Technicians

21086v – Lab Sample Processing


Results Statement: To ensure great patient care by making sure lab samples are properly
processed in a way that takes the least amount of time for our staff.




Primary Responsible Position: Technicians

Participating Positions: Technician Assistants

IMPORTANT: ALL SAMPLES AND TUBES ARE:
1. Immediately labeled with pet name, client last name, and today’s
date. This includes empty containers sent home with clients.
2. Samples are sent out the SAME DAY we receive them.

How to process lab samples:
 All samples are placed in the test tube rack, kept in treatment room,
IMMEDIATELY after obtained and labeled.
 In AVImark after the lab requisition form is printed the TA’s will:
1. Compare the lab requisition form to the patient’s record to
ensure that we have obtained the appropriate samples.
2. Check to see if any item that the owners have declined get
removed from the requisition.
3. Reprint a new lab requisition if needed.
4. Document a “note” in the patient’s AVImark record under the
line item.
(Example: Sr. Wellness: highlight the line item, choose notes
then time stamp: JJW: 09-11-12 at 9:11a: blood obtained, urine
UFC or Cysto) *Also making a note on the Antech requisition.
Urine = UFC (Urine by Free Catch)
 For all lab tests - except fecals:
o Change the patient’s Follow-Up tab, from “Exam/Consult,
Comprehensive” to “DTC”












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 What If’s:
o If it’s a urine sample:
 Write “UFC” or “Cysto” on the lab requisition form.
 Add an AVImark “note” under the line item with a
“UFC” or “Cysto”.
 Add your date/time stamp to this note.
o If the sample is not obtained at the time of appointment:
 For urine: Give the client a syringe and labeled pill vial.
Remind the client to keep the sample in the refrigerator
until they can bring it to us.
 For Fecals: Give the client a labeled fecal sample tube.
 For Lab Requisition: Write “to follow” for these samples
 Serum Separator Tubes: After clotted spin the tube in the centrifuge.
 Place all samples AND lab requisition from in the Antech bag.
 Place the bag in the drawer in the pharmacy fridge. Make sure it’s
sealed.

Quiz/Drill for “Lab Sample Processing”:
1. What would happen if we all did not follow this procedure as written? How would it affect you?
2. What do you with a sample IMMEDIATELY after it’s put into a container? Do you do this to the
container/tube if sent home with a client?
3. Where are all of the samples put immediately after obtained and labeled?
4. With your trainer watching go to “practice client” and enter a senior wellness under one of the
patients. Pretend you obtained the urine sample by free catch.
a. Print a lab requisition form
b. Show your trainer what two places you put “UFC”.
c. Show your trainer where you would put the samples and forms after in the bag.
5. What do you do if the fecal sample is not obtained at the time of appointment?


























[102]

21088 – Labwork Guidelines

Result Statement: To assure continuity of patient care and client service among all
doctors in regards to labwork.

To also assure we have smooth transitions with transfer of
handling labwork results from doctor to doctor.




Primary Responsible Position: Associate DVM’s

Participating Positions: Technicians

In-House vs. Antech:
 Most of our blood work is through Antech unless the pet is too sick and
there is not enough time to wait for the results (evenings, Saturdays, and
Sundays).
How to handle results:
 When speaking with clients tell them you “will call when the lab results
come in”. Don’t say “tomorrow”.
 Antech lab results faxes will be left in the doctor’s lab result box outside the
doctors’ office.
 We ONLY call clients between 9 AM and 9 PM, unless there is an emergency
situation, in order to respect their family bed times.
 Senior wellness report cards will be mailed to all clients with senior
wellness profiles within ONE WEEK of the panel. The phone consult based
on the results will occur as with other tests, on the day they arrive when
that doctor is working.
 After Senior report card is completed and mailed add a line to the last
follow-up with a date/time stamp stating “senior report card mailed”.
 Negative fecal and heartworm test results alone will be called by lay staff.
These negative results will not be given to the doctors.
 If patient needs future service or test, we add both:
1. Follow-up and
2. Reminder - with appropriate date(s).

















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Which Doctor Calls the client?
 The doctor calls every client with lab work results the next scheduled shift
that the doctor receives them.
o We add a “Follow-up” in AVImark of what was discussed.
o We will leave the vast majority of lab results client calls for the
doctor who examined the patient.
When a DIFFERENT Doctor calls:
 If one doctor is off the doctor on duty can call the sick patients with a plan.
In this case the examining doctor must leave a written note for the doctor
that will call the client so that they know to look for results.
 If one doctor is scheduled off work for more than 3 days and has pending
lab work that doctor should leave a note for the doctor that will call the
patient.
 Doctors should use their best professional judgment when reviewing lab
work, making a treatment plan, making a diagnostic plan, or scheduling
surgery for another doctor. The best end result of this judgment should be
what is best for BOTH the patient care AND client service.
 When reviewing lab work or treatment plans with clients for another doctor
we will leave a message for the other doctor to make the final call UNLESS:
1. Patient treatment is critical or in the best interest to
treat now.
2. Client requests or demands that the treatment plan or
further diagnostics start now, BEFORE the original
doctor is in to make the decision.






































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Which doctor gets the production:
 Standard cases: routine labs
o Examples: ALP recheck, chest rads next year, recheck renal profile,
PB monitoring panel, etc.)
o Goes under the drop-off doctor or doctor seeing the appointment.

 Management or complicated cases: Decisions after lab work must be made
more quickly or require more detailed knowledge of history:
o Examples: Glucose curve, surgery follow-ups, recheck exams, ACTH
stim after loading dose, etc.)
o PRIMARY concern is the best patient care and client service. The
basic guidelines for these heavily managed cases are:
1. We attempt to schedule the test with same doctor ON A
DAY HE/SHE IS WORKING.
2. If it’s an emergency, critical, or time-sensitive (results and
plan is needed soon) case the test will it simply goes to the
FIRST AVAILABLE doctor.
3. For all other cases the test will go under the doctor that is
has been recently managing the case, even if the doctor is
not working that day.
Drill/Quiz for “Labwork Guidelines”:
1. If you do a senior wellness what do you mail the client? Within what maximum time frame?
2. What times do we call clients? Why not before or after?
3. What do tell the client when you will be calling them with lab results?
4. If you call the client and the pet needs some future service or test what TWO things do you add?
5. Doctors: When do you call the client with results from YOUR tests? What shift?
6. Doctors: In your own words describe how or when you would transfer calling of lab work results
to another doctor or taking over the plan after?































[105]

21090 – Laser Therapy

Results Statement: To relieve pain and improve healing. We do this by properly
administering therapeutic laser and properly charging for this service.





Primary Responsible Position: Technicians

How it Works: Laser Therapy uses light waves to help with inflammation and pain in
patients. It is a medical proven fact that it works.

