+VETERINARY CLINICAL CASE PROFORMA+

1) Patients Data:
Out Door Case No.: Owners Name & Address Date Of Admission: Clinician: Dr. Name Of Student: months / /

Species Of Animal: Breed: Age: Weight: Kgs. Colour: No. Of Calving: Stage Of Lactation/Pregnancy:

Sex: M/F Ear No.: Milk Yield: ltrs.

2) Case History:
a)Present Complaint/illness: b)Appetite: c)Duration Of illness: d)Feeding Pattern: e)Water Intake: f)Physiological Processes: 1)Defecation & consistency: 2)Urination & consistency: g) Past History: h) Past Treatment: i)Any Other:

3) Clinical Observations:
a)Body Condition: c)Posture: e)Muzzle: g)Mouth Cavity: i)Mucus Membrane: k)Pulse Rate(No./min): m)Examination of Lung: o) Examination of Rumen: b)Behaviour: d)Gait: f)Skin & Hair Coat: 0F 0C h)Rectal Temperature: j)Respiration Rate(No./min): l)Heart Rate(No./min): n)Examination of Heart: p)Ruminal Motility: /3min.: /5min.:

4) Laboratory investigations & Results :(Haematology/Faeces/Urine/CMT/Blood

Biochemistry/Culture and Drug sensitivity/X-ray etc.):

5) Diagnosis: Tentative:
Confirmative:

6) Clinical Profile & Treatment:

Date Observations Treatment

Date

Observations

Treatment