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Veterinarian Information  Pet's Serial Number: 98567

Veterinarian Name  Sample Veterinarian Name  Phone  123-456-7890  Clinic  Sample Clinic Name  Fax  123-456-7890  Address  1234 Mockingbird Lane  E-mail  Sample@email.com  City  Tulsa  State  Oklahoma  ZIP  56789    Pet Information:   Name  Duchess  Breed  Setter, Irish  Color  Red  Weight (lbs)  45  Birthday (mm/dd/yy)  8/24/2001  Spayed/Neutered   Yes  Sex  Female  Rabies ID  49124  Species  Canine  Microchip  FR93329

Chronological Date Given Time Given  Description / More Stuff Qty  Note 8/6/2004 10:26AM Revolution-Lavender (45-50 lbs) #17371 1 Apply 1 application monthly, to back of neck. For heartworms, ticks, fleas, ear mites, and sarcoptic mange 8/6/2004 10:26AM Periodontal Disease 1 Click here for more information. 8/6/2004 10:27AM Greenies Petite 1 7/8/2004 12:34PM Brief Wellness with Heartworm Click here for More Stuff 1 See More Stuff 7/8/2004 11:15AM Anterior Cruciate Rupture - Right 1 7/8/2004 11:15AM Patellar Luxation - Bilateral ** 1 7/8/2004 11:12AM Clavamox 15 ml. #16855 1 Give 1/2 ml every 12 hours, by mouth. REFRIGERATE! Shake Well! 7/8/2004 11:11AM Notes to record 1 Restrict activity for 14 days. May do left knee in 6 weeks. 7/8/2004 11:09AM Pulse oximeter- 1 7/8/2004 11:09AM ELECTROCARDIOGRAM-monitor 1 7/8/2004 11:09AM Electrolytes 1 7/8/2004 11:09AM MiniProfile 2 1 7/8/2004 11:09AM Mini-Profile Results 1 7/8/2004 11:09AM Complete Blood Cell Count - Laser Cyte 1 7/8/2004 11:09AM Atropine inj 1 7/8/2004 11:09AM Injection for pain-Torb 1 7/8/2004 11:09AM Diazepam-Ketamine 1 7/8/2004 11:09AM Additional Anesthesia SEVO-60 min. 2 7/8/2004 11:09AM Patella-surgery for luxation 1 Partial torn cruciate. Deepened trochlear groove, stabilized joint and tightened patella 7/7/2004 11:38AM Metacam 0.4mg/ml #16843 1 Give 1 cc 1st day then, 1/2 cc once daily. Orally Shake well. Refrigerate. (9.3 cc) 7/7/2004 11:37AM Patient check-in 1 7/7/2004 11:30AM Revolution-Lavender (45-50 lbs) 1 7/7/2004 11:28AM Doctors Comprehensive Physical 1 7/7/2004 11:18AM Capstar 2-25# (6 pk) 1 Give one tablet for fleas. Kills 100% of fleas in 4-6 hrs. Lasts 36 hrs. Repeat in 36 hours if needed. 6/4/2004 9:30AM Revolution-Lavender (45-50 lbs) #16202 1 Apply 1 application monthly, to back of neck. For heartworms, ticks, fleas, ear mites, and sarcoptic mange 5/3/2004 10:31AM Revolution-Lavender (45-50 lbs) #15726 1 Apply 1 application monthly, to back of neck. For heartworms,ticks, fleas, ear mites, and sarcoptic mange 3/24/2004 5:44PM By: JO, SPAY <25# 1 AD: 03-24-04 at 5:44p: Doing wonderful 3/17/2004 3:45PM Coupon 1 3/17/2004 2:31PM Diazepam-Ketamine 1 3/17/2004 2:31PM Pulse oximeter- 1 3/17/2004 2:31PM ELECTROCARDIOGRAM-monitor 1 3/17/2004 2:31PM SPAY <25# 1 3/17/2004 2:31PM Injection for pain-Torb per 30 lbs. 1 3/17/2004 2:31PM Extraction Adult Canine-simple/each 4 3/17/2004 2:31PM Metacam 0.2mg/ml 1 Give 2 cc 1st day then, 1 cc once daily. Orally Shake well.. Refrigerate. 