Title of Regulation: 18VAC150-20. Regulations Governing the Practice of Veterinary Medicine (amending 18VAC150-20-10, 18VAC150-20-30 through 18VAC150-20-140, 18VAC150-20-172 through 18VAC150-20-220; adding 18VAC150-20-201).

Statutory Authority: § 54.1-2400 of the Code of Virginia.

Public Hearing Information:

February 8, 2017 - 9 a.m. - Department of Health Professions, Perimeter Center, 9960 Mayland Drive, 2nd Floor Conference Center, Board Room 1, Henrico, VA 23233

Public Comment Deadline: February 24, 2017.

Agency Contact: Leslie L. Knachel, Executive Director, Board of Veterinary Medicine, 9960 Mayland Drive, Suite 300, Richmond, VA 23233, telephone (804) 367-4468, FAX (804) 527-4471, or email leslie.knachel@dhp.virginia.gov.

Basis: Section 54.1-2400 of the Code of Virginia establishes the general powers and duties of health regulatory boards, including the Board of Veterinary Medicine, and includes the responsibility to promulgate regulations.

The specific authority of the board relating to practical training for students of veterinary medicine is found in § 54.1-3804 of the Code of Virginia.

Purpose: Issues relating to informed consent, practice by preceptees and the accountability of supervising veterinarians, drug security, responsibilities of a veterinarian-in-charge, and standards for veterinary establishments have been addressed during the periodic review and in the proposed amendments in this action. Concerns about patient health and safety in veterinary care and about the lack of security for prescription drugs were the major foci of the review. The goal of the planned action is to update and clarify rules in such a manner to address the concerns expressed by members of the public and the issues identified by the department inspectors and board members through the inspection and the disciplinary process.

Substance: Proposed amendments include:

18VAC150-10. Definitions are added, deleted, or modified to update terminology used in regulation.

18VAC150-70. Requirements for licensure renewal are amended to clarify that falsification of compliance with continuing education requirements may subject the licensee to disciplinary action.

18VAC150-110. Requirements for licensure by examination are reorganized; there are no new requirements proposed.

18VAC150-115: Specifying the examination acceptable to the board and clarifying the board's authority to deny licensure for acts that constitute unprofessional conduct.

18VAC150-120: Requirements for licensure by endorsement for a veterinarian are amended to eliminate the need for an applicant to meet all the requirements for licensure by examination, so the endorsement process will be less onerous. Provisions for attestation of reading the laws and regulations and having committed no acts that would constitute unprofessional conduct are added for consistency with licensure by examination and for public safety. Other amendments are clarifying.

18VAC150-121. Requirements for licensure by endorsement for veterinary technicians are amended similarly to provisions for veterinarians.

18VAC150-130. Requirements for practical training in a preceptorship or externship are amended to (i) specify that the supervising veterinarian must be in the operatory when a preceptee is performing or assisting in surgery; (ii) that a veterinarian must disclose to owners when there is a preceptee working in the establishment; and (iii) that the supervising veterinarian remains responsible for the care and treatment of the patient.

18VAC150-140. Regulations stating causes for unprofessional conduct are amended for clarification of certain provisions and to add a cause for action in the failure to submit evidence of correction resulting from a violation noted in an inspection within 14 days unless an extension has been granted.

18VAC150-172. The delegation of duties to an unlicensed assistant is amended to specify that an assistant cannot be delegated the induction of sedation or anesthesia, and to restrict monitoring of a sedated patient, unless a licensee remains on premises. Other amendments clarify current provisions.

18VAC150-173. The text ", preceptee, or extern" is added.

18VAC150-180. Regulations for veterinary establishments are amended to change the categories from full service or restricted service to stationery or ambulatory to be more descriptive and consistent with current practice.

18VAC150-181. Requirements for the veterinarian-in-charge (VIC) of an establishment are amended to clarify that the VIC must be regularly on-site as often as necessary to provide oversight for patient safety and compliance with law and regulation. A new subsection is proposed to incorporate current language about patient records upon sale or closure of a practice (in 18VAC150-20-195) and to add a notification to the board about the location of records and disposition of scheduled drugs.

18VAC150-185. The requirements for renewal of an establishment permit are amended to clarify that practicing on an expired permit may subject the permit holder or licensee to disciplinary action.

18VAC150-190: Requirements for drug storage, dispensing, destruction, and records are amended to incorporate recommendations for strengthening the security and integrity of prescription drugs. Amendments are proposed for veterinary establishments consistent with other types of establishments in which prescription drugs are stored and dispensed. Those amendments include (i) clarification that only the veterinarian or licensed veterinary technician has access to Schedule II through V drugs; (ii) specification about the storage in a securely locked cabinet or safe that is not easily movable; (iii) provision to allow Schedule II through V drugs that are in direct possession of licensed personnel and necessary for use during business hours to be maintained outside of a locked container; (iv) provision that all general and working stock and prescriptions dispensed but not delivered are securely stored after business hours; (v) allowance for prescriptions that have been dispensed to be maintained in a place not accessible to the public and deliverable to an owner by an unlicensed person; (vi) more specificity about the process to follow when a loss or theft of drugs occurs; (vii) more specificity about refrigerated drugs and their security; (viii) requirements for inventories and maintenance of records, including drug invoices; and (ix) provisions for records of drug distribution if a limited or ambulatory practice uses the facilities of another veterinary establishment.

18VAC150-195. Amendments to the recordkeeping requirements incorporate provisions related to records that are currently found in other sections and a more specific requirement for the content of the record.

18VAC150-20-200. The current terminology for "full-service" establishments is changed to "stationary" establishments to distinguish them from those that are mobile. Requirements are reorganized for ease of understanding and compliance, and the specific listing of laboratory services is eliminated. A subsection is added with requirements to ensure that patients receive appropriate care at establishments that are open to the public 24 hours a day; a disclosure is required if an establishment is not open 24 hours a day and the establishment does not have continuous staffing. All stationary establishments must provide continuity of care when transferring a patient to another facility.

18VAC150-20-201. The current terminology for "large animal" and "small animal" establishments is changed to "ambulatory" in the categories of "agricultural or equine" and "house call or proceduralist." Requirements for such establishments are consistent with current requirements and with the services provided.

18VAC-150-220: Requirements for continuing education for equine dental technicians are amended for consistency with other regulants of the board in the conditions for granting exemptions or exceptions and the timeframe for provision of continuing education documentation.

The board may propose other amendments as a result of public comment or in the review of its draft language resulting from the periodic review of regulations.

Issues: The primary advantages to the public are more security for drug stocks and more specificity about patient records. There are no disadvantages to the public. There are no advantages and disadvantages to the agency or the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. As a result of a periodic review of this regulation,¹ the Board of Veterinary Medicine (the Board) proposes to 1) make licensure by endorsement less burdensome, 2) strengthen the security and integrity of prescription drugs, and 3) clarify a number of existing practices and requirements.

Result of Analysis. The benefits likely exceed the costs for all proposed changes.

Estimated Economic Impact. One of the proposed changes will make licensure by endorsement less burdensome for both veterinarians and technicians. Currently, transcripts and national exam scores must be submitted for licensure by endorsement. The Board proposes to eliminate the requirement to submit those documents. The Board contends that the consistency of licensure requirements among all states makes it virtually certain that the applicant has met those qualifications. Additionally, the minimal competency is assured by the requirement that the license is unrestricted, that the applicant has been in active practice, and that he or she has completed hours of continuing education. In addition, provisions for attestation of reading the laws and regulations and having committed no acts that would constitute unprofessional conduct are proposed for consistency with licensure by examination and for public safety.

