archie eye doctor

8/7/2019 Archie Eye Doctor

http://slidepdf.com/reader/full/archie-eye-doctor 1/3

Cathy Stanley (# 21348)14320 Ventura Blvd. #236Sherman Oaks, CA 91423

Archie (# E)Species: Canine

Age: 7 years,old

Breed: CockerSpaniel

Coat Color: BulfWeight 0lbs.

Rabies Tag Number: '

Date Code Desc

1211612010 N 106

106818

Allison Hoffrnan. DVM

Eye Care for Animals-Pasadena150 N. San Gabriel, Ste 100

Pasadena, CA 91107(626) 564-0202

Home Phone: (310)

WorkPhone:(

)ext:

Sex: Male Neutered

6 Month Recheck Dental:

Allergy Testing:

CBC/Platelet:

CERF Exarnination:

Electroretinogram:

Final Exarn:

Eye Specialist lnitial Exam - NEST code

I Eye Specialist Exam Basic lnitialI Fluorescein Stain - lnitialoT

$

$$

Sen d pet pi ctu res to : pasaden aphoto@eyec areforani m al s.com

$ 207.00

$ 207.00

$ (51.75

$ 155.25

$ o.oo

155.25

"r*c/ttb

Pric

1

1

1

1

Total for Archie:

Total Products:Rescue Groups:

Total Invoice:Previous Balance:

Total Amount Due:

MasterCard

Total Payments - Thank you:

New Balance Due: $

lnvoice Number48672

0.00

109.0045.00

53.00

Dec 2010

155.25

155.25

I niirice hJLrrnher 1,867 2 Cashier:Jen



Eye Care for Animals-Pasadena150 N. San Gabriel, Ste. '100

Pasadena, CA 91'107

(626) 564-0202

Cathy Stanley (# 21348)14320 Ventura Blvd. #236

Sherman Oaks, CA 91423

Home Phone: (310)

WorkPhone: ( ) ext:

Male Neqtered

Dec 16,2010

Estimate Number1 0386

Archie (# E)Species:

Age:

Breed:

Coat Color:

Weight;Rabies Tag Number:

Caninp

7 years old

Cocker Spaniel

,Buff0 lbs.


Allergy Testing:

CBC/Platelet:

CERF Examination:

Electroretinogram:

Final Exam:

Low PriceCode

Bto Electroretinogram (ERG) - Pre-cataract83+ Ocular Ultrasound

874 Gonioscopy: Pre-Cataract

srzrH VetScan ln House Profile-with CBC

2573*Pred-G5ml

Allison Hoffman, DVM

1.00 1.001.00 1.00

1.00 1.00

1.00 1.00

313.00 $ 376.00219.00 $ 263.00

89.00 $ 107.00

103.00 $ 123.00

69.00 $ 83.00

$$

$

$

Total for Archle:


Total lnvoice:

$ 793.00 $

$ 7e3.00 $

$ (155.25) $

$ 637.75 $

952.00

(1

This document lists procedures to be performed on your pet.

Please note that this is only an estimate of charges based on the best information currently available. This is not a guarantee of charges. lf the actu

charge differs significantly from this estimate we will attempt to notify you prior to additional treatment. This estimate is good only for the next thirty

days.

Payment in full is expected at the time of your pet's release.

Unless there is an item listed as PREPAID EXAM (MEDS NOT INCLUDED), then postoperative visits are NOT included and WILL BE CHARGED

FOR at the time of the post-operative visit. You are responsible for all fees incurred in today's visit included or not in this estimate.

Future refills of medication, if needed, are not included in this estimate.

Be assured that the health of your pet is our highest concern and we will do every thing possible to maintain that health. During your pet's admissionthe hospital we may utilize medications that although well tested and routinely used, may be considered off-label for a particular species orcompoundedbyapharmacyforouruse. YoursignaturebelowindicatesthatyouownthepatientandauthorizeEYECAREFORAN|MALSanditsstaff to hospitalize, administer medications, test, administer anesthetics, perform surgical procedures, and/or administer treatments that the doctordeems necessary for the health, safety and well being of your pet. Your signature also indicates you realize that sedation, tranquilization and/oradministration of anesthetic agents carries a small but realistic possibility of side effects, which may include, but are not limited to, respiratory arrest

cardiac arrest, and/or death. Charges may be incurred during life saving efforts.

