© TANUVAS, 2011 Veterinary medical records

Veterinary medical records Introduction  Veterinary medical records meant to provide necessary information to all person involved in an animal’s care  which demonstrate and document adequate medical care  Veterinary medical care records should be consistent with professional standards

© TANUVAS, 2011 Components of medical records The record contain following type of information  Identification of animals  Clinical information such as result of physical examination, behavior of the animal  Immunization and other prophylactic treatment

© TANUVAS, 2011  Documentation of diagnostic test and interpretation  Reference to the research intervention where appropriate  Surgery anesthesia and analgesia and pre/post operative care  Control pf pain and distress  Documentation of euthanasia and necropsy findings

© TANUVAS, 2011 Types of medical records Individual health records  should be maintained for animals that received regular individual evaluation  Clinical records maintained on individual animals are used to document routine preventive care ( physical examination., vaccination, dental prophylaxis)

© TANUVAS, 2011 Group health records  It maybe appropriate for animals that are members of a larger cohort (flock, herd)  Animals that undergo periodic evaluation by means of examination of several representative individuals of the group

© TANUVAS, 2011 Records of sedation and anesthesia  Animal or group identification and date of procedure  All drugs administrated including dose route time  Description of surgical procedure and identification of surgeon  Any variation from normal and expected events during anesthetic and recovery periods

© TANUVAS, 2011 Experimentally induced diseased/research records  This record have several components such as animal identification information  Date and time of procedure performed  Adverse or unexpected complication and date of euthanasia

© TANUVAS, 2011 Breeding records  Pedigree of the animals identification genotype, sire and dam  Identification animals breeding history and productivity of the animals

© TANUVAS, 2011 Retention of veterinary medical records  Most maintain there veterinary medical records beyond the legally required a duration  One legal authority states that veterinarians should maintain medical records for at least ten years

© TANUVAS, 2011 Conclusion  Medical records used to management of clinical disease and diagnostic therapeutic procedure  Also used research, teaching and testing of adequate veterinary care  Maintain should be determined by the institution and professional judgment of attending veterinarian

© TANUVAS, 2011 Thank you students!