Form FDACS-09212 "Accession General Submission Form" - Florida

What Is Form FDACS-09212?

This is a legal form that was released by the Florida Department of Agriculture and Consumer Services - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 1, 2018;
  • The latest edition provided by the Florida Department of Agriculture and Consumer Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form FDACS-09212 by clicking the link below or browse more documents and templates provided by the Florida Department of Agriculture and Consumer Services.

ADVERTISEMENT
ADVERTISEMENT

Download Form FDACS-09212 "Accession General Submission Form" - Florida

709 times
Rate (4.8 / 5) 43 votes
Florida Department of Agriculture and Consumer Services
Contact Information:
Division of Animal Industry
Bronson Animal Disease
Bureau of Diagnostic Laboratory
Diagnostic Laboratory
Phone: (321) 697-1400
Fax: (321) 697-1467
ACCESSION GENERAL SUBMISSION FORM
ADAM H. PUTNAM
COMMISSIONER
FreshFromFlorida.com/BADDL
Chapter 585, Florida Statutes
Note: All documents and attachments submitted with this request are subject to public review pursuant to Chapter 119, F.S.
Sample Information
Send Results by:
Accession Number
Mail
Fax
Collection Date
$2 Mail/Fax
E-Mail
Report Fee
(no fee)
Premise ID
Each Report
FDACS Use Only
Submitter
Owner
-
Same as Submitter
Name
Name
Clinic
Address
Name
City,
Address
State, Zip
City, State, Zip
Phone
Phone
Mobile
Animal Identification (Use Continuation Form FDACS-09228 for additional specimens / history)
Sex Codes: M=Male, F=Female, C=Castrated Male, S=Spayed Female
Animal or Sample ID
Species
Breed
Sex
Age
Tests Requested*
1
2
3
4
5
6
7
8
*For up-to-date test list, sample requirements and pricing information, please visit our website at:
FreshFromFlorida.com/BADDL
Sample Description:
Blood, EDTA
Qty:
Serum
Qty:
Feces
Qty:
Hair
Qty:
Type and Quantity of
Tissue (fixed)
Qty:
Fluid
Qty:
Slide
Qty:
Swab
Qty:
Specimens:
Tissue (fresh)
Qty:
Carcass
Qty:
Other
Qty:
Testing Purpose:
Clinical
Regulatory
Surveillance
Import
Export Country of Destination:
Type of flock/herd:
Size of flock/herd:
Number sick:
Number sampled:
History / Provisional Diagnosis:
If necropsy,
Natural Death
Euthanasia
Date & time of death:
Bronson Animal Disease Diagnostic Laboratory Delivery Service Address
2700 N John Young Pkwy, Kissimmee, FL 34741-1266
* We regret that we are unable to return any animal samples or remains submitted for necropsy or other analyses.
FDACS-09212 Rev. 02/18
Florida Department of Agriculture and Consumer Services
Contact Information:
Division of Animal Industry
Bronson Animal Disease
Bureau of Diagnostic Laboratory
Diagnostic Laboratory
Phone: (321) 697-1400
Fax: (321) 697-1467
ACCESSION GENERAL SUBMISSION FORM
ADAM H. PUTNAM
COMMISSIONER
FreshFromFlorida.com/BADDL
Chapter 585, Florida Statutes
Note: All documents and attachments submitted with this request are subject to public review pursuant to Chapter 119, F.S.
Sample Information
Send Results by:
Accession Number
Mail
Fax
Collection Date
$2 Mail/Fax
E-Mail
Report Fee
(no fee)
Premise ID
Each Report
FDACS Use Only
Submitter
Owner
-
Same as Submitter
Name
Name
Clinic
Address
Name
City,
Address
State, Zip
City, State, Zip
Phone
Phone
Mobile
Animal Identification (Use Continuation Form FDACS-09228 for additional specimens / history)
Sex Codes: M=Male, F=Female, C=Castrated Male, S=Spayed Female
Animal or Sample ID
Species
Breed
Sex
Age
Tests Requested*
1
2
3
4
5
6
7
8
*For up-to-date test list, sample requirements and pricing information, please visit our website at:
FreshFromFlorida.com/BADDL
Sample Description:
Blood, EDTA
Qty:
Serum
Qty:
Feces
Qty:
Hair
Qty:
Type and Quantity of
Tissue (fixed)
Qty:
Fluid
Qty:
Slide
Qty:
Swab
Qty:
Specimens:
Tissue (fresh)
Qty:
Carcass
Qty:
Other
Qty:
Testing Purpose:
Clinical
Regulatory
Surveillance
Import
Export Country of Destination:
Type of flock/herd:
Size of flock/herd:
Number sick:
Number sampled:
History / Provisional Diagnosis:
If necropsy,
Natural Death
Euthanasia
Date & time of death:
Bronson Animal Disease Diagnostic Laboratory Delivery Service Address
2700 N John Young Pkwy, Kissimmee, FL 34741-1266
* We regret that we are unable to return any animal samples or remains submitted for necropsy or other analyses.
FDACS-09212 Rev. 02/18