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HomeMy WebLinkAbout31842 / 82-16. ;, L, 19�2 #i 16 RESOLUTIOn PURPOSE: INITIATED BY EXT�ND RETIRE2IENT DATE PERSONNEL DEPAP.TifE:IT WHEREAS, the City of Oshkosh, on the 6th da� of December, 1979, adopte3 a Uniform Extension Policy for employees of the Police Department; and 'dHEREAS, the following Police Department personnel has met ments of said Uniform Extension Policy and has requested a of his e�ployr.�ent: � DONALD UTECHT - lst Request - Police DepartmenC Date of Birth: 5/15/2; Original Retirement Date: 6/34/32 Employment Extension Through: 6/30/83 - 16 - the require- one-year exter.^ion SUBMITTED BY AppROVED � Y Nu�� i-Y }� aa: . ��r..t` .,� rCi'_iCt V�.�ra:3T.':�_f`.i�ii December 28, 19&1 Mr. William Frueh City Manager Oshkosh, Wi. Dear Sir• On May 15, 1982, I will be 55 years of age ^.Cp =G! t .._"_ 'rvs. � . � �� At this time I would like to request that my ecaployment wich the City of Oshkosh Police Department be extended for one �ear. Respectfully submitted, �;;%, ' � � ��:��i��_��`-_ Donald C. Utecht Chief of Police SAF'cTY BUILUING • 420 JACKSOi� ST. + G517XG5!!, Yll 549G I STEPHEN S. DUDIEY, iN. D. D{sea:as and Surqery ot �he Eyey � Rx for �:. . c , . Di.ronc� � � � � / ,/ I � ���.�L p� Oo _ � 2/- — iw N�w � Cq�i R�mor4u � n � . � � � �/i/ ..�`i �,.i �� 727 �octors Cou:; Oahkosh,NA 54Sv1 Tel: 235-575t --..—. De...._—._•�. __- �---7e1.--- - -� --------- cw �� -�� P.J. �� TYpe of BI(or =_" _—_ d'--P — .,._ i '_I ; ` " -__ _ "'_ _ — i��i — - ^ R '— e a Ir � // / _ 1•'' . � �� �� � � ' . � � � � �TH� MEDICAL EXAi'�1[�lATlaN R�PORi �� POLICE ANB FIRE DEPA.RT�fEi�IT Fzamioa:ioa for f%�-; ,.° o P'•,� ;•• _ t':�_--1=i. � ^ �4.-- DatP �� l '1 Q� (c6s� ri�lc) 1. Nazie (Princ) 4. Sigaanxre�oE a S. Heighr S / Don�ld C ii _6. & Epess3hc: Snellin 'Sesr. Left 20% Correcc�d m; Lek 20/ �� 2. Datr of birth__ 5��5-27 3. Ag�_ ��; �_. 7. Ches���.—: . � J.—�. cto�he FiPaoded Mobifip Na�ur:l Right 20/— Iiath 20/�. Righs 20/— � 12ocJa 20% Colo[ tes ��� �.���--4-n 9• Hraring: R eaz �4"'Q�-' �--Z: eu�'�w�� DiscLarge? �� . L0. Nos��_-� _. 11. DeaiaL s�eY`.'��rk cca: '•O•, if capped or picoq „I'�iYmi.siag; •'X'" ff cario��s; •,F,• if (;eixe. O R� 7 6 5 4 3 z i I 2 3 4 5 5 7� L Pertec�.___ Uvici slighc � 7� 6 5 4 3 2 i 1 2 3 4 S 6 7�� � 12 Toasti. ^%.L�t A �e t3. Th� 14. Tnproi� � _ ��' ��s-�'�-P ♦ 'l 15. Spc 16. Lna�: CLeck for as�hm.