HomeMy WebLinkAbout05-1016
TABAS & ROSEN, P.C.
BY: LEWIS C. TRAUFFER
I.D.1160267
22nd Fl.,1845 walnut Street
Phi1a., PA 19103
215 569-:5050
P/o;ntij[(s)
THE MILTON S. HERSHEY MEDICAL CENTER
P.O. Box 853
Hershey, PA 17033
ATTORNEY FOR Plaintiff
vs
D~fi?ndo",s(s)
MICHAEL D. FRASER
126 Heather Drive
Carlisle, PA 17013
COURTOFCOMMON PLEAS
DIVISION
CUMBERLAND COUNTY
TERM,
No OS;- - 1611.:,
CIL>', l'l-ffl.. "'>1
NOTICE
COMPLAINT-CnnLACTION
"VISO
You have been sued in court. If you wish to
defend against the claims 'set forth in the fol lowing
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 fHing 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 rel i ef 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. I F YOU DO NOT HAVE A LAWYER, GO TO OR
7ELEPHONE THE OFFICE SET FORTH 6ELOW. 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 INFORMATlON
ABOUT AGENCIES 7HAT MAY OFFER LEGAL SERVICES TO
ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, PA 17013
(717) 249-3168
(800)990-9108
Le han demandado a usted en La corte. Si
usted qui ere defenderse de estas demandas expuestas
en Las paginas siguientes, usted tiene veinte (20)
dias de plazo at partir de ta fecha de La demandanda
y La notificacion. Hace faLta asentar una
comparencia escrita 0 en persona 0 con un abogado y
entregar a La corte en for escrita sus defensas 0 sus
objeciones alas demandas en contra de su persona.
Sea avisado que si usted no se defiencle, ta corte
tamara medidas y puede continuar La demandanda en
contra suva sin previa aviso a notificacion. Ademas,
La corte puede decidir a favor deL demandante y
requiere que usted cumpla con todas las provisiones
de esta demands. Usted puede perder dinero 0 sus
propiedades u atros derechos importantes para usted.
LLEVE EST A DEMANDA A UN ABOGADO
INMEDIATAMENTE. SI USTED NO TIENE ABOGADO, VAYA
PERSONALMENTE 0 LLAME POR TELEFONO A LA OFICINA
MENCIONADA A CONTlNUACION. ESTA OFICINA LE PUEDE
PROVEER LA INFORMACION NECESARIA PARA CONTRATAR A UN
ABOGADO.
SI USTEO CARECE DE LOS MEDIOS NECESARlOS PARA
CONTRATAR A UN ABOGADO, DtCHA OFICINA LE PUEDE
SUMINISTRAR LA INFORMACION NECESARIA ACERCA DE
AQUELLAS AGENCIAS QUE OFRECEN SERVICIOS LEGALES A LAS
PERSONAS QUE TIENEN DERECHO A RECIBIR TAL AYUDA
GRATIS 0 A UNA CUOTA REDUCIOA.
CUMBERLAND COUNTY BAR ASSOCIATION
2 Liberty Avenue
Carlisle, PA 17013
(717) 249-3168
(800)990-9108
COMPLAINT - CIVIL ACTION
THE MILTON S. HERSHEY MEDICAL CENTER
VS. MICHAEL D. FRASER
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 on November 20, 2002, thru
November 25, 2002.
4. The amounts, quantities and nature of said medical care,
the dates on which said medical care was rendered, and the
charges therefore are set forth in Exhibit "A" which is incor-
porated 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 plain-
tiff, implied, constructive and oral contracts arose
between defendant and plaintiff by the terms of which defendant
became obligated to pay plaintiff the charges for the medical
care rendered by plaintiff to defendant.
7. Defendant refuses to pay the balance due although
plaintiff has made demand that defendant do so.
THIS DOCUMENT IS BEING USED IN CONNECTION WITH THE COLLECTION OF
A DEBT; ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.
8. As a result of the foregoing, there is due and owing
from defendant to plaintiff the sum indicated in Exhibit "A".
