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ARTHUR A, KUSIC
TlfTOIINEY AT LAW
4201 rll"M~ MIll ROAD
rOil'" fi7015
HAHlW,IlUIUi. Plt'H-t'~'l'LVMfl^ 17106.7015
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HOLU SPIRIT HOSPITAL,
IN THE COURT OF COMMON PLEAS
CUMDERt,AND COUNTY PENNSYLVANIA
Plalntlff
y,
CIVIL ACTION - LAW
I'ATR I C I A DASOM,
Defendant
NO.
NOTlelA
La han demandada a usted en la corte. Sl uated Quiere
defenderse de eslas demandas e~puestas ell laB paglnas Biguientes,
usted tlene Vlente (20) dias de plaza a1 partlr presentar una
anar 1 enc 1 a eBc r 1 t.a 0 en persona a par abogado y arch j var en I a
Gorte en forma ~scrlta BUB defensas a SUS abJeclones a laB demandaB
en contra de su persona. Sea aVlBado Que Bl usted no Be def1ende.
la corte tomara medldas y puede entrar una orden Gontra uBted sin
preVla aV1BO 0 natlflcaclon y par CualQUler Queja 0 alivio Que e8
ped 1 do ell 1 a pet. 1 cIon lie demanda, Usted puede perder d 1 nero 0 BUB
propledades 0 otros derechos lmpartanteB para uBted.
LLEYE ESTA DEMANDA A UN ABOGADO lNMEDIATAMENTE. 51 NO
TlEtlE ABOGADO 0 51 NO TIEtlE EL DINERO SUFICIENTE DE PAGAR TAL
5ERVICIO. YAYA EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA
DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR OONOE SU PUEDe
CONSEllUIR ASISTENCIA LE(,AL:
LAWYER REt'ERRAI,
Cumberland Co, Court Admin,
Fourth Floor
One Courthouse Square
Carlislo, VA 17011-3387
(717) 240-6200
Respectful ly Bubml~ted:
~~T~t" kU
4201 Crums Ml ~}ad
Post ('ff lce 80' 67015
lilH'rlSLJuro, flA ql1~
1717) ~40-F>6'O
G"PRE~1E ,'OUR1 NIl. 07207
I,PI'R/j~, FOR PLAINTIFF
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1M THI COURT or COMMOM PLIAS
CUHBIRLAlfD COUMTY, PIIlIOlSYLVAlfIA
CIVIL ACTIOM - LAW
HOLY SPIRIT HOSPITAL,
plaintiff
PATRIOIA BASOH,
MO.
Defendant
COM P L A I N T
AND NOW comes Plaintiff by and through its attorney,
Arthur A. Kusic, Esquire, and respectfully represents the
following I
1. plaintiff, HOLY SPIRIT HOSPITAL, is a hospital
faoility organized and existing under the laws of the Commonwealth
of Pennsylvania located at North 21st street, camp Hill, cumberland
county, Pennsylvania.
2, Defendant, PATRICIA BASOH, is an adult individual
residing at 103 North 21st street, camp Hill, cumberland county,
Pennsylvania 17011.
3, On or about July 3, 1993 and from time to time
through September 3, 1993, Defendant was admitted to Plaintiff1s
facility for treatment.
4, plaintiff in good faith provided the neoessary
medioal services to Defendant, and thereafter billed the Defendant
for those services and expenses incurred. As evidence whereof,
copies of the billing for services rendered to the Defendant are
attached hereto, made a part hereof and r.\arked Exhibit "A",
5. Defendant executed a Permission for Treatment
Insurance Release with Plaintiff whereby she assumed responsibility
for payment of services rendered. As evidence whereOf, a copy of
ths Release is attached hereto made a part hereof and marked
Exhibit "B".
6. Plaintiff I s charges for services rendered to the
Defendant are its usual and customary charges,
7. Should the Defendant not be held liable for the
necessary medical services provided, she would be unjustly enriched
and the Plaintiff unjustly impoverished,
8. The Defendant is indebted to Plaintiff in the amount
of Two Thousand Eighty-Three and 25/100 ($2,083.25) Dollars.
