Form AQS-39 "Summary for Veterinarians" - Hawaii

What Is Form AQS-39?

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

Form Details:

  • Released on August 21, 2019;
  • The latest edition provided by the Hawaii Department of Agriculture;
  • 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 printable version of Form AQS-39 by clicking the link below or browse more documents and templates provided by the Hawaii Department of Agriculture.

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Download Form AQS-39 "Summary for Veterinarians" - Hawaii

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8/21/2019
RABIES QUARANTINE BRANCH
99-951 Halawa Valley Street
Aiea, HI 96701
Phone (808) 483-7151
Fax (808) 483-7161
e-mail: RabiesFree@hawaii.gov
DEAR PET OWNER: PLEASE PRESENT THIS FORM TO THE VETERINARIAN WHO WILL
PREPARE THE HEALTH CERTIFICATE FOR YOUR PET.
Dear Doctor:
This summary is provided to assist in the process of preparing your client’s pet for Hawaii’s 5
Day Or Less quarantine program. Please fill out one form for each animal as completely as
possible and sign it. The signature must be the same as the one on the health certificate. Do not
hesitate to call, fax or email us with any questions. Thank you. Refer to the information on page
2 and the “Checklist For 5-Day-Or-Less Program” for complete requirements.
Owners Name:
Pet Name:
Microchip Number:
Species (Canine or Feline):
HEALTH CERTIFICATE MUST:
Be filled out in English
Have the microchip number listed
Have veterinary identifying information
Have animal identifying information
Have necessary rabies vaccination
information
1
Confirm animal treated with fipronil or equivalent product within 14 days of arrival
(Revolution not acceptable) List product and date animal was treated.
*
Most Recent Rabies Vaccination
Previous Rabies Vaccination
(Not within 30 days before arrival)
Product
(More than 30 days before most recent rabies vaccination)
2
Product or Mfg name:
or Mfg name:
Date Administered:
Date Administered:
Route Administered:
Route Administered:
Serial or Lot Number:
Serial or Lot Number:
Expiration date of the Lot
Expiration date of the Lot:
*(3 Year licensed vaccines are valid for 36 months)
(1 Year licensed vaccines are valid for 12 months)
_____________________________________________________________________
Print Veterinarian’s Name
Signature
Date
Properly executed rabies vaccination certificates will suffice.
1
If detailed information is not available for this vaccination, documentation of administration of the vaccine will suffice.
2
1
8/21/2019
RABIES QUARANTINE BRANCH
99-951 Halawa Valley Street
Aiea, HI 96701
Phone (808) 483-7151
Fax (808) 483-7161
e-mail: RabiesFree@hawaii.gov
DEAR PET OWNER: PLEASE PRESENT THIS FORM TO THE VETERINARIAN WHO WILL
PREPARE THE HEALTH CERTIFICATE FOR YOUR PET.
Dear Doctor:
This summary is provided to assist in the process of preparing your client’s pet for Hawaii’s 5
Day Or Less quarantine program. Please fill out one form for each animal as completely as
possible and sign it. The signature must be the same as the one on the health certificate. Do not
hesitate to call, fax or email us with any questions. Thank you. Refer to the information on page
2 and the “Checklist For 5-Day-Or-Less Program” for complete requirements.
Owners Name:
Pet Name:
Microchip Number:
Species (Canine or Feline):
HEALTH CERTIFICATE MUST:
Be filled out in English
Have the microchip number listed
Have veterinary identifying information
Have animal identifying information
Have necessary rabies vaccination
information
1
Confirm animal treated with fipronil or equivalent product within 14 days of arrival
(Revolution not acceptable) List product and date animal was treated.
*
Most Recent Rabies Vaccination
Previous Rabies Vaccination
(Not within 30 days before arrival)
Product
(More than 30 days before most recent rabies vaccination)
2
Product or Mfg name:
or Mfg name:
Date Administered:
Date Administered:
Route Administered:
Route Administered:
Serial or Lot Number:
Serial or Lot Number:
Expiration date of the Lot
Expiration date of the Lot:
*(3 Year licensed vaccines are valid for 36 months)
(1 Year licensed vaccines are valid for 12 months)
_____________________________________________________________________
Print Veterinarian’s Name
Signature
Date
Properly executed rabies vaccination certificates will suffice.
1
If detailed information is not available for this vaccination, documentation of administration of the vaccine will suffice.
2
1
HDOA is committed to maintaining an environment free from discrimination, retaliation, or harassment on the basis of race, color, sex, sexual
