The URL can be used to link to this page

Home My WebLink About03-3412TABAS & ROSEN, P.C. BY: LEWIS C. TRAUFFER I.D.#60267 22nd F1.,±845 Walnut Street Phila.. PA 19103 (215) ~69-§050 Pla~t~f($) THE MILTON S. HERSHEY MEDICAL CENTER P.O. Box 853 Hershey, PA 17033 ATTORNEYFOR Plaintiff COURT OF COMMON PLEA S DIVISION CUMBERLAND COUNTY TERM, VS DeJbn~nts~) LARRY R. HALTEMAN & RACHEL E. HALTEMAN, h/w 1223 Pine Road Carlisle, PA 17013 NOTICE CIVIL ACTION COMPLAINT AVISO 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) da~; after this complaint and notice are served, by entering a written appearance personally or byattorney and filing in writing with the court your defenses or objections to the claims set forth against you. You ave warned that if you fail to do so thc 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 plaintiff. You may lose money or property or other rights important to you. 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 FINDOUT WHERE YOU CAN GET LEGAL HELP. demandas expuestas en las paginas siguientes, ~,;t ed tiene veinte (20) dias de plazo al partir de la fecha de la demanda y la notificacion. Hace faBa asentar cumpla con todas las provisiones de esta demanda. Usted puede pcrder di~ero o sus propiedades o otros derechos importames para usled. CUMBERLAND COUNTY 2 LIBERTY AVENUE CARLISLE, PA (717)249-3166 I_LEVEESTADEMANDAAUNABOGADOINMEI)IAIAMENIE SI NO TIENE ABOGADO O SI NO TIENE El_ DINERO SUFICIENTE DE PAGAR TAL SERVICIO. VAYA EN PERSONA O LIAME POR TEl EFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABA.lO PARA AVERIGUAR DONDE SE PUEDE CONgEGUIR ASISTENCIA LEGAL BAR ASSOCIATION 17013 OR 800-990-9108 address 2. COMPLAINT - CIVIL ACTION THE MILTON S. HERSHEY MEDICAL CENTER VS. LARRY E. HALTEMAN AND RACHEL E. HALTEMAN Plaintiff is a non-profit corporation located at the indicated in the caption hereof. Defendants are individuals who reside at the address indicated in the caption hereof. 3. At all times material hereto, parents of Kenton E. Halteman, a minor. 4. As the result of a certain medical condition, was treated at the plaintiff hospital on Nov. 2, 2002 5, 2002. defendants were the said child thru Nov. 5. The amounts, quantities and nature of the medical care rendered, the dates on which said medical care was rendered, and the charges therefor are set forth in Exhibit "A" which is incor- porated herein as if set forth at length. 6. Said medical care was commensurate with the condition of defendants' child and was necessary for the health and welfare of defendants' child. 7. At or about the time of defendants' child's admission to the plaintiff hospital, implied, constructive and oral contracts arose between defendants and plaintiff by the terms of which, defendants became obligated to pay plaintiff's charges for the medical care rendered by plaintiff to defendants' child. 