Lab use only:
Equine Export
Specimen Advice
V1
Date received
Submitter & Clinic Details:
ABN:
Address:
Phone :
Mobile:
Email:
Export Details
Invoice to: Export Agent ☐ Submitter ☐
Export Agent:
Phone:
(submitter charged if not specified)
Fax:
Email:
Country of Destination:
☐ Protocol attached – if no, please specify testing dilutions if applicable.
Departure Date:
PEQ Start date (if applicable):
TESTING REQUIREMENTS – Please mark
☐ Equine Infectious Anaemia (coggins) AGID
☐ Equine Influenza by PCR – nasal swabs
☐ Strep Equine Culture (Strangles)
☐ Equine Viral Arteritis (EVA) VNT
☐ Equine Herpes Virus (EHV1) VNT
☐ Other
☐ Hendra Virus ELISA
☐ Equine Influenza – EIH1
Please specify
Number of Horses:
Total Samples:
Collection date:
Details of Horses – all sample tubes MUST have a serial sample number
Horse name / ID
Description of Horse
Consignor/Vendor’s name &
address of property of origin
1.
2.
3.
4.
5.
Details of further horses in this consignment should be presented on a separate piece of paper.
Conditions apply to submitting samples for testing:
1. Samples must be received at EMAI at least seven (7) days before the stated export departure date.
2. DPI makes NO representation that the test results will be available before the state export departure date.
3. DPI makes NO responsibility for any costs related to a delayed departure should test results NOT be available until after the stated export
departure date.
Veterinarian’s Name (please print)
EMAI Form SRD 3
QA
Sign
18/12/2015
Date
Page 1 of 2
D ☐ M ☐ AI ☐ E ☐ OTHER ☐_____________ NOTIFIABLE ☐ EXOTIC ☐ ACCREDITATION ☐ TSE ☐ RESIDUE ☐ ANIMAL WELFARE ☐
Details of Horses – all sample tubes MUST have a serial sample number
Sample
Number
Horse name / ID
Description of Horse
(breed, sex, age, colour & brands)
Consignor/Vendor’s name
& address of property of
origin
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
Details of further horses in this consignment should be presented on a separate piece of paper.
EMAI Form SRD 3
QA
18/12/2015
Page 2 of 2
D ☐ M ☐ AI ☐ E ☐ OTHER ☐_____________ NOTIFIABLE ☐ EXOTIC ☐ ACCREDITATION ☐ TSE ☐ RESIDUE ☐ ANIMAL WELFARE ☐