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2018 Exam Cycle - Case Log FormatDate: Applicant Information Number (AIN):
Instructions: Include date, patient identification (name or number), number of visits, species/breed, age, sex, weight, veterinary diagnosis, immediate rehabilitative goals, equipment, modalities or therapeutic aides used (please reference equipment or physical modalities listed in the skills list), demonstration of advanced skills and knowledge (referencing the skills list), use of objective scales, final outcome/goals, and succinct summary outcome including ONE advanced skill (not to exceed three case logs per page) of veterinary physical rehabilitation techniques, skills, and procedures performed by the applicant on the patient. Abbreviations recognized by the Academy can be found in the application packet. If an abbreviation is used and is not in the abbreviation list, it must be fully spelled out with the abbreviation in parentheses. For example: Under Water Treadmill (UWTM). Applicants can find approved validated and approved objective scales in the supplemental section of the APRVT application packet. Please use Times New Roman 9-point font. Image Submissions will NOT be accepted.
Case log: # Example Patient ID: Number of Visits: Date:Species/Breed: Age: Sex: Weight (kg):Diagnosis/Conditions:Immediate rehabilitative goals:Representative Signed Advanced Skills (including assistance in) and Knowledge.☐ Canine Behavior and Handling ☐ Small Animal Anatomy, Physiology & Directional Terms☐ Responses of Musculoskeletal Tissues to Disuse & Remobilization ☐ Patient Assessment and Management☐ Physical Modalities, Manual Techniques & Adjunctive Treatments ☐ Common Conditions & Surgical Procedures☐ Client Communication ☐ Nutrition☐ Small Animal Anatomy, Physiology and Directional Terms ☐ Supplemental SkillsValidated Objective Scales Used: ☐ Pain score ☐ Lameness Score ☐ Neurologic ScoreSummary of Care (include final outcome if any and goals including ONE advanced skills that the applicant performed):
Case log: Patient ID: Number of Visits: Date:Species/Breed: Age: Sex: Weight (kg):Diagnosis/Conditions:Immediate rehabilitative goals:Representative Signed Advanced Skill (including assistance in) and Knowledge:☐ Canine Behavior and Handling ☐ Small Animal Anatomy, Physiology and Directional Terms☐ Responses of Musculoskeletal Tissues to Disuse & Remobilization ☐ Patient Assessment and Management☐ Physical Modalities, Manual Techniques & Adjunctive Treatments ☐ Common Conditions and Surgical Procedures☐ Client Communication ☐ Nutrition☐ Small Animal Anatomy, Physiology and Directional Terms ☐ Supplemental SkillsValidated Objective Scales Used: ☐ Pain score ☐ Lameness Score ☐ Neurologic ScoreSummary of Care (include final outcome if any, equipment used and goals including ONE advanced skills that the applicant performed):
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2018 Exam Cycle - Case Log FormatDate: Applicant Information Number (AIN): Case log: Patient ID: Number of Visits: Date:Species/Breed: Age: Sex: Weight (kg):Diagnosis/Conditions:Immediate rehabilitative goals:Representative Signed Advanced Skills (including assistance in) and Knowledge.☐ Canine Behavior and Handling ☐ Canine Behavior and Handling☐ Responses of Musculoskeletal Tissues to Disuse & Remobilization ☐ Responses of Musculoskeletal Tissues to Disuse & Remobilization☐ Physical Modalities, Manual Techniques & Adjunctive Treatments ☐ Physical Modalities, Manual Techniques & Adjunctive Treatments☐ Client Communication ☐ Client Communication☐ Small Animal Anatomy, Physiology and Directional Terms ☐ Small Animal Anatomy, Physiology and Directional TermsValidated Objective Scales Used: ☐ Pain score ☐ Lameness Score ☐ Neurologic ScoreSummary of Care (include final outcome if any and goals including ONE advanced skills that the applicant performed):
