Prontuário Nº____________________________

Data ____/_____/______

Data Internação:____/____/______ Hora____:_____

Alta: ____/____/_____ Hora_____:_____

Nome Proprietário:______________________________________________________________

Endereço:_____________________________________________________________________

CEP:____________________________Bairro______________________Estado_____________

Tel.______________________ Cel._____________________ Rec._______________________

Espécie:______________________ Raça:_____________________ Fêmea: Macho:

Nome:_________________________________ Idade: ______________ Peso: ___________Kg

1º Consulta: Retorno:

Castrado: Inteiro:

FC:________bpm FR:________rpm FP________ppm Tº ________Cº

Mucosas:_______________________________________________________________________

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Linfonodos: Submandibular:_______________ Poplíteo:_____________

TPC: ________________________segundos

Nível de hidratação:_______________________________________________________________

Queixa Principal – História Médica Recente:

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Tratamento Anterior: _____________________________________________________________
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Sistema Digestivo: ______________________________________________________________

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Sistema Cardiorrespiratório: _______________________________________________________

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Sistema Gênito-urinário:___________________________________________________________
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Sistema Oto-tegumentar:__________________________________________________________
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Sistema Nervoso:________________________________________________________________
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Outros:________________________________________________________________________
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Exames complementares:_________________________________________________________
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Tratamento indicado: _____________________________________________________________

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Medicação prescrita:______________________________________________________________
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Diagnóstico Provável: ____________________________________________________________

Diagnóstico Final: _______________________________________________________________

Prognóstico: Bom Reservado Mau

Enfermeiro Veterinário Responsável: _______________________________________

Data: _____/_____/_____