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Howard Drutman, Ph.D.

900 Old Roswell Lakes Parkway, Suite 340


Roswell, GA 30076
678-867-7020
Client Name:
Account Nbr:
Provider:
Provider NPI:

Forrest and Julianna Durham


11035-10586
Howard Drutman, Ph.D.
1316002462

06-16-2014

Statement
Date

Insurance Other Insurance Client


Client
Charges Payments Adjusts Submitted Payments Responsibility

Description

05-25-12
05-30-12
05-31-12
06-04-12
06-04-12
06-07-12
06-08-12
06-12-12
06-12-12
06-14-12
07-05-12
07-10-12
07-10-12
07-23-12
07-23-12
07-23-12
08-11-12
08-11-12
08-11-12
09-23-12
09-23-12
09-23-12
09-27-12
09-27-12

Retainer Paid
Retainer Paid
Forensic Evaluation 90-120 Min.
Forensic Testing 60 Min.
Forensic Testing 60 Min.
Forensic Evaluation 90-120 Min.
Forensic Evaluation 90-120 Min.
Forensic Testing 60 Min.
Forensic Testing 60 Min.
Forensic Evaluation 90-120 Min.
Forensic Record Review 60 Min.
Forensic Record Review 60 Min.
Forensic Record Review 60 Min.
Forensic Testing 60 Min.
Forensic Testing 60 Min.
Forensic Testing 60 Min.
Travel Time 60 Min.
Forensic Home Visit 90-120 Minutes
Travel Time 60 Min.
Travel Time 60 Min.
Travel Time 30 Min.
Forensic Home Visit 90-120 Minutes
Forensic Evaluation 90-120 Min.
Forensic Evaluation 60 Min.

Current

Over 30

Over 60

0.00
0.00
450.00
275.00
275.00
450.00
450.00
275.00
275.00
450.00
225.00
225.00
225.00
275.00
275.00
275.00
225.00
450.00
225.00
225.00
112.50
450.00
450.00
225.00

-3000.00 -3000.00
-3000.00 -3000.00
450.00
275.00
275.00
450.00
450.00
275.00
275.00
450.00
225.00
225.00
225.00
275.00
275.00
275.00
225.00
450.00
225.00
225.00
112.50
450.00
450.00
225.00

Over 90

Now Due
Next Page

Please Remit To:


Howard Drutman, Ph.D.
900 Old Roswell Lakes Parkway, Suite 340
Roswell, GA 30076

Amount Paid $

Provider: Howard Drutman, Ph.D.

Forrest and Julianna Durham


621 Gordon Combs Rd
Marietta, GA 30064
PLEASE RETURN BOTTOM PORTION WITH YOUR PAYMENT. RETAIN TOP PORTION FOR YOUR RECORDS

Howard Drutman, Ph.D.


900 Old Roswell Lakes Parkway, Suite 340
Roswell, GA 30076
678-867-7020
Client Name:
Account Nbr:
Provider:
Provider NPI:

Forrest and Julianna Durham


11035-10586
Howard Drutman, Ph.D.
1316002462

06-16-2014

Statement
Date

Insurance Other Insurance Client


Client
Charges Payments Adjusts Submitted Payments Responsibility

Description

09-29-12
09-29-12
09-29-12
09-30-12
09-30-12
09-30-12
09-30-12
09-30-12
10-02-12
10-02-12
10-02-12
10-03-12
10-03-12
10-03-12
10-04-12
10-04-12
10-04-12
10-08-12
10-08-12
10-08-12
10-09-12
10-09-12
10-16-12
10-16-12

Forensic Record Review 60 Min.


