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HCM/RCM screening within health programme
Participating clubs: see httpJ/wwupawpeds.com/healthprogrammes/hcmclubs,html
Éq.î EIIj#
Visit httpJ/www.pawpeds.com/healthprogrammes/ for more information Owne/s name
Patient lnformation
FALLER CHANTAL
uars registered name
Address
IRINA DES BORDS DU RHIN
49 QUAI DES ALPES Post code/citÿstate
l(egrstratDn number
LOOF 2013 1525
67000 STRASBOURG
lD number, microchip ortattoo
country
25026960601 7901
FRANCE
Breed of cat
Phone (including country code)
NORWEGIAN FOREST CAT
]
lMale tlFemale
0033620978433 :mail
Not altered
[email protected]
ElAltered
Born (yeaÈmonth-day)
I have read PawPeds' instructions for HCM screening and are aware that I must inform the examiner about my cats health status and if ii is on medication. I am aware that lhe results will he rê-iâined for ihe records of PawPcds I arrlhnrize
2013-06-10 Sire
PawPeds to publicly release all results from this form.
Signature\ i
HONEY SWEET DE SIGRIOU
Examination Bruo
-
with:
ltî/,/{ -
t'tittüfrf? Ocÿ
Eruo Auscultation:
Weight Heart
E[Normat Ecuttop n Murmur, characteristics
kg
rate ,UU
',
bpm
Grade: I ll lll lV V Vl
IDehydrated EPregnan t n Lactating f]other, dr:scribe IVSd LVIDd
,l?.+
LVFWd
ÿt
[
ffiu-mode Dz-o
Subjective left atrial size
dr-mode Ez-o
Ùfvriro enlargement
lVSs
b.t(
Su-roo" flz-o Su-moce nz-o
LVIDs
r",3
(u-mooe
LVFWs
t2
Ao
E
.&n,7
LA LA/Ao
[z-o
ür-mooe Dz-o
r,
