Associate Doctor

What TO do (in order):
 Executive Director:
o Exam Room Efficiency: Schedule ERE for all or part of the day
(2 exam rooms per doctor). Re-book client appointment times
as needed. Do this if you have enough support staff.
o Reschedule ROUTINE visits” (if above cannot happen): Clients
will be happy they had that choice.
 Offer them something for the trouble (free bath, etc)
 We keep seeing emergencies, sick and hurt pets.
o Lead receptionist does the above if ED is unavailable.
 Doctors:
o “Advanced Appointments” become drop-offs (see other
procedure. Lead tech and techs help.
o “Non-Routine” block-offs: See procedure under main policies
o Lead tech helps the doctor with this.
 Receptionists: BOOK DROP-OFFS instead of appointments!
o Client: I need to set up an appointment for my dog.
o Receptionist: Perfect. What seems to be the problem with your
dog?
o C: He’s had some diarrhea for the past couple of days.
o R: Oh no, I’m sorry to hear that. OK, how soon can you be here?
o C: In about 15 minutes.
o R: That’s great. To ensure our doctor has plenty of time to
examine, diagnose, and observe (pet name), we will have you
leave him/her here with us. This will also save YOU time so
you can come in right away. We will call you as soon as we
have a treatment plan for your approval. We will see in 15
minutes.
o Underlined portion above must be memorized WORD-FOR-
WORD!

Reference Procedure to Use When Needed. No need for Drill/Quiz.

























[101]

1056 – Pain Control Packages


Results Statement: To provide simplified yet comprehensive pain control to our
patients.





Primary Responsible Position: Associate DVM’s

What is Included: In general, for routine painful surgeries our preemptive and
post-op NSAID of choice is Carprofen. The “Package” in
AVImark is a standard charge for various size patients is
intended to manage a pet’s pain for that day and 4-5 days after.

It includes:
1. Preemptive analgesia
2. Post-op injections
3. ONE Oral Medications: Standard is only 4-5 days!
a. NSAID’s – pills only!
b. Tramadol
c. Buprenorphine
d. SMALL DOGS: Very small sized dog pain packages
are more expensive because we typically have to
use oral liquid NSAID’s which costs more than a few
pills.
e. Multiple medications: Require additional charges
ADDED to treatment DURING PRE-OP VISITS.

What is NOT Included: If the patient needs a different ORAL medication due to size or
health condition that client will need to be charged an
ADDITIONAL fee for whatever medication the doctor chooses,
including fentanyl patches, bottles of Metacam, more than 5
days of meds, etc.

Exception: Pain control packages for declaws include many
options including fentanyl patches, local blocks, etc. This is
included in the package price of this shopped surgery.


“Inventory Used” in AVImark: All inventory used MUST be accounted for AVImark and the
patient label must legally read what the medication,
concentration, and dosage is.

This is done by highlighting the pain control package in AVImark
and clicking “inventory used” on the right side.

[102]

If you do not do this step WE WILL RUN OUT OF PAIN MEDS
FOR YOUR NEXT PATIENTS!

Client Communication: As with all other services and items the client needs to be
informed and approve ALL charges prior to the service/item
being delivered…..DURING THE PRE-OP VISIT.

Drill Quiz for “Pain Control Packages”:
1. What does pain control packages include? What do they not include?
2. What happens if you do not do “inventory used” in AVImark?
3. Show your trainer where you would do the inventory used on a pain control package by showing
your trainer using “practice client”.

























































[103]

1058 – Personally-Owned Pets of Doctors


Results Statement: Doctors can choose to treat their own pets or get care from another
doctor.







See Hospital Policies under “benefits” for more details on discounts:

MEDICAL CARE OF PERSONAL PETS OF DOCTORS:
 Owner of the pet can decide who the doctor of record will be. They can control the case
themselves or transfer case to another doctor if needed in order to avoid the personal and
emotional involvement in the care.
 Fees are based on the standard doctor discounts set up in AVImark. Dr. Julius or medical
director may make some exception or overrides based on the service needed and cost to the
hospital.
 For non-urgent or non-emergency conditions personal pets will be taken care of AFTER all of the
regular patients and clients are taken care of (blood work called, messages returned, etc.), OR
anytime outside of the doctor’s scheduled shift.
 Urgent care or emergency issues with personal pets will be triaged the same as if a regular
client.
 It is approved for doctors to use clocked-in staff for assistance with procedures or surgeries.

SURGERIES ON PERSONAL PETS OF DOCTORS:
 Owner of the pet can decide who the doctor of record will be. They can control the case
themselves or transfer case to another doctor if needed in order to avoid the personal and
emotional involvement in the care.
 Fees are based on the standard doctor discounts set up in AVImark. Dr. Julius or medical
director may make some exception or overrides based on the service needed and cost to the
hospital.
 It is approved for doctors to use clocked-in staff for assistance with procedures or surgeries.
 Pre-operative lab work - Same as with regular clients. We have a two month requirement but
final judgment is always with the doctor of record. This judgment should be in line with what
we recommend to routine clients.
 Scheduling – routine surgeries should be scheduled within the routine regular blocked off
surgery time. This keeps payroll under control as the doctor will need to use support staff to
help with the surgery.
 Anesthesia – all decisions are made by the doctor of record, even if during another doctor’s
blocked off surgery time (Owner doctor may not have available surgery days on his/her
schedule).

This procedure has no drill/quiz. It is only a reference procedure.

[104]

1060 – Pet Foods Regularly Stocked

Result Statement: This list of pet foods and sizes are almost
guaranteed to always be in stock. All other foods
will need to be special ordered or ordered online
by clients.

This list is very dynamic due to medical advances,
company trust, ordering, patient load, consumer
demand, etc.

Position with Overall Accountability: Inventory Manager

Pet food Manufacturer Size

DM Feline Purina
Hydrolyzed Royal Canin
OM Canine Purina
OM Feline Purina
Pro Plan Cat Maintenance Purina
Pro Plan Dog Maintenance Purina
Pro Plan Dog Grain-Free Purina
Pro Plan Puppy Purina
Pro Plan Puppy Large Breed Purina
Pro Plan Kitten Purina
Urinary SO Canine Royal Canin
Urinary SO Feline Royal Canin

This is a reference procedure only. No drill/quiz is needed.


























[105]

1062 – Pet Food Recommendations

Result Statement: Doctors, in general, will recommend THE SAME brand and types of pet
foods for our patients. This simplifies the decision for clients. It allows
us to ASSURE the pet foods we most often recommend are always in
stock. It also allows to keep the amount of pet food kept in stock at a
reasonable level that will fit on the food rack and in the storeroom.

As with all medical recommendations, there will be exceptions and
variations on a case-by-case basis. When any of our patients are NOT
on the standard list of recommended and regularly stocked foods it will
almost always require additional steps in getting their pet food (special
orders, online ordering, borrowing from other clinics, etc.)

