General Information
Patient Information:
Age, Sex, Species, Breed
Mode of arrival (e.g., walked in, carried, arrived by stretcher, owner-driven, ambulance)
Document initial, observable condition (e.g., "ambulatory and alert," "recumbent but responsive," "non-responsive").
Include physical indicators such as respiratory effort, vocalizations, or visible injuries.
History of Present Illness
Primary Reason for Visit: Clearly document the owner's main concern in their own words. Include specific behaviors or symptoms observed and any relevant context (e.g., "not eating since yesterday" or "difficulty walking after a fall").
Onset: Note when symptoms began to understand chronicity, including the specific onset date if known.
Location: Describe the specific areas affected (e.g., "limping on left hind leg" or "rash on ventral abdomen").
Duration: Document how long the symptoms have been present and any notable patterns (e.g., intermittent vomiting for a week).
Progression: Describe whether the symptoms are worsening, improving, or stable to gauge urgency.
Triggers/Alleviating Factors: Record any situations that worsen (e.g., activity, eating) or improve symptoms (e.g., rest, certain positions).
Associated Symptoms (Signs and Systems)
System-Specific Observations
Constitutional: Anorexia, weight changes, energy level changes, general demeanor, restlessness, or unusual postures.
Neurological: Seizures, disorientation, tremors, or hyperactivity.
HEENT
Respiratory: Coughing, sneezing, or difficulty breathing.
Cardiovascular: Signs like collapse, fainting, or lethargy.
GI/GU: Vomiting (retching?), diarrhea. Changes in frequency, straining, or abnormalities like blood in urine.
Musculoskeletal: Lameness, stiffness, or mobility issues. Note recent trauma.
Dermatological: Skin changes, pruritus, or hair loss
Pain and Discomfort
Observable Signs of Pain: Vocalization, guarding, reluctance to move.
Pain Scale (Colorado State Pain Scale):
Score 0: No pain. Normal behavior with no signs of discomfort.
Score 1 (Mild): Slight changes in behavior, such as decreased activity or mild guarding.
Score 2 (Moderate): Reluctance to move, intermittent vocalization when handled, or visible discomfort.
Score 3 (Severe): Continuous guarding, vocalizing, aggression, or avoiding interaction.
Score 4 (Extreme): Extreme distress or agitation, such as constant vocalization or frantic movements.
Behavior Changes
Temperament Changes: Increased aggression, fearfulness, or avoidance.
Routine Changes: Alterations in sleeping patterns or inappropriate elimination.
Behavioral Triggers: Stressors like new environments, social interactions, or loud noises.
Past Medical History
Medical History:
Vaccination history
Prior significant medical conditions or diagnoses.
Known allergies (medications, food, environmental).
Previous surgeries or hospitalizations (type and date).
Current Medications:
Prescribed medications (name, dose, frequency, and duration).
Over-the-counter products and supplements.
Responses to prior treatments (effectiveness and side effects).
Preventatives
Diet and Lifestyle:
Current diet (brand, type, quantity, feeding frequency).
Are they eating and drinking and last feeding.
Dietary changes.
Environmental factors:
Indoor/outdoor access.
Access to social scenarios (dog parks, grooming facilities, daycare).
Access to standing water, rivers, lakes, or ponds.
Foreign Object/Toxin Ingestion:
Access to toys, bones, trash, or other potential foreign bodies.
Access to chocolate, xylitol, grapes/raisins, rodenticides, household cleaners, antifreeze, pesticides, or recreational drugs.
Fear and Stress Assessment (Fear Free® FAS)
FAS Scale Rating:
FAS 0: Relaxed, playful, cooperative. Loose body posture, open mouth, wagging tail (dogs), kneading paws (cats).
FAS 1: Mild stress, slight tension, or reduced interest. Lip licking, yawning, slight withdrawal.
FAS 2: Moderate stress, reluctance to interact, trembling. Avoiding eye contact, panting, or cowering.
FAS 3: Severe stress defensive behaviors. Growling, snapping, hissing, or escape attempts.
FAS 4: Extreme stress, unmanageable without intervention. Frantic escape attempts, continuous vocalizations, or overt aggression.
Stress Triggers: Document procedural or environmental factors exacerbating stress (e.g., loud noises, handling).
Document how the owner perceives the animal's behavior during past veterinary visits.
To add: pain med ok?