RG: _______________

DATA: ____/____/____

FICHA DE ATENDIMENTO CLÍNICO DE PEQUENOS ANIMAIS

DADOS DO RESPONSÁVEL
Nome CPF
Endereço Cidade UF
Telefone fixo ( ) Celular ( ) Celular ( )
IDENTIFICAÇÃO DO ANIMAL
Nome Espécie Raça Sexo Idade Peso

Pelagem Procedência

ANAMNESE GERAL
Queixa principal (evolução do quadro, tratamentos, resultados): __________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Histórico médico pregresso: ________________________________________________________________________
Alimentação: _____________________________________________________________________________
Contactantes:_____________________Ambiente em que vive: _____________________________________
Vacinação: _____________________________________________________________________________________
Vermifugação: __________________________________________________________________________________
ANAMNESE ESPECIAL
Sistema respiratório (secreção, tosse, espirro, cianose, dispnéia, ruído na respiração etc):_______________________
_______________________________________________________________________________________________
Sistema cardiovascular (intolerância a exercícios, cansaço, síncope, cianose, tosse etc): _______________________
_______________________________________________________________________________________________
Sistema digestório (apetite, vômito, diarréia): _________________________________________________________
_______________________________________________________________________________________________
Sistema urinário (ingestão de água, aspecto, volume e frequência da urina, tenesmo vesical, disúria): _____________
_______________________________________________________________________________________________
Sistema reprodutor: (secreção, cio, anticoncepcional, prenhez, número de filhotes, mamas, alteração de
comportamento): ________________________________________________________________________________
_______________________________________________________________________________________________
Sistema locomotor (claudicação, trauma, aumento de volume, marcha, impotência de membro, frequência e tipo de
exercícios): _____________________________________________________________________________________
_______________________________________________________________________________________________
Sistema neurológico (convulsão, síncopes, déficits neurológicos, deambulação, audição, olfato, propriocepção, manias,
deglutição, alteração latido/miado): __________________________________________________________

_______________________________________________________________________________________________
Pele e anexos (higiene, secreção, alopecia, prurido, lesões, descamação, parasitas, orelha): ____________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Olhos (secreção, olho vermelho, olho esbranquiçado, déficit visual, blefaroespasmo, fotofobia, primeiro olho
afetado):_______________________________________________________________________________________
_______________________________________________________________________________________________
EXAME FÍSICO
Postura Nível de consciência Escore Corporal

TR: °C FR: mpm FC: bpm TPC: seg Pulso: ppm Hidratação
Linfonodos Submand. Linf. Pré-escapulares Linf. Poplíteos Linf. Inguinais:

Mucosa ocular Mucosa oral Mucosa peniana/vulvar Mucosa anal

EXAME FÍSICO ESPECÍFICO
Sistema respiratório: ____________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Sistema cardiovascular: ___________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Sistema digestório: _______________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Sistema genito-urinário: ___________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Sistema locomotor: _______________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Sistema neurológico: _____________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Pele e anexos: ___________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Olhos: _________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
SUSPEITA(S) CLÍNICA(S)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
______________________________________________________________________________________________
EXAME(S) COMPLEMENTAR(ES)
_______________________________________________________________________________________________
_______________________________________________________________________________________________
________________________________________________________________________________________
PROGNÓSTICO
_______________________________________________________________________________________________
DIAGNÓSTICO
_______________________________________________________________________________________________
_______________________________________________________________________________________________
TRATAMENTO
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
________________________________________________________________________________________
Plantonista(s) discente(s):__________________________________________________________________________
Médico(s) Veterinário(s) Responsável(is): ____________________________________________________________