"Request to Use Amicar" - Delaware

This fillable "Request to Use Amicar" is a document issued by the Delaware Department of Agriculture specifically for Delaware residents.

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DELAWARE HARNESS RACING COMMISSION
REQUEST TO USE AMICAR
NAME OF HORSE___________________________
DATE:_________________
TATTOO NUMBER___________________________
TRACK:_______________
Only horses that are ON SALIX (furosemide) may be given Amicar.
Amicar may be used only in addition to Salix; never without Salix.
Trainers must declare use of Amicar when the horse is entered.
Once on Amicar, a horse must remain on Amicar for at least 30 calendar days; if
removed from Amicar, a horse must remain off Amicar for at least 90 calendar days.
Amicar will not be administered at the same time as Lasix. Amicar will be given by the
Bleeder Medication Veterinarian (formerly “Lasix Vet”) in the horse’s race stall, 60 to
90 minutes prior to racing.
TRAINER’S NAME (PRINT) _____________________________
TRAINER’S SIGNATURE _______________________________
APPROVED______________________ DATE:____________
(Bleeder Medication Vet)
IN REFERENCE TO RULE 8.3.5
DELAWARE HARNESS RACING COMMISSION
REQUEST TO USE AMICAR
NAME OF HORSE___________________________
DATE:_________________
TATTOO NUMBER___________________________
TRACK:_______________
Only horses that are ON SALIX (furosemide) may be given Amicar.
Amicar may be used only in addition to Salix; never without Salix.
Trainers must declare use of Amicar when the horse is entered.
Once on Amicar, a horse must remain on Amicar for at least 30 calendar days; if
removed from Amicar, a horse must remain off Amicar for at least 90 calendar days.
Amicar will not be administered at the same time as Lasix. Amicar will be given by the
Bleeder Medication Veterinarian (formerly “Lasix Vet”) in the horse’s race stall, 60 to
90 minutes prior to racing.
TRAINER’S NAME (PRINT) _____________________________
TRAINER’S SIGNATURE _______________________________
APPROVED______________________ DATE:____________
(Bleeder Medication Vet)
IN REFERENCE TO RULE 8.3.5
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