Request for Payment of Veterinary Services for DSA Brucellosis Testing
This form is to be filled out by contracted veterinarians only.
Veterinarian Name
*
Clinic Name
*
Clinic Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Client Name
*
Commuter Permit #
*
Client Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date Tested
*
-
Month
-
Day
Year
Date
Number of Cattle Tested
*
Amount to reimburse ($5 per head)
Amount shown is in dollars
UVDL Accession #
*
Conditions (check to show agreement with these conditions):
*
I understand that no less than 20% of breeding-age cattle returning from the DSA are to be tested for brucellosis no later than November 30, 2020. The tested cattle will include all open, late-bred, or dry cows and breeding-age heifers, bulls, and all cull cattle. Pregnant cattle will make up the rest of the tested animals.
I understand that the State Veterinarian may require more than 20% testing for herds at higher risk of brucellosis infection based on grazing locations and dates.
I understand that if I submit blood from cattle that were not in the DSA on a commuter permit, I will not receive payment for those cattle.
I understand that the cattle may not be released for grazing or commingled with other herds until the test results come back negative. If the blood samples are broken, autolyzed, or otherwise unable to be tested, additional tests must be taken before the animals may be released.
I agree to provide a copy of the test results to my client for submission to UDAF as proof of testing.
By clicking "Submit", I agree that the information above is correct to the best of my knowledge. Payment will not be made until the provided information is confirmed.
Submit
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