CHANCE – A1120011

Brooklyn Center

Chance A1120011, Stray, 3 Weeks Old, Female, Brown Tabby DMH .8 lbs

Medical::

 

DVM Intake Exam

 

Estimated age: 3 WK

Microchip noted on Intake NONE

 

History :   STRAY IN DRAINAGE DITCH

 

Subjective: STRAY

Observed Behavior – DOCILE

Evidence of Cruelty seen – NONE

Evidence of Trauma seen – NONE

Objective

 

T =                             P =                           R =                               BCS

EENT:  Eyes clear, ears clean, no nasal discharge noted

Oral Exam:

PLN:  No enlargements noted

H/L:  NSR, NMA, CRT < 2,    Lungs clear, eupneic

ABD:  Non painful, no masses palpated

U/G:

MSI:  Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat

CNS:  mentation appropriate – no signs of neurologic abnormalities

Rectal:

Assessment

Plan

Prognosis:

 

SURGERY: Okay for surgery

Temporary waiver due to

Permanent waiver due to

A1120011 – CHANCE

FEMALE, BRN TABBY, DOMESTIC MH MIX,21 days STRAY – WAITING4PU, NO HOLD Reason PET NO MOM Intake condition UNSPECIFIE Intake Date 07/27/2017, From NY 11236, DueOut Date 07/27/2017, Medical Behavior Evaluation GREEN Medical Summary DVM Intake Exam Estimated age: 3 WK Microchip noted on Intake NONE History : STRAY IN DRAINAGE DITCH Subjective: STRAY Observed Behavior – DOCILE Evidence of Cruelty seen – NONE Evidence of Trauma seen – NONE Objective VOCALIZING ACTIVE P = WNL R = WNL BCS 6/9 EENT: Eyes clear, ears clean, no nasal discharge noted Oral Exam: MM PINK PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD: Non painful,DISTENDED U/G: FEMALE, ABLE TO URINATE AND PASS FECES MSI: Ambulatory x 4, HIND LIMBS PARAPARETIC, HAVE MOTION BUT DIFFICULTY ADDUCTING LIMBS skin free of parasites, no masses noted, healthy hair coat CNS: mentation appropriate – no signs of neurologic abnormalities Rectal: NOT PERFORMED Assessment NEONATE SEEMS WELL FED PARAPARESIS, R/O DEVELOPMENTAL/ TRANSIENT Plan ABDOMINAL AND LEVIC XR- NO FC SEEN, JUNVENILE SKELETON APPEARS NORMAL WILL NEED TO SUPPORT NUTRITIONALLY AND MONITOR MOTOR SKILLS AS PET GROWS NH PLACEMENT/FOSTER Prognosis: FAIR SURGERY: Temporary waiver due to UNDERWEIGHT/UNDERAGE Weight 0.8

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