Positon with Overall Accountability: Director of Medical Services or Owner (DVM)

Resources Needed:
1. Marketing materials for clients on each food.
2. Sample bags if available
3. First choice foods in-stock.
4. This procedure is understood and agreed to by ALL doctors
5. Client info for SPECIAL ordering or ONLINE ordering (see procedures manual)











































[106]

Overview: Our doctors’ first choice recommendations were decided upon by our group of doctors. The
owner and DMS always has the ultimate decision making ability. In order to avoid inconveniences of
out-of-stock foods it is critical that this procedure is understood and followed. The first-choice
recommendations are as follows:

Life Stage: First Choice: Brand:
Puppies Pro Plan Puppy (+Lg B) Purina
Kittens Pro Plan Kitten Purina
Adult Maintenance (canine or feline) Pro Plan Purina
Adult Maintenance (canine or feline) Pro Plan Grain Free Purina

Dental Diet Dental Royal Canin

Disease or Condition: First Choice: Brand:
Atopy Hydrolyzed Royal Canin
Food allergy trial Hydrolyzed Royal Canin
IBD Hydrolyzed Royal Canin
Acute GI case – dog or cat GI Low Fat Royal Canin
Food Trial – Diagnostic for AFR Hydrolyzed Royal Canin
Urinary stones – dogs or cats SO Royal Canin

Diabetes – Feline DM Purina
Overweight or obese dogs OM Purina
Overweight or obese cats OM Purina
Renal Disease - Dogs NF Purina
Renal Disease – Cats NF Purina

Osteoarthritis j/d Hill’s
Diabetes – Canine w/d Hill’s
Neoplasia, neonate, surgery, cachexia a/d Hill’s


End Result: The above list leaves us only carrying 15 core diets, each with
various sized bags and canned versions.

We have 9 Purina Diets, 5 Royal Canin Diets, and 3 Hill’s Diets that
we will primarily recommend and ALWAYS keep in stock.

Other diets may be needed or recommended. For these we may
have it in stock. In most of these cases the client should order it
through our online store with home delivery and free shipping.












[107]

1064 – Phone Messages from Clients


Results Statement: To return calls from clients at or before the time expected and in a way
that helps both the client and pet.












Primary Responsible Position: Associate DVM’s

How:
 Phone messages will be left for doctors using the hand-written
pink/whte messages and posted on message corkboard pads
outside the doctors’ office.
 Doctors will return all phone messages before they leave their shift
for the day.
 We ONLY call clients between 9 AM and 9 PM, unless it’s an
emergency, to respect their family bed times.
 Any messages left after the doctors scheduled shift can be left for
the next scheduled work shift.

Drill/Quiz for “Phone Messages from Clients”:
1. Where do you find your phone messages?
2. What times do we call clients? Why not before or after?
3. If you are working 10 minutes past your scheduled shift and you get a phone message from 5
minutes ago are you required to call this client back today? If not, when?




















[108]

1066v – Quality Assurance Checks by Doctors

Results Statement: To assure patient safety by having doctors double check certain
medications before they are dispensed or administered.

Primary Responsible Position: Associate DVM’s

Dangerous Medication Double Checks by Doctors:
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

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:
 ONLY doctors have these keys and the code to the lock
box on the drug box.
 Doctors only lend keys to TECHS to get drugs.
 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:
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.
Who has drug box keys? Who has the drug box lock box code? Anyone else?
Who do you lend keys to? Do you lend keys to receptionists or TA’s?
How are you going to assure the RIGHT drugs are gotten out of the drug box?





[109]

1068 – Prescription Pet 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.



















[110]

1070 – Prescription Refill Approvals

Results Statement: To be sure prescription refill requests from clients are approved
and filled promptly.












Primary Responsible Position: Associate DVM’s

How:
 Client prescription refill requests will be handwritten on the
proper refill request form and posted on the “Refill
Requests” board in the pharmacy.
 Doctors will look for these requests and process them
throughout the day. This board should not go more than
two hours without being checked and processed. It should
also be checked by the doctor before closing at the end of
each day. This keeps client medication refills timely for
pickup and avoids client wait times when they arrive
without meds filled and waiting in reception.
 In AVImark Prescription refills are placed under “Dr.
____Rx” NOT the doctor’s name.
 In general, we never fill more than 90 days at a time. We do
this because it causes to run out of meds for other clients.
It also can cause us to have to do a large refund at our cost
if something changes with the pet or the client.
 With more critical or dynamically changing conditions we fill
less than 90 days, even on chronic meds. An example
would be Vetmedin where the dosage or condition may
change.


Drill/Quiz for Prescription Refill Approvals:
1. What is the maximum amount of time a refill request should go without a doctor looking at it to
approve?
2. What doctor does prescription refills go under in AVImark?
3. What is typically the max number of days we fill on a chronic drug? Why?







[111]

1071 – 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”.













[112]

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.


















[113]

1072 – Referring Cases (in-house or outside vets)

Results Statement: Patients that need to be referred (either to another in-
house doctor or another facility) are done so in the
same way each time. It is done in a way that
accomplishes three things:
1. Efficiency
2. Best Patient Care
3. Best Client Service

Position with Overall Accountability: Associate DVM’s

Referring to In-House doctor:
1. Preferably set up a no-charge consult appointment with the in-house doctor. This may be able
to be done RIGHT NOW.
2. If the appointment above cannot be set up (likely because client not interested) then leave a
phone message for the in-house doctor to call the client.
3. Tell the client when they should expect the call.
4. Document this referral as a follow-up in AVImark.

Referring to another facility:
1. Fill out the appropriate forms
2. Delegate the appropriate staff member to send forms/records. Delegate this IN WRITING even
if it’s only something on the tech board.
3. Document this referral as a follow-up in AVImark.



This is a reference procedure only. No drill/quiz is needed.


























[114]

1074 – 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.






[115]

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.
































[116]

1075 – Reproductive Services: Financial Analysis


Result Statement: To easily analyze the numbers on reproductive services over any
given periods of time. This will help us analyze how successful
we are in promoting and helping clients with specialized repro
services.





How:
1. In AVImark under treatments double click the category
“Reproductive Specialty Services”.
2. Make sure it has the report code of “R” on the green window.
3. Click OK
4. Go to Work With > Reports
5. On this purple window in the top right under “Report Code”
make sure to enter “R” here
6. On the top left, pick what time frame you want to look at.
7. On the middle left under “PRINT THESE” move everything over
to the right so it’s empty on this side. Use the arrow sign to the
right of this box to do this.
8. Find “Income by Treatment” on the “DON’T PRINT THESE” box.
Move it left to the “PRINT THESE” box.
9. If you just want to preview (not print) check the “preview” box
on the top middle of this purple window.
10. Make sure you have the correct printer selected on the top
middle box under “Print To”
11. Click “Print” on the bottom left. It will print or show you a
preview window of the numbers.





