"n"`frr,/"bt - des Bords du Rhin
Transcription
"n"`frr,/"bt - des Bords du Rhin
rnerrn +ÈË HCM/RCM screening within health programme Participating clubs: see httpJ/www.pawpeds.com/healthprogrammes/hcmclubs.html Visit httpJ/www.pawpeds.com/healthprogrammes/ for more information EiI# Owner's nâme Patient lnformation FALLER CHANTAL Çat's registered name Address LEO DES BORDS DU RHIN 49 QUAI DES ALPES Post code/CiÿState Registration number LOOF 2015 201350 67000 STRASBOURG lD number, microchip or tattoo Country 250269606516410 FRANCE Breed of cat Phone (including country code) NORWEGIAN FOREST CAT 0033620978433 !-lAhered :mall Not altered $Male -l Female [email protected] Born (year-monih-day) I have reâd PawPeds' instructions for HCM screening and are aware that I must inform the examiner aboui my cats health status and if it is on medication. I am aware thât thê rebults will be retainêd for the remrds of PawPeds I âuthorizc 2015-07-02 si16 PawPeds to publicly release all results from this form. Signature TITRAN'S PLATO Dam Examination Sedated n ation i_lfrài,/ I t, ".r.irt " rr, DIruo with: Date rd.:) il i ,/ .ù r,l EIuo Auscultation: Weight E[ttormat kg 41-o Heart rate E bpm IDehydrated f]Pregnant ! Lactating I IIVSd LVIDd Otn"r, describe ÿ''ü [c, p,, 4\ü LVFWd ÿ,r lVSs é,.7 LVIDs ,'{tO LVFWs 1,) ,' Grade: I ll lll lV V Vl I Dynamic Estrti" Timing: Esystotic ÜDiastotic IaoÛ' E Continuous Location: n I-ett apex (sternum) E tett gase Eotn"r, describe pna-mooe $rra-mooe Qtr,t-moae Ez-o Ez-o fJz-o Eu-mode nz-o Eltr"t-moae J^-7 Dcattop ùturmur, charâcteristics ffiu-moae Ez-o Ez-o Subjective left atrial size I ! frllitO enlargemènt Moderate enlargement Isevere enlargement Systolic anterior motion of the mitral valve K,t' IJM-mode lÀz-o flu-mooe E[z-o LA LA/Ao /,,\ Assessment (based on phenotype) ny"" lf yes, LV outflow tract flow velocity (DopÉler) End-systolic cavity obliteration SF Ao nyes M'o Papillary muscles @§ormal f] I Abnormal, moderate enlargement Abnormal, severe enlargement Commenis E[ruormat IEquivocal !ncrrl !rritito IModerate flncn,t E otn"r, nsevere describe name, clinic's name and address Veterinarian PawPeds' examination instructions has been followed Cat's identity verified Elyes no, describe why not ! "n"'frr,/"bt Date ,t ,tr. t7 .," .t, ,/ b/t't.!(rt/ >,t !,!, Ç j ,,1{telntierpraxis Andreas Kirsch ; ]r. ri+J. v.:t. (ir:n- i il f,l,' u. iieimiiere ;T,\ .rr: Ii'r-.r:ii lieCirui ,' Kardiui*Eie d : ^; i'.':t ç:',.!:;:it 1, 7 ti7 3 P{orlheiin For registration of the result, the veterinarian shall send a copy of this form to: PawPeds, c/o Olsson, Angsmyrvâgen 1 Bâsna, SE-781 95 BORLANGE, Sweden Rev 1.13 (en) 201'l-01-07 tp.. *-$ j';(t' ) iil ItL Examination eouioment [Yes, with: !Yes, i ,i '/^ t'[' î' FLORADORA DES BORDS DU RHIN Exam , Etrno