NAHMS 339 Fecal Data Collection Record

NAHMS Equine 2015

Fecal

Data Collection Record

National Animal Health Monitoring System

2150 Centre Ave, Bldg B

Fort Collins, CO 80526

Form Approved

OMB Number 0579-0269

EXP. DATE: XX/20XX

Animal and Plant

Health Inspection

Service

Veterinary

Services

Farm ID: (6 digits)	Kit #:	Collector’s name and phone #	Date: (mm/dd/yy)

1. How many resident equids are on this premises? _____ head

2. How many samples are being submitted to the lab? _____

# resident horses # horses to sample

Fewer than 10 All

10–19 10

20–49 15

50 or more 20

3. [Interviewer’s assessment. Do not ask this question of the owner.]

What is the overall cleanliness of the equine housing/pasture area compared to other equine operations in your area?

₁ Poor ₂ Average ₃ Excellent

4. Sample collection

• Place labels on whilrpak bags and write farm ID, animal name/unique ID, and sample number on each bag

• Turn a whirlpak bag inside out over your hand (wear gloves provided)

• Pick up a small handfull (golf ball sized) of fecal material from the ground

• Turn the bag right side out, squeeze any extra air out of the bag and close firmly

• Place all the labeled sample bags inside the large ziploc bag and seal the bag

• Keep samples cool (do not freeze the samples) and ship on ice within 24 hours

Paperwork and shipping

• Complete the information on the data collection form for each horse sampled

• Send the original white copy to your NAHMS coordinator within 3 business days

• Include the yellow copy on top of the styrofoam lid and ship with samples

• Ship overnight on Mon-Wed only. No shipping Thr-Sat.

• The lab cannot receive samples Fri-Sun.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0579-0269. The time required to complete this information collection is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

NAHMS-339

July 2014

Reference codes for Fecal Collection

Gender codes
1 – Intact male (stallion or colt)	4 – Pregnant female
2 – Castrated male (gelding)	5 – Spayed female
3 – Non-pregnant female (mare or filly)
Primary use codes
1 – Pleasure	4 – Racing
2 – Show or competition (not betting)	5 – Farm or ranch work
3 – Breeding	6 – Other (specify in column)
Equine type
1 = horse	4= pony
2 = mule	5 = miniature horse
3 = donkey	6 = other
Breed codes
1 – Appaloosa	9 – Quarter horse
2 – Arabian	10 – Standardbred
3 – Draft breed	11 – Tennessee Walker
4 – Miniature horse	12 – Thoroughbred
5 – Morgan	13 – Warmblood breeds
6 – Mustang	14 – Other registered breed (specify on collection form)
7 – Paint	15 – Other nonregistered breed (specify on collection form)
8 – Saddlebred
Antibiotics (see separate sheet)
Route of administration of antibiotic
1 = oral	2 = injected (into muscle or joint, or IV)

