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HomeMy WebLinkAbout03-4898BEVERLY HEALTH & REHABILITATION SERVICES, INC. Plaintiff VS. NANCY C. MENZIES Defendant : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA :NO. :CIVIL ACTION - LAW 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 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, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. CUMBERLAND COUNTY BAR ASSOCIATION 32 SOUTH BEDFORD STREET CARLISLE, PA 17013-3308 (717) 249-3166 BEVERLY HEALTH & REHABILITATION SERVICES, INC. NANCY C. MENZIES : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : PENNSYLVANIA : CIVIL ACTION - LAVV C;OMPLAINT AND NOW, comes the Plaintiff, by and through its attorney, Mark K. Emery, and files this Complaint, as follows: 1. Plaintiff Beverly Health & Rehabilitation Services, Inc. ("PlaintifF') is a Pennsylvania corporation, doing business as West Shore Health and Rehabilitation Center, with an address for conducting business at 770 Poplar Church Road, Camp Hill, PA 17011. 2. Defendant Nancy C. Menzies ("Defendant") is an adult individual, sui juris, with a current residence of 770 Poplar Church Road, Camp Hill, PA 17011. 3. At all times relevant hereto, Defendant was, and is, a patient and resident at PlaintifFs nursing home facility. 4. Plaintiff is a nursing home facility licensed as such by the Commonwealth of Pennsylvania. 5. On or about March 6, 2002, Defendant voluntarily admitted herself to Plaintiff's facility, and entered into an Admission Agreement with Plaintiff. A copy of such Agreement is attached and incorporated herein as Exhibit 6. Plaintiff has, at all times, provided all necessary services and care to Defendant, continues to do so at the time of filing of this Complaint, and anticipates continuing to provide such services in the future. COUNT I BREACH OF CONTRACT 7. Paragraphs 1 through 6 are incorporated fully herein by reference. 8. Defendant agreed to provide payment for all services and care provided by Plaintiff. 9. As of this date, Defendant has failed and refused to pay for services totaling $12,218.92. 10. The amount due will increase daily as Plaintiff continues to provide services and care to Defendant. 11. Despite requests, Defendant has failed and refused to make payment of the amount due. WHEREFORE, Plaintiff respectfully requests this Honorable Court enter judgment for it against Defendant in the amount of $12,218.92, plus interest and costs of suit. Said amount is, at this point in time, an amount requiring compulsory arbitration. COUNT II QUANTUM MERIUT 12. Paragraphs 1 through 11 are incorporated fully herein by reference. 13. Plaintiff has provided services and care, and Defendant has accepted such services and care, which have a fair market value of $12,218.92. 14. 15. 16. DATE: Plaintiff will continue to provide such services and care daily to Defendant while Defendant is a resident at Plaintiff's facility. The costs charged by Plaintiff are reasonable and customary in the industry. It would be unjust for Defendant to accept the benefit of such services and care without remuneration to Plaintiff. WHEREFORE, Plaintiff respectfully requests this Honorable Court enter judgment for it against Defendant in the amount of $12,218.92, plus interest and costs of suit. Said amount is, at this point in time, in an amount requiring compulsory arbitration. Respectfully submitted, LAW OFFICES OF MARK K. EMERY Mark K. Emery, Esq~ Supreme Court I.D. No. 72787 410 North Second Street Harrisburg, PA 17101 (717) 238-9883 Attorney for Plaintiff [q~rivate RESIDENT-SPECIFIC INFORMATION .. This Facility accepts the following types of payments: (Check all that apply.) [~edicare [~d~l~edic aid [dJd~erans Administration PARTIES The parties to this Agreement are: (Name of Facility) (Name of R~,~/lefft) (./ (Narrate c~f R~e/s~dent,s [~e g~al~Re~p~ .~' en~ ative) If a Legal Representative signs, check the Type of Legal Representative (below): [ ] Conservator of Person [ ] Conservator of Estate [ l Other, specify [ ] Guardian [ ] Durable Power of Attorney for Health Care (DPAHC) [ ] Agent Acting Under General POA If you are signing this Agreement on behalf of the Resident, note your relationship to the resident: On this ~ day of ~/IiZ}.~-~. , 20Z~,, the above parties agree that on the ~ day of .,~'~o~J~ , 20 ~ the Resident shall be admitted to this Facility. As of that day, the Facility shall pro- vide the services described in this Agreement to the Resident until the date of the Resident's discharge or transfer. The Resident shall pay for the services provided by the Facility according to the terms of this Admission Agreement. ACKNOWLEDGEMENTS By signing the Admission Agreement Signature Page, the Resident/Agent/Legal Representative acknowl- edges that he or she has been given and has read this Agreemem in its entirety, and all addendums. The Resident also acknowledges that the following information was provided upon or before admission by the Facility. Initial the lines below (if not applicable, write N/A): 1. A list of supplies and services that are included in the Facility's private daily rate or that will be paid for by the Medicaid or Medicare programs and a list of supplies and services not included in the Facility's private daily rate or