndant has failed to pay for the services
provided.
COUNT I
QUANTUM MERUIT
7, PlaintitT hereby incorporates by refercnce thc avcrments contained in pal'agraphs I
through 6 of this Complaint.
PB . 1. 1 CARLISLE HOSPITAL 10/10/97
PATIENT MASTER INQUIRY CHARGES
Number 3668076 Name BURGE I DANIEL Amt Due 4309,00 PC .30
Nrv Chg, Qty Amount Date Bat Reference Descript ion Post Dt
124 16500 1 524.00 092597 RBO 05100 1240 ROOM-BED/ 092597
730 76001 1 87.00 092697 PHO 93005 EKG 092697
124 16500 1 524.00 092697 RBO 0510D 1240 ROOM-BEDI 092697
124 16500 1 524.00 092797 RBO 05100 1240 ROOM-BED/ 092797
124 16500 1 524.00 092897 RBO 05100 1240 ROOM-BED/ 092897
301 55258 1 78.00 092697 CIO INTPCE CliO TSII 092997
301 55258 -1 -'/a.oo 092697 CIO INTF'CE CHG TSH 092997
124 16500 1 524.00 092997 RBO 05100 1240 ROOM-BEDI 092997
124 16500 1 524.00 093097 RBO 05100 1240 ROOM-BED/ 093097
250 RIS01 1 10.00 093097 CIO IN'I'PCE CliO RISPERIDONE TABLET 1M 100197
*. End of Page ..
ENTER Cont inue N Nxt Patient S Chg Inquiry F1 Charges
F2 Credit Notes F3 Insur Estmts F4 Insur Plans F5 Stmt Delta
I!llchibit "AI!
PB.l.1 CARLISLE HOSPITAL 10/10!97
PATIENT MASTER INQUIRY CHARGES
Number 3668076 Name BURGE, DANIEl. Amt Due 4309.00 FC. 30
Nrv Chg. Qty Amount Date Bat Reference Description Post Dt
250 RIB01 1 10.00 100197 CIO INTFCE CHG RISPERlDONE TABLET 1M 100197
124 16500 1 524.00 100197 RBO 05100 1240 ROOM-BED! 100197
250 RIB01 1 10,00 093097 PIl INl'F'CE CHG RISPERIDONE TABLET 1M 100297
250 RISOl 1 10.00 100197 CIa INTFCE CHG RISPERIDONE TABLET 1M 100297
250 RIS01 -2 -20.00 100197 CIO INTFCE CHG RISPERIDONE TABLE'r 1M 100<197
250 RISOl 1 10.00 100297 CIO INTFCE CHG RISPERIDONE TABLET 1M 100297
124 16500 1 524.00 100297 RBO 05100 1240 ROOM-BED! 100297
.. End of List ..
ENTER Continue
F2 Credit Notes
N Nxt Patient
F3 Insur Estmts
S Chg Inquiry
F4 Insuz' Plans
F1 Charges
F5 Stmt Data