HomeMy WebLinkAboutMEDICAL ADDENDUM TO FOSTER CONTRACT
ANIMAL SERVICES
1601 Eubanks Road http://orangecountync.gov/animalservices phone: (919) 942-7387
Chapel Hill, NC 27516 fax: (919) 918-2393
ADDENDUM TO FOSTER CONTRACT
NOTIFICATION OF SPECIAL MEDICAL CONDITIONS
_____________________
FOSTER: __________________________
ANIMAL ID: __________________________
I, the Foster Volunteer, affirm that Orange County Animal Services (OCAS)
staff has explained to me that the animal I am fostering has been diagnosed with heartworm disease by the
shelter’s medical staff. By my signature below, I affirm that I have read and understood this document,
including the following information regarding the medical abnormalities and treatment of the dog I am
fostering:
1. Orange County Animal Services will provide the initial treatment for the heartworms as described below
at no cost to you. As part of the treatment process, OCAS agrees to the following (applicable items will
be initialed by a member of OCAS management):
o Provide 30 days of antibiotic treatment with Doxycycline that must be completed prior to the
heartworm treatment.
_______ The shelter’s medical staff began the course of treatment with Doxycycline, but it has not
yet been completed. OCAS is sending you home with the balance of that medication along with
instructions for its administration.
_______ The shelter’s medical staff completed the course of treatment with Doxycycline while the
pet was in the custody of OCAS as documented in the copy of the shelter medical record you have
been provided.
o Provide a series of injections with Immiticide that are intended to kill the adult heartworms.
_______ The Immiticide injections have not yet been completed. You will need to return the
animal to OCAS in accordance with the schedule outlined below for this portion of the treatment.
_______ The shelter’s medical staff completed the course of treatment with Immiticide while the
animal was in the custody of OCAS as documented in the copy of the shelter medical record you
have been provided.
o Consult with your regular veterinarian as needed to discuss the case. Feel free to have your
veterinarian contact Veterinary Health Care Manager Jasmine Johnson at
jajohnson@orangecountync.gov
2. Heartworm treatment is a lengthy process that will involve several steps on your part in addition to what
is outlined in the Foster Contract. As part of the treatment process, you agree to the following
(applicable items will be initialed by a member of OCAS management):
_______ Make an appointment with your regular veterinarian to schedule an examination right
away to be sure you have a plan in place in case any emergencies arise. It is essential that you
restrict exercise for ________________ while treatment is underway, as well as at least one month
following the final injection. Your regular veterinarian can help you outline a plan for that portion of
the treatment protocol.
_______ Administer the balance of the Doxycycline in accordance with the instructions provided at
the time of foster.
_______ Return the dog to OCAS for the series of Immiticide injections. You are scheduled to drop
off _____________ at the Animal Services Center on the morning of ____________ for Immiticide
treatment on ____________ and ____________. You may pick up on ___________ anytime
between 12PM and 6PM. If you have any questions during his stay, please feel free to contact a
member of our health care team at 919-942-7387 ext. 232. Please leave a message and someone will
return your call.
3. The majority of heartworm infections will be resolved by the Immiticide treatment. However, any
subsequent treatment or testing that may be required after the Doxycycline and Immiticide treatments
provided by OCAS and referenced above must be completed by your regular veterinarian at your own
expense. OCAS strongly recommends scheduling ___________ for a heartworm test at your regular
veterinarian six months after the completion of the Immiticide injections to confirm the animal is
negative for heartworms. The test should be scheduled on or around ___________ and will be at your
own expense.
4. As with any medical procedure, there is some risk involved in the heartworm treatment. You agree to
hold OCAS harmless for any complications that may arise as a result of the treatment.
5. Any and all expenses incurred in the care of ______________, the dog you are fostering, with the
exception of the prescribed Doxycycline regimen and scheduled Immiticide treatment described above,
will be the sole responsibility of you, the Foster. Orange County will assume neither liability nor
responsibility for any expense incurred in the care and treatment of this animal.
_________________________________________ _____________________________________________________
Foster Date Jasmine Johnson, Veterinary Health Care Manager Date