36C25020Q0004-005.pdf
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36C25020Q0004 ATCH-2 - Trip Report 36C25019D0710 from 1-31Aug19 (Redacted).pdf
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Date: Time:9/19/2019 3:22:32PM
Picked Up Report
Date Range: 8/1/2019 - 8/31/2019
Category: FREESTANDING ESRD FACILITY
KIDNEY CARE COLUMBUS
Trip Num DOS Patient Name Total Bill Debs/Creds Balance
Location:
00000007237F 8/15/2019
00000007263F 8/20/2019
00000007340F 8/31/2019
Totals for location: KIDNEY CARE COLUMBUS Num Trips: 3
MID AMERICA DIALYSIS
Trip Num DOS Patient Name Total Bill Debs/Creds Balance
Location:
00000007339G 8/31/2019
Totals for location: MID AMERICA DIALYSIS Num Trips: 1
Totals for category: FREESTANDING ESRD FACILITY Num Trips: 4
Category: HOSPITAL
DUBLIN METHODIST HOSP
Trip Num DOS Patient Name Total Bill Debs/Creds Balance
Location:
00000007232F 8/13/2019
00000717888 8/13/2019
Totals for location: DUBLIN METHODIST HOSP Num Trips: 2
JAMES CANCER HOSPITAL
Trip Num DOS Patient Name Total Bill Debs/Creds Balance
Location:
00000007186F 8/8/2019
Totals for location: JAMES CANCER HOSPITAL Num Trips: 1
MT CARMEL EAST
Trip Num DOS Patient Name Total Bill Debs/Creds Balance
Location:
00000007171F 8/5/2019
00000007246F 8/15/2019
00000007344F 8/30/2019
Totals for location: MT CARMEL EAST Num Trips: 3
RIVERSIDE METHODIST HOSP
Trip Num DOS Patient Name Total Bill Debs/Creds Balance
Location:
00000007170F 8/5/2019
00000007268F 8/19/2019
00000007274F 8/20/2019
Page 1 / 6
Totals for location: RIVERSIDE METHODIST HOSP Num Trips: 3
ST ANNS HOSPITAL
Trip Num DOS Patient Name Total Bill Debs/Creds Balance
Location:
00000007237G 8/15/2019
Totals for location: ST ANNS HOSPITAL Num Trips: 1
VA COLUMBUS
Trip Num DOS Patient Name Total Bill Debs/Creds Balance
Location:
00000007140F 8/1/2019
00000007150F 8/2/2019
00000007151F 8/2/2019
00000007153F 8/3/2019
00000007154F 8/3/2019
00000007155F 8/3/2019
00000007157F 8/4/2019
00000007158F 8/4/2019
00000007159F 8/4/2019
00000007160F 8/4/2019
00000007161F 8/2/2019
00000007172F 8/5/2019
00000007173F 8/5/2019
00000007174F 8/5/2019
00000007175F 8/5/2019
00000007179F 8/6/2019
00000007180F 8/6/2019
00000007181F 8/6/2019
00000007190F 8/7/2019
00000007191F 8/7/2019 0
00000007196F 8/8/2019
00000007197F 8/8/2019
00000007198F 8/8/2019
00000007200F 8/8/2019
00000007201F 8/8/2019
00000007212F 8/9/2019
00000007214F 8/9/2019
00000007215F 8/10/2019
00000007216F 8/10/2019
00000007217F 8/10/2019
00000007218F 8/11/2019
00000007227F 8/12/2019
00000007228F 8/12/2019
00000007229F 8/12/2019
00000007239F 8/14/2019
00000007240F 8/14/2019
00000007241F 8/12/2019
00000007242F 8/14/2019
00000007247F 8/15/2019
00000007255F 8/16/2019
00000007256F 8/17/2019
Page 2 / 6
00000007163F 8/6/2019
00000007168F 8/6/2019
00000007176F 8/7/2019
00000007178F 8/7/2019
00000007183F 8/8/2019
00000007185F 8/8/2019
00000007187F 8/8/2019
00000007189F 8/7/2019
00000007192F 8/9/2019
00000007193F 8/9/2019
00000007195F 8/9/2019
00000007203F 8/10/2019
00000007207F 8/12/2019
00000007208F 8/12/2019
00000007209F 8/12/2019
00000007210F 8/12/2019
00000007220F 8/13/2019
00000007222F 8/13/2019
00000007224F 8/13/2019
00000007231F 8/14/2019
00000007233F 8/14/2019
00000007235F 8/15/2019
00000007245F 8/16/2019
00000007249F 8/17/2019
00000007253F 8/19/2019
00000007260F 8/20/2019
00000007270F 8/20/2019
00000007273F 8/21/2019
00000007278F 8/22/2019
00000007280F 8/22/2019
00000007281F 8/22/2019
00000007292F 8/24/2019
00000007300F 8/27/2019
00000007303F 8/27/2019
00000007311F 8/28/2019
00000007316F 8/28/2019
00000007317F 8/28/2019
00000007320F 8/29/2019
00000007330F 8/30/2019
00000007337F 8/29/2019
00000007339F 8/31/2019
Totals for category: RESIDENCE Num Trips: 46
Category: RESIDENTIAL/CUSTODIAL FACILITY
BROOKDALE CHESTNUT HILL
Trip Num DOS Patient Name Total Bill Debs/Creds Balance
Location:
00000007177F 8/7/2019
00000007225F 8/13/2019
Totals for location: BROOKDALE CHESTNUT HILL Num Trips: 2
Page 4 / 6
BROOKDALE PINNACLE
Trip Num DOS Patient Name Total Bill Debs/Creds Balance
Location:
00000007211F 8/12/2019
00000007223F 8/13/2019
00000007314F 8/28/2019
$ Totals for location: BROOKDALE PINNACLE Num Trips: 3
Totals for category: RESIDENTIAL/CUSTODIAL FACILIT Num Trips: 5
Category: SKILLED NURSING FACILITY
CROWNE POINT NH
Trip Num DOS Patient Name Total Bill Debs/Creds Balance
Location:
00000007133F 8/1/2019
00000007134F 8/1/2019
00000007143F 8/3/2019
00000007165F 8/6/2019
00000007184F 8/8/2019
00000007188F 8/7/2019
00000007204F 8/10/2019
00000007213F 8/10/2019
00000007221F 8/13/2019
00000007226F 8/13/2019
00000007236F 8/15/2019
00000007238F 8/15/2019
00000007244F 8/16/2019
00000007250F 8/17/2019
00000007251F 8/17/2019
00000007262F 8/20/2019
00000007279F 8/22/2019
00000007293F 8/24/2019
00000007294F 8/24/2019
00000007302F 8/27/2019
00000007304F 8/27/2019
00000007322F 8/29/2019
00000007324F 8/29/2019
00000007341F 8/31/2019
00000007596F 8/26/2019
Totals for location: CROWNE POINT NH Num Trips: 25
DARBY GLENN NH
Trip Num DOS Patient Name Total Bill Debs/Creds Balance
Location:
00000007132F 8/1/2019
00000007147F 8/5/2019
00000007194F 8/9/2019
00000007230F 8/14/2019
00000007243F 8/16/2019
00000007252F 8/19/2019
00000007264F 8/20/2019
00000007295F 8/26/2019
00000007301F 8/27/2019
Page 5 / 6
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