Veterinary Prescription Checklist

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Veterinarian:
Clinic:
Producer:
Veterinary Prescription Checklist
(all items are mandatory unless otherwise indicated)
Requirements Items
Date on which the prescription is written Date
Veterinarian's signature (includes digital signature/identification methods) Signature
Name and address of the person for whom the feed is to be manufactured and by whom it is intended to be used Name
Address
Generic name and level of inclusion in the feed of the medicating ingredient prescribed by the veterinarian Medication
Inclusion Level
Type and amount of feed to be manufactured (The amount of feed manufactured does not exceed the amount that would be normally consumed by the number of animals prescribed to receive the feed during the prescribed period of medication) Type of Feed
Amount of Feed
Number, kind, class and age and/or weight of the livestock intended to be fed the feed Number
Kind
Class
Age and/or Weight
Special manufacturing instructions including necessary mill clean up warnings, if any Manufacturing Instructions
Feeding instructions or directions for use of the feed which should include the period of medication during which the feed is to be fed to the livestock Feeding Instructions
Warning statements and caution statements, where applicable Warnings
Cautions
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