Bad Debt Write Off Report by pengtt

VIEWS: 61 PAGES: 7

									                                                                               Bad Debt Write Off Report

                                                                Date:           1/30/2006         Time:        5:31:03PM

                                                                                    GOLDEN CARE EMS
                                                                                    7500 GENERAL WAY
                                                                                        PO BOX 4500
                                                                                   BRAVERTON, PA 15666

                                                                        Transaction Date Range: 01/30/2000 - 01/30/2006


Patient Name                   Trip Num           DOS         Address                 City                    State Zip        DOB         Trans Date   Phone        Billed       Trans Amount
SSN                          Picked Up Location                                                   Taken To Location                        Trans Desc
Comments

IRILOND, CARL E                00000021626         12/22/2002 1261 MONROE             PITTSBORO               PA      13601-   7/18/1967   1/15/2004    ( )   -         $344.65           $344.65
 - -                         HWY 65 & 190, PITTSBORO PA 64601                         JACKSON MEDICAL CENTER                               WRITE OFF TO BAD DEBT



Tue Aug 26, 2003 11:55:44:
ADDED FROM OLD A/R FILE

Thu Jan 15, 2004 10:01:05:
PT XIX ENDED 06-30-02 PT DECEASED-NO ESTATE-----WRITE OFF BAD DEBT




MORINO, MICHAEL A              00000035115         6/7/2003                         MINNEAPOLIS
                                                              2336 PORTLAND AVE SOUTH #11                     MN      55303-   11/1/1958   4/2/2004     ( )   -         $648.00           $648.00
897-66-7179                  HWY 36 W, BRECKENRIDGE PA 64625                          JACKSON MEDICAL CENTER                               WRITE OFF TO BAD DEBT
CALLED TO MVA THAT HAPPENED ABOUT 1 OR 2 HOURS BEFORE WE WERE CALLED AND TROOPERS THOUGHT HE WAS NOT ACTING NORMAL. UPON ARRIVAL PT WAS
WALKING ALONG ROADWAY AND STATES HE IS NOT HURT AND DOES NOT WANT TREATED PT DID AGREE TO TRANSPORT. PT ANSWERS QUESTIONS OK AND HAS
INAPPROPRIATE BEHAVIOR.
HEENT- EYES NORMAL
NECK NORMAL
CHEST- DENIES PAIN OR SOB
CARDIAC MONITOR- NSR
ABN- SOFT AND NON TENDER
EXT- PT MAE NO EDEMA
SKIN-WET
PT REFUSES TO LET US START IV BUT DID AGREE TO D STICK. CARDIAC MONITOR AND PULSE OX. he SAID ANY OTHER TREATMENT NEEDS TO BE DONE AT HOSPITAL.

Tue Jul 01, 2003 10:52:28:
SENT HIPAA FORM TO PT TO SIGN



Wed Oct 08, 2003 10:42:10:
MEDICA INS DENIED AS INELIGIBLE SHOULD BE AUTO INS LIABILITY
CALLED HOSPITAL-NO OTHER INS INFO AVAILABLE FORM THEM

Thu Dec 11, 2003 13:58:18:
1ST LETTER



Mon Jan 12, 2004 11:38:26:
DELIQ

Thu Feb 26, 2004 13:30:27:
FINAL



Fri Mar 26, 2004 10:56:03:
COLLECTION



Fri Apr 02, 2004 09:22:01:
KCI REFUSED CLAIM---THEY CAN'T COLLECT IN STATE OF MINNESOTA---WRITE OFF BAD DEBT




                                                                                                                                                              Page      1 /           7
Patient Name              Trip Num           DOS          Address          City                    State Zip        DOB         Trans Date   Phone            Billed       Trans Amount
SSN                     Picked Up Location                                             Taken To Location                        Trans Desc
Comments

