C71~: is ~ k I~J t:3 . ~' 1 ~'7 ti i_:L_t-1 ). P1`=+ FiI'~IIJ ~IL:LC.1LIt~.i t ;:ti ! t: 1''~ E~ r'` r' t:~o~_~n•ty anc: ~thP V~r-i~3~_ts l,ommis sinner s; E'r~e c_ inst. which r_:i:_tsms anrJ aC'C'o!lnt5 ct~C'?Y~avcc.l fr.~r° ~:~C-~ymer•~t o~_it c~fi CcnNral. i=c~,- •~'=~9,~1.`~i.~,:i, J~_~ry i'or-• ~~1,::;~r.~,~i3~C~, ~fo:ac7 ~~ncJ >;~r°iricJe Fad~Jitic;r~~.~~1. i•~egi=.trcjtion for' ~~~~6,41`;.~7ti•, Flr'e F'r-•otectian far° ~4, ie~6.~~%, f~oad ~-~n~i tsricine for ~h6, 44~~.'._3!•3, i~o~..inty L_aG-; i_ibrar-•;.~ 'f'or `ti~;9`~;, ~`~, a~_tveni le `Mate laid F~~_ir,cJ for-• ~~6. `~;~, lr-•affic safety f~'~_~nd for ~1, 98 ~. ~r.?;, 1ndi~3ent F-iPaJ.tr~ r;ar-~c_~ I'or ~4~,. 4~~!~, ~~er~manent l:mprovr;nent. fc,r-• ~1'=;i, ~`~; ~t~ste F~_tndecl -- F'Fr-~1=or,manct~ Newa.i^ds for ~.:~9c'. ~E~, ancJ t56._~tate ~~_dr7de~_J ;~'1f~.rh l:iistr~~ic~I, ~~r~obat ion for ~_', E.~.::;9. 4~~. Can motion ma~~e ty i::ommissioner~ f.lelekam~, seconded Ly i_;ommissioner-• t.~ackey, the Gc;~_ir,t unanimously approved by a vote of 4-0-0~ to c~ay said claim=. c~ncJ acco~..~nts and to incl~_~cJe tF-te Inch ~3ent Healtf-~ E~`ar•e Hi I I s for- ~>4-7. l~;, ~ i i, 44~'. `=;~+, ~1,~~~.8`T, and ~1,~341,~'4'~. T.P.A. DAZE. 08l2i/92 D A I L Y CHECK F ~ 6 1 5 T E n PA6E: 25 ~' FRIUAY AUGUST 21. 1942 ~ E ~ REGISTER NUMBER 2Z1 ;,,, CHECK CHECK CHECK , NUMBER DATE CLAiM NO GROUP Np SOC SEC ND EMPLOYEE ClA[MANT PAY TO AnOUHT , , picsascrrra'arriasmraarascrraarrrrctacrrsapssatratarzsaacanrrzerlsrrcrzerasasezsaioaai6izaseia,tias'wieciaawansacrse.eraaseataaz~uazr.aa:. ~~ CHECK GROUP 024 KERR COUNTY ~ 1844 ' 08/21/92 TPX-0024 ~ MANUAL OTHER VOID .00 ~ 1845 08/21!92 LINE UP *~ V p I D C'H E C K ~# - .00 - ~~ - -`~17L}~ K -T~UI!ITFFY`~HF7iTfiLTi&Y 12$.~e y;~,~. 1847 08!21/92 TPX-0024 VOUCHER PAYMENT SEVERANCE B ASSOCIATES 317.48 1848 08/21/92 TPX-0024 VOUCHER PAYMENT uALI M'0. MICHAEL ------- 363.77 --- '~1I84'4 ~87217y?`~---- ,. ~Z4- ------_,____~r..~ . -`-yDOLNER-FICYMENT`~7CAE5THESIA` A55DZTATES b3.02 ;;, 1850 08/21/92 TPX-0024 VOUCHER PAYMENT SID PETERSON MEM NpSPITAI 365.00 ~~~i 1851 08/21/92 TPX-0024 ~ VOUCHER PAYMENT ALIEN MD. WILLIAM M - ' - 520.64 J"~ '--TB~ .. G I~Th ~ iiV.vN j ;',,~I 1853 08/21/92 TPX-0024 VOUCi~ER PAYMENT MOBLAD UPM. ROGER (; __. .--_30 "0 } ,~;_~__._ _ .__-___._-__- ~ ~^__ ~ ----_-__---~-~-~-~IJ6T-OTALS.--_.- -------_-_____ ~-_CH~CKS`-_ -7:908.87 '' - ~,~'; ~ - .I ua I ___ ~~ - ,,, { s: i ~s~~ g., ii ,,yam-~.