o: Billing
Page 2 of 5
2017-05-02 16:5653 (GMT)
19202732538 From: Ronald W. Tusler
TUSLER LAW, LLC
Selected ''Nation ·s Top One Percent" by the National &sociation ofDistinguished Counsel
Ronald W. Tusler
Representative to the Wisconsin State Assembly
il..fember: Insurance Committee
Judiciary Committee
Devon E. Tusler
Debbie A. Slagle
Paralegals
207 W. College A venue, Suite I 00
Appleton, Wisconsin 54911
Phone: 920-7 49-0400
Fax: 920-273-2538
May 2, 2017
The Illinois State Toll Highway
Via Fax: 630-241-6103
.:-:-/t}f
RE: Lisa Sell
Reference No.: E-22948
!--."5:
To Whom It May Concern:
Enclosed please find an authorization for the release of patient records. Your facility is a health
care provider as defined in Sec. 655.00 l (8) and/or 908.03 (6m), Wis. Stats., and your patient is a "party"
as referenced in Chapters 788,800 and/or 900 et~.,Wis. Stats. You are hereby advised that Section
2433e of Act 28 creates sec. J46.83(lg) which governs fees for such medical records providing a health
care provider may charge no more than the following: (a) $ J.00 per page for the first 25 pages; 75 cents
per page for pages 26 to 50; 50 cents per page for pages 51 to 100; and 30 cents per page for pages IO I
and above (b) $1.50 per microfiche or microfi Im page, (c) $10.00 per x-ray image, ( d) For a print of an Xray, $10 per image ,(e) If the requester is not the patient ora person authorized by the patient, for
certification of copies, a single $8 charge, (f) If the requester is not the patient or a person authorized by
the patient, a single retrieval foe of $20 for all copies requested, (g) actual shipp~ng costs.
Pursuant to the above statutory sections, we hereby request a legible itemized statement for your
services rendered to the patient/party from 11/14/2015 to present and whether~,..,dmqW:~
~ptf'fd1:f.dtr,er·m~,
If you have any questions or comments, please contact me.
TUSLER LAW, LLC
fr
RT/ds
Encl.
cc: Client
Ronald W. Tusler
[email protected]
Page 1 of 1
. Billing
2017-05-021656:53 (GMT)
Page 4 of 5
19202732538 From: Ronald W. Tusler
TUSLER LAW, LLC
Selected ·'Nation's Top One Percent" by the National Association qf Distinguished Counsel
Ronald W. Tusler
207 W. College Avenue, Suite 100
Representative to the Wisconsin State Assembly
Appleton, Wisconsin 54911
Member: Insurance Committee
Phone: 920-749-0400
Judiciary Committee
Fax: 920-273-2538
Devon E. Tusler
Debbie A. Slagle
Paralegai,s
May 2,2017
The Hlinois State Toll Highway
Via Fax: 630-241-6103
RE: David Pancake
Reference No.: E-22914
To Whom It May Concern:
Enclosed please find an authorization for the release of patient records. Your facility is a health
care provider as defined in Sec. 655.001(8) and/or 908.03 (6m), Wis. Stats., and your patient is a "party"
as referenced in Chapters 788, 800 and/or 900 et. ~.,Wis. Stats. You are hereby advised that Section
2433e of Act 28 creates sec. 146.83(1g) which governs fees for such medical records providing a health
care provider may charge no more than the following: (a) $1.00 per page for the first 25 pages; 75 cents
per page for pages 26 to 50; 50 cents per page for pages 51 to I 00; and 30 cents per page for pages 10 l
and above (b) $1.50 per microfiche or microfilm page, (c) $10.00 per x-ray image, (d) For a print of an Xray, $10 per image ,( e) If the requester is not the patient or a person authorized. by the patient, for
certification of copies, a single $8 charge, (t) If the requester is notthe patient or a person authorized by
the patient, a single retrieval fee of$20 for all copies requested, (g) actual shipping costs.
Pursuant to the above statutory sections, we hereby request a legible itemized statement for your
services rendered to the patient/party from 11/14/2015 to present and whether •notihe e ~ have.
•heen:·,-lfai.full• Mn
pa"'
If you have any questions or comments, please contact me.
TUSLER LAW, LLC
ff
RT/ds
Encl.
cc: Client
Ronald W. Tusler
[email protected]
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