MORRIOTT, PHILLIP E       00000035339         9/5/2003    BOX 25           WHEELING                PA      13688-   9/23/1943   4/23/2004    ( )   -             $557.00           $43.15
111-68-7696             605 MISSOURI AVE, PITTSBORO PA 64601               JACKSON MED CENTER                                   WRITE OFF TO BAD DEBT
TRANSPORTING PATIENT TO HMC FOR EVALUATION OF BEING STRUCK IN THE HEAD 2 DAY'S AGO, AND HAS SEVERAL STITCHES IN THE FRONTAL REGION OF HIS HEAD,
AND THE RIGHT TEMPORAL REGION OF HIS HEAD. ETOH ON BOARD, STATES THAT HE HAS HAD HIS HEAD HURTING SINCE THIS ALL BEGAN. DENIES HAVING ANY PAIN
MEDS FOR HIS HEAD AS WELL. STAGGERED OUT TO THE COT, WITH ASSISTANCE FROM EMS AND CPD. TOOK SET OF VITAL SIGNS AND TRANSPORTED THE PATIENT TO
THE HOSPITAL END OF REPORT P-11205

Thu Sep 18, 2003 10:54:37:
SENT AUTHORIZATION AND HIPAA FORMS TO PT TO SIGN



Fri Oct 24, 2003 15:19:45:
RESENT AUTHORIZATION AND HIPAA FORMS TO PT TO SIGN



Tue Dec 09, 2003 08:33:21:
RESENT AUTHORIZATION AND HIPAA FORMS TO PT TO SIGN--CORRECTED ADDRESS FROM HMC




Mon Mar 01, 2004 13:43:53:
SENT AUTHORIZATION AND HIPAA FORMS TO PT TO SIGN



Tue Mar 16, 2004 14:45:18:
RESENT AUTHORIZATION AND HIPAA FORMS TO PT TO SIGN---NEW ADDRESS 605 PERSHING RD LACLEDE

Fri Mar 19, 2004 09:48:12:
MAIL RETURNED AS MOVED NO FORWARDING ADDRESS

04-19-04
MAIL RETURNED---NO FORWARDING


OSHFORD, TERRY J          00000033009         6/12/2003   1318 COOPER ST   PITTSBORO               PA      13601-   7/20/1974   1/12/2004    (412) 757-5543      $868.00           $75.00
696-78-7999             JACKSON MEDICAL CENTER                             FREEDOM HOSPITAL                                     WRITE OFF TO BAD DEBT




                                                                                                                                                   Page          2 /           7
Patient Name                       Trip Num           DOS           Address                        City                        State Zip             DOB           Trans Date     Phone             Billed       Trans Amount
SSN                              Picked Up Location                                                               Taken To Location                                Trans Desc
Comments

EMERGENCY ROM DOCTOR-CAMPBELL
PATIENT DOCTOR-UNKNOWN
Thu Jun 12, 2003 23:03:39: 28M06/12/2003 22:20HEDRICK MEDICAL CENTERLIBERTY HOSPITALABDOMINAL PAIN 01
 Time: 06/12/2003 22:05 - Perf By: 2, Pulse Rate: 80, Card. Rthm: Not applicable, Resp Rate: 20, Resp Effort: Non-Labored, Syst: 139, Diast: 88, Palp: , Skin Perf: Normal, Skin Color: PINK, Skin Temp:
NORMAL, Skin Moist: NORMAL, Treatment: , Comments: , GCS Eye: 4-Opens eyes spontaneously, GCS Verbal: ,GCS Motor: , GCS Total: 15, Ectopy: , Pulse Ox: 93, Glucose: , Left Lung: CLEAR ,
Right Lung: CLEAR , Left Pupil: , Right Pupil:

 Abdominal pain

HEENT-NG TUBE CLAMPED OFF AND IN PLACE
NECK-NE
CHEST-PT DENIES CHEST PAIN OR SOB
CARDIAC MONITOR-NE
LUNG SOUNDS-CLEAR
HEART TONES-CLEAR
ABDOMEN- C/O PAIN
PELVIC AREA-NE
GENT/RECTA-NE
UPPER EXTREMITIES-MAE
LOWER EXTREMITIES-MAE NO EDEMA NOTED
SKIN-NORMAL
NURO-NORMAL

TREATMENTS
1-ASSESSMENT WITH VITALS
2-PULSE OX
3-MAINTAIN IV KO
4-HEMO DYNAMIC MONITOR
5-
6-
7-
8-
9-
10-

NOTES-
Thu Jun 12, 2003 23:04:40:

Tue Jul 08, 2003 16:41:50:
SENT HIPAA FORM TO PT TO SIGN



Wed Aug 13, 2003 08:44:02:
SENT INV TO PT FOR BALANCE

Fri Oct 10, 2003 12:03:31:
1ST LTR



Mon Nov 10, 2003 13:40:37:
DELIQ



Thu Dec 11, 2003 14:15:09:
FINAL



Mon Jan 12, 2004 11:37:15:
WROTE OFF TO BAD DEBT---TO SMALL AMOUNT TO SEND TO KCI


PRINDLI, STEVEN H                  00000031070          7/2/2003    268 S MAPLE                    GALLATIN                    PA      13630-        9/13/1967     4/13/2004     (412) 333-4347        $868.00           $75.00
111-88-8799                     JACKSON MEDICAL CENTER                                             FREEDOM HOSPITAL                                                WRITE OFF TO BAD DEBT




                                                                                                                                                                                      Page             3 /           7
Patient Name                       Trip Num           DOS           Address                       City                        State Zip             DOB          Trans Date     Phone             Billed        Trans Amount
SSN                              Picked Up Location                                                              Taken To Location                               Trans Desc
Comments

EMERGENCY ROM DOCTOR-
PATIENT DOCTOR-
Wed Jul 02, 2003 21:05:05: 35M07/02/2003 19:30HEDRICK MEDICAL CENTERLIBERTY HOSPITALCHEST PAIN /DISCOMFORT 08
 Time: 07/02/2003 20:01 - Perf By: 2, Pulse Rate: 86, Card. Rthm: Normal Sinus Rhythm, Resp Rate: 20, Resp Effort: Non-Labored, Syst: 135, Diast: 64, Palp: 0, Skin Perf: Normal, Skin Color: PINK,
Skin Temp: NORMAL, Skin Moist: NORMAL, Treatment: , Comments: , GCS Eye: 4-Opens eyes spontaneously, GCS Verbal: ,GCS Motor: , GCS Total: 15, Ectopy: NO, Pulse Ox: 95, Glucose: , Left
Lung: CLEAR , Right Lung: CLEAR , Left Pupil: PERL, Right Pupil: PERL
 Time: 07/02/2003 20:20 - Perf By: 2, Pulse Rate: 74, Card. Rthm: Normal Sinus Rhythm, Resp Rate: 16, Resp Effort: Non-Labored, Syst: 129, Diast: 74, Palp: 0, Skin Perf: Normal, Skin Color: PINK,
Skin Temp: NORMAL, Skin Moist: NORMAL, Treatment: , Comments: , GCS Eye: , GCS Verbal: ,GCS Motor: , GCS Total: , Ectopy: , Pulse Ox: 99, Glucose: , Left Lung: , Right Lung: , Left Pupil: ,
Right Pupil:
 Time: 07/02/2003 20:50 - Perf By: 2, Pulse Rate: 77, Card. Rthm: Normal Sinus Rhythm, Resp Rate: 18, Resp Effort: Non-Labored, Syst: 126, Diast: 81, Palp: 0, Skin Perf: Normal, Skin Color: PINK,
Skin Temp: NORMAL, Skin Moist: NORMAL, Treatment: , Comments: , GCS Eye: 4-Opens eyes spontaneously, GCS Verbal: ,GCS Motor: , GCS Total: 15, Ectopy: NO, Pulse Ox: 99, Glucose: , Left
Lung: , Right Lung: , Left Pupil: , Right Pupil:
 Time: 07/02/2003 21:10 - Perf By: 2, Pulse Rate: 65, Card. Rthm: Normal Sinus Rhythm, Resp Rate: 20, Resp Effort: Non-Labored, Syst: 124, Diast: 82, Palp: 0, Skin Perf: Normal, Skin Color: PINK,
Skin Temp: NORMAL, Skin Moist: NORMAL, Treatment: , Comments: , GCS Eye: 4-Opens eyes spontaneously, GCS Verbal: ,GCS Motor: , GCS Total: 15, Ectopy: NO, Pulse Ox: 99, Glucose: , Left
Lung: , Right Lung: , Left Pupil: , Right Pupil:

 Chest pain

HEENT
NECK
CHEST
CARDIAC MONITOR
LUNG SOUNDS
HEART TONES
ABDOMEN
PELVIC AREA
GENT/RECTAL
UPPER EXTREMITIES
LOWER EXTREMITIES
SKIN
NURO

