CAC Documentation & Record Management 3 — Questions and Answers
Question 1: A certified veterinary chiropractor notices a discrepancy between the referring veterinarian's diagnosis and her own palpation findings. How should this be documented?
- Only the referring veterinarian's diagnosis should appear in the record
- Both findings should be recorded clearly, noting the source of each assessment (Correct answer)
- The discrepancy should be omitted to avoid legal conflict
- The chiropractor's findings should replace the veterinary diagnosis entirely
Correct answer: Both findings should be recorded clearly, noting the source of each assessment
Accurate recordkeeping requires documenting all clinical findings with their respective sources so the complete picture is preserved for ongoing care and legal accountability.
Question 2: Which abbreviation system is most commonly used in veterinary chiropractic records to denote a vertebral motion unit (VMU) fixation?
- ROM
- VMU-F or 'F' following the segment listing (Correct answer)
- CBC
- BCS
Correct answer: VMU-F or 'F' following the segment listing
A fixation at a specific vertebral motion unit is typically noted as VMU-F or by appending 'F' to the listing, distinguishing it from a normal or hypermobile segment.
Question 3: Which component of a chiropractic intake form is most useful for establishing a baseline neurological status in a dog suspected of cervical involvement?
- Owner's preferred appointment times
- Proprioception test results and cranial nerve screen findings (Correct answer)
- Annual flea-prevention product brand
- Coat and skin condition description
Correct answer: Proprioception test results and cranial nerve screen findings
Proprioceptive testing and a cranial nerve screen provide objective baseline neurological data that are especially important when cervical vertebrae are implicated.
Question 4: When documenting patient consent for a first chiropractic session, which statement should be explicitly included in the consent form?
- A guarantee that the animal will be symptom-free after one session
- An acknowledgment that chiropractic care does not replace conventional veterinary diagnosis and treatment (Correct answer)
- A clause that the chiropractor assumes sole responsibility for the animal's health
- A list of all competing practitioners in the area
Correct answer: An acknowledgment that chiropractic care does not replace conventional veterinary diagnosis and treatment
Consent forms must clarify that veterinary chiropractic is a complementary modality and does not replace veterinary diagnosis or treatment, protecting both the client and the practitioner.
Question 5: For a feline patient receiving chiropractic care, at which body region would documentation of a 'C1 A-S listing' indicate a finding?
- First coccygeal vertebra, caudal subluxation
- Atlas (first cervical vertebra), anterior-superior misalignment (Correct answer)
- First costovertebral junction, anterior-superior rotation
- First carpal bone, antero-superior displacement
Correct answer: Atlas (first cervical vertebra), anterior-superior misalignment
C1 refers to the atlas, the first cervical vertebra, and 'A-S' (Anterior-Superior) describes the direction of misalignment in standard chiropractic listing notation.
Question 6: Why is it important to document the force level (thrust amplitude) used during an equine sacral adjustment in the patient record?
- To calculate the owner's invoice more accurately
- To allow reproducibility and calibration of technique for future sessions and other providers (Correct answer)
- To meet breed registry documentation standards
- To comply with stable management regulations
Correct answer: To allow reproducibility and calibration of technique for future sessions and other providers
Recording thrust amplitude ensures the technique can be replicated consistently, adjusted as the patient progresses, and communicated accurately to any covering or collaborating clinician.
Question 7: A horse owner requests a copy of chiropractic records to share with a new trainer. What should the practitioner do before releasing the records?
- Release the records immediately since the owner verbally requested them
- Obtain a signed written authorization from the owner specifying who may receive the records (Correct answer)
- Contact the referring veterinarian first and obtain their approval
- Redact all clinical findings before releasing the document
Correct answer: Obtain a signed written authorization from the owner specifying who may receive the records
A signed written authorization from the record owner (the animal's owner) is required before releasing medical records to any third party, protecting privacy and providing a legal audit trail.
CAC Documentation & Record Management 3
A certified veterinary chiropractor notices a discrepancy between the referring veterinarian's diagnosis and her own palpation findings.
How should this be documented?