This a reference only procedure.














[117]

1076 – Stone Analysis


Result Statement: Qualitative AND quantitative urolith analysis at significant cost
savings to Legacy Veterinary Hospital.

Overview: The Minnesota Urolith Center performs quantitative urolith
analysis utilizing optical crystallography and infrared
spectroscopy.

STONE SUBMISSION
 The Minnesota Urolith Center does not provide containers or prepaid mailers.
 Always submit the largest stone, and a representative portion of sizes, shapes and colors
 If uroliths were retrieved from different parts of the urinary tract (i.e. kidney and bladder)
o Send them in separate containers, identified with the source
 If the sample can be seen (size of a poppy seed) it can be analyzed at the Center.
o Write TINY SAMPLE on the packing slip
 Do not submit samples in Formalin it can interfere with analysis, dissolve samples and may alter
crystalline structure
 Sample analysis may be delayed due to inappropriate submission methods
 Choleoliths, sialoliths and enteroliths cannot be analyzed at the Center
 Turnaround time depends on complexity of sample and volume of samples received by the
lab. Typically, turnaround time is 12-14 days.

FILLING OUT THE SAMPLE ANALYSIS FORM ONLINE
 Log into www.urolithcenter.org.
o Email Address = [email protected]
o Password = legacyvh2
o User Name if needed = Kent Julius Clinic ID # = 38240

 Select -- New Sample from the main menu





















The submission information page will open. Enter the patient information by completing all the
fields. When you have completed entering all the fields – Select –> Create Urolith .

[118]

CONFIRMATION OF SAMPLE SUBMISSION

This screen lists the sample number, our clinic id, veterinarian requesting analysis, owner and patient
names.

 Record the sample number in AVIMARK in case of any problem printing the packing slip.
 Select Print Address Label and Packing Slip



[119]

A printable Packing slip will be generated on the next screen.
 The top portion should be included in the package with the sample.
 The bottom portion can be cut off and used as an address label on the package.










































If you are unable to print the packing slip, or the slip does not print correctly, DO NOT reenter the
sample - this will create two records for the same sample.
To reprint a packing slip:



[120]

If you are still unable to print a packing slip you can print a copy of the confirmation email, send the lab
a note with the sample submission number, or provide a note including our clinic name, patient and
owner name and be sure to include the information "SAMPLE SUBMITTED ONLINE".

They will be able to match the sample and online information when it is received in the laboratory.

Be sure to label the sample with the owner and patient name and ship in a non-breakable container.


REGULAR MAIL SAMPLE SUBMISSION FORM

 You can retrieve the form through the patient record in AVIMARK
 Right click in the patient area – Document – Right Click – Choose
 Double click on Legacy Vet Documents – Select Minnesota Urolith Sample Submission
 Fill out remaining information – Make a copy of completed form to scan into file


PACKAGING AND SHIPPING INSTRUCTIONS

 Samples shipped via priority mail or through FEDEX OR UPS typically arrive sooner than samples
sent via US Postal Service.
 Tracking provided by the carrier gives you information on the path of the sample before it
arrives at the laboratory.
 Samples must be submitted dry – not in blood, liquid, or preservatives
 Place samples in a leakproof tube and padded to prevent breakage





RECEIVING RESULTS
 Log onto the system at www.urolithcenter.org, or
www.cvm.umn.edu/depts/minnesotaurolithcenter I
o Enter the clinic e-mail and password.
o Click on Search/Retrieve.
 Reports can be accessed for several months after finalized


[121]

 Sample was submitted online but you cannot find it listed when searching?
o Entering less information is better, so try entering the first couple letters of the patients
name or the owner’s name.
o If you leave all the fields blank and use the submit button, it will show all samples that
have been submitted in the last three months.

 How will I know when results are available?
o For samples submitted online, an e-mail is sent to [email protected]
 Results and recommendations will be attached.

 I can see the sample listed but cannot view results?
o When looking at the listing of your results it will show date created C:,
o Date received R:
o and a date analyzed A:.
o If no date is listed after the A:, the sample analysis has not been completed. Please
allow 10-14 days for analysis after the sample has been received in our
laboratory. When the analysis is completed a date will be listed after the A:, and a view
results link will be shown in the last column.

 How will I know if my sample arrived at the lab?
o For samples submitted online, an email will be sent to [email protected] when
the sample is received at the lab

 If you fill out a paper submission form
o Results and recommendations will be faxed

AVIMARK CODING
 Use code UROLITH – Price includes Packaging, Analysis & Shipping via FEDEX
















This is a reference procedure only. There is no need for a drill/quiz.









[122]

1078 – Supervision of Lay Staff by Doctors


Result Statement: Doctors supervise on-the-floor lay staff and complete small on-the-spot
SUPPORT for our lay staff in a positive way. We praise in public and criticize in
private. Even criticism should be given so that individual getting criticized feels
that it’s in an effort to SUPPORT them and make them successful here.

Doctors DO NOT complete CORRECTIONS for lay staff. If doctors seen
corrections needed they report the needed correction with specific
reason/event to the appropriate supervisor IN WRITING.

Overview:

 SUPERVISION (by doctors): For these purposes SUPERVISION would be considered directing
staff where they need them and what they need them to be in order to help us provide the best
care for our patients and clients. This is basically being a traffic cop or music conductor.

 SUPPORT (by doctors): For these purposes SUPPORT would be the response a doctor would
have for staff members when they see they made a mistake, need better skills, or need more
education on a given subject. These are SMALL on-the-spot supportive HELP for that staff
member. All support that may make a person feel inadequate or embarrassed will be done IN
PRIVATE

 CORRECTIONS (NOT by doctors): For these purposes CORRECTIONS would be the same as
RETRAINING. These corrections are most likely needed because the staff member never truly
learned what they needed in their original training, did not get properly trained, or are non-
compliant in what we expect. In all of these cases there is going to need to be PLANNED
PRIVATE TIME for this corrections. The only way this planned time can happen is by the
supervisor getting the appropriate info from the doctor in WRITING.

Basis for the above: If the above is followed in most cases all staff should feel supported our
doctors. They should feel that our doctors are here to HELP THEM
BECOME SUCCESSFUL. This includes those staff that may still be
learning, not knowing exactly what to be doing at certain times (traffic
cop), making mistakes (support), or non-compliant (corrections by non-
doctors).

It also SAVES THE DOCTOR TIME. Doctors are here to assure patients
and clients get the care they need and expect. Doctors are not
expected to be spending their time correcting staff at the same time.
We save that for other supervisors for later and in private. Those
supervisors should follow-up with the reporting doctor so the doctor
knows how and when it’s being handled.

Drill/Quiz for Supervision of Lay Staff by Doctors:
Explain in your own words how you would SUPERVISE and SUPPORT lay staff…but NOT CORRECT.

