code

Description

ML ML tNlo6o AMPICILLIN INJECTION 300MG/ML, pER ML tN1o6o AMPICILLIN INJECTION 300MG/ML, PER ML tN1o6o AMPICILLIN INJECTION 300MG/ML, PER ML tNlooo AMPICILL|N INJECTION 300MG/ML, pER ML rN1o6o AMPICILLIN INJECTION 300MG/ML, PER ML rN'r060 AMPICILLIN INJECTION 300MG/ML, pER ML IN1o60 AMPICILLIN INJECTION 300MG/ML, pER ML tN106o AMPICILLIN INJECTION 3OOMG/ML, PER ML lNlooo AMPICILLIN INJECTION 300MG/ML, PER ML tNiooo AMPICILLIN INJECTION 300MG/ML, pER ML PPoooe E-COLLAR SOFT, 5 l/2 INCH HPD3oTo UD FELINE,4LB BAG HPD3oso l/D FELINE, 5.5 OZ CAN, PER CAN oMo88o CLAVAMOX DROPS 15 ML oM048s BUPRENORPHINE ORAL SUSPENSION 0.3MG/ML oMlses ONSIOR, 6MG TABLETS, 3 CT (CATS ONLY)
rNlooo AMPICILLIN INJECTION 300MG/ML, pER
tN1o6o AMPICILLIN INJEGTION 300MG/ML, pER

- ...

Low Qtv High

Qtv

Low

Your Technician

T,

lVas Kristina

T.

O.OO Total for Strax: $ 2,716.68

1.oo

t.oo 1.oo $ 1.oo 1.oo $ 1.oo 1.oo $ 1.oo 1.oo $ 1.oo 1.oo $ 1.oo 1.oo $ o.oo 1.oo $ o.oo 1.00 $ o.oo 1.00 $ o.oo 1.oo $ o.oo 1.oo $ o.o0 1.oo $ 1.oo i.og $ 1.00 1.oo $ 2.oo 4.oo $ ,r.oo 1.oo $ 1.oo 1.oo $ 1.oo 1.oo $
1.oo

price High price 19.42 $ 19.42 19.42 $ 19.42 19.42 $ 19.42 19.42 $ 19.42 19.42 $ 19.42 19.42 $ 19.42 O.OO $ 19.42 O.O0 $ 19.42 O.O0 $ 19.42 O.O0 $ 19.42 0.00 $ 19.42 O.OO $ 19.42 12.35rt $ 12.35*t 19.99,r,$ 19.99*u 3.34*r,$ 6.6g,r, 24.60 $ 24.60 18.50 $ 18.50 B.BO $ B.BO

O.OO

Dr. Justin Bienkowski

Total Products:
Sales Tax:

Total !nvoice:

$ $ 2,716.68 $ 2.50 $ $ $ 2,719.18 $

4,221.41 4,221.41

2.73 4.224.14

I hereby authorize the veterinarian(s) on duty and the assistant(s) the doctor may designate to administer treatment as is considered therapeutically and /or diagnostically necessary on the basis offindings during ihe eviluation. I also consent to the administration of sedatives and anesthetics deemed necessary to perform these procedures. I heieby certify that I have read and fully understand the above authorization for medical and /or surgical treatment, the reasons why surgery or treatment is considered ,"""rrury, its advantages and possible complications, if any, as well as possible altemative modes oftreatment which were explained to me by-tire veterinarian. I realize that neither guarantee nor warranty can ethically or professionally be made regarding these resulis. I understand that this is an estimate of the total charges based on the current information available and it is not a guarantee ofthe final charges. In the event that charges should exceed this estimate, or the treatment plan should change, efforts will be made to contact me. A deposit equal to the low end of the estimate is required at the time of admission and the balance is due at the time my pet is discharged. Met vet accepts many forms of payment, including care credit, and does no billing.

x x

X
Signature
Date

x
Witness Date

I decline the above recommended treatments.

x
Signature Date

Treatment Plan 6156

Page 2 of 3

(irlot) ovo9to-tdN IueduoJ aluelnsul lenln'{ oplMuolleN tlOZ O

'Aueduo) eruelnsul lentnh aplMUo!]eN
+o

$1reu of,r^ras ere opru]reus puP'aprs rno/\ uo

sr

aprMuolleN'llPUeue4 aplauolleN aql'eplMuollpN

1L'-______..-.,
er 22,2013

:t alaa.L lrt

Species: Feline Age: ll weeks and 3 days old Breed: Domestic Mediumhair

lr/

Annual Physical Exam:

Sex: Female

Biannual Senior Wellness Exam: Blood

kvels for Phenobarbital:

Dental Cleuning: Distemper Vaccine:

Coat Color: cali

Blood Levels for Thyroid Medic:

Weight
Rabies Tag Number:

0 tbs.

