ORDER HO. 20567
APPROVAL TO PAY INDIGENT HEAL'CH CARE BILLS
TO VARIOUS PROVIDERS
On this the 23rd day of September 19`1, upon motion made by
~:ommissioner Holekamp, seconded by Commissioner- Oehler, the
court approved by a majority vote of 3-0-0, to pay Indigent
Health Care bills in the amount of 5208.26 to various
providers.
a ,r
~-
~ p
~-- ~
_ ...- "". ~_ y4
,-- I PAEE~ 48 1
~-
-..,---'`ter~~ T.P~A' y 1 E a CHECK
~-" C K R E 0 j 30r 19R1 AMOUNt
~''"'--~'~~ ~ 1 l ,~ C N E FRIDASTER~NUMBER 14i .. ~~,,,s.~•,,..
:.~.. T
E pAiE: 08130!41 CLATMAN - ADD - LL
~ '
ENPL4Y~~ ~ ~ ~•DO
ypC SEC NO ~ • .. ~ +~ , ; •
CK ~ ~` ~ ~ K~ ~ ~ •D0 • ~ ~ °~
CriE ClA1N NO VOtO D ~ C M
ptNERs'~'.~; ;~~ V 0 t ~• it
CHECK GATE pUN1Y MANUAL . ,. C N E C K 2q. ;¢;~;' ~„
.'~~~y..~,,,t" GROUPs TPX~D024 KERR C .. 0 t 0 Y RApt'~gb~~T~_..-..--}~_ ,.
Hilt COUNTR 64.aR
TPX'DD24 „- PAYMENT
EUNOs .. VOUCHER ~ C 1{656D1 ',:
...: 1443 08!30/R1 UP r.~~` -R--P-A-'R~E t AS54
LINE 6 yEYERANCE 2p~.2
:., 1444 08130/42 'R PA'tN~r.~---~-"'-'"..
1~~~~~~~~~ 08130/91 LINE UP VpUCHE
r""__ 1449 08!;0191
1449
OIRI ----i--~•'
1452 0913
~~
~ .,~
n~~
,.
,,
a
".---~
I ~il~
~~
}~
~~
~1
~:,/
. ~.
e ~.`,~t "'' ~ ~.
ri,,
~t
;;~~~,~
y kt
`'"'"-~
,• ~i

T.P.A.
j IJATE gsli?I}J')1		F~,IIi;IDfR VIu1CNER LISTIIIb		F'116E 1
				iFU003)
EGR PRr,1!Ilii:t?:	7r1-T133T6i	NI4_L #:+3E1NTR'! RADIOtOSY		
FGR GRC-L+P=	TPK-+J~Z4	I(E~SR CDEI)!TV		
~ SEQl1f iir;E k+? ~	165			
		PEaTIftTT CLAI)f INCGRRED	COUF~ED	fC+TAI
,; CLt~itIRH!	BEP.	HO N0. Tk011 TO	CilRt',^•E	PAID
	
K Ad+JStl~!	E 13Q123 90b4424803 04ii3I91 04/i3/41	~t7.25	24.17
'		6ROt1P T01AL=	47.15	29.}1
		PkOUIDER T01AL-	47.15	29.17

'	Z.F.R.		
U(il E 4f~!?Cf 91	PRUUiDFR 0t3lfCRFR LIS~Iii6		PA6F f
"			(PU443f
fC{t Ft;GUIDE#I:	7~#-25518?0 SID F~TfRSOi~ flEl1 HUSPITAL		
FOR GFOU6':	TPX-04211 KEfiR COUHTV		
SEQJF~lCE ~t0:	15G _		
'
	PATIENT CLAIit IltCI1RRED	CQUECED	
,
TdTAI
Gi.AIf1A~lT	DEP. tt0. fl0. Ff{OR TO	GNARtiE	PAID
_~~__~________________________~s_~~=--__==_==-=-=_--=__=-__--=_==__=-=_=_=~___=___=_=
C NAUA	E 5036$ 940040b202 04/f4/91 09/10191	1f5.00	1f5.00
	.GROUP TOTAL	115.00	115.00

~

~~	PRO~fI9Eit TOTAI:	115.00	f1g.4D
--
i

1

QATE 08/30/91 PROVIDER t+01N;HER LI5TIHC PAGE i
tPU003)
FOR PROVIDER: 74-1b48b14Q SEVERAltCE a ASSOC 1~f,5b0i
fOR GROUP: 1PK-001A NERR t~UNTY
SEQUENCE NO: 168
PATIERT CLhII! - I1ICURREII COVFRFA TOTAL
CLAIttAMT DEP. HO. HO. fROB TO CHARSE PAID
xeemomsaxce:a..a====xxcxxooasssasaersaae_sxsaeaeamsacszaasas¢sessaxmsxssosmaasomsmrx:
J BOLGREM E 014$161 9Q0033b617 01/15!91 Qiii5/9i 125.00 b4.04
GROUP TOTAL: 12'3.00 b9.09 ,
PROVIDER 70TA1: 1Z5.OD b4.09
ORpER N0. 20567
APPROVAL TO PAY INDIGENT
HEALTH CARE BILLS TO
VARIOUS PROVIDERS
September 23, 1991
Vol S, Page 417