TREATMENTS
1-
2-
3-
4-
5-
6-
7-
8-
9-
10-

NOTES-



Fri Jul 25, 2003 10:34:13:
SENT HIPAA FORM TO PT TO SIGN

Thu Aug 28, 2003 09:35:59:
SENT BILL TO PT FOR BALANCE

Fri Jan 12, 2004 11:34:25:
1ST LETTER

Wed Feb 11, 2004 13:41:44:
DELIQ



Tue Mar 16, 2004 10:48:38:
FINAL


SMITH, GERALD W                    00000035054         5/21/2003    118 TRENTON RD                PITTSBORO                   PA     13601-        12/23/1953    6/24/2003      ( )   -               $357.00           $357.00
686-68-6918                     JACKSON MEDICAL CENTER                                            GRAND RIVER HEALTH CARE                                        WRITE OFF TO BAD DEBT
TRANSPORTING PT TO NURSING HOME. HE WAS TRANSFERRED TO HMC FOR NOT WANTING TO TAKE HIS MEDS. PT WAS FOUND TO BE SEPTIC, WITH SLIGHT PNEUMONIA
IN LOWER LOBE. PT WAS ALERT TO EYE OPENING ONLY, SOME VERBAL RESPONSE, NOT MUCH THOUGH. MOVED PATIENT TO THE COT, AND TRANSFERRED TO NURSING
HOME. CARE WAS TURNED OVER TO NURSING HOME STAFF. END OF REPORT, P-11205

Tue Jun 24, 2003 16:17:24:
RECEIVED DIAGNOSIS CODES FROM HMC




Tue Jun 24, 2003 16:17:59:
M/CAID WRITE OFF DUE TO BEING NON-EMERGENCY




                                                                                                                                                                                      Page            4 /           7
Patient Name                       Trip Num           DOS           Address                       City                        State Zip             DOB           Trans Date    Phone              Billed         Trans Amount
SSN                              Picked Up Location                                                              Taken To Location                                Trans Desc
Comments

SOMM, BARBARA J                    00000031131         8/25/2003    PO BOX 83                     CONWARE                     PA      13635-        7/20/1932     10/23/2003    (412) 332-3752          $627.00            $56.84
779-86-7671                     PO BOX 84, CHULA PA 64635-                                        JACKSON MEDICAL CENTER                                          WRITE OFF TO BAD DEBT
EMERGENCY ROOM DOCTOR:CAMPBELL
PATIENT DOCTOR: SENSENICH
 Mon Aug 25, 2003 12:48:58: MEDICAL Treated, transported by EMS
Respiratory distress
6.61
Protocol (standing orders)

  NKDA
{
Tbl.TripEKGResults}NSR

 Time: 11:45: Treatment: ALS - IV INFUSION , Att: 1, Succ: 1, Perf By: 2, Route: , Qty: , UOM: , IV Rate: KVO
 Time: 11:45: Treatment: ALS - EKG MONITOR, Att: 1, Succ: 1, Perf By: 2, Route: , Qty: , UOM: , IV Rate:
 Time: 11:45: Treatment: BLS - OXYGEN BY MASK, Att: 1, Succ: 1, Perf By: 2, Route: NRB, Qty: 15, UOM: LPM, IV Rate:
 Time: 11:42: Treatment: ALS - DRUG ADMINISTERED, Att: 1, Succ: 1, Perf By: 2, Route: IV, Qty: 4, UOM: ML, IV Rate:
 Time: 11:42: Treatment: ALS - DRUG ADMINISTERED, Att: 1, Succ: 1, Perf By: 2, Route: NEB, Qty: 3, UOM: ML, IV Rate:



 Time: 08/25/2003 11:42 - Perf By: 2, Pulse Rate: 100, Card. Rthm: Normal Sinus Rhythm, Resp Rate: 30, Resp Effort: Labored, Syst: 110, Diast: 62, Palp: 0, Skin Perf: Normal, Skin Color: PALE, Skin
Temp: NORMAL, Skin Moist: NORMAL, Treatment: , Comments: , GCS Eye: 3-Opens eyes in response to verbal stimulation, GCS Verbal: ,GCS Motor: , GCS Total: 10, Ectopy: NO, Pulse Ox: 88,
Glucose: 131, Left Lung: RALES, Right Lung: RALES, Left Pupil: PERL, Right Pupil: PERL

TripInfo.sPatAge} 71
F
08/25/2003 11:29
TripInfo.sPatientPickedUp}
HEDRICK MEDICAL CENTER
RESPIRATORY DISTRESS 17