8. Defendants' child is indigent. THIS DOCUMENT IS BEING USED IN CONNECTION WITH THE COLLECTION OF A DEBT; ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE 9. Defendants are financially able to pay for the medical care of the child. 10. By virtue of the Act of 1937, June 24, P.L. 2045 §3, as amended, 62 Pa. Cons. Stat. Ann. §1973 and all other applicable statutes, laws, and ordinances, defendants have a duty to support defendants' child. 11. Defendants have been unjustly enriched by plaintiff's discharge of defendants' duty to support defendants' child, which duty, defendants failed to perform. 12. Defendants refuse to pay the balance due although plaintiff has made demand that defendants do so. 13. As a result of the foregoing, there is due and owing from defendants to plaintiff the sum indicated in Exhibit "A". WHEREFORE, plaintiff demands judgment against defendant for the sum of $23,999.49 plus six percent (6%) interest per annum from the date of discharge to the date of judgment, record costs and non-record costs. TABAS &ROSEN, P.C. ~ESQUIRE Attorney for Plaintiff THIS DOCUMENT IS BEING USED IN CONNECTION WITH THE COLLECTION OF A DEBT; ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 05/09/03 at 01:39 PM PAGE: 1 Guarantor: HALTEMAN RACHEAL 1223 PINE RD CARLISLE, PA 17013-0000 Patient: HALTEMAN KENTON E Visit #: 2906229 Date I Svc Code I Description I Unitsl Debits I Credits 11/02/02 10387 11/02/02 46472 11/02/02 46620 11/02/02 245525 11/02/02 245717 11/02/02 246057 11/02/02 246162 11/02/02 246706 11/02/02 250577 11/02/02 251846 11/02/02 272129 11/02/02 272199 11/02/02 272473 11/02/02 307290 11/02/02 410032 11/02/02 410052 11/02/02 410060 11/02/02 410067 11/02/02 422004 11/02/02 464046 11/02/02 502000 11/03/02 10277 11/03/02 245472 11/03/02 246556 11/03/02 246706 11/03/02 251174 11/03/02 272199 11/03/02 600522 11/03/02 621385 11/03/02 627069 11/03/02 670330 11/04/02 10277 11/04/02 191010 11/04/02 245472 11/04/02 246556 11/04/02 621385 11/05/02 245472 11/05/02 246556 04/30/03 980090 04/30/03 980091 8 PEDS INTERMEDIATE C 1 EMERGENCY VISIT, LEVE 1 ROUTINE VENIPUNCTURE 1 HEPARIN SODIUM 1000 U 1 DEXAMETHASONE 4 MG/ML 1 CEFAZOLIN 1 GM/5 ML 2 FENTANYL CITRATE 5 ML 3 MORPHINE SULFATE 2 MG 4 PROPOFOL 20ML 1 VERSED 5MG/5ML 1 ROCURONIUM BROMIDE 5M 1 ONDANSETRON 2MG/ML 2M 8 PAPAVERINE 30MG 2ML A 1 HAND 3 OR MORE VIEWS 1 O.R. TIME @ 15MIN INC 22 MAJOR SET-UP, ADD.SUP 1 ELECTROCAUTERY 1 MICROSCOPE 1 1/2 TO 1 HOUR-RECOVER 1 MICROSCOPE Dt~APE 1 ANESTHESIA TIME-HOSP 22 7 PEDS PRIVATE RM 1 CEFAZOLIN 10 GM/50 ML 7 ASPIRIN 81 MG 1 MORPHINE SULFATE 2 MG 3 ACETAMINOPHEN/CODEINE 1 ONDANSETRON 2MG/ML 2M 4 AMBUBAG PED MAUAL RES 1 IV KCL 20MEQ+D5 NACL 2 ST EXT MICRO 60" IML 2 IV INFUSION SET, UNIV 1 7 PEDS PRIVATE RM 1 LVL1 SURGICAL PATHOLO 1 CEFAZOLIN 10 GM/50 ML 4 ASPIRIN 81 MG 1 IV KCL 20MEQ+D5 NACL 1 CEFAZOLIN 10 GM/50 ML -1 ASPIRIN 81 MG 1 HOSPITAL BAD DEBT W/O -1 HOSPITAL BAD DEBT PLA 1 1615 00 478 00 13 00 6 45 2 10 10 30 2 10 8 4O 23 90 3 75 32 10 107 52 5 65 91 00 4664 00 1084 00 26 00 376 00 291 00 45 00 1331 00 930 00 14~.r~ 2.10 6.30 2.10 