Бланк истории болезни. Казанская государственная академия ветеринарной медицины имени Н. Э. Баумана
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1 2 Казанская государственная академия ветеринарной медицины имени Н.Э. Баумана Клиника____________________ ИСТОРИЯ БОЛЕЗНИ Вид животного______________________пол_____________возраст__________________ Кличка_______________________________бирка__________________________________ Кому принадлежит____________________________________________________________ ДИАГНОЗ__________________________________________________________________ Дата поступления________________________Дата выписки________________________ ИСХОД:____________________________________________________________________ Старший ветврач_____________________________________________ Куратор (Ф.И.О., группа, курс)__________________________________________________ Клиника________________________________ ИСТОРИЯ ЗАБОЛЕВАНИЯ №___ I. ОБЩИЕ СВЕДЕНИЯ Хозяйство или Ф.И.О. владельца животного________________________________________ Адрес____________________________________________________Телефон_____________ Паспортные сведения о животном: вид_____________пол____________возраст__________ Кличка, тавро, бирка№__________________________масть,приметы___________________ ____________Порода, сорт____________________Вес__________Беременность_________ Дата поступления_____________________Исход заболевания_________________________ Число дней лечения____________________________________________________________ Подпись врача (помощника куратора)_______________ II. АНАМНЕЗ А) Анамнез об условиях содержания, кормления, эксплуатации: ______________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Б) Анамнез о заболевании: (сведения о перенесенных ранее заболеваниях; санитарно-эпизоотическое состояние хозяйства; история настоящего заболевания – первоначальные симптомы, время и обстоятельства их появления, первые лечебные и профилактические меры, проведены кем и когда): ___________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Подпись врача (куратора) _____________________________________ III. СОСТОЯНИЕ ЖИВОТНОГО ПРИ ПОСТУПЛЕНИИ “____”______________________ _______г.______________часов Температура ______оС; Пульс_______уд/мин; Дыхание _______движ/мин. Габитус______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Упитанность__________________________________________________________________ Шерстный покров и кожа________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Лимфоузлы_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Слизистые оболочки___________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Органы кровообращения _______________________________________________________ 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Органы дыхания_______________________________________________________________ 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Органы пищеварения___________________________________________________________ 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Молочная железа______________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Мочеполовые органы__________________________________________________________ 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Нервная система_______________________________________________________________ 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____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ДОПОЛНИТЕЛЬНЫЕ ИССЛЕДОВАНИЯ 1. Рентгеновские, электрокардиографические и др._________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 2. Серологические, аллергические, бактериологические, паразитологические___________ __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 1 2 |