WHEREFORE, plaintiff demands judgment against defendant for
the sum of $13,047.82 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.
~ -r~ --,
LEWIS C. TRAUFFER, ESQUIRE
Attorney for Plaintiff
THIS DOCUMENT IS BEING USED IN CONNECTION WITH THE COLLECTION OF
A DEBT; ANY INFORMATION OBTAINED MAY BE USED FOR THAT PURPOSE.
f
--MS HERSHEY MEDICAL CENTER
500 UNIVERSITY DRIVE
HERSHEY, PA 17033
Statement on: 09/05/03 at 01:47 PM
Guarantor: FRASER MICHAEL D
126 HEATHER DR
CARLISLE, PA 17013-0000
PAGE:
1
Patient: FRASER MICHAEL D
Visit #: 24140
Description
I Units I
Date
I Svc Code I
--------------------------------------------------------------------------------
Credits
Debits
--------------------------------------------------------------------------------
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
Ll/20/02
Ll/20/02
46010
46023
46121
46122
46177
46188
46472
46479
46620
46630
46673
46694
46696
46697
46699
46717
101003
101004
101005
104002
104009
104042
1'0.4'060
104111
104131
104145
104156
104711
105037
105052
105059
105656
106011
109104
246706
246764
272199
307101
307205
307220
310501
310516
YANKEUR CATHETER
TUBING, SUCTION
URINALYSIS DIPSTIX PR
HEMOCCULT, STOOL
COLLAR RIGID (ASPEN)
SUCTION CANISTER
EMERGENCY VISIT, LEVE
CLOSED DRAIN SYSTEM S
ROUTINE VENIPUNCTURE
ARTERIAL PUNCTURE
BLADDER CATH, SIMPLE
ADMIN VACCINE, SINGLE
IV INFUSION TX 0-1 HR
IV INF TX,EA ADDL HR
THERA/DIAG INJECTION
NONINVAS PULSE OX, MU
ABO BLOOD GROUP
ANTIBODY SCREEN
RH TYPE
ALCOHOL (ETOH), BLOOD
AMYLASE, BLOOD
CREATININE, BLOOD
GLUCOSE, BLOOD
BLOOD GAS PANEL W/02
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
MORPHINE SULFATE 2 MG
DIPHTHERIA TETANUS O.
ONDANSETRON 2MG/ML 2M
CHEST 1 VIEW
C-SPINE 2-3 VIEWS
PELVIS 1-2 VIEWS
CT HEAD UNENHANCED
CT THORAX ENHANCED
1
1
1
1
1
1
1
1
1
1
1
1
2
4
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
4
1
1
1
1
1
5.00
5.00
7.00
7.00
85.00
5.00
478.00
17.00
6.00
43.00
79.00
5.00
338.00
336.00
74.00
77.00
17.00
30.00
16.00
42.00
36.00
10.00
7.00
124.00
10.00
10.00
11.00
79.00
6.00
30.00
19.00
25.00
18.00
43.00
2.10
6.41
53.76
98.00
125.00
128.00
612.00
1268.00
(h~C';:,;
------------------------------------------------------~------------------------
- Continue -
A -{
MS HERSHEY MEDICAL CENTER
500 UNIVERSITY DRIVE
HERSHEY, PA 17033
Statement on: 09/05/03 at 01:47 PM
PAGE:
2
Guarantor: FRASER MICHAEL D
126 HEATHER DR
CARLISLE, PA 17013-0000
Patient: FRASER MICHAEL D
Visit #: 24140
--------------------------------------------------------------------------------
I Units I
I Svc Code I
Credits
Description
Debits
Date
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/20/02
