Veterinary-Client-Patient Relationship (VCPR)
Just as in the human medical field, a veterinarian must have a valid Veterinary-Client-Patient Relationship (VCPR) established in order to provide medical recommendations and prescribe medications for a patient.
The American Veterinary Medical Association defines the the VCPR as being present when the following conditions are met:
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.
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.
The veterinarian is readily available for follow-up evaluation or has arranged for the following: veterinary emergency coverage, and continuing care and treatment.
The veterinarian provides oversight of treatment, compliance, and outcome.
Patient records are maintained.
According to Section of 54.1-3303 (B) from the Virginia Board of Pharmacy code, a valid VCPR as it pertains to prescribing medications:
“A prescription shall be issued only to persons or animals with whom the practitioner has a bona fide practitioner-patient relationship or veterinarian-client-patient relationship. If a practitioner is providing expedited partner therapy consistent with the recommendations of the Centers for Disease Control and Prevention, then a bona fide practitioner-patient relationship shall not be required.
A bona fide practitioner-patient relationship shall exist if the practitioner has (i) obtained or caused to be obtained a medical or drug history of the patient; (ii) provided information to the patient about the benefits and risks of the drug being prescribed; (iii) performed or caused to be performed an appropriate examination of the patient, either physically or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically; and (iv) initiated additional interventions and follow-up care, if necessary, especially if a prescribed drug may have serious side effects. Except in cases involving a medical emergency, the examination required pursuant to clause (iii) shall be performed by the practitioner prescribing the controlled substance, a practitioner who practices in the same group as the practitioner prescribing the controlled substance, or a consulting practitioner.”
A “timely” examination will depend on various factors, including the signalment (age, breed, sex) of the patient, underlying conditions, and what medications are involved. For example, for a young and healthy patient on routine heartworm and flea/tick preventative medication, “timely” is typically an exam every 12 months; however, for a middle-aged patient with underlying kidney disease that’s on chronic blood pressure medication, this may be six months or even less. Ultimately it is at the discretion of the medical professional to determine what the appropriately timely interval is, though in no case would this be more than 12 months as this is the minimum interval needed to have “sufficient knowledge” of the patient and their condition.