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04-2902
JURY TRIAL WAIVED THIS IS NOT AN ARBITRATION MATTER ASSESSMENT OF DAMAGES HEARING NOT REQUIRED TABAS & ROSEN, P.C. BY: HOWARD R. MANILOFF Attorney I.D. 42398 1845 Walnut Street, 22nd Floor Philadelphia, PA 19103 (215) 569-5050 THE MILTON S. HERSHEY MEDICAL CENTER 600 Centerview Drive Hershey, PA 17033 DANIEL J. DITONNO 6 Sinclair Road Mechanisburg, PA 17055 Attorney for Plaintiff IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. ~1'~--~0~ ~t'to'tL~-'~._ CIVIL ACTION COMPLAINT - CIVIL ACTION NOTIC~ AVI~ You have been sued in court. If you wfsh 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 · written al~oearsnce 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 n~y proceed without you and a j~lgment my 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 maney or property or other rights in,portent to you. yOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO HOT HAVE A LAWYER, GO TO OR TELE- PRONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT RIMING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAy SE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR SO FEE. CUMBERLAND COUNTY BAR ASSOCIATION 32 S. BEDFORD STREET CARLISLE, PA 17013 (717) 249-3166 (800) 990-9108 Le hen den~ndado a usted en la corte. Si usted quiets defenderse de estas demandas expuestas en [as paginas siguientes, usted liens veinte (20) dias de plazo al partir de [a fecha de la dee~andanda y la notificacion. Hace faits asentar una comparen- cia escrite o en persona o con un sbogado y entregar a la corte en for escrita sus defenses o sus objeci- ones a las defl~ndas en contra de su persona. Sea avisado que si usted no se defiende, la corte to, fa n~didas y puede continuer la den~ndanda en contra suya sin previo aviso o notificacion. Ademas, la corte puede decidir a favor de[ demaedante y requiere qua usted cuff~o[a con todas [as provisiones de esta demands. Ustedpuede perder dinero o sus propfedades u otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABOGADO INMEDIATA- MEHTE. SI USTEO NO TIENE ABOOADO, VAYA PERSORALMENTE 0 LLAME POR TEL~FONO A LA OFICINA MEHCIONADA A COHTINUACION. ESTA OFICINA LE PUEDE PROVEER LA INFORMACiON NECESARIA PARA CONTRATAR A UN ABOGADO. SI USTED CARECE DE LOS MEDIOS NECESARIOSPARA CONTRATAR A UN ABOGADO~ DICHA OFICINA LE PUEDE SUMiNISTRAR LA IRFORMACION NECESARIA ACERCA DE AQUELLAS AGENCIAS QUE OFRECEN SERVICIOS LEGALES A LAS PERSONAS OUR TIENER DERECHO A RECIBIR TAL AYUDA GRATIS 0 A USA CUOTA REDUCIDA. CUMBERLAND COUNTY BAR ASSOCIATION 32 S. BEDFORD STREET CARLISLE, PA 17013 (717) 269-3166 (800) 990-9108 COMPLAINT - CML ACTION Plaintiff v. Daniel J. Ditonno 1. Plaintiff is a non-profit corporation located at the address indicated in the caption hereof. 2. Defendant is an individual who resides at the address indicated in the caption hereof. 3. As the result of a certain medical condition, defendant was treated by the plaintiff from August 10, 2002 to October 18, 2002. 4. 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 incorporated herein as if set forth at length. 5. Said medical care was commensurate with the condition of defendant and was necessary for the health and welfare of defendant. 6. At or about the time of defendant's treatment by plaintiff, implied, constructive, and oral contracts arose between defendant and plaintiff by the terms of which, defendant became obligated to pay plaintiff the charges incurred for the medical care rendered by plaintiff to defendant. 7. As a result of the foregoing, there is due and owing from defendant to plaintiff the sum of $92,955.17 as indicated in Exhibit "A". 8. On or about April 28, 2004, the Pennsylvania Victims Compenstion Assistance Program paid $31,374.23 on behalf of defendant. 9. Defendant refuses to pay the balance due although plaintiff has made demand that defendant do so. WHEREFORE, plaintiff demands.judgment against defendant for the sum of $61,580.94 plus six percent (6%) interest per annum from the date of discharge to the date of judgment, record costs and non-record costs. ~or~ey~~c r ilaintiff t/ ~ MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 AM PAGE: 1 Guarantor: DITONNO D/LN 6 SINCLAIR RD MECHANICSBURG, PA I7055-0000 Patient: DITONNO DAN J Visit #: 23725 Date I Svc Code I Description ( UnitsI Debits I Credits 08/10/02 10144 08/10/02 46032 08/10/02 46061 08/10/02 46111 08/10/02 46121 08/10/02 46122 08/10/02 46177 08/10/02 46472 08/10/02 46479 08/10/02 46612 08/10/02 46630 08/10/02 46673 08/10/02 46694 08/10/02 46696 08/10/02 46697 08/10/02 46699 08/10/02 46717 08/10/02 46794 08/10/02 101003 08/10/02 101004 08/10/02 101o05 08/10/02 101021 08/10/02 104002 08/10/02 104009 08/10/02 104028 08/10/02 104042 08/10/02 104049 08/10/02 104060 08/10/02 104111 08/10/02 104131 08/i0/02 104145 08/10/02 104156 08/10/02 104711 08/10/02 105037 08/10/02 105052 08/10/02 105059 08/10/02 105656 08/10/02 106011 08/10/02 109104 08/10/02 245553 08/10/02 246162 08/10/02 246705 I CRITICAL CARE UNIT BLOOD GAS KIT IV SOLUTION PRIME MACRO/MICRO TUB URINALYSIS DIPSTIX PR HEMOCCULT, STOOL COLLAR RIGID (ASPEN) EMERGENCY VISIT, LEVE CLOSED DRAIN SYSTEMS CHEST TUBE FOR PNELTMO ARTERIAL PUNCTURE BI2kDDER CATH, SIMP ADMIN IMMUNIZTION,'ONE IV INFUSION TX 0-1 HR IV INF TX,EA ADDL HR THERA/DIAG INJECTION NONINVAS PULSE OX, MU IV PUMP, SINGLE LINE ABO BLOOD GROUP ANTIBODY SCREEN RH TYPE COMPAT, IMMED SPIN ALCOHOL (ETOH), BLOOD AMYLASE, BLOOD IONIZED CALCIUM CREATININE, BLOOD TROPONIN GLUCOSE, BLOOD BLOOD GAS PANEL W/O2 POTASSIUM (K), BLOOD SODIUM (NA), BLOOD SGPT (ALT) DRUG SCREEN, URINE HEMOGLOBIN PARTIAL THROMBOPLAS T PROTHROMBIN TIME CBC W/PLT AUTO URINALYSIS-BASIC & MI MARIJUANA CONF LIDOCAINE 1 ML FENTAI~YL CITRATE 5 ML MORPHINE SULFATE 4'MG 1 2390.00 1 7.00 2 20.00 1 12.00 1 14.00 1 14.00 1 85.00 1 478.00 1 17.00 1 202.00 1 43.00 1 79.00 1 17.00 2 188.00 60 2700.00 5 260.00 1 62.00 1 3.00 1 17.00 1 30.00 1 16.00 2 11~ 00 1 42 00 1 36 00 1 71 00 1 10 00 1 48 00 1 9 00 1 124 00 1 10 O0 1 10 00 1 11.00 1 79.00 1 14.00 1 30.00 1 19.00 1 25.00 1 18.00 1 43.00 1 2.60 3 2.10 2 4.5( - Continue - MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 AM PAGE: 2 Guarantor: DITONNO DAN 6 SINCLAIR RD MECHANICSBURG, PA 17055-0000 Patient: DITONNO DkN J Visit #: 23725 Date I Svc Code I Description I Unitsl Debits I Credits 08/10/02 246764 08/10/02 247786 08/10/02 248390 08/10/02 251846 08/10/02 272192 08/10/02 307101 08/10/02 307206 08/10/02 310534 08/10/02 310560 08/10/02 620168 08/10/02 621044 08/10/02 621264 08/10/02 669072 08/10/02 670330 08/10/02 670334 08/10/02 711107 08/10/02 711108 o8/11/o2 10145 08/11/02 104026 08/11/02 104106 08/11/02 104398 08/11/02 105656 08/11/02 246037 08/11/02 246371 08/11/02 246579 08/11/02 247786 08/11/02 250310 08/11/02 272192 08/11/02 272915 08/11/02 273271 08/11/02 307 0 08/11/02 516304 08/11/02 516351 08/11/02 516956 08/11/02 621264 08/12/02 601 08/12/02 10223 08/12/02 102105 