 Breathing difficulty

Drugs given 40 MG LASIX IVP AND SWVN WITH PROVENTAL AND ALBUTEROL



NOTES:



Thu Oct 23, 2003 15:13:15:
WRITE OFF BALANCE. DECEASED 8-27-03              NO ESTATE


SOMM, BARBARA J                    00000033107         8/25/2003    PO BOX 83                     CONWARE                     PA      13635-        7/20/1932     10/23/2003    (412) 332-3752          $868.00           $101.31
779-86-7671                     JACKSON MEDICAL CENTER                                            FREEDOM HOSPITAL                                                WRITE OFF TO BAD DEBT




                                                                                                                                                                                     Page               5 /           7
Patient Name                      Trip Num            DOS          Address                        City                       State Zip           DOB          Trans Date    Phone             Billed          Trans Amount
SSN                              Picked Up Location                                                              Taken To Location                            Trans Desc
Comments

EMERGENCY ROOM DOCTOR:CAMPBELL
PATIENT DOCTOR: SENSENICH
 Mon Aug 25, 2003 18:17:35: MEDICAL Treated, transported by EMS
Respiratory distress
7.84
Written orders (patient specific)

  NKDA
{
Tbl.TripEKGResults}

 Time: 18:00: Treatment: BLS - PULSE OX, Att: 1, Succ: 1, Perf By: 2, Route: , Qty: , UOM: , IV Rate:
 Time: 18:00: Treatment: BLS - OXYGEN BY MASK, Att: 1, Succ: 1, Perf By: 2, Route: NRB, Qty: 15, UOM: LPM, IV Rate:
 Time: 18:00: Treatment: ALS - IV MAINTAINED, Att: 1, Succ: 1, Perf By: 2, Route: IV, Qty: , UOM: MG, IV Rate: KVO



 Time: 08/25/2003 18:00 - Perf By: 2, Pulse Rate: 121, Card. Rthm: , Resp Rate: 28, Resp Effort: Labored, Syst: 141, Diast: 110, Palp: 0, Skin Perf: Normal, Skin Color: PINK, Skin Temp: NORMAL,
Skin Moist: NORMAL, Treatment: , Comments: , GCS Eye: 4-Opens eyes spontaneously, GCS Verbal: ,GCS Motor: , GCS Total: 14, Ectopy: , Pulse Ox: 92%, Glucose: , Left Lung: CONGESTED, Right
Lung: CONGESTED, Left Pupil: PERL, Right Pupil: PERL

TripInfo.sPatAge}
F
08/25/2003 17:46
TripInfo.sPatientPickedUp}
LIBERTY HOSPITAL
RESPIRATORY DISTRESS 17



 Breathing difficulty

Drugs given__________________________________



NOTES:CALLED TO TRANSFER PT FROM HMC TO LIBERTY WITH A C/C OF RESP DISTRESS. PT HAS A VENTURI MASK AT 40% AT 15L. PT HAS IV NS AT TKO RATE. PT AOL X 3
WITH SOME MODERATE CONFUSION. PT LUNGS CONGESTED, PT BREATHING LABORED. PT HAS HX OF COPD. PT SENT TO RULE OUT POSSIBLE BREAST CA. PT CARE
TRANSFERRED TO STAFF AT LIBERTY HOSPITAL. 319



Thu Oct 23, 2003 15:13:15:
WRITE OFF BALANCE. DECEASED 8-27-03              NO ESTATE


SYKIS, MICHAEL W                  00000035445          10/20/2003 RT 1 BOX 151                    DAWN                       PA      13638-     3/26/1960     2/11/2004     (412) 322-4411          $592.00           $592.00
699-71-1196                     CTY RD 233, PITTSBORO PA 64601                                    JACKSON MEDICAL CENTER                                      WRITE OFF TO BAD DEBT
{Date/TimeStamp} 03/26/1960 43
M White Street or Highway
337    SCENE OF ACCIDENT CTY RD 233 HEDRICK MEDICAL CENTER SH

ALTERED LOC <Not Entered>{TripInfo. mmoComments}
Closest Facility (none below) MEDICAL <Not Entered>
Altered level of consciousness On-line (radio telephone) Emergency response requested Urgent, transported

