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1. Pet Owner Information: Details of the pet owner including full name, address, contact information, and alternative contact methods
2. Pet Information: Comprehensive details about the pet including name, species, breed, age, sex, microchip number, and distinguishing features
3. Veterinary History: Current veterinarian details, relevant medical history, existing conditions, and current medications
4. Emergency Contacts: Names and contact information for authorized persons who can make decisions in owner's absence
5. Authorization Scope: Specific medical treatments and procedures authorized, including financial limits and decision-making parameters
6. Financial Responsibility: Agreement to pay for authorized treatments and payment method details
7. Liability and Indemnification: Provisions regarding liability limitations and indemnification of the veterinary facility
8. Duration and Validity: Period for which the authorization is valid and conditions for renewal or termination
9. Execution: Signature section for pet owner and witness, including date and declaration of understanding
1. Insurance Information: Details of pet insurance coverage and claim procedures, included when pet has insurance coverage
2. Special Care Instructions: Specific care requirements or preferences, included for pets with special needs or owner preferences
3. End of Life Decisions: Instructions for euthanasia decisions, included when owner wants to specify these preferences
4. International Travel: Additional authorizations for pets who may require care while traveling internationally
5. Breeding Restrictions: Specific instructions regarding breeding-related medical decisions, included for breeding animals
1. Schedule A - Current Medications: Detailed list of current medications, dosages, and administration instructions
2. Schedule B - Medical History: Comprehensive medical history including vaccinations, previous surgeries, and chronic conditions
3. Schedule C - Cost Authorization Limits: Specific financial limits and requirements for different types of procedures
4. Schedule D - Authorized Procedures: Detailed list of pre-authorized procedures and treatments
5. Appendix 1 - Emergency Facility List: List of approved emergency veterinary facilities and their contact information
Veterinary Services
Pet Care
Animal Healthcare
Emergency Medical Services
Professional Services
Insurance
Legal Services
Legal
Veterinary Operations
Client Services
Emergency Care
Administration
Risk Management
Compliance
Customer Relations
Veterinarian
Veterinary Practice Manager
Pet Insurance Agent
Legal Counsel
Veterinary Nurse
Emergency Care Coordinator
Animal Welfare Officer
Practice Administrator
Client Relations Manager
Risk Management Officer
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