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https://www.avma.org/KB/Resources/Reference/Pages/VCPR.aspx

VCPR: The Veterinarian-Client-Patient Relationship

 

The veterinarian-client-patient relationship (VCPR) is the basis for interaction among veterinarians, their clients, and their patients and is critical to the health of animals.

View a printable form of the VCPR to post in your office.

Establishing a Veterinarian-Client-Patient Relationship

A VCPR is present when all of the following requirements are met:

  1. The veterinarian has assumed the responsibility for making clinical judgments regarding the health of the patient and the client has agreed to follow the veterinarians' instructions.
  2. The veterinarian has sufficient knowledge of the patient to initiate at least a general or preliminary diagnosis of the medical condition of the patient.  This means that the veterinarian is personally acquainted with the keeping and care of  the patient by virtue of a timely examination of the patient by the veterinarian, or medically appropriate and timely visits by the veterinarian to the operation where the patient is managed.
  3. The veterinarian is readily available for follow-up evaluation or has arranged for the following: veterinary emergency coverage, and continuing care and treatment.
  4. The veterinarian provides oversight of treatment, compliance, and outcome.
  5. Patient records are maintained.

The VCPR is defined in Section III of the AVMA’s Principles of Veterinary Medical Ethics. This document also includes a description of how the VCPR may be terminated.

The AVMA Model Veterinary Practice Act (Section 2 and Section 2 Commentary) further states the following:

The definition of “veterinarian-client-patient relationship” (VCPR) in subsection 20 was changed in 2012, and is now different from that embodied in federal regulation 21 CFR 530.3(i) relating to extralabel drug use.
 
In 2012, subsection 14 was revised to define “patient” as “an animal or group of animals.” Therefore, the definition of VCPR can be applied to individual animals as well as a group or groups of animals within an operation (production system).
 
The AVMA recognizes that individual states may wish to more clearly define specific terms within the definition of VCPR. For example, a state regulatory board may wish to include a specific time period (eg, no less frequent than 6 or 12 months) to better delineate the term “timely” relating to examinations and visits. 
 
The term “timely” should be considered in light of the nature and circumstances of the patient (eg, species, condition or disease, or operation).
 
In 2012, subsections 20-b and 20-c were revised for purposes of clarification. Subsection 20-e was added to state that patient records must be maintained to establish a VCPR.
 
States may also wish to further specify that when establishing a VCPR in the case of large operations, “sufficient knowledge” can be supplemented by means of:
 
1. examination of health, laboratory, or production records; or
2. consultation with owners, caretakers or supervisory staff regarding a health management program for the patient; or
3. information regarding the local epidemiology of diseases for the appropriate species.

Section 5 (and commentary) of the AVMA Model Veterinary Practice Act states the following:

No person may practice veterinary medicine in the State except within the context of a veterinarian-client-patient relationship.
A veterinarian-client-patient relationship cannot be established solely by telephonic or other electronic means.

COMMENTARY TO SECTION 5—This section, which was added in 2003, emphasizes not only that veterinary medicine must be practiced within the context of a veterinarian-client-patient relationship (VCPR), but also emphasizes that because a VCPR requires the veterinarian to examine the patient, it cannot be adequately established by telephonic or other electronic means (ie, via telemedicine) alone. However, once established, a VCPR may be able to be maintained between medically necessary examinations via telephone or other types of consultations.

Veterinarian-Client-Patient Relationship (VCPR) FAQ

 

The following FAQs provide simplified explanations and answers about the VCPR as it relates to the veterinary care of pets. These FAQs do not address the VCPR in animal shelter or large animal contexts. For a complete definition of the VCPR, read the VCPR section of the Principles of Veterinary Medical Ethics.

 

Q: What is a Veterinarian-Client-Patient Relationship (VCPR)?

A: A Veterinarian-Client-Patient Relationship, or VCPR for short, exists when your veterinarian knows your pet well enough to be able to diagnose and treat any medical conditions your animal develops. Your part of the VCPR is allowing your veterinarian to take responsibility for making clinical judgments about your pet's health, asking questions to make sure you understand, and following your veterinarian's instructions. Your veterinarian's part of the VCPR involves making those judgments; accepting the responsibility for providing your pet with medical care; keeping a written record of your pet's medical care; advising you about the benefits and risks of different treatment options; providing oversight of treatment, compliance (your follow-through on their recommendations) and outcome; and helping you know how to get emergency care for your pet if the need should arise.

Q: How is a VCPR established and maintained?

A: A VCPR is established only when your veterinarian examines your animal in person, and is maintained by regular veterinary visits as needed to monitor your animal's health. If a VCPR is established but your veterinarian does not regularly see your pet afterward, the VCPR is no longer valid and it would be illegal and unethical for your veterinarian to dispense or prescribe medications or recommend treatment without recently examining your pet.
A valid VCPR cannot be established online, via email, or over the phone. However, once a VCPR is established, it may be able to be maintained between medically necessary examinations via telephone or other types of consultations; but it’s up to your veterinarian’s discretion to determine if this is appropriate and in the best interests of your animals’ health. 

Q: Why is a VCPR so important?

A: For one, it's required by law in many states – in order for a veterinarian to diagnose or treat your animal, or prescribe or dispense medications, a VCPR must be in effect according to the state's Veterinary Practice Act (if you have questions about your state's Practice Act, contact your state veterinary medical board). Two, it's the best thing for your animal's health. Your veterinarian should be familiar with your animal's medical history and keep a written record of your animal's health so they can provide your animal with the best possible care. The AVMA's Principles of Veterinary Medical Ethics also requires a VCPR for a veterinarian to prescribe medication or otherwise treat an animal.

Q: How can a VCPR be ended?

A: You, as the client, can terminate a VCPR at any time by notifying the veterinarian. If your veterinarian chooses to end the VCPR, they should notify you and, if your animal has an ongoing illness, provide medical care until you have transitioned to another veterinarian.

Q: What does my veterinarian offer that an online source can't match?

A: Your veterinarian knows you and knows your animal(s), and this is critical to keeping your animal(s) healthy. For example, your veterinarian can customize a vaccination program to give your animal the best protection from disease and make sure that it isn't getting a vaccine it doesn't need. Vaccine and drug reactions, although uncommon, can occur, and your veterinarian is trained to recognize and treat them to minimize the chance that the reaction will become severe or even life-threatening – you can't get that from a website!

Figuring out what's wrong with an animal is like solving a very complex puzzle – your veterinarian has to figure out how to fit all of the clues (pieces of the puzzle) together to solve it. Veterinarians have, on average, 8 or more years of college and in-depth veterinary school training to prepare them for this task. Their training makes it possible for them to thoroughly evaluate, diagnose and treat your animal's problem. Doing these things effectively involves thorough knowledge of your animal's body systems and how they function, as well as a familiarity with how medications and other treatments work and if any treatments interfere with others. Hands-on physical examination is incredibly valuable to your pet and can't be replaced by a phone conversation, web-based conversation, or email description.

This information has been prepared as a service by the American Veterinary Medical Association. Redistribution is acceptable, but the document's original content and format must be maintained, and its source must be prominently identified.

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