SAMPLE: LOGOS MISSING

 

Producer/owner:

Name:______________________

TREATMENT HISTORY RECORD

 

 

 

PROTOCOL #
List all antibiotics (antimicrobials) used for treatment (Lot #)
Injection site

Injection Route (IM, SubQ, IV)

Withdrawal Time

Label Dose

A
         
B 
          
C
          
D
          
E
          
F
          
Animal ID
Protocal
Date

Earliest Harvest Date

  
Animal ID
Protocal
Date
Earliest Harvest Date
  
Animal ID
Protocal
Date
Earliest Harvest Date
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           
                           

I certify that all products were given in compliance with federal and state laws; therefore,complying with specified withdrawal time requirements.

Further, I certify that these animals did not receive any animal protein products except milk, blood or fat products, or protein from swine or poultry in compliance with FDA regulations.

Signed: ________________________ Date: __________

  
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