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.comOwner 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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