FORM 4110H (REV. 9-66)
DATE
HOLMES &
SUMMARY OF CHARGES
FOR MEDICAL SERVICES
NARVER, UNC.
|
ft-ebyCOMET TO THE
any se oo
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TO:
HOLMES & NARVER, INC.
ENGINEERS
-
P.O. BOX 580
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(1) (N LIEW OF ASPORCIZASE ORDER (OR
96809
'.DIVIDUAL PRICES NOT SHOWN ON THE
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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_.
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t
TOTAL PURCHASE ORDER BILLED TO DATE
(Including this Summary of Charges)
$
12.48
12.48