Estimate Number 10386 Page 1 of 2



Eye Care for Animals-Pa150 N. San Gabriel, Ste. 100

Pasadena, CA 91107(626) 564-0202

\.L

Dec 16, 2010

Estimate Number1 0387

ext:

Cathy Stanley (# 21348)14320 Ventura Blvd. #236

Sherman Oaks, CA 91423

Archie (# E)Species: Caninq

Age: 7 years'old

Breed: Cocker Spaniel

Coat Color: ,BuffWeight: 0 tbs.

Rabies Tag Number:

Allison Hoffrnan, DVM

Exarn Prepaid

Home Phone: (310)

Work Phone: ( )

Sex: Male Neutered


Allergy Testing:

CBC/Platelet:

CERF Examination:

Electroretinogram:

Final Exam:

Gode

1401 Outpatient Hospitalization Sm>

4 hourstooo Catheter lV Sovereign

roza Fluids lV-Per Litertoso Analgesic lnjection-lntramuscular

r ooo Antibiotic lnjection-lntravenous

t ooo Anti-lnflammatory lnj- lntravenous

t gst Paralytic-lntravenous

r32s Parenteral lV Propofol w/lso 1st 30 mi 1

tgts lnhalant Maint Anes: lso ea. add 15 min

122 Surgery Tech each half hour (30 min)

1829 Surgery Room

18ot Ekg/Pulse OX

t 803 Respiratory/Bld.Press Monitor

1682 Lensectomy- Phacoemulsification wlOL unirzoeo Regional lndex - Phaco w/lOL Uni

regg Ventilator

t az6 Operating Microscope

t82B Phacoemulsifier

tozt Fluids Intraocular-Per Litert806 lntraocular Surgical Pack

zooo Blade - Surgery 64 Beaver

2112* Viscoelastic - Hylartin

ztge Surgical Spears

2o3s* lmplant - Foldable PFI 14 SE IOL

zoor Blade - Surgery 2.8 mm Spear

2106 Suture: 9-0 Vicryl/Double (V449G)

t o3o Subconjunctival lnjection- Anesth111

*Eye Specialist Exam Prepaid"

2518 Clavamox 375 mg

zors Flurbiprofen 2.5 ml - i.e. Ocufen

zssz Methazolamide 50 mg

2s32 Prednisone 20 mg 1

2o3o E-Collar size 30

Low Price h Pr

1.0001.000

1.000

1.000

1.000

1.000

'1.000

1.000

1.000

2.000

1.000

1.000

1.000

1.0001.000

1.000

1.000

1.000

1.000

1.000

1.000

1.000

1.000

1.000

1.000

1.000

2.000

4.000

20.000

1.000

60.000

30.000

1.0001.000

1.000

1.000

1.000

1.000

1.000

1.000

2.000

3.000

1.000

1.000

1.000

1.0001.000

1.000

1.000

1.000

1.000

1.000

1.000

1.000

1.000

1.000

1.000

1.000

2.000

4.000

20.000

1.000

60.000

30.000

44.00 $53.00

88.00 $ 105.00

100.00 $ 1 19.00

55.00 $ 66.00

76.00 $ gt.oo

76.00 $ 91.00

76.00 $ 91.00

370.00 $ 444.00

51.00 $ 121.00

68.00 $ 121.00

95.00 $ 1 13.00

84.00 $ 100.00

84.00 $ 100.00

1,059.00 $ 1,270.00(631.00) $ (631.00

38.00 $ 46.00

121.00 $ 145.00

319.00 $ 382.00

90.00 $ 107.00

117 .00 $ '141 .00

8.00 $ 10.00

114.00 $ 136.00

16.00 $ 19.00

292.00 $ 348.00

35.00 $ 41.00

126.00 $ 150.00

'120.00 $ 144.00325.00 $ 390.00

68.00 $ 81.00

23.00 $ 28.00

46.00 $ 55.00

8.00 $ 8.00

22.00 $ 27.001 1

Total for Archie:


$$

$

$

$

$

$

$

$

$

$

$

$

$$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$ 3,583.00 $ 4,512.00

3,583.00 $ 4,512.00(864.00) $ (1,060.00

$

$

Estimate Number 10387 Page1

of 3

archie eye doctor

Documents