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CLINIQUE DE PRÉVENTION des AVC/
STROKE PREVENTION CLINIC
1111 Ghislain, Hawkesbury, Ontario K6A 3G5
(613) 632-1111, poste/ext. 482
Télécopieur/fax
: (613) 636-6194
Requête de consultation/Request for Consultation
Date: ____________________
Médecin référant/Referring physician: ________________________ Signature:_____________________
(en lettres moulées/printed)
Date ICT/TIA: ______________________ OU/OR Date AVC/Stroke: __________________
Raison de consultation/ Reason for consultation:
_______________________________________________________________________________________ _______________________________________________________________________________________ Cochez tout ce qui s’applique/check all that apply TA lors de l’évènement/BP at time of incident: _____________________
Faiblesse/Weakness: □ Oui/Yes □ Non/No □ Face □ Bras/Arm □ Jambe/Leg
Trouble de la parole/Speech disturbance: □ Oui/Yes □ Non /No □ Aphasie/Aphasia □ Dysarthrie/Dysarthria
Trouble de vision/Visual disturbance: □ Oui/Yes □ Non/No □ Amaurosis fugax □ Hémianopsie/Hemianopia
Sensation anormale/Abnormal sensation: □ Oui/Yes □ Non/No □ Face □ Bras/Arm □ Jambe/Leg
Durée des symptômes/Symptoms’ duration : □ < 10 minutes □ >10 & < 59 minutes □ > 60 minutes
Fréquence/Frequency:
□ > 1 dans la dernière semaine/ > 1 in the last week Facteurs de risque majeurs/Major risk factors
□ Maladie vasculaire périphérique/PVD □ F. auriculaire/A. fibrillation □ Tabagisme ou ATCD/Smoking or history of smoking □ Maladies valvulaires/Valvular ♥ diseases □ Sténose carotidienne asymptomatique/Asymptomatic carotid stenosis □ ATCD d’AVC-ICT/Previous Stroke-TIA □ ATCD familiaux de maladies ♥-AVC/Fam. History of ♥diseases-Stroke
Médicaments initiés/Medication initiated : □ Aggrenox
□ Anticoagulant: _____________________________________ Investigations: Indiquer les examens ayant été prescrits et les télécopier S.V.P. / Indicate tests that have been
ordrered and please fax the information - FAX (613) 636-6194
□ Copie de la consultation à l’urgence/Copy of the Emergency record
□ FSC/CBC, Electrolytes, Creat, PTT, INR, LFTs, Glucose, CK
□ Doppler carotidien/Carotid Doppler Médecins de famille, S.V.P. ajouter/Family Physicians, please add : □ Glucose et lipides à jeun/FBS and lipids
Signature: _______________________________________________ 6097 2007.02.13

Source: http://www.hgh.ca/Documents/6097%20-%20Requete%20de%20consultation%20-%20Prevention%20AVC%20_%20Request%20for%20Consultation%20-%20Stroke%20Prevention%20Clinic.pdf

“endocrinopathic laminitis has been defined as laminitis developing from hormonal influences” (rather than in association with pro-inflammatory and intestinal conditions)

Endocrinopathic laminitis Notes from powerpoint slides – Sweden (Tidaholm), 18th May 2010 Melody de Laat BVSc (Hons) Australian Equine Laminitis Research Unit The University of Queensland Gatton, Qld, Australia m.delaat@uq.edu.au “Endocrinopathic laminitis has been defined as laminitis developing from hormonal influences” (rather than in association with pro-inflammatory and inte

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III.- OTRAS DISPOSICIONES Y ACTOS Universidad de Castilla-La Mancha Resolución de 01/07/2013, de la Universidad de Castilla-La Mancha, por la que se aprueban las bases de la convocatoria de ayudas para la adquisición de plantas piloto con cargo al Programa Operativo Feder 2007-2013. [2013/8266] Este Rectorado, de conformidad con las competencias que tiene atribuidas en virtu

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