107.52 40.00 16.00 14.00 12.00 930.00 19.00 8.40 2.10 8.00 2.10 12328.49 2.10- 12328.49- MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 05/09/03 at 01:39 PM PAGE: 2 Guarantor: HALTEMAN RACHEAL 1223 PINE RD CARLISLE, PA 17013-0000 Patient: Visit #: HALTEMAN KENTON E 2906229 Date I Svc Code I Description I Unitsl Debits I Credits * - Not posted I Balance: I 12328.49 PHYSICIAN SERVICES PENN STATE LARRY HAL1 EMAN 1223 PINE RD The Milton S. Hershey Medical Center CARLISLE PA 17013-9372 Thc College of Medicine ACCOUNT # 1276684 H DATE PROCEDURE DIAG CODE CODE >>> P~IENT: KENTOH E HALTEHAN IF ANY QUESTIONS, PLEASE CONTACT: MSHMC PATIENT FINANCIAL SERVICES 11/02/02 20827. FA 885.1 01/06/03 11/02/02 26951, FA 886.1 01/06/03 11/02/02 20627.GC 885.1 01/06/03 11/02/02 7313026 9S9.4 QTY DESCRIPTION 12766~ 2906229 PERFORHEO BY: DIV PLAST/C RECONST SURG PLACE OF SVC: INPATIENT REPLANTATIDN, THUHB BALANCE TRANSFER TO GUAR ANP FINGER SINGLE BALANCE TRANSFER TO GUAR PERFORHED BY: D'rv OF ANESTHESIA 31 REPLNT THUNG,COHPLTE ANPU BALANCE TRANSFER TO GUAR PERFORHED BY: DIV OF DIAG RADIOLOGY HAND >3 VIENS BALANCE: KENTON E HALTEHAN 811671.00 INS CHARGE 7923.00 1377.00 2325.00 46.00 IF YOU HAVE ANY QUESTIORS ABOUT THE ANOUNT YOUR INSURANCE COHPANY PAID, CONTACT THEH DIRECTLY. FOR ANY OTHER QUESTIONS REGARDING YOUR BALANCE:, PLEASE CONTACT OUR OFFICE. ZF PAYHENT HAS BEEN HADE, TRAKq~ YOU AND DISREGARD THIS BILL. RJKO THAIJ(YOU FOR USINGHSHHC PHYSZCZANSOROUP FOR YOUR PHYSICIAN SERVICES. IF YOU HAVE ANY QUESTIONS REGARDING THIS BILL, PLEASE CONTACT US AT 717-531-5069 OR 800-2.~,-2619, BETHEEN 8;OOAN ~ 5:30PH NGNDAY THROUGH NEDNESDAY OR BETHEEN 8:00AN AND 4:30PN THURSDAY AND FRIDAY. 1of 2 STATEMENT DATE: 04101103 LAST STATEMENT DATE: 03124103 FED TAX ID # 251857035 PAYMENT/ GUARANTOR ADJUSTMENT BALANCE 7923.00 1377.00 2325.00 46.00 CHECK BOX AND ENTER ANY ADDRESS OR INSURANCE CORRECTIONS ON BACK HALTEMAN, KENTON #1276684 $12,328.49 (Hosp) 11,671.00 (Phys) VERIFICATION Medical Center, The that the statements correct to the best of her knowledge, The undersigned understands that the are made subject to the penalties of LINDA SCHLADER hereby states that she is the Super- visor of Financial Counselors and Collection of Milton S. Hershey Pennsylvania State University and verifies made in the foregoing pleading are true and information and belief. statements therein 18 Pa. C.S. §4904 relating to unsworn falsification to authorities. TABAS & ROSEN, P.C. BY: LEWIS C. TRAUFFER, ESQUIRE I.D. No. 60267 1845 Walnut Street, 22nd Floor Philadelphia, PA 19103 (215) 569-5050 THE MILTON S. HERSHEY MEDICAL CENTER P.O. BOX 853 HERSHEY, PA 17033 VS. :COURT OF COMMON PLEAS :CUMBERLAND COUNTY :NO. #03-3412 CIVIL TERM LARRY R. HALTEMAN & RACHEL E. HALTEMAN, h/w 1223 PINE ROAD CARLISLE, PA 17013 PRAECIPE TO THE PROTHONOTARY: Please mark the above matter settled, discontinued and ended upon payment of your costs only. LEWIS C. '~RAUFFER, ESQUIRE Attorney for Plaintiff