9. Demand has been made upon Defendant for prompt
payment amount due, which demand has gone unheeded.
10. Plaintiff avers that the amount due and owing does
not exceed the juriSdictional amount requiring arbitration referral
by local rule,
WHEREFORE, Plaintiff prays your Honorable court to enter
Judgment in its favor and against Defendant in the amount of
$2,093.25 along with interest at the rate of 6% per annum and the
oosts of this prooeeding,
RESPECTFULLY SUBMITTED I
Arth~ire
4201 Crums Mill Road
Post Offioe Box 11595
Harrisburg, PA 17108
(717) 540-5610
supreme court No. 07207
Attorney for the plaintiff
DATED I
10LY .PIIIT HO.PITAL,
plaintiff
IN THI COUIT or OOHMON PLIA.
CUK..ILAMDCOUMTY, P....YLVAMIA
CIVIL ACTION - LAW
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Deren4ent
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Gl1oqjl1 Rowl1rs
,the Crpritt lL Cnllprt Inns
MAnAQ'"''
of HOLY SPIRIT 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 HOLY SPIRIT
IIOSPITAL, I understand that false statements herein are subject
to the psnalties of 18 Pa, C, S, secticn 4904, relating to unsworn
ralsification to authority,
HOLY
SPIRIT HOSPITAL ir.
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I tHud \hl balanc, dUI 01 thl provldrr, rClul3f ,Mia" lin lhu ptflU\J JI hOlp1l3\llJIIOn,
lhl ho.pllU for chul" no' CDvefl~ by lhll JulhonUlll1n
bene flu ')lI1.rwll. ~.y.aDI. to me IN!
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I HEREBY AUTIIORJZE PAYME~T dlfaclly 10 the tbo~t namell rh)t1C'a.1 rOf ml!dll.:~t
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ph)tlCl&n for chlf'" nol coy rd by Ihll 1ulhanUllon.
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10 InlUtwU comp&l1lU fur UlI
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SIONATURE:
ST.\TE~IE~T TO Pr.Il~11T P.IYIIE=,T OF IIEDIC.lllt OE~EFITS
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: IN THE COURT OF COHMON PLEAS
: CUMBERLANOCOUNTY, PENNSYL VANIA
:
: CIVIL ACTION - LAW
:
: NO. 9S-JOBl Civil Torm
:
:
:
PR A E C I P E
HOLY SPIRIT HOSPITAL,
PlaintIff
PATRICIA BASOM,
Defendant
TO THE PROTHONOT4R'r:
Please mark the above caotloned matter as satisfied.
settled and dIscontInued.
DA TE: .J~fihf)..bt [I .3t',lqrU,
RESPECTFULLY SUBMITTED:
~
420' Crums Mill Road
P.O. Box 670'5
Harrisburg, PA '7/06
(7'7) 540-5610
SUPREME COURT NO. 07207
ATTORNEY FOR PLAINTIFF
HOLY SPIRIT HOSPITAL,
Pia lilt I ff
1 N 11/[ L'OUI/ I 0/ COMMON I'll AS
: CUHDEnt,ANllCOUNIY, /'ENNIJYLVANIA
CIVIL ACTION. lAW
: NO. 95-3081 Civil 'form
V. :
:
PATRICIA DASOH,
Defendant
CEHllFlCAfE Of SERVICE
1. Arthur A. IIUSIC. ESQUIre, do herebY certlfv that on
th IS 130 d!lY of .JtfAto...J.LLl, I ~I' /(,. r placed 1/1 the Un I ted
States Ma I I true and correct cOP le<' of Praecipe to sstisfy,
settle and discontinue
addressed to following:
Patricia Basom
103 North 21st Street
Camp Ifill, PA 17011
.. ,
/;jg/" ~), )
{~';i'~~. (lFs'l~~SQUrRE
4201 CrumB Hi II Road
P,O, Box 1/585
HarrIsburg, PA 17112
(" 71 540-5610
Attornev for the PlaIntiff
Supreme Court 1,0. 07207