Contract for pathology services (B)

Surgical pathology requisition (C)

Payment for pathology services (G)

Contract for pathology waste disposal (H)

Waste tracking document (pre-disposal) (I)

Procedure list (A)

Pathology Lab

PPSLR

Surgical pathology report (D)

Invoice for pathology services for June
(E) and July (F) 2015

Waste Disposal

Waste tracking document (stamped with disposal

certification) (J)
Invoice for waste disposal services (K)

Surgical Abortion Procedures at PPSLR from 6/1-2015 - 6/30/2015

Service Item Description
Induced abortion, by D & C 9 wk

Accession #
R15-08120

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08135

06/02/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08128

06/02/2015
06/02/2015

Type Procedure
1st Tri Surgical Procedure

Date of Service
06/02/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08121

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08134

06/02/2015

2nd Tri Surgical Procedure

Induced AB by D&E 15 wk

R15-08137

06/02/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08133

06/02/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08125

06/02/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11wk

R15-08139

06/02/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08123

06/02/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 5 wk

R15-08130

06/02/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08131

06/02/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 12 wk

R15-08138

06/02/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08132

06/02/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-08122

06/02/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08127

06/02/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08129

06/02/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 12 wk

R15-08136

06/02/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08126

06/02/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08119

06/02/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08124

06/02/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 10 wk

R15-08152

06/03/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08141

06/03/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-08144

06/03/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08145

06/03/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08148

06/03/2015

1st Tri Surgica I Procedure

Induced abortion, by D & C 8 wk

R15-08140

06/03/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08149

06/03/2015

1st Tri Surgical Procedure

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

Induced Abortion, by D & C 13 wk

R15-08143
R15-08150

06/03/2015
06/03/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-08151

06/03/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08142

06/03/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08146

06/03/2015

2nd Tri Surgical Procedure

Induced AB by D&E 17 wk

R15-08153

06/03/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 5 wk

R15-08147

06/03/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 10 wk

R15-08235

06/05/2015

2nd Tri Surgical Procedure

Induced AB by D&E 14 wk

R15-08238

06/05/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08233

06/05/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 12 wk

R15-08242

06/05/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08236

06/05/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08234

06/05/2015

1st Tri Surgical Procedure

Induced Abortion, by D & C 13 wk

R15-08240

06/05/2015

Procedure list (A)

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08237

06/05/2015

2nd Tri Surgical Procedure

Induced AB by D&E 15 wk
Induced abortion, by D & C 11 wk

R15-08239
R15-08241

06/05/2015
06/05/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08232

06/05/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-08230

06/05/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08231

06/05/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08208

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-08213

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-08226

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08209

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 10 wk

R15-08224

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 12 wk

R15-08223

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-08225

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08214

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-08206

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-08221

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 10 wk

R15-08204

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08215

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11wk

R15-08220

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08216

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 12 wk

R15-08218

06/06/2015

2nd Tri Surgical Procedure

Induced AB by D&E 17 wk

R15-08228

06/06/2015

1st Tri Surgical Procedure

Induced Abortion, by D & C 13 wk

R15-08227

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11wk

R15-08222

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08212

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08207

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-08219

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08211

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08217

06/06/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08210

06/06/2015

1st Tri Surgical Procedure

R15-08205
R15-08229

06/06/2015

2nd Tri Surgical Procedure

Induced abortion, by D & C 9 wk

Induced AB by D&E 20 wk

1st Tri Surgical Procedure

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08471

06/09/2015

Induced abortion, by D & C 10 wk

R15-08477

06/09/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08474

06/09/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-08465

06/09/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08461

06/09/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08458

06/09/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08469

06/09/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08459

06/09/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-08462

06/09/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08475

06/09/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08472

06/09/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-08460

06/09/2015

1st Tri Surgical Procedure

06/06/2015

Procedure list (A)