08/12/02 102183 08/12/02 102184 08/12/02 105657 08/12/02 106011 DIPHTHERIA TETANUS 0. MORPHINE SULFATE 10 M METHYLPREDNISOLONE 1M VERSED 5MG/5ML RANITIDINE RTU CHEST 1 VIEW C-SPINE 4-5 VIEWS CT MULTIPLJ~NAR 3D CT C-SPINE UNENHANCED COVER DISPO BAIR HUG I V SODIUM CHLORIDE 0 I V DEXTROSE 5% LACT MATTRESS DECUBITUS LG IV INFUSION SET, UNIV IV INFUSION SET, UNIV AIR AMBULANCE TRA/~SPO AIR AMBULANCE MILEAGE T INTERMEDIATE CARE U CALCIUM MAGNESIUM ELECTROLYTES CBC W/PLT AUTO BISACODYL 10 MG PETROLATUM 30 GM HYDROXYPROPYLMETHYLCE MORPHINE SULFATE 10 M OXYMETAZOLINE 15ML RANITIDINE RTU OXYCODONE 10MG SR TAB OXYCODONE 5MG U/D TAB CHEST 1 VIEW AEROSOL TREATMENT SUB AEROSOL TREATMENT INI NEBULIZER I V DEXTROSE 5% LACT INITIAL EVALUATION-PT P PRIVATE MED/SURG RM CULTURE, BLOOD CULTURE, URINE COL CO CULTURE, URINE PRESUM CBC W/PLT/DIFF AUTO URINALYSIS-BASIC & MI 1 6.22 5 12.00 3 136.05 1 3.75 2 23.30 1 98.00 1 153.00 1 462.00 1 678.00 1 17.00 2 12.00 2 14.00 1 47.00 2 24.00 1 8.00 1 4601.00 20 1780.00 1 1155.00 1 10.00 1 40 00 1 25 00 1 25 00 1 2 10 1 2 10 1 4 75 5 12 00 1 3 05 2 23.30 2 5.90 2 4.20 2 196.00 2 74.00 1 37.00 1 2.00 3 21.00 1 129.00 1 845.00 2 136.00 1 20.00 1 20.00 1 30.00 1 18.00 Continue MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 AM PAGE: 3 Guarantor: DITONNO DAN 6 SINCLAIR RD MECPIANICSBURG, PA 17055-0000 Patient: Visit #: DITONNO DAN J 23725 Date I Svc Code I Description I UnitsI Debits I Credits 246127 246371 246470 246705 246706 247831 272192 272915 272916 273271 307101 307205 307319 621264 674 680 10431 104026 104106 104129 104398 246037 247831 272192 272916 273271 307205 670832 674 10431 11530 102105 102183 102184 105656 106011 245695 246470 246747 247831 251683 272192 08/12/02 08/12/02 os/12/o2 08/12/02 08/12/02 08/12/02 08/12/02 08/12/02 08/12/02 08/12/02 08/12/02 08/12/02 08/12/02 08/12/02 08/13/02 08/13/02 08/13/02 08/13/02 08/13/02 08/13/02 o8/13/o2 08/13/02 08/13/02 08/13/02 08/13/02 os/13/o2 08/13/02 08/13/02 08/14/02 o8/14/o2 08/14/02 08/14/02 08/14/02 08/14/02 08/14/02 08/14 /02 08/14 /02 08/14 /02 08/14/02 08/14/02 08/14/02 08/14 /02 DIPHENHYDRAMINE 25 MG PETROLATUM 30 GM SENNA CONCENTRATE TAB MORPHINE SULFATE 4 MG MORPHINE SULFATE 2 MG RCETAMINOPHEN 325 MG R3tNITIDINE RTU OXYCODONE 10MG SR TAB OXYCODONE 20MG SR TAB OXYCODONE 5MG U/D TAB CHEST 1 VIEW C-SPINE 2-3 VIEWS ANKLE 3 OR MORE VIEWS I V DEXTROSE 5% LACT THER EXERCISE 15 MIN THERAPEUTIC EXERCISE 1 1:1 CARE BED MED/SU CALCIUM MAGNESIUM PHOSPHORUS, BLOOD ELECTROLYTES BISACODYL 10 MG ACETAMINOPHEN 325 MG R3kNITIDINE RTU OXYCODONE 20MG SR TAB OXYCODONE 5MG U/D TAB C-SPINE 2-3 VIEWS COLLAR RPLMT PAD ASPE THER EXERCISE 15 MIN 1 1:1 CARE BED MED/SU ORTH FABRIC/FIT/TRN 1 CULTURE, BLOOD CULTURE, URINE COL CO CULTURE, URINE PRESUM CBC W/PLT AUTO URINALYSIS-BASIC & MI AL MAG HYDROX SIMETH SENNA CONCENTRATE TAB RANITIDINE 150 MG ACETAMINOPHEN 325 MG PAROXETINE 20MG TABS RANITIDINE RTU 1 2.10 1 2.10 1 2.10 3 6.75 7 15.40 2 4.20 3 34.95 2 5.90 1 11.25 8 17.40 3 294 00 2 250 00 1 104 00 1 7 00 2 86 00 1 43 00 1 1500 00 1 10 00 1 40 00 1 10 00 1 25 00 1 2 10 2 4.20 3 34.95 2 22.50 8 19.80 1 125.00 1 30.00 2 86.00 1 1500.00 6 258.00 2 136.00 1 20.00 1 20.00 1 25.00 1 18 00 1 2 10 1 2 10 1 2 10 7 14 70 1 6 80 1 11 65 - Continue - MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 AM PAGE: 4 Guarantor: DITONNO DAN 6 SINCLAIR RD MECHANICSBURG, PA 17055-0000 Patient: Visit #: DITONNO DA/q J 23725 Date I Svc Code I Description I Unitsl Debits I Credits 08/14/02 272916 08/14/02 273271 08/14/02 307101 08/14/02 621043 08/14/02 626081 08/14/02 670330 08/14/02 670334 08/15/02 10223 08/15/02 246037 08/15/02 246747 08/15/02 247831 08/15/02 249402 08/15/02 272916 08/15/02 273271 08/15/02 273298 08/15/02 513304 08/15/02 513354 08/15/02 513807 o8/16/o2 674 08/16/02 680 08/16/02 10223 08/16/02 246470 08/16/02 246747 08/16/02 247831 08/16/02 249402 08/16/02 272915 08/16/02 272916 08/16/02 273271 o8/16/o2 600518 08/17/02 434 08/17/02 10223 08/17/02 246037 08/17/02 246703 08/17/02 246747 08/17/02 249402 08/17/02 251683 08/17/02 272916 08/17/02 273271 08/17/02 661140 08/18/02 10223 08/18/02 246470 08/18/02 246747 OXYCODONE 20MG SR TAB 2 OXYCODONE 5MG U/D TAB 3 CHEST 1 VIEW 2 I V SODIUM CHLORIDE 0 1 IV DILUENT NNL SALINE 1 IV INFUSION SET, UNIV 1 IV INFUSION SET, UNIV 1 P PRIVATE MED/SURG RM 1 BISACODYL 10 MG 1 RANITIDINE 150 MG 2 ACETAMINOPHEN 325 MG 4 CYCLOBENZAPRINE 10MG 1 OXYCODONE 20MG SR TAB 1 OXYCODONE 5MG U/D TAB 3 COMBIVENT INHALER 14. 1 AEROSOL TREATMENT SIXB 15 MDI TREATMENT INITIAL 1 MDI SYSTEM SPACER THER EXERCISE 15 MIN 2 THEP~APEUTIC EXERCISE 1 P PRIVATE MED/SURG RM 1 SENNA CONCENTRATE TAB 1 RANITIDINE 150 MG 2 ACETAMINOPHEN 325 MG 2 CYCLOBENZAPRINE 10MG 3 OXYCODONE 10MG SR TAB 4 OXYCODONE 20MG SR TAB 1 OXYCODONE 5MG U/D TAB 6 IN-HALER SYS METERED D 1 THERAPEUT ACTIVITIES 2 P PRIVATE MED/SLrRG RM 1 BISACODYL 10 MG 1 LORAZEPAM 2 MG 1 RANITIDINE 150 MG 2 CYCLOBENZAPRINE 10MG 3 PAROXETINE 20MG TABS 1 OXYCODONE 20MG SR TAB 2 OXYCODONE 5MG U/D TAB 6 BAG URINARY DP~AINAGE 1 P PRIVATE MED/SURG RN 1 SENNA CONCENTRATE TAB 1 RANITIDINE 150 MG 2 - Continue - 22.50 B.10 196.00 6.00 8.00 12.00 8.00 845.00 2.10 4.20 8 40 2 10 11 25 8 10 125 65 555 00 37 00 7 00 86 00 43 00 845.00 2.10 4.20 4.20 6.30 11.80 11'.25 16.20 12.00 86.00 845.00 2.10 8.70 4.20 6.30 6.80 22.50 16.20 7.00 845.00 2.10 4.20 MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 A/~ PAGE: 5 Guarantor: DITONNO DAN 6 SINCLJ~IR RD MECH3~NICSBURG, PA 17055-0000 Patient: DITOArNO DAN J Visit ~: 23725 Date I Svc Code I Descriptio.n I Unitsl Debits I Credits 08/18/02 246907 08/18/02 249402 08/18/02 251226 08/18/02 272916 08/18/02 273271 08/19/02 246037 08/19/02 246747 08/19/02 249402 08/19/02 251226 08/19/02 272916 08/19/02 273271 08/19/02 307331 02/28/03 980090 02/28/03 980091 LORAZEPAM 0.5 MG 1 CYCLOBENZAPRINE 10MG 3 NYSTATIN 5 CC ETD 3 OXYCODONE 20MG SR TAB 2 OXYCODONE 5MG U/D TAB 3 BISACODYL t0 MG 1 P~ANITIDINE 150 MG CYCLOBENZAPRINE 10MG 1 NYSTATIN 5 CC UD 1 OXYCODONE 20MG SR TAB 1 OXYCODONE 5MG U/D TAB 2 ABDOMEN 1 VIEW AP 1 HOSPITAL BAD DEBT W/O -1 HOSPITAL BAD DEBT PLA 1 2 10 6 30 6 30 22 50 8 10 2 10 2 10 2 10 2 10 11.25 5,40 135,00 28075.97 28075.97- * - Not posted I Balance: I 28075.97 Guarantor: MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 AM DITONNO DAN J 6 SINCLAIR RD MECHANICSBURG, PA 17055-0000 Patient: Visit #: PAGE: 1 DITONNO DAN J 2699088 Date I Svc Code I Description I Unitsl Debits I Credits 308 601 10198 246037 246124 246644 249402 249531 250092 250143 272915 273525 273688 518354 630833 662361 667340 667732 434 435 674 680 731 10198 102183 102184 104042 104060 104065 104398 105656 106010 246037 246124 246470 246519 246644 246848 247831 249402 250092 272915 o8/19/o2 o8/19/o2 o8/19/o2 08/19/02 o8/19/o2 08/19/02 08/19/02 08/19/02 08/19/02 08/19/02 08/19/02 08/19/02 08/19/02 08/19/02 o8119102 08/19/02 o8/19/o2 08/19/02 08/20/02 08/20/02 08/20/02 08/20/02 08/20 /O2 08/20/02 08/20/02 08/20/02 