The Board also proposes requirements to strengthen the security and integrity of prescription drugs. The proposed amendments include adding specificity about the storage in a securely locked cabinet or safe that is not easily movable, a provision to allow working stock of drugs during business hours to be maintained outside of a locked container, a provision that all general and working stock and prescriptions dispensed but not delivered are securely stored after business hours, an allowance for prescriptions that have been dispensed to be maintained in a place not accessible to the public and deliverable to an owner by an unlicensed person, more specificity about the process to follow if there is a loss or theft of drugs; more specificity about refrigerated drugs and their security, new requirements for inventories and maintenance of records, including drug invoices; and provisions for records of drug distribution if a limited or ambulatory practice uses the facilities of another veterinary establishment. While some of these requirements are more restrictive and some may introduce small administrative costs, some of the other changes are less restrictive and would benefit veterinary establishments.

The remaining changes include updating the regulation to reflect changes in stationary and ambulatory veterinary establishments, clarifying the delegation of duties; clarifying the responsibilities of the veterinarian in charge, and updating a number of definitions. None of these amendments represent a change in practice and consequently are not expected to create any significant economic effects other than improving the clarity of the regulation.

Businesses and Entities Affected. There are 4,042 veterinarians and 1,930 veterinary technicians currently licensed and 22 equine dental technicians registered in Virginia. There are 329 veterinary establishments with restricted licenses and 770 establishments with full licenses.

Localities Particularly Affected. The proposed changes apply statewide.

Projected Impact on Employment. No impact on employment is expected.

Effects on the Use and Value of Private Property. No impact on the use and value of private property is expected.

Real Estate Development Costs. No impact on real estate development costs is expected.

Small Businesses:

Definition. Pursuant to § 2.2-4007.04 of the Code of Virginia, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

Costs and Other Effects. Almost all of the veterinary establishments would be considered small businesses. The effects on affected small businesses are the same as discussed above.

Alternative Method that Minimizes Adverse Impact. No adverse impact on small businesses is expected.

Adverse Impacts:

Businesses. The proposed amendments do not have an adverse impact on non-small businesses.

Localities. The proposed amendments will not adversely affect localities.

Other Entities. The proposed amendments will not adversely affect other entities.

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¹ http://townhall.virginia.gov/L/ViewPReview.cfm?PRid=1372.

Agency's Response to Economic Impact Analysis: The Board of Veterinary Medicine concurs with the analysis of the Department of Planning and Budget.

Summary:

As a result of a periodic review, the proposed amendments (i) organize requirements for greater clarity, (ii) update the descriptions and requirements for veterinary establishments consistent with current practices, (iii) specify rules in accordance with board interpretation for ease of compliance, (iv) adjust requirements for licensure by endorsement, and (v) increase accountability and security for prescription drugs.

Part I
General Provisions

18VAC150-20-10. Definitions.

The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"AAVSB" means the American Association of Veterinary State Boards.

"Animal shelter" means a facility, other than a private residential dwelling and its surrounding grounds, that is used to house or contain animals and that is owned, operated, or maintained by a nongovernmental entity including, but not limited to, a humane society, animal welfare organization, society for the prevention of cruelty to animals, or any other organization operating for the purpose of finding permanent adoptive homes for animals.

"Automatic emergency lighting" is lighting that is powered by battery, generator, or alternate power source other than electrical power, is activated automatically by electrical power failure, and provides sufficient light to complete surgery or to stabilize the animal until surgery can be continued or the animal moved to another establishment.

"AVMA" means the American Veterinary Medical Association.

"Board" means the Virginia Board of Veterinary Medicine.

"Companion animal" means any dog, cat, horse, nonhuman primate, guinea pig, hamster, rabbit not raised for human food or fiber, exotic or native animal, reptile, exotic or native bird, or any feral animal or animal under the care, custody or ownership of a person or any animal that is bought, sold, traded, or bartered by any person. Agricultural animals, game species, or any animals regulated under federal law as research animals shall not be considered companion animals for the purposes of this chapter.

"CVMA" means the Canadian Veterinary Medical Association.

"DEA" means the U.S. Drug Enforcement Administration.

"Full-service establishment" means a stationary or ambulatory facility that provides surgery and encompasses all aspects of health care for small or large animals, or both.

"Immediate and direct supervision" means that the licensed veterinarian is immediately available to the licensed veterinary technician or assistant, either electronically or in person, and provides a specific order based on observation and diagnosis of the patient within the last 36 hours.  

"NBVME" means the National Board of Veterinary Medical Examiners.

"Owner" means any person who (i) has a right of property in an animal; (ii) keeps or harbors an animal; (iii) has an animal in his care; or (iv) acts as a custodian of an animal.

"Pound" means a facility operated by the state or a locality for the purpose of impounding or harboring seized, stray, homeless, abandoned, or unwanted animals; or a facility operated for the same purpose under a contract with a locality or an incorporated society for the prevention of cruelty to animals.

"Preceptee" or "extern" means a student who is enrolled and in good standing in an AVMA accredited college of veterinary medicine or AVMA accredited veterinary technology program and who is receiving practical experience under the supervision of a licensed veterinarian or licensed veterinary technician.

"Preceptorship" or "externship" means a formal arrangement between an AVMA accredited college of veterinary medicine or an AVMA accredited veterinary technology program and a veterinarian who is licensed by the board and responsible for the practice of the preceptee. A preceptorship or externship shall be overseen by faculty of the college or program.

"Private animal shelter" means a facility that is used to house or contain animals and that is owned or operated by an incorporated, nonprofit, and nongovernmental entity, including a humane society, animal welfare organization, society for the prevention of cruelty to animals, or any other organization operating for the purpose of finding permanent adoptive homes for animals.

"Professional judgment" includes any decision or conduct in the practice of veterinary medicine, as defined by § 54.1-3800 of the Code of Virginia.

"Public animal shelter" means a facility operated by the Commonwealth, or any locality, for the purpose of impounding or sheltering seized, stray, homeless, abandoned, unwanted, or surrendered animals, or a facility operated for the same purpose under a contract with any locality.

"Restricted service establishment" means a stationary or ambulatory facility which does not meet the requirements of a full-service establishment.

"Specialist" means a veterinarian who has been awarded and has maintained the status of diplomate of a specialty organization recognized by the American Board of Veterinary Specialties of the American Veterinary Medical Association, or any other organization approved by the board.

"Surgery" means treatment through revision, destruction, incision or other structural alteration of animal tissue. Surgery does not include dental extractions of single-rooted teeth or skin closures performed by a licensed veterinary technician upon a diagnosis and pursuant to direct orders from a veterinarian.

"Veterinarian in charge" means a veterinarian who holds an active license in Virginia and who is responsible for maintaining a veterinary establishment within the standards set by this chapter, for complying with federal and state laws and regulations, and for notifying the board of the establishment's closure.

"Veterinary establishment" means any fixed stationary or mobile ambulatory practice, veterinary hospital, animal hospital, or premises wherein or out of which veterinary medicine is being conducted.

"Veterinary technician" means a person licensed by the board as required by § 54.1-3805 of the Code of Virginia.

