The following information is requested to aid in planning I-131 treatment for this patient. Please include any additional information that you feel may be relevant for the pre-treatment assessment of this patient.Hospital: Fax:Client:* First Last Phone:*Patient:* Date & Time of Appt: Medical HistoryChronic Problems of Concern: Diagnosis & Previous Treatment for HyperthyroidismWhen was the cat diagnosed and what symptoms lead to the diagnosis?Has there been previous treatment?MethimazoleYesNoWhat is the dosage? Previous I-131 treatmentYesNoWhen was the cat treated? ThyroidectomyYesNoWhat date was the surgery performed? Has there been evidence of adverse drug reaction to methimazole?YesNoHas the client discontinued fish products at least 2 weeks before treatment?YesNoFish meal or oil as a minor ingredient is okMedicationsIs the cat currently taking any medications other than methimazole? Please provide prescription information for each drug and specify whether the drug needs to be given while the cat is in our facility. Δ