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Washington D. C. 
APril 16th 1867

Ketchum A.P.
Bvt Lt Col
A.A.A.G.

States that no bill will be allowed for medical attendance at places where an A.A. Surg. is employed. Also that not more than Fifty Dolls per month will be allowed in contract with an A. A. Surg who is at the same time under contract by the Med Dept of the Army to attend troops.