�y eubercvlosis, bronchi�is, che:[ %tay-Ggding� 17. Hc+r.: Cardi�vascular sy�sce�„ iv ]+L r (I.��C PaLu reo- AG, 1& Crer-o-incaunal tracz: Check Cfieck for ga+uit uIcer_ Gall bladdet � 19. C�aitoucioary: veaeieai d'sease /�`--L ���L--- Vazicoeele �-1 -��' r Kidnry• -,t�c-�-c-itiC'_tt.ti<J.a-c\, � r __.� CLt..nu � ._��G�-�. l:ood. rep�ir .._ Carses mu3:ed_ � - Pyo:rLea._��.�Need clraning n u�:m� Zi yd co:e! e___t�=.�z'�--�- .._ 2Q. :c^:a /L'�.{}'��'`- 21. \'aricose Veins_' _''V�.ev�i'.. � ! , �.�� (nom tocm) [' (� 22_ "ra-es_-1L:h-'a��; --'P� 23, l.'ee�C��P e.S�-e-.�.c,_4 � �e�. /t-c-c�.-t-�..^--cR-Y q � (� 4��((lnc ec M,A,rr mnditloa) 24. �oaes aad loinn Vl E�^�-^�-��'�r-"C 25. Spine�'�" i''--� 26. �na'ailirie�l(cSco¢ic caurz6, sinus, Eismla, rectal diseasu, cutaneous diseases, ete)—°_� -- 27. i::aess sad iajuries- �'--n-'�r- ✓�-��-�°-w'� ZH. Operacion� ����-t'- ---- 29. -:eurorie [mdaci?t �-'�"��— _ 3Q. Couid rhi� man Perfoim duty involving being oo his feec fot t2 hours con[inuously7—. 31. Coeld chu man perfocm dury inwlviag long hours of dury involving sittivg or ridiag?__ 3L Remarti• _�._ I i�REBY CEAT'IFY TTIAT THIS IS A TRL7E RECORD OF THE .�fEDICAI. 1sXAMI:�ATIQN OF THF. ABOVTi F.YhT3INLT: AlQD THAT I FUiS'l FOiI�n? kSIbi ��UALIFIED O� PHYSICALI.Y �FOR. THF. DUTA's5 OI .�� ��; �' �/ r.t' r.—_ QUALIFYEC :dm dc4) . (ti=G l�k:� / � 1.,... (�� _.-�-��.:.�.G..__ M. fJ. � Medical Fiamiu<e _ �;... MEUlCAL }3E�T(iRY ST�.T��YE�►�T : _ f'Ta be tal;en in gresence of exam�aiag physicis.^�.; - � , ., � C Do yoa betieve you are sound sud weff now? �_..�t�Are you cnhjece to tiizziness?_LN1�r�.To xvc�c hea17sc3e?_.ls.�.r—.' r To pain ie the brean? _�-t�� To �uaeri�g of che 6earttLt��-� Te ahorcncss of bres.t:?_ �c_t^- .._.,.. To coughs? �"` =. -� To di.rcfiea7 ^ti��— To pila? ^^�'-� To rLeumatism? ��* Hare yon had �x�ce cycs oc nny defect of �is[ao?� Runaiag from ei[her car? M«` Is your :ense of hcaring good?._E�1 � - H:re y�xr haci 6rs or coawl�iont? /��"� IE sq how frequendy!_ —'- _.Unceastioue speils? ,�1,:a�� ; if ::,, huw frzcp�audy?.__T �� ._ Asthma7 ^^f��� Apprndidris? ^.• �L=If sq were you opc:ated upne?_ ^�_._.Gocrossl+ea?_ �-��'�— Whm? A wre of any kind upoa your penst /+�-y- _�Ghea? An� sveiL'ng about or of yuuc iestiales? _t�����'-'� rn bo''_ arar che aau:r �Cis[nin)?...v..fl%�F.