__- ________ 4 ~° T.P.A. DATE 08/2il92 PROVIDER VOUCHER LISTING PAGE 1 tPV003? FOR PROVIDER: 14-1733761 HILL COUtitR4 RADIOLOGY FOR GROUP: TPX-4029 NERR COUNTY SEQUEIIGE M0: 141 PATIENT CLAIM IRCURRED COVERED TOTAL CLAIAAkT DEP. 1l0. M0. FROA TO CNAR6I PAID - -- --- - -- - -- -- - -- - L HILL E 134065 92000$1302 Oi113l92 Oi113/92 225.06 119.96 E NELLER E 066359 920008060$ 01111!92 01/11!92 9.OD 9.fl0 GROUP TOTAL: 234.OG 12$.9$ PROVIDER TDTAI: 234.00 12$.9$ T.P.A. DATE 08/21/92 PROVIDER UO1lCNER LISTINt- PAGE t (P1t003t FOR PROVIDER: 74-1b486J4 SEVERANCE a ASSOCIATES FOR 6RORlP: TP%-0024 IiERR COUNTY SEQUENCE ttO: t 42 PATIENT CLAIM INCURRED COVERED TOTAL CLAIttANT DF P. NO. NO. FRO@1 TO CAARCE PAiti J GARCES E 326931 9200013411 81/21/92 01!21/42 230.00 127.81 R KIt16 E 0346845 9000493111 02118192 02!19/92 168.20 158.06 A ROYBAL E 4299350 9200029517 12/10/91 12/10/91 18.65 18.85 A ROYBAL E 0298104 9200029513 12/09191 12/09/91 12.98 12.90 6RalP TOTAL: 449.75 317.48 PROVIDER TOTAL: 449.75 317.48 T.P.A. DATE 08/21!92 PROlIIDER VOUgIER LISTI86 ~~ 4 (Pt~043~ FOR PR~lIDER: 14-Zi86835 DAtI MD, nlgtAEl FOR 6RO1~: TP%-0024 KERR Gi11Ali4 SEQNENCE k0: 143 PATIENT CLAIn Iin3NtRED COVERED TOTAL aAinAi{T DFP. 140. il0. FROn TO CNAR6F PRID n CAiiTU E 9000513629 03!31192 04/28192 120.00 62.94 R KItA; E 9400493119 03/05!42 03!45/92 25.00 23.00 L GBALLE E 1407 9240082005 05/1$!92 06/42/92 65.OD 4b.50 l UBALLE E 9244482046 04142!92 4bt29/92 415.00 231.37 CROIfP TOTAL : b25.0D 3b3.77 PROtlIDER TOTAL: 625.00 363.77 T.P.A. DATE 08/21/92 PROVIDER VOOpIER LISTI116 PACE t {pV~1 FOR PROVIDER: ?4-207828$ A1~STHESIA ASSOCIATES fOR 6ROiIP: TPR-0024 KERB COtkITY SEQUEkCE 110: t44 PATIEIIT CLAIM IIICIDiRED CWERED TOTAL CLAIMAifT DEP. 11i1. IIO. FROlI TO CNARCE PAiD exaeeaooeeeeaocoteeeeeaaasaeo=:same:seseaeaexaeeeosaaoeeeeesexeese~eeeae-_----.esse W LEE E 403923 9200123?03 04/27/92 06122/92 400.OD 63.42 SROVP TOTAL: 400.OD 63.Q2 PROVIDER TOTAL: 400.OD b3.02 F.P.A. DATE 4$/21/92 PROVIDER VOVt31ER LIS7INl; PAGE i tPV0031 FOR PROVIDER: T4-2557824 SID PETERSON tlFM HOSPITAL FOR 6'ROI~: TPR-4024 KERR COUNTI~ SEQUENCE NO: 145 PATIENT CIAIA INCURRED COVERED TOTAL CtAIlIANT DEP. N0. N0. FRO11 i0 CHARSE PAID :=szsaaesesae:=x .-.e----~::ea---o oeoea.sea.