18VAC150-20-30. Posting of licenses; accuracy of address.

A. All licenses, and registrations and permits issued by the board shall be posted in a place conspicuous to the public at the establishment where veterinary services are being provided or available for inspection at the location where an equine dental technician is working. Licensees who do relief or temporary work in an establishment shall carry a license with them or post it at the establishment. Ambulatory veterinary practices that do not have an office accessible to the public shall carry their licenses and permits registrations in their vehicles.

B. It shall be the duty and responsibility of each licensee, registrant, and holder of a registration permit to operate a veterinary establishment to keep the board apprised at all times of his current address of record and the public address, if different from the address of record. All notices required by law or by this chapter to be mailed to any veterinarian, veterinary technician, registered equine dental technician, or holder of a permit registration to operate a veterinary establishment, shall be validly given when mailed to the address of record furnished to the board pursuant to this regulation. All address changes shall be furnished to the board within 30 days of such change.

18VAC150-20-70. Licensure renewal requirements.

A. Every person licensed by the board shall, by January 1 of every year, submit to the board a completed renewal application and pay to the board a renewal fee as prescribed in 18VAC150-20-100. Failure to renew shall cause the license to lapse and become invalid, and practice with a lapsed license may subject the licensees licensee to disciplinary action by the board. Failure to receive a renewal notice does not relieve the licensee of his responsibility to renew and maintain a current license.

B. Veterinarians shall be required to have completed a minimum of 15 hours, and veterinary technicians shall be required to have completed a minimum of eight hours, of approved continuing education for each annual renewal of licensure. Continuing education credits or hours may not be transferred or credited to another year.

1. Approved continuing education credit shall be given for courses or programs related to the treatment and care of patients and shall be clinical courses in veterinary medicine or veterinary technology or courses that enhance patient safety, such as medical recordkeeping or compliance with requirements of the Occupational Health and Safety Administration (OSHA).

2. An approved continuing education course or program shall be sponsored by one of the following:

a. The AVMA or its constituent and component/branch associations, specialty organizations, and board certified specialists in good standing within their specialty board;

b. Colleges of veterinary medicine approved by the AVMA Council on Education;

c. International, national, or regional conferences of veterinary medicine;

d. Academies or species-specific interest groups of veterinary medicine;

e. State associations of veterinary technicians;

f. North American Veterinary Technicians Association;

g. Community colleges with an approved program in veterinary technology;

h. State or federal government agencies;

i. American Animal Hospital Association (AAHA) or its constituent and component/branch associations;

j. Journals or veterinary information networks recognized by the board as providing education in veterinary medicine or veterinary technology; or

k. An organization or entity approved by the Registry of Approved Continuing Education of the American Association of Veterinary State Boards AAVSB.

3. A licensee is exempt from completing continuing education requirements and considered in compliance on the first renewal date following his initial licensure by examination.

4. The board may grant an exemption for all or part of the continuing education requirements due to circumstances beyond the control of the licensee, such as temporary disability, mandatory military service, or officially declared disasters.

5. The board may grant an extension for good cause of up to one year for the completion of continuing education requirements upon written request from the licensee prior to the renewal date. Such an extension shall not relieve the licensee of the continuing education requirement.

6. Licensees are required to attest to compliance with continuing education requirements on their annual license renewal and are required to maintain original documents verifying the date and subject of the program or course, the number of continuing education hours or credits, and certification from an approved sponsor. Original documents must be maintained for a period of two years following renewal. The board shall periodically conduct a random audit to determine compliance. Practitioners selected for the audit shall provide all supporting documentation within 10 14 days of receiving notification of the audit unless an extension is granted by the board.

7. Continuing education hours required by disciplinary order shall not be used to satisfy renewal requirements.

8. Falsifying the attestation of compliance with continuing education on a renewal form or failure to comply with continuing education requirements may subject a licensee to disciplinary action by the board, consistent with § 54.1-3807 of the Code of Virginia.

C. A licensee who has requested that his license be placed on inactive status is not authorized to perform acts that are considered the practice of veterinary medicine or veterinary technology and, therefore, shall not be required to have continuing education for annual renewal. To reactivate a license, the licensee is required to submit evidence of completion of continuing education hours as required by § 54.1-3805.2 of the Code of Virginia and this section equal to the number of years in which the license has not been active for a maximum of two years.

18VAC150-20-75. Expired license; reinstatement; practice with an expired or lapsed license not permitted.

A. A license may be renewed up to one year after the expiration date, provided a late fee as prescribed in 18VAC150-20-100 is paid in addition to the required renewal fee. A license shall automatically lapse if the licensee fails to renew by the expiration date. The practice of veterinary medicine without a current, active license is unlawful and may subject the licensee to disciplinary action by the board.

B. Reinstatement of licenses expired for more than one year shall be at the discretion of the board. To reinstate a license, the licensee shall pay the reinstatement fee as prescribed in 18VAC150-20-100 and submit evidence of completion of continuing education hours as required by § 54.1-3805.2 of the Code of Virginia and 18VAC150-20-70 equal to the number of years in which the license has been expired, for a maximum of two years. The board may require additional documentation of clinical competency and professional activities.

18VAC150-20-100. Fees.

The following fees shall be in effect:

Veterinary application for licensure	$200
Veterinary license renewal (active)	$175
Veterinary license renewal (inactive)	$85
Veterinary reinstatement of expired license	$255
Veterinary license late renewal	$60
Veterinarian reinstatement after disciplinary action	$450
Veterinary technician application for licensure	$65
Veterinary technician license renewal	$50
Veterinary technician license renewal (inactive)	$25
Veterinary technician license late renewal	$20
Veterinary technician reinstatement of expired license	$95
Veterinary technician reinstatement after disciplinary action	$125
Equine dental technician initial registration	$100
Equine dental technician registration renewal	$70
Equine dental technician late renewal	$25
Equine dental technician reinstatement	$120
Initial veterinary establishment permit registration	$300
Veterinary establishment renewal	$200
Veterinary establishment late renewal	$75
Veterinary establishment reinstatement	$75
Veterinary establishment reinspection	$300
Veterinary establishment -- change of location	$300
Veterinary establishment -- change of veterinarian-in-charge	$40
Duplicate license	$15
Duplicate wall certificate	$25
Returned check	$35
Licensure verification to another jurisdiction	$25

Part II
Licensure for Veterinarians and Veterinary Technicians

18VAC150-20-110. Requirements for licensure by examination as a veterinarian.

A. The applicant, in order to be licensed by the board to practice veterinary medicine, shall:

1. Have received a degree in veterinary medicine from a college or school of veterinary medicine accredited by the AVMA or have fulfilled the requirements of the Educational Commission of Foreign Veterinary Graduates (ECFVG) of the AVMA or any other substantially equivalent credentialing body as determined by the board., as verified by an official transcript from the applicant's college or school, indicating completion of the veterinary degree; and

2. Have passed the North American Veterinary License Examination (since the fall of 2000) or the National Board Examination and the Clinical Competency Test (prior to the fall of 2000) of the NBVME or any other substantially equivalent national examination as approved by the board with a score acceptable to the board.

3. In lieu of a degree from an accredited college or school, an applicant may submit verification that he has fulfilled the requirements of the Educational Commission of Foreign Veterinary Graduates (ECFVG) of the AVMA or the Program for the Assessment of Veterinary Education Equivalence (PAVE) of the AAVSB or any other substantially equivalent credentialing body as determined by the board.