08/20/02 08/20/02 08/20/02 08/20/02 08/20/02 o8/2o/o2 08/20/02 08/20/02 08/20/02 08/20/02 08/20/02 08/20/02 08/20/02 08/20/02 08/20/02 08/20/02 INITIAL EVALUATION-OT INITIAL EVALUATION-PT D PRIVATE REHAB RM BISACODYL 10 MG DOCUSATE NA/CASANTHR BACLOFEN 10 MG CYCLOBENZAPRINE 10MG IPRATROPIUM BROMIDE / OXYCODONE APAP 1TAB CHLORHEXIDINE GLUC 48 OXYCODONE 10MG SR TAB OLANZAPINE 2.SMG TAB TIZANIDINE 2MG TAB MDI TREATMENT INITIAL URETHRAL CATH PREP TR BRACE NIGHT SPLINT ME ABD BINDER 36-64 WAIS STOCKINGS THIGH MED R THERAPEUT ACTIVITIES ACT DAILY LIVING 15 M THER EXERCISE 15 THERAPEUTIC EXERCISE DORSAL WRIST SUPPORT D PRIVATE REHAB RM CULTURE, URINE COL CO CULTURE, URINE PRESUM CREATININE, BLOOD GLUCOSE, BLOOD UREA NITROGEN (BUN), ELECTROLYTES CBC W/PLT AUTO URINALYSIS-BASIC/REFL BISACODYL 10 MG DOCUSATE NA/CASANTHR SENNA CONCENTRATE TAB WARFARIN SODIUM 10 MG BACLOFEN 10 MG LIDOCAINE 10 ML ACETAMINOPHEN 325 MG CYCLOBENZAPRINE 10MG OXYCODONE APAP 1TAB OXYCODONE 10MG SR TAB 129.00 129.00 845.O0 2.10 2.10 2.10 2.10 119.90 4 20 11 10 2 95 13 65 3 45 37 00 33 00 160 00 15 O0 28 00 86 00 86 00 258 00 43.00 83.00 845.00 20.00 20.00 10.00 9.00 9.00 25.00 25.00 14.00 2.10 4.20 2.10 2.10 4 20 13 40 4 20 4 20 2 10 5 90 - Continue - MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 AM PAGE: 2 Guarantor: DITOAINO DAN J 6 SINCLAIR RD MECHANICSBURG, PA 17055-0000 Patient: Visit #: DITONNO DAN J 2699088 Date I Svc Code I Description I Unitsl Debits I Credits 08/20/02 273482 08/20/02 273525 08/20/02 273688 08/20/02 273737 08/20/02 273776 08/20/02 630833 08/21/02 428 08/2z/02 435 08/21/02 674 08/21/02 10198 08/21/02 105059 08/21/02 246037 08/21/02 246517 08/21/02 246644 08/21/02 247831 08/21/02 249402 08/21/02 272915 08/21/02 273482 08/21/02 273525 08/21/02 273688 08/21/02 273737 08/21/02 273776 08/21/02 630833 08/21/02 703316 08/22/02 429 08/22/02 435 08/22/02 674 08/22/02 10198 08/22/02 105059 08/22/02 246037 08/22/02 246344 08/22/02 246470 08/22/02 246644 08/22/02 250092 08/22/02 251428 08/22/02 272915 08/22/02 273482 08/22/02 273525 08/22/02 273688 08/22/02 273737 08/22/02 630833 08/23/02 674 CITALOPRAM 20MG TAB OLJtNZAPINE 2.5MG TAB TIZANIDINE 2MG TAB PANTOPRAZOLE 40 MG TA DALTEPARIN 5000U SYR URETHP~AL CATH PREP TR THER EXERCISES 15 MIN ACT DAILY LIVING 15 M THER EXERCISE 15 MIN D PRIVATE REHAB RM PROTHROMBIN TIME BISACODYL 10 MG WARFARIN SODIUM 5 MG BACLOFEN 10 MG ACETAMINOPHEN 325 MG CYCLOBENZAPRINE 10MG OXYCODONE 10MG SR TAB CITALOPRAM 20MG TAB OLANZAPINE 2.5MG TAB TIZANIDINE 2MG TAB PANTOPRAZOLE 40 MG TA DALTEPARIN 5000U SYR URETHRAL CATH PREP TR NUTR TX, INITIAL, 15 MI NEUROMUSCULAR REED 15 ACT DAILY LIVING 15 M THER EXERCISE 15 MIN D PRIVATE REHAB RM PROTHROMBIN TIME BISACODYL 10 MG NYSTATIN 15 GM SENNA CONCENTRATE TAB BACLOFEN 10 MG OXYCODONE APAP 1TAB PROMETHAZINE TABS OXYCODONE 10MG SR TAB CITALOPRAM 20MG TAB OLANZAPINE 2.5MG TAR TIZANIDINE 2MG TAB PANTOPRAZOLE 40 MG TA URETHRAL CATH PREP TR THER EXERCISE 15 MIN 1 5.65 1 13 65 1 3 45 1 2 10 1 39 90 8 88 00 2 86 00 2 86 00 2 86 00 1 845 00 1 19 00 1 2 10 1 2 10 2 4.20 1 2.10 1 2.10 2 5.90 1 5.65 1 13.65 2 6.90 1 2.10 1 39.90 6 66.00 1 64.00 6 258.00 2 86.00 3 129.00 1 845.00 1 19.00 1 2.10 1 49.65 1 2.10 4 8.40 1 2.10 1 2.50 2 5.90 1 5.65 1 13.65 2 6.90 1 2.10 6 66.00 5 215.00 - Continue MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 AM PAGE: 3 Guarantor: DITONNO DAN J 6 'SINCLAIR RD MECHANICSBURG, PA 17055-0000 Patient: Visit #: DITONNO DAN J 2699088 I SvC Code I Description I Unitsl Debits I Credits I Date 08/23/02 680 08/23/02 10198 08/23/02 105059 08/23/02 246037 08/23/02 246470 08/23/02 246517 08/23/02 246644 08/23/02 250092 08/23/02 272915 08/23/02 273482 08/23/02 273525 08/23/02 273688 08/23/02 273737 08/23/02 630833 08/24/02 428 08/24/02 10198 08/24/02 246037 08/24/02 246470 08/24/02 246517 08/24/02 246644 08/24/02 250092 08/24/02 272915 08/24/02 273482 08/24/02 273525 08/24/02 273688 08/24/02 273737 08/24/02 630833 08/25/02 674 08/25/02 10198 08/25/02 246037 08/25/02 246470 08/25/02 246517 08/25/02 246644 08/25/02 247831 08/25/02 250092 08/25/02 272915 08/25/02 273482 08/25/02 273525 08/25/02 273688 08/25/02 273737 08/25/02 630833 08/26/02 434 THERAPEUTIC EXERCISE D PRIVATE REHAB RM PROTHROMBIN TIME BISACODYL 10 MG SENNA CONCENTRATE TAB WARFARIN SODIUM 5 MG BACLOFEN 10 MG OXYCODONE APAP 1TAB OXYCODONE 10MG SR TAB CITALOPRAM 20MG TAB OLANZAPINE 2.5MG TAB TIZANIDINE 2MG TAB PANTOPRAZOLE 40 MG TA URETHRAL CATH PREP TR THER EXERCISES 15 MIN D PRIVATE REHAB RM BISACODYL 10 MG SENNA CONCENTRATE TAB WARFARIN SODIUM 5 MG BACLOFEN 10 MG OXYCODONE APAP 1TAB OXYCODONE 10MG SR TAB CITALOPRAM 20MG TAB OLANZAPINE 2.5MG TAB TIZANIDINE 2MG TAB PANTOPRAZOLE 40 MG TA URETHRAL CATH PREP TR THER EXERCISE 15 MIN D PRIVATE REHAB RM BISACODYL 10 MG SENNA CONCENTRATE TAB WARFARIN SODIUM 5 MG BACLOFEN 10 MG ACETAMINOPHEN 325 MG OXYCODONE APAP 1TAB OXYCODONE 10MG SR TAB CIT/kLOPRAM 20MG TAB OLANZAPINE 2.SMG TAB TIZANIDINE 2MG TAB PANTOPRAZOLE 40 MG TA URETHRAL CATH PREP TR THERAPEUT ACTIVITIES 1 43.00 1 845.00 1 19.00 2 4.20 1 2.10 1 2.10 3 6.30 3 6.30 2 5.90 1 5.65 1 13.65 2 6.90 1 2.10 2 22 00 2 86 O0 1 845 00 1 2 10 1 2 10 1 2 10 3 6.30 2 4.20 2 ~ 5.90 1 5.65 1 13.65 1 3.45 1 2.10 3 33.00 2 86.00 1 845.00 1 2.10 1 2.10 1 2.10 3 6.30 1 2.10 1 2.10 2 5.90 1 5.65 1 13.65 2 6.90 1 2.10 6 66.00 2 86.00 - Continue - MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 AM PAGE: 4 Guarantor: DITONNO DAN J 6 SINCLAIR RD MECHANICSBURG, PA 17055-0000 Patient: Visit #: DITONNO DAN J 2699088 Date I Svc Code I Description -[ UnitsI Debits { Credits 435 674 680 10198 105059 246037 246644 246923 250092 272915 273482 273525 273688 273737 630833 434 435 436 674 10198 105059 246037 246515 246644 250092 272916 273482 273525 273737 630833 661136 434 435 674 680 683 10198 246037 246515 246644 272915 272916 08/26/02 08/26/02 08/26/02 08/26/02 08/26/02 08/26/02 08/26/02 08/26 08/26/02 08/26 /02 08/26 /02 08/26 /02 08/26 /02 08/26/02 08/26/02 08/27/02 08/27/02 08/27/02 08/27/02 08/27/02 08/27/02 08/27/02 08/27/02 08/27/02 08/27/02 08/27/02 08/27/02 08/27/02 08/27/02 08/27/02 08/27/02 08/28/02 08/28/02 08/28/02 08/28/02 08/28/02 08/28 /02 08/28 /02 08/28 f02 08/28 ~o2 08/28 ~02 08/28/02 ACT DAILY LIVING 15 M 3 129.00 THER EXERCISE 15 MIN 3 129.00 THERAPEUTIC EXERCISE 2 86.00 D PRIVATE REHAB RM 1 845.00 PROTHROMBIN TIME 1 19.00 BISACODYL 10 MG 1 2.10 BACLOFEN 10 MG 3 6.30 PROMETHAZINE 25MG 2 2.10 OX¥CODONE APAP 1TAB 2 4.20 OXYCODONE 10MG SR TAB 2 5.90 CITA~OPRAM 20MG TAB 1 5.65 OLANZAPINE 2.5MG TAB 1 13.65 TIZANIDINE 2MG TAB 1 3.45 PANTOPP~AZOLE 40 MG TA 1 2.10 URETHRAL CATH PREP TR 5 55.00 THERAPEUT ACTIVITIES 2 86.00 ACT DAILY LIVING 15 M 2 86.00 COMMUNITY/WORK TRi~ 15 2 86.00 THER EXERCISE 15 MIN 6 258.00 D PRIVATE REHAB RM 1 845.00 PROTHROMBIN TIME 1 19.00 BISACODYL 10 MG 1 2.10 WARFARIN SODIUM 2 MG 1 2.10 BACLOFEN 10 MG 3 6.30 OXYCODONE APAP 1TA~ 1 2.10 OXYCODONE 20MG SR TAB 2 10.30 CITALOPRAM 20MG TA~ 1 5.65 OLANZAPINE 