[123]

1080 – Surgeries by Mobile Surgeons

When clients need a surgery from a mobile surgeon:
1. The DOCTOR first discusses the expected list of services that will be included with the surgery
with the client WITHOUT listing the price. The best way to do this is to hand write what things
we will be doing (anesthesia, bloodwork, pain meds, recovery, etc).
2. The DOCTOR assures the client fully understands AND AGREES on what we will need to do for
their pet BEFORE the client is turned over to the technician, tech assistant or client coordinator.
3. The DOCTOR adds a follow-up in AVImark of WHO is being delegated and responsible that the
following steps are followed.
4. The TECHNICIAN, TA or CLIENT COORDINATOR then generates and prints a treatment plan of
expected services. Remember we have pre-packaged estimates in AVImark that can be used.
They are all listed under “Turner - ………”
5. The TECHNICIAN, TA or CLIENT COORDINATOR then shows this printed treatment plan to the
doctor for approval BEFORE presenting it to the client.
6. After approved by the doctor the TECHNICIAN, TA or CLIENT COORDINATOR presents the
treatment plan with prices to the client. Inform the client that is an ESTIMATED cost. It could
be a little higher or lower depending on what Dr. Davidson’s current fees are. The overall
cost should not vary by more than 10%.
7. Once the CLIENT APPROVES the treatment plan by signing the TECHNICIAN, TA, RECEPTIONIST
or CLIENT COORDINATOR will work on scheduling:
a. Ask the client if there are any days that would NOT work for them.
b. Call Dr. Davidson 213-479-2716 (or other doctor) to get two things:
i. The date and time he can do it.
ii. His cost.
c. You may have had to leave a message at this point. If so:
i. Add a follow-up to the patient’s record of your message left for Dr. Turner.
ii. Add another follow-up due in 1 day that reads, “Schedule Dr. Turner Surgery”.
You should add more notes that reads we need to “double check that the Dr.
Turner has called back, surgery is scheduled, and client has been contacted.
d. Change the treatment plan to assure the client cost of the surgery itself is 10% MORE
than the surgeon’s fee.
e. Schedule as listed in the “Scheduling Surgery” procedure (client drop off time, etc).


** Note: In AVImark Dr. Davidson’s surgery itself is entered under “Charisse Davidson, DVM”. All
other treatment and items will go under the doctor of record (our doctor).


This is a reference procedure only. There is no drill/quiz.






[124]

1082 – Surgery Guidelines


Results Statement: To assure great patient care and client service of offering
appropriate and convenient surgery services among all doctors.








Primary Responsible Position: Associate DVM’s

Scheduling and Surgery Fit-Ins:

 See Surgery Scheduling Guidelines under Receptionist Procedures
 We encourage surgeries to be “fit in” outside of our normal surgery scheduling. It can be very
helpful to both pets and clients. If done too often or improperly it can also cause mistakes,
confusion, and wasted time for many. Surgeries can be “fit-in” to a doctor’s appointment schedule
with the following:
o “Fit-in” surgeries should NOT be common place as it can:
 Limit our available doctor appointment hours for clients
 Have two surgeries going at the same time with limits on space and equipment.
o FIRST try to fit them into your own SCHEDULED surgery time.
o Do NOT create more than a 4-hour period with available appointment doctor.
o Do NOT create a schedule with no doctor available for appointments at 8 AM.
o ONLY do a surgery “fit-in” if it’s needed in order to assure the surgery gets done.’
o Occasional exceptions to the above can be made with good judgment by the doctors or
execs, or both.
o For AVIMARK:
 Schedule the surgery “fit-in” APPOINTMENT AVImark from 7-8 AM during your
normal block-off
 Add a BLOCK-OFF for the surgery itself UNDER YOUR COLLUMN in AVIMARK.
 DO NOT add a block-off on the surgery column
 Make sure you have scheduled enough time to start and finish the surgery in the
planned time. You may need a little extra for the support staff to prep and recover
the patient before the next block of appointments.














[125]

Surgery Patient Prep:

 Surgeries should be prepped by techs by completing one patient at a time completely before
starting the next patient or inducing as directed by the doctor.
 Surgery prep by techs take priority over bath packages or healthy drop off patients
 We must have the first patient under anesthesia within 30 minutes of scheduled surgery time. The
surgery doctor must supervise techs to make sure this happens. (only ICU cases or emergencies
should prevent this). Surgery patients take priority only behind emergencies and ICU/Critical
patients.

Order of Surgeries:

 Doctors should start the patient with the longest surgery time followed by the next longest, etc.
This allows us to be able to work-in shorter surgeries after if needed.

After Surgery:

 The surgery doctor calls every client when patient is recovering after anesthesia/surgery to let the
owner know everything went well. A “Follow-up” is added to the record in Avimark.
 Unless otherwise directed by the doctor, in general, routine surgery patients will be offered food
and water by mouth within 6 hours of recovery and discontinuing IV Fluids.

Mobile Surgeons:

 Surgeries or services completed by a specialist will be entered in under “Dr. Davidson/Dr. Fager” in
AVImark.
 The doctor of record will only get production from the other services.
 The associate doctors will not be compensated for the production or fee of the surgery or procedure
itself.

SURGERIES ON PERSONAL PETS OF DOCTORS:
 Owner of the pet can decide who the doctor of record will be. They can control the case
themselves or transfer case to another doctor if needed in order to avoid the personal and
emotional involvement in the care.
 Fees are based on the standard doctor discounts set up in AVImark. Dr. Julius or medical
director may make some exception or overrides based on the service needed and cost to the
hospital.
 It is approved for doctors to use clocked-in staff for assistance with procedures or surgeries.
 Pre-operative lab work - Same as with regular clients. We have a two month requirement but
final judgment is always with the doctor of record. This judgment should be in line with what
we recommend to routine clients.
 Scheduling – routine surgeries should be scheduled within the routine regular blocked off
surgery time. This keeps payroll under control as the doctor will need to use support staff to
help with the surgery.
 Anesthesia – all decisions are made by the doctor of record, even if during another doctor’s
blocked off surgery time (Owner doctor may not have available surgery days on his/her
schedule).

[126]

Drill/Quiz for “Surgery Guidelines”:
1. Do we do surgery fit-ins?
2. Give your trainer an example of when would be good to do a surgery fit-in? When would NOT
be a good time?
3. When techs are prepping surgeries should they do one patient completely before moving onto
the next?....or should they do all the catheter placements, then ECG’s, then all drugs?
4. How long (maximum) after you start your surgery block should he first patient be under
anesthesia?
5. If there are multiple non-critical patients dropped off for vaccines and ear infections, but also
there are surgery patients dropped off which should the techs be working on FIRST?
6. When you have multiple surgeries and/or dentals which should you start first?
7. Who calls the client after surgery? What do you do after you call?
8. Do associate DVM’s get production on the surgery fee of mobile surgeons?






















































[127]

1083 – Suture and Staple Removal

Results Statement: To assure the highest quality of care and convenience for clients, staff,
and doctors when sutures are removed.

