Veterinary Prescription Checklist
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|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|
|Generic name and level of inclusion in the feed of the medicating ingredient prescribed by the veterinarian||Medication|
|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|
|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|
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