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Home My WebLink About94-01663 .:, J' ~ #.,.....,~'"' ~LL,,:n . cct+IONWEAL'1ll OF PENNSYLVANIA: COUNI'Y OF ClMBERLAND SllERIFF"S REWRN In The Court of Common Pleas of Cumberland County, Pennsylvania No. 94-1663 Civil Term Complaint' in Civil Action Law and Notice Chambersburg Hospital VS Kenneth Alexander and Joan Alexander Robert L. Fink , J6IOIU(MlfXU Deputy Sheriff of Cumberland County, Pennsylvania, who being duly swam according to law, says, that he served the within Complaint in Civil Action Law and Notice upon Kenneth & Joan Alexander , the defendant, at 2: 10 o'clock p.M. 2XJt I EDST. on the 13 day of April , 1994at 43 Town Mill Road. Shippensburg . Cumberland County, Pennsylvania, by handing to Kenneth Alexander, defendant and adult in charqe. accepted for both a true and attested copy of the Complaint in Civil Action Law and Notice, and at the same time directing his attention to the contents thereof and the "Notice to Plead" endorsed thereon. Sheriff's Costs: Docketing Service Affidavit Surcharge So answers: 18.00 11.76 4.00 33.76 Pd. by Atty. 4-14-94 :r'~r."<:~ R. Thomas Kline. Sheriff bY~~~ Deputy Sheriff SWOrn and subscribed to before Ire this /') '1-' day of 6'/,J 19 1'1 A.D. q~/' C 111."';'", I ,uJ/~ Prothonotary . ., CHAMBERS BURG HOSPITAL, : IN THE COURT OF COMMON PLEAS :CUMBERLAND COUNTY PENNSYLVANIA Plaintiff V. KENNETH ALEXANDER and JOAN ALEXANDER, Defendants CIVIL ACTION - LAW NO. 94-1663 Civil Term : P RAE C I P E TO THE PROTHONOTARY: Pursuant to Rule 237.1 of the Pennsylvania Rules of Civil Procedure, Notice of Praecipe for Entry of Default Judgment has been given to the Defendants: a copy of said notice is attached hereto. Please enter Judgment in favor of the Plaintiff and aga i nst Defendants in the amount of ___$1,]J.1.."Q1L, _ along wi th interest at the rate of 6.00..!-_ from _._~/4/94 , and the costs of this proceeding for failure to enter a defense or otherwise file a responsive pleading in the above captioned matter. RESPECTFULLY SUBMITTED: DATE: 6\1' f'~ IC ESQUIRE Crums Mill Road P.O. Box 67015 Harrisburg, PA 17106 (717) 540-5610 ATTORNEY FOR PLAINTIFF SUPREME COURT NO. 07207 NO. 94-1663 Civil Term , CHAMBERS BURG HOSPTIAL, Plaintiff : IN THE COURT OF COMMON PLEAS :CUMBERLAND COUNTY PENNSYLVANIA V. KENNETH ALEXANDER and JOAN ALEXANDER, Defendants : CIVIL ACTION - LAW TO: Kenneth & Joan Alexander Defendants You are hereby notified that on ________ the following Judgment has been entered against you in the above- captioned case. Amount: In the amount of $1,397.00 along with interest at the rate of 6.00% from 4/4/94 and the costs. Date: Prothonotary