3/17/2004 1:10PM Electrocardiogram-preanesthesi 1 3/17/2004 1:09PM Electrolytes 1 3/17/2004 1:09PM MiniProfile 2 1 3/17/2004 1:09PM Mini-Profile Results 1 3/17/2004 1:09PM Complete Blood Cell Count - Laser Cyte 1 3/4/2004 10:58AM Doctors Exam Brief 1 3/4/2004 10:58AM Pedicure w/Assistace 1 3/4/2004 10:58AM Malacetic wipes 1 3/4/2004 10:58AM Cestex 25 mg-for tapeworm 1 Give 1 tablet for tapes. Repeat if see again. 12/31/2003 11:12AM Nemex 12.5 mg/ml 1/2 oz. #14089 1 Give 1 cc per 5 lbs. ORALLY! Repeat in every 2 weeks 3 times mo. of age then once monthly. SHAKE WELL! Gets hook & round worms. 12/31/2003 11:12AM Intestional parasite ex. Results- 1 12/31/2003 11:11AM Puppy Physical Exam 1 12/31/2003 11:11AM DIST-HEP-PARA-PARVO 1 12/31/2003 11:11AM Rabies-Canine-rr-, #4124 1 12/31/2003 11:11AM Intestional parasite exam- 1  Injections Date Given Time Given  Description / More Stuff Qty  Note 7/8/2004 11:09AM Injection for pain-Torb 1 3/17/2004 2:31PM Injection for pain-Torb per 30 lbs. 1  Laboratory Date Given Time Given  Description / More Stuff Qty  Note 7/8/2004 11:09AM ELECTROCARDIOGRAM-monitor 1 7/8/2004 11:09AM Electrolytes 1 7/8/2004 11:09AM MiniProfile 2 1 7/8/2004 11:09AM Mini-Profile Results 1 7/8/2004 11:09AM Complete Blood Cell Count - Laser Cyte 1 3/17/2004 2:31PM ELECTROCARDIOGRAM-monitor 1 3/17/2004 1:10PM Electrocardiogram-preanesthesi 1 3/17/2004 1:09PM Electrolytes 1 3/17/2004 1:09PM MiniProfile 2 1 3/17/2004 1:09PM Mini-Profile Results 1 3/17/2004 1:09PM Complete Blood Cell Count - Laser Cyte 1 12/31/2003 11:12AM Intestional parasite ex. Results- 1 12/31/2003 11:11AM Intestional parasite exam- 1  Prescriptions Date Given Time Given  Description / More Stuff Qty  Note 7/8/2004 11:12AM Clavamox 15 ml. #16855 1 Give 1/2 ml every 12 hours, by mouth. REFRIGERATE! Shake Well! 7/7/2004 11:38AM Metacam 0.4mg/ml #16843 1 Give 1 cc 1st day then, 1/2 cc once daily. Orally Shake well. Refrigerate. (9.3 cc) 3/17/2004 2:31PM Metacam 0.2mg/ml 1 Give 2 cc 1st day then, 1 cc once daily. Orally Shake well.. Refrigerate. 3/4/2004 10:58AM Cestex 25 mg-for tapeworm 1 Give 1 tablet for tapes. Repeat if see again. 12/31/2003 11:12AM Nemex 12.5 mg/ml 1/2 oz. #14089 1 Give 1 cc per 5 lbs. ORALLY! Repeat in every 2 weeks 3 times mo. of age then once monthly. SHAKE WELL! Gets hook & round worms.  Reminders Date Due    Description     12/31/2005   Puppy Physical Exam     12/15/2004   DIST-HEP-PARA-PARVO     10/19/2003   Rabies-Canine-rr-, #4124     5/12/2003   Intestional parasite exam-      Surgeries Date Given Time Given  Description / More Stuff Qty  Note 7/8/2004 11:09AM Patella-surgery for luxation 1 Partial torn cruciate. Deepened trochlear groove, stabilized joint and tightened patella 3/17/2004 2:31PM SPAY <25# 1  Vaccinations Date Given Time Given  Description / More Stuff Qty  Note 12/31/2003 11:11AM DIST-HEP-PARA-PARVO 1 12/31/2003 11:11AM Rabies-Canine-rr-, #4124 1

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