FORM 4110H (REV. 9-66) DATE HOLMES & SUMMARY OF CHARGES FOR MEDICAL SERVICES NARVER, UNC. | ft-ebyCOMET TO THE any se oo ’ TO: HOLMES & NARVER, INC. ENGINEERS - P.O. BOX 580 Dr, i wot yu ie mt Oe de a te thi G. a 7 ~ yt (1) (N LIEW OF ASPORCIZASE ORDER (OR 96809 '.DIVIDUAL PRICES NOT SHOWN ON THE ‘ SERVICES OF me 8 CONSTRUCTORS HONOLULU, HAWAII! Dec. 27, 1972 ENGINEERS — CONSTRUCTORS “URCHAS® ORGES Tht PRICES Ac jr a0, eM et BR, QUANTITY A, Weeks wn “RUE VENDORS NORMAL Lit’ PURCHA SE ORDER M.D. — oe see ee ame NO. ae ae DESCRIPTION UNIT PRICE PRE-EMPLOYMENT EXAMINATION @ PRE-EMPLOYMENT EXAMINATION @ AMOUNT | (DISQUALIFIED) “TERMINATION EXAMINATION @ STOOL EXAMINATION @ TYPHOID/PARATYPHOID INOCULATION @ SMALLPOX VACCINATION @ POLYVALENT INFLUENZA VIRUS — a INOCULATION @ CHOLERA INOCULATION @ SABIN ORAL VACCINE @ TETANUS TOXOID INOCULATION @ BLOOD COUNT @ VISIT @ __12,.00 | oe @ @ @ e oh 8 L% state tax EPOSITORY OLLECTION OX No. OLDER TOTAL PASo Doe/ # “DO E/VV Jad’, “Ex0A* 3 71O-N1C0 if DR. CONARD Of hau (2hFAAS_. ' t TOTAL PURCHASE ORDER BILLED TO DATE (Including this Summary of Charges) $ 12.48 12.48