I hereby certify that the name and address of the proper person(s) to receive this Notice under Pa.R.Civ.P. Section 236 is: Kenneth & Joan Alexander 43 Town mill Rd. Shippensburg, PA 17257 Defendants '. , Arthur A. Kusic, Esquire Supreme Court No: 07207 420 I Crums Mi 11 Road Harrisburg, PA 17112 (717) 540-5610 Attorney for Plaintiff CHAMBERSBURG HOSPITAL, Plaintiff : IN THE COURT OF COMMON PLEAS .'CuMBERLAND COUNTY, PENNSYL VANIA : CIVIL ACTION - LAW : NO. 94-1663 Civil Term v. KENNETH ALEXANDER and JOAN ALEXANDER, : : : De fendanta : .lMPQRTANT ...lIQT ICE TO: Kenneth and Joan Alexander DATE OF NOTICE: May 4, 1994 YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO TAKE ACTION REQUIRED OF YOU IN THIS CASE. UNLESS YOU ACT WITHIN TEN (to) DAYS FROM THE DATE OF THIS NOTICE, A JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU MA Y 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: Lawyer Referral Cumberland County 4th Floor 1 Courthouse Sq. Carlisle, PA 17013 (717) 240-6200 RESPECTFULLY SUBMITTED: c;.;?~IRE ..~.". .... A L Arthur A. Kusic, Esquire Supreme Court No: 07207 4201 Crums Hi 7 7 Road Harrisburg, PA 17112 (717J 540-5610 CHAMBERS BURG HOSPITAL, P7aintiff Attorney for P7aintiff : IN THE COURT OF COMHON PLEAS : CUMBERLl\NOOUNTY, PENNSYLVANIA : : CIVIL ACTION - LAW : NO. 94-1663 Civil Term v. KENNETH ALEXANDER and JOAN ALEXANDER, Defendants : : : : NQTICI~ _IHfQRT.AN.IfE A: Kenneth & Joan Alexander FECHA DE NOTICIA: May 4, 1994 USTED NO HA COHPLIDO CON EL AVISO ANTERIOR PROQUE HA FAL TADO EN TOHAR HEDIDAS REQUERIDAS RESPECTO A ESTE CASO. SI USTED NO ACTUA DENTRO DE DIEZ (t 0) DIAS DESDE LA FECHA DE ESTA NOTICIA, ES POSIBLE QUE UN FALLO SERIA REGISTRADO CONTRA USTED SIN UNA AUDlfENCIA Y USTED PODRIA PERDER SU PROPIEDAD 0 OTROS DERECHOS IHPORATANTES. USTED DEBE LLEVAR ESTA NOTICIA A SU ABOGADO EN SEQUIDA. SI USTED NO TIENNE ABOGADO 0 NO TIENE CON QUE PAGAR LOS SERVIDIOS DE UN ABOGADO. VAYA 0 LLAHE A LA OFICIAN ESCRITA ABAJO PARA AVERIGUAR A DONDE USTED PUEDE OBTENER LA AYUDA LEGAL: Lawyer Referral Cumberland County Fourth Floor 1 Courthouse Square Carlisle, PA 17013 (717) 240-6200 RESPECTFULLY HITTED: ~ Defendants : : : : : : : : : : : IN THE CVURr Of' COMMON PLEAS ctlMBEIU.J\tmOUNTY. PENNSYL VANIA CIVIL ACTION - LAW NO. 94-1663 Civil Term CHAMBERS BURG HOSPITAL, Plaintiff v. KENNETH ALEXANDER and JOAN ALEXANDER, CERTIFICATE PF SERVICE I. Arthur A. KUSIC. ESQuire. do hereby certify ~hat on this 3th.., da.v of May.____"., 19~~. I Dlaced in the United States Mail true and correct copIes of NOTICES. ,1,0 ,.oCiY _~_~P9~'!',~N.'