11/21/02
11/21/02
11/21/02
11/21/02
11/21/02
11/21/02
11/21/02
11/21/02
11/21/02
11/21/02
11/22/02
02/18/03
876.00
780.00
462.00
678.00
994.00
332.00
105.00
5.70
2.10
2.10
2.10
12.00
12.00
432.00
275.00
169.00
672.00
51. 00
CT ABDOMEN ENHANCED
CT SINUS MAXILLOFAC U
CT MULTI PLANAR 3D
CT C-SPINE UNENHANCED
CT PELVIS ENHANCED
LIMITED CT ANY BODY P
CT LOCM 300-399 MG
CLINDAMYCIN 150 MG
SENNA CONCENTRATE TAB
MORPHINE SULFATE 2 MG
OXYCODONE APAP ITAB
I V SODIUM CHLORIDE 0
IV INFUSION SET, UNIV
OBS NON-MON/PER HR/l-
OBS NON-MON/HR 9HRS &
IV INF THERAPY UP TO
IV INF THERAPY EA ADD
LEGAL ETHANOL (BLOOD)
AUTO/WORK COMP PAYMEN
1
1
1
1
1
1
1
2
1
1
1
2
1
8
11
1
8
1
-1
310519
310528
310534
310560
310567
310575
310641
246077
246470
246706
250092
621044
670330
712014
712015
712021
712022
109436
902040
3126.08-
--------------------------------------------------------------------------------
7129.19 I
Balance:
* - Not posted
It - d--
MS HERSHEY MEDICAL CENTER
500 UNIVERSITY DRIVE
HERSHEY, PA 17033
Statement on: 09/05/03 at 01:48 PM
Guarantor: FRASER MICHAEL D
126 HEATHER DR
CARLISLE, PA 17013-0000
Date
I Svc Code I
--------------------------------------------------------------------------------
11/25/02
11/25/02
11/25/02
11/25/02
11/25/02
11/25/02
11/25/02
11/25/02
11/25/02
11/25/02
11/25/02
11/25/02
11/25/02
11/25/02
11/25/02
11/25/02
11/25/02
11/25/02
11/25/02
11/25/02
11/25/02
11/25/02
47132
47180
85017
245431
245717
246182
246316
246379
246478
246705
248716
250577
272199
272205
272661
410032
410051
410060
422006
502000
503129
670334
PAGE:
1
I Units I
1
1
1
1
1
3
1
1
1
2
2
1
4
2
1
7
1
1
1
7
1
1
Patient: FRASER MICHAEL D
Visit #: 2962449
ff-j
Debits
Credits
Description
PRE/POST CARE 0-1 HRS
PRE/POST CARE 12-14 H
IV, LACTATED RINGERS
METOCLOPRAMIDE 5 MG/M
DEXAMETHASONE 4 MG/ML
GLYCOPYRROLATE 0.2 MG
NEOSTIGMINE 10 ML
PHENYLEPHRINE 15 ML
SODIUM CHLORIDE 30 ML
MORPHINE SULFATE 4 MG
LABETALOL 100MG/ML
PROPOFOL 20ML
ONDANSETRON 2MG/ML 2M
CLINDAMYCIN 600MG IV
ROCURONIUM BROMIDE 10
O.R. TIME @ 15MIN INC
BASIC SET-UP, ROUTINE
ELECTROCAUTERY
1-1/2 TO 2 HOURS-RECO
ANESTHESIA TIME-HOSP
BAIR HUGGER LOWER BOD
IV INFUSION SET, UNIV
90.00
321. 00
12.00
2.10
2.10
6.30
2.10
9.20
2.10
4.20
11. 40
23.90
53.76
52.50
76.50
1484.00
653.00
26.00
385.00
476.00
34.00
8.00
* - Not posted
>J,.i~;~)- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - _ - - - - - - - - - - - - _"._,,~.l~::.....-~..;;.;~~--.- - - - - - - - - - - - - - - - - - --
Balance:
3735.16 I
PENNSTATE
~ The Milton S. Hershey Medical Center
.. The College of Medicme
MICHAEL 0 FRASER
126 HEATHER DR
CARLISLE PA 17013-9659
STATEMENT
DATE: 08121/03
LAST STATEMENT
DATE: 07/08/03
FED TAX 10 # 251857035
PAYMENTI GUARANTOI
INS CHARGE ADJUSTMENT BALANCE
ACCOUNT #
1280816
IH IF ANY QUESTIONS, PLEASE CONTACT: MSHMC PATIENT FINANCIAL SERVICES
PROCEDURE DIAG
DATE CODE CODE
>>> P~TIENT: MICH~EL D FR~SER
11/lO/02
D1I20/03
11/20/02
01l20/03
99291.25
959,8
53670
959.6
11/20/02
01l20/03
99243.GC
959,8
11/20/02 7101026
01/30/03
11/20/02 7204026
01/30/03
11/20/02 7217026
01/30/03
11/20/02 7416026
01/30/03
11/20/02 7219326
01/30/03
11/20/02 7126026
01/30/03
11/20/02 7045026
Dl/30/03
11/20/02 7212526
01/30/03
11/20/02 7637526
01/30/03
02126/03
02/26/03
11/20/02 7046626
01l10/03
11/20/02 7638026
02110/03
959.1
959.1
959.1
789,9
789.9
789.9
959.09
959.09
959.09
959.09
959.09
. 11/25/02 21453.QK 802.28
. 02/20/03
. 02120/03
DESCRIPTION
QTY
1280816
365254 24140
PERFORMED BY: DIY OF EMERG ROOM
PLACE OF SVC: EMERGENCY ROOM
CRITICAL CARE FIRST HR
HKC OR AUTO P~YMENT
BLADDER CATH SIMPLE
HKC OR AUTO PAYMENT
PERFORMED BY: DIY OF ANESTHESI~
OFFICE CONSULT~TION
HKC OR AUTO P~YMENT
PERFORMED BY: DIY OF DI~G R~DIOLOGY
CHEST 1 VIEW
HKC OR ~UTO P~YMENT
SPINE CERYIC ANT/POS L~T
HKC OR AUTO P~YMENT
PELVIS ANTERPOSTER
HKC OR AUTO PAYMENT
C T ABDOMEN ENHANCED
HKC OR AUTO PAYMENT
CT PELVIS ENHANCED
NKC OR AUTO PAYMENT
CT THORAX ENHANCED
HltC OR AUTO PAYMENT
CT HE AD UNENHANCED
HKC OR AUTO PAYMENT
CT CERVICAL SPINE UNENHAN
HKC OR AUTO PAYMENT
CT CORONAL SAGITTAL OBLIQ
HKC OR AUTO PAYMENT
PHYSICIAN COURTESY (INS)!!
PHYSICIAN COURTESY (IN
CT MAXILLOFACIAL UNENH
HKC OR AUTO PAYMENT
CT TOMO LIMIT LOC~L INTER
HKC OR AUTO PAYMENT
440.00
113.00
159.00
46,00
59,00
46,00
336,00
308.00
327,00
226,00
308,00
46,00
302,00
258,00
2962449
PERFORMED BY: DIY OF ANESTHESIA
PLACE OF SVC: SURGERY - SHORT STAY
13 TRT OPN MAND FRAC HlMANIP
HKC OR AUTO PAYMENT
ACT 6 AUTO ALLOH~NCE
BALANCE: MICHAEL 0 FRASER $2163.47
907.50
. INDICATES NEW FINANCIAL ACTIVITY SINCE LAST BILL,
A-q
PAGE
1 of ~
211.41- 226.59
27.27- 85.73
95,60- 63.40
9.61- 36,39
11,94- 47,06
9.22- 36,76
68,15- 267.85
62.39- 245,61
66.28- 260,72
45.80- 180,20
62,39- 245.61
8.63-
37.17-
37,17 37.17
61.24- 240,76
52,40- 205.60
106,31-
801.19-
0,00
o CHECK BOX AND ENTER ANY ADDRESS OR INSURANCE CORRECTIONS ON RA"IC
PENN STATE
I!.'!! The Milton S. Hershey Medical Center
. The College of Medicme
MICHAEL D FRASER
126 HEATHER DR
CARLISLE PA 17013-9659
2 of ~
STATEMENT
DATE: 08/21/03
LAST STATEMENT
DATE: 07108/03
ACCOUNT #
1280816
[Ill IF ANY QUESTIONS, PLEASE CONTACT: MSHMC PATIENT FINANCIAL SERVICES
DATE PROCEDURE DIAG QTY DESCRIPTION INS
CODE CODE
IF YOU HAVE ANY QUESTIONS ABOUT THE AMOUNT YOUR INSURANCE
COMPANY PAID, CONTACT THEM DIRECTLY. FOR ANY OTHER QUESTIONS
REGARDING YOUR BALANCE, PLEASE CONTACT OUR OFFICE, IF PAYMENT
HAS BEEN MADE, THANK YOU AND DISREGARD THIS BILL,
FED TAX 10 # 251857035
CHARGE PAYMENTI GUARANTOI
ADJUSTMENT BALANCE
RRZ2
THANK YOU FOR USING MSHMC PHYSICIANS GROUP FOR YOUR PHYSICIAN
SERVICES. IF YOU HAVE ANY QUESTIONS REGARDING THIS BILL, PLEASE
CONTACT US AT 717-531-5069 OR 800-254-2619, BETWEEN 8:00AM AND
5:30PM MONDAY THROUGH WEDNESDAY OR BETWEEN 8:00AM AND 4:30PM
THURSDAY AND FRIDAY.
BALANCE SUMMARY
RESPONSIBLE PARTY
*** GUARANTOR RESPONSIBILITY
POLICY II
TOTAL
~ 2183.47
___'________'__'__________,___Jc'L~~Q~_~!tIL!_~~~'_~_Q~!J!~!!J!~p,lt~rbl~~,~_Qr!_Q~~Q~.rJ_Q~_9f_~.r~!1C~1C~r_~IJ:tl_Y9_~~_!J!Yb!~~_I,j_,____,________,__,__._____,__
STATEMENT DATE: GUARANTOR RESPONSIBILITY: MINIMUM PAYMENT
08/21/03 $ 2183.47 $ 2183.47
BF6
MSHMC PHYSICIANS GROUP
BILLING SERVICES
POBOX 854
HERSHEY PA 17033.0854
00001280816 UP 0000000000218347082103
1.,,11.1.1..,1.1,11.,,1,,1..11.,.11....11..11.,..11.,11.1..1.1
Mail MSHMC PHYSICIANS GROUP
To:
PO BOX 643313
PITTSBURGH PA 15264-3313
1...111...111,..."11..11.1.1".11."1.1.1,',,,,1.1.11,",,III
MICHAEL 0 FRASER
126 HEATHER DR
CARLISLE PA 17013-9659
OFFICE USE ONL V
I CHECK ONE
FOR CREDIT CARD PAYMENT, PLEASE FILL IN INFORMATION BelOW
,ID'$
_M/C
_VISA
1280816
CARD NUMBER
EXP DATE
.
.W
">1\;-
09/11/03
He: F6BO
TVP: DMND
CARDHOLDER NAME (PRINT)
..-"
It ,~
o CHECK BOX AND ENTER ANV ADDRESS OR INSURANCE CORRECTIONS ON BACK
CONSENT UPON ADMISSION TO HOSPITAL FORMElJ/CAL TREATMENT
..,~.~ 1180816
"^ OOS. 1901449
PATIIENrNUMB~R) ADMISSION DATE F R A <; f R '" ("1( I. I)
It. ,[. /' ( -q-~ .' "'''(KAY CO"AlD R 176~:
I, (/r.!CfI'4...e ( (tJr~ ~P" , ~I'behalfof )
knowing thet /, (he/she) am (Is) suffering from a condition requiring hospital care, dOfhereby voluntarily consent to such hospffal oare
enoompasslng routine diagnostic prooedures and medical treatment by the medl<1JI staff of University Hospital, The Milton S, Her-
shey Medical Center, their assistants, or their designees as necessary In their judgement. '
I am aware that the practice of medicine and surgery is not an exaot science, and I acknowledge that no guarantees have been
made to me as to the result of treatments or examinations In the hospital. For the purpose 01 advanoing medloel knowledge I con-
sent to the admittance of medical students and other observers in acoordance with ordinary practices of this medloal fec/lity. This
form has been fully explained to me. I certify th i understan~ Its contents and have a ee Usa..ptOJllSions.
WITNESS A TlENT'S SIGNA TURE
55'>
OU 1 0 II q !,
PA TlIENT NAME
Patient Is unable to consent because he/she Is:
o a minor
o undergoing emergency treatment
o other, describe
WITNESS
CLOSEST RELA TlVE OR LEGAL GUARDIAN SIGNA TURE
RELA TlONSHIP
HOSPITAL MEDICAL RECORD RELEASE AUTHORIZATION/PERSONAL EFFECTS
The Milton S. Hershey Medical Center may disclose Information about me and the treatment for which I am being admitted, in-
cluding copies of my medical records, to (1) my health insurance company, (2) my employer, (3) any person or firm which conducts
reviews of my treatment at the University Hospital, The Milton S. Hershey Medical Center on behalf of my health insurance company
or my employer, and (4) the peer review organization designated by the appropriate governmental bodies to review hospital utiliza,
lion under the Medicare program.
This information will be used by these parties to determine the medical necessity 01 the medical and hospital services I will be
receiving, and to promote timely and appropriate discharge Irom the hospital. The information may also be used to get all or part of
my hospital bill paid. I have read this consent and understand it fully. I have had the opportunity to ask any questions relating to this
consent, and any questions I had, have been answered to my satisfaction.
Safety deposit boxes are maintained in the Hospital Financial Management Office for the safekeeping of patient's valuabie per-
sonal effects. Patients are urged to avail themselves of this facility as the Hospital does not assume responsibility for any valuables,
The underSigned accepts the full responSibility for any personal effects taken to the hospital room, including but not limited to such
things as money, dentures, eye glasses, contact (en s, he ring aids, jdlOS, a~eV/YJn sjtsfr r-' ,-
..2.5: OJ.... I ~ tAA~.1 /\
DA Tf. PA TIENT
DA Tf. PARENT OR GUARDIAN
PA T1ENT RESPONSIBILITY AGREEMENT
I, the undersigned, do hereby acknowledge and acce . finan7'alp~SPOnSibiIitY for the payment of all charges
For services rendered to {e I, the undersigned, do
hereby acknowledge and understand that all charges not covered by insurance will be payable In full prior to or upon date of and
time of discharge. I, the undersigned, authorize the hospital to make a credit investigation if necessary.
I hereby assign and authorize payment directly to The Milton S. Hershey Medical Center Hospital, Pennsylvania State University,
Should the account become delinquent, and should it become necessary for the account to be referred to an attorney or collec,
tion agency, for collectlo r uit, e u dersl n shall pay the reasonable attorney's fees or collect' n expe;pe.
Signed Date ~S / o=z.....
::f/gd
~ ~
Date
Witness
All persons wifl be accepted for admission without regard to race, color, creed, religion, national origin or sex.
(j
. _._vun.cd... 1J. 0280816
$10,864.35 (Hasp)
2,183.47 (Phys)
VERIFICATION
LINDA SCHLADER hereby states that she is the
Team Manager, Customer Service of the Milton S. Hershey
.
Medical Center and verifies that the statements made in the
foregoing pleading are true and correct to the best of her
knowledge, information and belief. The undersigned understands
that the statements therein are made subject to the penalties of
18 Pa. C.S. ~4904 relating to unsworn falsification to
authorities.