2. File the following documents with the board: B. All applicants shall also:

a. A 1. Submit the application fee specified in 18VAC150-20-100 and a complete and notarized application on a form obtained from the board;

b. An official copy, indicating veterinary degree, of the applicant's college or school transcript;

c. Certification of a full and unrestricted 2. Provide verification that any license to practice veterinary medicine by each board from which the applicant holds a license. issued by a board of veterinary medicine in another state or United States jurisdiction is in good standing;

3. Pass the North American Veterinary License Examination or the National Board Examination and the Clinical Competency Test approved by the American Association of Veterinary State Boards or any other substantially equivalent national examination as approved by the board with a score acceptable to the board.

4. 3. Sign a statement attesting that the applicant has read, understands, and will abide by the statutes and regulations governing veterinary practice in Virginia.; and

5. 4. Have committed no acts which that would constitute a violation of § 54.1-3807 of the Code of Virginia.

B. C. If the application for licensure has not been successfully completed within one year from the date of initial submission, a new application and fee shall be required.

18VAC150-20-115. Requirements for licensure by examination as a veterinary technician.

A. The applicant, in order to be licensed by the board as a veterinary technician, shall:

1. Have received a degree in veterinary technology from a college or school accredited by the AVMA or the CVMA.

2. Have filed with the board the following documents:

a. A complete and notarized application on a form obtained from the board;

b. An official copy, indicating a veterinary technology degree, of the applicant's college or school transcript; and

c. Certification Verification that the applicant is in good standing by each board in another state or United States jurisdiction from which the applicant holds a license, certification, or registration to practice veterinary technology.

3. Pass a Have passed the Veterinary Technician National Examination approved by the AAVSB or any other board-approved, national board examination for veterinary technology with a score acceptable to the board.

4. Sign a statement attesting that the applicant has read, understands, and will abide by the statutes and regulations governing veterinary practice in Virginia.

5. Have committed no acts that would constitute a violation of § 54.1-3807 of the Code of Virginia.

B. The application for licensure shall be valid for a period of one year after the date of initial submission, after which time a new application and fee shall be required.

18VAC150-20-120. Requirements for licensure by endorsement as a veterinarian.

A. The board may, in its discretion, grant a license by endorsement to an applicant who is licensed to practice veterinary medicine in another state, the District of Columbia, or possessions or territories of the United States, provided that the applicant:

1. All licenses are in good standing. Holds at least one current, unrestricted license in another jurisdiction of the United States and is not a respondent in any pending or unresolved board action in any jurisdiction;

2. The applicant has been Provides documentation of having been regularly engaged in clinical practice for at least two of the past four years immediately preceding application; and

3. The applicant has met all applicable requirements of 18VAC150-20-110, except foreign-trained veterinarians who have attained specialty recognition by a board recognized by the AVMA are exempt from the requirements of ECFVG or any other substantially equivalent credentialing body as determined by the board. Provides documentation of completion of at least 30 hours of continuing education requirements during the preceding four years;

4. Signs a statement attesting that the applicant has read, understands, and will abide by the statutes and regulations governing veterinary practice in Virginia; and

5. Has committed no acts that would constitute a violation of § 54.1-3807 of the Code of Virginia.

B. Provided that the applicant has met the requirements of subsection A of this section, the board may, in its discretion, waive the requirement that the applicant pass the national board exam or the clinical competency test, or both.

18VAC150-20-121. Requirements for licensure by endorsement for veterinary technicians.

In its discretion, the board may grant a license by endorsement to an applicant who is licensed, certified or registered to practice as a veterinary technician in another state, the District of Columbia, or possessions or territories of the United States, provided that the applicant:

1. All licenses, certificates or registrations are in good standing Holds at least one current and unrestricted license, certification, or registration in another jurisdiction of the United States and that he is not a respondent in any pending or unresolved board action in any jurisdiction;

2. The applicant has been Provides documentation of having been regularly engaged in clinical practice as a licensed, certified, or registered veterinary technician for at least two of the past four years immediately preceding application; and

3. The applicant has Has received a degree in veterinary technology from a college or school accredited by the AVMA or the CVMA or has passed a the Veterinary Technician National Examination approved by the AAVSB or any other board-approved national board examination for veterinary technology with a score acceptable to the board.;

4. Provides documentation of completion of at least 12 hours of continuing education requirements during the preceding four years;

5. Signs a statement attesting that the applicant has read, understands, and will abide by the statutes and regulations governing veterinary practice in Virginia; and

6. Has committed no acts that would constitute a violation of § 54.1-3807 of the Code of Virginia.

18VAC150-20-130. Requirements for practical training in a preceptorship or externship.

A. The practical training and employment of qualified students of veterinary medicine or veterinary technology shall be governed and controlled as follows:

1. A veterinary student who is duly enrolled and in good standing in a veterinary college or school accredited or approved by the AVMA may be engaged in a preceptorship or externship. A veterinary preceptee or extern may perform duties that constitute the practice of veterinary medicine for which he has received adequate instruction by the college or school and only under the on-premises supervision of a licensed veterinarian.

2. A veterinary technician student who is duly enrolled and in good standing in a veterinary technology program accredited or approved by the AVMA may be engaged in a preceptorship or externship. A veterinary technician preceptee or extern may perform duties that constitute the practice of veterinary technology for which he has received adequate instruction by the program and only under the on-premises supervision of a licensed veterinarian or licensed veterinary technician.

B. Whenever a veterinary preceptee or extern is performing surgery on a patient, either assisted or unassisted, the supervising veterinarian shall be in the operatory during the procedure. Prior to allowing a preceptee or extern in veterinary medicine to perform surgery on a patient unassisted by a licensed veterinarian, a licensed veterinarian shall receive written approval from the owner.

C. When there is a preceptee or extern practicing in the establishment, the supervising veterinarian shall disclose such practice to owners.  The disclosure shall be by signage clearly visible to the public or by inclusion on an informed consent form. 

D. A veterinarian or veterinary technician who supervises a preceptee or extern remains responsible for the care and treatment of the patient.

18VAC150-20-135. Voluntary practice by out-of-state practitioners.

Any veterinarian who seeks registration to practice on a voluntary basis under the auspices of a publicly supported all volunteer, nonprofit organization that sponsors the provision of health care to populations of underserved people shall:

1. File a complete application for registration on a form provided by the board at least five business days prior to engaging in such practice. An incomplete application will not be considered;

2. Provide a complete record of professional licensure in each state in which he has held a license and a copy of every current license;

3. Provide the name of the nonprofit organization, the dates and location of the voluntary provision of services;

4. Pay a registration fee of $10; and

5. Provide a notarized statement from a representative of the nonprofit organization attesting to its compliance with provisions of subdivision 4 of § 54.1-3801 of the Code of Virginia.

Part III
Unprofessional Conduct

18VAC150-20-140. Unprofessional conduct.

Unprofessional conduct as referenced in subdivision 5 of § 54.1-3807 of the Code of Virginia shall include the following:

1. Representing conflicting interests except by express consent of all concerned given after a full disclosure of the facts. Acceptance of a fee from both the buyer and the seller is prima facie evidence of a conflict of interest.

2. Practicing veterinary medicine or equine dentistry where an unlicensed person has the authority to control the professional judgment of the licensed veterinarian or the equine dental technician.

