United States Interstate And International Certificate of Health Examination for Small Animals

NVAP Module 2: Role of Agencies, Health Certicates
October 2010 • Page 2 of 2
“X” APPLICABLE STATEMENTS: The Owner/Consignor Certication box should be marked certifying that the animals
listed in the Animal Identication section are true and correct and that the individual identifying said animals has physical
and legal custody of such animals.
NOTE: The 2010 issue of the form does not have the acclimation certication. If the animal needs to have an ac-
climation certication made for the shipment, mark the box of “acclimated to air temperatures lower than 7.2º C”.
If the acclimation certication needs to be made and the form does not have the certication, the owner should print
the certication on the form and initial the certication. USDA released a new APHIS Form 7001 in November
2010. It is available online as a llable form at http://www.aphis.usda.gov/library/forms/pdf/APHIS7001.pdf.
NOTE: Box numbers have changed so read carefully and complete accordingly.
SIGNATURE: Signature of owner or consignor.
DATE: Date the form is signed by the owner or consignor.
6. VACCINATION HISTORY: To be completed by veterinarian.
**Attach a Rabies certicate with an original signature to this document.
RABIES: Mark type of rabies vaccine administered (Killed or Live).
DATE: Indicate the date that the vaccine was administered.
PRODUCT: Indicate the name of the product or manufacturer of the rabies vaccine administered.
D-H-L: Indicate the date and product name of the distemper, hepatitis, and leptospirosis vaccination if administered.
OTHER VACCINATIONS, TESTS OR TREATMENTS: Indicate any additional vaccinations administered or tests and
treatments performed.
DATE: Indicate the date that vaccination(s), test(s), or treatment(s) were administered.
TYPE/RESULT: Indicate any procedures performed and appropriate test results. Examples: Parvo Vacc,
Bruc Test/Neg.
VETERINARY CERTIFICATION: Mark with an “X” all appropriate statements.
NAME, ADDRESS AND TELEPHONE NUMBER: Name, mailing address, and telephone number (including area code)
of the certifying veterinarian.
LICENSE NO.: State license number of the certifying veterinarian. Check the appropriate box regarding accreditation status.
LICENSING STATE: Enter the state in which the veterinary license number posted in the above box was issued.
SIGNATURE: Signature of the certifying veterinarian. The National Accreditation Number (NAN) should be added after the
signature if required.
DATE: Date the document was signed by the certifying veterinarian.
ENDORSEMENT FOR INTERNATIONAL EXPORT: This section is to be lled out by the proper USDA veterinarian
(usually the Area Veterinarian-in-Charge).
APHIS Form 7001 United States Interstate and International Certicate of Health
Examination for Small Animals (Aug 2001 Version) (contd)
Page 2/2
Free Download

United States Interstate And International Certificate of Health Examination for Small Animals PDF

Favor this template? Just fancy it by voting!
  •  
  •  
  •  
  •  
  •  
(0 Votes)
0.0
Related Forms
  •  
  •  
  •  
  •  
  •  
2 Page(s) | 1089 Views | 3 Downloads
  •  
  •  
  •  
  •  
  •  
3 Page(s) | 1289 Views | 3 Downloads
  •  
  •  
  •  
  •  
  •  
9 Page(s) | 2450 Views | 1 Downloads
  •  
  •  
  •  
  •  
  •  
2 Page(s) | 1285 Views | 15 Downloads
  •  
  •  
  •  
  •  
  •  
1 Page(s) | 472 Views | 2 Downloads