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08473

06/09/2015

1st Tri Surgical Procedure

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

Induced abortion, by D & C 11 wk

R15-08479
R15-08467

06/09/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 10 wk

R15-08463

06/09/2015

2nd Tri Surgical Procedure

Induced AB by D&E 15 wk

R15-08478

06/09/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08466

06/09/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 12 wk

R15-08480

06/09/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-08464

06/09/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 10 wk

R15-08476

06/09/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08468

06/09/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-08490

06/10/2015

2nd Tri Surgical Procedure

Induced AB by D&E 17 wk

R15-08492

06/10/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08484

06/10/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-08488

06/10/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-08486

06/10/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 10 wk

R15-08487

06/10/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08482

06/10/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08485

06/10/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08483

06/10/2015

2nd Tri Surgical Procedure

Induced AB by D&E 21wk

R15-08491

06/10/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-08504

06/12/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08497

06/12/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 12 wk

R15-08508

06/12/2015

2nd Tri Surgical Procedure

Induced AB by D&E 15 wk
Induced abortion, by D & C 8 wk

R15-08510

06/12/2015

1st Tri Surgical Procedure

R15-08500

06/12/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 5 wk

R15-08496

06/12/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-08494

06/12/2015

2nd Tri Surgical Procedure

Induced AB by D&E 17 wk
Induced abortion, by D & C 7 wk

R15-08511

06/12/2015

1st Tri Surgical Procedure

R15-08503

06/12/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 10 wk

R15-08509

06/12/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08501

06/12/2015

1stTri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08505

06/12/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08502

06/12/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08499

06/12/2015

1st Tri SurgicaI Procedure

Induced abortion, by D & C 6 wk

R15-08493

06/12/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

06/12/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 12 wk

R15-08507
R15-08506

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08498

06/12/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-08523

06/13/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08516

06/13/2015

2nd Tri Surgical Procedure

Induced AB by D&E 20 wk

R15-08526

06/13/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 5 wk

R15-08519

06/13/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08521

06/13/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08515

06/13/2015

06/09/2015

06/12/2015

Procedure list (A)

Induced AB by D&E 20 wk

R15-08527

06/13/2015

1st Tri Surgical Procedure

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

Induced abortion, by D & C 6 wk

R15-08513
R15-08520

06/13/2015
06/13/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08518

06/13/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 12 wk

R15-08524

06/13/2015

2nd Tri Surgical Procedure

Induced AB by D&E 17 wk

R15-08525

06/13/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-08522

06/13/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08514

06/13/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08512

06/13/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08517

06/13/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08770

06/16/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08769

06/16/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 12 wk

R15-08786

06/16/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08761

06/16/2015

1st Tri Surgical Procedure

Induced Abortion, by D & C 13 wk

R15-08781

06/16/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08772

06/16/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 10 wk

R15-08784

06/16/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08771

06/16/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08773

06/16/2015

1st Tri Surgical Procedure

Induced Abortion, by D & C 13 wk

R15-08776

06/16/2015

2nd Tri Surgical Procedure

Induced AB by D&E 16 wk

R15-08789

06/16/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08774

06/16/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 10 wk

R15-08782

06/16/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08763

06/16/2015

2nd Tri Surgical Procedure

Induced AB by D&E 15 wk

R15-08783

06/16/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08764

06/16/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08767

06/16/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08768

06/16/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-08785

06/16/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-08779

06/17/2015

1st Tri Surgical Procedure

1st Tri Surgical Procedure

R15-08777
R15-08760

06/17/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

Induced abortion, by D & C 7 wk
Induced abortion, by D & C 7 wk

R15-08756

06/17/2015

1st Tri Surgica I Procedure

Induced abortion, by D & C 6 wk

R15-08775

06/17/2015

2nd Tri Surgical Procedure

Induced AB by D&E 20 wk

R15-08788

06/17/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08759

06/17/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-08780

06/17/2015

1st Tri Surgical Procedure

Induced Abortion, by D & C 13 wk

R15-08778

06/17/2015

2nd Tri Surgical Procedure

Induced AB by D&E 16 wk

R15-08787

06/17/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08758

06/17/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08757

06/17/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08833

06/19/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08830

06/19/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-08836

06/19/2015

2nd Tri Surgical Procedure

06/17/2015

Procedure list (A)