3. Issuing a certificate of health unless he shall know of his own knowledge by actual inspection and appropriate tests of the animals that the animals meet the requirements for the issuance of such certificate on the day issued.

4. Revealing confidences gained in the course of providing veterinary services to a client, unless required by law or necessary to protect the health, safety, or welfare of other persons or animals.

5. Advertising in a manner which that is false, deceptive, or misleading or which that makes subjective claims of superiority.

6. Violating any state law, federal law, or board regulation pertaining to the practice of veterinary medicine, veterinary technology or equine dentistry.

7. Practicing veterinary medicine or as an equine dental technician in such a manner as to endanger the health and welfare of his patients or the public, or being unable to practice veterinary medicine or as an equine dental technician with reasonable skill and safety.

8. Performing surgery on animals in an unregistered veterinary establishment or not in accordance with the establishment permit registration or with accepted standards of practice.

9. Refusing the board or its agent the right to inspect an establishment at reasonable hours.

10. Allowing unlicensed persons to perform acts restricted to the practice of veterinary medicine, veterinary technology, or an equine dental technician including any invasive procedure on a patient or delegation of tasks to persons who are not properly trained or authorized to perform such tasks.

11. Failing to provide immediate and direct supervision to a licensed veterinary technician or an assistant in his employ.

12. Refusing to release a copy of a valid prescription upon request from a client an owner, unless there are medical reasons documented in the patient record and the veterinarian would not dispense the medication from his own practice.

13. Misrepresenting or falsifying information on an application or renewal form.

14. Failing to report suspected animal cruelty to the appropriate authorities.

15. Failing to release a copy of patient records when requested by the owner; a law-enforcement entity; or a federal, state, or local health regulatory agency.

16. Committing an act constituting fraud, deceit, or misrepresentation in dealing with the board or in the veterinarian-client-patient veterinarian-owner-patient relationship, or with the public.

17. Representing oneself as a "specialist" without meeting the definition set forth in 18VAC150-20-10 or using the words "specialist" or "specialty" in the name of a veterinary establishment unless there is a veterinarian on staff who meets the definition of a "specialist."

18. Failure to submit evidence of correction resulting from a violation noted in an inspection or reported by another agency within 14 days, unless an extension is granted by the board.

18VAC150-20-172. Delegation of duties.

A. A licensed veterinarian may delegate the administration (including by injection) of Schedule VI drugs to a properly trained assistant under his immediate and direct supervision. The prescribing veterinarian has a specific duty and responsibility to determine that the assistant has had adequate training to safely administer the drug in a manner prescribed.

B. Injections involving anesthetic or chemotherapy drugs, subgingival scaling, or the placement of intravenous catheters shall not be delegated to an assistant. An assistant shall also not be delegated the induction of sedation or anesthesia by any means. The monitoring of a sedated or anesthetized patient may be delegated to an assistant, provided the patient is no longer intubated and provided a veterinarian or licensed veterinary technician remains on premises until the patient is fully recovered.

B. Additional C. The following tasks that may be delegated by a licensed veterinarian to a properly trained assistant include but are not limited to the following:

1. Grooming;

2. Feeding;

3. Cleaning;

4. Restraining;

5. Assisting in radiology;

6. Setting up diagnostic tests;

7. Prepping for surgery Clipping and scrubbing in preparation for surgery;

8. Dental polishing and scaling of teeth above the gum line (supragingival);

9. Drawing blood samples; or

10. Filling of Schedule VI prescriptions under the direction of a veterinarian licensed in Virginia.

C. D. A licensed veterinarian may delegate duties electronically, verbally, or in writing to appropriate veterinary personnel provided the veterinarian has physically examined the patient within the previous 36 hours.

D. E. Massage therapy or, physical therapy, or laser therapy may be delegated by a veterinarian to persons qualified by training and experience by an order from the veterinarian.

E. F. The veterinarian remains responsible for the duties being delegated and remains responsible for the health and safety of the animal.

18VAC150-20-173. Informed consent for surgery.

A. Before surgery is performed, informed consent shall be obtained from the owner and documented in the patient record. Veterinarians shall inform an owner of the risks, benefits, and alternatives of the recommended surgery that a reasonably prudent practitioner in similar practice in Virginia would tell an owner.

B. An exception to the requirement for consent prior to performance of surgery may be made in an emergency situation when a delay in obtaining consent would likely result in imminent harm to the patient. 

C. If a veterinary student, preceptee, or extern is to perform the surgery, the informed consent shall include that information.

Part V
Veterinary Establishments

18VAC150-20-180. Requirements to be registered as a veterinary establishment.

A. Every veterinary establishment shall apply for registration on a form provided by the board and may be issued a permit registration as a full-service or restricted service stationary or ambulatory establishment. Every veterinary establishment shall have a veterinarian-in-charge registered with the board in order to operate.

1. Veterinary medicine may only be practiced out of a registered establishment except in emergency situations or in limited specialized practices as provided in 18VAC150-20-171. The injection of a microchip for identification purposes shall only be performed in a veterinary establishment, except personnel of public or private animal shelters or pounds may inject animals while in their possession.

2. Applications for permits registration must be made to the board 45 days in advance of opening or changing the location of the establishment or requesting a change in the establishment category to a full-service establishment listed on the registration.

3. Any addition or renovation of a stationary establishment or an ambulatory establishment that involves changes to the structure or composition of a surgery room shall require reinspection by the board and payment of the required fee prior to use.

B. A veterinary establishment will be registered by the board when:

1. It is inspected by the board and is found to meet the standards set forth by 18VAC150-20-190 and 18VAC150-20-200 or 18VAC150-20-201 where applicable. If, during a new or routine inspection, violations or deficiencies are found necessitating a reinspection, the prescribed reinspection fee will be levied. Failure to pay the fee shall be deemed unprofessional conduct and, until paid, the establishment shall be deemed to be unregistered.

2. A veterinarian currently licensed by and in good standing with the board is registered with the board in writing as veterinarian-in-charge and has paid ensures that the establishment registration fee has been paid.

18VAC150-20-181. Requirements for veterinarian-in-charge.

A. The veterinarian-in-charge of a veterinary establishment is responsible for:

1. Regularly being on site on a schedule of no less than monthly and providing as necessary to provide routine oversight to the veterinary establishment for patient safety and compliance with law and regulation.

2. Maintaining the facility within the standards set forth by this chapter.

3. Performing the biennial controlled substance inventory and ensuring compliance at the facility with any federal or state law relating to controlled substances as defined in § 54.1-3404 of the Code of Virginia. The performance of the biennial inventory may be delegated to another licensee, provided the veterinarian-in-charge signs the inventory and remains responsible for its content and accuracy.

4. Notifying the board in writing of the closure of the permitted registered facility 10 days prior to closure.

5. Notifying the board immediately if no longer acting as the veterinarian-in-charge.

6. Ensuring the establishment maintains a current and valid permit registration issued by the board.

B. Upon any change in veterinarian-in-charge, these procedures shall be followed:

1. The veterinarian-in-charge registered with the board remains responsible for the establishment and the stock of controlled substances until a new veterinarian-in-charge is registered or for five days, whichever occurs sooner.

