HomeMy WebLinkAbout12-05-11NOTICE OF CLAIM
(Filed Pursuant to 20 Pa.C.S. § 3532)
.COURT OF COMMON PLEAS OF
COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF ~~~ 1~1 ~-~t • ~.~-(.' DECEASED
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To the Clerk of the Ornhans' Crnirt nivicinn~
Enter
amount of
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said claim was given to ~~V ~~~
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~'ENNSTATE
The Milton S. Hershey
Medical Center
Patient Financial Services
P.O. Box 853
Hershey, PA 17033-0853
1-800-254-2619 or 717-531-5069
December 1, 2011
Clerk of the Cumberland County Courthouse
Register of Wills Room 102
1 Courthouse Square
Carlisle, PA 17013
RE: File # 21-2011-00772
Estate of Leon G. Ramsey
To Whom It May Concern:
Attached are claims to be filed with the estate of Leon G. Ramsey.
If you have any questions, or need additional information, please contact Customer Service at
717-531-5069 or 1-800-254-2619 Monday-Wednesday from 8:00 a.m. until 5:30 p.m., Thursday
and Friday from 8:00 a.m. - 4:30 p.m.
Sincerely,
Shannon Ohl
Patient Financial Services
MS HERSHEY MEDICAL CENTER PAGE: 1
500 UNIVERSITY DRIVE
HERSHEY, PA 17033
Statement on: 12/01/11 at 11:55 AM
Guarantor: RAMSEY LEON G
839 NORTH WEST STREET
CARLISLE, PA 17013-0000
Patient: RAMSEY LEON G
Visit #: 10509869
-------------------------------------------------------------------------
Date ~ Svc Code ~ Description ~ Units Debits ~ Credits
06/11/11 16501 ADULT LEVEL I TRAUMA 1 8185.00
06/11/11 20114 50 TRAUMA 1:1 CARE IC 1 4802.00
06/11/11 44604 INTUBATE,ENDOTRACH,EM 1 563.00
06/11/11 46334 CPR FOR CARDIAC ARRES 1 932.00
06/11/11 46473 ER,CRITICL CARE,30-75 1 1892.00
06/11/11 46612 CHEST TUBE FOR PNEUMO 1 1030.00
06/11/11 46620 VENIPUNCTURE 1 23.00
06/11/11 46623 TRANSFUSION, BLOOD/CO 1 616.00
06/11/11 46699 THERA/DIAG INJECTION 1 181.00
06/11/11 46843 BLADDER OATH, SIMPLE 1 192.00
06/11/11 46910 INSERT CVP>=5YRS 1 671.00
06/11/11 46937 THER IV PUSH,EA ADDL 2 158.00
06/11/11 101003 ABO BLOOD GROUP 2 100.00
06/11/11 101004 ANTIBODY SCREEN 1 99.00
06/11/11 101005 RH TYPE 1 50.00
06/11/11 101032 COMPAT, ELECTRONIC 12 1080.00
06/11/11 101212 RED BLD CELL LR EA U 12 10428.00
06/11/11 101225 FFP W/IN 8-24 HRS EA 8 2112.00
06/11/11 104002 ALCOHOL (ETON), BLOOD 1 74.00
06/11/11 104009 AMYLASE, BLOOD 1 63.00
06/11/11 104042 CREATININE, BLOOD 1 21.00
06/11/11 104060 GLUCOSE, BLOOD 1 20.00
06/11/11 104065 UREA NITROGEN (BUN), 1 36.00
06/11/11 104398 ELECTROLYTES 1 42.00
06/11/11 105052 PARTIAL THROMBOPLAS T 1 55.00
06/11/11 105059 PROTHROMBIN TIME 1 32.00
