Compassion Pet Hospice
This informed consent is for the hospice treatment of the animal listed here and for the support of the named caregivers. This caregiver(s) represents that she/he is the legal owner of said animal and is authorized to make all treatment and end-of-life decisions pertaining to the animal. The owner accepts sole responsibility for the payment of veterinary costs and expenses relating to treatment, care, and services. Pursuant to the terms set forth below, and as may be added from time to time with the express consent of the owner(s), Compassion Pet Hospice and all associated staff are authorized to provide veterinary care, treatment, and end-of-life services as described in this registration process. Compassion Pet Hospice is not responsible for damages or legal issues brought forth from contracted, independent pet care providers.
The owner has been informed of the cancellation policy, and has been advised of zoonotic disease risk (refer to the Zoonotic Diseases section below), understands these risks, and by agreeing to the nature of this appointment, has hereby agreed to assume these risks. The Compassion Pet Hospice staff is not held responsible for any injuries to the owner/caregiver, animal being treated, and other household pets resulting from the owner's rendering of medical care and treatment to the animal receiving care.
Whether treatment includes dispensation of controlled substances, all medications will be dispensed in strict accordance with the veterinarian 's instructions. The Compassion Pet Hospice staff must be consulted before disposing of any medications, especially those indicated as controlled substances. All sharps (needles, blades, etc) should be placed in hard plastic (non-puncture) containers and turned in to Compassion Pet Hospice.
Owner acknowledges that because the care of the animal will be rendered at home, the Compassion Pet Hospice staff will be limited in our ability to observe all symptoms, progress, and reactions to treatments and disease progression. The owner understands that a prompt update on the animal's condition helps to minimize suffering and a rapid decline of health. The owner does not hold Compassion Pet Hospice responsible for any injuries arising from or relating to said treatments, including damage to private property. If necessary, Compassion Pet Hospice staff members are authorized to provide home care for said animal in the absence of the owner/caregiver.
In the event that an euthanasia procedure is to be performed, I certify that I am the legal owner or an authorized agent of the companion animal described above and give Compassion Pet Hospice and any authorized agents, staff, or representatives full and complete authority to euthanize and dispose of my companion animal in an humane manner. I forever release and hold harmless Compassion Pet Hospice and any authorized agents, staff, or representatives from any and all liability for euthanasia and disposal of my companion animal.
Dogs, Cats and Ferrets: To the best of my knowledge, the dog, cat or ferret described above has not bitten, scratched and/or potentially exposed any person or other animal to rabies in the past ten (10) days. Other Species: To the best of my knowledge, the animal described above has not bitten, scratched and/or potentially exposed any person or other animal to rabies in the past thirty (30) days.
I understand that if the animal described above has bitten or otherwise potentially exposed any person within the time specified, a rabies test must be performed.
I understand euthanasia is the act of ending the life of an animal in a painless way to prevent unnecessary suffering. To the best of my knowledge, the information I have provided is accurate and complete. I understand my wishes may be carried out immediately upon me giving consent to this article. Fees for these services have been explained to me, and I assume full responsibility for all charges applicable to such services. I have carefully read and fully understand the foregoing provisions.
In the event that a palliative/hospice care treatment is to be pursued, I certify that I am the legal owner or an authorized agent of the companion animal described above and give Compassion Pet Hospice and any authorized agents, staff, or representatives full and complete authority to examine, prescribe for and/or treat the above described companion animal. I agree Compassion Pet Hospice, and any authorized agents, staff, or representatives shall not be liable for any direct, indirect, or consequential damages resulting from such hospice care.
I understand palliative/hospice care is focused on preserving quality of life for as long as possible and is not focused on curing medical conditions or providing routine veterinary care, surgical care and/or emergency treatment/transport. Compassion Pet Hospice has informed me if additional diagnostics, procedures and/or more aggressive hospice care are recommended for my companion animal at this time. I have either declined additional diagnostics, procedures and/or more aggressive hospice care, or accepted the recommendations, and Compassion Pet Hospice has made necessary referrals.
I assume full responsibility for the actions of the companion animal described above and all charges incurred during his/her palliative/hospice care. I also understand all professional fees are due at the time palliative/hospice care rendered. I have carefully read and fully understand the above provisions.
If you must change or cancel your appointment, we kindly ask that you give us at least a 24-hour advance notice. For all in-home visits, there is a $50 fee for change or cancellation made within 24 hours of the appointment time, $100 fee within 2 hours of the appointment time, and $150 fee when Dr. Ma is already driving to your house or no one answering the door at the appointment time (Dr. Ma will wait up to 15 minutes at the door).
Please understand that this fee system is necessary as short-notice changes and cancellations adversely affect our ability to help other pets and families in need.
What are zoonotic diseases?
Zoonotic diseases are diseases that can be spread between animals and people. They can be caused by pathogens (disease-causing organisms) such as viruses, bacteria, parasites, and fungi. Examples include rabies, Salmonella, ringworm, Plague, and West Nile Virus, just to name a few.
How are they spread?
Zoonotic disease can be spread in a number of ways. Some methods of transmission include:
How can I reduce the risk to my family and myself?
Sometimes animals carrying a zoonotic disease appear perfectly healthy. It is important to practice these habits with all animals, even if they do not appear sick.
Who is most at risk of contracting a zoonotic disease?
Children are at higher risk of infection because they are less likely to thoroughly wash their hands immediately after handling animals: they might not have fully developed immune function . Young children, pregnant women, older people, and all people with certain health conditions such as asthma, heart disease, or weakened immune system should be extra careful when interacting with animals.
Can I pass disease to my animal?
Reverse zoonoses can occur when a person spreads a disease to an animal. In hospice care, an immune-compromised pet may be more susceptible to pathogens that you spread. Examples include methicillin-resistant Staphylococcus aureus (MRSA), ringworm, and some strains of the flu . Preventative measures you take can help limit the spread of pathogens to your own pet.
Is zoonotic disease transmission more common during end-of-life?
Transmission can happen anytime your pet is infected with a pathogen. During the end of life, your pet's immune system may be weaker and make them more susceptible to infections. They may therefore carry more pathogen infections at the end-of-life making transmission to loved ones more common. Following the recommended prevention habits will help minimize the spread of infection. Staying infection-free should help your pet thrive longer and help maintain the human-animal bond.
Taken from the American Veterinary Medical Association 's brochure on Preventing Zoonotic Disease, www.avma.org
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