Guide - Establishing, Maintaining and Discontinuing a VCPR

A VCPR may only be established by a veterinarian. The task of establishing a VCPR cannot be delegated.  

A veterinarian is required to establish a VCPR prior to providing veterinary services (including the prescribing, dispensing, or administering of drugs) for any animal(s) or group of animals.  

There are rare and specific circumstances where a VCPR is not required before providing veterinary services, such as in emergency situations. For more information, please refer to Sections 18 and 33 of Regulation 1093.  

A veterinarian is under no obligation to establish a VCPR. A veterinarian is expected to practice within their sphere of knowledge and competency and use their professional judgment to determine if they wish to establish a VCPR.  

A veterinarian may establish a VCPR with the owner(s) of the animal(s) or group of animals, an authorized agent of the owner(s) or an individual who the veterinarian reasonably determines is acting in the best interest of the animal(s) or group of animals. 

Veterinarians must document the client’s name and contact information in the medical record, and should include the names and contact information for all owners and authorized agents of the owner(s) that have decision-making authority when the VCPR is established. 

If the ownership of an animal(s) or group of animals is unclear or where there is a dispute over ownership, please refer to the Policy Statement: Managing Questions of Ownership and Ownership Disputes of Companion Animals for further information. 

A VCPR is established through an intentional conversation between a veterinarian and a client. A VCPR can be established in-person or via telemedicine by using electronic means. The conversation to establish a VCPR must contain all of the following components: 

• The veterinarian has been retained by the client; 
• The veterinarian and client have reached an agreement on the scope of services to be provided by the veterinarian; and 
• The veterinarian has advised the client that services will only be provided in accordance with the standards of practice of the profession. 

Veterinarians are encouraged to consider establishing a VCPR in writing in circumstances where there is increased complexity to ensure both parties understand the scope of services to be provided. They may do this by providing a document for the client to review and keep. 

A veterinarian must discuss and reach an agreement with a client as to the scope of services to be provided by the veterinarian. The scope of services can vary depending on particular circumstances and can be very narrow or very broad in their inclusion of types of assessment and treatment over any period of time. 

Examples of details that should be shared during a scope of services discussion include:  

• The range of services to be provided; 
• The way in which the services are to be provided; and 
• The duration for which the services are to be provided.  

If a veterinarian is concerned that a client may not be understanding the scope of services that they are offering, they are encouraged to provide a written copy to review and keep. 

A veterinarian is responsible for providing reasonably prompt services outside of their regular business hours if the services are medically necessary for an animal(s) or group of animals they have treated recently or they treat regularly2. A veterinarian is not permitted to set a scope of services that does not uphold this requirement. 

Where a veterinarian provides a limited scope of services, their obligation for after-hours care services may pertain directly to the services that they have provided.  

For more information related to the provision of after-hours care services, please refer to Policy Statement: After-Hours Care Services.  

Given the interconnected nature of the VCPR, it is reasonable for the veterinarian to request that the client contribute to maintaining the relationship. The duties of the client should be clearly outlined during establishment of the VCPR. Potential duties may include: 

• Intervals for examinations; 
• Client conduct and accepted behaviour; and 
• Terms of discontinuation for non-payment. 

When discussing the client’s duties, the veterinarian should ensure that the client understands their duties and answers any questions that may arise. At no time can a veterinarian assign duties to a client that are a veterinarian’s responsibility.  

If a veterinarian is concerned that a client may not understand the duties that are being applied, it is the veterinarian’s responsibility to ensure clarity. In circumstances of increased complexity, veterinarians are encouraged to provide clients with a written copy of the duties to review and keep. 

If a client has an existing VCPR with another veterinarian licensed in Ontario, a veterinarian is expected to inform the client that they may only provide treatment after they:  

1. notify the other veterinarian that is providing care to the animal(s) or group of animals that they will be providing care and obtaining relevant historical information from said veterinarian as soon as possible; and  

2. advise the client that treating an animal(s) or group of animals that is receiving care from another veterinarian who did not provide a referral that such uncoordinated services may place the animal(s) or group of animals at risk. 

A VCPR is formed between a veterinarian and a client for a specific animal(s) or group of animals. Unless otherwise agreed to at the establishment of the VCPR, a veterinarian is not obligated to provide veterinary services to any other animal(s) or group of animals owned by the client.  