2.5MG TAB 1 13.65 PANTOPRAZOLE 40 MG TA 1 2.10 URETHRAL CATH PREP TR 7 77.00 URN COLL BAG NLTX LG 1 16.00 THERAPEUT ACTIVITIES 2 86.00 ACT DAILY LIVING 15 M 2 86.00 THER EXERCISE 15 MIN 2 86.00 THERAPEUTIC EXERCISE 1 43.00 WHEELCHAIR MGMT 15 MI 1 43.00 D PRIVATE REHAB RM 1 845.00 BISACODYL 10 MG 1 2.10 WARFARIN SODIUM 2 MG 1 2.10 BACLOFEN 10 MG 3 6.30 OXYCODONE 10MG SR TA~ 1 2.95 OXYCODONE 20MG SR TAB 1 5.15 Continue - MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 AM PAGE: 5 Guarantor: DITONNO DAN J 6 SINCLAIR RD MECHANICSBURG, PA 17055-0000 Patient: Visit #: DITONlqO DAN J 2699088 Date I Svc Code I Description I Unitsl Debits I Credits 08/28/02 273482 08/28/02 273525 08/28/02 273737 08/29/02 429 08/29/02 435 08/29/02 606 08/29/02 674 08/29/02 680 08/29/02 10198 08/29/02 105059 08/29/02 246037 08/29/02 246515 08/29/02 246644 08/29/02 272176 08/29/02 272915 08/29/02 273482 08/29/02 273525 08/29/02 273737 08/29/02 630833 08/30/02 674 08/30/02 680 08/30/02 683 08/30/02 10198 08/30/02 246037 08/30/02 246515 08/30/02 246644 08/30/02 250092 08/30/02 272915 08/30/02 272964 08/30/02 273482 08/30/02 273525 08/30/02 273737 08/30/02 630833 08/30/02 703317 08/30/02 703321 08/31/02 674 08/31/02 683 08/31/02 10198 08/31/02 245969 08/31/02 246037 08/31/02 246515 08/31/02 246644 CITALOPR3AM 20MG TAB 1 OLANZAPINE 2.5MG TAB 1 PANTOPRAZOLE 40 MG TA 1 NEUROMUSCULAR REED 15 2 ACT DAILY LIVING 15 M 2 COMM~ITY/WORK TRN 15 3 THER EXERCISE 15 MIN 3 THERAPEUTIC EXERCISE 2 D PRIVATE REHAB RM 1 PROTHROMBIN TIME 1 BISACODYL 10 MG 2 WARFARIN SODIUM 2 MG 1 BACLOFEN 10 MG 3 ZOLIPIDEM 5MG TAB 1 OXYCODONE 10MG SR TAB 2 CITALOPRAM 20MG TAB 1 OLANZAPINE 2.5MG TAB 1 PANTOPRAZOLE 40 MG TA 1 URETHRAL CAT}{ PREP TR 6 THER EXERCISE 15 MIN 4 THERAPEUTIC EXERCISE 2 WHEELCHAIR MGMT 15 MI 1 D PRIVATE REI{AB RM 1 BISACODYL 10 MG 1 WARFARIN SODIUM 2 MG 1 BACLOFEN 10 MG 3 OXYCODONE APAP 1TAB 2 OXYCODONE 10MG SR TAB 2 FLUTICASONE 0.05% NAS 1 CIT~J~OPRAM 20MG TAB 1 OLANZAPINE 2.5MG TAB 1 PANTOPRAZOLE 40 MG TA 1 URETHRAL CATH PREP TR 4 NUTR TX,REASSES,15 MI 1 IP CALORIE COUNT,PER 1 THER EXERCISE 15 MIN 3 WHEELCHAIR MGMT 15 MI 1 D PRIVATE REHAB RM 1 DIAZEPAM 2 MG 1 BISACODYL 10 MG 1 WARFARIN SODIUM 2 MG 1 BACLOFEN 10 MG 3 5.65 13.65 2.10 86.00 86 00 129 00 129 00 86 00 845 00 19 00 4 2O 2 10 6.30 5.65 5.90 5.65 13.65 2.10 66.00 172.00 86.00 43.00 845.00 2.10 2.10 6.30 4.20 5.90 145.65 5.65 13.65 2 10 44 00 64 00 28 00 129 00 43 00 845 00 2 10 2.10 2.10 6.30 - Continue - MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 AM PAGE: 6 Guarantor: DITONNO DAN J 6 SINCLAIR RD MECHA~NICSBURG, PA 17055-0000 Patient: DITONNO DAN J Visit #: 2699088 Date I SVC Code I Description I UnitsI Debits I Credits 08/31/02 246923 08/31/02 250092 08/31/02 272915 08/31/02 273209 08/31/02 273482 08/31/02 273737 08/31/02 630833 09/01/02 10198 09/01/02 105059 09/01/02 245969 09/01/02 246037 09/01/02 246516 09/01/02 246644 09/01/02 247831 09/01/02 251922 09/01/02 272915 09/01/02 273209 09/01/02 273482 09/01/02 273737 09/01/02 630833 o9/o2/o2 818 09/02/02 1062 09/02/02 10198 09/02/02 105059 09/02/02 245969 09/02/02 246516 09/02/02 246644 09/02/02 251922 09/02/02 272915 09/02/02 273209 09/02/02 273482 09/02/02 273737 09/02/02 630833 09/03/02 429 09/03/02 435 09/03/02 674 09/03/02 683 09/03/02 10198 09/03/02 11618 09/03/02 246037 09/03/02 246516 09/03/02 246644 PROMETHAZINE 25MG OXYCODONE APAP 1TAB ' OXYCODONE 10MG SR TAB QUETIAPINE FUMARATE 2 CITALOPRA24 20MG TAB PANTOPRAZOLE 40 MG TA URETHRAL CATH PREP TR D PRIVATE REHAB RM PROTHROMBIN TIME DIAZEPAM 2 MG BISACODYL 10 MG WARFARIN SODIUM 2.5 M BACLOFEN 10 MG ACETAMINOPHEN 325 MG COUMADIN 1MG UD OXYCODONE 10MG SR TAB QUETIAPINE FLtMARATE 2 CITALOPRAM 20MG TAB PANTOPRAZOLE 40 MG TA URETHRAL CATH PREP TR THER EXCERCISES 15 MI THER EXERCISES 15 MIN D PRIVATE REHAB RM PROTHROMBIN TIME DIAZEPAM 2 MG WARFARIN SODIUM 2.5 M BACLOFEN 10 MG COUMADIN 1MG UD OXYCODONE 10MG SR TAB QUETIAPINE FUMARATE 2 CITALOPRAM 20MG TAB PANTOPRAZOLE 40 MG TA URETHRAL CATH PREP TR NEUROMUSCULAR REED 15 ACT DAILY LIVING 15 M THER EXERCISE 15 MIN WHEELCHAIR MGMT 15 MI D PRIVATE REHAB RM THERAPEUT ACTIV-RT 15 BISACODYL 10 MG WARFARIN SODIUM 2.5 M BACLOFEN 10 MG 2 2.10 1 2.10 2 5.90 1 3.75 1 5.65 1 2.10 5 55.00 1 845.00 1 19.00 1 2.10 2 4.20 1 2.10 3 6.30 1 2.10 1 2.10 2 5,90 1 3.75 1 5.65 1 2.10 5 55 00 1 43 00 3 129 00 1 845 O0 1 19 O0 1 2 10 1 2 10 3 6.30 I 2.10 2 5.90 1 3.75 1 5.65 1 2.10 1 11.00 2 86.00 2 86.00 4 172.00 2 86.00 1 845.00 2 86.00 1 2.10 1 2,10 3 6.30 Continue MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 AM Guarantor: DITONNO DAN J 6 SINCLAIR RD MECHANICSBURG, PA 17055-0000 Patient: Visit #: PAGE: 7 DITONNO DAN J 2699088 Date I Svc Code I Description I Units l Debits I Credits 09/03/02 250092 09/03/02 251922 09/03/02 272915 09/03/02 273209 09/03/02 273482 09/03/02 273737 09/03/02 630833 09/03/02 667716 09/04/02 429 09/04/02 435 09/04/02 674 09/04/02 680 09/04/02 10198 09/04/02 102003 09/04/02 102183 09/04/02 102184 09/04/02 102189 09/04/02 106011 09/04/02 246015 09/04/02 246516 09/04/02 246644 09/04/02 246655 09/04/02 249819 09/04/02 250092 09/04/02 250663 09/04/02 251922 09/04/02 272915 09/04/02 273482 09/04/02 273525 09/04/02 273688 09/04/02 273737 09/05/02 429 09/05/02 435 09/05/02 674 09/05/02 10198 09/05/02 104014 09/05/02 104016 09/05/02 104042 09/05/02 104065 09/05/02 104156 09/05/02 104398 09/05/02 105036 OXYCODONE APAP 1T~ COUMADIN 1MG UD 1 OXYCODONE 10MG SR T~ 2 QUETIAPINE FUMARATE 2 1 CITALOPRAM 20MG TAB 1 PANTOPRAZOLE 40 MG TA 1 URETHRAL CATH PREP TR 10 COLLAR CERVICAL FOAM 1 NEUROFFUSCULAR REED 15 2 ACT DAILY LIVING 15 M 2 THER EXERCISE 15 MIN 2 THERAPEUTIC EXERCISE 2 D PRIVATE REHAB RM 1 SENSI, DISK METHOD/PL CULTURE, URINE COL CO 1 CULTURE, URINE PRESUM 1 ID DEFIN AEROB ISOL E 1 URINALYSIS-BASI.C & MI 1 ASCORBIC ACID 250 MG 1 WARFARIN SODIUM 2.5 M 1 BACLOFEN 10 MG 3 BUROW'S SOLN(MOD) TAB 1 CIPROFLOXACIN 500MG 1 OXYCODONE APAP 1TAB DIVALPROEX SODIUM250M 2 COUIW~ADIN 1MG UD 1 OXYCODONE 10MG SR TAB 2 CITALOPRAN 20MG TAB 1 OLANZAPINE 2.5MG TAB 1 TIZANIDINE 2MG TAB 1 PANTOPRAZOLE 40 MG TA 1 NEUROMUSCULAR REED 15 2 ACT DAILY LIVING 15 M 2 THER EXERCISE 15 MIN 1 D PRIVATE REHAB RM 1 ALKALINE PHOSPHATASE 1 BILIRUBIN TOTAL 1 CREATININE, BLOOD 1 UREA NITROGEN (BUN), 1 SGPT (ALT) 1 ELECTROLYTES 1 HEMATOCRIT 1 2.10 2.10 5.90 3.75 5.65 2.10 110.00 21.00 86.00 86.00 86 O0 86 O0 845 00 31 00 20 00 20 00 30 00 18 00 2 10 2 10 6.30 21.35 11.95 2.10 5.50 2.10 5.90 5.65 13.65 3.45 2.10 86.00 86.00 43.00 845.00 10.00 10,00 10.00 9.00 11.00 25.00 14.00 - Continue - MS HERSHEY MEDICAL CENTER SO0 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 AM PAGE: 8 Guarantor: DITONNO DAN J 6 SINCLAIR RD MECHANICSBURG, PA 17055-0000 Patient: DITONNO DAN J Visit #: 2699088 Date I Svc Code Description I Units I Debits I Credits 09/05/02 105037 09/05/02 105059 09/05/02 245206 09/05/02 246015 09/05/02 246037 09/05/02 246338 09/05/02 246516 09/05/02 246644 09/05/02 247922 09/05/02 