Forensic Record Review 60 Min.
Forensic Record Review 60 Min.
Phone Conference with GAL or PC
Prof Fees for Collateral Interview/Service
Forensic Report Writing
Forensic Report Writing
Forensic Report Writing
Forensic Report Writing
Forensic Tel. Con. 15 Min
Forensic Tel. Con. 15 Min
Telephone Conference w/Therapist/Physician/O
Forensic Tel. Con. 15 Min
Forensic Tel. Conf. 30 Min.
Phone Conference with GAL or PC
Telephone Conference w/Therapist/Physician/O
Forensic Tel. Con. 15 Min
Forensic Record Review 30 Min.
Forensic Tel. Con. 15 Min
Forensic Report Writing
Forensic Collateral Interview
Forensic Collateral Interview
Forensic Collateral Interview
Forensic Report Writing

Current

Over 30

Over 60

225.00
225.00
225.00
225.00
275.00
275.00
275.00
275.00
275.00
56.25
56.25
225.00
56.25
112.50
225.00
225.00
56.25
112.50
56.25
275.00
225.00
225.00
112.50
275.00

225.00
225.00
225.00
225.00
275.00
275.00
275.00
275.00
275.00
56.25
56.25
225.00
56.25
112.50
225.00
225.00
56.25
112.50
56.25
275.00
225.00
225.00
112.50
275.00

Over 90

Now Due
Next Page

Please Remit To:


Howard Drutman, Ph.D.
900 Old Roswell Lakes Parkway, Suite 340
Roswell, GA 30076

Amount Paid $

Provider: Howard Drutman, Ph.D.

Forrest and Julianna Durham


621 Gordon Combs Rd
Marietta, GA 30064
PLEASE RETURN BOTTOM PORTION WITH YOUR PAYMENT. RETAIN TOP PORTION FOR YOUR RECORDS

Howard Drutman, Ph.D.


900 Old Roswell Lakes Parkway, Suite 340
Roswell, GA 30076
678-867-7020
Client Name:
Account Nbr:
Provider:
Provider NPI:

Forrest and Julianna Durham


11035-10586
Howard Drutman, Ph.D.
1316002462

06-16-2014

Statement
Date

Insurance Other Insurance Client


Client
Charges Payments Adjusts Submitted Payments Responsibility

Description

10-16-12
10-18-12
10-20-12
10-20-12
10-20-12
10-20-12
10-21-12
10-21-12
10-21-12
10-21-12
10-22-12
10-22-12
10-22-12
10-23-12
10-30-12
11-05-12
12-02-12
12-28-12
03-21-13
06-18-13
07-01-13
07-02-13

Forensic Collateral Interview


Forensic Report Writing
Forensic Report Writing
Forensic Report Writing
Forensic Report Writing
Forensic Report Writing
Forensic Report Writing
Forensic Report Writing
Forensic Report Writing
Forensic Report Writing
Forensic Report Writing
Future Feedback Sessions with Atty/GAL/PC
Future Feedback Sessions with Atty/GAL/PC
Retainer Paid
Retainer Paid
Retainer Paid
Retainer Paid
Retainer Paid
Copying &amp Printing Fees
Retainer Paid
Forensic Record Review 60 Min.
Court Full Day
TOTALS:

112.50
275.00
275.00
275.00
275.00
275.00
275.00
275.00
275.00
275.00
275.00
225.00
225.00
0.00
0.00
0.00
0.00
0.00
250.00
0.00
250.00
2500.00
17643.75

112.50
275.00
275.00
275.00
275.00
275.00
275.00
275.00
275.00
275.00
275.00
225.00
225.00
-4321.88
-1321.88
-1500.00
-750.00
-750.00
250.00
-3000.00
250.00
2500.00

-4321.88
-1321.88
-1500.00
-750.00
-750.00
-3000.00

0.00

0.00

0.00

-17643.76

-0.01

Current

Over 30

Over 60

Over 90

Now Due

0.00

0.00

0.00

-0.01

-0.01

Please Remit To:


Howard Drutman, Ph.D.
900 Old Roswell Lakes Parkway, Suite 340
Roswell, GA 30076

Amount Paid $

Provider: Howard Drutman, Ph.D.

Forrest and Julianna Durham


621 Gordon Combs Rd
Marietta, GA 30064
PLEASE RETURN BOTTOM PORTION WITH YOUR PAYMENT. RETAIN TOP PORTION FOR YOUR RECORDS