You can always press Enter⏎ to continue
Wake County Animal Shelter/Control Form
15
Questions
START
1
Admission Date
*
This field is required.
Date
Year
Month
Day
Previous
Next
Submit
Press
Enter
2
Admission Time
*
This field is required.
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
10
20
30
40
50
00
10
20
30
40
50
Minutes
AM
PM
PM
AM
PM
Previous
Next
Submit
Press
Enter
3
*
This field is required.
Dr.
Tech
Patient ID/Name
Acct #
Patient #
Species #
Breed #
Male
Female
Male
Female
Sex
Previous
Next
Submit
Press
Enter
4
Color
Age
Weight
Officer Name
Previous
Next
Submit
Press
Enter
5
Email
*
This field is required.
example@example.com
Previous
Next
Submit
Press
Enter
6
I authorize that WAKE COUNTY ANIMAL CONTROL has taken ownership of this animal prior to admittance to Animal Emergency Hospital & Urgent Care
Previous
Next
Submit
Press
Enter
7
I authorize Animal Emergency Hospital & Urgent Care to humanely euthanize this animal
Previous
Next
Submit
Press
Enter
8
Officer picked up stray
From Shelter
Previous
Next
Submit
Press
Enter
9
Microchip scanned
Tech initials
EUTH
TREATING
EUTH
TREATING
Checked/Logged in Hospital Lost & Found
EUTH
TREATING
EUTH
TREATING
Checked/Logged in Triangle Lost Pets
Previous
Next
Submit
Press
Enter
10
**
Call Dr. Federico for any treatments/estimates over $100-—Cell:
(919) 270-3976
**
Previous
Next
Submit
Press
Enter
11
Objective
T
HR : bpm
RR: bpm
MM
CRT
Previous
Next
Submit
Press
Enter
12
Presenting Complaint/History
Previous
Next
Submit
Press
Enter
13
Wake County Account
**Call Wake County Animal Control for p/u (not RAC)**
Call Dr. Federico
Charges Entered
Approve Invoice
Previous
Next
Submit
Press
Enter
14
Dr. Signature
*
This field is required.
Clear
Previous
Next
Submit
Press
Enter
15
*
This field is required.
Scan
Fax
Drugs Logged
Flowsheet
Dr. Finished
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
15
See All
Go Back
Submit