248402 09/05/02 249026 09/05/02 249795 09/05/02 249819 09/05/02 250663 09/05/02 251922 09/05/02 272915 09/05/02 273323 09/05/02 273482 09/05/02 273525 09/05/02 273688 09/05/02 273737 09/05/02 630833 09/06/02 429 09/06/02 435 09/06/02 674 09/06/02 10198 09/06/02 11620 09/06/02 104014 09/06/02 104016 09/06/02 104156 09/06/02 104390 09/06/02 246015 09/06/02 246516 09/06/02 246644 09/06/02 247922 09/06/02 249819 09/06/02 250663 09/06/02 251922 09/06/02 273323 09/06/02 273482 09/06/02 273525 09/06/02 273737 HEMOGLOBIN 1 PROTHROMBIN TIME 1 LIDOCAINE 10MG/ML 2 ASCORBIC ACID 250 MG 3 BISACODYL 10 MG 1 METHYLPHENIDATE 5 MG 2 WARFARIN SODIUM 2.5 M 1 BACLOFEN 10 MG 3 METHADONE 5MG 1 SILVER SULFADIAZINE 5 1 CEFTRIAXONE 1GM/10ML 1 CEFTRIAXONE 1000MG/4M 2 CIPROFLOXACIN 500MG 2 DIVALPROEX SODIUM250M 2 COUMADIN 1MG UD 1 OXYCODONE 10MG SR TAB TIAGAJBINE 4MG TAB 1 CITALOPRAM 20MG TAB 1 OLANZAPINE 2.5MG TAB 1 TIZANIDINE 2MG TAB 1 PANTOPRAZOLE 40 MG TA 1 URETHRAL CATH PREP TR 2 NEUROMUSCULAR REED 15 2 ACT DAILY LIVING 15 M 2 TKER EXERCISE 15 MIN 5 D PRIVATE REHAB RM 1 COMMUNITY/WORK TRN 15 1 ALKALINE PHOSPHATASE 1 BILIRUBIN TOTAL 1 SGPT (ALT) 1 VALPROIC ACID 1 ASCORBIC ACID 250 MG 3 WARFARIN SODIUM 2.5 M 1 BACLOFEN 10 MG 3 METHADONE 5MG 3 CIPROFLOXACIN 500MG 2 DIVALPROEX SODIUM250M 2 CO~IN 1MG UP 1 TIAGABINE 4MG TAB 1 CITALOPRAM 20MG TAB 1 OLANZAPINE 2.SMG TAB 1 PANTOPRAZOLE 40 MG TA 1 14.00 19.00 4.20 6.30 2.10 4.20 2.10 6.30 2.10 8.05 184.25 147.70 23.90 5.50 2.10 2.95 3.60 5.65 13.65 3 45 2 10 22 00 86 00 86 O0 215 00 845 O0 43 00 10 00 10 00 1100 72.00 6.30 2.10 6.30 6.30 23.90 5.50 2.10 3.60 5.65 13.65 2,10 - Continue MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 AM PAGE: 9 Guarantor: DITONNO DAN J 6 SINCLAIR RD MECHANICSBURG, PA 17055-0000 Patient: Visit #: DITONNO DAN J 2699088 Date I Svc Code I Description I Unitsl Debits I Credits 09/06/02 o9/o6/o2 09/07/02 09/07/02 09/07/02 09/07/02 09/07/02 09/07/02 09/07/02 09/07/02 09/07/02 09/07/02 09/07/02 09/07/02 09/07/02 09/07/02 09/07/02 09/07/02 09/08/02 09/08/02 09/08/02 09/08/02 09/08/02 09/08/02 09/08/02 09/08/02 09/08/02 09/08102 09/08/02 09/08/02 09/08/02 09/08/02 09/09/02 09/09/02 09/09/02 09/09/02 09/09/02 09/09/02 09/09/02 09/09/02 09/09/02 09/09/02 622014 630833 429 435 10198 246015 246037 246516 246644 247922 249819 250663 251922 273323 273482 273525 273737 630833 10198 246015 246516 246644 247922 249819 250663 251922 273323 273482 273525 273737 622023 630833 428 429 435 674 10198 11620 105059 246015 246037 246516 IRRIGATION WATER 1000 URETHRAL CATH PREP TR NEUROMUSCULAR REED 15 ACT DAILY LIVING 15 M D PRIVATE REHAB RM ASCORBIC ACID 250 MG BISACODYL 10 MG WARFARIN SODIUM 2.5 M BACL©FEN 10 MG METHADONE 5MG CIPROFLOXACIN 500MG DIVALPROEX SODIUM250M COUMADIN 1MG lid TIAGA_BINE 4MG TAB CITALOPRAM 20MG TAB OLANZAPINE 2.5MG TAB PANTOPRAZOLE 40 MG TA . URETHRAL CATH PREP TR D PRIVATE REHAB RM ASCOREIC ACID 250 MG WARFkRIN SODIUM 2.5 M BACLOFEN 10 MG METHADONE 5MG CIPROFLOXACIN 500MG DIVALPROEX SODIUM250M COUMADIN 1MG UD TIAGABINE 4MG TAB CITALOPRAM 20MG TAB OLANZAPINE 2.5MG TAB PANTOPRAZOLE 40 MG TA IRRIGATION SOD CHL 0. URETHRAL CATH PREP TR THER EXERCISES 15 MIN NEUROMUSCULAR REED 15 ACT DAILY LIVING 15 M THER EXERCISE 15 MIN D PRIVATE REHAB RM COMMUNITY/WORK TRN 15 PROTHROMBIN TIME ASCORBIC ACID 250 MG BISACODYL 10 MG WARFARIN SODIUM 2.5 M 6 O0 33 O0 43 00 43 00 845 00 6 30 2 10 2 10 6 30 6 30 23 90 5 50 2 10 3.60 5.65 13.65 2.10 44.00 845.00 6.30 2.10 6.30 6.30 23.90 5.50 2.10 3.60 5.65 13.65 2.10 6.00 44.00 43 00 43 00 86 00 258 00 845 00 86 00 19 00 6 30 2 10 2 10 - Continue - MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 AM PAGE: 10 Guarantor: DITONNO DAN J 6 SINCLAIR RD MECHANICSBURG, PA 17055-0000 Patient: DITONNO DAN J Visit #: 2699088 Date [ Svc Code I Description I Unitsl Debits J Credits 09/09/02 246644 09/09/02 247922 09/09/02 249819 09/09/02 250663 09/09/02 251922 09/09/02 273323 09/09/02 273482 09/09/02 273525 09/09/02 273737 09/09/02 630833 09/10/02 428 09/10/02 429 O9/lO/O2 43s 09/10/02 674 09/10/02 680 09/10/02 752 09/10/02 10198 09/10/02 11620 09/10/02 246015 09/10/02 246516 09/10/02 246644 09/10/02 247922 09/10/02 250663 09/10/02 251922 09/10/02 273323 09/10/02 273482 09/10/02 273525 09/10/02 273737 09/11/02 428 09/11/02 429 09/11/02 435 09/11/02 674 o /11/o2 68o o9/ii/02 i0igs 09/11/02 11618 09/11/02 104568 09/11/02 104569 09/11/02 246015 09/11/02 246516 09/11/02 246644 09/11/02 247922 09/11/02 250663 BACLOFEN 10 MG 3 6.30 METHADONE 5MG 3 6.30 CIPROFLOXACIN 500MG 1 11.95 DIVALPROEX SODIUM250M 2 5.50 COUMADIN 1MG lid 1 2.10 TIAGABINE 4MG TAB 1 3.60 CITALOPRAM 20MG TAB 1 5.65 oLANZAPINE 2.SMG TAB 1 13.65 PANTOPRAZOLE 40 MG TA 1 2.10 URETHRAL CATH PREP TR 2 22.00 THER EXERCISES 15 MIN 1 43.00 NEUROMUSCULAR REED 15 1 43.00 ACT DAILY LIVING 15 M 2 86.00 THER EXERCISE 15 MIN 4 172.00 THERAPEUTIC EXERCISE 2 86.00 QUAD-QUIP INSP MIRROR 1 43.00 D PRIVATE REHAB RM 1 845.00 COMMUNITY/WORK TRN 15 2 86.00 ASCORBIC ACID 250 MG 2 4.20 WARFARIN SODIUM 2.5 M 1 2.10 BACLOFEN 10 MG 4 8.40 METHADONE 5MG 2 4.20 DIVALPROEX SODIUM250M 2 5.50 COUMADIN 1MG UD 1 2.10 TIAGABINE 4MG TAB 1 3.60 CITALOPRAM 20MG TAB 1 5.65 OLANZAPINE 2.SMG TAB 1 13.65 PANTOPRAZOLE 40 MG TA 1 2.10 THER EXERCISES 15 MIN 1 43.00 NEUROMUSCULAR REED 15 1 43.00 ACT DAILY LIVING 15 M 2 86.00 THER EXERCISE 15 MIN 2 86.00 THERAPEUTIC EXERCISE 2 86.00 D PRIVATE REHAB RM 1 845.00 THERAPEUT ACTIV-RT 15 2 86.00 TSH THYROID STIM HORN 1 64.00 FREE T4 1 47.00 ASCORBIC ACID 250 MG 3 6.30 WARFARIN SODIUM 2.5 M 1 2.10 BACLOFEN 10 MG 4 8.40 METHADONE 5MG 3 6.30 DIVALPROEX SODIUM250M 2 5.50 Continue - MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 AM PAGE: 11 Guarantor: DITONNO DAN J 6 SINCLJIIR RD MECHANICSBURG, PA 17055-0000 Patient: Visit #: DITONNO DAN J 2699088 I Svc Code I Description I Unitsl Debits I Credits Date 09/11/02 251922 09/11/02 273323 09/11/02 273482 09/11/02 273525 09/11/02 273737 09/11/02 630833 09/12/02 428 09/12/02 434 09/12/02 435 09/12/02 674 09/12/02 680 09/12/02 10198 09/12/02 246015 09/12/02 246400 09/12/02 246516 09/12/02 246644 09/12/02 247922 09/12/02 250663 09/12/02 251922 09/12/02 272176 09/12/02 273323 09/12/02 273482 09/12/02 273525 09/12/02 273737 09/12/02 630833 09/13/02 434 09/13/02 435 09/13/02 674 09/13/02 680 09/13/02 10198 09/13/02 11618 09/13/02 102183 09/13/02 102184 09/13/02 106011 09/13/02 246015 09/13/02 246037 09/13/02 246516 09/13/02 246644 09/13/02 247922 09/13/02 250663 09/13/02 251922 09/13/02 272176 COUMADIN 1MG UD TIAGABINE 4MG TAB CITALOPR3~M 20MG TAB OLANZAPINE 2.5MG TA~ PANTOPRAZOLE 40 MG TA URETHRAL CATH PREP TR THER EXERCISES 15 MIN THERAPEUT ACTIVITIES ACT DAILY LIVING 15 M THER EXERCISE 15 MIN THERAPEUTIC EXERCISE D PRIVATE REHAJB RM ASCORBIC ACID 250 MG PROMETHAZINE 25 MG/ML WARFARIN SODIUM 2.5 M BACLOFEN 10 MG METHADONE 5MG DIVALPROEX SODIUM250M COUMADIN 1MG UD ZOLIPIDEM 5MG T~LB TIAGABINE 4MG TAB CITALOPRAM 20MG TAB OLANZAPINE 2.SMG TAB PANTOPRAZOLE 40 MG