The Washington State Veterinary Board of Governors (Board) is tasked with protecting the health, safety, and welfare of the public and their animals by regulating the competency and quality of veterinary healthcare providers and facilities.  The Board has adopted rules relating to topics such as the establishment of veterinarian-client-patient relationships, telehealth, emergency services, and prescription drugs.

Veterinarian-Client-Patient Relationship.
A veterinarian-client-patient relationship is the basis for interaction between veterinarians and their clients and patients, and it exists when the veterinarian:

• has assumed responsibility for clinical judgment regarding the animal's health, and the client has agreed to follow the instructions of the veterinarian;
• has sufficient knowledge of the animal to initiate, at a minimum, a general or preliminary diagnosis of the animal's medical condition; and
• is readily available for follow-up evaluation or has arranged for emergency coverage and continuing care.

To establish sufficient knowledge of an animal, such that a veterinarian-client-patient relationship exists, a veterinarian must have physically examined the animal within the last year, unless circumstances exist where telehealth is permitted.  To establish sufficient knowledge in cases involving several animals, such as at farms, the veterinarian must be personally acquainted with the keeping and care of the animals.

A veterinarian-client-patient relationship may be terminated under specified conditions. 

Telehealth.
Once a veterinarian-client-patient relationship has been established, ongoing care may be provided via telemedicine if certain conditions are met.  If such a relationship has not been established, allowable telehealth services are limited to:

• teleadvice;
• teletriage in an emergency situation;
• telemedicine for the purpose of prescribing sedation in certain circumstances;
• dispensing drugs prescribed by another veterinarian in certain circumstances; and
• poison control services.

A veterinarian providing care through telehealth must meet specific requirements.  In addition to other requirements, a veterinarian providing care under the telehealth exceptions for establishing knowledge of a patient must:

• be licensed in Washington;
• to the extent practicable, have an association with practices that are registered in Washington;
• notify the client that prescription drugs or medications may be available at a pharmacy;
• provide the client with the veterinarian's identity and clinic address; and
• encourage the owner of the animal to schedule an in-person examination if there are concerns about the animal's health that cannot be addressed through telehealth.

  A veterinarian who practices through telehealth must also:

• obtain client consent;
• certify a certain number of days per year of practice in a clinic setting with hands-on experience, unless an exception applies;
• comply with applicable privacy protection laws;
• have historical knowledge of the animal patient;
• employ sound professional judgment to determine whether using telehealth is appropriate;
• be familiar with available medical resources, be able to provide the client with a list of nearby veterinarians, and maintain patient records;
• provide the client with certain licensing information;
• secure an alternative means of contacting the client; and
• not claim to be a specialist unless certified as such.

A veterinarian may deny telehealth treatment if the veterinarian believes that a physical examination is necessary.

Animals Used in Commercial Operations.

For animals or animal products used in commercial operations, the following requirements apply:

• there must be a written agreement between the client and a veterinarian of record who is accountable for drug use and treatments administered on the commercial operation;
• the veterinarian of record is responsible for providing oversight of drug use on the commercial operation;
•  the provision of drugs or prescriptions must be for appropriate time frames and specific management groups; and
• a veterinarian issuing a veterinary feed directive must comply with applicable federal laws.

Prescriptions.

A veterinarian may use or prescribe drugs only within the context of a veterinarian-client-patient relationship, subject to exceptions.  Certain limitations apply to prescriptions provided through telehealth.

Definitions.

Definitions are established for "animal patient," "client," "commercial operation," "livestock," "teleadvice," and "telehealth."