Primary Responsible Position: Technicians

Participating Positions: Doctors, Tech Assistants

When: 10-14 days after surgery (unless otherwise directed by doctor)

Who: Technician (unless otherwise directed by doctor)
A doctor is not needed on routine suture removals.

How:
1. Pet is taken to the treatment area away from the owner (unless a
special circumstance).
2. Using proper restraint to fully visualize the entire suture site before
starting to remove.
3. Check the area of anything unusual (swelling, non-healing, oozing,
etc.)
4. If something looks unusual DO NOT REMOVE THE SUTURES. Get a
doctor.
5. If a doctor is not available or not in the building. Coordinate it with
the client so that a doctor can look and decide when they will be
removed.
6. Sutures are removed with suture scissors. Staples with staple
removers.
7. The surgery site is cleaned routinely so the area looks presentable
to the client.
8. The pet is returned to the owner.

Special Circumstances: There will be certain cases where the doctor wants to check the surgery
site before sutures are removed. In these cases, the client will be
SCHEDULED IN ADVANCE for a 10-minute recheck exam and suture
removal on the doctor’s AVImark schedule. It most all cases these
rechecks will be no-charge to the client.

Drill/Quiz for Suture and Staple Removal:
1. Why do we have this procedure?
2. Who removes the sutures? Where will the pet be for this? On routine cases do you need a vet
for this?
3. What is done if a doctor wants to see the surgery site when sutures are removed?






[128]

1084 – Transfer of Cases Among Doctors



Result Statement: Any patients that must have their care transferred from one
doctor to another is done so in a way that does not lower the
QUALITY of that PATIENT CARE or CLIENT SERVICE in any way.


Lab results on NON-complicated cases: Decisions after lab work do not require attention until the
original doctor is back at work (<3 days).
o It simply goes to the doctor of record associated with the lab result.
o Exceptions would be when the patient care or client service REQUIRES a different doctor
handling it.
Examples:
 Client calls and demands to get results and plan now, when the original
doctor is not available.
 Patient’s condition or treatment plan changes and demands attention
now, when the original doctor is not available.

Lab results on complicated cases: Decisions after lab work on these cases must be made more quickly
or require more detailed knowledge of history (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.
o We do not risk a patient being improperly cared for
o We avoid the client or pet waiting if care needs to be done now.
o We avoid upsetting original doctor by changing care plan or taking over a case that has
not effect on patient care or client service by wating.
o We attempt follow-up care to be SCHEDULED with same doctor WHEN HE/SHE IS HERE.
o If follow-up client or patient care is NOT scheduled with original doctor in must involve
COMMUNICATION AND AGREEMENT ON 3 THINGS WITH ORIGNAL DOCTOR via voice
call, text, e-mail, etc.:
1. Who gets credit for the test?
2. Client communication – what doctor? When?
3. Follow-up care – what doctor? When?
4. We also add appropriate follow-ups and notes to patient records












[129]

Emergency/Critical Cases:
o The case goes to the doctor that is AVAILABLE NOW.

Patients having surgery THE SAME DAY by another doctor:

In some cases, one doctor may need to direct staff to give medications/pre-meds to a surgery
patient scheduled for surgery with ANOTHER doctor that same day.

Unless it’s an emergency or critical situation, the non-surgery doctor should contact the surgery
doctor BEFORE giving the medication. This helps the patient by assuring that the surgery doctor
is in complete control of the anesthetics or other medications that may be planned.

Patients currently under anesthesia or in recovery:
In VERY RARE circumstances there may be times when doctor handling a case under anesthesia
or in recovery needs to transfer the care of that patient and client to another doctor that it is in-
house. This can be done but only under the following guidelines:
1. The original doctor ASSURES the doctor now handling the case knows all information
needed on the patient and the client.
2. The original doctor ASSURES the doctor now handling the case is willing and has the
time available and is willing to handle the case with NO DROP in patient care or client
service.
3. The original doctor notates the transfer of the case as a follow-up with a date/time
stamp and name of the doctor of record ON OR BEFORE the exact time of transfer of
that case (ONLY an emergency situation with people or pets my keep this from
happening).

Example of an approved reason to transfer this type of case:
A technician is recovering a young healthy patient who just had a prophylactic dental
cleaning. The doctor in-charge is working the rest of the day and NEEDS to step out now
in order to get food to avoid any drop in their decision-making and mental alertness.
The doctor follows the above steps before the transfer.

A doctor has a dog under anesthesia and makes the first incision on a mass removal.
The doctor gets a call that his/her immediate family member has been in a car accident
and is being taken to the ER by ambulance. The doctor immediately transfers this
surgery to another doctor in-house and leaves WITHOUT adding a follow-up in #3
above.

Example of an UNapproved reason to transfer this type of case:
A technician is finishing a dental cleaning on a senior patient that is still under
anesthesia. There may be extractions needed. The doctor wants to transfer the case



[130]

because he/she has scheduled a lunch with a friend or family member and does not
want to be late to this lunch.

Note: It is clear that this policy requires a high level of good judgment. Each situation must be handled
appropriately making sure the highest priorities are handled appropriately.

Drill/Questions for transfer of cases among doctors:
1. Why do we have this procedure? Why should you follow it?
2. What would happen if we didn’t follow this procedure?
3. Give me another example using good judgment, not listed above, of:
4. A case that SHOULD be transferred to you. Why?
5. A case that SHOULD NOT be transferred to you. Why not?


























































[131]

1084.1 – Treatment Plan Creating

Result Statement: To create an accurate treatment plan for various
pet’s planned/recommended services and items.

Primary Responsible Position: Receptionist

Participating Positions: Doctor, Tech, TA

Why not called “Estimates”: “Treatment plan” is more appropriately named as opposed to
something you may get at an auto repair shop.

How to Create a Treatment Plan:

1. Go to the patient’s chart. Review what is due in the reminders list as
well as review what the dog has been to us for recently. (if they have
been in at all)
2. Viewing the patient’s account in AVImark, you will go to the “estimates”
tab on the right upper side of the screen.
a. Right click in the Estimates box, and select “New”
i. Put a general description for the estimate in the
“description” line. ie. Exam, vaccine updates, limping,
bath, etc.
ii. Select the doctor who is seeing the pet, from the drop
down menu on the upper right.
b. A window will pop up; right click in the center of the window.
Select “new”.
i. Note: shortcut is F2 for a new entry on the estimate.
c. To search for items to enter on the estimate, type in the
description or the code to the item. (items are anything from:
exams, inventory items/products, or vaccines.
3. You can also right click and select “Choose”  “Estimate…”
a. You can select one of many options for packages you wish to
choose from. ie. senior wellness w/ vaccines, canine or feline
annuals, dental pre ops, etc.
b. See the cheat sheets below for items needed for different
common appointments.
i. Also make sure to add any item necessary from the
reminder list.
4. Once you have completed all the items necessary for the appointment
and due items from the reminder list, select the “print” button. (The
estimate will print and the window will automatically close.)
5. If the estimate is for the follow day(s), make sure you go to the
appointment on the calendar and note “estimate made and printed”.