Information You Need: The vet should give you the following information:
1. Reason for Treatment: ex. Chronic pain
2. Type of treatment: P2P or Scan
3. How many points: 18 pts
4. Location: ex. Lumbar spine

How to Enter in AVImark: When laser therapy is prescribed this should be documented in a note
under laser therapy in the computerized medical record. Like this:







































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How to Use the Laser:
1. Put googles on yourself and the patient.
2. Make sure the laser machine is plugged in. We do not use the battery.
3. Turn the machine on with the rear lower right silver button.
4. Make sure the laser machine is PLUGGED in. We do not use the battery.
5. Turn laser machine "On" with the silver start/stop button on rear lower
right of the machine.











6. Choose the species:












7. Choose treatment regimen-ex chronic, P (for P2P), B (for black dogs), L
(for 18 pts).











8. Press the green start button

Drill/Quiz for “Laser Therapy”:
1. Go treat a joint on a pet, yourself, or your trainer. There is no harm

[107]

21092 – Medicating Boarders

Results Statement: To assure patient safety by properly medicating all pets.

Primary Responsible Position: Kennel Attendants

Participating Positions: Techs and TA’s


How:
 Check each Boarder Med Sheet (see separate procedure “Boarder
Medication Sheet”) to ensure that patient has not yet been medicated.
 Check each Boarder Med and label on the actual medication. Assure they
match. If it does not match, ask management or a doctor which label is
correct. DO NOT MEDICATE UNTIL YOU KNOW.
 Check to see if medicine how often the medication is given and how it is
given.
 Ask for assistance if you cannot give the medication properly or if you are
NOT 100% SURE YOU ARE DOING IT EXACTLY RIGHT. If not you could put
the pet in danger.
 Mark the Boarder Med Sheet just BEFORE you give it. Why?
a. If you give the medication, then immediately get distracted, move
on to another pet, or get pulled away it may not be documented
you gave it. If this happens someone else WILLcome along and give
the medicine again. This could make the pet very sick or even
cause death due to the double dosing.
b. Mark it on the right spot for morning, mid-day, or afternoon.
c. If you do this wrong you could lose your job immediately!
 Medicate according to directions.
 Make sure animal swallows medicine. Do not walk away or put in food and
think the patient will eat it. You may have to walk back to the cage in a few
minutes to make sure it was swallowed and not spit out.


























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Drill/Quiz for “Medicating Patients”:
1. How important is it that pets get medicated properly? Is there anything else we do that is more
important?
2. What do you do if you are not 100% sure you can and will give the med exactly as you supposed
to?
3. When do you document the med given on the Boarder Med Sheet? Why this way?
4. What may happen if you medicate a patient wrong or don’t medicate when you should? To the
pet? To you? To our practice?




[109]

21094 – Microchip Registration

Result Statement: To ensure every patient who gets microchipped is registered online
through our Home Again portal and notify client at time of procedure
that we will register patient and membership is good for lifetime.






Primary Responsible Position: Client Coordinator

Participating Positions: All managers and Execs (in the absence of a Client Coordinator)

Why: This assures that if pet is ever lost, we can identify lost pet and notify
owner and return pet safely back to owner

When: The Techs or TA’s will bring the completed registered Home Again form
to client coordinator when they have a patient who has just been
microchipped or place in client coordinator box if absent to complete
and register online.

What: The Client Coordinator will then notify owner that it has been
completed and time stamp in patient medical history microchip has
been registered

How: Here are the listed steps to complete microchip registration

Tech/TA: All Techs and TAs are Responsible for having the client(s) fill out the
HomeAgain Microchip registration form before client and patient leave
the
building. This usually takes place after a pet’s surgery, dental, or if
client
Picks up from daycare or boarding and had microchip service done while
in our
care.
o Techs/TAs will present HomeAgain Registration form to
client. They will have the Client fill out all necessary
fields with the correct information




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o It is a Tech/TAs job to make sure each field is completed
with the Microchip ID sticker placed on the top right
hand corner of the form.
o Tech/Ta will then present to the client the Microchip ID
card, HomeAgain dog tag and the remaining microchip
stickers that were in the same package as the
microchip. They will also give the client the tear off at
the bottom of the HomeAgain registration form. This
tear off is for clients only, it gives them the option to
buy a nicer tag than the one that is provided.
o Once they have presented the client with the necessary
belongings and information, Tech/TA will then turn in
the Microchip Registration form into the Client
Coordinator, Or Client Coordinators box if he/she were
absent for the day.


Client Coordinator: The client coordinator is responsible for
checking his/her box for any HomeAgain microchip
forms. Follow the below steps for registering
microchips.

o Open your internet browser and enter into the search
bar WWW.Homeagain.com.
o When the HomeAgain screen loads, Click Login in the
top right hand corner of the screen.
o Under Username and Password enter the login info for
the hospital.
o UN: 0010029405 PW: : Lvhstaff1!
o Once you have entered the correct information, click
“Login”
o Once you are logged on you will be automatically
directed onto the main screen. From there you will
want to Click on the Blue tab in the top left hand corner
of the screen that says Manage HomeAgain Business
o You will then see two drop down tabs. You will want to
click on Enroll Patients Online
o The Enroll Patients Online form will then pop up. You
will then copy all information that the Owner has filled
out on the hard copy into the appropriate fields.
o Once you have filled out the form, Double check your
spelling and make sure there are no mistakes. Click
Checkout


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o A Second screen will pop up asking if you are sure you
want to check out. This is your last chance to check or
change any information you have entered. Once you
have done that, you will click checkout a second time.
o The final page loads showing that the microchip has
been registered. You will want to print one copy of the
receipt and give that to reception to file away.
o After you are finished with the above steps, Be sure to
log into Avimark and go to the patients chart in which
you just registered a microchip for.
o Click on the Follow-up tab. Right click New. Title it
Microchip Registration. In the notes section be sure to
tag your notes and state that microchip was registered.
Also be sure to include microchip number.
o If you have multiple microchips to register, Just follow
the above steps


Drill/Quiz for Marketing Reaches Stats and Plan:
1. Why do we have this procedure? What happens if we did not?
2. How does it make things better for YOU?
3. Discuss each step with your trainer
4. What would happen if we did not follow each step, in order?
5. Get a pass and sign off when both you and your trainer are confident you can handle it
independently every time.

































[112]

21096v – Muzzling

Results Statement: To maintain safety to our staff, clients, and the pets by
proper muzzling patients using good judgment.