A VCPR can only be established through an intentional conversation between a veterinarian and a client. Given this, the booking of an initial appointment by a member of a veterinarian's team does not constitute the establishment of a VCPR.  

Individuals may be under the assumption that the booking of an appointment means that a VCPR has been established. To avoid confusion, veterinarians are encouraged to direct their teams to inform all individuals that part of their first visit will be a discussion with a veterinarian about the possibility of establishing a VCPR. 

Scenario One: 
A veterinarian works at a facility that provides general medical and surgical services for food producing animals, specifically for dairy cows.  The veterinarian explains to clients that they provide preventive healthcare services, general medical and surgical services, and services outside of regular hours of operation when there is an urgent medical need for all animals in the herd.  A veterinarian explains that the VCPR has no pre-determined endpoint and either the veterinarian or the client can end the VCPR if they feel the relationship is not able to continue. 

Scenario Two:  
A veterinarian working at a companion animal hospital explains to clients that they provide general medical, diagnostic, dental and surgical services; preventative health care; nutrition and behaviour consultations; non-conventional therapies such as laser therapy. Referrals to specialists and/or other veterinary clinics are made pending the expertise required for a given circumstance. The veterinarian also explains how after-hours care services will be provided. The VCPR will continue until such time as the veterinarian, or the client decide that it should be discontinued 

Scenario Three: 
An individual calls a companion animal hospital concerned that their dog has an ear infection. The veterinarian discusses with the individual that the clinic can establish a VCPR limited to providing treatment related to the ear infection only.  The VCPR will be discontinued once the ear infection has resolved, and the patient is no longer on medication if any is prescribed. Provision of after-hours care would be related to the ear infection only. If any new health concerns occur during this treatment time, the veterinarian will need to decide if they wish to establish a new VCPR to offer a new scope of services.  

Scenario Four: 
A veterinarian works at a facility that is restricted to performing equine spinal manipulative therapy. The veterinarian explains to clients the scope of services to be provided within the VCPR. This includes that the provision of after-hours care services is limited to care related only to the treatment provided by that veterinarian.  The veterinarian also explains that the VCPR is discontinued once the agreed upon treatment plan (one treatment or a series of treatments) has been completed.   

Scenario Five: 
When establishing a VCPR with a client, a veterinarian describes the scope of services that are to be provided by both the veterinarian and the veterinary facility as well as what is expected of the client to maintain the VCPR. The veterinarian clearly explains and provides in writing that any form of verbal abuse or threatening behaviour toward the staff of the clinic and non-payment of fees will result in the VCPR being discontinued. 

Once a VCPR has been established it can be maintained by either the veterinarian who established the VCPR or by any other veterinarian who works at or from the same accredited facility where the VCPR was established. When the VCPR is established, the client should be informed that other veterinarians at the facility may provide services within the VCPR. 

When a VCPR is established by a veterinarian at a multi-practitioner accredited facility the VCPR remains with the veterinarian(s) at that accredited facility. If the veterinarian who established the VCPR leaves the accredited facility the VCPR does not “travel” with them.  

If the client wishes to have the original veterinarian continue to treat their animal(s) or group of animals, a new VCPR will need to be established at the veterinarian’s new accredited facility.  

If the client wishes to continue to receive veterinary care for their animal(s) or group of animals at the original accredited facility, a new VCPR is not required.  

Scope of services and informed client consent are two distinct and separate concepts. A veterinarian is required to obtain informed client consent for each specific service or group of services to be provided in accordance with the Professional Practice Standard: Informed Client Consent.  

A VCPR ends when the scope of services agreed upon between the veterinarian and the client are completed, ownership of the animal(s) or group of animals has changed, or upon the death of the animal(s) or group of animals.  

A VCPR can also end through the process of discontinuation, despite attempts to address conceerns. This occurs in situations where the veterinarian and/or the client determine that they would no longer like to maintain the VCPR. There are a number of reasons why a veterinarian may choose to discontinue a VCPR. These include:  

• Persistent non-adherence to recommended treatment plans;  
• Differences in philosophy as to the approach taken to diagnose and treat the animal(s) or group of animals;  
• Verbal abuse or threatening behaviour of a client towards the veterinarian and/or staff;  
• Unreasonable demands for unnecessary medications and services, requesting illegal or unethical actions; or  
• For non-payment of fees owed for services rendered. 

