ALARI – 25190

[DVM Intake]
DVM Intake Exam

Estimated age: 1-2 yo
Microchip noted on Intake? none
Microchip Number (If Applicable):

History : O surrender 3 cats together – 25191, 25189, 25190.

Subjective: BAR-H.

Observed Behavior – Very wide eyes, pupils constricted. Nervous. Hissed at fake hand and swatted at it. Hissing during exam but better wrapped in towel.

Evidence of Cruelty seen -n

Evidence of Trauma seen -n

Objective

T =
P = 220
R = eup
BCS= 4/9

EENT: Eyes clear, ears clean, no nasal or ocular discharge noted
Oral Exam: clean young adult teeth
PLN: No enlargements noted
H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic
ABD: Non painful, no masses palpated
U/G: Male – 2 scrotal testicles.
MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat.
CNS: Mentation appropriate – no signs of neurologic abnormalities
Rectal:

Assessment:
Healthy 1 yo M DSH

Prognosis: Excellent

Plan: Set up for next neuter date.

SURGERY:
Okay for surgery