orientation, religion, national origin, age, or disability with respect to any employment, program or activity. Should you feel you have been discriminated
against, please contact the HDOA Title VI Coordinator at 1428 S. King Street, Honolulu, HI 96814, (808) 973-9560 or via email at
hdoa.info@hawaii.gov. For information on how to file a complaint, go to: http://hdoa.hawaii.gov/blog/main/discriminationcomplaints/.
The following is a summary of entry requirements for Dogs and Cats to qualify for 5-Day Or Less
quarantine program. Please refer to the “Checklist For 5-Day-Or-Less Program” for all requirements
available at: http://hawaii.gov/hdoa/ai/aqs/info.
RABIES VACCINATIONS:
At least two rabies vaccinations are required.
A nimals with a prior vaccination history that can be documented need a booster vaccination
given. This booster must be given more than 30 days after the prior documented vaccination. This
booster must not be expired by the date the pet arrives in Hawaii (no more than 12 months before
arrival for 1 year licensed rabies vaccines and no more than 36 months before arrival for 3 year
licensed rabies vaccines) and the booster must be given more than 30 days before arrival.
F or animals that have never been vaccinated for rabies, there must be an interval of one month
(30 days) or more between the two required vaccinations. This category would include adult
animals with no documented history of rabies vaccination and puppies and kittens. For puppies,
vaccination cannot be given before three (3) months of age with current vaccines. For kittens, a
vaccine is available that can be administered at two (2) months of age (check with your veterinarian).
For puppies and kittens you must wait at least one month (thirty days) before a booster vaccination
can be administered.
The most recent vaccination is valid for 12 months for 1 year licensed rabies vaccines. For 3 year
licensed rabies vaccines, the most recent vaccination is valid for 36 months.
No rabies vaccination may be given within the immediate 30 days before arrival in Hawaii.
Please insure that your veterinarian does not inadvertently administer a rabies vaccination during
the immediate 30 days prior to entry. The above listed time intervals and expirations are required
and specific. Vaccinations not in compliance with these requirements will disqualify a pet from the
5-Day-Or-Less pr ogram.
An electronic microchip (U.S. or ISO spec.) must be
ELECTRONIC MICROCHIP IMPLANTATION:
implanted prior to or when blood is collected for rabies serology (OIE-FAVN test). The microchip number
must be recorded on the laboratory submission form completed by your veterinarian.
Laboratories will not perform the OIE-FAVN test without a numeric or alphanumeric electronic
microchip sequence recorded on the submission form.
PRE-ARRIVAL RABIES BLOOD TEST (OIE-FAVN):
A passing result is 0.5 International Units
(IU) or more. Laboratory results will be sent to your veterinarian and directly to Animal Quarantine. Do not
call laboratories about results. Instead contact your veterinarian to make sure that the result is adequate
and to obtain a copy of the results. If blood is collected for the OIE-FAVN test at the same time as rabies
vaccination, your animal may fail the test. If this occurs, repeat testing in 10 to 14 days usually results in
an adequate test result. Be sure HAWAII is listed as the destination on the lab submission form!
• For the 5-Day-Or-Less Program:
The most recent OIE-FAVN test is valid for 36 months.
Animal must wait at least 30 days from the time the blood sample is received by the laboratory
before arriving in Hawaii to be considered for 5-Day-Or-Less quarantine. The mandatory waiting
period after passing the test is 30 days.
PRE-ARRIVAL WAITING PERIODS:
Animals must meet both of the following minimum waiting
periods after a recent rabies vaccination or passing an OIE-FAVN blood test.
• Following a successful OIE-FAVN test result, animals must wait at least 30 days before arriving in
Hawaii. If arrival occurs before 30 days has elapsed, the animal is subject to quarantine until 30 days
are completed for it to then qualify for the 5-Day-Or-Less program.
• Following the most recent rabies vaccination, animals must wait at least 30 days before arriving in
Hawaii. If arrival occurs before 30 days has elapsed from the most recent rabies vaccination, the
animal is subject to quarantine until 30 days are completed for it to then qualify for the 5-Day-Or-
Less
program.
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