*—�-: . Ha�e yo¢ been rvpcuicd? �+� 2-�"— Do you dr:nk iatoxica[iag ;.ic;uozs to exteas?_.!J�`-- . If no[, [u whu exsend - . Do you vse cr ha�-e �o�n e,scd opinm, moryhin4 ���n4 or �any other nazeutia? �-� ,'�'� W&rn? What w•u nc� r;-se of yoer faei:e;'s deatL+?_..6��� Whac was �he cause of yout motha's dea[h?�"yd �.t�--� - Has aQy vs:mber of yaur ia.mily ha3 tube:culo.u, � insan�cy, e,rnlepry, or inflarnatacery rheumacim? �y�,y,�*-�� _�..�._.__� I-Saveyon ever spir blood? ^��+��� Have you e�er bccn hur� upnc �6c head?_..��--" - Aasnc iully_-�— .. __. �.��_..__._..._ � Hax �oa had a spraio? �sxifi joiaG? -��r--�c-booe or j^.int aa: o" Pl.ccz_...lk�.S�-F uone �a:okc;:?�j__-v--. What Soea bro3cm? t�6rc-s.-�.�.��t'Len? —_Caus:? -- :...._ ._._.Rrc you subjcct [a painfal meas or wre feec? M-�� � ,Nic�cioo carefullc• ioj�iies or s�*gies,l opeiaeiocu Yoa mag have I�,ad npon any part of yaur b�Cy, e�pecially burns, cuu, sevcrt btuis:s� or c-ar waund�rY�d'"�-h. ..__�._ �. What hospicalizauon 6ave you 6ad for U. S. waz Gix aame and addtess of p6ysidan who las[ aaeaded you, for whac ailment, . ... . . _. _ ,. . .. . . . I hereby eerrify [ha[ [he foregoing .tacernm� are :rue to tLe best oE ray kaos�Jecge aod ix�ilc'. - �� � Sigaacurc of Applicao� {sign ful! name) � I 1 t�`'I:��„I ' I=1 i�1�'}*.`r�k_"_.�, �s s,_ , pay,n=_,ur no�. CUftRENT PaEVI0U5 NAM � REFF_BENCE �ES IPTION CHARGE CREDITS BALANCE BAI.ANCc �- � This is Your RECEIPT tor this amount � �This is a ST�TF.MENT of yaur:aaourtt to da � ��ATi�EN.DWGPHYSICIAN'SSTATEMENT � AP.7ACPT4thEditir.n � � ±_.S _,� �_ �i - � � . U:icot7:xvice - .. - . . � �r . � � �.. _ �, . .. PROCEOJRES tCON'Tl : COO� rF:. � � ' . FD _ _- '- . r - . . 7AY � N.n �YR M. - F. . _ . � JFFICESEfiVIC°.5 NEN' ESIAE FEE Ex.:�ocFxCOnj. ,�6870C -� . .. .. .. , -90000 90040 --. !ntlzctcr�1 �' uPn`"at 566<. ._._.._ . �- . '�� �-' . . Bdef - � IIV2...'J' NJ. _'- '-'_---_-- . . .1 LimiteC 90010 900 O .-. Oib�.: Fx w/t ..p an[ `�l?S .-' .:.. � _ Proo� CLL_�. . . � � G8820 � . _ .- �� �_{ � Intarmetli»e � 92002 ` 92012 � � ' Macular �eSenerallon 362 So i Comprtnr�.��c ��� --92004...9201�},.: �---- .� P�ebe IV LG. Gan. Anestn.iia 59825 ..- E) ncte c:,o R^2• 250.0 ,_ . .- ° 3E820 MkziE"YeErmhk�Gisra,c.V /iF Exam unaer A^<zMesia �' 92018 -. � Probe Lac. Caraliwli . 