2. An application for a new permit registration, naming the new veterinarian-in-charge, shall be made five days prior to the change of the veterinarian-in-charge. If no prior notice was given by the previous veterinarian-in-charge, an application for a new permit registration naming a new veterinarian-in-charge shall be filed as soon as possible, but no more than 10 days, after the change.

3. The previous establishment permit registration is void on the date of the change of veterinarian-in-charge and shall be returned by the former veterinarian-in-charge to the board five days following the date of change.

4. Prior to the opening of the business, on the date of the change of veterinarian-in-charge, the new veterinarian-in-charge shall take a complete inventory of all Schedule II-V II through V drugs on hand. He shall date and sign the inventory and maintain it on premises for two three years. That inventory may be designated as the official biennial controlled substance inventory.

C. Prior to the sale or closure of a veterinary establishment involving the transfer of patient records to another location, the veterinarian-in-charge shall:

1. Follow the requirements for transfer of patient records in accordance with § 54.1-2405 of the Code of Virginia; and

2. Provide to the board information about the location of patient records and the disposition of all scheduled drugs.

18VAC150-20-185. Renewal of veterinary establishment permits registrations.

A. Every veterinary establishment shall be required to renew the registration permit by January 1 of each year and pay to the board a registration fee as prescribed in 18VAC150-20-100.

B. Failure to renew the establishment permit registration by January 1 of each year shall cause the permit registration to expire and become invalid. Practicing veterinary medicine in an establishment with an expired registration may subject a licensee or registration holder to disciplinary action by the board. The permit registration may be reinstated without reinspection within 30 days of expiration, provided the board receives a properly executed renewal application, renewal fee, and a late fee as prescribed in 18VAC150-20-100.

C. Reinstatement of an expired permit registration after 30 days shall be at the discretion of the board and contingent upon a reinspection and payment of the late fee, the reinspection fee, the renewal fee and the veterinary establishment permit registration reinstatement fee.

18VAC150-20-190. Requirements for drug storage, dispensing, destruction, and records for all establishments, full service and restricted.

A. All drugs shall be maintained, administered, dispensed, prescribed and destroyed in compliance with state and federal laws, which include § 54.1-3303 of the Code of Virginia, the Drug Control Act (§ 54.1-3400 et seq. of the Code of Virginia), applicable parts of the federal Food, Drug, and Cosmetic Control Act (21 USC § 301 et seq.), the Prescription Drug Marketing Act (21 USC § 301 et seq.), and the Controlled Substances Act (21 USC § 801 et seq.), as well as applicable portions of Title 21 of the Code of Federal Regulations.

B. All repackaged tablets and capsules dispensed for companion animals shall be in approved safety closure containers, except safety caps shall not be required when any person who requests that the medication not have a safety cap, or in such cases in which the medication is of such form or size that it cannot be reasonably dispensed in such containers (e.g., topical medications, ophthalmic, or otic). A client An owner request for nonsafety packaging shall be documented in the patient record.

C. All drugs dispensed for companion animals shall be labeled with the following:

1. Name and address of the facility;

2. Name First and last name of client owner;

3. Animal identification and species;

4. Date dispensed;

5. Directions for use;

6. Name, strength (if more than one dosage form exists), and quantity of the drug; and

7. Name of the prescribing veterinarian.

D. All drugs shall be maintained veterinary establishments shall maintain drugs in a secured secure manner with precaution taken to prevent theft or diversion. Only the veterinarian or licensed veterinary technician shall have access to Schedule II through V drugs.

1. All Schedule II through V drugs shall be maintained under lock at all times, with access to the veterinarian or veterinary technician only, but not to any unlicensed personnel In a stationary establishment, the general stock of Schedule II through V drugs shall be stored in a securely locked cabinet or safe that is not easily movable.

2. The establishment may also have a working stock of Schedule II through V drugs that shall be kept in (i) a securely locked container, cabinet, or safe when not in use or (ii) direct possession of a veterinarian or veterinary technician. A working stock shall consist of only those drugs that are necessary for use during a normal business day or 24 hours, whichever is less.

3. Whenever the establishment is closed, all general and working stock of Schedule II through V drugs and any dispensed prescriptions that were not delivered during normal business hours shall be securely stored as required for the general stock.

4. Prescriptions that have been dispensed and prepared for delivery shall be maintained under lock or in an area that is not readily accessible to the public and may be delivered to an owner by an unlicensed person, as designated by the veterinarian.

2. 5. Whenever a veterinarian discovers a theft or any unusual loss of Schedule II, III, IV, or through V drugs is discovered, he the veterinarian-in-charge, or in his absence, his designee, shall immediately report such theft or loss to the Board of Veterinary Medicine and the Board of Pharmacy and to the U.S. Drug Enforcement Administration DEA. The report to the boards shall be in writing and sent electronically or by regular mail. The report to the DEA shall be in accordance with 21 CFR 1301.76(b). If the veterinarian-in-charge is unable to determine the exact kind and quantity of the drug loss, he shall immediately take a complete inventory of all Schedule II through V drugs.

E. Schedule II, III, IV and through V drugs shall be destroyed by (i) transferring the drugs to another entity authorized to possess or provide for proper disposal of such drugs or (ii) destroying the drugs by burning in an incinerator that is in compliance with applicable local, state, and federal laws and regulations. If Schedule II through V drugs are to be destroyed, a DEA drug destruction form shall be fully completed and used as the record of all drugs to be destroyed. A copy of the destruction form shall be retained at the veterinarian practice site with other inventory records.

F. The drug storage area shall have appropriate provision for temperature control for all drugs and biologics, including. If drugs requiring refrigeration are maintained at the facility, they shall be kept in a refrigerator with the interior thermometer maintained between 36°F and 46°F. If a refrigerated drug is in Schedule II through V, the drug shall be kept in a locked container secured to the refrigerator, or the refrigerator shall be locked. Drugs stored at room temperature shall be maintained between 59°F and 86°F.

G. The stock of drugs shall be reviewed frequently, and expired drugs shall be removed from the working stock of drugs at the expiration date and shall not be administered or dispensed.

G. H. A distribution record shall be maintained in addition to the patient's record, in chronological order, for the administration and dispensing of all Schedule II-V II through V drugs.

This record is to be maintained for a period of two three years from the date of transaction. This record shall include the following:

1. Date of transaction;

2. Drug name, strength, and the amount dispensed, administered, and wasted;

3. Client Owner and animal identification; and

4. Identification of the veterinarian authorizing the administration or dispensing of the drug.

H. I. Original invoices for all Schedule II, III, IV and through V drugs received shall be maintained in chronological order on the premises where the stock of drugs is held, and the actual date of receipt is shall be noted. Invoices for Schedule II drugs shall be maintained separately from other records. All drug records shall be maintained for a period of two three years from the date of transaction.

I. J. A complete and accurate inventory of all Schedule II, III, IV and through V drugs shall be taken, dated, and signed on any date that is within two years of the previous biennial inventory. Drug strength must be specified. This inventory shall indicate if it was made at the opening or closing of business and shall be maintained on the premises where the drugs are held for two three years from the date of taking the inventory.

K. Inventories and records, including original invoices, of Schedule II drugs shall be maintained separately from all other records, and the establishment shall maintain a continuous inventory of all Schedule II drugs received, administered, or dispensed, with reconciliation at least monthly. Reconciliation requires an explanation noted on the inventory for any difference between the actual physical count and the theoretical count indicated by the distribution record. A continuous inventory shall accurately indicate the physical count of each Schedule II drug in the general and working stocks at the time of performing the inventory. 