paid for by the Medicaid or Medicare the Resident will be separately charged. White - Business Office Pink - Medical Records Information about the Facility's bed hold procedures. A written explanation of how to apply for and use Medicare and Medicaid benefits and how to receive refunds for previous payments covered by these benefits. A statement explaining that the Resident may file a grievance with the appropriate State Agency about resident abuse, neglect, and/or misuse/theft of resident personal property in the Facility. Copies of the State Resident Rights. A written explanation of the Facility's Rules and Regulations. I have been informed, both orally and in writing, in a language I understand, of my rights and the rules and regulations governing my conduct and responsibilities during my stay at the Facility. If your condition warrants, you may be placed in the facility's Medicare-Certified Distinct Part ~ Unit. At some point, circumstances may occur which will make residing in another unit more x~ appropriate for you. In that case, the facility will discuss such a transfer with you. Under law, you cannot be discharged from this facility unless you agree or unless, following an appeal, it is determined that you may be involuntarily discharged or transferred. A copy of the facility policy regarding implementation of the Patient Self Determination Act and of the applicable State law. I do do not .~ have an advance directive. ~,~ NOTICES Notices shall be mailed to the address(es) indicated below. The Agent and/or Legal Representative is responsible for notifying the Facility in writing of any change of address. The Resident designates the following person(s) to be notified when any legally required notices are provid- ed to the Resident, Agent, and/or Legal Representative. LEGAL REPRESENTATIVE AND/OR AGENT Street/~q~ ~'¢hCY~ ~ City~J/~'l-~X~ State~3~ Zip OTHER PERSON TO BE NOTIFIED Street~O~ ~/~?ft°~t ~)F. City ~0[~)Pm State'~ Zip~-~x~ White - Business Office Pink - Medical Records Yellow - Resident 09/04/200S 10:S7 2S898B4 M~RK K EMERY PaGE 06 VERIFICATION I, Susan Metelevich, on behalf of Beverly Health & Rehabilitation Services, Inc. hereby verify that I have reed the foregoing Complaint and that the information contained therein is true and correot tot he best of my knowledge, information and belief. I understand that false statements herein are subject to the penalties of 18 Pa.C.S. § 4g04 relating to unsworn falsification to authorities_ Susan Metelevich Eeceived $,,p-O4-ZO03 111:40am From-Z3908114 To-~ST SWORE Ft£ALTH AR Page 0n6 BEVERLY HEALTH & REHABILITATION SERVICES, INC. NANCY C. MENZlES : IN THE COURT Of COMMON PLEAS : OF CUMBERLAND COUNTY : PENNSYLVANIA : NO. 03-4898 : CIVIL ACTION - LAW PRAECIPE TO ENTER DEFAULT JUDGMENT TO THE PROTHONOTARY: Please enter judgment by default against Defendant Nancy C. Menzies in the amount of 12, 218.92, as requested in the Complaint. It is hereby certified that the ten-day Notice of Default, attached hereto as Exhibit A, was served upon the Defendant over ten days prior to the filing of this Praecipe. Respectfully submitted, LAW OFFICES OF MARK K. EMERY DATE: By: Mark K. Emery, Esquir~ Supreme Court I.D. No-~ 72787 410 North Second Street Harrisburg, PA 17101 (717) 238-9883 BEVERLY HEALTH & REHABILITATION SERVICES, INC. NANCY C. MENZIES : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : PENNSYLVANIA : NO. 03-4898 : CIVIL ACTION - LAW TO: NANCY C. MENZIES DATE OF NOTICE: October 14, 2003 IMPORTANT NOTICE YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN APPEARANCE PERSONALLY OR BY ATTORNEY AND FILE IN WRITING WITH THE COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST YOU. UNLESS YOU ACT WITHIN TEN DAYS FROM THE DATE OF THIS NOTICE, A JUDGEMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE THIS NOTICE TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE FOLLOWING OFFICE TO FIND OUT WHERE YOU CAN GET LEGAL HELP: CUMBERLAND COUNTY BAR ASSOCIATION 32 SOUTH BEDFORD STREET CARLISLE, PA 170'13-3308 (717) 249-3166 Mark K. Emery, Esquire CERTIFICATE OF SERVICE AND NOW, this 14th day of October, 2003, I, Mark K. Emery, Esquire do hereby certify that I have served the foregoing Important Notice by mailing a true and correct copy via United States first class mail, addressed as follows: Nancy C. Menzies 770 Poplar Church Road Camp Hill, PA 17011 LAW OFFICES OF MARK K. EMERY Mark K. Emery CERTIFICATE OF SERVICE AND NOW, this 31st day of October, 2003, i, Mark K. Emery, Esquire do hereby certify that I have served the foregoing Praecipe to Enter Default Judgment by mailing a true and correct copy via United States first class mail, addressed as follows: Nancy C. Menzies 770 Poplar Church Road Camp Hill, PA 17011 LAW OFFICES OF MARK K. EMERY Mark K. Emery~ BEVERLY HEALTH & REHABILITATION SERVICES, INC. NANCY C. MENZIES : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : PENNSYLVANIA : NO. 03-4898 : CIVIL ACTION - LAW PRAECIPE TO MARK JUDGMENT SATISFIED TO THE PROTHONOTARY: Please mark the judgment entered at this docket as SATISFIED. Respectfully submitted, LAW OFFICES OF MARK K. EMERY DATE: February 20, 2004 By: Mark K. Emery, Esquire Supreme Court I.D. No. 72787 410 North Second Street Harrisburg, PA 17101 (717) 238-9883 Attorney for Plaintiff