GUIDE TO THE PROFESSIONAL PRACTICE STANDARD

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GUIDE TO THE PROFESSIONAL PRACTICE STANDARD Veterinarian-Client-Patient Relatinship (VCPR) Published: July 2016 Revised: April 2017; Nvember 2017 Intrductin The Cllege s Prfessinal Practice Standard:

1 GUIDE TO THE PROFESSIONAL PRACTICE STANDARD Veterinarian-Client-Patient Relatinship (VCPR) Published: July 2016 Revised: April 2017; Nvember 2017 Intrductin The Cllege s Prfessinal Practice Standard: Veterinarian-Client-Patient Relatinship (VCPR) establishes the expectatins that are fundamental fr establishing and maintaining a veterinarian-client-patient relatinship (VCPR). The VCPR is ne f the fundatins f effective veterinary care and service. A VCPR is established when a veterinarian agrees with a client t prvide veterinary services t an animal r grup f animals. 1 Using a questin and answer frmat, this Guide t the Prfessinal Practice Standard addresses questins and ffers suggestins n hw t apply the Prfessinal Practice Standard in situatins that arise in veterinary practice. Frequently Asked Questins abut Establishing and Maintaining a VCPR Hw shuld a veterinarian establish a VCPR with a client? Establishing a VCPR invlves a cnversatin where the client retains the veterinarian, the veterinarian and client reach an agreement as t the scpe f the services t be prvided by the veterinarian, and the veterinarian advises the client that services will nly be prvided in accrdance with the standards f practice f the prfessin. A VCPR can be established in persn r via telemedicine with varius technlgy. 1 Please nte that, in this cntext, grup f animals refers t mre than ne animal f any species. Guide t the Prfessinal Practice Standard Veterinarian-Client-Patient Relatinship (VCPR) 1

2 In a multi-veterinarian veterinary facility, des each veterinarian have t establish a VCPR with a client? A veterinarian shuld explain t the client that, althugh the VCPR has been established with a particular veterinarian, any f the veterinarians in that same practice are able t prvide care t their animal r grup f animals, in rder t ensure cntinuity f care, if the client agrees. If a veterinarian leaves a practice and starts t wrk at a new practice, wuld he r she have t establish a new VCPR with a client that the veterinarian previusly had a VCPR with at his r her previus practice? Yes. A VCPR des nt travel with a veterinarian. It is established with a veterinary facility. When a veterinarian leaves a veterinary facility and a frmer client wishes fr him r her t treat an animal, a new VCPR will have t be established at the new facility that the veterinarian is wrking at. One f the requirements fr a veterinarian t cntinue t prvide treatment r services within an established VCPR is having recent and sufficient knwledge f an animal r grup f animals. Hw can a veterinarian determine what cnstitutes recent and sufficient knwledge? What cnstitutes recent and sufficient knwledge f an animal r grup f animals will depend n all f the circumstances f a particular case. Each case will be different and will depend n the veterinarian s prfessinal judgment and the presenting circumstances f the animal r grup f animals. There are certain factrs, hwever, that may assist a veterinarian in cnsidering whether he r she has recent and sufficient knwledge f an animal r grup f animals, and whether an examinatin and/r ther assessment is warranted prir t recmmending and/r prviding treatment (including prescribing, dispensing, r administering). These factrs may include, but are nt limited t: The animal s age; The species f the animal; The animal s health status, including any medical cnditin(s); The animal s medical histry as recrded in its medical recrd, including immunizatin histry; The animal s nutritin; The animal s envirnment; The animal s hygiene; The type f treatment plan being cnsidered, including type(s) f medicatin(s); and Whether there are any industry standards r prfessin-based guidelines setting ut best practices related t hw ften a veterinarian shuld see an animal r a grup f animals f a particular species. Guide t the Prfessinal Practice Standard Veterinarian-Client-Patient Relatinship (VCPR) 2