TA URETHRAL CATH PREP TR THERAPEUT ACTIVITIES ACT DAILY LIVING 15 M THER EXERCISE 15 MIN THERAPEUTIC EXERCISE D PRIVATE RE~IAB RM THERAPEUT ACTIV-RT 15 CULTURE, URINE COL CO CULTURE, URINE PRESUM URINALYSIS-BASIC & MI ASCORBIC ACID 250 MG BISACODYL 10 MG WARFARIN SODIUM 2.5 M BACLOFEN 10 MG METHADONE 5MG DIVALPROEX SODIUM250M COUMADIN 1MG lid ZOLIPIDEM 5MG TAB 1 2.10 1 3.60 1 5.65 1 13.65 1 2.10 3 33.00 2 86.00 2 86.00 2 86,00 5 215.00 4 172.00 1 845.00 3 6.30 1 6.00 1 2.10 3 6.30 3 6.30 2 5.50 1 2.10 1 5 65 1 3 60 1 5 65 1 13 65 1 2 10 4 44 00 2 86.00 2 86 O0 2 86 00 4 172 00 1 845 00 2 86 00 1 20 00 1 20 O0 1 18 00 3 6.30 1 2.10 1 2.10 3 6.30 2 4.20 1 2.75 1 2.10 1 5.65 - Continue - MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 AM PAGE: 12 Guarantor: DITONNO DAN J 6 SINCLAIR RD MECHANICSBURG, PA 17055-0000 Patient: DITONNO DAN J Visit #: 2699088 Date I Svc Code I Description { UnitsI Debits I Credits 273482 273525 273688 273737 622023 630833 428 674 10198 246015 246516 246644 247831 247922 251922 272176 273482 273525 273688 273737 621043 630833 670330 674 680 10198 102183 102184 106010 246015 246037 246516 246644 247922 251922 273482 273525 273688 273737 630833 435 436 09/13/02 09/13/02 09/13/02 09/13/02 09/13/02 09/13/02 09/14/02 09/14/02 09/14/02 o9/14/o2 o9/14/o2 o9/14/o2 o9/14/o2 09/14/02 09/14/02 09/14/02 09/14/02 09/14/02 09/14/02 09/14/02 o~/14/o2 o9/14/o2 os/14/o2 O9/lS/O2 o9/ls/o2 o9/19/o2 09/15/02 09/15/02 09/15/02 o9/15/o2 os/15/o2 09/15/02 09/15/02 09/15/02 O9/lS/O2 o9/ls/o2 o9/15/o2 os/~5/o2 os/15/o2 os/15/o2 os/16/o2 o9/16/o2 CITALOPRAJW 20MG TAB OLANZAPINE 2.5MG TAB TIZANIDINE 2MG TAJ3 PANTOPRAZOLE 40 MG TA IRRIGATION SOD CHL 0. URETHRAL CATH PREP TR THER EXERCISES 15 MIN THER EXERCISE 15 MIN D PRIVATE REHJLB RM ASCORBIC ACID 250 MG WARFARIN SODIUM 2.5 M BACLOFEN 10 MG ACETAMINOPHEN 325 MG METHADONE 5MG CO~IN 1MG LTD ZOLIPIDEM 5MG TAB CITALOPRAM 20MG TAB OLANZAPINE 2.SMG TAB TIZANIDINE 2MG TAB PANTOPRAZOLE 40 MG TA I V SODIUM CHLORIDE 0 URETHRAL CATH PREP TR IV INFUSION SET, UNIV THER EXERCISE 15 MIN THERAPEUTIC EXERCISE D PRIVATE REHAB RM CULTURE, URINE COL CO CULTURE, URINE PRESUM URINALYSIS-BASIC/REFL ASCORBIC ACID 250 MG BISACODYL 10 MG WARFARIN SODIUM 2.5 M BACLOFEN 10 MG METHADONE 5MG COUMADIN 1MG ETD CITALOPRAM 20MG TAB OLANZAPINE 2.5MG TAB TIZANIDINE 2MG TAB PANTOPRAZOLE 40 MG TA URETHRAL CATH PREP TR ACT DAILY LIVING I5 M COMMUNITY/WORK TRN 15 5.65 13.65 3.45 2.10 6.00 33.00 43.00 129.00 845.00 6.30 2.10 6.30 2.10 4.20 2.10 5.65 5.65 13.65 3.45 2.10 6.00 33.00 12.00 43.00 43.00 845.00 20 O0 20 00 14 00 6 30 2 10 2 10 6 30 4.20 2.10 5.65 13.65 3.45 2.10 55.00 86.00 172.00 Con t inue MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 PAGE: 13 Guarantor: DITONNO DAN J 6 SINCLAIR RD MECHANICSBURG, PA 17055-0000 Patient: Visit #: DITONNO DAN J 2699088 Date I Svc Code I Description I UnitsI Debits { Credits 09/16/02 674 09/16/02 680 09/16/02 10198 09/16/02 11620 09/16/02 105059 09/16/02 246015 09/16/02 246516 09/16/02 246644 09/16/02 247922 09/16/02 249557 09/16/02 251922 09/16/02 273482 09/16/02 273525 09/16/02 273737 09/16/02 630833 09/17/02 428 09/17/02 435 09/17/02 674 09/17/02 680 09/17/02 683 09/17/02 10198 09/17/02 11618 09/17/02 11620 09/17/02 246015 09/17/02 246037 09/17/02 246516 09/17/02 246644 09/17/02 247922 09/17/02 249364 09/17/02 249557 09/17/02 251922 09/17/02 273482 09/17/02 273509 09/17/02 273525 09/17/02 273737 09/17/02 630833 09/18/02 429 09/18/02 434 09/18/02 435 09/18/02 674 09/18/02 680 09/18/02 10198 THER EXERCISE 15 MIN THERAPEUTIC EXERCISE D PRIVATE REHAB RM COMMUNITY/WORK TRN 15 PROTHROMBIN TIME ASCORBIC ACID 250 MG WARFARIN SODIUM 2.5 M BACLOFEN 10 MG METHADONE 5MG ACY'CLOVIR 200MG COUMJ%DIN 1MG UD CITALOPRAM 20MG TAB OLANZAPINE 2.SMG TA~ PAMTOPRAZOLE 40 MG TA URETHRAL CATH PREP TR THER EXERCISES 15 MIN ACT DAILY LIVING 15 M THER EXERCISE 15 MIN THERAPEUTIC EXERCISE WHEELCHAIR MGMT 15 MI D PRIVATE REHAB RM THERAPEUT ACTIV-RT 15 COMMUNITY/WORK TRN 15 ASCORBIC ACID 250 MG BISACODYL 10 MG WARFARIN SODIUM 2.5 M BACLOFEN 10 MG METHADONE 5MG INSTANT BREAKFAST SUG ACY'CLOVIR 200MG COUMADIN 1MG UD CITALOPRA34 20MG TAB BOOST EN CHOC DRINK OLANZAPINE 2.SMG TAB PANTOPRAZOLE 40 MG TA URETHRAL CATH PREP TR NEUROMUSCULAR REED 15 THERAPEUT ACTIVITIES ACT DAILY LIVING 15 M THER EXERCISE 15 MIN THERAPEUTIC EXERCISE D PRIVATE REHAB RM 4 172.00 3 129.00 1 845.00 4 172.00 1 19.00 3 6.30 1 2 10 2 4 20 2 4 20 3 6 30 1 2 10 1 5 65 1 13 65 1 2 10 4 44 O0 2 86 O0 2 86 00 3 129 00 3 129 00 1 43 00 1 845.00 2 86.00 2 86.00 3 6.30 1 2.10 1 2.10 3 6.30 2 4.20 21 44.10 6 12.60 1 2.10 1 5.65 8 20.80 1 13.65 1 2.10 4 44.00 2 86.00 2 86.00 2 86.00 2 86.00 2 86.00 1 845.00 - Continue - MS HERSHEY NEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 A/~ PAGE: 14 Guarantor: DITONNO DAN J 6 SINCLAIR RD MECHA/~ICSBURG, PA 17055-0000 Patient: DITOArNO DAN J Visit ~: 2699088 Date I Svc Code I Description I Unitsl Debits I Credits 09/18/02 11619 09/18/02 246015 09/18/02 246344 09/18/02 246516 09/18/02 246644 09/18/02 247831 09/18/02 247922 09/18/02 249557 09/18/02 251922 09/18/02 273482 09/18/02 273525 09/18/02 273737 09/18/02 630833 09/19/02 428 09/19/02 429 09/19/02 674 09/19/02 765 09/19/02 10198 09/19/02 13540 09/19/02 246015 09/19/02 246516 09/19/02 246644 09/19/02 247831 09/19/02 247922 09/19/02 249557 09/19/02 251922 09/19/02 273482 09/19/02 ,273525 09/19/02 273737 09/19/02 630833 09/20/02 435 09/20/02 436 09/20/02 680 09/20/02 10198 09/20/02 11620 09/20/02 246015 09/20/02 246516 09/20/02 246644 09/20/02 247922 09/20/02 249557 09/20/02 251922 09/20/02 273482 SELF CARE/HONE TRN 15 2 86.00 .ASCORBIC ACID 250 MG 3 6.30 NYSTATIN 15 GM 1 49~65 WARFARIN SODIUM 2.5 M 1 2.10 BACLOFEN 10 MG 2 4.20 ACETA/~INOPHEN 325 MG 1 2.10 METHADONE 5MG 2 4.20 ACY'CLOVIR 200MG 5 10.50 COUMADIN 1MG UD 1 2.10 CITALOPRAM 20MG TAB 1 5.65 OLANZAPINE 2.SMG TAB 1 13.65 PANTOPRAZOLE 40 MG TA 1 2.10 URETHRAL CATH PREP TR 5 55.00 THER EXERCISES 15 NIN 1 43.00 NEUROMUSCULAR REED 15 1 43.00 THER EXERCISE 15 MIN 2 86.00 SPLINTING MATERIALS 5 80.00 D PRIVATE REHAB RM 1 845.00 ORTH FABRIC/FIT/TRN 1 3 129.00 ASCORBIC ACID 250 MG 3 6.30 WARFARIN SODIUM 2.5 M 1 2.10 BACLOFEN 10 MG 3 6.30 ACETAMINOPHEN 325 MG 1 2.10 METHADONE 5MG 2 4.20 ACY'CLOVIR 200MG 5 10.50 COUMADIN lNG UD 1 2.10 CITALOPRAM 20MG TAB 1 5.65 OLANZAPINE 2.5NG TAB 1 13.65 PANTOPRAZOLE 40 MG TA 1 2.10 URETHRAL CATH PREP TR 4 44.00 ACT DAILY LIVING 15 M 2 86.00 COMMUNITY/WORK TRN 15 8 344.00 THERAPEUTIC EXERCISE 2 86.00 D PRIVATE REPiAB RM 1 845.00 COMMUNITY/WORK TP~N 15 8 344.00 ASCORBIC ACID 250 MG 3 6.30 WARFARIN SODIUM 2.5 M 1 2.10 BACLOFEN 10 MG 3 6.30 METHADONE 5MG 1 2.10 ACY'CLOVIR 200MG 4 8.40 COUMADIN 1MG UD 1 2.10 CITALOPRAM 20MG TAB 1 5.65 - Continue - MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 AM PAGE: 15 Guarantor: DITONNO DAN J 6 SINCLAIR RD MECHANICSBURG, PA 17055-0000 Patient: Visit #: D/TON-NO DAN J 2699088 Date l Svc Code I Description I Unitsl Debits I