66A4 --- ���t �(`�a _ 36..3 . � �°-�Pte.yg�umExcision� i�� 654e0 -._.- Ec4.epior� 3:4.10 Migraine CAnsultatioo-Con+DRh<nsive � 30620 _,- , -� � 367-7 GoniotmpY .' �- L � 92D2� -- � Ret..Detachnxnt Cryopary� 671�� �_ Entropio:. -� g�4.00 Myopia .... � '�-- E�'scicriti'� :'1..,. 3>S.00 nY5ta9m�'s �. � 3/1.5(� -NezS $craert C' _ '- ± - �- SVabism�� Sur9 1 Muzcle �.. fi733i ___._ - �5ensorimotor°um' � ��92066��--- -Strabisrrus5urg.2fv'.uscle -. 67312 _-_. frocfure,�.rbit 8�2.6POU��cAt�ot���d �� s�����' [ Stfabismuz Su�g. 3 Muscle .- 6T?I3 -_ Gl.rvwm�, �cute� � 365.22 OV��� Neuntls 3�>.3�% � -.YisualFicltls.K+:u[i< _� -.^ - . t � 6nronic 365.11 PoPilledxma . �377.G0� . +92082 ��-� �•.SUbconJ. Ini�ion . 6S20Q -- -- C•lzucoma. � GolOmann :.-. " ":� u5R5G � ('ISUCOm.-.,;cconCar; ?6S.G0 PlnnuccWUm '37?.57 - ODhthalmoSCOPY (Biomlc�ouopy52225 _- �'Tnbecuteciomy � --- � �3 _ E� n. -'- 92235 � " -Tarso-Levator Resect � ' E 67903 _'__ Gf uaom::. SusF�tt . 365.00�A'esEYaP�a � � � �- a72.6 � � w(Flurai PheLO?raphY -- _ : Grar Ar�z!ritis �. -� 4C7.8 � Rten'9�um - 'v,r(Fumus?nomgcaphy � 92250 -___ -T*ichiazi;Epfa:iooFOra .� 67820��.____ �Q�� Rr.t.tear/Dtnc�r�ier +(1.00�--1 � 92 60 '� ricblas s Fle ta. � G�R2 __- �leay_ t . .� W/0.0.M. • ' - � _- H i d . . � . - � v �sntl 0.epa r Linear 120 P �s 5 n0 St�af isn us, Conv 3/E i �L:1!(�-- '-- � �dC01 f: . i3.11 $ll'd�15lI1115� O VBfn /B i�� � ynuntl Repa - Jnrpl x � 131 _-_ .��� �, ' - H)PC oC �� � � ����Q - Sl�abizmas, Vort � .,, . .,, : Woun6 Repa�f, L�tl Mzr9m 7 F79 0 -. � ' ��DCOn Hemort�aqc +J2.72 .� � �_'KO��nU RaPart. Full T�ick �- 6]9 ____.__ H r�e;.- o� w/P.e. S 1� LONTA[T LEnS FtT'- .- . � rte�.v��n v� c' cc�� -.TOxoP!asmosis . . 130.5 YHa�Q�f. -��q2;yp __ °WOUntlRapa7�,Canaliculi ;j 687W � � HY� �. .-�64.4TTricniass � --.3]n.00� AGnakia, f'�9231P .__ ' IOL..Pnma�Y :� 66980 - HYP�em[.a ':. . . : ' . `' .q� 669E5 I K ' 3 , . .• ]0 -0 U•eif{5, Idtis -� 3GA 5 . ' ^�92070 �_._" --.tCL-Seconoary . � --- . .. � . ,�,T�araGeoii - .. . � KiaJtL' nri .•:.os�.t2 Vif��sRtp�flt,�tu� I�.i4 - MoCiflcat�cr, -_'�92325 _- -'-'-- � ;/7,G� Vltrcous,Hernorr��a9c379.'r3 - RePlacement '- ' 92326 �- � �.- ��- -_ � "•� ra l�e a ma - " . .-� KEietUCr.,.. �': ta0.qBCr� f.�Plf+hO 3)SSC Xdn I 5 2724p �. Pd/ameters _ � - �INGNO515 ,4; `70�!�- _ Keratome�Y R ..