Case log: # Example Patient ID: Number of Visits: Date:Species/Breed: Age: Sex: Weight (kg):Diagnosis/Conditions:Immediate rehabilitative goals:Representative Signed Advanced Skills (including assistance in) and Knowledge:☐ Canine Behavior and Handling ☐ Small Animal Anatomy, Physiology and Directional Terms☐ Responses of Musculoskeletal Tissues to Disuse & Remobilization ☐ Patient Assessment and Management☐ Physical Modalities, Manual Techniques & Adjunctive Treatments ☐ Common Conditions and Surgical Procedures☐ Client Communication ☐ Nutrition☐ Small Animal Anatomy, Physiology and Directional Terms ☐ Supplemental SkillsValidated Objective Scales Used: ☐ Pain score ☐ Lameness Score ☐ Neurologic ScoreSummary of Care (include final outcome if any and goals including ONE advanced skills that the applicant performed):
Case log: # Example Patient ID: Number of Visits: Date:Species/Breed: Age: Sex: Weight (kg):Diagnosis/Conditions:Immediate rehabilitative goals:Representative Signed Advanced Skill (including assistance in) and Knowledge:☐ Canine Behavior and Handling ☐ Small Animal Anatomy, Physiology and Directional Terms☐ Responses of Musculoskeletal Tissues to Disuse & Remobilization ☐ Patient Assessment and Management☐ Physical Modalities, Manual Techniques & Adjunctive Treatments ☐ Common Conditions and Surgical Procedures☐ Client Communication ☐ Nutrition☐ Small Animal Anatomy, Physiology and Directional Terms ☐ Supplemental SkillsValidated Objective Scales Used: ☐ Pain score ☐ Lameness Score ☐ Neurologic ScoreSummary of Care (include final outcome if any and goals including ONE advanced skills that the applicant performed):
Case log: # Example Patient ID: Number of Visits: Date:Species/Breed: Age: Sex: Weight (kg):
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2018 Exam Cycle - Case Log FormatDate: Applicant Information Number (AIN): Diagnosis/Conditions:Immediate rehabilitative goals:Representative Signed Advanced Skill (including assistance in) and Knowledge:☐ Canine Behavior and Handling ☐ Small Animal Anatomy, Physiology and Directional Terms☐ Responses of Musculoskeletal Tissues to Disuse & Remobilization ☐ Patient Assessment and Management☐ Physical Modalities, Manual Techniques & Adjunctive Treatments ☐ Common Conditions and Surgical Procedures☐ Client Communication ☐ Nutrition☐ Small Animal Anatomy, Physiology and Directional Terms ☐ Supplemental SkillsValidated Objective Scales Used: ☐ Pain score ☐ Lameness Score ☐ Neurologic ScoreSummary of Care (include final outcome if any and goals including ONE advanced skills that the applicant performed):
Case log: # Example Patient ID: Number of Visits: Date:Species/Breed: Age: Sex: Weight (kg):Diagnosis/Conditions:Immediate rehabilitative goals:Representative Signed Advanced Skill (including assistance in) and Knowledge:☐ Canine Behavior and Handling ☐ Small Animal Anatomy, Physiology and Directional Terms☐ Responses of Musculoskeletal Tissues to Disuse & Remobilization ☐ Patient Assessment and Management☐ Physical Modalities, Manual Techniques & Adjunctive Treatments ☐ Common Conditions and Surgical Procedures☐ Client Communication ☐ Nutrition☐ Small Animal Anatomy, Physiology and Directional Terms ☐ Supplemental SkillsValidated Objective Scales Used: ☐ Pain score ☐ Lameness Score ☐ Neurologic ScoreSummary of Care (include final outcome if any and goals including ONE advanced skills that the applicant performed):
Case log: # Example Patient ID: Number of Visits: Date:Species/Breed: Age: Sex: Weight (kg):Diagnosis/Conditions:Immediate rehabilitative goals:Representative Signed Advanced Skill (including assistance in) and Knowledge:☐ Canine Behavior and Handling ☐ Small Animal Anatomy, Physiology and Directional Terms☐ Responses of Musculoskeletal Tissues to Disuse & Remobilization ☐ Patient Assessment and Management☐ Physical Modalities, Manual Techniques & Adjunctive Treatments ☐ Common Conditions and Surgical Procedures☐ Client Communication ☐ Nutrition☐ Small Animal Anatomy, Physiology and Directional Terms ☐ Supplemental SkillsValidated Objective Scales Used: ☐ Pain score ☐ Lameness Score ☐ Neurologic ScoreSummary of Care (include final outcome if any and goals including ONE advanced skills that the applicant performed):
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