Credits 09/20/02 273545 09/20/02 273737 09/20/02 630833 09/21/02 674 09/21/02 10198 09/21/02 246015 09/21/02 246037 09/21/02 246516 09/21/02 246644 09/21/02 247831 09/21/02 249557 09/21/02 251922 09/21/02 273482 09/21/02 273525 09/21/02 273545 09/21/02 273737 09/21/02 630833 09/22/02 10198 09/22/02 246015 09/22/02 246516 09/22/02 246644 09/22/02 251922 09/22/02 273482 09/22/02 273525 09/22/02 273545 09/22/02 273688 09/22/02 273737 09/22/02 630833 09/23/02 428 09/23/02 435 09/23/02 674 09/23/02 10198 09/23/02 11620 09/23/02 105059 09/23/02 246015 09/23/02 246037 09/23/02 246516 09/23/02 246644 09/23/02 251922 09/23/02 273482 09/23/02 273525 09/23/02 273545 CELECOR lB 200MG PANTOPRAZOLE 40 MG TA URETHtLAL CATH PREP TR THER EXERCISE 15 MIN D PRIVATE REPIAB RM ASCORBIC ACID 250 MG BISACODYL 10 MG WARFARIN SODIUM 2.5 BACLOFEN 10 MG ACETAMINOPHEN 325 MG ACY'CLOVIR 200MG COUMADIN 1MG UD CITALOPR3kM 20MG TAB OLANZAPINE 2.SMG TAB CELECOR lB 200MG PANTOPRAZOLE 40 MG TA URETHRAL CATH PREP TR D PRIVATE REHAB RM ASCORBIC ACID 250 MG WARFARIN SODIUM 2.5 M BACLOFEN 10 MG COUMADIN 1MG UD CITALOPR3~4 20MG TAB OLAI~ZAPINE 2.5MG TAB CELECOR lB 200MG TIZANIDINE 2MG TAB PANTOPRAZOLE 40 MG TA URETHRAL CATH PREP TR THER EXERCISES 15 ACT DAILY LIVING 15 M THER EXERCISE 15 MIN D PRIVATE REHAB RM COMP~3NITY/WORK TRN 15 PROTHROMBIN TIME ASCORBIC ACID 250 MG BISACODYL 10 MG WARFARIN SODIUM 2.5 M BACLOFEN 10 MG COUMADIN 1MG lid CITALOPRAM 20MG TAB OLANZAPINE 2.5MG TAB CELECOR lB 200MG 6 80 2 10 11 00 43 00 845 00 6 30 2 10 2 10 6 30 2 10 2 10 2 10 5 65 13 65 6 80 2.10 22.00 845.00 '6.30 2.10 6.30 2.10 5.65 13.65 6.80 3.45 2.10 33.00 86.00 86.00 129.00 845.00 43.00 19.00 6.30 2.10 2.10 6.30 2.10 5.65 13.65 6.80 - Continue - MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 PAGE: 16 Guarantor: DITONNO DAN J 6 SINCLAIR RD MECHANICSBURG, PA 17055-0000 Patient: Visit #: DITONNO DAN J 2699088 Date I Svc Code I Description I Unitsl Debits I Credits 09/23/02 273737 PANTOPRAZOLE 40 MG TA 1 2.10 , 09/23/02 630833 09/24/02 428 09/24/02 429 09/24/02 435 09/24/02 680 09/24/02 10198 09/24/02 11618 09/24/02 245958 09/24/02 246015 09/24/02 246644 09/24/02 247831 09/24/02 251922 09/24/02 273482 09/24/02 273545 09/24/02 273737 09/24/02 630833 09/25/02 428 09/25/02 435 09/25/02 10198 09/25/02 11620 09/25/02 246015 09/25/02 246515 09/25/02 246644 09/25/02 246848 09/25/02 272176 09/25/02 273482 09/25/02 273545 09/25/02 273737 09/25/02 630833 09/26/02 429 09/26/02 435 09/26/02 436 09/26/02 680 09/26/02 683 09/26/02 10198 09/26/02 11618 09/26/02 246015 09/26/02 246515 09/26/02 246644 09/26/02 251428 09/26/02 272176 URETHRAL CATH PREP TR 2 THER EXERCISES 15 MIN 2 NEUROMUSCULAR REED 15 2 ACT DAILY LIVING 15 M 2 THERAPEUTIC EXERCISE 6 D PRIVATE REHAB RM 1 THERAPEUT ACTIV-RT 15 2 HEPA~RIN SODIUM 100 UN 1 ASCORBIC ACID 250 MG 3 BACLOFEN 10 MG 3 ACETAMINOPHEN 325 MG 1 COUMADIN 1MG UD 1 CITALOPRA/4 20MG TAB 1 CELECOR lB 200MG 1 PANTOPRAZOLE 40 MG TA 1 URETHRAL CATH PREP TR 5 THER EXERCISES 15 MIN 2 ACT DAILY LIVING 15 M 2 D PRIVATE REH/LB RM t COMMUNITY/WORK TRN 15 2 ASCORBIC ACID 250 MG 3 WA/~FARIN SODIUM 2 MG 1 BACLOFEN 10 MG 3 LIDOCAINE 10 ML 1 ZOLIPIDEM 5MG TAB 1 CITALOPRAM 20MG TAB 1 CELECOR lB 200MG 1 PANTOPRAZOLE 40 MG TA 1 URETHRAL CATH PREP TR 3 NEUROMUSCULAR REED 15 2 ACT DAILY LIVING 15 M 2 COMMUNITY/WORK TRN 15 2 THERAPEUTIC EXERCISE 1 WHEELCHAIR MGMT 15 MI 3 D PRIVATE REHAB RM 1 THERAPEUT ACTIV-RT 15 1 ASCORBIC ACID 250 MG 3 WARFARIN SODIUM 2 MG 1 BACLOFEN 10 MG 2 PROMET}{AZINE TABS 1 ZOLIPIDEM 5MG TAB 22.00 86.00 86 O0 86 00 258 00 845 00 86 00 2 10 6 30 6 30 2 10 2 10 5 65 6 80 2 10 55 00 86.00 86.00 845.00 86.00 6.30 2.10 6.30 13.40 5.65 5.65 6.80 2.10 33.00 86.00 86.00 86.00 43.00 129.00 845.00 43.00 6.30 2.10 4.20 2.50 5.65 - Continue - MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 AM PAGE: 17 Guarantor: DITONNO DAN J 6 SINCLAIR RD MECHANICSBURG, PA 17055-0000 Patient: DITONNO DAN J Visit #: 2699088 I Date ~ I Svc Code I Description I Unitsl Debits I Credits 09/26/02 273482 CITALOPPJ~M 20MG TAB 1 5.65 09/26/02 273525 OLANZAPINE 2.5MG TAB 1 13.65 09/26/02 273545 CELECOR lB 200MG 1 6.80 09/26/02 273737 PANTOPRAZOLE 40 MG TA 1 2.10 09/26/02 622023 IRRIGATION SOD CHL 0. 1 6.00 09/26/02 630833 URETHRAL CATH PREP TR 5 55.00 09/27/02 435 ACT DAILY LIVING 15 M 2 86.00 09/27/02 683 WHEELCHAIR MGMT 15 MI 3 129.00 09/27/02 11620 COMMUNITY/WORK TRN 15 2 86.00 09/27/02 246015 ASCORBIC ACID 250 MG 2 4.20 09/27/02 246644 BACLOFEN 10 MG 2 4.20 09/27/02 249364 INST~NT BREAKFAST SUG 12 25.20 09/27/02 272949 COLLANENASE OINT 30 G 1 149.45 09/27/02 273482 CITALOPPJ~M 20MG TAB 1 5.65 09/27/02 273545 CELECOR lB 200MG 1 6.80 09/27/02 622023 IRRIGATION SOD CHL 0. 1 6.00 09/27/02 630833 URETHRAL CATH PREP TR 2 22.00 02/28/03 980090 HOSPITAL BAD DEBT W/O -1 02/28/03 980091 HOSPITAL BAD DEBT PLA 1 53187.05 53187.05- * Not posted Balance: I 53187.05 MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/17/03 at 10:31 AM PAGE: 1 Guarantor: DITONNO DAN J 6 SINCLAIR RD MECHANICSBURG, PA 17055-0000 Patient: DITONNO DAN J Visit ~: 2814377 Date I Svc Code I Description I Units l Debits I Credits 09/27/02 230098 COUNADIN TAB 2MG 60 5.40 09/27/02 230645 BACLOFEN TAB 10MG 45 4.05 09/27/02 232711 CITALOPR3kM HYDROBROMI 30 81.00 09/27/02 232732 CELEBREX 200MG CAP 30 100.20 09/27/02 232767 ZYPREXA OLANZAPINE 2. 30 201.00 09/27/02 232903 PANTOPRAZOLE 40 MG TA 30 10.50 02/28/03 980090 HOSPITAL BAD DEBT W/O -1 02/28/03 980091 HOSPITAL B~LO DEBT PLA 1 402.15 402.15- * - Not posted I Balance: I 402.15 I STATEMENT OF PHYSICIAN DATE PROCEDURE UIAG CODE CODE >>> PAT/ENT: DAN J DZTOMqO )I:~,I~.ICTA'r~: DAN J DITONNO 6 SINCLAIR RD W ~'~he ~Mi!.ton $. J~.e. rs.h. eff J~JedicaJ Center MECHANICSBURG PA 170S5 ACCOUNT # 1255955 ~ IF ANY QUESTIONS, PLEASE CONTACT: MSHMC PATIEN ! FINANCIAL SERVICES OTY DESCRIPTION 08/10/02 99245.25 959,8 08/10/02 32020.Nfl 959,8 08/10/02 00999 959°09 00/10/02 7101026 959,1 06/10/0~' 7205026 959,1 08,/10/0~'721~'5'% 959,1 08/10/02 7637526 959,1 08/10/02 01922 959. 06/10/02 99254 9.6~*, 09 08/11/02 7101026 V58,89 08/11/02 7101026 706.09 08/11/02 99252 952.09 06/11/02 99255.GC 516,5 06/11/02 99255 959.8 08/12/02 7101026 969.1 06/12/02 7~61026 959.1 06/12/02 7101026 760.6 08/12/02 7204026 959.6 08/12/02 7101026 786.09 08/15/02 7204026 953.0 06/14/02 7101026 766.6 06/14/02 7101026 780.6 08/14/02 99251 952,09 06/1.6/02 99231 962.09 16/19/02 7400026.GE 789.00 36~622 25725 PERFOPJ4EO S¥I TRAUMA SURGERY DZV PLACE OF SVC: ENERGENCY ROSFI TRAONA TEA~ OZAG EYAL ZNT THORACOSTONY TU~E RENOTR LT PERFORFEO DY: OZV OF E~RG ROON NO CHARGE VISIT TRAUMA PERFOPJ4ED BY: DIY OF INESTXESTA OFFICE CONSULTATION PERFOR/4EO BY; DZV OF DZAG RADIOLOGY PLACE OF SVC: INPATIENT CHEST I V'ZEH SPINE CERV ANT/POS LAT :~ CT CERVICAL SPINE UNENH"q CT CORONAL SAGZTTAL 08LXq PERFORHED BY: DZV OF N4ESTHESZA 14 ANES FOR NON ZNV ZI4G PERFOIUdED BY; DZV OF NEURO SURGERY IRZTIAL IRPT CONSULTATION PEEFOPJdED BY; DIV OF OIAG RADZOLOSY CHEST I VZEN CHEST 1 VZEN PERFORNED RV; D'rv OF NEUflO SURGERY DAILY NOSPZTAL CARE PERFORI4ED DY: DIV RESP& INTENSIVE CARE DAILY HOSPITAL CARE PERFORI4ED BY; TRAUMA SURGERY DZV DAILY HOSPITAL CARE PERFORHED BY; DZV OF DZAG RADZOLOSY CREST Z VIE# AISLE COHPLETE CREST 1 VIEN SPINE CERVTC ANT/POS LAT CREST 1 VIEN SPINE CERVZC ~NT/POS LAT PERFOflFfED BY; RER/~ZLZTATZON CENTER DZV ZNZT'ZAL ZNPT CONSULTATION PERFOIU4ED BY; DZV OF DZAG RADIOLOGY SPINE CERVZC ANT/POS LAT CHEST 1 VIEH CREST 1 VZEH PERFORNED BY,' OZV OF NEURO SURGERY D~LY HOSPITAL CARE DAILY HOSPITAL CARE PER~D BY: DZV OF DZAG RADTOLOGY ABDONEfl SINGLE VIEN 269908~ INS CHARGE 2675,00 896,00 159.00 ~.00 64.00 308.00 46.00 Z05O. O0 290.00 48,00 ~.00 117,00 166.00 166.00 ~6.00 46,00 ~8.00 59.00 69.00 200.00 59,00 ~.