J. L. Veterinary establishments in which bulk reconstitution of injectable, bulk compounding, or the prepackaging of drugs is performed shall maintain adequate control records for a period of one year or until the expiration, whichever is greater. The records shall show the name of the drug(s) drugs used; strength, if any; date repackaged; quantity prepared; initials of the veterinarian verifying the process; the assigned lot or control number; the manufacturer's or distributor's name and lot or control number; and an expiration date.

M. If a limited stationary or ambulatory practice uses the facilities of another veterinary establishment, the drug distribution log shall clearly reveal whose Schedule II through V drugs were used. If the establishment's drug stock is used, the distribution record shall show that the procedure was performed by a visiting veterinarian who has the patient record. If the visiting veterinarian uses his own stock of drugs, he shall make entries in his own distribution record and in the patient record and shall leave a copy of the patient record at the other establishment.

18VAC150-20-195. Recordkeeping.

A. A legible, daily record of each patient treated shall be maintained by the veterinarian at the permitted veterinary establishment and shall include pertinent medical data such as drugs administered, dispensed or prescribed, and all relevant medical and surgical procedures performed. Records should contain at a minimum:

1. Name of the patient and the owner;

2. Identification of the treating veterinarian and of the person making the entry (Initials may be used if a master list that identifies the initials is maintained.);

1. 3. Presenting complaint/reason for contact;

4. Date of contact;

2. 5. Physical examination findings, if appropriate;

3. 6. Tests and diagnostics performed and results;

4. 7. Procedures performed/treatment given and results; and

5. 8. Drugs (and their dosages) administered, dispensed, or prescribed, including quantity, strength and dosage, and route of administration. For vaccines, identification of the lot and manufacturer shall be maintained;

9. Radiographs or digital images clearly labeled with identification of the establishment, the patient name, date taken, and anatomic specificity. If an original radiograph or digital image is transferred to another establishment or released to the owner, a record of this transfer or release shall be maintained on or with the patient's records; and

10. Any specific instructions for discharge or referrals to other practitioners.

B. Individual records An individual record shall be maintained on each patient, except that records for economic animals or litters of companion animals under the age of four months may be maintained on a per client owner basis. Client Patient records, including radiographs or digital images, shall be kept for a period of three years following the last office visit or discharge of such animal from a veterinary establishment.

C. An animal identification system must be used by the establishment.

D. Upon the sale or closure of a veterinary establishment involving the transfer of patient records to another location, the veterinarian shall follow the requirements for transfer of patient records in accordance with § 54.1-2405 of the Code of Virginia.

E. C. An initial rabies certification for an animal receiving a primary rabies vaccination shall clearly display the following information: "An animal is not considered immunized for at least 28 days after the initial or primary vaccination is administered."

18VAC150-20-200. Standards for stationary veterinary establishments. 

A. Full-service Stationary establishments. A full-service stationary establishment shall provide surgery and encompass all aspects of health care for small or large animals, or both. All full-service stationary establishments shall meet the requirements set forth below in this subsection:

1. Buildings and grounds must be maintained to provide sanitary facilities for the care and medical well-being of patients.

a. Temperature, ventilation, and lighting must be consistent with the medical well-being of the patients.

b. Water and waste. There shall be on-premises:

(1) Hot and cold running water of drinking quality, as defined by the Virginia Department of Health;

(2) An acceptable method of disposal of deceased animals, in accordance with any local ordinance or state and federal regulations; and

(3) Refrigeration exclusively for carcasses of companion animals that require storage for 24 hours or more.

c. Sanitary toilet and lavatory shall be available for personnel and clients owners.

2. Areas within building. The areas within the facility shall include the following:

a. A reception area separate from other designated rooms;

b. Examination room or rooms containing a table or tables with nonporous surfaces;

c. Surgery room. There shall be a A room which that is reserved only for surgery and used for no other purpose. The walls of the surgery room must be constructed of nonporous material and extend from the floor to the ceiling. In order that surgery can be performed in a manner compatible with current veterinary medical practice with regard to anesthesia, asepsis, life support, and monitoring procedures, the surgery room shall:

(1) Have walls constructed of nonporous material and extending from the floor to the ceiling;

(2) Be of a size adequate to accommodate a surgical table, anesthesia support equipment, surgical supplies, the veterinarian, an assistant, and the patient and all personnel necessary for safe performance of the surgery;

(2) (3) Be kept so that storage in the surgery room shall be limited to items and equipment normally related to surgery and surgical procedures;

(4) Have a surgical table made of nonporous material;

(5) Have surgical supplies, instruments, and equipment commensurate with the kind of services provided;

(6) Have surgical and automatic emergency lighting to facilitate performance of procedures; and

(3) (7) For small animal facilities establishments that perform surgery on small animals, have a door to close off the surgery room from other areas of the practice.

d. Laboratory. 3. The veterinary establishment shall have, as at a minimum, proof of use of either in-house laboratory service or outside laboratory services for performing the following lab tests, consistent with appropriate professional care for the species being treated:.

(1) Urinalysis, including microscopic examination of sediment;

(2) Complete blood count, including differential;

(3) Flotation test for ova of internal parasites;

(4) Skin scrapings for diagnosing external parasites;

(5) Blood chemistries;

(6) Cultures and sensitivities;

(7) Biopsy;

(8) Complete necropses, including histopathology; and

(9) Serology.

e. Animal housing areas. These shall be provided with 4. For housing animals, the establishment shall provide:

a. An animal identification system at all times when housing an animal;

b. Accommodations of appropriate size and construction to prevent residual contamination or injury;

(1) Separate compartments constructed in such a way as to prevent residual contamination;

(2) c. Accommodations allowing for the effective separation of contagious and noncontagious patients; and

(3) d. Exercise runs which areas that provide and allow effective separation of animals or walking the animals at medically appropriate intervals.

3. Radiology. 5. A veterinary establishment shall: a. Either either have radiology service in-house or documentation of outside services for obtaining diagnostic-quality radiographs. b. If radiology is in-house:

(1) Each radiograph shall be permanently imprinted with the identity of the facility or veterinarian, patient and the date of exposure. Each radiograph shall also be clearly labeled by permanent imprinting to reflect anatomic specificity.

(2) Document, the establishment shall:

a. Document that radiographic equipment complies with Part VI (12VAC5-481-1580 (12VAC5-481-1581 et seq.), Use of Diagnostic X-Rays in the Healing Arts, of the Virginia Radiation Protection Regulations of the Virginia Department of Health, which requirements are adopted by this board and incorporated herewith by reference in this chapter.

c. Maintain radiographs as a part of the patient's record. If a radiograph is transferred to another establishment or released to the client, a record of this transfer must be maintained on or with the patient's records.

b. Maintain and utilize lead aprons and gloves and individual radiation exposure badges for each employee exposed to radiographs.

4. Equipment; minimum requirements. 6. Minimum equipment in the establishment shall include:

a. Examination room containing a table with nonporous surface.

b. Surgery suite.

(1) Surgical table with nonporous surface;

(2) Surgical supplies, instruments and equipment commensurate with the kind of surgical services provided;

(3) Automatic emergency lighting;

(4) Surgical lighting;

(5) Instrument table, stand, or tray; and

(6) Waste receptacle.

c. Radiology (if in-house).