!',_,__ addressed to following: Kenneth & Joann Alexander 43 Town Mill Road ~hippensburg, PA 17257 ;""'.' ,A. IC, ESQUIRE 4201 Crums Mill Road P.O. Box 11585 Harrisburg, PA 17112 (717) 540-5610 Attorney for the Plaintiff Supreme Court 1.0. 07207 , I , \ ., .. ~ ?,)- St- ~ ~ a; i ~ ~"1- .-&:. ~..... .....,.~ I .- ~)~ l~) Cl(;. ,..;~ [,)70..\ ::~ '~'.l I.t.; ~__.::'~ J - ::i i1; ~ ~'~ ~ .J ': \ ~~ - - .- .~ ~ = ,.,,: \.. L" a ~ ~ --. '. ~ ~ ~, 8-J:@ CHAMBERS BURG HOSPITAL, Plaintiff IN THE COURT OF COMMON PLEAS ~ COUNTY PENNSYLVANIA V. KENNETH ALEXANDER and JOAN ALEXANDER, Defendants CIVIL ACTION - LAW NO. f4-/(P{P3 ~Jt/VYY'-' NOTIPE 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 judgment may be entered against you by the court without further notice for any money claimed in the Complaint for any other claim or reI ief 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 OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Respectfully submitted: Lawyer Referral Cumberland Co. Court Administrator Fourth Floor 1 Courthouse Square Carlisle, PA 17013 (717) 240-6200 ~~ ~:- :--- A -HU A: I,C, ESQUIRE. 4201 Crums Mill Road Post Office Box 67015 Harrisburg, PA 17112 (717) 540-5610 SUPREME COURT NO. 07207 ATTORNEY FOR PLAINTIFF Dated: .If -/.. l/'1 ~'~,";~ .. ff"'-..-" '-----...... . CHAMBERS BURG HOSPITAL, Plaintiff IN THE COURT OF COMMON PLEAS ~ COUNTY PENNSYLVANIA V. mmETH IlLEXANDER and JOAN IlLEXANDER, Defendants CIVIL ACTION - LAW NO. t(QTtQ!!I Le han demandado a usted en la corte. Si usted quiere defenderse de estas demandas expuestas en las paginas siguientes, usted tiene Vlente (20) dias de plazo al partir presentar una apar i enc i a esc r i ta 0 en persona 0 por abogado y arch i var en 1 a corte en forma escrita sus defensas 0 sus objeciones alas demandas en contra de su persona. Sea avisado que si usted no se defiende, la corte tomara medidas y puede entrar una orden contra usted sin previo aviso 0 notificacion y por cualquier queja 0 alivio que es pedido en la peticion de demanda. Usted puede perder dinero 0 sus propiedades 0 otros derechos lmportantes para usted. LLEVE ESTA OEMANDA A UN ABOGADO INMEDIATAMENTE. SI NO nENE ABOGADO 0 SI NO nENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA OIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SU PUEOE CONSEGUIR ASISTENCIA LEGAL: Lawyer Referral Cumberland Co. Court Fourth Floor 1 Courthouse Square Carlisle, PA 17013 (717) 240-6200 Administrator Respectfully submi~ted: .~~ 4201 Crums Mill Road Post Office Box 67015 Harr1sburg, PA 17112 (717) 540-5610 SUPREME COURT NO. 07207 ATTORNEY FOR PLAINTIFF Dated: 'Y -1- 9'1 '. I ! i ; t , o .. . ",~_t>,\i~ CHAMBBRSBURG HOSPITAL, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW V. KENNETH ALEXANDER and JOAN ALEXANDER, NO. Defendants C 0 M P L A I N T AND NOW comes Plaintiff by and through its attorney, Arthur A. Kusic, Esquire, and respectfully represents the following: 1. Plaintiff, CHAMBERS BURG HOSPITAL, is a hospital facility organized and existing under the laws of the Commonwealth of Pennsylvania with its facilities located at 112 North Seventh street, Chambers burg , Franklin County, Pennsylvania. 2. Defendants, KENNETH ALEXANDER and JOAN ALEXANDER, are adult married individuals residing at 43 Town Mill Road, Shippensburg, Cumberland County, Pennsylvania. 3. On or about July 18, 1992 through October l5, 1993, Defendants' child, Jamie L. Alexander was admitted to The Chambers burg Hospital for treatment. Plaintiff in good faith provided the necessary medical services to Defendants' child, Jamie L. Alexander and thereafter billed the Defendants for those services and expenses incurred, which are its usual and customary charges for these services. 4. A copy of the billing for services rendered to Defendants I child, Jamie L. Alexander by Plaintiff is attached hereto, made a part hereof and marked Exhibit "A". 5. Defendants are indebted to Plaintiff in the amount of One Thousand Three Hundred and Ninety-seven and 00/100 ($1,397.00) Dollars. 6. Any and all monies received have been credited to the Defendants' account. 7. Demand has been made upon Defendants for prompt payment amount due, which demand has gone unheeded. WHEREFORE, Plaintiff prays your Honorable Court to enter JUdgment in its favor and against Defendants in the amount of $1,397.00, along with interest at the rate of 6% per annum and the costs of this proceeding. Dated: I../.I-C/'-/ usi 4201 Crums Mill Post Office Box Harrisburg, PA (717) 540-5610 Supreme Court No. 07207 Attorney for the Plaintiff '_"~...i: v. . . . IN THB COURT or COKMON PLBAS CUMBBRLAND COUNTY, PBNNSYLVANIA CIVIL ACTION - LAW CHAMBBRSBURG HOSPITAL, plaintiff I I I I I I I I I NO. V. KBHHBTH ALBXANDBR and JOAN ALBXANDBR, Defendants V B R I r I CAT ION I, k\J...~~f\ ~(.(4 \~j--' the -CX~ ~/\--\- ~~~,~~ ~ of CHAMBERSBURG HOSPITAL verify that the statements made in the COMPLAINT are true and correct and that I am authorized to make this Verification on behalf of CHAMBERSBURG HOSPITAL. I understand that false statements herein are subject to the penalties of 18 Pa. C. S. Section 4904, relating to unsworn falsification to authority. C~ERSBURG HOSPITAL BY'~~ TITLE: DATE: ~~ '-\ ~~ , t t^~::J',D6!:);,;!;,;:'''Y,~::.!~t.;.1 , I" - . \, ~ , " '. " '. KJtHIHl:T "An I". ,- . "','__', 1 "'29/93 PAGE 1 THE CHAMBERS BURG HOSPITAL 112 NORTH SEVENTH STREET CHAMBERSBURG. PA 17201 PATIENT NAME ALEXANDER, JAMIE L F/C PAT NOR [cIR DATE ADM DATE DISCH DATE 30 664614-5 09/30/76 07/18/92 07/18/92 TOl DIP FINAL BILLED ALEXANDER, KENNElIl 43 TOWN MILLS SHIPPENSBURG. PA 17257 INSURANCE 'A' INSURANCE '[I' INSURANCE 'C' CODE REF SRV DT CHARGE DESCRIPTION llTY PRICE TOTAL 62170-PHO 07/19/92 A.P. PELVIS 1 80.00 80.00 320 TOTAL RADIOLOGY-GENERAL 1 80.00 01101-829 07/18/92 ER SURGERY/TREATMENT RM 1ST 1/2 HR, 1 55.00 55.00 450 TOTAL EMERGENCY ROOM-GENER 1 55.00 01075-B29 07/18/92 PHYS INTERMEDIATE EXAM 1 52.00 52,00 981 TOTAL PROFESSIONAL FEES-EM 1 52.00 TOTAL CHARGES 187.00 TOTAL PAYMENTS 0.00 * * * * NET TOTAL 187.00 t: 11 n ::1 , 12/29/93 PAGE 1 . THE CHAMBERS BURG HOSPITAL 112 NORTH SEVENTH STREET CHAMBERSDURG. PA 17201 PATIENT NAME ALEXANDER. JAMIE L F/C PAT N8R 8IR DATE ADM DATE DISCH DATE 30 671226-9 09/30/76 09/10/92 09/10/92 TO: O/P FINAL BILLED ALEXANDER. KENNETH 43 TOWN MILLS SHIPPENSBURG. PA 17257 INSURANCE 'A' INSURANCE '8' INSURANCE 'C' CODE REF SRV DT CHARGE DESCRIPTION OTY PRICE TOTAL 06076-102 09/10/92 ER IMMOBLZER. KNEE 1 58.00 58.00 270 TOTAL MED-SURG SUPPLIES-GE 1 58.00 63564-PHO 09/10/92 KNEE COMP 5 VIEWS 1 127.00 127.00 320 TOTAL RADIOLOGY-GENERAL 1 127.00 01101-102 09/10/92 ER SURGERY/TREATMENT RM 1ST 1/2 HR. 1 55.00 55.00 450 TOTAL EMERGENCY ROOM-GENER 1 55.00 01074-102 09/10/92 PHYS LIMITED EXAM 1 38.00 38.00 00973-102 09/10/92 PHYS KNEE STRAPPING 1 47.00 47.00 981 TOTAL PROFESSIONAL FEES-EM 2 85.00 TOTAL CHARGES 325.00 TOTAL PAYMENTS 0.00 * * * * NET TOTAL 325.00 12/29193 PAGE 1 . THE CHAHBERSDURG 1l0SPJTAL 112 NORTH SEVENTH STREET CHAHBERSDURG. PA 17201 PATIENT NAME ALEXANDER, JAMIE L FIC PAT NBR BIn DATE ADM DATE DISCH DATE 30 588697-3 09/30/76 10/27/92 10/27/92 TOI DIP FINAL DILLED ALEXANDER, KENNETH 43 TOWN MILLS SHIPPENSDURG, PA 17257 INSURANCE 'A' INSURANCE 'B' INSURANCE 'C' CODE REF SRV DT CHARGE DESCRIPTION OTY PRICE TOTAL 63130-PHO 10/27/92 HAND 1 85.00 85.00 320 TOTAL RADIOLOGY-GENERAL 1 85.00 TOTAL CHARGES TOTAL PAYMENTS 85.00 0.00 * * * * NET TOTAL 85,00 12/29/93 TIlE CHr'lHBERSDURG HOSPITIIL 112 NORTH SEVENTH STREET CHIIHBERSBURG. PII 17201 PIITIENT NIIHE IILEXIINDER, JIIHIE L F/C Pr'lT NDR DIR Dr'lTE IIDH DIITE DISCH DIITE 30 593686-9 09/30/76 11/13/92 11/13/92 TO: O/P FINr'lL BILLED IILEXIINDER. KENNETH 43 TOWN HILLS SHIPPENSBURG, PII 17257 INSURIINCE 'II' INSURIINCE 'fl' INSURIINCE 'C' CODE REF SRV DT CHIIRGE DESCRIPTION DTY PRICE 63130-PHO 11/13/92 HIIND 1 85.00 320 TOTIIL RIIDIOLOGY-GENERIIL 1 TOTr'lL CHIIRGES TOTr'lL PIIYHENTS * * * * NET TOTIIL ,_ ~- "F_"___. .~,q Pr'lGE 1 TOTIIL 85.00 85.00 85.00 0.00 85.00 12/29193 PAGE . 