Code Desc

Low Price
1.00 2.00

oclooo EMERGENCY DOCTOR EXAM LP3OO CBC,IN HOUSE, DIFFERENTIAL_ 1p340 cl-lEM 14, lN HOUSE, COMPREHENSIVE
LABORATORY DRAW FEE * _ OST3O BIOHMARD DISPOSAL FEE HZsOOO HOSPITAL BOARD, lNlTlAL, <',loLB HZlOOO DOCTOR AND NURSING CARE, lNlTlALPS,I 6008 CATHETERIZATION, !V PERIPHERAL.B HS2O58 INJECTION CAP
PSs8OO LH3OO

1.00

PCV (PACKED CELL VOLUME) & TOTAL PROTEIN

2.00 2.00 2.00 2.00 2.00 2.00 2.00

1.00 1.00

1.OO $ 1.OO $

4.OO $ 4.OO $

95.00 't24.96 217.96 34.02 10.38

4.00

4.OO $ 4.OO $ 4.OO $

1.OO $ 1.OO $

HS2O56
AN2OOO

T-PORT,4" lV, lNlTlAL, <10L8

HZ2lOO FLUID THERAPY,

2.00
1.00

4.OO $
1.OO $

ANESTHESIA INDUCTTON, INJ, <10 LBS AN4OOO ANESTHESIA MONITOR, 15 MIN <lOLBS AN3OOO ANESTHESIA, 15 MINUTES <lOLBS ST343OB GASTROTOMY, FELINE.B22g 5T2630 .ENTEROTOMY, 1, FELINE

3.00 3.00
1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00

4.Oo $
4.OO $
1.OO $ 3.OO $

ST435O .LAPAROTOMY,FELINE

IN1161 BUPRENORPHINE O.6MG/ML INJECTION, PER ML IN1161 BUPRENORPHINE O.6MG/ML INJEGTION, PER ML IN1161 BUPRENORPHINE O.6MG/ML INJECTION, PER ML IN1161 BUPRENORPHINE O.6MG/ML INJECTION, PER ML IN1161 BUPRENORPHINE O.6MG/ML INJECTION, PER ML IN1161 BUPRENORPHINE O.6MG/ML INJECTION, PER ML IN1161 BUPRENORPHINE O.6MG/ML INJECTION, PER ML

1.00 1.00 1.00 1.00 1.00 1.oo

$ $ $ 1.OO $ 1.00 $
$

1.OO $
$ $ 1.OO $ 1.OO $ 1.00 $ 1.OO $

IN1161 BUPRENORPHINE O.6MG/ML INJECTION, PER ML

IN1161 BUPRENORPHINE O.6MG/ML INJECTION, PER ML IN1161 BUPRENORPHINE O.6MG/ML INJECTION, PER ML IN1161 BUPRENORPHINE O.6MG/ML INJECTION, PER ML Ii.I1161 BUPRENORPHINE O.6MG/ML INJECTION, PER ML

0.00 0.00 0.00 0.00 0.00 0.00

$ $ $ $ $ 7.00 $ 56.30 $ 57.60 $ 105.00 $ 0.00 $ 0.00 $ 61.38 $ 28.55 $ 63.36 $ 71.37 $ 400.95 $ 501.19 $ 500.20 $ 29.56 $ 29.56 $ 29.56 $ 29.56 $ 29.56 $ 29.56 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $

95.00 62.48
108.98

68.04 20.76
14.00 112.60 115.20

210.00 0.00 0.00

122.76

28.55 84.48 95.16 400.95

1,503.57

s00.20 29.56 29.56 29.56 29.56 29.56 29.56 29.56 29.56 29.56 29.56 29.56 29.56

Treatment Plan 6156

Page 1 of 3