A veterinarian may also choose to discontinue a VCPR if a client fails to uphold their duties for maintaining the VCPR that were agreed to when the VCPR was established.  

A veterinarian is not required to provide a client with notice in these circumstances. However, should a veterinarian wish to ensure that a client understands that the VCPR has ended, they may provide notice to the client.  

A veterinarian is required to provide the client with adequate notice when they choose to discontinue the VCPR, allowing the client a reasonable amount of time to arrange care with another veterinarian and to ensure the appropriate transfer of medical information in accordance with the Professional Practice Standard: Medical Records.  

When notice is given, it should specify:  

• A date after which services will no longer be provided; 
• Indication that until that date, emergency services will be provided to the animal(s) or group of animal(s); and 
• Information about the transfer of medical records. 

A veterinarian is not required to provide written notice to the client when discontinuing a VCPR. In many cases, verbal notice is sufficient. It should, however, also be documented in the medical record.  

While not required, veterinarians are encouraged to provide written notice in circumstances of increased emotion or potential conflict in order to ensure clarity and understanding.  

When written notice is given, it should specify:  

• A date after which services will no longer be provided; 
• Indication that until that date, emergency services will be provided to the animal(s) or group of animal(s); and 
• Information about the transfer of medical records.  

A sample discontinuation letter is provided in Appendix A of the PDF version to illustrate how written notice may be provided. 

How much time is reasonable for a client to arrange care with another veterinarian will vary with the circumstances (e.g. reasons for the discontinuation, available alternatives, or whether assistance is provided in locating other services), and may be dependent upon the location of the veterinary facility. In rural or remote areas, the time required to obtain a new practitioner would likely be longer than in an urban area. Where the reason for discontinuation is abusive behaviour towards a veterinarian or staff, or where genuine safety concerns exist, the reasonable opportunity might be brief.

A veterinarian is not obligated to arrange alternate veterinary care for a client when they discontinue a VCPR. A veterinarian is only obligated to continue to provide care for a reasonable amount of time in which the client can arrange care with another veterinarian. A client’s inability or unwillingness to seek other veterinary care does not affect this requirement.  

A veterinarian may adopt a clinic policy that outlines the circumstances in which a VCPR will be discontinued. These policies may speak to a variety of different circumstances including the length of time since the animal(s) or group of animal(s) was last seen, non-compliance with prescribed treatments, or non-payment of fees. If a veterinarian chooses to implement this form of clinic policy, they are encouraged to provide a written copy of the policy to their clients for them to review and keep. 

Regardless of whether the circumstances are outlined in a clinic policy, a veterinarian is required to provide the client with adequate notice of the discontinuation of the VCPR, allowing the client a reasonable amount of time in which to arrange care with another veterinarian including the appropriate transfer of medical information in accordance with the Professional Practice Standard: Medical Records. 

The veterinarian does not need to provide additional notice when initial notice comes from the client, but the veterinarian is encouraged to provide written confirmation of the client’s decision to discontinue the VCPR particularly in situations where there may be increased emotion or potential conflict.  

A veterinarian should note in the medical record that the client has discontinued the VCPR and if written confirmation was provided. 

Whether it is the veterinarian or the client who discontinues the VCPR, a veterinarian is required to provide care for a reasonable amount of time in which the client can arrange care with another veterinarian and have medical records appropriately transferred3. How much time is reasonable will vary with the circumstances and may be dependent upon a variety of factors including the reason for the discontinuation and the immediate medical needs of the animal(s) or group of animals. A veterinarian is expected to use their professional judgement when determining the allotted time. 

A veterinarian is encouraged to document all aspects of the VCPR within the medical record. This includes the scope of services to be provided, any agreed-upon client duties, as well as any steps related to the discontinuation of the VCPR. If they provide written notice to the client of the discontinuation of the VCPR, a copy should be maintained in the medical record. 

A request for the transfer of medical records does not automatically indicate the discontinuation of a VCPR. The request for the transfer of medical records is tied to continuity of care for the animal(s) or group of animals. If the veterinarian wishes to discontinue the VCPR when transferring records, they are required to take the appropriate steps to notify the client of the discontinuation. 

As part of the intentional conversation that a veterinarian has with a client to establish a VCPR, a veterinarian may use a written document that is reviewed with and provided to the client. A copy of the document should be included in the medical record. While not necessary, written documents can be useful in circumstances where there is increased complexity to ensure both parties understand the scope of services to be provided.