��L . . -.. --- .. Amaumsix , �� . __� _._._ _"'__.�_-'-'" --._._. .SPeclat FepoK�. ' ..99C80--- '��ArbIYOG�a �. � .:-� � ;��d.0 �i1.er UI:. n,., LL.' � .. . - - Anisocoria _ ! - ���79.43 . . _ - _ .- �..��, ,- , . � . . .�AnisomeVOP�e _ 'i67.31 -'-�_. . _.- '- --_ � ♦ -cL MeE�wl.OSnkosr uvl 54901) ' .hakia �rurg cal � �-79 3Y � . . .. . . HOSVITAL .. � 3G8 13 _ . __. - .-,� ^.-- Vbitss__ INITIALSUE. ��AS:henopta ; � � 90266 � 90Za0 Asti9matism 36L20 , . . � , , � � � "Briet ' -- 3]3.00 # � - -- � -- � � � Limitea �. 90 50 _ BleanariLS � - ____ �90215 ..9026o.� - `BlePharoP.osis - . . 3743D C..HCF'?F b. RJICF -._Of(Ice _F.R. ' lntermetlid . .�� . - . . -.. . T. :t �' . `�366.9 . -- .��spitel (A9ercY Metlical.OShkosh, WI SG9031 � � 'Cacarzct � � �COmPtehmx s� ' - 90220. � - , _'.J73.20 --C:'h Y_.._-'------ .'-- '� -' � '�-90P8G ' '�Cnalar�on � '' " . ExtentleC � , .� -- ��' ::: +G320 -' - Fr:ilEM11T A�SABtLIlY STl�TEMEN"( - � , - ."Churiorei�n�t�s �-, � =a _ � _ �. , � � - .Chcriore:inalOe?eneraLOn :.i -��E3-46 - LIU{abletl 1 ❑�'aRiallyDlsablcQ i ' l____- _ia�-(--r/- �GhnetEa�'tnbataP '�-��66°26 �- :CUni-�FOreignBOtlY '�'9301 -'M D, / Y _ M D �' - �' � :172J2 . ,. .�� . Conius�G� _. �.3= Femoval _ 65214 �-- '�COnI. He��orrha9e.. " "i72.9 � . W<;� i � � � �! .°.. . Conl�ne::vat �e SeraPin4 , - �'Cenl- �esiom Beniyn O.K. t�� : . .. hl ..- " p \'`.. - �..cen'une I iL's +--. � .Jl2.00 --:� :- - -' -- {orneai FS 4n"oval '6�2?2 - 1 .� . i . _ . � � eorneal o wna e a3o -.�ca�cact Lenswuarzr ... . e TF "HE�f S[?�lL7L.E�/, M.�., l 1 D. . CYCIOm e?xY ' ' .. 6672,. _ - �.. ontac+ Lens Overwea q �� ' � 2i C � C . . 11.9 � . ` � .. � " .. O C R- ?b8720 - �.COntusurt, GculaY. .� _ � / cCl��i 5.our5 _'0��_�µ���m.`� =.68eo0�'_ �-^vergn�cclnsufE� ��y -�%8�83 � (�gHKO$H,WISCOh'SW 549Ui . -r6791F �.i-� ::COrneal Abrasion �- �' ^T ', �� � q18.1 � . 135.5151 � EctmeicrTarsa�Wea9e . -_ . �, ,�..lctcFhone' . ,:., . - .fo�n^a1 PYSt r,o�Y:• a'l1.5'] � - -. . 'EntraP�an-ar;a�N/eA9e :67923 - '� . . . _EXCi5i6nGaldsion =6�BQ0 _- ComealFOie9n6odY 430A `IPFL- 1 EA#'"tLE/ SS+f9A04('�(.i.t . � 152.9 �MFD 0. ai h']1 OS]opC .�. W�SY 1825• �cizton 3s Litl-Lesiort -- 57.1C __ 'C:aNal Nerve Palsy� � .�� �c�� enn s- . � � �_! �4 �-53� �> . . . . t�acrocvsJLS -.', �j - /� ry - - , �DllatePvFdsNextV�sit � _ �- 'Oiabe[e.w/RetiwPaH�Y J ,' :i0.5 qM � . c.. �j��pyy(,. ,i _ _ ..