Primary Responsible Position: Technicians

Participating Positions: Tech Assistants, Doctors, Bathers, Groomers

WHY Muzzle: When we get bit, it results in:
1. Pain to the staff member
2. Injury report by the staff member
3. Likely hospital visit(s)
4. Stress and lost confidence in us from the client.
5. 10-Day legally mandated pet quarantine at our cost
6. Medical expenses to the hospital
7. Hours of lost time to several staff members working on
this.
8. Lost $25 weekly bonus to over 15 staff members.



WHERE Muzzles are Kept: A full set of all sizes of muzzles are kept:
1. Treatment room drawer AND
2. Bathing room drawer.

After each use, or after washing, each muzzle is
immediately put back where it belongs.

If they are not replaced properly we will likely not have the
right size readily available when dealing with an aggressive
patient. When we cannot find the right muzzle is wastes
everyone’s time and further stresses everyone, including
the pet.

WHEN to use Muzzles: On EVERY potentially painful or surprising procedure to
the pet outside of client areas. In client areas it requires
good judgment by DOCTORS OR TECHS ONLY!




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HOW to Apply Muzzles:
1. The dog that needs muzzling should be restrained by a
leash while the other person finds the appropriate size
muzzle for the dog being handled. THE MUZZLE MUST
BE TIGHT ENOUGH THE PET CANNOT OPEN THE
MOUTH AT ALL, NOT EVEN ¼ INCH!







2. While still being restrained by the leash, the person
with the muzzle then comes around from the dog’s
back end and brings the muzzle around the face.








3. The person with the muzzle then brings the muzzle up
and over the dog’s nose and brings the straps around
the dogs head.








4. The buckle is then latched together and the strap is
adjusted to fit the head correctly and securely.








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5. Please make sure that the muzzle does in fact fit
correctly, but not too tight.








6. Once the muzzle has been correctly placed, you may
start your treatments.











Drill/Quiz for “Muzzling”:
1. Why do we have this procedure? Name 2-3 things that happens when we get bit.
2. How tight should the muzzle fit around the pet’s mouth? Should the pet be able to open the
mouth a little?
3. When do you use muzzles? Who decides if a muzzle is needed in front of a client?
4. Where do you put the muzzles immediately when done? Why?
5. With your trainer watching go muzzle dog in treatment or kennel with your trainer watching.
6. Get a pass when both you and your trainer are comfortable you can AND WILL do this procedure
properly.

























[115]

21098 – Neuter Feline Supplies for Dr. Julius

Results Statement: To assure consistency of patient care and simplicity for our team by
maintaining and accurate list of surgery supplies needed for each doctor
for basic surgeries.







Primary Responsible Position: Technicians

Participating Position: Tech Assistant

Supplies Needed:

 10 Blade
 Curved Hemostat
 2 Dry Gauze
 Paper Towel (For Surgical Supplies)
 Medium Latex Gloves

Patient Prep: Once under anesthesia both testicles are to be plucked completely,
patient then needs to be placed on his side.

Reference Procedure. No need for a drill/quiz.
































[116]

21100 – Out-of-Stock Items


Result Statement: In the event we run out of an item, which should be very rare, we
assure we have steps in place to get the item for the pet and client in a
way that satisfies both.




Primary Responsible Position: Inventory Manager (ALL other positions use this procedure)

Key Point: We never “owe” a client pills or medication. Clients can pre-pay for a
product before it arrives but our records will NOT show they got an
item(s) if they have not.

“Why” for The Key Point: If we “owe” a client a product, the medical record will be inaccurate by
showing a client got and item but did not. This is illegal!
If we “owe” a client a product, it will also create inaccurate counts in
our inventory system by showing we have a negative quantity of an
item. This is impossible!

What is Out-Of-Stock: If we do not have enough pills or are completely out of stock on a
prescribed medication:








































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What to Do:

1. Ask the doctor is they would like to offer a substitute or prescribe the number of pills we have in
stock.
2. If so:
A. Fill the medication as usual
3. If not:
A. Give a written note to the inventory Manager of the medication needed to be ordered.
B. Call the client to let them know we are ordering it and let them know when we expect to
have it in stock. If the inventory Manager is not in or not available you will need to call the
client again after we know when to expect it. Make sure this is okay with the client.
Otherwise we may need to borrow from another clinic.
C. Add a follow-up to AVImark to call the client when it is in stock.
D. Fill out the Out of Stock Medication Form. (located in the drawer below the computer in
pharmacy and in the procedures manual under “Forms-Misc”)
E. Place the completed form and the printed prescription label on the Out of Stock board
(under the refill request board) with a push pin.
F. When the medication is in stock and in AVImark fill the medication as usual.
1. Fill the medication
2. File the medication in reception
3. Call the client
4. Add a follow-up of the call.
G. File the completed form in reception in the Out of Stock Medication folder located in the
drawer where the filled medication is filed.

Drill/Quiz for “Out-Of-Stock”:
1. Why do we have the procedure? Why do we do it this way?
2. If we run out of med can we just enter in their record as if they got it and then “owe” it to them
when it comes in? Why or why not? Explain exactly why or why not.
3. Open “practice client” with your trainer. Pretend the client wants 2 bags of canine EN 6 lbs and
we are out. Follow all the steps showing your client what forms you fill out, how, and where.
Print the form, fill it out, show your trainer where you would put it.
4. Now with the “practice client” situation above pretend the food just came in. What do you do.
Do those steps all in pretend.
5. Get a pass when your trainer is certain you know exactly what to do when we are out of
something a client needs/wants.












[118]

21102 – Puppy and Kitten Client Discussions

Results Statement: To ensure great care of puppy and kittens and great service to our
clients we discuss SIX different subjects at least once before they are
finished with the puppy/kitten vaccine series. We document these
discussions in AVImark under the “diagnosis” codes in red to be sure we
covered everything.

What Six Topics:
1. Puppy or Kitten Packet
2. Microchips
3. Spay/Neuter
4. Housebreaking
5. Dental care
6. Pet Insurance
How it is done:
1. The clients receive a puppy/kitten packet on the first visit and the
tech, TA, CC, or DPC discussed each individual component on the
FIRST visit.
2. When a doctor or technician has discussed a topic, we enter that
diagnosis code into the patients record. It shows up in red.
3. When we see a puppy or kitten we look at the record to see what
has been discussed and what would be good to discuss next. The
simplest way to do this is to click the “diagnoses” tab at the bottom.
4. We assure all 5 have been discussed before the end of the
puppy/kitten vaccine series.

Drill/Quiz for “Puppy and Kitten Discussions”:
1. Why do we have this procedure? What would happen if we did not have this? For the client?
For the pet?
2. Name all six subjects discussed by MEMORY.
3. Explain how you document these discussions while showing your trainer on the “Practice Client”
in AVImark.






















[119]

21104 – Prescriptions Filling

Results Statement: To assure great patient care by filling medication both accurately and
efficiently.



