1. ANIMAL NURSING PRACTICE ADMISSION, DISCHARGE AND MEDICAL RECORDS

2. RECEPTION DUTIES INCLUDE BOOKING APPOINTMENTS For consults For surgeries For house calls Admission best in a separate room so client can discuss detail with admitting staff

3. CLINIC ADMISSION POLICY SHOULD BE CLEAR Who admits patients if vet not available When the pre-op check takes place Owner visits to see where animals will be hospitalised Check contact details and up to date status of the animal and record

4. REMEMBER Record all possessions the animal is admitted with Suitable restraint when moving animals around to kennels/cattery Ask owner to leave the animal rather than try to drag the animal away from the owner Get consent forms signed and ensure owners understand them (18+years) Ensure estimate of costs given and recorded and if problems prearranged payment plan

5. PROTOCOLS FOR ANIMALS ADMITTED Identification system and inpatient records Appropriate enclosure for species

6. DISCHARGE Before the animal is presented Clean animal Discuss case with the owner Collect the fee Book revisit Return belongings Dispense meds and explain their use After the animal is presented Demonstrate any ongoing care required Check the owner is confident to cope Encourage the owner to contact the clinic if concerned

7. ROLE PLAY You are the receptionist on duty in a busy multi-vet practice, and a client is ringing to book an appointment to get their cat its annual vaccination. Ensure you gather up to date contact details and check who their usual vet is. The reason for the visit and give an estimate of the usual cost. Give clear instructions for the restraint of the cat as it is brought into the clinic You are the nurse on duty first thing in the morning and the vet does not arrive till later. The client has brought their pup in for a spay operation later that morning. It is your job to admit the animal, its possessions, update any records required, get the surgical consents signed carry out practice policy about the owner in the kennels and get the animal settled in the hospital

8. MEDICAL RECORDS

9. individualised record of all the medical interactions and information the clinic has on an animal They provide continuity of care Reference of past medical history relevant to current problems Information for financial management Legal evidence in court

10. MEDICAL RECORD IS COMPOSED OF… Client and animal details Hx PE Dx Prognosis Authorisations Lab and radiography reports Sx and anaesthesia records Tx and hospital records May or may not include financial records

11. WHO OWNS THE MEDICAL RECORD? A client is moving to another town and asks for his medical record so he can take it to the next vet. The vet is on a lunch break, is he legally entitled to the file? What do you do?

12. PURGING OLD FILES 3 years after the last visit clients can be filed as inactive Old records can be destroyed after 7years Shred or burn

13. COMPUTERISED RECORDS Most practices use database software the staff must be able to use

14. HANDWRITTEN MATERIAL Legible Indelible Accurate Corrections dated and signed original still legible

15. THE MEDICAL RECORD IS CONFIDENTIAL May not discuss medical records with outside party without clients written permission Except if court requests