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Post-Treatment Update
This form allows us to update the medical record for a horse that received medication.
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* Indicates required question
What is the horses Name
*
Your answer
What is the veterinarian's name on the prescription
*
Your answer
Please indicate the level of neurological deficit.
*
Please put in a gait score (GAS) or deficit for polyneuritis
0
1
2
3
4
5
Prior to treatment
After treatment
0
1
2
3
4
5
Prior to treatment
After treatment
Is this horse free of signs (remission)?
yes
no
I did not re-examine the horse
Clear selection
How many times has this horse had repeat signs of neuromuscular deficits?
Never, this is the first instance
Once
Twice
Three or more
Clear selection
Please provide any comments you may have.
Your answer
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