Primary Responsible Position: Technicians

Participating Positions: Tech Assistants

When: Within 2 hours of time refill requests, no longer
Before leaving each night. No prescriptions are left for tomorrow.
Steps to take:
1. Read the label thoroughly
2. Fill as directed on bottle
3. If patient IS in the hospital now:
a. Place the medication on the cage-front bin.
4. If the patient is NOT in the hospital now:
a. Place the medication in the front med bins under the
correct letter of the client’s last name.
b. Call the client to let them know it’s ready
c. Add a follow-up on the record with date/time stamp that it
is ready for pickup.

What NOT to do:
 Medication should be split or halved.
 If we split the pills and the client does not pick up the
medication (pet is better without it, owner changes their
mind, pet needs different med, etc.) we will not be able to
put that back into inventory.
 The only time we should split/cut tablets is if the OWNER
requests it.

Drill/Quiz for “Prescription Filling”:
1. Why do we have this specific procedure? What would happen if we didn’t?
2. What is the maximum amount of time a prescription should go before being filled?
3. Do we leave unfilled prescriptions at night before leaving?
Do we split pills automatically for clients? Why or why not? Or if not, when could we?















[120]

21106 – Prescription Foods for Non-Clients

Result Statement: To be able to sell prescription foods for future clients or non-clients
both safely and legally. We sell it in a way that helps the pet, client,
and hospital.



Primary Responsible Position: Receptionist

Legal Requirement: It is legal to sell prescription food to non-clients as long as the food does
not have a federal drug legend. None of our foods have this, therefore
they are not considered prescription drugs at the state or federal level.
We can sell any over-the-counter pet foods to anyone at any time. We
prefer to get the client’s contact info and enter them into AVImark as a
client, but this step is not required.
What We do:
1. We will sell prescription food to non-clients that request it so long as
they fill out a new client form and are entered into our data base.
2. We will attempt to get their medical records from their vet, but it isn’t
required.
3. AFTER the sale and the records are received, we will submit them to a
doctor for review. This is simply to make sure we sold the appropriate
food and address any medical concerns or future care needed.
4. Optional - Doctors or nutritional tech specialists can add a follow-up to
the record for any present or future recommendations.


Drill/Quiz for “Prescription Foods”:
1. Why do we have this procedure?
2. How would it be for the client if we did not follow this procedure and would not sell the food
until they had an exam? How would it be for you?
3. What do you do when a future client or non-client requests to buy a prescription pet food?
4. Get a pass for this procedure when your trainer is sure you know what to do in these cases…and
know how.




















[121]

21108 – Propofol

Results Statement: To assure safe care of patients using Propofol properly and
economically.






Primary Responsible Position: Technicians

Participating Positions: Veterinarians

Drawing-Up: When drawing up premeds for surgery we draw the Propofol amount
selected by the surgery doctor.

AVImark Inventory: After we draw the drugs up we enter them in to inventory under the
Patients name. On that patient’s record left click the anesthesia charge.
With that line highlighted on the right, left-click “inventory used”. Enter
the amount you drew up into the syringe.
This is the ONLY way we know to re-order Prop0fol. If you don’t do the
above step WILL run out of Propofol.

Administering: We only use it to effect (give enough to get the pet sedated enough for
entubation or other planned procedure).
Most of the time we have some left over.

Left-Over in Syringe: Instead of wasting that amount the Doctors have made a plan to save
the unused portion and use that ONLY for euthanasia.
There is an old Propofol bottle that is marked and kept in the
refrigerator in treatment for Euthanasia. ALL unused propofol in
syringes needs to be placed into this bottle.

AVImark for Left-Over When this left-over Propofol is used you do NOT need to change the
amount in inventory; as it is pulled from inventory and is already
accounted for.

Drill/Quiz for “Propofol”:
1. Why do we have this procedure?
2. Do we give all the Propofol in the syringe every time?
3. Where do put the amount of Propofol drawn up into AVImark? Show your trainer on the
computer. Why do you do this? What happens if you don’t?
4. Where do you do with left-over Propofol in syringes?
5. When using this bottle of Propofol for euthanasia do you need to document in THAT patient’s
record?


[122]

21110v – Quality Assurance Checks by Doctors

Results Statement: To assure patient safety by having doctors double check certain
medications before they are dispensed or administered. This
double check system is mandatory and recorded in writing.

Primary Responsible Position: Associate Doctors

Participating Positions: Technicians

Dangerous Meds Double Checked: Certain items or medications need to be physically checked by
the doctor because they may have a narrow margin of safety.
This is our double check system to be sure patients are getting
the right medication. Medications or items that are double
checked by doctors BEFORE given to clients or patient:
 All anesthetics
 All insulin
 All insulin Syringes
 Apomorphine
 Immiticide or other heartworm treatment medications
How they are checked:
1. When the item is entered into the patient’s record and automatic
“notes” window pops up asking for the doctor’s date/time stamp.
2. The staff member asks the doctor to physically look at the medication or
item to make sure it is the right amount and type.
3. The doctor enters his or her date/time stamp onto this note on the
patient’s record.
4. Medication is given to client or pet.
5. The initials of the employee under the “By” on the line item is
responsible for assuring a doctor has double checked the drug before
giving it or dispensing it.
Drug Box Keys:
1. ONLY doctors have these keys and the code to the lock box on the drug
box.
2. Doctors only lend keys to TECHS to get drugs.
3. Doctors assure the techs are only getting drugs in a legal manner.
Doctor license and hospital survival is on the line


Drill/Quiz for “Quality Assurance by Doctors”:
1. Go through with your trainer at least one practice on these drugs being entered under “practice
client” in AVImark. Get a pass when your trainer is confident you can and will do it this way.
2. Who has drug box keys? Who has the drug box lock box code? Anyone else?
3. Who do you lend keys to? Do you lend keys to receptionists or TA’s?
4. How are you going to assure the RIGHT drugs are gotten out of the drug box?




[123]

21112 – Radiograph Image Saving, Storing, & Sending

Results Statement: To efficiently store, save, store, and burn to disc radiograph images.