Sample #

Animal name or unique ID

A. Age (months or years)

B. Gender (See code sheet.)

C. Primary use (See code sheet.)

D. Equine Type (See code sheet.)

E. Breed (See code sheet.)

F. Fecal score 1=normal 2=soft/ cowpie-like 3=watery 4=bloody 5-other, describe

G. Body condition score 1=thin 2=normal 3=fat

H. Did this animal receive an antibiotic in the last 12 months? (Yes/No) [If No, SKIP cols I,J,&K.]

I. Did this animal receive an antibiotic in the last 30 days? (Yes/No) [If No, SKIP cols J&K.]

J. Which antibiotic(s) were given in the last 30 days (enter code)

K. Route of administration of antibiotic(s) if given in the last 30 days (enter code)

1

___ mo OR ___ yr

2

___ mo OR ___ yr

3

___ mo OR ___ yr

4

___ mo OR ___ yr

5

___ mo OR ___ yr

6

___ mo OR ___ yr

7

___ mo OR ___ yr

8

___ mo OR ___ yr

9

___ mo OR ___ yr

10

___ mo OR ___ yr

Sample #

Animal name or unique ID

A. Age (months or years)

B. Gender (See code sheet.)

C. Primary use (See code sheet.)

D. Equine Type (See code sheet.)

E. Breed (See code sheet.)

F. Fecal score 1=normal 2=soft/ cowpie-like 3=watery 4=bloody 5-other, describe

G. Body condition score 1=thin 2=normal 3=fat

H. Did this animal receive an antibiotic in the last 12 months? (Yes/No) [If No, SKIP cols I,J,&K.]

I. Did this animal receive an antibiotic in the last 30 days? (Yes/No) [If No, SKIP cols J&K.]

J. Which antibiotic(s) were given in the last 30 days (enter code)

K. Route of administration of antibiotic(s) if given in the last 30 days (enter code)

11

___ mo OR ___ yr

12

___ mo OR ___ yr

13

___ mo OR ___ yr

14

___ mo OR ___ yr

15

___ mo OR ___ yr

16

___ mo OR ___ yr

17

___ mo OR ___ yr

18

___ mo OR ___ yr

19

___ mo OR ___ yr

20

___ mo OR ___ yr

Code	Proprietary name	Established name	Manufacturer	Picture
1	Amiglyde-V	Amikacin	Zoetis
2	Amoxicillin	Amoxicillin	Ranbaxy
3	Ampicillin	Ampicillin	Various manufacturers
4	Zithromax	Azithromycin	Pfizer
5	Mefoxin	Cefoxitin	Merck
6	Ceftazidime	Ceftazidime	Various manufacturers
7	Simplicef	Cefpodoxime	Zoetis
8	Excede (Ceftiofur Crystalline Free Acid)	Ceftiofur	Zoetis
9	Naxcel (Ceftiofur Sodium)	Ceftiofur	Zoetis
10	Cefazolin (Injectable and Powder)	Cefazolin	Various manufacturers
11	Ceftriaxone	Ceftriaxone	Various manufacturers
12	ToDay	Cephapirin	Boehringer Ingelheim
13	Chloromy-cetin (Human)	Chloramphenicol	Pfizer
14	Biaxin	Clarithromycin	Abbott Laboratories
15	Doxycycline Hyclate (Powder, Tablet and Suspension) Vibramycin	Doxycycline	Various manufacturers
16	Baytril 100	Enrofloxacin	Bayer
17	Erygel	Erythromycin	Merz Pharma-ceutical
18	E-Mycin	Erythromycin	Pacific Pharma-ceutical
19	Nuflor	Florfenicol	Merck
20	Legacy	Gentamicin	AgriLabs
21	GentaMax	Gentamicin	Phoenix
22	Gentamicin Sulfate	Gentamicin	Vet One
23	Primaxin IV	Imipenem	Merck
24	Flagyl (Human form)	Metronidazole	Pfizer
25	Bio-Mycin	Oxytetracycline	Boehringer Ingelheim
26	Liquamycin LA-100 Liquamycin LA-200	Oxytetracycline	Zoetis
27	Terra-Vet	Oxytetracycline	Aspen
28	Penicillin G Potassium USP	Penicillin G Potassium	Agri Laboratories, Agripharm
29	Pen-G	Penicillin G Procaine	Phoenix
30	Pro-Pen-G	Penicillin G Procaine	Bimeda
31	PenOne Pro	Penicillin G Procaine	Vet One
32	Rifadin	Rifampin	Aventis Pharma-ceuticals
33	Rimactane	Rifampin	Novartis
34	Timentin	Ticarcillin	GlaxoSmith-Kline
35	Uniprim	Trimethoprim Sulfadiazine	Neogen
36	Tucoprim	Trimethoprim Sulfadiazine	Zoetis
37	SMZ Tablets	Trimethoprim Sulfadiazine	Various manufacturers
38	SMZ/TMP	Sulfamethoxazole Trimethoprim	Various manufacturers
39	Vanococin	Vancomycin	Baxter Healthcare, ViroPharma, Sandoz
40	Other	-	-	-