[132]

COMMON TREATMENT PLANS: In most all of these cases it is faster and easier to go to
“Estimates” and “Choose”….not “New”. It will keep you from
forgetting certain things.

Ear Infection:
 Code 2301- Comprehensive Exam / Unless has had an exam within the last 24 days then use:
Code 2304- Recheck Exam w/in 24 days.
 Code 7040 - Cytology - ear with stain / Unless has had an exam within the last 24 days then use:
Code 7212 - Recheck ear cytology - w/in 24 days
 Code 2496 - Ear Cleaning - Medical SIMPLE
 Code 51139 - Oti-PAK E (per cc) (Okay to leave as quantity 1)

Urinary Tract Infection:
 Code 2301- Comprehensive Exam / Unless has had an exam within the last 24 days then use:
Code 2304- Recheck Exam w/in 24 days.

New pet but the owner wants the pet checked with their Veterinarian (Us):
 Code 2301- Comprehensive Exam / Unless has had an exam within the last 24 days then use:
Code 2304- Recheck Exam w/in 24 days.
 Code NEWCLIE : New Patient - Complimentary Exam

Vaccines: See vaccine protocol list. Every dog/cat is a different case.
 Code 2301- Comprehensive Exam / Unless has had an exam within the last 24 days then use:
Code 2304- Recheck Exam w/in 24 days.
 Depending on what vaccines each pet needs, you will add the due vaccines and lab work. (see
vaccine protocol procedure for guidance)


Limping:
 Code 2301- Comprehensive Exam / Unless has had an exam within the last 24 days then use:
Code 2304- Recheck Exam w/in 24 days.
 Code 5570 : Radiograph - Per Study (any # of views) – This will expand when selected, leave
expansion.
 IF the pet has had x-rays within the last 24 days for any reason, use the following charge instead:
 Code 5591 : Radiograph - Post op or Follow-up (24d) – This will expand when selected, leave
expansion.

Post Ops:
 Code EXAMPOST: Exam - Post Op Courtesy














[133]

Pre Ops:
 For Dentals ONLY: (be aware these are discounted prices)
o Code 2482: Pre-op Exam/Consult – included at $0.00
o Code 9910: Biohazard Fee (OSHA) at $___
o Code 4180: ECG – Preoperative at $___
o Code 4360: Pre-Op Screen / CBC - SA050 at $___

 Pre-Ops for other surgeries:
 Code 2482: Pre-op Exam/Consult – included at $0.00
 Code 9910: Biohazard Fee (OSHA) at $4.50
 Code 4180: ECG – Preoperative at $59.50
 Code 4360: Pre-Op Screen / CBC - SA050 at $89.90

“Bumps or Masses”:
 Code 2301- Comprehensive Exam / Unless has had an exam within the last 24 days then use:
Code 2304- Recheck Exam w/in 24 days.

Drill/Quiz for “Treatment Plan Creating”:
1. Why do we have this procedure?
2. What happens if you don’t know how to do this correctly? What happens for the client? For the
pet?
3. Go to the appointment calendar for TWO days from now.
a. Find three patients and make accurate estimates for them either using the “new” or
“choose” feature in AVImark. Do this in front of your trainer.
4. Get a pass when you can do three accurately in less than 5 minutes each. Do as many as it
takes to get it right.



































[134]

1084.2 – Ultrasound Charges and Production

Results Statement: To assure we have great patient care by offering multiple modality
options for ultrasounds with client charges and associate pay that is fair
to all parties (client, doctor, and hospital).

Primary Responsible Position: Associate Veterinarians

Why This Procedure? Unlike mobile surgeon fees we have some ultrasound fees that are
marked up higher, which gives us the ability to pay production pay for
our associates. These ultrasounds most often require additional
assessment and planning from our associate veterinarians.

Associate Production Pay?

 Associates GET production pay on:
o Ultrasounds Performed by Mobile Company
o In-House Ultrasounds performed by us
o U/S guided FNA’s performed by us
o Other procedures performed by us
o Histopath/Cytology/Labs sent to OUR lab.

 Associates Do NOT get production pay on:
o U/S guided FNA’s performed by Mobile Company –
 because of how high their fees are it’s not fair to client
to mark it up enough for associates to get production
pay.
o Histopath/Cytology/Labs sent to Mobile Company’s Lab
 Because of how higher fees are it’s not fair to the client
to mark it up high enough for associates to get
production pay on it.

What’s Usually Best? If a mobile ultrasound company needs to do an FNA or other
procedure themselves they charge us a high fee. We mark it up
about 10% and cannot afford to pay our doctors production on it.

Try to send all samples to OUR lab. It’s more cost effective and
we CAN pay our doctors production pay on it.



This is a reference procedure. No Drill/Quiz Required








[135]

1085 – Ultrasound Tips


Improving results for Cytopathology – (.jpeg) Self- Captured Images

1) Proper slide preparation of the sample is important.
a. Make an impression smear of the sample – by compressing 2 slides together GENTLY
and then lifting apart – DO NOT DRAG the slides across each other…
b. Samples should be a monolayer – large amounts of material does not make evaluation
easier! We are looking for monolayers of cellularity for evaluation.


Fine Needle Aspiration Technique


Supplies:
 22 gauge needles
 Clean microscope slides – preferably frosted to enable labeling with pencil
 Cleaned site for aspiration (does not necessarily need to be clipped)


There is no need for syringe aspiration (negative pressure). This would only create excessive blood contamination and
fracturing of cells.

I. Stabilize mass or lymph node between fingers.
Use the needle only (no attached syringe), make multiple advances into the mass (4 or 5 times). Generally, you will not see
anything in the hub of the needle with this technique.



















This same process is done with Ultrasound guided FNA procedures – NO negative pressure on
the 22 gauge needle. Once the target lesion or site is identified the needle is advanced into this
area, then moved up and down (SLIGHTLY) while spinning the hub within your fingers. So we
have 2 movements occurring at the same time. The normal capillary pressure within the
needle and hub are adequate to pull cells into the needle while minimizing hemodilution
(usually noted with negative pressure aspirates).




[136]

II. Attach a 12 cc syringe (with about 10 cc of air in it) to the needle. Holding the needle in place on the syringe be sure the
bevel of the needle is pointed down toward the slide surface. Push the plunger with moderate force to expel material.

