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Clinic's stamp

Pećiatka kliniky

East European Society of Veterinary Ophthalmology

CERTIFICATE OF EYE EXAMINATION

Registratlon for the Slovak Republic

Address: Bukovec 265,044 20 Bukovec Slovak Republic E-mail: [e-mail] www.EESVO.org

Komom vctenr^aamvch :k..rr»v 5>R

MVDr. Mirosiav FAGA

\—irrv IcV.i/

iisło OSVl*;:    ■* \

Animal /

Name/Mcno: | ^

O____1__ I    V¹ J /--

Breed/Ptem»no: [    C ^ o 7 Wdjf//

Sex:

/Pohl arie

Małe / Samce Female/Samka

Dateof birth

/ Di tum narodenia

t

—-

(7 LC

Studbook No^

TatooNo/f^,_a„.

SP^P -/5~-

Coat colour /Farbami

				^—l
pu^No/ 1
Result negative/n^Btfvny /VyU«k* posłtlve/poiWvny	s	partial cha nges / 6asto&k mwty uncłear cha nges / nciasik zmmy	B

Prevlous eye exam / Y**ikno

Pmkhidrajucc vyictrcokod no/Nic

Datę/w tum /?. C?*!. J o

Tatoo/

Methods

/Metódy

directophthalmoscopy    go

/ prttfM oft^mo ifc cipta V* ^    _    __

indirect cyhthalmoscopy [7| Fundus pte^^raph^-g--

‘"S222 0    ’    ^TS-B

□ £>£«* □ un/tdąble □

SgSET* □ 52583?“ □stea*

STTk RE: mm/min		1 iOP: RŁmmHg	ś
LŁmm/mln		| LŁmmHg	s

Resul te for the p lesume dinheri fed eye dise ases /

•a | Condbonsvalidfor 12morths/

Unaffected/ Suspicious/ Affected/

Unaffected/ Undetermined / Affected/ negatńme neurfen* pozitryne

I.Goniodysplasia	a □ □?§£■?•	9. Distichiash/Irichiasłs
1 Cataract (coogenitaO -y OOII	0 □ □ 2 □	10. Entropion / Ectopic cillla
3. PrM emiomr pąAtn mrabnrw		11. Ectropion / Macrobłepharon
4. Hypoplasia/Micro papilla	EJ □ □ _	llComealdystrophy
5. RDrrttuidr^	2 □ c^yŁ^h,t	13. Cataract (non-congwital)
6.	0 □ Dcajau	14. lens liaation (primary)
7. Other.	e- & -b	15. Rettoal degeneration (PRA)
8. CEAtoicncw««ty	ą O	IŁOther.

•.Unaffected” signlfies that there b no evidence of the presumed eye dbease(s) spedfted. whereaj "affected” slgnlftes that there b juch evłdence./'Negatfvne”rnamen4, h zvtera nevyłcazuie Ładne Drtznakv dedtfn* podmlenenćho/nych ofrkho/nyth ochorenla/l, zatiaf ćo'pozitfvne" potvrdzu)e prfiomnosf dediine podmienen<ho/nych odkho/nych ochorenia/l.    ⁷

• The animal dispUys dinkal featurej that couid pouibły frt the presumed eye dljease(j) mentioned. but the dtanęej are lnconduslve. /. 2viera yykazuje UlnłcW petznaky. ktor* by mohll zodpovedaf dedkne Dod mienen^mu/nym o&kmu/nym ochorenlu/lam, ale zmeny nie su Jednoznaćrk.

12

2

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□

□

□

□

□

□

□

□

□

□

□ □

□

□

B-

cortical

M.

punctala

nodear

Reexamination in months /Opatovnć vyie trenie

vmeaacoch

‘ B^anMS^ys minor,but spjKłfjc^s Mt^f presumed^ di$ea$e(s) mentioned. Further devełopment will conftrm the dlagnosls. / Zviera yykazuje mak. ale ipectficW priznaky dedtfne podmieneneho/nych

Descriptive comments (Eye disease No): / Komenttre (Ochocenie t)

Exam per fomned by / Vyietril:

(stampand dgnatur*/ pcCiatka a podpis

Komora vctrr.r leklrw SR

• • M VDr: M::iv;hv FAGA

\ *•» •/ i" lim l.»L