--ao-nse.eo..nseeoces.a====-=---==-====-== B PADILLA E 531711 9400491148 46/42/92 46112/92 55.04 55.44 P RICHARDSON E 9244125741 02f04f92 42!44/92 88.50 19.54 L SUTTON F 531184 9204463405 05/11142 45/#8192 290.54 290.50 GROUP TOTAL: 434. DD 3b9.DD PRtNtIUER TOTAL: 434.40 365.40 T.P.A. DATF 0$/21192 PROUIDFR U01lCIIFR LISTI1l6 PACE 1 tP0003i FOR PRWIDFR: 14-2046814 AlLFM ND, IIILLIAM M FOR CROUP' TPX-0824 KFRR COUNTY SEQUFNCF 110: i 4b PATIFiiT CLAM! Ii1gDZRFD C011FRFB TOTAL CLAil1At1T DFP. N0. 11f1. FROlI TO CNARCE PAID ssassoss.assosssssssssxsssossssssssxsssssssssaaesssss.sesxssnessasszsssaszen.ssxsaas~ u LFf E 1580 9200123202 Q4127192 04/27/92 501.02 472.54 W LEE F 1580 92001TI203 44127/92 46/22/92 48.14 48.14 CROUP TOTAL: 549.ib 520.64 PRfWIDFR ;DIAL: 549.16 510.54 T.P.A. DATE 88/2f/92 PROVIDER OOUCNER LISTING PACE 1 tPtl0431 FOR PR01lIDER: 74-2251097 NILL CO DIA6 IMAGING Fri GROt1P: iPK-0424 KERB COUItTY SE~IEtN:E ilO: 147 PATiFMT CLAIM INCURRED CENIFREH TOTAL CLAIMANT DEP. NO. NO. FROM TO CHARGE PAID L NILL E 134065 9200081302 Ot/13/92 01/13!92 5150.04 119.9B CRAP TOTAL: 55fl.QD 119.98 P'RtNIIDER TOTAL: 554.OD 119.98 T.P.A. DATE 08f2t/92 PROVIDER ViOMCNER LiSTINC PACE t tPU0431 FOR PRWIDER: 56b-6D-b5b3 II~LAO DPR, ROCER 6 FOR CROUP: TPK-0424 KERB COIARY SEQUEKCE N0: t48 PATiEttf CLAID ilfGllRRED COVERED TOTAL CLAIMAIIT DEP. MO. lID. FROR TO FARCE PAID rsae:=ox.a..se.aasooxaaaoass:sxaee.xas:easxmeeseooe.asaest.~=:xessnsexs:xe~x:e..saa B f1EBSTER E 9200107082 02f44f92 02104/92 38.00 38.00 CRQVP TOTAL: 30.00 34.00 _ ~ PROVIDER IOTAL: 34.0D 30.00 ,~~ ~ t^:Il.t,,v koa.i~T 28, ?yY? ~ '. I .c1~,1 ~ ~I,i r!rtk ~ ~ - ~-- - CMECr, =i C+~, Ct,ELX ~I~jMAtdT ~PPLUY~F TO __ .._. PAY A~lbtiWi " CtAIN Nd GRCrUI' r~~~[ 5~C a _ klJ e:casarez ee ac z>=FSOt/-=car_szteaam˘emcee//s . a/ae espi9taa:ae/mse a: a:/a ssa/x /x/aaeea^e ~i,~... .: x oa~~r. ~-ce^ezc-az/sea=ss se na:aanm~x'%nsne~n˘r.. ~i, '~c:{-_CK ~ _ ~i4 ~f_P.F CuUP~TY _. .___ ~__ i 185 TPx-Ofl24 OrfZB/92 ~tANUAI UTHER VUICf C N E C K#* ~~ Y b 117 ,OA .GO r . ~ ~ 1855 n?'./28f~2 i IMF UP ' -,_ YDUCMEn PRY~+~NI . _ __ SI:~ pcTEFaQN MF1~ H~SPITfI i 441_7 ~;~ 1856 1G24 Ur./2o/92 TPk- -__ _ _ >~,~! __.__ . _ ~t;a SGSTOTALS_ ____m.._-~..-__ _ ~_.._..... _ _ ______ ~ 2 Ch-CKS __.___._._... LS41.7~ i~: _ 1 . ____ f~_ __, w " x F p -_._ f ~. -. ._...-.... ...~._..s.....~.. ---...- -..-... _..,.. ,.._. ...... ~ ~ r ~ i, ~ ,: } .-~ - ., .~- ,_» - -- - e ~" ~ _ __._ ___. _. -. _... .._ ~. - - 1 __- _ ~__~_.._ . ~~u I pie ~ I `' .._._-~,. .._.. _.. .. _...,. ... .. - _ . 1 _--___. - .__ ..._.. - _._ - ._ _.- n ~v ^ 1': f e e~ sz ~.