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Home My WebLink About03-03-06 (4) ~ The iVliIton S.Hershey . l\/ledical Center Patient Financial Services PO Box 853 Hershey, PA 17033 717-531-5069 February 28, 2006 Courthouse 1 Courthouse Sq. Carlisle, PA 17013-3387 RE: File# 2005-148 Estate of Alfred Deimler To Whom It May Concern: Attached are claims to be filed with the estate of Alfred Deimler. If you have any questions, or need additional information please contact me directly at 717 531-5378. Sincerely, juU~~/-ufu Tricia Fultano Financial Counselor Patient Financial Services Enclosure MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/01/06 at 10:39 AM Guarantor: DEIMLER ALFRED 1790 GOOD HOPE ROAD ENOLA, PA 17025-0000 Date 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 02/04/05 I Svc Code I 16501 44604 46061 46149 46177 46185 46191 46192 46334 46473 46478 46479 46589 46620 46623 46673 46717 46755 46778 46794 46924 101003 101004 101005 101021 101213 104009 104028 104042 104060 104111 104131 104145 105052 105059 105656 249220 250617 307101 307205 307220 310516 Description ADULT LEVEL I TRAUMA INTUBATE,ENDOTRACH/EM IV SOLUTION LEVEL 1 TUBING COLLAR RIGID (ASPEN) CVP CATHETER KIT-ALL RESUSCITATION BAG C02 ADAPTORS CPR FOR CARDIAC ARRES ER/CRITICL CARE/30-75 SUCTION SET UP SUPPLI CLOSED DRAIN SYSTEM S APP LONG LEG SPLINT ROUTINE VENIPUNCTURE TRANSFUSION, BLOOD/CO BLADDER CATH/ SIMPLE NONINVAS PULSE OX, MU BODY SHROUD PELVIC TRAUMA BELT IV PUMP, SINGLE LINE IV INFUSION TX 0-1 HR ABO BLOOD GROUP ANTIBODY SCREEN RH TYPE COMPAT/ IMMED SPIN RED BLD CELLS EA U AMYLASE, BLOOD IONIZED CALCIUM CREATININE/ BLOOD GLUCOSE/ BLOOD BLOOD GAS PANEL W/02 POTASSIUM (K) / BLOOD SODIUM (NA) / BLOOD PARTIAL THROMBOPLAS T PROTHROMBIN TIME CBC W/PLT AUTO MIDAZOLAM 5MGL ML 10M ADENOSINE 6MG/2ML CHEST 1 VIEW C-SPINE 2-3 VIEWS PELVIS 1-2 VIEWS CT THORAX ENHANCED - Continue - PAGE: 1 Patient: DEIMLER ALFRED Visit #: 6501357 I Unitsl 1 1 4 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 4 4 1 1 1 1 1 1 1 1 1 1 50 1 2 1 2 1 Debits 3339.00 356.00 48.00 160.00 95.00 70.00 50.00 29.00 590.00 1064.00 44.00 19.00 1 0 3.. 0 0 15 -.'0'0 3 9 0 . OO:__~~ 43.00 86.00 33.00 281.00 3 . 0 0--1 188.00 19.00 34.00 18.00 256.00 640.00 40.00 79.00 12.00 11.00 138.00 12.00 12.00 34.00 21.00 28.00 32.90 102.95 218.00 140.00 286.00 1411.00 Credits - (.; ." : -)\ ,,' ~~ \ (-),=~ .....-~ *''': ...-- . . _r:- eo MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/01/06 at 10:39 AM PAGE: 2 Guarantor: DEIMLER ALFRED 1790 GOOD HOPE ROAD ENOLA, PA 17025-0000 Patient: DEIMLER ALFRED Visit #: 6501357 Date I Svc Code I Description I Units I Debits Credits -------------------------------------------------------------------------------- 02/04/05 310519 CT ABDOMEN ENHANCED 1 975.00 02/04/05 310534 CT MULTI PLANAR 3D 1 515.00 02/04/05 310560 CT C-SPINE UNENHANCED 1 755.00 02/04/05 310567 CT PELVIS ENHANCED 1 1107.00 02/04/05 310694 CT TRAUMA SPINE RECON 1 515.00 02/04/05 310704 OMNIPAQUE 300MG/ML 15 1 74.00 02/04/05 503143 OFF SITE LIMITED SERV 1 134.00 02/04/05 513202 VENTILATOR DAY INITIA 1 463.00 03/01/05 985039 AUTOjWKC LATE CHG ADJ -1 134.00- * - Not posted Balance: 14954.85 I MS HERSHEY MEDICAL CENTER 500 UNIVERSITY DRIVE HERSHEY, PA 17033 Statement on: 03/01/06 at 10:39 AM Guarantor: DEIMLER ALFRED 1790 GOOD HOPE ROAD ENOLA, PA 17025-0000 Date I Svc Code I 02/04/05 02/04/05 03/31/05 711107 711108 902040 * - Not posted Description AIR AMBULANCE TRANSPO AIR AMBULANCE MILEAGE AUTO/WORK COMP PAYMEN PAGE: Patient: DEIMLER ALFRED Visit #: 5256702 I Units I 1 16 -1 Debits 10229.00 1584.00 Balance: 1 Credits 8038.04- 3774.96 I ~ "'" ~ ... t: ~ "?;: ~ c.-; - 0 Q.. 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