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Methocarbamol Case Details Submission

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Contact Details

Vet Name

First

Last

Clinic Name

Best Contact Number

Patient Details

Age (Years)

Sex

Male Neutered
Male Intact
Female Spayed
Female Intact

Breed

Weight (kg)

Case (toxicosis) type (e.g. metaldehyde, methiocarb, chocolate, etc)

Symptoms (e.g. tremors, hypersalivation, seizures, etc)

Date / Time Methocarbamol first administered?

Date

Time

Methocarbamol dose rate (DAY 1)

1st dose

2nd dose

3rd dose

1st dose Dosage Units

2nd dose Dosage Units

3rd dose Dosage Units

1st dose route of admin

2nd dose route of admin

3rd dose route of admin

Methocarbamol dose rate (DAY 2)

1st dose

2nd dose

1st dose Dosage Units

2nd dose Dosage Units

1st dose route of admin

2nd dose route of admin

Methocarbamol dose rate (DAY 3)

1st dose

2nd dose

1st dose Dosage Units

2nd dose Dosage Units

1st dose route of admin

2nd dose route of admin

Other medications administered

Drug name 1

Drug name 2

Drug name 3

Drug name 4

Drug name 5

Drug dose 1

Drug dose 2

Drug dose 3

Drug dose 4

Drug dose 5

Dosage Units 1

Dosage Units 2

Dosage Units 3

Dosage Units 4

Dosage Units 5

Frequency 1 (e.g once, BID)

Frequency 2 (e.g once, BID)

Frequency 3 (e.g once, BID)

Frequency 4 (e.g once, BID)

Frequency 5 (e.g once, BID)

Adverse reactions (if any e.g. CNS depression, etc)

Outcome (Recovered/Euthanised/Died/Discharged home, etc)

Time to recovery (e.g. Within 12h)

Call between 8am and 4pm

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Methocarbamol Case Details Submission

Contact Details

Patient Details

Methocarbamol dose rate (DAY 1)

Methocarbamol dose rate (DAY 2)

Methocarbamol dose rate (DAY 3)

Other medications administered

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