~1 1 is I ~I :d T. !., IHC. DATE 08/28/92 PROVIDER V4OC}iER LISTIHC Pfl&E ' #PV0031 FOR PROVIDER= 74-2557820 SID PiTERSQM IIER HOSPITflL FOR &ROUP: TPX-0024 HERB COUKTt' SEQVEifCE lIO: 1 PflTIENT CLAIit IHCtH7RfH GOUFRfB TOTAL CLAINflNT DEP. kO. HO. FROt! TO CHflRSE PAID R KIH6 E 239993 91100493118 43/14/92 03120/92 10509.55 1941.7f} 6ROtM TOTAL: 10509.55 1991.70 PROVIDER TOTAL: 10504.55 1941.70 ~~~ T. r. k.. INC. u~TC: 48/07/V2 U A I L Y (F. E C K R_ ~~ I= T '- k yaU~; 4 FP.IPAY kUGuST 7. Iv~l RtGISTF~+ '.L'TM.°,Ek 18 :i ChLCK CHECK (NECK ~' NuhHER GATE CLAIM NO GROUP NO SOC SEC NU EMPLOYEE CLAIMANT PAY TO AMOUNT ~sczmcecamcaeocecccmesmzwaeswate eeawwemasaaecwwcmtsa~˘csaaacssac~::~sxaw--rav a=aza-aee!rc_c ~a~ausnsimss~sc~~:eu~e es~cucsaa~anacmax zacccc i : R!,i:HECK GkUUP 024 KERH COUNTY 1823 UiS/07192 7P%-0024 t7ANUAt tITMEfi VOID .00 ~ ~ 182_4 ( 08/07/92 LINE UP ~ ~~ Y U I 0 C N E C K ~~ .00 ~~~ 1h25 Ob/07/92 LINE UP _ _ ~~ ~~ Y U I U C tit C K o____ -_-.Oh ~- 1026 08/07/92 TPx-0024 YOUCNErc FAYhŁNT NAU MD. TMONA.S 547.73 ---- - - ------- ~; ~ S U Bi Ofi AL 5 _ _- ---- --2 ~-N~K~--- ---_ _ 5 4~. 7 3 ~,; ~~ ,} ' 1 ---- r 7 t -~. - ---- ~- __ _ (J _~ ., 'ti:~'_~~L Via :L ~ Li. ;.IL.'_ i 4?+` tt~ .. _.. ~f ~__ i5'. ~~~.,Lii :L41it~ i~l.~~~h~~ t,1fUt.~lLu !~.'+3._ ,,,~{i4i• ,_ ~~' ~St,;, rt~(;yi Il _i1flL~'1c: 1'i:i. T,P,A., DATE: GS/14/92 D A I L Y C H_ ~/ K E b 1 5 r E N r; Y V K O U P PAGE: 7 f~IDAY PUGUST 14, 19 92 ~EGISrER vurlBra 21a CHECK CHECK CHECK 'i~Jrs6ER DATE CLAIM NO SDC StC NU cMPLOYEE CI AI MA NT PAY TO AMOUNT .._:.:_:..xsssxx-sz.aarvsae:r5,aatt__ x.xsttttoccx_~:aasattrc-aecsces~.caatt_cscx,xr,xttttttc-_x;:a=r_aeaeax~esccvarrxtta~-s atema:a˘sur.:aa˘~===aa-. rU'iD: TPX-0004 GRDUP: TPX-4024 r:ERr• CDUhTY CHECK GROUP: 024 KEisk CUUNTY 127 08/14/92 _.__.. +IANUAL OTHER YUID .00 1828 08/14/92 LINE UP ~~ Y 0 I D C HECK s# .p0 ld2V 0A/14/92 YpUCHER PAYMENT HILL COUNTRY RADIOLOGY 937.56 1430 06/14/92 VDUCHLR PAYMEHT SPECK kD, FRED 22.80 1831 08/14/92 VOUCHEit PAYMENT H E B PHARMACY 1089 811.83 183% 08/14/92 VDUCHER PAYMENT GONEZ SKIN PATHOLOGY 5ERV 42.38 1833 08/14/92 VOU(HEtt PAYMENT AtiESTNESIA ASSOCIATES 143.52 1L~34 08/14/92 VOUCHErt PAYMENT, MITCHELL MD, ROBERT E 15.44 1035 OR/14/92 VOUCHER PAYHEl1T NAU MD, THDNA5 15't.80 12536 DE/14/92 VOUCHER PAYMENT ALAitiG PHYSICIANS SERVICE 244.72 j 1837 08/14/92 VOUCHER PAYMENT SID PETERSON MEM HOSPITAL 7,724.24 1;138 08/14/92 VOUCHER PAYMEM7 DELANEY MD, R GDRuDN 63.01 1339 08/14/92 YOUCH~k PAYMENT SHAD MD, HILTON p 29.04 184D 08/14/92 _ VOUCHER PAYMENT H[LL CO NUCLEAR IMAGING 2aC.53 1841 OR/14/92 VOUCHER PAYMENT HILL CO D[AG IMAGING 102.44 1842 08/14/92 VOUCHER PAYMENT 41ELL5 MD, JAMES D 749.18 1843 08/14/92 VOUCHER PAYMENT dOONE ND, DAN 41.40 11,442.54 d r .v T.