Laserfiche WebLink
<br /> <br />C!) <br /> <br />~.. <br /> <br />UJ <br />!;: <br />o <br />. .ii: <br />~ CJ _,. <br /> <br />W LOWER HA FTC <br />0.""."""'" <br /> <br />(3..- <br />ED _ ~ F<<~;7~.:'rs) <br />~ .. u.....~ <br />.. :- <br /> <br />.. 0Ih0r . 20- <br />. ~....CJ ....CJ <br />Lc:'::.____ <br /> <br />. <br />PH~EN &3 -:-.ltfl-'- 73>>: <br />81~' <br />. I <br /> <br />D'".\JcJV.... 5 <br />'Zyr.l.IcNac:c. Oltwr <br />DA.~VACCIN"TED: <br /> <br />m A-.ll f3 ..llD <br />Month Day <br />VACClNI.110N EXPIRES: <br /> <br />{nIJ."-I f~.. ib <br />Month DIP/ <br />------ <br />N ABN <br />Doctors Comments and Next Visit <br /> <br />. T~mp <br />Teeth/MQuth <br /> <br />Ears <br /> <br />;Eyes <br />Skin <br /> <br />.' HeartlLung <br /> <br />. Credit Card #: . <br /> <br /> <br />D. <br />D <br />D <br />D <br />. D Signature <br /> <br />Exp Date: <br /> <br />How ~id you. hear about our clinic tod.ay? . ... .. . <br />.pe~o: 0 1 Ayer-Hand~u~R~p~al ~ervjce 01 Word 01 Mouth d 1 Int!"met 0 1 Newsp.aper-Magazine. 0 <br /> <br />o APPLE VALLEY 0 HIGHLAND PARK 0 OAKDALE .~ <br />, 0 BROOKlYN PARK 0 UNWOOP 0 RICHFIELD . . <br />o BURNSVILLE 0 MANKA TO 0 ROSEVILLE <br />o COON RAPIDS o MAPLE GROVE 0 STILLWATER <br />o EDEN. PRAIRIE 0 MA. PLEWOOD 0 WES~.PAUL <br />o FRIDLEY .0 MINNETONKA : ~iJ{" <br /> <br />. MEDICAL RECORD - SAVE for your permanent file ~ <br />LABORATORY TESTS. consider your r.esullS normal unless notifieawllhin 5 days . <br /> <br />IO~ Any past madical . .. <br />AGE ". . lrealmenlorlllness? yON 0 ,Anymedicalion? yON 0 <br /> <br /> . ../ <br /> 1 . RABIES (0 [,4 <br /> 2 D!STEMPER-PARVO COMBO I ( t.}/ :J~ <br /> 3 CORONA ,ff: ( ) . . <br /> 4 LYME ( ) <br />., S BORDETELLA (COUGH VIRUS) (~ Il t"J'. <br /> 6 HEARTWORM TEST ( . ) <br /> 7 FECAL (STOOL) :rEST. ( ) .. <br /> 8 FELINE DIST-RESP COMBO ( ) <br /> 9 FELINE LEUKEMIA & F.I.V. TEST ( ) <br /> 10 FELINE LEUKEMIA ( ) <br /> 11 EXAMINATION ( ) <br /> ,12 ' TREATMENT ( ) <br /> 13 HEALTH .CERTIFICATE (EXAM) ( ) <br /> 14 DEWORMING , ( ) <br /> .15 MEDICATION " ( ) <br /> 16 HEARTWORM PREVENTION ( ) <br /> 17 FRONTLINE plus ( ) <br /> 18 MICROCHIP (HOME AGAIN) . ( ) <br /> . <br /> SUBTOTAL <br /> lCHECK# {WQ3C TAX ' <br /> CC I CASH TOTAL '.~Lf . DC <br /> <br />., ' <br />c' );>~'7 ~-- ~..:~~:,;'7:<:.T7fC~~:::}\ ',: ;:]?T,~::."'. ."": ,Of~;:::~ :' ' .. ,~;,;. ~:~~.':6'{~;;~~;':~:!}'.'< .;:;., ~;; ;~;j:~::::;~;;N'~:~ "(f:~ ::.r:;:y,~~!.:~~~tf.~' <br /> <br />.; ........ .' ". <br /> <br />.I'~. <br />.~r. <br /> <br />CITY Olf RAMSEY <br />:QOG LICENSE <br /> <br />Tag No.: 5 0 d 1 Date: <br />, . ' ~ <br />owner~~ 1<,tinlJ Phone No.: <br />71 l10 )11 1 [J <br /> <br />.- . . <br /> <br />Information on Dog: <br /> <br />.~ ). <br />Naine: ~UtlWr' <br />.v V <br />Color:1?ill J N .h f <br /> <br />Address: <br /> <br />RabIes Shot: <br /> <br />\ <br /> <br />: ,.}, <br />, <br /> <br />5J}W )iif'. <br /> <br />; <br /> <br /> <br />a {II.; -J 3;;;; r <br /> <br />,",' <br /> <br />,! <br />. ...~1 <br /> <br />'~ <br /> <br /> <br />. '. <br /> <br />Breed: Jaff /tftz{!A.1t <br />~~ ~re4~ <br />Female Spayed <br />License Expires;; ;, '8 f f 0 <br /> <br /> <br />.~~~ <br /> <br />,',.; <br /><.~ <br />"','.' <br /> <br />....?~ <br /> <br />.', 'Ji~;"~ <br /> <br />) 'I~' }~g <br /> <br />, <br /> <br /> <br /> <br />;j}. <br /> <br />-183- .' <br />