Farm Name: Product: Product: Size: Size: Rx Expiration Rx Expiration Unlimited Yes Unlimited Yes Date: Date: Quantity: Quantity: Quantity: Quantity: No No Refills: Refills: Animal ID Adult Dairy Cattle Youngstock Beef Animal ID Adult Dairy Cattle Youngstock Beef or Group or Group: Dairy Veal Other: Dairy Veal Other: Directions: Specify instructions below OR Directions: Specify instructions below OR Read and follow manufacturer instructions along with withholds Read and follow manufacturer instructions along with withholds Hold Milk Hours Hold Meat Days Hold Milk Hours Hold Meat Days Test milk/urine before marketing Test milk/urine before marketing Product: Product: Size: Size: Rx Expiration Rx Expiration Yes Yes Unlimited Unlimited Date: Date: Quantity: Quantity: Quantity: Quantity: No No Refills: Refills: Animal ID Adult Dairy Cattle Youngstock Beef Animal ID Adult Dairy Cattle Youngstock Beef or Group or Group: Dairy Veal Other: Dairy Veal Other : Directions: Specify instructions below OR Directions: Specify instructions below OR Read and follow manufacturer instructions along with withholds Read and follow manufacturer instructions along with withholds Hold Milk Hours Hold Meat Days Hold Milk Hours Hold Meat Days Test milk/urine before marketing Test milk/urine before marketing Product: Product: Size: Size: Rx Expiration Rx Expiration Yes Yes Unlimited Unlimited Date: Date: Quantity: Quantity: Quantity: Quantity: No No Refills: Refills: Animal ID Adult Dairy Cattle Youngstock Beef Animal ID Adult Dairy Cattle Youngstock Beef or Group or Group: Dairy Veal Other : Dairy Veal Other: Directions: Specify instructions below OR Directions: Specify instructions below OR Read and follow manufacturer instructions along with withholds Read and follow manufacturer instructions along with withholds Hold Milk Hours Hold Meat Days Hold Milk Hours Hold Meat Days Test milk/urine before marketing Test milk/urine before marketing Client: Farm Name: Product: Product: Size: Size:
Farm Name: Product: Product: Size: Size: Unlimited Quantity: Yes Rx Expiration Date: Unlimited Quantity: Yes Rx Expiration Date: No Quantity: No Quantity: Refills: Refills: Animal ID or Group Adult Dairy Cattle Youngstock Beef Animal ID or Group: Adult Dairy Cattle Youngstock Beef Dairy Veal Other: Dairy Veal Other: Directions: Specify instructions below OR Read and follow manufacturer instructions along with withholds Directions: Specify instructions below OR Read and follow manufacturer instructions along with withholds Hold Milk Hours Hold Meat Days Hold Milk Hours Hold Meat Days Test milk/urine before marketing Test milk/urine before marketing Product: Product: Size: Size: Unlimited Quantity: Yes Rx Expiration Date: Unlimited Quantity: Yes Rx Expiration Date: No Quantity: No Quantity: Refills: Refills: Animal ID or Group Adult Dairy Cattle Youngstock Beef Animal ID or Group: Adult Dairy Cattle Youngstock Beef Dairy Veal Other: Dairy Veal Other : Directions: Specify instructions below OR Read and follow manufacturer instructions along with withholds Directions: Specify instructions below OR Read and follow manufacturer instructions along with withholds Hold Milk Hours Hold Meat Days Hold Milk Hours Hold Meat Days Test milk/urine before marketing Test milk/urine before marketing Product: Product: Size: Size: Unlimited Quantity: Yes Rx Expiration Date: Unlimited Quantity: Yes Rx Expiration Date: No Quantity: No Quantity: Refills: Refills: Animal ID or Group Adult Dairy Cattle Youngstock Beef Animal ID or Group: Adult Dairy Cattle Youngstock Beef Dairy Veal Other : Dairy Veal Other: Directions: Specify instructions below OR Read and follow manufacturer instructions along with withholds Directions: Specify instructions below OR Read and follow manufacturer instructions along with withholds Hold Milk Hours Hold Meat Days Hold Milk Hours Hold Meat Days Test milk/urine before marketing Test milk/urine before marketing Client: Farm Name: Product: Product: Size: Size:
Prescription%20Form.docx