~ ..~. DATE 08!14/92 PROVIDER UOUCtfER LISTING PAC! 1 (PU003} FOR PROOIBER: 74-17337b1 MILL COIMfTRY RABIOLO6Y FOR GROUP. TPR-0024 HERR CiRIlfi4 SEQUENCE N0: 1 PATIENT CLRItI INCURRED CQUERED TOTA! CLAIMANT DE P. il0. N4. FROM TO GIARGE PAIR seaaaesasasce~s:e.aeasoca.ca.oe.azaesa=osezsa:seaxaxasaaxoaeseaea a=sea=a:eeeeoo=ezeee E CEPEDA E 3242b3 9204123401 07110!92 07!17/92 74.OD b1.27 q DOHDV E 493bb] 9200028904 02!24/42 02!20!92 24.44 24.60 R DOND1' E 043bb7 9200028905 f1/41l41 ?1/22!91 90.4D 50.55 N DUNHAM E 091452 920410b342 06/15/92 41!24!92 104.4D 104.00 C CARCIA E 114419 9200040507 02!1$!92 02!18!92 29.00 29.64 C MONELL E 034b42 9040572804 ttlZ0191 13/24/43 Z3.OD 23.00 R KING E 115773 9000493135 42/18!92 03/19/92 237.00 18b.4~ J LOIIREY E 499517 9440442b27 05!45!92 07!18!92 37.0D 37.44 B MARSCNAIL E 135321 9T00Qb4644 04/13/92 04/13/92 24.44 24.00 B PABILLA E 482079 9000441107 06/12!92 O7/T2/92 10.4D 10.00 R RODRICUEI E 6b86b2 9200d$0102 04!05/92 44/05!92 23.54 12.88 B SAMCBEI E 4092481 900449031b 09!28/92 05!28!92 16.60 15.00 L SUTTON E 334585 9200063404 42119!92 42!19/9? 54.25 35.77 ~L~E~lftt- A . i'~ ~ n, E 47212 9200105403 06107!42 06/07192 73.5D 90.41 C AALIi(SI E 108482 92600b3115 03!10!92 07/29/92 45.OD 43.00 C NALIKY E 14$482 9T000b3fib 01/25/92 04/1814? 258.65 159.59 J 11ALIKY E 13479! 920410570b 03/05/91 45!21192 130.25 112.17 N iIILLIS E 0019202477 4004493508 45!19!42 47!17!92 16.0D 1b.0#I GROUP TOTAL: 3254.19, 987.5b PR~tIDER TOTAL: 1254.15 987.56 T....,. DRTE A8li4192 PROVIDER VOIfCitER LISTING PAGE 1 (PV003) FOR PROVIDER: 74-21T4i29 SFEC!€ riD, FRED FOR CROUP: TPlt-0029 KERR COtDiTY SE~?ENCE N0: 2 PATIENT CLAIM INCURRED COVERED TOTAL CLAI!lANT DEP. N0. NO. FROM TO CHARGE PAID :.ssssassssaxsssass=a«,sassasxssassssassassssssasassaas sssossssesssss~ossssesssass- P DRISCOtt E 4404489214 A2119/92 62/19!92 25. A4 22.8!# CROiiP TOTAL : 25.OD 22. SO PROVIDER T6TAt: 29.OD ?2.80 T...a. BATE 08/14/92 PROVIDER U01~1tER tISTIkC PAGE 1 iPV003~ fOR PROVIDER: 7+1-0537175C H E 8 PIMRIIACY ~9 f0R 6R041P: TPX-0024 KERB COtlkT4 SE~kCE H0: 3 PATIfkT CLAI11 IlipfRRED COVEREi TOTAL CLA2MAkT DER. MO. k0. FROIi TO CBAR6E PAID c..ssazaces=osa. zsceae..aca..ons ao.aasae-xsessaa=:xoaaseazs-:exr_eo:aestssasecc:xssa M CAkTU E 250542 9000573628 01/0219? 