Holter Monitor Activity Log

Dr. Luis Braz-Ruivo, DVM, DVSc,

Diplomate ACVIM (Cardiology)

11660 Annapolis Rd., Glenn Dale MD, 20769, USA

Ph: 301-809-8800, Fax: 240-218-0091, Email: beltwaycardio@aol.com

Owner Name: _______________ Dog’s name: ____________ AKC/CKC#: ___________

Sex: M, F, MC, FS, Breed: ___________ Color: _______________ Wt:____

If on medication please list the name, dose and how often is given. Also do not forget to enter in the log the accurate that each medication is given

Medication: 1______________ 2______________ 3_______________

TIME

ACTIVITY

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