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08826

06/19/2015

1st Tri Surgical Procedure

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

Induced abortion, by D & C 6 wk

R15-08828
R15-08829

06/19/2015
06/19/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08832

06/19/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-08835

06/19/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 10 wk

R15-08837

06/19/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-08825

06/19/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 10 wk

R15-08838

06/19/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08831

06/19/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08827

06/19/2015

2nd Tri Surgical Procedure

Induced AB by D&E 14 wk

R15-08834

06/19/2015

2nd Tri Surgical Procedure

Induced AB by D&E 21wk

R15-08865

06/20/2015

2nd Tri Surgical Procedure

Induced AB by D&E 19 wk

R15-08868

06/20/2015

2nd Tri Surgical Procedure

R15-08866

06/20/2015

1st Tri Surgical Procedure

Induced AB by D&E 18 wk
Induced abortion, by D & C 8 wk

R15-08849

06/20/2015

2nd Tri Surgical Procedure

Induced AB by D&E 17 wk

R15-08869

06/20/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08839

06/20/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08848

06/20/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11wk

R15-08863

06/20/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08842

06/20/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08851

06/20/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-08847

06/20/2015

2nd Tri Surgical Procedure

Induced AB by D&E 15 wk

R15-08857

06/20/2015

2nd Tri Surgical Procedure

Induced AB by D&E 14 wk

R15-08860

06/20/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-08861

06/20/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 10 wk

R15-08843

06/20/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08844

06/20/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11wk

R15-08856

06/20/2015

2nd Tri Surgical Procedure

Induced AB by D&E 17 wk

R15-08867

06/20/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-08859

06/20/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

Induced abortion, by D & C 7 wk

R15-08864

06/20/2015

R15-08850

06/20/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-08852

06/20/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08840

06/20/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 10 wk

R15-08862

06/20/2015

1st Tri Surgical Procedure

Induced Abortion, by D & C 13 wk

R15-08858

06/20/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-08854

06/20/2015

1st Tri Surgical Procedure

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-08846

06/20/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 12 wk

R15-08855

06/20/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-08841

06/20/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-09100

06/23/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-09105

06/23/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-09097

06/23/2015

2nd Tri Surgical Procedure

Induced AB by D&E 16 wk

R15-09109

06/23/2015

Procedure list (A)

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-09111

06/23/2015

1st Tri Surgical Procedure

1st Tri Surgical Procedure

Induced Abortion, by D & C 13 wk

Induced abortion, by D & C 11 wk

R15-09114
R15-09116

06/23/2015

1st Tri Surgical Procedure

Induced Abortion, by D & C 13 wk

R15-09113

06/23/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-09099

06/23/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 5 wk

R15-09108

06/23/2015

06/23/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 10 wk

R15-09106

06/23/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-09112

06/23/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-09101

06/23/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-09115

06/23/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-09103

06/23/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-09104

06/23/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-09107

06/23/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-09102

06/23/2015

2nd Tri Surgical Procedure

Induced AB by O&E 15 wk

R15-09110

06/23/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-09098

06/23/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 10 wk

R15-09093

06/24/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-09092

06/24/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-09090

06/24/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-09094

06/24/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-09089

06/24/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-09086

06/24/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-09087

06/24/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-09091

06/24/2015

2nd Tri Surgical Procedure

Induced AB by D&E 16 wk

R15-09096

06/24/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-09084

06/24/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-09088

06/24/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 12 wk

R15-09095

06/24/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-09160

06/26/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-09166

06/26/2015

2nd Tri Surgical Procedure

1st Tri Surgical Procedure

Induced AB by D&E 17 wk
Induced abortion, by D & C 10 wk

R15-09173
R15-09172

06/26/2015
06/26/2015

2nd Tri Surgical Procedure

Induced AB by D&E 15 wk

R15-09175

06/26/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-09169

06/26/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

06/26/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-09163
R15-09165

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-09171

06/26/2015

2nd Tri Surgical Procedure

Induced AB by D&E 16 wk

R15-09174

06/26/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-09170

06/26/2015

2nd Tri Surgical Procedure

Induced AB by D&E 17 wk

R15-09176

06/26/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 10 wk

R15-09167

06/26/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-09164

06/26/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-09159

06/26/2015

2nd Tri Surgical Procedure

Induced AB by D&E 14 wk

R15-09168

06/26/2015

06/26/2015

Procedure list (A)

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-09161

06/26/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

Induced abortion, by D & C 9 wk

R15-09162
R15-09192

06/26/2015

1st Tri Surgical Procedure

2nd Tri Surgical Procedure

Induced AB by D&E 20 wk

R15-09190

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-09256

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-09191

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 5 wk

R15-09186

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-09179

06/27/2015

2nd Tri Surgical Procedure

Induced AB by D&E 18 wk

R15-09198

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-09187

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-09181

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-09184

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 12 wk

R15-09196

06/27/2015

2nd Tri Surgical Procedure

Induced AB by D&E 18 wk

R15-09199

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-09188

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-09182

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-09180

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-09189

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-09185

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 4 wk

R15-09177

06/27/2015

2nd Tri Surgical Procedure

Induced AB by D&E 16 wk

R15-09197

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 5 wk

R15-09178

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-09193

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-09183

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-09194

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

R15-09195

06/27/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 12 wk

R15-09426

06/30/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-09428

06/30/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-09417

06/30/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-09423

1st Tri Surgical Procedure

1st Tri Surgical Procedure

Induced abortion, by D & C 8 wk

Induced abortion, by D & C 11 wk

R15-09420

06/30/2015
06/30/2015

R15-09429

06/30/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-09424

06/30/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-09416

06/30/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 6 wk

R15-09422

06/30/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11 wk

R15-09425

06/30/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-09421

06/30/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 7 wk

R15-09415

06/30/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 5 wk

R15-09418

06/30/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 9 wk

R15-09414

06/30/2015

2nd Tri Surgical Procedure

Induced AB by D&E 14 wk

R15-09432

06/30/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 11wk

R15-09427

06/30/2015

1st Tri Surgical Procedure

Induced abortion, by D & C 5 wk

R15-09419

06/30/2015

06/27/2015

Procedure list (A)

