Form FDACS-09107 "Contagious Equine Metritis Treatment and Testing Procedures Worksheet for Mares" - Florida

What Is Form FDACS-09107?

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 March 1, 2013;
  • 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-09107 by clicking the link below or browse more documents and templates provided by the Florida Department of Agriculture and Consumer Services.

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Download Form FDACS-09107 "Contagious Equine Metritis Treatment and Testing Procedures Worksheet for Mares" - Florida

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Remit $1,250.00 for the first horse
Florida Department of Agriculture and Consumer Services
and $750.00 Fee for each additional
Division of Animal Industry
horse in the same group Online at:
www.FreshFromFlorida.com
Bureau of Animal Disease Control
- or -
Check or Money Order Payable to
CONTAGIOUS EQUINE METRITIS
FDACS and remit to:
NICOLE "NIKKI" FRIED
TREATMENT AND TESTING
FDACS
COMMISSIONER
P.O. Box 6710
PROCEDURES WORKSHEET FOR MARES
Tallahassee, Florida
32314-6710
Pursuant to 5C-22.005(3), FAC, and 9 CFR § 92.301(e)
EquinePrograms@FreshFromFlorida.com
www.FreshFromFlorida.com/ai
The procedures outlined below apply to all imported mares over 731 days of age and those mares 731 days of
PERMIT #:
age or younger that have been bred.
Name of Mare
Pregnancy Status:
Pregnant
Non-Pregnant
Identification of Mare
QUARANTINED AT THE FOLLOWING FACILITY:
Approved CEM Quarantine Facility
Date of Arrival
All required laboratory tests and cultures must be conducted by the Bronson Animal Disease Diagnostic Laboratory in Kissimmee or by
the USDA National Veterinary Services Laboratory in Ames, Iowa. All materials for culture and serological testing must be properly
identified (see USDA, VS Guidance Document, 13406.1) and MUST BE RECEIVED BY THE LABORATORY WITHIN 48 HOURS OF
COLLECTION. Specimens must be submitted in Ames transport media (with charcoal) and refrigerated at approximately four to six
degrees centigrade (39-42ºF) during transit. Payment of charges for the required tests is the responsibility of the veterinarian submitting
the samples.
TESTING AND TREATMENT REQUIREMENTS FOR MARES
1. a.
Complement Fixation Test (CF):
All imported mares shall have blood collected for a Complement Fixation test upon arrival at the
Approved CEM Quarantine Facility.
Date of Sample Drawn
Results of CF Test
:
Lab Name and Accession Number
DATE
b.
Specimen Collection:
Specimens shall be collected from the mare on three (3) separate occasions within a twelve (12) day
period, with a minimum of 72 hours between culture sets. Specimens shall be collected from mucosal
surfaces of the clitoral fossa, the clitoral sinuses, and the cervix and/or uterus (endometrium).
Clitoral fossa
Clitoral Sinuses
(1) Cervical or (2) Endometrial
Laboratory
Accession Number
Indicate with number (1) or (2)
Name
1
Culture
Date Collected:
Date Collected:
Date Collected:
st
Results:
Results:
Results:
2
Culture
Date Collected:
Date Collected:
Date Collected:
nd
Results:
Results:
Results:
3
Culture
Date Collected:
Date Collected:
Date Collected:
rd
Results:
Results:
Results:
Comments:
Comments:
Comments:
Press Tab several times to continue to page two.
Org. Code 42090201000
EO: A2 EO
Object Code: 001196
$1,250.00 / $750.00
FDACS-09107 Rev. 03/13
Page 1 of 2
Remit $1,250.00 for the first horse
Florida Department of Agriculture and Consumer Services
and $750.00 Fee for each additional
Division of Animal Industry
horse in the same group Online at:
www.FreshFromFlorida.com
Bureau of Animal Disease Control
- or -
Check or Money Order Payable to
CONTAGIOUS EQUINE METRITIS
FDACS and remit to:
NICOLE "NIKKI" FRIED
TREATMENT AND TESTING
FDACS
COMMISSIONER
P.O. Box 6710
PROCEDURES WORKSHEET FOR MARES
Tallahassee, Florida
32314-6710
