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 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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