07/02/92 104.56 104.56 k DU101AM E 262249 9200106302 06/15192 07/24/92 80.41 80.47 D ERICSOk E 261314 9000488617 07/08/92 07/28/97 149.09 149.09 6 FLORA E 261476 9000489326 06/29/92 07/16/92 114.73 119.73 D 6ARR4 E 260743 9200061306 06/16!92 06/22/92 33.3+1 33.34 k HUROk F 211486 9700081402 47113192 47113/9? 8.98 8.98 G LI6O11 E 261075 9000492013 06/25/92 06/25/9? 59.49 39.49 J lONRFY F ?63417 9000492627 05!05/9? 47!18/9? 108.96 102.74 C ORCUTT E 258669 9200116402 07!03192 07!03/92 24.67 24.67 R PIEPER E Z5S003 9000492421 04/04/92 07/01/92 12.99 12.99 T ROBERTS E 253944 9200080904 07/14197 47!14/97 55.21 55.21 N MILLIS E 263425 9000493308 05/19/92 07/17/42 bS.56 69.Sb CR08P TOTAL: $18.OS 811.83 PROUIDFR iOTAI: 818.05 $11.83 t.- . _.. BATE 08114/42 PROVIBER U011CNfR LISTING PACE 3 tPU4031 FOR PROUIDFR: 74-1948376 COriE2 SKIN PATNOLOCP SERA FOR 6R1#fP: TPR-0424 NERR COUtTY SEQUENCE 110: 4 PATIENT CLAIM INClRZREB COt1ERE0 TOTAL CLAIlIAtlT BEP. N0. N0. FROM TO p1ARCE F~AID ssoe:ssnrt.eaa=secxoscaexe.oessseasesaea=aznr_=~aoessaaxxa~xa==;es:aaai:==ccnsx..c.s R PIEPER E 9040442923 04/04/92 41/43/92 50.04 42.3a 67t01JP TOTAL : 54.OD 42.38 PROVIBER TOTAL: 54.00 42.35 T., ..~. GATE 08!14/9Z PRWIDER VOUCHER LISiiNC PASE 1 tPV4031 fOR PROVIDER: 74-307828$ ANE&TNE6IA ASSOCIATES Ft1R GROUP: TPlt-0024 KFRR COUNTY SEQUEHCf NO: 5 PATIEKi CLAIq INCURRED COVERED TOTAL CLAIMANT DEP. N0. !~. FROM i0 CHARSE PAID ====t=====_==:_~~:: n=====-====-=-====-=-=====-====-=======-==-==~======_===__===_ D MARSGIRLL E 003805 92000b4610 64!13!92 04!13!92 320.0Q 143.52 6ROtR TOTAL: 3ZO.OD 143.52 PROVIDER TOTAL: 320.04 143.52 r.- ... DATE 4$/14192 PRWIDER VOUCHER LISTING PACE } fPV443} F4R PROVIDER: 511-58-?142 MITCAEII MD, ROBERT f FOR CROUP: TPR-0024 KERR COUNTY SEQUENCE !!O: 6 PATIENT CLAIM INCU(UtED fAVERfB TOTAL CLAIMANT DEP. NO. Nfl. FROM TO CNARCE PAIR csas=sco.:seeeeczs~rzexss:==eaeec_xaetano==~eaesasee:taataoezssa:a~sote_ eaeecesasme H PADILLA E 97427945 4044491107 4b/12l92 47/22/92 45.44 75.94 6R'OUP TOTAL: 45.44 x.44 PROVIDER TOTAL: 45.44 25.44 1.~ .,1. GATE 08/14/92 PROVIDER VWCiEER liSTI11G PAGE 1 ~34iO03? FOR PROVIDER: 74-2456173 MAt! MB, itlOMAS FOR CROOP~ TPR-0024 KERB COUiRY SEQUENCE lM1: 7 PATIEM'i CLAIM I10X1RRED COVERFfl TflTA! CLAIf(AMT BEP. M0. MD. FROM TO CNARCE PAID :33'L~L3O-SSA--~LCCS~DS~3--CS~~~---~~C4CDSCLSi~.