3 Scenari A veterinarian shuld dcument his r her clinical reasning prcess fr reaching a decisin as t whether r nt he r she has sufficient and recent knwledge f an animal r a grup f animals. Based n the Cllege s previus VCPR plicy, Dr. Vet wuld nt refill a prescriptin fr a patient unless she had examined the patient within the past year. Based n the current Prfessinal Practice Standard: VCPR and cnsidering the abve factrs, Dr. Vet uses her prfessinal judgment t determine if she will refill the prescriptin. Depending n her recent knwledge f the individual patient, the purpse f the medicatin, and the risks and benefits t the patient, she will determine what infrmatin she needs t fill the prescriptin, which may r may nt include a physical examinatin. The apprpriate time between examinatins can vary depending n the factrs enumerated abve, each individual assessment f an animal, and the circumstances. In additin t the usual questins regarding the histry f an animal r grup f animals, what else shuld a veterinarian ask a client when establishing a VCPR t ensure cntinuity f care? Additinal questins that assure cntinuity f care include asking a new client whether he r she has seen anther veterinarian recently. If s, the veterinarian shuld infrm the client that he r she will btain the animal s (animals ) medical recrds frm the previus veterinarian. Is a VCPR required fr dispensing any prduct? A VCPR must be in place befre a veterinarian prvides veterinary services r recmmends treatment (including the prescribing, dispensing, r administering f drugs) in respect f an animal r grup f animals, unless ne f the exceptins t the requirement fr a VCPR, which are utlined in the Prfessinal Practice Standard: VCPR, applies. A VCPR is nt required when a veterinarian dispenses any substance r preparatin manufactured, ffered fr sale r sld as, r as part f, a fd, drink r csmetic (nt defined as a drug). Currently, natural health prducts require a VCPR t be dispensed. Frequently Asked Questins Regarding Client Issues Hw shuld a veterinarian establish whether a persn has decisin-making authrity with respect t an animal r grup f animals? It is a best practice t establish, in writing, all wners and agents that have decisinmaking authrity at the utset f a VCPR. The names f all wners and agents that have decisin-making authrity shuld be included in the client infrmatin. Where an individual wh is nt a knwn wner presents himself r herself as an agent and appears t be acting in the best interest f the animal r grup f animals, a veterinarian may, where reasnable, assume that the persn in questin is a designated agent f the Guide t the Prfessinal Practice Standard Veterinarian-Client-Patient Relatinship (VCPR) 3

4 wner and has decisin-making authrity, unless he r she has reasn t believe therwise. What shuld a veterinarian d when he r she knws r believes that a client is seeking services frm multiple veterinarians? In cases where a client has established VCPRs with multiple practices, a veterinarian may wish t explain the imprtance and benefits f cntinuity f care t the client and the challenges and ptential dangers that may result t an animal s r grup f animals health when there is a lack f cntinuity f care and where a veterinarian is nt aware f an animal s full medical histry. In situatins where a veterinarian is nt cmfrtable with a client wh he r she believes has established a VCPR with multiple veterinarians which results in a lack f cntinuity f care r a substandard level f care, he r she may wish t discuss withdrawal f his r her services and a ptential terminatin f the VCPR. Frequently Asked Questins Regarding the Terminatin f a VCPR Is there a certain perid f time after which a veterinarian has nt seen a client and patient after which the VCPR will autmatically expire r lapse? N, a VCPR des nt autmatically end after a certain perid f time. A client may assume that he r she still has a VCPR with a veterinarian if the client has nt visited the veterinarian in a number f years, and even if the client has requested that their medical recrds be transferred t anther veterinary facility. In these kinds f circumstances, a veterinarian may want t cntact the client and clarify whether the client wants the veterinarian t cntinue t prvide veterinary services t his r her animal r grup f animals. The veterinarian may want t suggest that the client schedule a visit t the veterinary facility. When the client r veterinarian wishes t terminate the VCPR, the veterinarian shuld cnfirm this in writing t the client. When and hw shuld a veterinarian terminate a VCPR? The Cllege recgnizes that, in certain situatins, a VCPR may need t be terminated, despite attempts t address cncerns r prblems. In the interests f ptimal animal care and treatment, terminatin f the VCPR may be the mst prductive ptin fr bth parties t address n-ging and unreslved issues. Ptential legitimate reasns fr terminating relatinships are many and can include: a client s persistent nn-adherence t prper treatment plans, resulting in ptential threats t the welfare f the animal; a difference in philsphy as t the apprach taken fr diagnsing and treating animals; verbal abuse and/r threatening behaviur f a client twards the practitiner and/r hspital staff; unreasnable demands fr unnecessary medicatins and services, r fr illegal r unethical actins (e.g. asking the veterinarian t alter a medical recrd); and nn-payment f fees wed fr services rendered. Guide t the Prfessinal Practice Standard Veterinarian-Client-Patient Relatinship (VCPR) 4