Primary Responsible Position: Technicians


Antech Imaging Website: Standard turnaround time is three hours, with STAT availability for an
additional fee

1. Login to the website: www.antechimaging.com
a. User Name: legacyvh
b. Password: legacyvh1
2. Enter Date(s) and select Go to see available imaging study or Consult
Report
3. Select:
a. Download Study or
b. View Only Study or
c. Radiology Consult Report

Download Report into AVIMARK:
1. Select Action
2. Print Report and save as a PDF file.
a. Scan as PDF
b. Save this PDF to the proper location on the server.
c. Attach into patient medical record on the radiograph charge
3. Highlight Patient Name on the printed report
4. Place in appropriate veterinarian message box by the associate’s office




















[124]

Accessing Disc Images from Other Clinics:
1. Place the blank disc in the disc drive at the E-Film work stations. If a
windows box comes up asking what you want to do with the blank disc
cancel out of it.
2. Open E-film program
a. In the very upper corner click on <File>, <Import>, < Dicom Images>.
b. In the Windows box drill down until you find the dicom images.
c. +Desktop, +Computer, +mDVRRWDrive (D:), +Dicom, +PA0000,
+ST0000, +SE0000, [] Blank page icon.
d. You can open several of these at once by pressing and holding the
Ctrl button and selecting several blank page icons until all images
are selected.
3. You should be able to then see the study listed on the Local Exams tab.
a. Highlight the study you just imported from the disc and click <Send>
that is just to the left under Study List.
b. A new box will open. Select []Soundbank and click <Send> below
that. This step stores the study off site and makes it available
through Antech Imaging services and to other stations.

Moving Images From “Image Channel” to Local Exams:
After Images have been taken at the acquisition station and sent to the
cloud, you should be able to locate the study on the Image Channel tab
on any Efilm workstation. To either Burn it to a disc or send the Dicom
images to DVM Insight you will need to get it on Local Exams tab.
1. Click on the Remote Exams tab.
2. Search for the study using the dates or yesterday or today buttons.
3. Highlight the Study you need to transfer.
4. Click on the <Retrieve> button on the left.
5. Now select the Local Exams tab. Search as before to locate the
study using the today, yesterday or dates buttons. You should see
the study you need there.




























[125]

Burn Radiographs to Disc: Now that you have the study on Local Exams tab, You can burn the
images to a disc.
1. Go the computer in exam room 102
2. Highlight the study on the Local Exams tab.
3. Click on the <Burn to Media> button to the left.
4. A new box called Efilm Media Burning Setup will appear. Your study
should be listed there.
5. Highlight it. Then click in the box for Package Title and name it with
date and patient’s last name.
6. Click on <Continue> at the bottom of the box
rd
7. The discs are in the 3 drawer under the computer in exam room
102

E-mailing x-ray link To Someone via “Antech imaging”:
1. Click on <Start> button lower left on toolbar and then click on the
Internet Explorer icon.
2. Click on Favorites/Gold star near upper left. Select <Antech imaging
3. go to the login on the upper right side
4. User name: legacyvh
5. Password: legacyvh1
6. Locate the study you want to send by fixing your date range. It gives
you the same choices as the Vetpacs program.
7. Select your study and click on the select action box. It will give you a
drop box. Select <e-mail study>.
8. Type in the e-mail address of the recipient and select the
appropriate Dr.
9. They will receive a link to those x-rays only and be able to
manipulate them.
10. Please verify that the recipient has received the e-mail

Reference Procedure for now. Drill/Quiz is upcoming.





























[126]

21114v – Radiograph Submissions via Oncura

Results Statement: To assure reasonably prompt and accurate consults in imaging that is
properly communicated and charged to clients.

Primary Responsible Position: Technicians

Participating Positions: Doctors, Tech Assistants

How:
1. Input all information into Smart Dr.
a. If patient is an existing patient, search for the patient by name in
the search bar at the top of the screen.
b. If new patient, click + on the top left on screen and input all
required information.
2. Select images by clicking on the image you need to take
3. Take images as normal. Be sure to label L or R on all images.
4. Once back on the main screen, click on PT name – allowing the options to
appear on the screen.
5. Find the NETWORK drop down (located on right hand side of the screen.)
6. Select “Oncura Solutions”
7. Then click “Send”.
8. Go to a computer in treatment and open the internet.
9. Go to telehealth.oncurapartners.com and enter username and password
10. View consult in “unsubmitted consults”
11. Double click on the patient you need to submit
12. Fill out the “Clinican” (which doctor) and all fields in “Details”.
13. Click over to “Services” tab and select “General Radiology”, “Radiographs-
Routine”, if you need to make them STAT, select that option under
“Priority” on the right side of the screen.
14. Then click over to “History” tab and fill in all information including “Relevant
History”, “Abnormal Lab Results”, “Previous Radiographs”, and “Date of
Previous Rads”.
15. When all completed, click “Submit” on the bottom left of screen and view in
“Active Consults”.













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Turnaround Time: Our standard read time:
Within 6-8 hours for any normal submission, though typically we see them
closer to 3 hours.

For consults submitted as a “STAT” exam:
Expected within 2 hours. For STAT rads submitted 11PM -5AM the turnaround
time may exceed 3 hours. Not all of our services currently offer stat reads,
please see below for more information regarding the availability of each
department.


Consults Availability: (Central Standard Time) listed by department -
Radiology: 8AM-10PM Monday-Sunday - Stat Consults: Yes
Cardiology: 8AM-5PM Monday-Friday – Stat Consults: Not Available
Int. Medicine: 9AM-6PM Monday-Friday – Stat Consults: Not Available
Oncology: 8AM-10PM Monday-Sunday – Stat Consults: Yes

STAT Consults Submissions 2 hours before closing:
1. The doctor will use good judgment and consider what is best for the patient
when recommending STAT over regular.
2. This will be determined on a case-by-case basis.
3. If the client is charged for STAT rads, the owner will get results that night.
4. This may result in the doctor staying late to provide treatment or to forward
the results to an emergency facility.



Drill/Quiz for “Radiology Submissions via Oncura ”:
1. Go through ALL the steps of entering information on “Practice Client” in AVImark into the
Oncura website (bookmark on the computer in the radiology) WITHOUT clicking submit.
2. Get a pass when both you and your trainer are comfortable that you know how to do these
steps independently and less than 10 minutes.
3. The trainer and trainee sign-off on a “policy sign-off” sheet when done.

















[128]

21116 – Report Cards and Release Instructions

Results Statement: Almost every client who has a pet seen by a vet, leaves with a
report card or release instructions. This assures the pet gets
better care because they client does not have to remember
everything we told them. It may assure a gets better home-care
or more prompt return visit.






Who Gets Report Cards: ALL new patients with non-critical patients and annual visits

Who Gets Release Instructions: All other doctor appointments, dentals, and surgeries.

Exceptions to Above: Follow-up puppy/kitten vaccines WITHOUT health problems.
Euthanasia
Recheck where no follow-up or meds are needed
Emergencies where it is inappropriate
Cases that are going directly to e-clinic or specialty hospital

How to Make Release Instructions:
1. In AVImark highlight either the exam charge or surgery by
single left clicking on it.
2. On the right side click “Form”.
3. The MS Word file will open. Fill it out completely. There
are 2-3 pages on surgery releases. Make sure you complete
both copies in the computer.
Note: The purpose of the extra copy with owner signature
for us to keep is to make sure they owner agrees they have
been properly informed of what to do and what we are NOT
responsible for.