~~~SlT.SOC~SCt~~~~=lO-~~CSC~-C~T.C~SSSIi C p8lIKY E 9200063115 03/10/92 07/29/92 170.fl0 152.80 6ROtV' TOTAL : 170.OD 13Z. 8A PROVIDER TOTAL: 110.00 152.80 T.i ..,. DATE 08/14!92 PROVIDER VOUCJIER LISTING PA6f t {P0003~ FOR PROVIDER: 74-2452361 ALAl10 PNYSICIA115 SERVICE FOR GROUP: TPK-0024 KERB COUkTY SEQUENCE NO: 8 PATIENT CLAIt! INClAtRED COVERED TOTAL CLAIbANT DEP. i'Ki. il0. fRtM! TO COARSE PAID aos~a=rsszsaass aoeeasts:ecezszxoeacaa.esasereoso:ax.sse:oeoa:=soesooos.esc,.acx.eaoe C COLLINS F 194016 9200105503 06/23192 06/23/92 160.OD 51.11 D GARRP E (93533 9240061306 06/15/42 06/22/92 58.00 33.45 C HOilELL F 9204125001 1f/ZO/91 11/20/91 82.00 51.71 D SANCREZ E 0092481 9000490316 09128/92 05/28/'92 290.00 99.07 H NILLIS E 0019202472 9000493508 091(9/92 01117192 110.00 48.78 TOTAL: 660.00 244.12 PROVIDER TOTAL: 664.00 244.72 T... A. DATE 08/!4/92 PROVIDER t1011CNER lISTII~ PASS ! 4PV0031 FOR PROVIDERS 74-1557820 SID PETERSOK MEd HOSPITAL FOR CROt1P: TP1l-0024 KERR COU1lTY SEQUEKGE M0: 9 P'ATIEitT CLAI11 I1p:11~tED COVERED 1O1AE CLAIfIAMT BEP. N0. 110. FROM TO C1IARCE PAiD rasosaeanszas=co.sre~sez:sasssoseae.axe:namssoo..aaass=a=a:asezsoaaeaaex=c:r_:ocsesx~ E CEPEDA E 533720 924412340f 07114192 87/f 7192 121.25 121.35 B DREISS E 531473 9000491619 46/29/92 46/29/42 84.50 89.50 K DUiNIRM E 531829 9240106342 06/15/92 47/24/92 641.40 64!.44 S FL03iA E 6884131 4000484326 46/29/92 07!16/92 19.75 19.75 R KIK~S f 234443 9004493116 02/14192 02/19/92 2190.18 219'4.78 S KIA.LFABERS E 699748 9000524004 07!17/91 07/17/91 215.00 215.00 q LEE E 361896 4240123201 09/27/92 09!2719? 1131.15 1151.15 J LOAREY f 514820 9000492627 05/05/92 07118/92 126.25 126.25 B PADILLA E 531713 9000491147 06112/92 47/22/92 127.50 127.SD A ROYBAL E 9?00029511 07/12/92 07/12/42 102.50 102.50 B SAKCKEZ E 224016 9044490315 OS/Z8/92 06/41/92 2525.55 2194.56 J tID11Ell E 53365 9200145402 47/14192 07115/42 T31.50 231.90 4: 11ALIKY E 53148b 9240(163115 03/14192 07/29/92 160.40 164.00 J WALIKY E 531737 9204105705 05121!92 07/22/92 246.40 296.40 W AILLIS E 531671 9004493508 05119!92 07/17!92 152.50 152.50 SROUP TOTAL: 8095.23 7729.24 PROVIDER 10TAL: 809'x.23 7729.24 T.~ .... DATE 48/14/92 PROVIDER VtM1C11ER tISTIk6 PACE 1 4Pi1003} FOR PROIRDER: 1+!-1738370 DELAAEI~ AD, R CORD011 F4R CRO1D': TP%-4424 KERR ~OUk'TY SEQUEkCf k0: 10 PRTIElR q.AIQ IkE~D C~lERE9 TOTAL CLAIRAk1 DEP. IlO. k0. FRDM TO CNAR6f PAID xxsszxrxxsxzzxssazzxzxsxz:zzxazzaxssxxxaasszexxsaazx~xsxzasxasaxosxacsxocoaxzaxzsaaz J DOI6REN E 44i0S076 4244123341 43114!91 43/14/41 85.40 63.41 CROt1P TDTRL: 85.44 63.01 PR~IIDER TOTAL: 85.40 63.01 T.