- d . ,. � Ci te v RETVR1a _OaYS�-weeks � Montns qPPT..�. DaY �MOntO :�Oa[e . Tme r� I , .- � __ Y��.�. � < <.:_ -... . . .. .. _ . . ..r�.�. ..,:..' � . `...__...�::. .�.::.:_....�...�...w..c.���.a9�., " � . . . �b...d_.._....�a:a.n... - ..'_ . i•.. " : . :�.::.. .... _.......,:...'....� _. �...._.... _'. ....._ :... � . • � . . . . ". . ._ ... .. ._..._ .. . . . .... .. .. . � «-� i 1 � .. � . _ '. "'.'. c� .� ". .. . . �, r ": . r. - . ; ... . .. . . . . "' � �i � ... 4 ,^, ����fi RADIOLOGY�ASSOCIATES � ��a.-� ��°'OF Ti-IH FOX V�LIEY' S.0 � � 3'�ri-MGCEAPEAVEt;�- OSHKOSNCIINIC�I.ILD�N3. -Y�,14u�nrszw os.�KO=n wisce��sir� :<e�i =; PATIENT NAME D0712�I�. �iP.c�}l� .. �T@ 1� . . noostess. .1909 Georgia _ _ _ . � _ _.. CITY AND STATE ���rW15.^.O1L�1S1 t/� _ I o. �. Avnn. w o E a_ R. P. DOUGlJS, M.D_ J. C. J. q. M�KENZI� M.O. O. C. �. T. T. FLAHFF.TY. M-P. q. h OhTE Of FCPGft` 4°.L�^S���I riuM n��!r�Era , 73y68 REFERRfhG Pt-I"(�tCtAFJ � . �• °��-������n PART FXNq,;iP�E�: ��bC�� ROENTGENOLOGICAL FEPORT: � Chest: Examtnation shoc:s no hony, cardiac, or diaphrsEmztic: pa:t�alogy. A fex hi2ar calcificaCions are seen, iung xielcis �re c:.�-� r ui�t,:•uC evidence of active dieease. � _ . .__ , __ _... _ -- - _ _. .{' .�;- . � . e . -- '. _. . - . _. . ,. . . - , ti-:�... � . � _ : . . ...� . -.. ,� �. � .. . . ... . -�:rtr: � /,F� /�(��' �, h `'�l,ijt��,�`!�" �✓' _ ' ';� 9 - _ . .. ` D.� .3tyan M.D. Cc�) SIG1dED _ ...-�--�.�.._.___�_.__ ..__.. __.�.-,..._ �, __ _......,�_< -,. • -:�-__ _ . ...:... _ . � _ _ . _.. _ _ _.. .. . . _ . . . _ ,+ .. ,. - _...:- - _ ._ � ; _ , .. - ..: I . T - ;_�.. _� —.�_u.r. 1, M.D. .�D N. At O. IT. 1A O � �.: ...�,.,,... �, 1 NAM �iN t`dZ//� �G� �� _(f MBCO d�<Ironin . FDDflES° – _OATE�����i�' BY 1222 �v. LYas:����dton Blvd. los Angeles, Cahf. 90007 �����'�'�9�' AUDIOGRA65 12131 i11�5131 LEFT EAR RIGHT EAR - SUO 1000 2000 3000 �000 600Q 500 3000 2000 3000 <000 6000 NORM)t Q _ O — J y 5 5 - �p 10 — ID IS IS Ih a 30 -- 20 — - �4 V 4 0 30 �C 3G c so ao — a`� 0 J sQ – -- 5� — - so � . se — — --- ce )O ]0 JP bp 80 . _.' . � row« us / � �i— � ,� � � � 'Ct Ci) f'. � � v � � � ..� . +� � �i � � N �6 W L1 +� U .,� � r-I � � •� a +� � I r-I O N � � N N aQ � m � a ¢ 0 ro ¢ ei � O •�-f H 3+ i� � � U O .� +� O � _-�� N W � � � � � � �x J FI \�y"�--I '��. U � `� � U