~
DATE:
{ /~<fk
~
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SHERIFF'S RETURN - REGULAR
CASE NO: 2005-01016 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
MILTON S HERSHEY MEDICAL CENTE
VS
FRASER MICHAEL D
JACOB BAKER
, Sheriff or Deputy Sheriff of
Cumberland County, Pennsylvania, who being duly sworn according t law,
says, the within COMPLAINT & NOTICE
was served upon
FRASER MICHAEL D
th
DEFENDANT
, at 1155:00 HOURS, on the 11th day of March
2005
at CUMBERLAND CO SHERIFF'S OFFICE ONE COURTHOUSE SQUARE
CARLISLE, PA 17013
by handing to
MICHAEL FRASER
a true and attested copy of COMPLAINT & NOTICE
together with
and at the same time directing His attention to the contents hereof.
Sheriff's Costs:
Docketing
Service
Affidavit
Surcharge
18.00
.00
.00
10.00
.00
28.00
So Answers:
""""~;';:::::',~4< 4&
R. Thomas Kline
03/11/2005
TABAS & ROSEN
Sworn and Subscribed to before By:
I{ -(~ of
A.D.
Pro tho
~i
.
TABAS & ROSIN., p.e.
sy, IilIlWIS e. TRAll1'J!'BR, ESQtlIlUlr ID No., 60267
1845 Walnut Street, 22nd J!'loor
Phil~delphia, PA 19103
(215) 569-5050 '
COURT OF COMMON PLEAS
THE MILTON S. HERSHEY MEDICAL CENTER
P.O. BOX 853
HERSHEY, PA 17033
VS.
MICHAELD. FRASER
126 HEATHER DRIVE
CARLISLE, PA 17013
CUMBERLAND COUNTY
NO.: 05-1016
ORDER FOR JUDGMENT FOR WANT OF AN
ANSWER AND ASSESSMENT OF DAMAGES
TO THE PROTHONOTARY:
Kindly enter judgment in the sum of $14,910.41
in favor of the Plaintiff(s) in the above entitled matter
for failure of the Defendant(s) to file an Answer'to
Plaintiff(s) Complaint in Civil Action and assess Plaihtif (s)
damages as follows:
Amount of Claim:
$ 13,047.82
Interest at 6% per
annum from date of 11/20/02
discharge 11/25/02
Total
1,862.59
$ 14,910.41
>
Attorney for Plaintiff(s)
I assess damages
Adc;ltl!.$$.
APRIL I, 2005
I..~:...............................ceftit)
that the above names are correct and t e Precise
Residence AddreSB 01 the Judgmwt editor is
Address ........................?.€!m.~.................. ........._....
Address 01
-iptebiants .................."Sa.mIL......, .
~O~C:P.i2~;:1~;;:~a:~:'J~~
MICHAEL D. FRASER
126 HEATHER DRIVE
CARLISLE, FA 17013
Defendant
ff.'a
-.
MIL TON S. HERSHEY MEDICAL CENTER
COURT OF COMMON PLE B
VB
CUMBERLAND COUNTY
MICHAEL D. FRASER
NO.
05-1016
AFFIDAVIT OF NON MILITARY SERVICE
COMMONWEALTH OF FA
~
COUNTY OF PHILADELPHIA
LEWIS C. TRAUFFER being legally sworn, deposes and says:
(a)
that the defendant(s) is/are not in the Military or
Naval Service of the United States or of its all es,
or otherwise within the provisions of the Soldie s' and
Sailors' civil relief action of Congress of 1940
as amended;
(b)
that defendant MICAHEL D. FRASER is over 21 ye rs of
age and resides at 126 HEATHER DRIVE 1701
d . 1 d' P' B' CARLISLE, PA
an ~s emp aye In r~vate USlness.
(e) that defendant is over 21 ye rs of
age and resides at
and is employed in Private Business.
Affiant has ascertained the foregoing information by inquir and
belief and makes this Affidavit with due authority.
. ~fl --
LE~/"C. TpJfUFER, ESQUIRE
Attorney for the Plaintiff
Sworn to and subscriRed
before me on this \.31" day
of ~~O-\'-, , ex 00..'5
~ ~cS~~~ ~
N~ PUBLIC
CO~"'L1' FP NNSVLII"N'"
NOT I'.RII'.L SEA', .