~ _.,. DATE 08/11/92 PROVIDER 4OIICRER LISTII~6 PARE 1 tPd043) FOR PROVIDER: 74-2391281 SYAp MD, MILTON D FOR 6ROtlP: TPS-0014 KERB COUlRY SEQUENCE MO: 11 PRTIERT CLAIM IMCIAtRED COVERER TOTAL CLAIMANT DEP. N0. N0. FR+~I TO CNAR6E PAID ccosenne_csos==ose-.ease-coons:so_so~-=Doan:c:oosxcoo~axssocec~c_oosessoor-c~_sosoccc D ERICSON E 220300 9040188617 07!08/92 47/28/92 17.04 29.44 GROlM' TOTAL: 47.06 29.04 PROVIDER TOTAL: 11.04 29.01 T.. _.~. DATE 08/14!9? PROVIDER V011CNER LISTING PA4'f 1 (PV0431 FOR PROVIDER: T4-14193~i AItt CO NiiCtEAR IDA6ING FOR CROIA': TPX-0024 KERB COIRfTY SEQUENCE N0: 12 PATIEltT CLAI11 INCURRED COVERED TOTAL CLAIMANT DEP. NO. 110. FROM TO CNARCE PAID :xsaasssxesssaaca.saa.ssaxssessso e:z~zxzasrrs~sooess~~a==aeo=.e-e~~eaaaa:se~e..e-as C YALIKY E 148481 92404b3115 03!14!92 07!29!91 161.40 b8.58 J {IALIKV E !3479! 9204!05745 45/2!/92 47122/92 801.08 222.00 6ROElP TOTAL: 9b1.00 194.58 PROVIDER TOTAL: 9b2.00 190.58 T....i. DATE 88/i4/9Z PROVIDER VOt1CNER LISTING PACE i tPa6431 f0~t PROVIBfR: 74-2251047 VIII W BIIR INACIN6 FOR 6R~IP: TPR-4024 1lERR EAINiTV SEQUENCE N0: i3 PATIENT CLRIM iNCURREII COVERFi i4TAl CLAIMANT DEP. !~. N0. FROM TO CNAR6E PRID easnt=ss=zxe=:cse.a~:-ss.s...xas.zscas~:seseea~zacosesaeaa_set:~snz=ccaaae;seszxcss J QALII{Y E i3479f 9246145745 85!21!92 47!22/92 Z1b.86 102.44 CROEIP T4TAl Zj b. 00 14Z. 44 PROVIDER TOTRL: E16.44 142.44 1. .t. DATE 08!14/92 PROVIDER VOUCHER EISTITl6 PACE i (PV003f FOR PROVIDER: 74-1915643 IIFLLS MD, JA1lES D FOR CRDUP: TPX-0029 KERB CDtNITY SEQI~ilCE NO: 19 PATIEtR CLAIM IIICIIRRED COVERED tOTAL ClAIgAKf DEF. N0. !!0. FROl1 TO CHARGE PRID oszaaaaxszeaeexzxoeaaazac:aaezzzeasszaaas=sz:-:ssasaaxsasxaes.azsex+eaazzae_eo_x°xsas N DUlgIAM E 92001063tl2 06l15J9Z 07/29/92 150.OD 72b.08 6 FLORA E 90000489326 46/29192 07/16/42 2'5.00 23.70 ~Ot1P TUTRl: 775.04 749.76 PRWIDER TOTAL: 775.OD 749.78 T....~. BATE 48/14!92 PROVIDER VOUCRER LISTING PACE 1 tpp003} FOR PROVIDER: 7i-2621366 MD, DAN FOR CR01~: TPR-00?9 tiERR COUNIY SEQUENCE N0: 15 PATIENT CLAIM INCURRED COVERED TOTAL CLAIMANT DEP. N0. NO. FROM i0 CNARGE PAIO s:seaxxsm=xxxsae~rsrxseaoaassao_sass=-!zsssncxsmsneassaase_ssosan:sesc=asxaaazssss C IMLIKY E 9204063115 43/10/92 47/29/92 34.04 23.74 J {IALIKV E 9244105705 45!21!92 41/22/92 143.91 23.70 6'ROtIP TOTAL : 133.91 47.40 _~ ~ .. PROVIDER TOTAL: 133.91 97.94