You've probably all heard the joke about the horse that walks into a bar. The health care version goes like this: “A miniature horse walks into the emergency department. The triage nurse asks the horse ‘Why the long face?’” It's funny until you realize that the miniature horse is a service animal under the Americans with Disabilities Act (ADA), and you now have a horse hanging out in the emergency department with the patient. But let's rein this in and talk about that horse later. Joking aside, how do you manage a service animal in the health care setting? In 1990, the ADA became the US law that prohibits discrimination against individuals with disabilities in all areas of public life, including the workplace, schools, transportation, and any public and private place that is open to the general public. Specific to service animals, the ADA states that “individuals with disabilities shall be permitted to be accompanied by their service animals in all areas of a place of public accommodation where members of the public, program participants, clients, customers, patrons, or invitees, as relevant, are allowed to go.” 1 The ADA is divided into5 sections. Title I addresses employment issues and is designed to assist people with disabilities access the same employment opportunities and benefits available to people without disabilities. Often, this is manifested in employers providing reasonable accommodations to qualified applicants and current employees. Title II prohibits discrimination on the basis of disability by “public entities.” This covers programs, services, and activities operated by state and local governments. The public entity must ensure accessibility to individuals with disabilities. Title III prohibits private places of public accommodation from discriminating against individuals with disabilities. “Public accommodation” means anywhere the public is invited or permitted; this is the section that has the greatest impact on health care because it specifically includes doctor's offices and hospitals.2 Additionally, it establishes the minimum standards for accessibility for renovations and new construction. Title III classifies private health care services as a public accommodation regardless of federal financing status. 3