Make the impression smears by placing another slide upside down on top of the sample slide. Apply GENTLE pressure and
pull the slides apart. DO NOT DRAG SLIDES ACROSS EACH OTHER!

Repeat the above procedure until you have 4-5 slides with adequate sample noted.




















Staining:
Use the standard Diff-Quik (Wrights Stain) in your hospital: HOWEVER
1) Have SEPARATE coplin jars of Diff-Quik for Cytology!
a. DO NOT use the same stain for ears and fecal cytology’s we do for blood or tissue
cytology’s
b. CLEAN jars and replace (not just refill) the Diff-Quik Stains every 4-6 weeks for improved
cytology results.


Once slides are stained: Image Acquisitions
1) Image under Microscope :
a. An average of 10 images is the best:
i. 2-3 images at low power
ii. 3 images at 40-60X
iii. 3 images at Oil Immersion (100X)
b. We are looking for a monolayer of cells – CLUSTERS of cells do NOT allow proper
evaluation by our cytologists. Focus on periphery of clusters if no real monolayer is
present.
2) Whenever possible, a good white balance at time of the image capture helps a lot with the
description/diagnosis. (Look at the camera users’ manual to improve WHITE Balance for images)
3) Do not duplicate the same image field – always move to a different field for EVERY image.
4) A gross description of the slide/sampling can be useful. (ex: fatty, crunchy…..)
5) Be sure to maximize FOCUS – again, the thinner layer of cells allows better focus on single cell
layers.
6) With FLUID analysis - please provide a Total Protein of the sample submitted for cytopathology
a. We also would like to know if the fluid sample is a DIRECT smear or Sediment.

[137]

Recommendation for setup allowing image capture using Smartphone:
http://vetlab.com/miPlatformSmartCaptureSystem.htm
1) Use any smartphone camera or tablet (smaller versions)
2) Upload images straight from your phone to the OPD telemedicine platform.
3) The platform is secured to a secondary eyepiece lens provided – so you just remove the entire
platform (with eyepiece lens) and replace original eyepiece lens when you wish to use the
microscope normally.
4) We recommend acquiring a smartphone dedicated to this platform (used or slightly older
models work fine).
a. Only use the smartphone on WiFi – so no costs are incurred for any wireless phone
plans!
b. You just need to capture images into photo gallery and then open the web browser to
the OPD Cytology case you started previously (patient data, clinical history, labs, etc..)
i. Then under Non-DiCOM images use the Browse button to find the image gallery
and tag the appropriate images to be uploaded onto the site.
ii. Save the OPD Telemedicine site under favorites and save login information to
make the process easy and smooth.
5) The miPlatform has a free app on iTunes store – this allows time and date stamping and writing
text on images.



















The above images show how the platform is attached to the lens piece. Then just replaced
onto microscope as needed for capture.



The above is a reference procedure only. There is no need for drilling/quizzing.














[138]

1086 – Urgent Cares Near Closing Time

Results Statement: To assure we have consistency for patients that need us close to
closing time, even those that may go into closing time.

Primary Responsible Position: Associate DVM’s

URGENT CARES OR EMERGENCIES WITHIN 30 MINUTES OF CLOSING:

All lay staff will ask doctor for instructions on whether or not we can see the patient. Doctor will use the
best judgment in determining whether or not we see the pet considering the care of the patient,
success of the hospital, and NOT the personal work schedule of the doctor or staff.

If a doctor advises we cannot see the patient, they MUST report the reason to the lay staff why we will
not be seeing the patient so they can relay this information to the client.

o Three Examples of Good Judgment Calls:
1. It’s 7:55 PM. A patient who had a spay here earlier that day has went home and
chewed out the sutures. The owner called and said there is “stuff” hanging out
of the incision. WE SEE THIS PATIENT. See procedure “complications in care” to
determine potential client fees.
2. It’s 7:55 PM. It’s been a very busy day and we are not caught up. A new client
calls. Their 14 year old cat with diabetes for the last year has been getting
worse the last few days. Tonight when they got home it cannot stand. WE
RECOMMEND THEY GO STRAIGHT TO THE E-CLINIC. We tell the staff and client
the reason: It will almost certainly need a lot of tests AND hospitalization. It will
be better for the patient and client to do this process at one hospital instead of
two. We inform the client AND staff of this reason
3. It’s 7:40 PM. It’s been a busy day and we are basically caught up. One of our
existing clients calls. Their dog who we have not seen in two years is vomiting
and extremely weak. WE WILL SEE THE PET. THERE WILL BE AN EMERGENCY
FEE. If they arrive after hours they will have an after-hours emergency fee.
They will NOT have both fees. They may still need to be transferred to the e-
clinic after the doctor exam and diagnostic/treatment plan.

URGENT CARES WITHIN 2 HOURS OF CLOSING (after 6 PM weekdays or after 2 PM Saturdays and
Sundays)

 Urgent Care fit-ins will turn into EMERGENCY exam fee if the fit-in is going to run into after
hours, NOT THE AFTER HOURS EMERGENCY FEE.
 All clients with urgent care fit-ins within 2 hours of closing will be well informed that the exam
fee may turn into an emergency fee if the doctor is so busy that they are seen after closing. We
will also give the client a good idea of when we think they will be able to be seen.

Drill/Quiz for Urgent Cares Near Closing Time:
1. What do you do if a client calls for an urgent care within 2 hours of closing? Within 30 minutes?
2. What exam fee applies? What if you start the exam after closing because you were so busy?

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1087 – Urinary Issues


Results Statement: To provide the highest quality patient care and consistency
among doctors for routine urinary issues







Primary Responsible Position: Associate Veterinarians

Standard of Care for Routine Cases: We prefer thorough diagnostics on urinary cases. We do this to
assure there are no urinary stones, kidney issues, and infections
are cleared.

Our recommendations:

 Radiographs and UA’s on urinary issues.
 Urine Culture/Sens/MIC when rods are seen, including
rechecks
 Recheck UA and in-house Uricult culture with recheck urine
 Recheck exam NOT needed routinely with recheck of urine.
 Urinary diets are prescribed with repeated issues. The diet
first prescribed is our “Brand Preferences” procedure.



No drill/quiz for this procedure. This a reference procedure.































[140]

1088 – Vacation Requests and Doctor Schedules


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Results Statement: Doctors are scheduled by the 5 of each month for the FOLLOWING
month. We do it this early so that clients can book well in advance AND
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lay staff can be scheduled around the doctors by the 15 .



Primary Responsible Position: Owner or Medical Director

Participating Positions: Associate DVM’s

 See Hospital Policies and General Procedures
 The owner or medical director will attempt to make the doctor schedule in a fair and
equitable manner as it pertains to evening/weekend/surgery/appointment shifts. It will
also be based on the best interest of the hospital at that time.
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 Doctor personal time off requests must be submitted by the 1 of the month for the
ENTIRE MONTH FOLLOWING. This is done in order to assure lay staff can be scheduled
appropriately and clients have the opportunity to book appointments and surgeries
accurately in advance with specific doctors.
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 Doctors must review the schedule by the 8 of each month in order to identify any
errors or concerns. The vet administrator has until the 11th to respond/correct any
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errors. For any concerns after the 8 of each month, the associate must follow the
guidelines below.

