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lD and Name:

Patient Visit Lisf Report

W3106 Cathy Stanley Camp Cocker Rescue

14320 Ventura Blvd. #236

$hermanOaks.CA 91423

Patient lD and NamE:

Sex:

Species/Breed:

Age and.Birthdate:I

10029 Conner

Male

Canine/Spaniel, Cocker

0 Yrs. 0 Mos.

Type Status Item lD DescriptionStafflD Disc

RevCtr Tax Quantity Pric

P PL P

Lab RequeslE A

Estimate # 4339E A

Estimate # 4339E A

Estimate # 4439E A

Estimate # 4339E A

Estimate # 4339E P

Estimate # 4339E P

Eslimate # 4339R

P

P

P

P

R

P

P PR

P

P

P

P

P

P

P

R

P

P PP

P

HH

N

N

N

N

N

H

18013

421

745

x5a

504

308

0992s

0772

t4686

510

3032

498

CHRRYE

PAINCO

T760

WBOO4

18013M020

200

w8004

w8004

w8004WBOO4

w8004

w8004

651

WBO04

12255w8004

WBOO4

w8004

w8004

w8004

12255

w8004w8004

Clavamox Tablets 1 25m9.STAT MINIPANEL

Neuter, Canine 1-20

CATH ETERIZATION/FLU IDS

AN ESTHESIA, lsoflurane

Neuter, Canine

DBSDBS

DBS

DBS

DBS

DBS

Elizabethan Buster Collar 25cm. DBS

NeoPolySulfaDex,Ophthalmic Oi DBSt

Rimadyl 25m9. DBS

ANESTHESIA, lsoflurane (add1) DBS

INJECTION, Antibiotic DBS

ANESTHESIA, lnduct: KetlVallA, DBS

Cherry Eye Surgery Unilateral DBS

Pain Control injection DBS

URINALYSIS-a DBS

Nebulization therapy DBS

Clavarnox Tablete 125m9. 1

AEROBIC CULTURE & MIC (norDBS

ANAL GLAND EXFRESSION DBS

Nebulization therapy DBS

Nebulization therapy DBS

Nebulization therapy DBS

Nebulization therapy DBS

Nebulization therapy DBS

Nebulization therapy DBS

MEDICAL BOARDING, Kg 21-5 DBS

Nebulization therapy DBS

Baytril 136m9. DBSNebulization therapy DBS

Nebulization therapy DBS

Nebulization therapy DBS

Nebulization therapy DBS

Nebulization therapy DBS

Baytril 136m9. DBS

Nebulization therapy DBS

Nebulization therapy DBS

YN

YNYNYNYNYNYNYN

YNYNYNYNYNYNYNYNYNYNYN

YNYNYNYNYNYNYNYNYN

14.001.00

1.00

1.00

1.00

1.00

1.00

1.00

14.00

1.00

1.00

1.00

1.00

1.00

1.00

18.00

18.001.00

1.00

1.00

1.00

1.00

1.00

1.00

1.00

23.00

1.00

7.001.00

1.00

1.00

1.00

1.00

7.00

1.00

1.00

$30.8$0.0

$0.0

$0.0

$0.0

$285.0

$5.0

$33.4

$36.1

$58.0

$43.0

$48.0

$150.

$43.

$52.

$6s3.0

$41.$123.

$29.

$38.

$38.

$38.

$38.

$38.

$38.

$1,150.

$38.

$51.$38.

$38.

$38.

$38.

$38.

$51.

$38.

$38.

Y

Y

P

P

P

P

P

P

P

H

H

H

H

H

H

H

HH

H

H

H

H

H

H

H

H

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HH

H

H

H

H

H

H

H

Type:A-appointmentitems, B-boarding, C-correspondenceitem$, E-estimates, L-lab, P-prescriptions, T-templateitems. X-examroomitem

Status: R - recommend€d, A - acoepted, P - performed

VILLAGE ANIMAL HOSPITAL Page I of2 Date: 11/2812011

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Patient Visit LislRepart " fund./'lD and Name: W3.106 Cathy Stanley Camp Cocker Rescue

14320 Ventura Blvd. #236

Sherman Oaks, CA 91423

Patient lD and Name:

$ex:

$peciee/Breed:

Age an( Birthdate:I

10029 Conner

Male

CaninelSpaniel, Cocker

0 Yrs. 0 Mos.

RevType Status Ctr Item lD

StaffDescription lD Disc Tax Quantity Price

HH

H

H

PP

P

P

w8004WBOO4

w8004

w8004

Nebulization therapyNebulization therapy

Nebulization therapy

Nebulization therapy

DBSYNDBSYNDBSYNDESYN

1.00 $38.501.00 $38.s0

1.00 $38.50

1.00 $38.50

$3,622.s2

$1,398.08

$0.35

$2,22s.19

Total:

Discount:

Tax:

Total:

tr-l) +6 Wh\foqo\ +-1#'D

(r+Y n^ ll'751A\tt

ype:A-appoinlmentitems, B-boarding, C-conespondenceilems, E-estimates, L-lab, P-prescriptions, T-iemplateilems. X'examroomitems

tatus: R - recommended. A - accepted, P - performed

VILLAGF ANIMAL HOSPITAL Page 2 of 2 Date: 11/28/2011