FICHA DE DIAGNSTICO

Pronturio No:___________
Canino ( ) Felino ( ) Outros ( )________________

Data: ____/____/______

Nome:_______________________________ Data Nascimento:___/___/____ Sexo: M F

Raa:______________________ Pelagem:_____________________Peso:_________________
Proprietrio:___________________________________________________________________
Suspeita Clnica:________________________________________________________________

EXAMES COMPLEMENTARES

Hemograma
Bioqumico
Funo Renal Funo Heptica
Esfregao sanguneo Raspado de pele
Bipsia
Coproparasitolgico Urinlise Outros: ___________________________________
RX________________________ US_______________________ ECG____________
Outros______________________________________________________________________
RESULTADOS
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DIAGNSTICO FINAL
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TRATAMENTO
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PROGNSTICO:______________________________________RETORNO:____/____/______