Office Address: 841 N Nolan River Rd Cleburne, TX 76033

Fax: 817-421-7560 DOS: 7/17/12 Dr. Colwick Office Address: 841 N Nolan River Rd Cleburne, TX 76033 Office Number: 817-645-8688 #1 Last, First: Raper, Preston Age: 3 Yr 10 Mo Wt: 33 Lbs 15 kg Start Time: PHONE:817-487-5634 2: 817-666-5871 PMHx:  Reflux as a baby 10:00 Arrival:9:30 Sex: M F DOB:09/22/08 PSHx: FMHx: IV Bolus Spoke With Parent Left Message Seasonal Allergies Y N

IV Sedate Emailed Patient NPO Solids: 12:00

Instructions Medicines: General Nasal Afrin NPO Clears: 6:30  Amoxicillin Anesthesia Drug Allergies: Instructions NKDA Tylenol Dose 1hr Video Acetaminophen Prior ______mg given prior to arrival

Fee: $ 1,100 Collect Date Of Service Received: $

CC Care Credit Check Cash

#2 Last, First: Stack, Autumn Calling Back w/ flex should be Age: 3 Yr 11 Mo Wt: 32 Lbs 15 kg coming in tuesday Start Time: PMHx:  Staph infection PHONE: 817-876-0185 11:00  Recent cough Sex: M F DOB: 08/14/08 PSHx: IV Bolus Arrival: 10:30  Tubes X2 Spoke With Parent Left Message IV Sedate  Adenoids Emailed Patient NPO Solids: 12:00 removed FMHx: General Instructions Seasonal Allergies Y N Anesthesia Nasal Afrin NPO Clears: 7:30

Instructions Medicines: Tylenol Dose 1hr Video  antibiotics Prior Drug Allergies: NKDA

Fee: $ 1,100 Collect Date Of Service Acetaminophen ______mg given prior to Received: $ arrival

CC Care Credit Check Cash Fax: 817-421-7560 DOS: 7/17/12 Dr. Colwick Office Address: 841 N Nolan River Rd Cleburne, TX 76033 Office Number: 817-645-8688 #3 Last, First: Barnett, Kenlee Age: 7 Yr 4 Mo Wt: 49 Lbs 22 kg Start Time: PHONE Mom (is bringing child): 682-553-0161 Dad:682-553-4571 PMHx:  Mild Murmur 12:00 Arrival: 11:30 Sex: M F DOB:02/21/05 diagnosed with @ age 3 IV Bolus Spoke With Parent Left Message PSHx: FMHx:

IV Sedate Emailed Patient NPO Solids: 12:00 Seasonal Allergies Y N Instructions General Nasal Afrin NPO Clears: 8:30 Anesthesia Medicines: Instructions Drug Allergies: Tylenol Dose 1hr Video NKDA

Prior Acetaminophen ______mg given prior to arrival Fee: $ 1,100 Collect Date Of Service Received: $

#4 Last, First: Freese, Callie Age: 4 Yr 4 Mo Wt: 34.5 Lbs 15.7 kg Start Time: PHONE: 817-964-5661 Work: 817-572-5553 PMHx: PSHx: FMHx: 1:00 Arrival: 12:30 Sex: M F DOB:02/16/08 Seasonal Allergies Y N IV Bolus Spoke With Parent Left Message

Emailed Patient NPO Solids: 12:00 IV Sedate Medicines: Instructions  Claritin as needed General Nasal Afrin NPO Clears: 9:30 Drug Allergies: Anesthesia  Omnicet Instructions NKDA Tylenol Dose 1hr Video Acetaminophen Prior ______mg given prior to arrival

Fee: $1,350 Collect Date Of Service Received: $