Pursuant to 5C-22.005(3), FAC, and 9 CFR § 92.301(e)
EquinePrograms@FreshFromFlorida.com
www.FreshFromFlorida.com/ai
The procedures outlined below apply to all imported mares over 731 days of age and those mares 731 days of
PERMIT #:
age or younger that have been bred.
Name of Mare
Pregnancy Status:
Pregnant
Non-Pregnant
Identification of Mare
QUARANTINED AT THE FOLLOWING FACILITY:
Approved CEM Quarantine Facility
Date of Arrival
All required laboratory tests and cultures must be conducted by the Bronson Animal Disease Diagnostic Laboratory in Kissimmee or by
the USDA National Veterinary Services Laboratory in Ames, Iowa. All materials for culture and serological testing must be properly
identified (see USDA, VS Guidance Document, 13406.1) and MUST BE RECEIVED BY THE LABORATORY WITHIN 48 HOURS OF
COLLECTION. Specimens must be submitted in Ames transport media (with charcoal) and refrigerated at approximately four to six
degrees centigrade (39-42ºF) during transit. Payment of charges for the required tests is the responsibility of the veterinarian submitting
the samples.
TESTING AND TREATMENT REQUIREMENTS FOR MARES
1. a.
Complement Fixation Test (CF):
All imported mares shall have blood collected for a Complement Fixation test upon arrival at the
Approved CEM Quarantine Facility.
Date of Sample Drawn
Results of CF Test
:
Lab Name and Accession Number
DATE
b.
Specimen Collection:
Specimens shall be collected from the mare on three (3) separate occasions within a twelve (12) day
period, with a minimum of 72 hours between culture sets. Specimens shall be collected from mucosal
surfaces of the clitoral fossa, the clitoral sinuses, and the cervix and/or uterus (endometrium).
Clitoral fossa
Clitoral Sinuses
(1) Cervical or (2) Endometrial
Laboratory
Accession Number
Indicate with number (1) or (2)
Name
1
Culture
Date Collected:
Date Collected:
Date Collected:
st
Results:
Results:
Results:
2
Culture
Date Collected:
Date Collected:
Date Collected:
nd
Results:
Results:
Results:
3
Culture
Date Collected:
Date Collected:
Date Collected:
rd
Results:
Results:
Results:
Comments:
Comments:
Comments:
Press Tab several times to continue to page two.
Org. Code 42090201000
EO: A2 EO
Object Code: 001196
$1,250.00 / $750.00
FDACS-09107 Rev. 03/13
Page 1 of 2
CONTAGIOUS EQUINE METRITIS TREATMENT AND TESTING PROCEDURES WORKSHEET FOR MARES
2.
Treatment:
After the sets of specimens are collected as prescribed above the clitoral sinuses and
fossa are cleaned of organic debris flushed with a cerumalytic agent. Following this for the
next 5 consecutive days, the external genitalia, vaginal vestibule and clitoral fossa and
clitoral sinuses (if present) shall be aseptically cleaned and washed (scrubbed) with a
solution of not less than 2% chlorhexidine in a detergent base. This is followed by filling
the clitoral fossa and sinuses and coating the vaginal vestibule and external genitalia with
antibiotic ointment effective against the CEM organism.
Comments:
Day 1
Date:
Day 2
Date:
Day 3
Date:
Day 4
Date:
Day 5
Date:
Recommended protocols for flushing of
A list of ointments effective against the CEM organism may be
clitoral sinuses may be obtained from the
obtained from the
National Center of Import and Export,
Import/Export Animals, VS, APHIS,
4700 River Road Unit 39,
Riverdale, MD 20737-1231.
QUARANTINE RELEASE
The mare may be released from quarantine when the CF test and all cultures performed on specimens taken from the mare are negative
for CEM and all protocols for specimen collection and treatment of the mare are conducted in accordance with 9 CFR 93.301(e)(5).
CEM PROTOCOL CERTIFICATION
Attending Veterinarian, Printed
Florida License Number
Signature of Attending Veterinarian
Date
Division of Animal Industry Representative, Printed
Signature of Division Representative
Date
FDACS-09107 Rev. 03/13
Page 2 of 2
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