 NKA

 SEE LIST

 Hypertension



 Time: 16:15: Treatment: Treatment - Glucose test, Att: 1, Succ: 1, Perf By: 2, Route: , Qty: , UOM: , IV Rate:
 Time: 16:20: Treatment: Treatment - Pulse oximetry, Att: 1, Succ: 1, Perf By: 2, Route: , Qty: , UOM: , IV Rate:
 Time: 16:20: Treatment: Treatment - Oxygen by cannula, Att: 1, Succ: 1, Perf By: 1, Route: , Qty: 4, UOM: lpm, IV Rate:
 Time: 16:20: Treatment: IV - Normal Saline, Att: 1, Succ: 1, Perf By: 2, Route: IV, Qty: , UOM: MG, IV Rate: TKO
 Time: 16:20: Treatment: Treatment - EKG monitor, Att: 1, Succ: 1, Perf By: 2, Route: , Qty: , UOM: , IV Rate:

 Syncope



 Time: 10/20/2003 16:09 - Perf By: 2, Pulse Rate: 102, Card. Rthm: SINUS TACYCARDIA, Resp Rate: 22, Resp Effort: Normal, Syst: 162, Diast: 94, Palp: 0, Skin Perf: Normal, Skin Color: PINK, Skin
Temp: NORMAL, Skin Moist: WET, Treatment: , Comments: , GCS Eye: 4-Opens eyes spontaneously, GCS Verbal: ,GCS Motor: , GCS Total: 14, Ectopy: NO, Pulse Ox: 92, Glucose: 126, Left Lung:
CLEAR, Right Lung: CLEAR, Left Pupil: PERL, Right Pupil: PERL



 CHILLICOTHE FIRE DEPARTMENT




Tue Oct 28, 2003 16:41:13:
PT DECEASED

Wed Feb 11, 2004 15:15:26:
MAIL RETURNED--PT DECEASED--NO ESTATE




                                                                                                                                                                                Page                6 /           7
Patient Name                   Trip Num           DOS          Address         City                    State Zip        DOB        Trans Date   Phone            Billed       Trans Amount
SSN                          Picked Up Location                                            Taken To Location                       Trans Desc
Comments

WOLTON, LEONARD J              00000035217         7/10/2003   15 WEBSTER ST   PITTSBORO               PA      13601-   6/4/1926   4/13/2004    (412) 343-1334      $557.00           $43.15
111-88-1689                  15 WEBSTER ST, PITTSBORO PA 64601-                JACKSON MEDICAL CENTER                              WRITE OFF TO BAD DEBT
HPI---CALLED TO PTS HOME BY PTS DAUGHTER THAT LIVES IN ANOTHER TOWN, DAUGHTER STATES PT HAD SOME BLOOD WORK DONE AT VA, WITH CRITICAL LEVELS
SHOWING VA WANTS PT SEEN IN ER FOR EVALUATION. PT COX3 PT DENIES ANY SOB OR CHEST PAIN STATES HIS ANKLES AND LOWER LEGS ARE SWELLING IS ONLY
PROBLEM HE HAS.
PRI----A PATENT B EUPNIC C STRONG AND REGULAR D COX3
SEC-----HEENT UNREMARKABLE NECK UNREMARKABLE CHEST DENIES PAIN ABD SOFT AND NON TENDER PELVIS INTACT LOWER EXTREM PULSE MOTOR SENSATION
PRESENT EDEMA NOTED ALL EXTREM UPPER EXTREM GRIPS STRONG AND EQUAL PULSE MOTOR SENSATION PRESENT ALL EXTREM BACK NOT CHECKED
TXT 1 VITALS 2 TRANSPORT
IMPACT----NO DIFFICULTIES ENROUTE CARE OF PT TURNED OVER TO HMC ER NURSING STAFF UNDER CARE OF DR CAMPBELL

Wed Jul 30, 2003 09:12:04:
SENT AUTHORIZATION AND HIPAA FORMS TO PT TO SIGN



Wed Sep 10, 2003 11:46:50:
M/C DENIED CLAIM---SENT BILL TO PT

Fri Oct 03, 2003 11:39:51:
BILL SENT RO PT FOR CO-PAY

Thu Dec 11, 2003 13:58:18:
1ST LETTER



FRI Mar 12, 2004 10:57:03:
DELIQ



Amount of Writeoffs:               $2,336.10
Number of claims:                   10




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