Dog or Cat Profile Summary Example

    This is an example of a Cat Profile containing contacts and medical records that a member can enter online.
    See an example of the Dog Emergency Profile.

     

     

    Cat Information

    • Cat’s Name / Owner’s Name:

      TABITHA – Cat / Lynn Smart

    • Telephone / Alternate

      +1-555/555-1212 – +1-555/555-1214

    • Birth Date

      4/5/2008

    • Breed – Blood Type – Gender

      American Shorthair – B – female

    • Height – Weight – Coat Color – Eye Color

      0' 10''– 8 lbs. – Black and White Van – Copper

    • Inoculations

      Rabies    Panleukopenia    Rhinotracheitis    Calicivirus

    • Other Treatments

      Feline Leukemia   

    • Cat Registration No. / Date

      C3672-00231    7 7 2008

    • Other Registration No. / Date

      Collin County    3623-7634    07 06 2008

       

    • Clinic-Hospital / Pet No.

      Pet Health Clinic    C06738

       

    • Microchip Provider / No.

      Chip Data    7368 2432 1234 876

    • Apartment Registration / No.

      Willow Creek Apt.    C12937

       

       

    Medical & Item Alerts

    • Medical Alert Condition:

      Medical Alert
       Please be advised that has Epilepsy

    • Medicine

      Phenobarbital

    • Contact / Telephone

      Lynn Smart / +1-555/555-1212

    • Alert Note

      Seizures under control with medicine

       

    Emergency Contacts

    • Name:

      Sam Fenton

    • Relationship / Contact Type

      Friend    — 1

    • Telephone

      1-555/111-2222

    • Alternate Telephone

      1-/-

    • Work Telephone

      1-/-

    • Email

      michael@mcgrathdesign.com

    • Address:

      4225 Rosemeade Road

    • City/State/Zip/Country

      Carrollton, TX 75076 – USA

       

    Veterinarian Profile

    • Veterinarian Name:

      Justin Browne, DVM,  – Primary

    • Specialty

      General   Behavior

    • Telephone

      1-555/555-1212

    • Alternate Telephone

      1-/-

    • Email

      michael@mcgrathdesign.com

    • Clinic - Hospital Name

      Pet Health Clinic

    • Address:

      4800 Grande Street

    • City/State/Zip/Country

      Dallas, TX 75220 – USA

       

    • Veterinarian Name:

      Rebecca Millstone, DVM

    • Specialty

      Internal medicine  

    • Telephone

      1-555/555-1232

    • Alternate Telephone

      1-/-

    • Email

      reb.m@millstone.com

    • Clinic - Hospital Name

      Shilo Veterinarian Clinic

    • Address:

      3267 Shilo Road

    • City/State/Zip/Country

      Garland, TX 75002 – USA

       

    Pet Pharmacy Data

    • Pharmacy Name

      PetPharm

    • Telephone

      1-555/555-1212

    • Address:

      7620 Montfort Lane

    • City/State/Zip/Country

      Dallas, TX 75248

       

    Pet Medicines

    • Medication:

      Dichlorophene   Toluene

    • Prescription # / Expiration Date

      364532   –   4 / 2018

    • Dosage / Frequency

      120mg   –   daily

    • Pet Name / Pharmacy Name

      Tabetha / PetPharm

    • Notes:

      Administer with 160mg of Toluene for six days

       

    Recent Treatments

    • Condition Treated:

      Arthritis  

    • Practitioner / Treatment Date

      Richard Durbin   –   4 / 9 / 2018

    • Facility Name

      Pet Health Clinic   –   Arthritic Pain Injection

    • Telephone

      1-555/555-1212

    • Address:

      6630 Lawnwood St.

    • City/State/Zip/Country

      Frisco, TX 75075 – USA

    • Recent Treatment Notes:

      Spinal disc deterioration

       

    Surgeries & Procedures

    • Surgery:

      Neutering  

    • Surgeon / Surgery Date

      David Blake   –   5 / 7 / 2018

    • Facility Name

      Pet Health   –   Clinic

    • Telephone

      1-555/555-1212

    • Address:

      6630 Lawnwood St.

    • City/State/Zip/Country

      Frisco, TX 75075 – USA

    • Notes:

      No problems after procedure

       

    Allergies

    •  

    Health Insurance

    • Insurance Company

      Petassurance   –   Primary Health Plan

    • Plan Name

      CatHealth

    • Subscriber Number / Group Number

      653728 38372   /  

    • Policy Members

    • Insurance Card Number / Card Date

        –   0 / 0 / 0

    • Payer ID Number / Effective Date

        –   0 / 0 / 0

    • COPAY – O Visit / Spec OV / Urg Care / ER

      / / /

    • RX COPAY – Tier 1 / Tiew 2 / Tier 3

      / /

    • Consumer Telephone

      - / -

    • Provider Telephone

      - / -

    • Health Insurance Notes:

    •  

    Edit and Print ECD Pet ID Cards

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