~ ~.00 70.00 70.00 ~.08 STATEMENT OAT£: 02112J03 LAST STATEMENT DATE: 02/08103 FED TAX ID # 2~8b/O35 PAYMEN~ GUARANI'O ADJUSTMENT BALANCE 2675.00 896.00 O.OO 159.00 ~8.00 6~.00 $08.00 46.00 1050. O0 290, O0 ~.00 117.00 166.00 166.00 ~.00 46.00 ~8.00 59.00 d~.O0 59.00 200.00 59.00 ~,~ ~.00 70.00 70.00 ~.00 STATEMENT OF PHYSICIAN SERVICES 'I NNSTATE The IVlilton S. .... .H.e. rs,h, ey MedicaJ Center I/1~ [.OllegC OI I~ICQICIIJC DAN J DITONNO 6 SINCLAIR RD MECHANICSBURG PA 17055 ACCOUNT # 1255955 PROCEDURE DIAG DATE CODE CODE IF ANY QUESTIONS, PLEASE CONTACT: MSHMC PATIENT FINANCIAL SERVICES 08/19/02 99123 V67.89 08/20/02 99232 V67.89 DATLY HOSPITAL CARE 08/21/02 99233 V67.89 DALLY HOSPZTAL CARE 08/22/02 99232 V67.B9 DAILY HOSPZTAL CARE 08/23/02 99232 V57,89 DALLY HOSpI'TAL CARE 08/26/02 99232 V57,89 OATLY HOSPZTAL CARE 08/27/02 99232 V67.89 DALLY HI~PITAL CARE 08/28/02 99233 V67,89 DA'rLYHO~PZTAL CARE 08/29/02 992]2 V67,89 DALLY HOSPZTAL CAPE 08/30/02 992]2 V67,89 DALLY ROSPZTAL CAPE 08/31/02 992]2 ¥57,89 DALLY ROSPZTAL CARE 09/01/02 99231 V57.89 DALLY HOSPZTAL CARE 09/0]/02 99231 V57,69 DALLY HOSPZTAL CARE 09/0d./02 99233 V67,69 DALLY HOSPZTAL CARE 09/05/02 99232 V67,89 DALLY HO$PZTAL CARE 09/06/02 99232 V67.89 DALLY ROSPZTAL CARE 09/09/02 99232 V67.89 DALLY HOSPZTAL CARE 09/10/02 99232 V67.89 DALLY HOSpI'TAL CARE 09/11/02 99233 ¥.r~7,69 DALLY HOSPZTAL CARE 09/12/02 99232 vr27,89 DALLY HOSPZTAL CARE 09/13/02 99232 V67.89 DALLY HOSP]'TAL CARE 09/],6/02 99232 V67,89 DALLY HOSPZTAL CAPE 09/17/02 99232 V~;7,89 DALLY HOSPZTAL CAPE 09/18/02 9923] V67,89 DALLY HOSPZTAL CARE 09/19/02 992]2 V67.B9 DALLY HOSPZTAL CARE 09/20/02 99232 V67.89 DALLY HOSPZTAL CARE 09/21/02 - 99232 V67.89 DALLY HO~OTTAL CARE 09/23/02 99232 V67.89 DALLY HOSPZTAL CARE 09/2¢/02 99232 V67,89 DALLY HOSPZTAL CaRE 09/26/0~ 99233 V67.89 DALLY HO~PZTAL CARE 09/26/02 99232 V67.a9 OAILY HO~PZTAL CARE 09/27/02 99238 V67.B9 HOSPZ?AL OZSC DAY DESCRIPTION PERFORflED BY: REH~ZLTTATTON CENTER DTV PLACE OF S~K::: INPATIENT TNZTZAL HOSPTTAL CARE 09/19/02 7204026 72]. 1 10/30/02 2736436 PERFORNED BY: DTV OF D'rAG RADI'OLOGY PLACE OF SVC: OP PHYSICIAN SPZNE CERVZC ANT/POS LAT BALANCE ~ANSFER TO GUAR L0/18/02 99214.GC 962.9 [0/26/02 2566707 PERFOPJ4ED BY: REHASZLZTATION CENTER DZV PLACE OF SV~: OP PHY$ZCTAN IXITPATZENT VZSZT EST DRZVERS TRAINZN6 DOES NOT COVE BALANCE; DAN J 01~ ~11290.00 TIGER CHAISES BZLLED TO YI~R ZN~UflANCE COff~ANY. 149. O0 INS CHARGE 529.00 117.00 166.00 117,00 117.00 117.00 117.00 166.00 117.00 117.00 117,00 70.00 70.00 166.00 117.00 117.00 117.00 117.00 166.00 117.00 117.00 117.00 117.00 166.00 117,00 117.00 117,00 117.00 117.00 166.00 117,00 69.00 99.00 2 ef ,STATEMENT DATE: 02/12103 I.,~$ T STATEMENT DATE: 02108103 FED TAX ID # 251867035 PAYMEN~I GUAHAfl IU ADJUSTMENT BALANCE 117,00 166.00 117,00 117.00 117.00 117.00 166.00 117.00 117.00 117.00 70.00 70,00 166.00 117.00 117.00 117.00 117.00 166.00 117.00 117.00 117,00 117.00 166.00 117.00 117.00 117,00 117.00 117,00 166.00 117.00 141.00 69,00 99.00 )~*kl~.lC~c DAN J DITONNO EINI NO/~/~ 6 SINCLAIR RD e ~i~on S.~e~cy ~ic~ Center MECHANICSBURG PA ~7055 ~ nc ~ouege o~ M~ ACCOUNT ~ 1255955 STATEMENT DATE: 02/12103 LAST STATEMENT DATE: 02/08103 3 of DATE IF ANY QUESTIONS, PLEASE CONTACT: MSHMC PATIEN I FINANCIAL SERVIGb$ CODE PED TAX IU # 251551Ue5 UiAG PAYMENT/ GUARANTO CODE OTY DESCRIPTION INS CHARGE ADJUSTMENT BALANCE IF YOU HAVE /~Y ~UESTIO~ ASOUT THE AHOUNT YOUR INSURANCE COHP/~Y PAID, CONTACT THEN DIRECTLY, FOR ANY OTHER quESTIONS REGARDING YOUR BAL~JCE, PLEASE CONTACT OUR OFFICE. IF PAYI'ENT HAS BEEN NAOE, THN~ YOU ~g DISREGARD THIS BILL. RJKO TH~J, IK YOU FOR USING HSHNC PHYSZCIAflS GROUP FOR YOUR PHY$ICI~ SERVICES. IF YOU H~VE AN"( qUESTIONS REGARDING THIS BILL) PLEASE CONTACT US AT 71?-SSI-S069 OR 800-2.~-2619, BETNEEN 8:00,~'1 AND 5:30PHHONDAY THROUGH NEDNESDAY OR BETHEEN 8~00~ ~D 4:30PH THURSDAY ~ FRIDAY.. BAL,~ICE SUI~ARY RESFOItSIBLE PARTY ~LICY I TOTAL ~ OUAR~J'.EOR RE~IOILITY ~ 11290.00 STATEMENT DATE; GUARANTOR RE;IPON~IBILJTY: MINIMUM PAYMENT.' BF6 1255955 02/12103 $ 11290.00 $11290.00 MSHMC PHYSICIANS GROUP BILLING SERVICES P O BOX 854 HERSHEYPA 17033-0854 00001255955 UP 000000000112900002120~ ~R, HSHHC PHYSICIANS GROUP DAN J DITONNO To: 6 SINCLAIR RD P O BOX 828611 NECHANICSBURG PA PHILA PA 19182-8611 17055 'ICE USE ONLY : F6B0 P: DMND M/C VISA FOR CREDIT CARD PAYMENT, PLEAEE PIL~ IN INFORMATION BELOW CARD NUMBER EXP DATE CARDHOLDER NAME (PRINT) ~REDIT CARD SIGNATURE 1255955 MSHMC PHYSICIANS GROUP Patient - Daniel J. Ditonno VERIFICATION I hereby verify that the statements made in the foregoing Complaint-Civil Action are true and correct to the best of my knowledge, information, and belief. This verification is made subject to the penalties of 18 Pa. Cons. Stat. § 4904 relating to unsworn falsification to authorities. Date: THE MILTON S. HERSHEY MEDICAL CENTER lad Team Leader, Customer Service SHERIFF'S RETURN - CASE NO: 2004-02902 P COMMONWEALTH OF PENNSYLV~NIA: COUNTY OF CUMBERIJkND MILTON S HERSHEY MEDICAL CENTE VS DITONNO DANIEL J REGULAR ROBERT BITNER , Cumberland County, Pennsylvania, Sheriff or Deputy Sheriff of who being duly sworn according to law, was served upon 28th day of June the by handing to ADULT IN CHARGE true and attested copy of COMPLAINT & NOTICE together with says, the within COMPLAINT & NOTICE DITONNO DANIEL J DEFENDANT , at 1225:00 HOURS, on the at 6 SINCLAIR ROAD MECHAiWICSBURG, PA 17055 MORGAN JOHNSTON, GIRLFRIEND, a 2004 and at the same time directing Her attention to the contents thereof. Sheriff's Costs: Docketing 18.00 Service 6.90 Affidavit .00 Surcharge 10.00 .00 34.90 Sworn and Subscribed to before me this [~ day of ~.~ ~&~o~ A.D. So Answers: R. Thomas Kline 06/29/2004 TABAS & ROSEN , HOWARD R. MANILOFF TABAS & ROSEN, P.C. ATTORNEY I.D. 42398 1845 Walnut Street, 22nd Floor Philadelphia, PA 19103-4788 (215) 569-5050 Attorney for Plainitff THE MILTON S. HERSHEY MEDICAL CENTER DANIEL J. DITONNO COURT OF COMMON PLEAS OF CUMBERLAND COUNTY CIVIL TERM NO. 04-2902 PRAECIPE TO MARK ACTION SETTLED, DISCONTINUED, AND ENDED TO THE PROTHONOTARY: Kindly mark the above-captioned matter settled, discontinued, and ended.