1 ' THE CHAMBERSDURG HOSPITAL 112 NORTH SEVENTH STREET CHAMBERSBURG. PA 17201 PI\TIENT NI\ME I\LEXANDER, JI\MIE L FIC PI\T NBR BIR DATE ADM DI\TE DISCH DI\TE 30 598661-7 09/30/76 12/02/92 12/02/92 TOI DIP FINAL DILLED I\LEXI\NDER, KENNETH 43 TOWN MILLS SHIPPENSBURG. PI\ 17257 INSURANCE '1\' INSURI\NCE 'D' INSURI\NCE 'C' CODE REF SRV DT CHI\RGE DESCRIPTION OTY PRICE TOTI\L 63130-PHO 12/02/92 HI\ND 1 85.00 85.00 320 TOTI\L RI\DIOLOGY-GENERI\L 1 85.00 TOTAL CHI\RGES TOTI\L PI\YMENTS 85,00 0.00 * * * * NET TOTI\L 85.00 I,"" ., ~. III 105/94 PIIGE 1 THE CHIIMDEW.iIIURCl 110SP ITIIL 112 Nanni seVENTH smCET CHIIMDERSBlJRG. PII .17201 PATIENT NIIME ALEXANDER. JIIMIE L F IC Pill' NIIR IlIR [tI\l'E 11[11'1 DATE DISCII DATE 30 303600-1 09/30/76 12/21/92 12/21/92 TOI OIP FINIIL BILLED ALEXANDER. KENNETH 43 TOWN MILLS SHIPPENSBURG, PA 17257 INSURANCE 'A' INSURANCE 'El' INSURIINCE 'C' CODE REF SRV DT CHARGE DESCRIPTION OTY 63130-f'HO 12/21/92 HAN[I 1 PRICE TOTAL 05.00 a:;i.OO 85.00 85.00 0.00 85.00 320 TOTIIL RADIOLOGY-GENERIIL 1 TOT ilL CHARGES TOTAL PAYMENTS * * * * NET TOTIIL 02/;>1/94 pF.PlI0610.1 -, SlIlIH PlIllENT FINIINCIAL SYSTEM TIlE CHIIHl'ET\GF'IIIW ItOSP r TilL PF:INl PAlIDIT ['ILLING [lIITA FEll 21. 1994 10 PAGE 1 PATIENT NO 310359-. CHt\T\GEl1 PIITIENT NAME ALEXANDER. JAMIE L SOC SEC 1 000000000 ANT DUE PIIYMEtHS NET CHIlS HOOM CHGG PREV [lAL 83.00 0.00 0.00 0.00 05.00 0/5 INS 0.00 NRV CIlO DrY IIMOUHT EXT I\MT SRV [IT PST DT DIIT REFERENCE [IESCHlPTlON :\20 63130 1 05.00 ~111l93 1'110 73130.000 HIIND ** ENII OF CHARGES ** 02n1l94 F'F.F'lt0610.1 PATIENT NO 697757-3 PAT I E N T N A M E ALEXANDER. JAMIE L SOC SEC t 000000000 NRV CHG OTY AMOUNT 320 63130 1 95.00 450 01101 1 65.00 270 06178 11 1.50 270 06097 1 1.50 '/Bl 01074 1 40.00 ZOl 08303 1 -210.50 ** END OF CHARGES ** SAINT PATIENT FINANCIAL SYSTEM THE CHAM[<ERSl<lJRG HOSPITAL PRINT PATIENT nlLLING DATA FED 21. 1994 10 PAGE 1 CHAHGES A~''fAYHEtHS NEl CHGS HOOM CHGS PflEV I<ftL ~ -210.50 0.00 0.00 218.00 OIS INS 0.00 EXT AMT SRU DT PST DT DAT REFERENCE DESCRIPTION 95.00 0414'l:l 041493 PHO 73130.000 65.00 041493 041093 205 W9047.000 16.50 041493 041893 205 1.50 041493 041093 205 40.00 041493 041893 205 99282 -21.0.50 05249:l 052593 032 PCICII HANIl ER SURGERY/TREATMEtlT RM 1ST 1./2 fiR ER SPLINT. OCL PER INCH ER BANDAGE ACE 2 INCH PHYS LIMITErI EXAM COMMERCIIIL INSURANCE PYMT 02/21/94 PF.P[c0610.1 PATIENT NO 698591-5 PAT I E N T N A M E ALEXANDER. JAMIE L SOC SECt 000000000 NRV CHG OTY AMOUNT 320 63130 1 95.00 450 01122 1 19.00 901 01073 1 26.00 ZOI 0830:3 1 -132.50 ** END OF CHARGES ** j,' ~1f~,:;::lt SAINT PATIENT FINANCIAL SYSTEM fHE CIIAMOERGI.CURO HOSPITAL PRINT PATIENT DILLING DATA FED 21. 1994 10 P^GE I CHARGES RHT t.i~r--YrAY~~N;,S NET CHGS ROOM CHGG pr~EV ItAL (,,<,?