Pets name
Photo The SAVIN Pet Hospital

Where ever you’re
Reg Date


Reg No
Owner’s name: Species Breed Age Sex Body weight
Kg
Address:
Phone Number:
Vaccination Brand Date Remarks
Deworming Brand Date Remarks
Bathing Soap / shampoo Date Remarks
Medical History

Surgical History
O / G History

• Primary complaints



• Areas affected

• Does it recur?


• Non dermatological complaints
Hair loss / discolorations / itching / smelling / self mutilation / alopecia/ dry scales / other…………….

Dorsal Ventral Facial Tail Paw
Other ……………………………..
Yes No Frequency ……Day….Month………….

Obesity / excess thirst / limb swelling / Yawning / recent estrus / other…………

• Duration of suffering
• Duration treated , Vets name
• Treatments details
Dr


Remarks :
• Is it breed predisposed condition
• Congenital or hereditary problems
Or developmental problem?
• Is it intact or spayed or Cryptorchid Yes No

No Yes Describe …………………..
Int Spy Cryp
• Itching and its severity None Moderate Severe
Lick Rub Scratch Chew
• Food allergy
• Drug Allergy Food Beef Pork Fish other
Sulpha penicillin Ceftr Bcomplex Other ………………………………….



• Evidence of occurring in seasons Yes No
• Presence of fleas or ticks Yes No
• Response to old treatments To steroids
To Antibiotics
• Frequency of bath Frequent 7 15 21 30 30+ none
• Environment animal stays Indoor Outdoor
• Does it come across other animal Household stray none
• Household disinfectants used Black phenyl
• Any use of OTC human products recently
• Any Further Details:
Diagnostic Test results Date
TC S LIPD T3 Antibogram Remarks
N RBS T4
M TSH TP
L FECAL PARASITE Microscopy
E TYPE
B URINE
CREA
BUN SMEAR
OTHER
Tentative Diagnosis Prognosis Confirmative Diagnosis
Date Observation Treatments & Advice

Date Observation Treatments & Advice

Date Observation Treatments & Advice
Date Observation Treatments & Advice
Date Observation Treatments & Advice
Date Observation Treatments & Advice
Date Observation Treatments & Advice
Date Observation Treatments & Advice
Final outcome ……………………………………………………………………………….

Diethylstilbestrol dosage

Dogs:
For pregnancy avoidance after mismating:
a) 0.1 - 1 mg PO for 5 days if animal is presented 24-48 hours after coitus. If animal is presented later than 5 days post-coitus: 1 - 2 mg PO for 5 days after ECP therapy (0.044 mg/kg (ECP) IM once during 3-5 days of standing heat or within 72 hours of mis-mating)

For treatment of perianal gland adenomas and prostatic hyperplasias:
a) 0.1 - 1 mg PO q24-48h
b) 1 mg PO q72h; or 1.1 mg/kg once. Do not administer more than 25 mg.

For treatment of estrogen-responsive incontinence:
a) Initially 0.1 - 1 mg PO daily for 3-5 days, followed by maintenance therapy of approximately 1 mg PO per week. Some animals may require much higher initial dosages
to obtain a response. Maximum initial doses of 0.1 - 0.3 mg/kg once daily for 7 days,
then reduce to once weekly. All maintenance doses should be gradually reduced to the
lowest effective dose.

b) 0.1 - 1 mg PO per day for 3-5 days, then 1 mg once weekly
c) 0.1 - 1 mg PO for 3-5 days followed by 1 mg every week or less often. Some animals
may require more than 1 mg weekly to maintain. (

Calcium dosage

Dogs:
For hypocalcemia:

a) Calcium gluconate injection: 94 - 140 mg/kg IV slowly to effect (intraperitoneal route may also be used). Monitor respirations and cardiac rate and rhythm during administration.

b) For acute hypocalcemia: Calcium gluconate 10% injection: Warm to body temperature
and give IV at a rate of 50 - 150 mg/kg (0.5 - 1.5 ml/kg) over 20-30 minutes. If
bradycardia develops, halt infusion. Following acute crisis infuse 10 - 15 ml (of a 10% solution) per kg over a 24 hour period. Long term therapy may be accomplished by
increasing dietary calcium and using vitamin D. Calcium lactate may be given orally at a rate of 0.5 - 2 g/day.

c) Calcium gluconate 10% 0.5 - 1.5 ml/kg or calcium chloride 10% 1.5 - 3.5 ml (total) IV slowly over 15 minutes; monitor heart rate or ECG during infusion.

d) For emergency treatment of tetany and seizures secondary to hypoparathyroidism:
Calcium gluconate 10%: 0.5 - 1.5 ml/kg (up to 20 ml) over 15-30 minutes. May repeat
at 6-8 hour intervals or give as continuous infusion at 10 - 15 mg/kg/hour.

For hyperkalemic cardiotoxicity:
a) Secondary to uremic crisis: Correct metabolic acidosis, if present, with sodium bicarbonate (bicarbonate may also be beneficial even if acidosis not present). Calcium gluconate (10%) indicated if serum K+ is > 8 mEq/L. Give at an approximate dose of 0.5 -1 ml/kg over 10-20 minutes; monitor ECG. Rapidly corrects arrhythmias but effects arevery short (10-15 minutes). IV glucose (0.5 - 1 g/kg body weight with or without insulin) also beneficial in increasing intracellular K+ concentrations.

Acepromazine dosage

Dogs:
a) Premedication: 0.03 - 0.05 mg/kg IM or 1 - 3 mg/kg PO at least one hour prior to
surgery
b) Restraint/sedation: 0.025 - 0.2 mg/kg IV; maximum of 3 mg or 0.1 - 0.25 mg/kg IM.
Preanesthetic: 0.1 - 0.2mg/kg IV or IM; max. of 3 mg; 0.05 - 1 mg/kg IV, IM or SQ.

c) 0.1 mg/kg IM or IV q8h
d) 0.55 - 2.2 mg/kg PO or 0.55 - 1.1 mg/kg IV, IM or SQ
e) 0.55 - 2.2 mg/kg PO or 0.055 - 0.11 mg/kg IV, IM or SQ