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<br />Con~ultacion/lnstruccion <br />Limited Exam <br />Hinor Physical exam <br />Complete Physical exam <br />Blood Pressure Monitoring <br />Tn test and CertificJtion <br />Record duplication <br />Injections (includes immunizÐtions)~ <br />Immunizations*- Inicial Series below <br /> <br />The followinG Race schedule is recommended: (per person) <br /> <br />200% <br /> <br />$3.00 <br />$3.00 <br />$5.00 <br />$ 10.00 <br />$ 2 .00 <br />$2.00 <br />$2.00 <br />$5.00 <br />$).00 <br />6.00 <br />$6.00 <br />'10.00 <br />$5.00 <br /> <br />Ha~:./r'::lIIi;,> <br /> <br />ßoo~ccrs <br /> <br />above 200% <br /> <br />Laboratory cests an( reports <br />Prenac21 carcZ<by application/approval) <br />BT \00' - 200' - $8.00 Initial + 3.00/vs x ~ <br />2004 - over - $20.00 Initial + 5.00/vs x ~ <br />Well-child clinic (by application/approval) <br /> <br />Hax/fami 1;- <br /> <br />Food Handlers Certification <br /> <br />$20.00 eotal <br />$~O.OO total <br />$3.00 per child <br />$6.00 Max/per f(1111 <br />$12.00 <br /> <br />'ami 1y <br /> <br />070_10070 <br />Povetty <br />! <br /> <br />100%-200" <br />Poven.y <br />Income <br /> <br />200% + <br />Povetty <br />Income <br /> <br />)ize ncome <br /> $ 5,250 $ 5,250 - $10,500 $ 10,500 <br />I <br />2 7,050 7,050 - 14 , 100 14 , 100 <br />3 8,850 8,850 - 17,700 17,700 <br />4 10,650 10,650 - 2 1,300 2 1,300 <br />5 12,450 12,450 - 24 ,900 24,900 <br />6 14,250 14,250 - 28,500 28,500 <br />7 16,050 16,050 - 32,100 32, 100 <br />8 17,850 17,850 - 35,700 35,700 <br /> \ <br /> I add $ 1,800 <br />for each add i ional family membler, <br /> I <br /> I <br /> i <br /> ! <br /> NONE FEES FEES OR REFER <br />?opulation)\ 2, 189 . 9366 24,366 <br /> : <br />~ of the 67. 26% 68% <br />¡)oDulation ~ <br /> <br />"ATTACHMENT B" <br />