"Veterinary Care Plan" - New York

Veterinary Care Plan is a legal document that was released by the New York State Department of Agriculture and Markets - a government authority operating within New York.

Form Details:

  • Released on March 1, 2020;
  • The latest edition currently provided by the New York State Department of Agriculture and Markets;
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Download "Veterinary Care Plan" - New York

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Revised 03/2020
New York State Department of Agriculture and Markets
Division of Animal Industry
10B Airline Dr.
Albany, NY 12235
VETERINARY CARE PLAN
A PROGRAM OF VETERINARY CARE HAS BEEN ESTABLISHED BETWEEN:
LICENSEE/REGISTRANT
VETERINARIAN
1. NAME:
1. NAME:
2. BUSINESS NAME:
2. CLINIC NAME:
3. BUSINES ADDRESS:
3. BUSINESS ADDRESS
5. CITY, STATE, AND ZIP CODE:
5. CITY, STATE, AND ZIP CODE:
6. TELEPHONE NUMBER (Home):
TELEPHONE NUMBER (Business):
6. TELEPHONE NUMBER (Business):
According to Ar cle 26‐A §401.5; Licensed pet dealers “shall designate an a ending veterinarian who shall provide
veterinary care to the dealer’s animals which shall include a wri en program of veterinary care and regular visits to
Veterinary visits to the pet dealer’s premises must occur at least once a year
the pet dealer's premises”.
.
The signing of this form means that you have reviewed the program of veterinary care and understand your respon‐
sibili es. The business address of the licensee is the address that will be visited per this plan. If the informa on con‐
tained within this plan is altered by either party, the plan must reflect the change within two weeks.
This sheet must remain a ached to the current plan at all mes, completed in its en rety and signed by both par‐
es to be valid.
SIGNATURE OF LICENSEE/REGISTRANT:
LICENSE #
DATE:
SIGNATURE OF VETERINARIAN:
LICENSE #
DATE:
EMERGENCY CARE – DETAIL PROVISIONS FOR EMERGENCY, OR WHEN FACILITY IS CLOSED FOR EXTENDED PERIODS
Revised 03/2020
New York State Department of Agriculture and Markets
Division of Animal Industry
10B Airline Dr.
Albany, NY 12235
VETERINARY CARE PLAN
A PROGRAM OF VETERINARY CARE HAS BEEN ESTABLISHED BETWEEN:
LICENSEE/REGISTRANT
VETERINARIAN
1. NAME:
1. NAME:
2. BUSINESS NAME:
2. CLINIC NAME:
3. BUSINES ADDRESS:
3. BUSINESS ADDRESS
5. CITY, STATE, AND ZIP CODE:
5. CITY, STATE, AND ZIP CODE:
6. TELEPHONE NUMBER (Home):
TELEPHONE NUMBER (Business):
6. TELEPHONE NUMBER (Business):
According to Ar cle 26‐A §401.5; Licensed pet dealers “shall designate an a ending veterinarian who shall provide
veterinary care to the dealer’s animals which shall include a wri en program of veterinary care and regular visits to
Veterinary visits to the pet dealer’s premises must occur at least once a year
the pet dealer's premises”.
.
The signing of this form means that you have reviewed the program of veterinary care and understand your respon‐
sibili es. The business address of the licensee is the address that will be visited per this plan. If the informa on con‐
tained within this plan is altered by either party, the plan must reflect the change within two weeks.
This sheet must remain a ached to the current plan at all mes, completed in its en rety and signed by both par‐
es to be valid.
SIGNATURE OF LICENSEE/REGISTRANT:
LICENSE #
DATE:
SIGNATURE OF VETERINARIAN:
LICENSE #
DATE:
EMERGENCY CARE – DETAIL PROVISIONS FOR EMERGENCY, OR WHEN FACILITY IS CLOSED FOR EXTENDED PERIODS
 VACCINATIONS
– TYPE & FREQUENCY (AGES) OF VACCINE ADMINISTRATION FOR THE FOLLOWING:
CANINE
FELINE
1st Dose
Booster
1st Dose
Booster
DISTEMPER
RHINOTRACHEITIS
ADENOVIRUS
CALICI
PARVO
PANLEUKOPENIA
PARAINFLUENZA
RABIES (Req’d btwn 12w-4m)
RABIES (Req’d btwn 12w-4m)
LEUKEMIA (FELV)
LEPTOSPIROSIS
BORDATELLA
 PARASITE CONTROL
– FREQUENCY OF SAMPLING OR TREATMENT FOR THE FOLLOWING:
ECTOPARASITES (Fleas, Ticks, Mites, Lice, Flies):
INTESTINAL PARASITES (Roundworm, Whipworm, Tapeworm, Hookworm, Coccidia, Giardia, Fecals & Deworming):
SKIN CONDITIONS (Ringworm):
BLOOD PARASITES (Heartworm, Babesia, Ehrlichia, Other):
 SICK/INJURED CARE & MEDICATIONS
— ANY TREATMENTS PERFORMED ON SITE (MEDICATION &
DOSAGES), EXTENT OF TREATMENT BEFORE CLINIC VISIT IS MADE:
RESPIRATORY (Coughing, Sneezing, Soiled Nose or Eyes)
INTESTINAL (Vomiting, Diarrhea, Anorectic)
ABNORMALITIES (Limping, Limb Favoring, Failure to Thrive)

OBSERVATION
— DESCRIBE SCHEDULES OF DAILY MONITORING. Indicate all areas where animals are
housed.
1)
2)
3)
 EXERCISE PROTOCOL
– DETAIL FREQUENCY, LOCATION AND FORM OF RECORDING:
ANIMAL OR GROUP of ANIMALS
EXERCISE TIME ALLOTED
AREA TO BE USED—(Cage or outdoor)
IDENTIFY HOW EXERCISE ACTIVITY IS BEING RECORDED:
RECORDED ANNUAL VISITS -
DESIGNATED VETERINARIAN (REQUIRED FOR INSPECTION)
ANNUAL DATE VISTED
VETERINARIAN’S SIGNATURE
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