(1) Lead aprons and gloves;

(2) Radiation exposure badges; and

(3) X-ray machine.

d. General equipment.

(1) Steam pressure sterilizer or an a. An appropriate method of sterilizing instruments;

(2) b. Internal and external sterilization monitors, if steam pressure sterilizers are used;

(3) c. Stethoscope;

(4) Thermometer;

(5) d. Equipment for delivery of assisted ventilation appropriate to the species being treated, including but not necessarily limited to: (a) A resuscitation bag; and (b) Endotracheal endotracheal tubes.;

(6) Scales e. Adequate means of determining patient's weight; and

(7) f. Storage for records.

B. Additional requirements for stationary establishments.

1. A stationary establishment that is open to the public 24 hours a day shall have licensed personnel on premises at all times and shall be equipped to handle emergency critical care and hospitalization. The establishment shall have radiology/imaging and laboratory services available on site.

2. A stationary establishment that is not open to the public 24 hours a day shall have licensed personnel available during its advertised hours of operation and shall disclose to the public that the establishment does not have continuous staffing in compliance with § 54.1-3806.1 of the Code of Virginia.

3. All stationary establishments shall provide for continuity of care when a patient is transferred to another establishment.

Restricted C. Limited stationary establishments. When the scope of practice is less than full service, a specifically restricted limited establishment permit registration shall be required. Upon submission of a completed application, satisfactory inspection, and payment of the permit registration fee, a restricted limited establishment permit registration may be issued. Such restricted establishments shall have posted in a conspicuous manner the specific limitations on the scope of practice on a form provided by the board.

1. Large animal establishment, ambulatory practice. A large animal ambulatory establishment is a mobile practice in which health care of large animals is performed at the location of the animal. Surgery on large animals may be performed as part of a large animal ambulatory practice provided the facility has surgical supplies, instruments and equipment commensurate with the kind of surgical services provided. All large animal ambulatory establishments shall meet the requirements of a full-service establishment in subsection A of this section with the exception of those set forth below:

a. All requirements for buildings and grounds.

b. All requirements for an examination room and surgery suite.

c. Equipment for assisted ventilation.

d. Scales.

2. Small animal establishment, house call practice. A small animal house call establishment is a mobile practice in which health care of small animals is performed at the residence of the owner of the small animal. Surgery may be performed only in a surgical suite that has passed inspection. Small animal house call facilities shall meet the requirements of a full-service establishment in subsection A of this section with the exception of those set forth below:

a. All requirements for buildings and grounds.

b. All requirements for an examination room or surgery suite.

c. Steam pressure sterilizer.

d. Internal or external sterilization monitor.

3. Small animal establishment, outpatient practice. A small animal outpatient establishment is a stationary facility or ambulatory practice where health care of small animals is performed. This practice may include surgery, provided the facility is equipped with a surgery suite as required by subdivision A 2 c of this section. Overnight hospitalization shall not be required. All other requirements of a full-service establishment shall be met.

C. D. A separate facility permit registration is required for separate practices that share the same location.

18VAC150-20-201. Standards for ambulatory veterinary establishments.

A. Agricultural or equine ambulatory practice. An agricultural or equine ambulatory establishment is a mobile practice in which health care is performed at the location of the animal. Surgery on large animals may be performed as part of an agricultural or equine ambulatory practice provided the establishment has surgical supplies, instruments, and equipment commensurate with the kind of surgical procedures performed. All agricultural or equine ambulatory establishments shall meet the requirements of a stationary establishment for laboratory, radiology, and minimum equipment, with the exception of equipment for assisted ventilation.

B. House call or proceduralist establishment. A house call or proceduralist establishment is an ambulatory practice in which health care of small animals is performed at the residence of the owner of the small animal or another establishment registered by the board. A veterinarian who has established a veterinarian-owner-patient relationship with an animal at the owner's residence or at another registered veterinary establishment may also provide care for that animal at the location of the patient.

1. Surgery may be performed only in a surgical suite at a registered establishment that has passed inspection.

2. House call or proceduralist establishments shall meet the requirements of a stationary establishment for laboratory, radiology, and minimum equipment, with the exception of equipment for assisted ventilation.

C. Mobile service establishment. A mobile service establishment is a veterinary clinic or hospital that can be moved from one location to another and from which veterinary services are provided. A mobile service establishment shall meet all the requirements of a stationary establishment appropriate for the services provided.

D. A separate establishment registration is required for separate practices that share the same location.

18VAC150-20-210. Revocation or suspension of a veterinary establishment permit registration.

A. The board may revoke or suspend or take other disciplinary action deemed appropriate against the registration permit of a veterinary establishment if it finds the establishment to be in violation of any provisions provision of laws or regulations governing veterinary medicine or if:

1. The board or its agents are denied access to the establishment to conduct an inspection or investigation;

2. The licensee holder of a registration does not pay any and all prescribed fees or monetary penalties;

3. The establishment is performing procedures beyond the scope of a restricted limited establishment permit registration; or

4. The establishment has no veterinarian-in-charge registered with the board.

B. The Administrative Process Act (§ 2.2-4000 et seq. of the Code of Virginia) shall apply to any determination under this section.

Part VI
Equine Dental Technicians

18VAC150-20-220. Requirements for registration as an equine dental technician.

A. A person applying for registration as an equine dental technician shall provide a recommendation from at least two veterinarians licensed in Virginia who attest that at least 50% of their practice is equine, and that they have observed the applicant within the past five years immediately preceding the attestation and can attest to his competency to be registered as an equine dental technician.

B. The qualifications for registration shall include documentation of one of the following:

1. Current certification from the International Association of Equine Dentistry;

2. Completion of a board-approved certification program or training program;

3. Completion of a veterinary technician program that includes equine dentistry in the curriculum; or

4. Evidence of equine dental practice for at least five years and proof of 16 hours of continuing education in equine dentistry completed within the five years immediately preceding application for registration.

C. In order to maintain an equine dental technician registration, a person shall renew such registration by January 1 of each year by payment of the renewal fee specified in 18VAC150-20-100 and attestation of obtaining 16 hours of continuing education relating to equine dentistry within the past three years.

1. Equine dental technicians shall be required to maintain original documents verifying the date and subject of the continuing education program or course, the number of continuing education hours, and certification of completion from a sponsor. Original documents shall be maintained for a period of two years following renewal. The board shall periodically conduct a random audit to determine compliance. Practitioners selected for the audit shall provide all supporting documentation within 10 14 days of receiving notification of the audit, unless granted an extension by the board.

a. The board may grant an exemption for all or part of the continuing education requirements due to circumstances beyond the control of the technician, such as temporary disability, mandatory military service, or officially declared disasters.

b. The board may grant an extension for good cause of up to one year for the completion of continuing education requirements upon written request from the technician prior to the renewal date. Such an extension shall not relieve the technician of the continuing education requirement.

2. Registration may be renewed up to one year after the expiration date, provided a late fee as prescribed in 18VAC150-20-100 is paid in addition to the required renewal fee.

3. Reinstatement of registration expired for more than one year shall be at the discretion of the board. To reinstate a registration, the applicant shall pay the reinstatement fee as prescribed in 18VAC150-20-100 and submit evidence of completion of continuing education hours equal to the number of years in which the registration has been expired, for a maximum of two years. The board may require additional documentation of clinical competency and professional activities.