5 While the Cllege generally des nt expect a veterinarian t cntinue a relatinship that has brken dwn, the Cllege als expects that practitiners will nt terminate a relatinship fr an unprfessinal reasn (e.g. discriminatin under the Ontari Human Rights Cde). After determining that the VCPR shuld nt cntinue, terminatin shuld cmmence. The client must be prvided with prper ntice f the terminatin and allwed a reasnable pprtunity t arrange fr care with anther practitiner. In rder t ensure the best interests f all parties invlved, the Cllege ffers the fllwing tips: 1. The client shuld be prvided with a written ntice, delivered by curier, registered mail r by hand, cnfirming the end f the relatinship. Electrnic cmmunicatin may be used as lng as the veterinarian has received cnfirmatin frm the client that the client has received and acknwledged the message. The reasns fr the terminatin need nt be clearly specified. 2. A reasnable pprtunity t secure a new practitiner shuld be prvided t the client. Hw much time is reasnable will vary with the circumstances (e.g. reasns fr the terminatin, available alternatives, r whether assistance is prvided in lcating ther services), and may be dependent upn the lcatin f the veterinary facility. In rural r remte areas, the time required t btain a new practitiner wuld likely be lnger than in an urban area. Where the reasn fr terminatin is abusive behaviur twards a veterinarian r staff, r where genuine safety cncerns exist, the reasnable pprtunity might be brief. 3. Practitiners shuld designate a perid f time fr which they will prvide emergency services nly, and specify a later date after which n services will be prvided. Bth shuld be clearly stated t the client in the terminatin letter. 4. The practitiner must als ensure the apprpriate transfer f medical recrds and ther relevant infrmatin. The terminatin letter shuld ensure the client is aware that all relevant infrmatin will be prmptly frwarded when a new practitiner is secured r alternatively, include a cpy f the animal s medical recrds with the terminatin letter. Scenari A veterinarian has been dealing with a client wh has ften exhibited prblematic and difficult behavir. The client has been verbally abusive twards the veterinarian and clinic staff and threatened a technician. The veterinarian decides t terminate the VCPR. She sends a letter t the client that day by curier, which indicates that nly emergency services will be prvided until the end f the week, at which pint n further services will be prvided. Guide t the Prfessinal Practice Standard Veterinarian-Client-Patient Relatinship (VCPR) 5

6 SAMPLE TERMINATION LETTER Date Dear (Client Name): This letter will advise yu that as f (dd/mm/yyyy), neither I nr the staff at ur ffice will be able t prvide further general care t yur animal(s). We suggest that yu seek an alternative veterinary facility t prvide care fr yur animal(s) frm this pint frward. We wuld like t suggest that yu refer t the Find a Practice sectin n the Cllege f Veterinarians website t lcate ther practices in yur area. In rder t give yu time t access alternative veterinary services, we are able t prvide emergency services fr yur animal(s) until (dd/mm/yyyy.) Once yu have made alternative arrangements, please have the facility cntact us and we will frward all medical recrds and relevant infrmatin immediately. (Alternatively, state Please find enclsed a cpy f yur animal s medical recrds, which yu shuld prvide t whmever yu select as yur veterinarian. ). We wish yu and yur animal(s) all the best in the future. Sincerely, (Yur name), DVM Guide t the Prfessinal Practice Standard Veterinarian-Client-Patient Relatinship (VCPR) 6

7 Legislative Authrity Veterinarians Act, R.S.O R.R.O. 1990, Reg. 1093: General (Veterinarians Act) Other References The fllwing can be fund n the Cllege s website at Prfessinal Practice Standard: Veterinarian-Client-Patient Relatinship Prfessinal Practice Standard: Medical Recrds Guide t the Prfessinal Practice Standard: Medical Recrds Prfessinal Practice Standard: Delegatin Prfessinal Practice Standard: Infrmed Client Cnsent Guide t the Prfessinal Practice Standard: Infrmed Client Cnsent Prfessinal Practice Standard: Use f Cmpunded Prducts in Veterinary Practice Guide t the Prfessinal Practice Standard: Use f Cmpunded Prducts in Veterinary Practice Plicy Statement: Cardiac Screening Prgrams Plicy Statement: Cnducting Prgrams fr the Implantatin f Electrnic Identificatin Devices in Cmpanin Animals Plicy Statement: Cngenital Deafness Screening Prgrams fr Cmpanin Animals Plicy Statement: Ophthalmic Screening Prgram Psitin Statement: Temprary Emergency Facilities Plicy Statement: After-Hurs Care Cllege publicatins cntain practice parameters and standards which shuld be cnsidered by all Ontari veterinarians in the care f their patients and in the practice f the prfessin. Cllege publicatins are develped in cnsultatin with the prfessin and describe current prfessinal expectatins. It is imprtant t nte that these Cllege publicatins may be used by the Cllege r ther bdies in determining whether apprpriate standards f practice and prfessinal respnsibilities have been maintained. The Cllege encurages yu t refer t the website ( t ensure yu are referring t the mst recent versin f any dcument. Guide t the Prfessinal Practice Standard Veterinarian-Client-Patient Relatinship (VCPR) 7

C.A.R.E. Pet Adoption Application & Contract

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