This form is to be completed for all animals being sent for overnight care at ARC where a treatment plan has been established by the referring veterinarian.

This is a service for stable patients whose status is not expected to change dramatically overnight

Ideal for post op recovery and analgesia, gastroenteritis cases, geriatrics and paediatrics

Patients will return to the referring clinic in the morning

Exclusions: oxygen dependent, unconscious, severe pain, needing a blood transfusion, needing diagnostic imaging, cases for specialist referral. Please use the standard ARC referral form for these cases; the ARC after hours team will assess and treat as appropriate.

Are you a machine? If not please enter nothing in here:

Animal Details

Name:*
Sex:*
Age:*
Client Name:*
Overnight contact number:*

Referring Veterinarian Details

Clinic:*
Treating Vet:*
Treating Vet overnight contact number:*
Vet Email:

Services Selected (tick box)

Service*

Brief Description of problem

Brief Description of problem*

Treatments

IV fluids supplied:
Type:
Rate:
Additives:
Medication supplied:
Drug Name:
Dose:
Time/s to be administered
Comments
Drug Name:
Dose:
Time/s to be administered
Comments
Drug Name:
Dose:
Time/s to be administered
Comments
Drug Name:
Dose:
Time/s to be administered
Comments
ARC overnight vet:
ARC overnight comments: