CERTIFIED VETERINARY PRACTICE MANAGER Applicationc.ymcdn.com/sites/ · CERTIFIED VETERINARY PRACTICE MANAGER Application ... Completed_Confidential Letter of Recommendation Formsshould_

CERTIFIED VETERINARYPRACTICE MANAGER

Application

Certified Veterinary Practice Manager Board PO Box 2280

Alachua, FL 32616 (518) 433-8911 • (888) 795-4520 fax [email protected] • www.vhma.org

March 2013

Veterinary Hospital Managers Association

APPLICATION FOR CERTIFIED VETERINARY PRACTICE MANAGER EXAM

Data Sheet

Name__________________________________________________ _ _Date______________________________

Home Address _____________________________________________________________________________

City/State/Zip ______________________________________________________________________________

Business Address ___________________________________________________________________________

City/State/Zip ______________________________________________________________________________

PLEASE NOTE: All correspondence from the CVPM Board is sent electronically. Would you prefer correspondence to be e-mailed to your personal or business address? __________________________________

Home Phone _______________________________ Personal_E-mail_ ______________________________

Business_Phone______________________________ _ _Business_E-mail_______________________________

EMPLOYMENT HISTORY (Please list employers for the last five years and begin with the most recent. If you need more space for your employment or educational background, please copy form and attach additional pages.)

Practice Name ______________________________________________________________________________

Practice Address ____________________________________________________________________________

City/State/Zip ______________________________________________________________________________

Name of Owner/Director _________________________________ Phone ____________________________

Dates Employed ________________________________________ Position __________________________

Practice Name ______________________________________________________________________________


City/State/Zip ______________________________________________________________________________



DAT

A S

HEE

T

1

Practice Name ______________________________________________________________________________


City/State/Zip ______________________________________________________________________________



EDUCATIONName of High School _________________________ Date Graduated _______________________________

City/State/Zip _____________________________________________________________________________

Major Field of Study ________________________________________________________________________

College/University _________________________________________________________________________

City/State/Zip ______________________________ Dates Attended _______________________________

Major Field of Study ____________________ ___________Degree Received _________ Date ________________________________________

College/University _________________________________________________________________________

City/State/Zip ______________________________ Dates Attended _______________________________

Major Field of Study ____________________ ___________Degree Received _________ Date ________________________________________

Other education or professional designations not listed under Section II or Section III of application: ________

_________________________________________________________________________________________

_________________________________________________________________________________________

Are you a member of any professional organizations? (please list) ____________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

2

APPLICATION INSTRUCTIONS

The certification process recognizes those veterinary practice managers who, through their education, practi-cal experience, and accountability to their employers and peers have achieved a high level of competence in the field of veterinary practice management. The certification process consists of three parts: the application, the examination, and ongoing recertification. The application must be completed, submitted, and accepted by the Certified Veterinary Practice Manager Board (CVPM Board) prior to scheduling an examination date.

The application documents the essential qualifications needed for veterinary practice management certification. All candidates for certification must meet these qualifications, there are no exceptions. The four areas in which a candidate for certification must qualify are:

EXPERIENCE - Acceptable experience is defined as active employment as a veterinary practice manager,performing a scope of duties that qualify as practice management for a minimum of three (3) years within the previous seven (7) years.

EDUCATION - Qualifying education is defined as the equivalent of eighteen (18) college semester/credit hours in courses that are pertinent to management.

CONTINUING EDUCATION - Forty-eight (48) hours of continuing education courses, seminars, etc., that are specifically devoted to management within the preceding seven (7) years are required for application approval. Additionally, documentation of forty-eight (48) hours of continuing education that are specifically devoted to management are required to be submitted every two (2) years to maintain certification.

REFERENCES - Four letters of recommendation are required as recognition of competence as a practice man-ager by employer and peers.

The application consists of four sections. A point system to verify that an applicant has fulfilled the minimum requirements in each area has been established. An applicant who achieves a total of one hundred (100) points, with the minimum required points in each area, is accepted as a candidate and will be scheduled for testing. The following are the minimum number of points needed in each area:

SECTION I Practice Management Experience 26 pointsSECTION Il Formal Education 18 pointsSECTION III Elective or Continuing Education 48 pointsSECTION IV References 8 points 100 points

Instructions for properly completing each section are contained in the application. Certain documentation is required and explained when necessary. The CVPM Board reserves the right to require additional documenta-tion or explanation of any question or section of the application.

INST

RUC

TIO

NS

3

SUBMISSION REQUIREMENTS

The CVPM Application and supporting documentation must be submitted to the CVPM Board in one (1) PDF [email protected]. Documentation supporting the requirements (except completed Confi-dential_Letter_of_Recommendation_Forms)_should be appropriately placed in the final application document file (i.e., continuing education certificates should immediately follow the completed CONTINUING EDUCATION form). Forms that require signatures can be electronically signed or should be signed and scanned for inclusion in the final application document file. The final application document file must be appropriately labeled using the bookmark feature (each section should be labeled, i.e., Data Sheet, Experience, Formal Education, Continu-ing Education, and Acceptance).

Completed_Confidential Letter of Recommendation [email protected]_by the individual who is submitting the recommendation._These_forms_can_be_electroni-cally_signed_or_signed_and_scanned_for_submission.

PLEASE NOTE: this form is provided to you as a fillable PDF file. You must have the full version of the Adobe Acrobate software to take advantage of the features such as saving your completed file and electronic signature. You will not be able to save your work or electronically sign your document with the Adobe Reader software only. If you do not have the full version of Adobe Acrobat you can complete the application electroni-cally but must print it out or print the blank form and complete it by hand.

If you are unable to scan documents and/or create a PDF file to e-mail, you may fax your completed applica-tion to the VHMA Office at 888-795-4520. Our electronic fax service will convert the file to a PDF. As noted above, the supporting documentation must be appropriately placed in the final application file before it is faxed to the VHMA Office. Due to some e-mail server size limitations, be sure to contact the VHMA Office to make sure it was received.

The CVPM Board will verify receipt of your application and notify you by e-mail of any additional informa-tion required. The CVPM Board has 60 days to review and respond to your completed application submission (reminder - your application is not considered complete until all the documentation and recommendation forms are received).

All correspondence from the CVPM Board will be by e-mail so be sure to identify the correct e-mail ad-dress you would like to receive your communication at. If your e-mail address changes during the appli-cation process be sure to provide an updated e-mail address to the CVPM Board.

Incomplete applications will not be processed.__Incomplete_or_unacceptable_applications_will_be_returned_to_the_candidate_along_with_a_check_or_credit_card_refund.__A_$100.00_processing_fee_will_be_deducted.

Application deadline dates for each scheduled examination administration are provided on the VHMA Web site.

The examination must be taken within two (2) years of the approval of your application.

The CVPM Board recommends that candidates keep a copy of their completed application for their own re-cords.

Applications and all questions regarding the certification process should be submitted to the CVPM Board: Certified Veterinary Practice Manager Board______PO_Box_2280,_Alachua,_FL_32616,________(518)_433-8911/(888)_795-4520_fax,[email protected].

4

INSTRUCTIONS FOR SECTION I - PRACTICE MANAGEMENT EXPERIENCE

This section is for reporting and documenting your veterinary practice management experience. Thirty (30) duties that are common to most veterinary practices are listed, and a definition is given for each. You must have performed at least twenty-six (26) of the thirty listed functions for at least three (3) years within the preceding seven (7) years to qualify as having the necessary management experience needed for certification.

Please read the listed duties carefully and select only those for which you were totally responsible a minimum period of three (3) years within the preceding seven (7) years. You may take credit for duties that you delegated to a staff member, if you were fully responsible for that staff member’s performance.

If you are unsure you have fully performed a duty that is listed, or if your experience differs from the descrip-tion, please write a detailed explanation and the CVPM Board will rule whether it may be counted toward the twenty-six (26) needed.

If you have not performed or been responsible for at least twenty six (26) of the listed duties, but have engaged in other activities not listed, you may request that the CVPM Board consider these as experience. Please submit a full description of the activity, including dates, and attach it to your application. The CVPM Board’s decision regarding these functions will be final.

If you are submitting experience from more than one practice to meet the three (3) years experience require-ment, please copy the PRACTICE MANAGEMENT EXPERIENCE section pages (or request an additional copy from the CVPM Board) and submit a separate section for each practice that you have managed. Both you and the owner/director of the respective practice must sign the applicable list.

Identify your experience for each duty by indicating the day, month, and year when you started being re-sponsible for that specific duty to the day, month, and year you stopped being responsible for that specific duty (i.e., March 16, 2005 to May 7, 2010). If you are still responsible for the duty, you should indicate the day, month, and year to present.

Performance for each listed duty for at least three (3) years within the last seven (7) years will count as one (1) point.

SEC

TIO

N I

5

SECTION 1

PRACTICE MANAGEMENT EXPERIENCE

1. Staff Development: Create and maintain staff manual. Include practice philosophy, policies, standards, and job descriptions. Create training protocols and manuals. Maintain reference library of training tapes and professional publications. Budget percentage of gross for staff continuing education.

Dates ______________________________________________ Points Achieved ________

2. Staff Maintenance: Design employment manual to recruit, interview, hire, train, evaluate, and discharge staff. Plan staff at optimum levels for practice needs, and create master schedules.


3. Staff Computer Training: Train staff to use computer software to its fullest capabilities. Implement or update the software, and maintain the smooth working of the system. Create paperwork to compliment the software. Back up system daily, and store backups safely.


4. Staff Communication: Plan and schedule regular staff meetings which are structured with an agenda. Hold full staff and area meetings. Maintain minutes of meetings and/or create an in-house newsletter.


5. Staff Interaction: Develop a practice Code of Ethics. Establish standards of behavior and protocols to resolve interpersonal conflict. Mediate, if necessary, and follow through with disciplinary action.


6. Staff Records: Maintain staff records in a locked file for confidential individual staff files which include such items as federal and state/provincial forms, medical records, warnings, timecards, pay rate and raises, and evaluations. Know applicable labor laws and regulations.


7. Staff Safety: Establish and maintain a safety manual in compliance with OSHA and EPA (U.S.) or WYMIS (Canada). Develop fire, accident and injury protocols, and develop a maternity and disability policy. Create an ongoing safety and training program.


8. Staff Benefits: Design staff benefit plan such as: insurance, personal time, vacation time, and retirement plan. Develop staff personal pet-care protocol. Maintain records of and make timely payments for the benefits.


6

Practice_Name__ ______________________________________

9. Staff Payroll: Compute hours or salaries and benefits, maintain adequate bank balance for payroll, and make timely payment of required payroll taxes and insurance. File payroll reports in a timely manner. Post labor law regulations.


10. Accounts Receivable: Develop protocols for receiving client monies. Limit number of cashiers; number receipts; and provide safe for undeposited monies, cash drawer, and petty cash. Have protocol for ex-changes, client refunds, and client credits. Create estimates and payment plans. Divide responsibilities among staff.


11. Income Reconciliation: Reconcile daily receipts to the daysheets or computer income reports. Make daily deposits and reconcile imprest petty cash account. Review monthly accounts receivable reports.


12. Credit Policies: Set and/or enforce established credit policies, maintain accounts receivable, send monthly statements, and maintain protocols for collection of overdue accounts and bad checks. Track collection and bad debt expense.


13. Accounts Payable: Verify accuracy of invoices, make timely payments of reconciled statements, pay all business taxes and licenses, reconcile monthly bank statements and maintain cash flow.


14. Inventory: Maintain diet, OTC products, hospital and office inventory at optimum levels. Cost compare and set fees for inventory items. Properly store and safeguard inventory. Complete a physical inventory at least annually.


15. Financial Reporting: Maintain Accounts Payable, Accounts Receivable, and General Ledger records either manually or in the computer. Produce monthly Balance Sheet, Income Statement (Profit and Loss), and Management Statement. Maintain DVM production reports.


16. Budgeting: Prepare a written budget, including projection for income and expense based on past finan-cial reports. Include future projections for staff and planned capital expenditures for equipment or facil-ity. Advise owners monthly if the practice is within budget projections for growth of gross and net.


7

Practice_Name__ ______________________________________

17. Purchasing: Plan major purchases of equipment by researching the product and providing financial and projected use data to make informed decisions. Use acceptable financial formulas.


18. Fee setting: Determine appropriate fee schedule from data in practice financial reports. Create tracking forms to make fees consistent, to capture all fees for services, and to monitor staff compliance.


19. Patient Medical Records: Oversee a legally-defensible patient medical record system which includes an accepted veterinary medical record format, regular review of records for accuracy, completeness and compliance (client education; informed consent, refusal of treatment plans, estimates, and phone con-versations), and purging schedules. Keep records for the required time. Release copies of records at the client's request. Maintain a safe storage system.


20. Medical Knowledge: Have a working knowledge of medical terminology for reviewing medical re-cords, preparing computer prescription labels, computer data entry, and general information.


21. Hospital Medical Logs: Establish and/or maintain medical logs for controlled drugs, anesthesia, sur-gery, radiology, laboratory and anesthesia/surgery mortality. Keep records for required time period and store safely.


22. Client Service: Develop staff training for exceptional customer service which includes practice goals, the Mission Statement; and protocols for surveys, focus groups, services, and the marketing plan for the services. Have responsibility for at least two marketing efforts in the three-year period.


23. Client Communication: Design staff training for client communications which includes protocols for at least three types. Types might include: new-client letters, referral thank yous, vaccine reminders, sym-pathy cards or letters, client call backs, scripts for telephone inquiries, and client newsletters.


24. Client Interaction: Create protocols for communicating effectively with clients, including difficult inter-actions with dissatisfied people. Implement staff training and establish expectations of staff.


8

Practice_Name__ ______________________________________

25. Client Grief Protocol: Maintain a protocol and staff training for interaction with a client who is experi-encing the loss of a pet or facing the decision to euthanize. Staff training includes consideration of the staff stress surrounding death.


26. Client Education: Create hospital brochure and educational packets specific to your practice. Create kits, such as handouts for pediatric patients, geriatric, and dental patients. Include brochures about specific ages, diseases, and preventive medical care. Show specimens, models, or pictures. Record cli-ent education and recommendations in the medical records.


27. Client Education Programs: Plan at least three veterinary health education programs for clients. Ex-amples might be: herd health, puppy and kitten health, geriatric care, dental care, video tapes, obedience training, and behavior counseling.


28. Client/Patient/Staff Comfort: Establish a standard for cleanliness and facility maintenance which includes a written schedule for regular housekeeping. Schedule work load to create a calm, quiet envi-ronment to enhance patient recovery and to prevent staff burnout. Be able to give hospital tours at any time.


29. Professional Liaison: Act as a liaison between the practice and professionals, such as accountants, in-surance agents, architects, bankers, attorneys, and consultants.


30. Community Involvement: Establish or maintain at least two community outreach or service programs during the three-year period. Examples: practice volunteer program, externship or cooperative place-ment program, open house, elementary school programs, career days, pet visitation to nursing homes, 4-H or Scouting, state fair demonstrations, and National Pet Week Observance.


Total Points ___________

I certify that the applicant submitting this documentation has performed the duties for practice managers asoutlined in the functions described or has been responsible and accountable for the same for the dates indicated.

____________________________________ _______________________________________ Applicant’s Signature Practice Owner/Employer’s Signature

____________________________________Date

9

Practice_Name__ ______________________________________

SEC

TIO

N II

INSTRUCTIONS FOR SECTION II

FORMAL EDUCATION

This portion of the application documents college courses in pertinent disciplines required for veterinary prac-tice management. You must have at least eighteen (18) points to complete the formal education requirement. Each semester/credit hour counts as one (1) point, so the usual college semester course will count as three (3) points. To qualify as a college course under this section, the course must be similar to the examples below and be taken at an accredited college or university. An official transcript from each college or university must be attached to the application as documentation, and you must have received a passing grade. Please highlight the courses you have listed to be counted toward your application. If you need to identify more courses than is allotted for in this form, please copy the FORMAL EDUCATION section pages (or request an additional copy from the CVPM Board) and submit the additional pages with your completed application.

Testing programs such as Educational Testing Service (ETS), the College-Level Examination Program (CLEP), or any program recognized by an accredited college or university will be accepted by the CVPM Board. Writ-ten verification from the testing agency will be required and must be submitted with the application .

You must have satisfactorily completed at least 18 college semester/credit hours in two (2) or more of these disciplines:

ACCOUNTING - Examples: Introduction to Accounting, Principles of Accounting, Financial Statement Analy-ses, Management Accounting, Business Income Taxation, Intermediate/Advanced Accounting or Statistics

ECONOMICS/FINANCE - Examples: Basic Economics, Micro/Macro Economics, Introduction to Finance, Principles of Finance, Financial Decisions, Investments, Business Finance, Banking

COMPUTER SCIENCE - Examples: Introduction to Computers, Computer Information Systems, Software Ap-plications, Computer Programming, Data Processing, Systems Analysis

MARKETING - Examples: Introduction to Marketing, Marketing Principles, Market Research, Methods of Marketing, Consumer Behavior, Advertising, Marketing Policy

MANAGEMENT - Examples: Introduction to Management, Business Ethics, Strategic Planning, Entrepreneur-ship, Communication

LABOR RELATIONS/HUMAN RESOURCES - Examples: English, Humanties, Speech, Personnel Adminis-tration, Labor Relations, Behavioral Problem Solving, Human Resource Management, Introduction to Psycholo-gy, Psychology of Personnel Management, Managerial Leadership, Personnel Training Performance Appraisals

LAW/TAXATION - Examples: Business Law, Introduction to Taxation, Business Taxation, Tax Principles, Federal Income Taxation

NOTE: If you have obtained a Bachelors or Masters Degree in Business Administration, you may submit a copy of your diploma (instead of transcripts) as documentation of the necessary formal education.

10

SECTION II

FORMAL EDUCATION

College/University ________________________ Course Name ________________ Course # __________

Discipline ___________________ Semester Credit Hours Achieved _______________ Date ___________

Points Achieved ______
















Total Points ________

11

INSTRUCTIONS FOR SECTION III

CONTINUING EDUCATION

This section gives credit for continuing education that is specifically devoted to management. Forty-eight (48 ) hours of continuing education within the preceding seven (7) years are necessary to meet the minimum requirement for this section.

For a continuing education course or seminar to be acceptable, it must be given or sponsored by a recognized entity (example: VHMA, AAHA, AVMA, VetPartners, etc.), and the subject must be management focused. Credit will not be given for courses relating primarily to veterinary medicine or seminars in the practice pre-sented by drug or food representatives.

The CVPM Board will determine on an individual basis whether a local seminar, or one given or sponsored by an unfamiliar speaker or sponsor, may be accepted. For a course to be considered, the applicant must submit:l. An outline describing in detail the subjects covered; 2. A biography or list of credentials of the person con-ducting the seminar; 3. Copies of all documents or handouts given in connection with the seminar.

Each hour of an acceptable presentation will count as one point toward the 48 minimum hours needed for Sec-tion III. For conferences or multi-program events, list the event name and the total number of manage-ment hours awarded or participated in; you do not need to list each individual program you attended on the form (in some cases the certificate of attendance will provide a list of the individual management programs attendeed).

All continuing education must be documented to be accepted. Because some seminars do not award certificates for completion, a variety of methods for documentation will be allowed. A printed list of attendees or partici-pants with your name highlighted, a copy of a canceled check or letter of confirmation to a seminar, or a letter from another participant or instructor are acceptable. If you are submitting proof of participation other than a certificate of attendance or completion, be sure to identify the total number of management hours participated in.

You are encouraged to provide a list of all seminars and classes that you attended, even if you exceed the num-ber of hours needed, since some may not qualify. The CVPM Board will be the final judge of which courses are acceptable and the number of hours that can be credited for each course.

If you need to identify more continuing education events than is allotted for in this form, please copy the CON-TINUING EDUCATION section pages (or request an additional copy from the CVPM Board) and submit the additional pages with your completed application.

SEC

TIO

N II

I

12

SECTION III

CONTINUING EDUCATION

Seminar/Course Name _________________________________________ Date(s) _____________________

City/State________________________________ Number of Hours _______________

Presented by ___________________________________________ Documentation ____________________

Points Achieved _____________




Points Achieved _____________ Seminar/Course Name _________________________________________ Date(s) _____________________









Points Achieved _____________

13
















Points Achieved _____________ Total Points _________________

14

INSTRUCTIONS FOR SECTION IV

REFERENCES

This_part_of_the_application_documents_recognition_of_your_competence_as_a_practice_manager_by_your__employer_and_peers.__Four_(4)_letters_of_recommendation_on_your_behalf_are_required_by_the_CVPM_Board_and_made_a_part_of_your_application.__An_average_score_of_4.5_(per_domain_and_overall)_is_required_for_each_of_the_six behavior skills identified in the Confidential Letter of Recommendation Form provided herein.

Recommendation #1: This recommendation must be from a person who is actively involved in the field of practice_management_and_is_in_a_position_to_be_familiar_with_your_work_as_a_manager_(i.e.,_fellow_manager_from_a_local_managers_group,_manager_from_another_practice_you_work_with,_a_current_CVPM,_etc.).__

Recommendation_#2:__This_recommendation_must_be_from_a_past_or_present_employer_for_whom_you_have_worked_as_a_practice_manager_or_from_a_peer_who_can_qualify_your_management_of_a_practice_you_have_owned._

Recommendations_#3_and_#4:__These_recommendations_should_be_from_peers_who_have_a_professional_asso-ciation_with_you_in_your_capacity_as_the_practice_manager_and_can_verify_your_character_and_integrity_(i.e.,_the_practice_attorney,_practice_CPA,_practice_consultant,_a_vendor_representative,_associate_DVM,_etc.).__PLEASE NOTE, the CVPM Board does not consider someone that you supervise a peer.

Recommendations must be submitted to the CVPM Board on the Confidential Letter of Recommendation Form provided_in_this_application_and_must_be_e-mailed_or_faxed_directly_to_the_CVPM_Board_by_the_person_who_signs_the_form.__Recommendation_Forms_must_be_signed_and_dated_within_60_days_of_the_application_submission_date.__Recommendation_Forms_older_than_60_days_will_not_be_considered_current_and_valid.

Please complete the name and address portion of the Confidential Letter before you give it to the persons you have_chosen_to_complete_the_recommendation_form.__Be_sure_to_include_a_copy_of_these_instructions_for_their_review.__Please stress the importance of e-mailing or faxing this form promptly since your application is not considered complete until all four letters are received.

Complete_Section_IV_by_listing_the_information_of_the_persons_who_will_be_completing_and_sending_the_recom-mendation_letters_to_the_CVPM_Board_on_your_behalf.__The_four_(4)_recommendation_letters_count_as_eight_(8)_points_towards_the_required_100_points._The_CVPM_Board_will_notify_you_if_one_or_more_of_your_recommenda-tions_have_not_been_submitted_when_your_application_is_received.

Completed_Recommendation_Forms_may_be_retracted_by_the_individual_who_completed_the_form_at_any_time_prior_to_the_candidate_taking_the_examination.__If_a_Recommendation_Form_is_retracted,_the_CVPM_Board_will_notify_the_candidate_within_60_days_to_let_them_know_their_application_is_no_longer_approved.__The_candidate_then_has_60_days_to_respond_to_the_notice_and_provide_additional_documentation_as_needed.__Details_for_the_ap-plication_appeal_process_are_provided_in_the_CVPM_Standards_and_Procedures_document_readily_available_on_the_VHMA_Web_site.

SEC

TIO

N IV

15

SECTION IV

LIST OF REFERENCES

Name _________________________________________ Phone Number ____________________________

Address __________________________________________________________________________________

City/State________________________________________

Relationship to you (check all that apply): p Practice Management Professional p_Past or Present Employer p_Peer


Address __________________________________________________________________________________

City/State________________________________________

Relationship to you (check all that apply): p Practice Management Professional p Past or Present Employer p_Peer


Address __________________________________________________________________________________

City/State________________________________________

Relationship to you (check all that apply): p Practice Management Professional p Past or Present Employer p_Peer


Address __________________________________________________________________________________

City/State________________________________________

Relationship to you (check all that apply): p Practice Management Professional p Past or Present Employer p_Peer_

Total Points Achieved________________

16

CONFIDENTIAL LETTER OF RECOMMENDATION

Name of Applicant ________________________________________________________

Applicant’s Address _______________________________________________________

It is extremely important this form be completed in its entirety. The individual whose name appears above has applied for candidacy as a Certified Veterinary Practice Manager (CVPM), and this letter of recommendation is required before the candidate’s application can be accepted. Please answer the questions below in as candid and as specific a manner as possible. Recommendation_Forms_must_be_signed_and_dated_within_60_days_of_the_application_submission_date.__Recommendation_Forms_older_than_60_days_will_not_be_considered_current_and_valid. When complete, e-mail or fax directly to:

Certified Veterinary Practice Manager BoardPO Box 2280, Alachua, FL 32616

[email protected] 877-599-2707 phone/888-795-4520 fax

Be assured that your comments will be held in the strictest confidence and the applicant will not haveaccess to your letter or the information it contains.

Name of person completing this form __________________________________________________________

Address __________________________________________________________________________________

Phone_____________________________________ _

E-mail_____________________________________

Your_relationship_to_the_applicant_(check_all_that_apply):_

p_Practice_Management_Professional____

p_Past_or_Present_Employer_____

p_Peer

Is the CVPM applicant that you are writing this recommendation for your supervisor? p_Yes_____p_No

If yes, does he/she evaluate your work in a way that could affect your performance evaluation? p_Yes_____p_No

How long have you known the applicant? _______________________________________________________

Describe your relationship with the applicant only as it pertains to their position as a veterinary management professional? ______________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

RECO

MM

END

ATIO

N

17

How would you describe the applicant’s moral character, integrity, and sincerity of commitment to the _veterinary practice management profession?

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

If you are a former or current employer or have the capacity to form an opinion, how would you rate theapplicant’s ability as a veterinary practice manager? (Please be specific.)

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

What trait or ability does this candidate possess that most impresses and will allow this candidate to be an asset to the veterinary practice management profession?

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

What trait or ability does this candidate possess that you would feel to be the most negative and may potentiallyaffect the candidate’s future success in this profession?

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

18

Please rate the candidate based on behaviors you have observed at work, compared to others you have observed in the same or similar settings. Use the following scale:

1= well below average 2 = a little below average 3 = about average 4 = somewhat above average 5 = well above average 6 = outstanding; one of the best

well below average

a little below average

about average

somewhat above average

well above average

outstanding

Ability to command respectCaptures the respect and trust of others. 1 2 3 4 5 6Group members look to him/her for

guidance. 1 2 3 4 5 6

Is a source of motivation for others. 1 2 3 4 5 6

Supervisory SkillsSets clear performance standards for

people he/she supervises. 1 2 3 4 5 6

Provides guidance and direction to subordinates. 1 2 3 4 5 6

Delegates work tasks effectively to competent employees. 1 2 3 4 5 6

Ability to follow through on projectsFinds the necessary resources to complete

tasks. 1 2 3 4 5 6

Completes tasks quickly and effectively. 1 2 3 4 5 6Does what is necessary to get the job done

well. 1 2 3 4 5 6

Abillity to be self-motivatedMeets predetermined targets and

deadlines. 1 2 3 4 5 6

Effectively organizes and prioritizes work tasks. 1 2 3 4 5 6

Keeps pushing to succeed in the face of obstacles. 1 2 3 4 5 6

Takes initiative on projects. 1 2 3 4 5 6

Communication SkillsPresents messages clearly and forcefully

when speaking to others. 1 2 3 4 5 6

Speaks in clear and articulate manner. 1 2 3 4 5 6Gives full attention to what others

are saying. 1 2 3 4 5 6

Ability to control emotionsKeeps his/her emotions in check. 1 2 3 4 5 6Hides his/her anger and frustration

in front of others. 1 2 3 4 5 6

Accepts criticism from others in a calm manner. 1 2 3 4 5 6

I certify that the information stated within this letter of recommendation is accurate and correct to the best of my knowledge._________________________________________ ________________________ Signature Date

19

I declare all of the information provided as part of this application or any additional information supplied to the CVPM Board as part of the certification process is complete and correct to the best of my knowledge. I under-stand that false information or statements made by me may result in denial of certification and disqualification of my application. I give permission to the CVPM Board to verify or otherwise check any information con-tained in this application. Additional information requested by the CVPM Board will be supplied upon request.

I certify I have not been convicted in either civil or criminal proceedings as a defendant where there were al-legations of fraud or misappropriation of property or funds.

I agree not to use the designation CVPM until I am officially informed by the CVPM Board I have been certi-fied.

I agree, should I obtain the designation of Certified Veterinary Practice Manager, I shall conduct myself in ac-cordance with the Code of Ethics of the Veterinary Hospital Managers Association, Inc.

_________________________________________ ________________________ Signature Date

PRIOR TO SUBMITTING APPLICATION

Review the contents and make sure the points add up to at least one hundred (100) overall with the required minimum in each area.

Ensure that all requested documentation is complete and enclosed.

Mail your check, made payable to the Veterinary Practice Manager Certification Board to the VHMA Of-fice (be sure to identify the CVPM candidate name on the check). Secure credit card payment may be made through your Member Portal on the VHMA Web site. A credit card payment form is also available in this ap-plication for your use. Applications will not be processed until the examination fee is paid.

Current examination fees:Veterinary Hospital Managers Association members - $675.00Non-members - $825.00

Please remember, incomplete applications will not be processed.

Incomplete or unacceptable applications will be returned to the applicant along with a check or credit card refund. There will be a $100.00 processing fee deducted.

All questions regarding the application or the certification process should be made in writing to [email protected].

Certified Veterinary Practice Manager Board PO Box 2280, Alachua, FL 32616

(518) 433-8911/(888) 795-4520 fax [email protected]

20

ACC

EPTA

NCE

Documents

CERTIFIED VETERINARY PRACTICE MANAGER Applicationc.ymcdn.com/sites/ · CERTIFIED VETERINARY PRACTICE MANAGER Application ... Completed_Confidential Letter of Recommendation Formsshould_