4. Click the “save” icon on the top left. Close the file
completely.
5. Go back into AVImark and highlight the same charge again
as you did in step 1 above.
6. Right click  “Form”  Print.
7. The form should will print and is saved for us to see in the
future so we know what we recommended the owner do.









[129]

How to Present: After the report card or release instructions are completely
filled out go over each section in person with the client End
with the recommendation or follow-up needed. When finished
the owner knows (and has a written copy) exactly what we
recommend they DO next. Attach any recommended treatment
plan.

All clients need to DO something. In some cases, it may simply
be needing returning next year.

Note: On all surgeries and splints the owner must sign the
second copy to assure they have been informed of what to do
or look for. After this copy is signed put it in the “re-file” box for
the receptionists.

Drill/Quiz for Report Cards and Release Instructions:
1. What is the purpose of report cards and release instructions? What would happen if we did not
do this?
2. Who gets report cards?
3. Who get release instructions?
4. Why do we have two copies for surgeries and splints? What do you do with the second copy?
5. Do you simply hand the report card or release instructions to the client? Or do you go over the
form with them? Why or why not?
6. With you trainer watching Go to “practice client” in AVimark. Enter an exam charge. Make a
release instruction for this exam and print it. Present it to your trainer as if the trainer is the
client.
7. Do the same as above but with a canine neuter making and printing the surgery release.
8. Show your trainer where you put the signed releases.































[130]

21118 – REPRO: Cesarean Sections

Results Statement: To provide great patient care consistent among all technical team
members performing cesarean sections.






Primary Responsible Position: DVM’s

Participating Positions: Technicians

How:

1. All patients will have catheter set and abdomen clipped while awake, as late pregnant dogs
are generally very compliant.
2. Butorphanol and Atropin/Glyco premedication will be given immediately prior to induction.
3. Supplies for puppy resuscitation
a. Warm towels
b. Bulb syringes/suction
c. Heating source – heating pad, hot water bottles
d. Oxygen – flow by and cage setup
e. Naloxone
f. Epinephrine
4. All puppies will be vigorously resuscitated until they are active and vocalizing
5. Under NO CIRCUMSTANCES will slinging puppies be tolerated
6. Each puppy will have umbilicus tied off with suture material
7. Each puppy will be weighed and assigned a number; an ID collar will be used to identify each
puppy.
8. Once puppies are resuscitated and fully dry they can be placed in the oxygen cage until the
bitch is out of surgery.
9. Once patient is out of surgery puppies can be placed on the bitch and allowed to nurse.
THIS WILL ONLY BE DONE UNDER DIRECT SUPERVISION.
10. Under no circumstances will puppies be left unattended with the bitch.


Reference Procedure. Drill/Quiz Upcoming














[131]

21120 – REPRO: Cycle Management

Results Statement: To provide great patient care consistent among all technical team
members performing cycle management.






Primary Responsible Position: DVM’s

Participating Positions: Technicians

How:
1. First Appointment – Exam, Brucella Card Test, Progesterone, Vaginal Cytology ($67), Digital
Vaginal Exam
a. Prior to appointment print 3 patient labels; one on Ziploc bag for progesterone
samples, one on paper plate for cytology slides, one on cycle management
worksheet.
b. Print cycle management worksheet – Shared folder > Dr. Cohen > Cycle
management word document
c. Brucella Card Test – serum sample needed, performed as per manufacturers
instructions
d. Progesterone Testing – Sent out to Antech
i. 3ml Blood drawn, tag location of each blood draw, rotate vein used to
prevent soreness and bruising
ii. Sample split into 2 serum separator tubes
iii. Centrifuge both samples
iv. Draw off serum and place in two red top tubes
v. Label both tubes with patient name and date
vi. One tube goes to Antech
vii. Place second tube in a bag with patient’s label on it and put it in the freezer.
viii. Frozen samples are kept until patient is found to not be pregnant, or she
whelps, and then discarded.
e. Vaginal Cytology
i. Large otoscope cone – clean thoroughly with alcohol and allow to dry
ii. Two cotton swabs
iii. Two slides
iv. Placed on labeled paper plate, kept until patient is found to not be
pregnant, or she whelps, and then discarded.
2. Each Subsequent Cycle Management Appointment – Tech appointment, Progesterone, +/-
Vaginal Cytology ($__)

Reference Procedure. Drill/Quiz Upcoming




[132]

21122 – Restraint and Control of Pets

Results Statement: To assure great patient care and safety for both staff and pets
by using proper restraint.









Primary Responsible Position: Kennel Attendant (in this case)

Participating Positions: All positions

Characteristics of Proper Restraint:
 The control of what restraint is used from the person
PERFORMING THE PROCEDURE, not the holder.
 The safety of staff and pets is the responsibility of the
HOLDER.
 They type used varies depending on many factors.
 Requires good judgment, possibly by consensus.
 May require advice from a doctor.
 Minimizes stress for the pet and our staff.
 Proper restraint is not painful.
 Allows us to be able to provide or perform a professional
treatment.





























[133]

WHY We Need Restraint: While we love and care for all pets that come into our facility it
is important to remember that many of them are in a very high
stress environment and are very scared or in pain.
A typical result of this fear or pain is the tendency for a pet to
want to protect themselves and this can result in a pet lunging
and snapping at our staff. They main immediately go into a
panic response that could include most anything.
Being “fast” is not enough to prevent a bite, so we must use
restraint on ALL pets within the hospital. Please remember that
this is for their safety as well as ours.
Just like people, animals can have good days and bad. Some
pets may require heavy restraint with a certain day or certain
procedure when they did not on another day.
See “Muzzling” and “Aggressive Patients” under the main
hospital policies for more information.























































[134]

What NOT to Do:
 Never put your face directly into the face of a dog or cat. They
often will bite whatever is closest
 Never put on a muzzle with ANY looseness. If they can open
their teeth even ¼ inch they can and often will bite you!
 NEVER sit on the floor while handling/examining a dog. If the
animal becomes aggressive or scared you will be unable to
move away or protect yourself. You will be at risk of serious
bites to your face and neck.
 Never place a label on a pet’s documents/cards/possessions
that is potentially offensive to a client.
o For example: “Use caution” is much better than “will
bite” or “Aggressive”.
 Never try to be “hero” or a “tough guy”. It’s not worth the risk
of the pain and nuisances you may to go through.
 Never lock eyes with a dog or cat. In our workplace they see
this as a challenge or dominance.

What TO DO:
 Credo: “Never let go.” Once you have good restraint the most
dangerous part is letting go.
 Concentrate on the animal’s body language. See below.
 If there is any doubt about the temperament of an animal or what
to do ASK FOR ASSISTANCE, even a doctor if necessary.
o When there is any question the best person to ask is an
experienced technician or doctor. They are used to
handling pets during scary or painful procedures. They also
are the ones that know how and when to use medications.
 Properly label a patient that needs to have caution used.





























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Types of Restraint:
1. Psychological/Verbal – this is the least restrictive type of
restraint and would be used in combination with other types of
restraint. Using a soft, soothing voice while gently stroking the
patient will help calm and sooth them.

Commands such as SIT, STAY, COME, DOWN, NO or even HEEL
may be useful tools to encourage a dog to cooperate. Also, soft
quiet words can calm a frightened animal. Yelling or screaming
should never be used as it can cause the animal to become
more fearful or aggressive.

2. Chemical – this method utilizes drugs such as sedatives,
tranquilizers and anesthesia to alter the patient’s mental state,
allowing the animal to stay immobilized and/or without pain,
and causing the patient to be cooperative during procedures.
Chemical restraint would be used if the patient is particularly
difficult to handle, if the patient is in pain, or if the procedure
requires stringent stillness such as surgical procedures. The
veterinarian will decipher whether or not the patient requires
chemical restraint, and will also determine the type, dosage and
route of administration of drug.

For animals who are too aggressive or stressed to handle safely
for procedures, sedation and/or general anesthesia may be
necessary to allow treatment. If you are unable to handle an
animal, notify a staff member to determine whether sedation is
appropriate.

3. Physical – this is the primary method of restraining an animal
and involves using the handler’s hands or body along with
muzzles, ropes or other equipment.




















[136]

PHYSICAL RESTRAINT: TOOLS AND EQUIPMENT
Leash: The most common tool used to handle animals in the clinic is the leash. Placed around a dog's
neck it normally controls even the largest dog. Some dogs have never seen a leash and will freeze up to
the sensation around a sensitive area like the neck. Leashes can be abused; never drag or strangle an
animal with a leash. Pause and let the dog calm down and try again after reassuring her. Sometimes a
quick tug on the leash will encourage a fearful dog to walk. If the dog refuses to walk, get help or carry
him/her if possible. In some cases, you can simply walk the dog in a different direction and “take the
long way around” to wherever you were going. It will confuse them and make them think they are
leaving.


Your hand: A very effective form of restraint, your hands are sensitive to the amount of pressure that is
being exerted on the animal and can be quickly modified to the situation. Hands can be used to gently
stroke a dog or to firmly grasp a struggling cat. Although hands can be the most versatile, they are also
the most vulnerable to injury. Recognizing when they would not be effective is very important.


Towels: A towel or blanket is a very useful tool for cats and small dogs. A towel can be used to
decrease an animal’s arousal by covering the head and body and can help protect from sharp claws.

Rabies pole or control pole: The control pole is used to safely handle extremely aggressive dogs. Used
appropriately it is an effective tool. Inappropriate or unskilled use can cause serious injury to the animal.
The rabies pole may further distress an upset animal and should only be used when the handler or
other's safety is genuinely threatened. Volunteers are NOT to use the rabies pole unassisted. If an
animal is aggressive enough to warrant the use of a rabies pole an experienced staff member should be
consulted for assistance as the animal will also be evaluated for chemical restraint options.


Muzzles: Muzzles are used when a snappy or potentially aggressive dog must be handled. There are
nylon muzzles and plastic basket available. A leash or strip of rolled gauze can be used as a temporary
muzzle. Because dogs often try to remove a muzzle, it is important that the muzzle be placed securely.
A weak or poorly made muzzle may lead to a false sense of security and the likelihood of being bitten.
Even with a securely placed muzzle, appropriate handling must be used to prevent injury from an animal
who resists.


Cat Muzzles: Muzzles designed for cats extend up to cover the eyes, reducing visual stimulation. For
some cats these can be very useful for calming the animal and helping to protect the handler from
injury,


The following pages have further diagrams and tips.







[137]

References/Images Restraining:



































































[138]

[139]

[140]

[141]

[142]

Quiz/Drill for “Restraint and Control of Pets”:
1. Why do we have this procedure?
2. Describe the consequences of us not restraining or muzzling correctly? For the pet? For the
client? For you? For the hospital?
3. If you have questions about the aggression of a pet or how should go about holding or walking
them safely who should you ask? Should you just make a best guess so to save everyone time?
4. What kind of label would be good enough to show our staff that a pet could be aggressive and
still not offend a client if they see it? What would offend a client if it were about their pet?
5. Should you sit on the floor or a table to restrain? Why or why not?
6. Should a muzzle be loose enough for the pet to pant a little? So that their teeth can open
maybe ½ inch? Why or why not?
7. With your trainer go get a 15-50 lb dog. Show them how you get them out of cage. How you
would hold them for a nail trim or anal gland. Physically demonstrate this.
8. Do the same for a cat. Physically demonstrate it.
9. You will not get a pass until both you and your trainer are comfortable with it. If you are scared
it’s because you don’t know enough yet. Discuss and practice as long as you need to become
comfortable. You cannot do the job if you are even a little scared of a normal non-aggressive
dog or cat.
















































[143]

21124 – Room Tech Procedure

Result Statement: To properly handle a doctor appointment assuring the pet gets proper
care and client gets proper service. The process avoids unnecessary
client waits and gives appropriate support for the doctor




Primary Responsible Position: Technician

Participating Positions: Technician Assistant

When This Applies: This is the procedure used 7 days a week, on every appointment. The
only exception is for emergencies. (See “emergencies” procedure).

How to “Tech” a Room:
1) Assign an exam room to use if not already assigned on AVImark
appointment scheduler
2) Look at the AVImark appointment schedule and be informed and
ready for what your next three rooms appointments are. (See
procedure “Appointment Flow and Staying On Time”)
3) Find the doctor and visit with them in person making sure they are
going to meet you in the exam room (or reception area) with the
client right now. Don’t start until the doctor is ready.
4) Get exam room ready for the appointment
a) Place one otoscope and one ear cone per pet in that exam room
near the computer monitor
b) Flip the appropriate doctor tag on wall outside that exam room.
c) Get patient’s record up on AVImark on the monitor in that exam
room. (See procedure “Appointment Flow and Staying On
Time”)
5) Once the doctor is in exam room and waiting - grab chart off the
back counter in reception
6) GREET THE PET BY NAME and pet by introducing yourself
7) Walk the owner into the room (offer to carry pet in carriers) and
allow the vet to introduce themselves and start the appointment.
8) Hold pet appropriately in the room assisting the doctor and
following the doctor’s direction. See procedure “Restraint and
Control of Pets”.
9) Once exam is complete put animal on floor.
10) When doctor directs you leave the exam room and meet with the
doctor in pharmacy.
11) Using a tech sheet (see procedure “Tech Sheets”) write down the
instructions the doctor dictates concerning what treatment plan to