KENNETH C. SLOVITSKY, NOI," y Public
Cily (II P\IiIadeIpllia:l'hila. Coullly
My ComfI\iSIicI1E 'res November 17, 2008
.
TABAS & ROSEN, P.C.
BY: LEWIS C. TRAUFFER, ESQUIRE 10 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
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
VS
NO. 05-1016
MICHAEL D. FRASER
126 HEATHER DRIVE
CARLISLE, PA 17013
NOTICE OF INTENTION TO TAKE DEFAULT JUDGMENT
TO: MICHAEL D. FRASER
126 HEATHER DRIVE
CARLISLE, PA 17013
DATE OF NOTICE/FECHA DEL AVISO:
APRIL 1, 2005
IMPORTANT NOTICE
YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO TAKE ACTION REQUIRED OF YOU I THIS
CASE. UNLESS YOU ACT WITHIN TEN DAYS FROM THE DATE OF THIS NOTICE A JUDGME MAY
BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU MAY LOSE YOUR PROPERTY OR HER
IMPORTANT RIGHTS. YOU SHOULD TAKE THIS NOTICE TO A LAWYER AT ONCE. IF YOU 0
NOT HAVE A LAWYER OR CANNOT AFFORD ONE GO TO OR TELEPHONE THE FOLLOWING OFF I E TO
FIND OUT WHERE YOU CAN GET LEGAL HELP.
Cumberland County Bar Association
2 Liberty Avenue
Carlisle, PA 17013 Phone No..: (717) 249-3166 or (800) 990-9108
AVISO IMPORTANTE
USTED ESTA EN REBELDIA PORQUE HA FALLADO EN TOMAR LA ACCION EXIGIDA DE SUP P RTE
EN ESTE CASO. A MENOS DE QUE USTED ACTUE ENTRO DE DIEZ DE LA FECHA DE ESTE
AVISO, SE PUEDE REGISTRAR UNA SENTENCIA CONTRA US TED SIN EL BENEFICIO DE UNA
AUDIENCIA Y PUEDE PERDER SU PROPIEDAD 0 DERECHOS IMPORTANTES. USTED DEBE LL VAR
ESTE AVIOS A UN ABOGADO ENSEGUIDA. SI USTED NO TIENE UN ABOGADO Y NO PAGAR OR
LOST SERVICIOS DE UN ABOGADO, DEBE COMUNICARSE CON LA SIGUIENTE OFICINA PARA
AVERIGUAR DONDE PUEDE OBTENER AYUDA LEGAL.
Cumberland County Bar Association
2 Liberty A venue
Carlisle, PA 17013 Phone Nos.: (717) 249-3166 or (800) 990-9108
LEWIS C. TRAUFFER, ESQUIRE
ATTORNEY FOR THE PLAINTIFF
THIS CORRESPONDENCE IS BEING USED TO COLLECT A DEBT AND
THE INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.
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OFFICE OF THE PROTHONOTARY
CUMBERLAND COUNTY - CARLISLE, PA 17013
CURTIS R: LONG
Prothonotary
.
To: MICHAEL D. FRASER
126 HEATHER DRIVE
CARLISLE, PA 17013
. .
THE MILTON S. HERSHEY MEDIAL CENTER
P.O. BOX 853
HERSHEY, PA 17033
CUMBERLAND COUNTY
NO.: 05-1016
vs.
MICHAEL D. FRASER
NOTICE
Pursuant to Rule 236 of the Supreme Court of Pennsylvania, you are hereby notified hat a
Judgment has been entered against you in the above proceeding as indicated below.
CURTIS R. LONG
Prothonotary
~k
g Judgment by Default
o Money Judgment
o Judgment in Replevin
o Judgment for Possession
o Judgment on Award of Arbitration
o J udgrnent on Verdict
o Judgment on Court Findings
IF YOU HAVE ANY QUESTIONS CONCERNING THIS :\OTICE, PLEASE CA L:
ATTORNEY
LEWISC. TRAUFFER
UllS~t[ AlIom~y' s N am#!)
215-569-5050
at this telephone number:
Esq ire