06/11/11 105657 CBC W/PLT/DIFF AUTO 1 68.00
06/11/11 245540 ETOMIDATE 2 MG/ML 1 38.50
06/11/11 245960 EPINEPHRINE 1 ML 40 14.10
06/11/11 246050 CALCIUM CHLORIDE 10 M 1 14.20
06/11/11 246144 EPINEPHRINE HCL 1 MG/ 140 97.30
06/11/11 246475 SODIUM BICARBONATE 50 2 22.10
06/11/11 246633 ATROPINE SULFATE 1 MG 200 22.60
06/11/11 305625 TIBIA & FIBULA AP&LAT 1 197.00
06/11/11 307101 CHEST 1 VIEW 2 342.00
06/11/11 307220 PELVIS 1-2 VIEWS 1 226.00
06/11/11 307331 ABDOMEN 1 VIEW AP 1 238.00
06/11/11 390824 DRAPE 3 198.00
06/11/11 391201 OR TIME EA ADD MIN >6 70 1820.00
06/11/11 391400 OR TIME EA MIN UP TO 60 3480.00
06/11/11 398552 CAUTERY TOOL 1 50.00
06/11/11 398641 PBDS MAJOR ABDOMINAL 1 125.00
Continue
MS HERSHEY MEDICAL CENTER PAGE: 2
500 UNIVERSITY DRIVE
HERSHEY, PA 17033
Statement on: 12/01/11 at 11:55 AM
Guarantor: RAMSEY LEON G
839 NORTH WEST STREET
CARLISLE, PA 17013-0000
Patient: RAMSEY LEON G
Visit #: 10509869
-------------------------------------------------------------------------
Date ~ Svc Code ~ Description ~ Units Debits ~ Credits
06/11/11 398652 PBDS BASIC PACK 1 113.00
06/11/11 398666 PBDS MINOR ORTHO PACK 1 113.00
06/11/11 460612 CLIP APPLIER 1 199.00
06/11/11 464593 SURGILAV SET MULTI-OR 1 134.00
06/11/11 470189 PDBS BASIN MINOR DBL 1 27.00
06/11/11 503000 ANES TIME HOSP COMP < 60 780.00
06/11/11 503001 ANES TIME HOSP COMP > 70 420.00
06/11/11 503035 SINGLE TRANSDUCER SET 1 171.00
06/11/11 503123 ADULT A-LINE KIT 1 48.00
06/11/11 503136 HOT LINE TUBING 1 57.00
06/11/11 503177 BELMONT SET UP 1 998.00
06/11/11 511202 VENTILATOR DAY INITIA 1 1070.00
06/11/11 621044 I V SODIUM CHLORIDE 0 5 10.00
06/11/11 625011 IV ADMIN SET BLOOD FI 3 60.00
06/11/11 636935 INTRODUCER 9 FR CARD 2 458.00
06/11/11 636940 CATHETER THORACIC 40F 1 13.00
06/11/11 661514 CHEST DRAIN SYSTEM DR 1 128.00
06/11/11 667127 SET HEAT EXCHANGE DIS 1 276.00
06/11/11 670826 COLLAR ASPEN CERV ADV 1 134.00
06/11/11 670931 PADS DEFIB MULTIFUNCT 1 106.00
06/11/11 670932 PADS DEFIB MULTIFUNCT 1 122.00
* - Not post ed ~ Balance: ~ 45846.80
'---.. .
MS HERSHEY MEDICAL CENTER PAGE: 1
500 UNIVERSITY DRIVE
HERSHEY, PA 17033
Statement on: 12/01/11 at 11:55 AM
Guarantor: RAMSEY LEON G
839 NORTH WEST STREET
CARLISLE, PA 17013-0000
Patient: RAMSEY LEON G
Visit #: 16172069
--------------------------------------------------------------------------------
Date ~ Svc Code ~ Description ~ Units Debits ~ Credits
--------------------------------------------------------------------------------
I06/11/11 I 711108 I AIR AMBULANCE MILEAGEI 31 I 14557.00
* - Not posted ~ Balance: ---16396.00 I;
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