[144]

make, charges to enter, medication instructions, follow-up/future
booking, etc.
12) Review the treatment plan in detail with owner. Owner signature
required ONLY if the owner is leaving and the pet is staying with us.
13) Decline items in AVImark that the owner does not wish to do.
a) Right click on line item on main screen; select DECLINE
b) Find the doctor at some point before the client checks out to let
the doctor know which things the owner declined. The doctor
may want to discuss it further.
14) After approval - take the pet to the treatment room:
a) Exam Room Efficiency Days: (see procedure “Exam Room
Efficiency”) Transfer pet to the treatment tech and treatment
TA along with estimate. Let them know what to do with the
pet. If they are busy with another pet put the pet in an ICU cage
with a cage card and write the treatments needing to be done
on the tech board.
b) Non-Exam Room Efficiency Days: Complete the treatments
needed with the help of your TA (or other staff if TA is busy with
next client)
15) Complete any release instructions that may be necessary and get
meds together. Put meds in a bag if there are more than two.
a) Note: On exam room efficiency days you do this while the
treatment tech and TA is completing the procedures).
16) Release the patient and escort them to the check-out receptionist
by mentioning this receptionist by name. (see procedure “Report
Cards and Release Instructions”)
17) If becomes and “advanced appointment” follow the procedure
listed under “Appointment Types”.
18) Once owner is turned over to the check-out receptionist clean the
room: Clean bench, table top, and sweep floor. If any eliminations
were made in the room, use mop to finish cleaning. Put ear cone in
diluted Spray cleaner (see procedure “Spray cleaner Mixing”).
19) Make sure room is ready and stocked for the next patient. See
procedure “Exam Room Re-Stocking”

Drill/Quiz for “Room Tech Process”:
1. Why do we do this procedure this way? Why do we have this procedure for everyone to follow
this way?
2. What would happen if we did not follow this exactly as written?
3. With your trainer use the following resources: Computer with AVImark, Poster Board Diagram
of the clinic, demo pieces (batteries, paper clips, lego people etc.)
4. Using demo pieces above follow all the steps written with you acting as the room tech go
through all of the steps above (open book) explain what you do and why at each step.
5. Get a pass and sign off when both you and your trainer are confident you can comfortably do
this.


[145]

21126 – Spay and Neuter Supplies: Dr. Julius


Results Statement: To assure consistency of patient care and simplicity for our team by
maintaining and accurate list of surgery supplies needed for each doctor
for basic surgeries.







Primary Responsible Position: Technicians

Participating Position: Tech Assistant

Supplies Needed:
 10 Blade
 V Surgical Table
 Polysorb Suture (depends on patient)
 Spay Pack or General Surgery Pack
 Gown
 Surgical Mask
 Surgical Gloves 7 ½
 Surgical Cap

Patient Prep: Patient is to be prepped on prep table in treatment using a v-tray
located at prep table. The belly should be shaved starting from the
bottom of the rib cage on down. Shave needs to be clean and neat.

Reference Procedure. No Drill/Quiz Needed.


























[146]

21128 – Special Orders
Result Statement: All special orders are ordered and available to the client when the
product arrives. This ensures the clients and pets receive high quality
customer service.





Primary Accountable Position: Inventory Manager

Participating Positions: Doctor, Department Heads, Execs

Note of Interest: In many cases, it will save everyone time, including the client, to NOT
order through us. Call in the product to a local pharmacy (compounding
pharmacy) or our online pharmacy. In these cases, we don’t have to
order, price, or receive anything. The client will get it themselves or get
it delivered to their home.
If you do the above, you can skip all these steps below.

















































[147]

How to Place Special Orders:
When a client makes a special request for food or other items:
 Get a Special Request Form located in “Forms - Misc” on “staff
shares” under “Procedures Manual (date)” on all computers.
 Complete steps 1-5 on the form





































 Reception:
1. Informs client that our inventory manager will call them
back client to verify the price and expected date of delivery.
2. Places the form on the Special Order board (located to the
right of Dr Julius’s office)
 Inventory Manager:
1. Check the board and place special orders DAILY (on the days
he/she works, even in another role), with the exception of
food. Food orders will be placed on Tuesdays.
2. Get full payment by phone before ordering.
3. Post this payment to the account as a pre-payment/credit
to their account for the full amount.
4. Notify client of the expected time of food order as they will
be longer. Call the client or tell them in person TODAY!!
 In some cases, a doctor, manager, or exec may need to order this
product if the patient needs it earlier and the inventory manager is
not working. They still follow these same steps.
 Inventory manger places the order:
1. Complete steps 6 – 8 on the form

[148]

2. Re-post on the Special Order board
 Receiving Orders
1. Complete step 9 on the form, note in client’s account in
AVImark
2. Tape Special Order Form to Product
 Remove Special Order form from product when client has picked
up. (Every needed documentation is already in the patient’s file by
using the above steps.)
How to Price it and Enter in AVImark:
In most cases, non-compounded items will need to have a NEW item
put into AVImark with proper cost and price and order qty of zero.
For compounded drugs, Roadrunner Pharmacy for example, enter a
treatment on the patient record of “8056 Misc Fee”. Change the name
to the correct name and size/strength. Change the price to the accurate
client price (generally 2.5 X cost).
What if client doesn’t pick up:
1. Between 7-10 days after initial call (telling the client that
nd
the we have the product in stock) the 2 call will be made
(Step 10)
a. Receptionist will contact owner
b. Annotate and post client communication in
AVImark
rd
2. Between 10-13 days owner after initial call the 3 call will
be made (Step 11)
a. Receptionist will contact owner
b. Annotate and post client communication in
AVImark
3. After 21 days:
a. Receptionist will notify Inventory Manager of
products not picked up
b. Inventory Manager will:
1. Return to Stock – items that we already
regularly stock (has and “order qty”)
2. Return to Vendor – items that are not
regularly stocked (has “order qty” of ZERO
in AVImark).




















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Drill for “Special Orders”:
1. Where are the Special Order forms kept?
2. Demonstrate how to print the form.
3. Where does the Special Order form go for the Inventory Manager to be able to see that there’s
a requested item?
4. When does the Inventory Manager check the Special Order board for orders? How often?
5. After the inventory manager finds the special order form what do they do? If they call the client
what do they do?
6. Do we get payment now or later? When? How? Do we put the charge in as a pre-payment or
with the item as if they already go it?
7. Why is it important all sections of the form are completed?
8. Why/when would a special order be return?
9. Why do we have special order procedure?
10. Demonstrate printing form, pretending we have a special order through all steps.
11. What happens if we don’t do this procedure completely?






















































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