What If you miss the vacation request deadline of the 1st?

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If a doctor needs to request personal time off AFTER THE 1 FOR THE FOLLOWING MONTH or
after the doctor schedule has been submitted they must:
a. Make suggested changes of doctor coverage in their absence assuring we
have plenty of doctor availability to take care of our patients.
b. Get written approval of above changes from the medical director or
owner.
c. Schedule relief doctor, change other doctors’ schedules, make changes in
the AVImark scheduler, and distribute new doctor schedule with changes
highlighted.
d. E-mail the new schedule to Owner, ED, D of A, Lead Tech, Lead
Receptionist, and Kennel Manager (all managers)

Drill/Quiz for Vacation Requests and Doctor Schedules:
1. What is the deadline to get your vacation request in as a vet?
2. What do you do if you miss the deadline and need some time off?



[141]

1090 – Vaccine Protocols and Requirements

Result Statement: To assure patient safety for all pets by knowing and following the doctor
recommendations for pets while appropriately service clients without
any surprise costs


Primary Responsible Position: All doctors, execs, department heads, receptionists, Techs, and TA’s

Puppies: Every 3 weeks until 4 months old, Exam on first visit, Recheck on follow-
ups if within 24 days.

1. 5-8 weeks:
o DA2PPV (without lepto)
2. 9-11 weeks:
o DA2PPV (without lepto)
3. 12-14 weeks (or older and overdue for vaccines)
o DA2LPPV (with lepto)
o Bordetella – 1 year
4. 15-18 weeks
o DA2LPPV (with lepto) – ONE YEAR (same vaccine as 3 year)
o Rabies – ONE YEAR (same vaccine as 3 year)

Puppy Boarding: All puppies can be boarded if current on vaccines AND
IF NOT completed with all puppy shots. If all puppy shots are not
complete they must:
 Have a bordetella vaccine NOW
 Be walked on the smaller concrete section of the boarding are, NOT
on the grass.

Fecals: LAST TWO fecal exams must be negative before going to yearly

De-wormings: 2 routine de-wormings 2-3 weeks apart from a vet. We
use Drontal Plus

Heartworm and Flea/tick Prevention: single dose every 3 weeks until
last puppy visit. ALWAYS get 6 month or more on last puppy visit.

** There are changes based on certain parasites, certain vaccines
previously given, weight of puppy, diseases, etc. The DOCTOR may
make changes to the above protocols based on many of these factors.











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Adult Dogs: ANNUAL EXAMS ARE REQUIRED WITH DA2LPPV, LEPTO, OR RABIES.


On YEAR ONE dogs come in for:

1. DA2LPPV
2. RV
3. BV
4. Fecal test
5. Hw test
6. Blood panel (K9 Early Detect if 1-6 yrs, Sr.Well if 7 or over)
7. ANNUAL EXAM WITH DA2LPPV and/or RV.



On YEARS TWO AND THREEE dogs come in for:

1. LEPTO* - WITH ANNUAL EXAM
2. BV
3. Fecal test
4. Hw test
5. Blood panel (K9 Early Detect if 1-6 yrs, Sr.Well if 7 or over)
6. ANNUAL EXAM IS WITH THE LEPTO VACCINE

*Dogs that have had a routine exam in the last 24 days do NOT need
another exam to get the 2-3 week BOOSTER lepto vaccine






































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Kittens: Every 3 weeks until 4 months old, Exam on first visit, Recheck on follow-
ups if within 24 days.

1. 5-8 weeks:
a. FVRCP
2. 9-11 weeks:
a. FVRCP
3. 12-14 weeks (or older and overdue for vaccines)
a. FVRCP
b. Feline Leukemia – First/12-14 weeks
4. 15-18 weeks
a. FVRCP – ONE YEAR (same vaccine as 3 year)
nd
b. Feline Leukemia – Adult/2 – ONE YEAR (same vaccine as 3
year).
c. Rabies – ONE YEAR (same vaccine as 3 year)

Fecals: LAST TWO fecal exams must be negative before going to yearly

De-wormings: Two routine de-wormings 2-3 weeks apart from a vet.
We use Drontal

Heartworm and Flea/tick Prevention: single dose every 3 weeks until
last kitten visit. Cats or kittens that NEVER go outside and do not have
dogs in household do not flea prevention. Some clients may want it
because they cannot pill their cat and revolution is topical. This extra
protection is great.

** There are changes based on certain parasites, certain vaccines
previously given, weight of puppy, diseases, etc. The DOCTOR may
make changes to the above protocols based on many of these factors.




























[144]

Adult CATS: ANNUAL EXAMS ARE REQUIRED WITH FVRCP, LEUKEMIA, OR
RABIES.

On YEAR ONE CATS come in for:

 FVRCP
 RV
 Feline Leukemia
 Fecal test
 Blood panel (Feline Wellness 1-6 yrs, Sr.Well if 7 or
over)
 Note: Heartworm testing on normal cats is NOT
necessary but comes with some routine panels
 ANNUAL EXAM WITH FVRCP, Leukemia or RV.



On YEARS TWO AND THREEE dogs come in for:

 Feline Leukemia - WITH ANNUAL EXAM
 Fecal test
 Blood panel (Feline Wellness if 1-6 yrs, Sr.Well if 7
or over)
 Note: Heartworm testing on normal cats is NOT
necessary but comes with some routine panels
 ANNUAL EXAM IS WITH THE Feline Leukemia
VACCINE



































[145]

Drill/Demonstration for “Vaccine Protocols and Requirements”:

Using the “practice client” in AVImark you will print estimates for the following visits:

1. A puppy comes in at 12 weeks with no vaccine or vet visit history. Print an accurate estimate for
what they need.

2. A kitten comes in at 5 months old with no vaccine or vet visit history. Print an accurate
estimate for what they need.

3. A 5-year old dog is due for Lepto shot. He had an annual visit last year and got RV, DA2LPPV, BV,
Hw, Fecal, and K9 Early Detection. Print an accurate estimate for what he needs.

4. An 11-year old cat is due for a Leukemia shot. He had an annual visit last year and got RV,
FVRCP, Feline Leukemia, Sr wellness, fecal, and Revolution. Print an accurate estimate for what
they need.

5. Do cats need flea prevention if they are kept indoor 100% of the time and no other animals in
the household are kept indoors also? What about heartworm prevention?

6. Do dogs need an exam with a lepto shot?

7. If a puppy or kitten comes in within 3 weeks of last booster do they pay for a recheck exam or
full exam price?









































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