-.,::,_~ -13~",0 0.00 0.00 140.00 0/5 IN5 0.00 EXI AMT SRV ~r PST DT OAT REFERENCE DESCRIPTION 95.00 042093 042093 PHO 73130.000 19.00 042093 042393 B26 W9047.000 26.00 042093 042393 026 99281 -132.50 052493 052593 032 PCICn HANIl ER HE-CHECKS PHYS BRIEF EX^M COMMERCIi'lL INSUR^NCE PYMT O?/:'1/94 PF.P[l0610.1 PIITIEtH tlO "722'103-2 1'lITIEflT NAME IILEXIINDER. JIIMIE L SOC SECt 000000000 NRV CHG DrY IIMOlJNT ~\20 61020 1 90.00 730 00500 1 95.00 270 00526 1 5.00 450 01103 1 104.00 250 MOT04 3 1.00 9111 010113 1 15.00 9111 01075 1 57.00 ** END OF CHIIRGES ** SIIINT rATIENT FINIINCIAL SYSTEM THE CH/II'IDERBI'UIlG HOSF' 11 AL PRINT ('IITIENT EcILLlNG l'AlII rED 21. 1994 PI'1GE CHABGES PAYMENTS t~ET elIGS ROOM CIIG[i ['REV BilL 0.00 0.00 0.00 369.00 OIS INS 0.00 EXT IIMT SRV DT PST DT BAT REFERENCE DESCBIPTION 90.00 101593 101593 PHO 71020 95.00 101593 1017<]3 PHO 93000 5.00 101593 101793 1'110 104.00 101593 101093 016 W9047 3.00 101593 J011193 016 15.00 101593 10JB93 817 93040 57.00 101593 101893 817 99283 CHEST (2 VIEWS P.II. & LIITERIIL) ELECTROC/lRDIOGRAM (ECG) EKG DISII ELECTRODES 10-PIIK ER OBSERVIITION RM 1ST 1/2 HI! IBUPROFEN TAD (MOTRIN) OOOMG PHYS RHYTHM STRIP INTERPRET PIIYS INTERMEDIIITE EXI'1" PAT I E N T N A M E ALEXANDER. JAMIE L. SOC SEC . I\YMENTS NET CHGS HOOM CHGS pr,EV BAL 0.00 0.00 0.00 0.00 0/5 INS 0.00 02121194 PF.PIl0610.1 SAINT PATIENT FINANCIAL SYSTEM THE CHAMIJERSBURG HOSPIIAl PRINT PATIENT UrlLING DATA FEll 21. 1994 PAGE PATIENT NO 507306-2 CHM<GES ** END OF CIIARGES ** ....-~, -~- .- ARTHUR A. KUSIC ATTORNEY AT LAW - ... . , !,> ; ( ''..:', , ':':,;~ :- ^j,.;!;~ "<',.:,,".;, " , , ;:. ,'<:;,::;f:S.\ , " (. : ' j Si::~~~~ ~o; _ Jl}~~~~';' :~ t~~ . ~;:. <,:~~;}\., ' ." '" '':i,; ." >; :';';>'t, f:;<'~:,~;:' :,.;. ';::,,:;;'t1" ;';~:';..T;;~ :~; ~,f~;: >; ;" :,>:~i "j .'.' ''''.''''\ ..,;;\.""-',. ';' .' ~;',.>:~: :'. C 'cl' "~';"'.i:o~"";'\ ~S;;;'::::-:.1:',::: . ,,'-"':'::1"':~" :'~/~ :'~~ ,:~_., ?;/'~t-::: >~':;:.,~!' "',- ":";':<;; 'C >. '," "\r::.~;\:~ ;) '>"/,;" t;~ ;", : "'","< .' '//;:~,;:':..,; ,~~, l.. 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'.'YI')'J 'ma rlt:I,:;,~,;:;n;:ini'p: t;l pt.'" .\"0 . r1i-w \' ;;~iin c';":.!I:i-"'(i~ :'!.r~!., ~;..':d /:; , <'~'f ~::'l;:~'~~.l. o~"'d' f?'u!l,j~t;~n{cnf I~t,oy be c, ,terecl DGainst YOll. .' _ Jury 'II j..1 l,,;;;,,;.r.cied. ....-f- .;.t:lrooy I.Ll. iou. C513Jl ..' '" _:'\~?;(t :>,'";.,. " ;:Ff~~(;~~::?' , ,{" '.~ \) \ . - . " , .. .',' .' ,~~._}-:"i}::::~~-:,::r.:.i" ARTHUR A. KUSIC ATTORNEY AT LAW \h 4201 CRUMS MILL ROAD P.O. Box 67015 HARRISBURG. PENNSYLVANIA 17106-7015 (717) 54005610 '--, ".'. ,..-.~---".::_~:< ' ':'\,;,'.',:; ;<. -::;:'-:. ',. .' .;C,.