Other Surgical Procedures from Reproductive Health Services from 6/1-6/30/15

Type Procedure
Service Item Description
Accession #

Date of Service

Post Surg AB Surg Mgmt

Treatment Of Missed AB 1st Tri 4-11Wk

R15-08118
R15-08470

06/19/2015
06/09/2015

Post Med Evac Procedure

Post Med AB Surg Mgmt

R15-08481

06/10/2015

Post Med Evac Procedure

Post Med AB Surg Mgmt

R15-08489

06/10/2015

Miscarriage Procedure

Treatment Of Missed AB 1st Tri 4-11 Wk

R15-08495

06/12/2015

Post Med Evac Procedure

Post Med AB Surg Mgmt

R15-08765

06/16/2015

Miscarriage Procedure

Treatment Of Missed AB 1st Tri 4-11 Wk

R15-08766

06/16/2015

Miscarriage Procedure

Treatment Of Missed AB 1st Tri 4-11 Wk

R15-08762

06/16/2015

Post Surg Evac Procedure

Miscarriage Procedure

Miscarriage Procedure

Treatment Of Missed AB 1st Tri 4-11Wk

R15-08824

06/19/2015

Miscarriage Procedure

Treatment Of Missed AB 1st Tri 4-11Wk

R15-08853

06/20/2015

Post Med Evac Procedure

Post Med AB Surg Mgmt

R15-08845

06/20/2015

Post Med Evac Procedure

Post Med AB Surg Mgmt

R15-09085

06/24/2015

Procedure list (A)

Contract for pathology services (B)

Contract for pathology services (B)

Surgical pathology requisition (C)

Surgical pathology report (D)

Invoice for pathology services for June 2015 (E)

Invoice for pathology services for June 2015 (E)

Invoice for pathology services for June 2015 (E)

Invoice for pathology services for June 2015 (E)

Invoice for pathology services for June 2015 (E)

Invoice for pathology services for June 2015 (E)

Invoice for pathology services for June 2015 (E)

Invoice for pathology services for June 2015 (E)

Invoice for pathology services for June 2015 (E)

Invoice for pathology services for June 2015 (E)

Invoice for pathology services for June 2015 (E)

Invoice for pathology services for June 2015 (E)

Invoice for pathology services for June 2015 (E)

Invoice for pathology services for July 2015 (F)

Invoice for pathology services for July 2015 (F)

Invoice for pathology services for July 2015 (F)

Invoice for pathology services for July 2015 (F)

Invoice for pathology services for July 2015 (F)

Invoice for pathology services for July 2015 (F)

Invoice for pathology services for July 2015 (F)

Invoice for pathology services for July 2015 (F)

Invoice for pathology services for July 2015 (F)

Invoice for pathology services for July 2015 (F)

Payment for pathology services (G)

Contract for pathology waste disposal (H)

Contract for pathology waste disposal (H)

Waste tracking document (pre-disposal) (I)

Waste tracking document (stamped with disposal certification) (J)

Customer Number

MedAssure
1013 S. Girls School Road
Indianapolis, IN 46231
(317) 635-8000

001101
Invoice Date

06/30/2015
Invoice Number

002088698

BILL TO:
PATHOLOGY SERVICES INCORPORATE
2916 S BRENTWOOD BLVD
BRENTWOOD, MO 63144-2714

SERVICE DATE

TERMS

DUE DATE

Due Upon Receipt

06/30/2015

DESCRIPTION

CONT. COUNT

SALES REP

QTY/WGHT

UNIT PRICE

1.00

570.00

AMOUNT

001 - PATHOLOGY SERVICES INCORPORATE - 2916 S BRENTWOOD BLVD

06/01/15 - 06/30/15

INCINERATE WASTE SERVICE

CURRENT

30 DAYS

60 DAYS

90 DAYS

OVER 90 DAYS

570.00

570.00

0.00

570.00

6,161.00

570.00

Invoice Amount

MedAssure
1013 S. Girls School Road
Indianapolis, IN 46231
(317) 635-8000

PATHOLOGY SERVICES INCORPORATE

2916 S BRENTWOOD BLVD
BRENTWOOD, MO 63144-2714

Payment Coupon

570.00

Customer Number

Please detach and enclose this portion

with your payment - do not send cash.

001101

Invoice Date

Your Invoice Number

06/30/2015

002088698

Due Date

Total Due

Amount Paid

Upon Receipt

$7,871.00

MedAssure
149 Yellowbrook Road
Suite 100
Farmingdale, NJ 07727

Invoice for waste disposal services (K)