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This form is necessary for licensure under Illinois Compiled Statutes, requiring details on euthanasia and controlled substances used in animal shelters. It must be completed annually by January 31.
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How to fill out euthanasia and controlled substances
How to fill out Euthanasia and Controlled Substances Record
01
Start by obtaining the Euthanasia and Controlled Substances Record form from your facility or relevant authority.
02
Fill in the date at the top of the form.
03
Record the name and identification number of the animal being euthanized.
04
Note the reason for euthanasia, providing a brief explanation.
05
Document the type and quantity of controlled substances used for the procedure.
06
Include the name of the person administering the euthanasia.
07
Sign the record to certify that the procedure was performed according to regulations.
08
Ensure the record is kept in a secure location as per the facility’s guidelines.
Who needs Euthanasia and Controlled Substances Record?
01
Veterinarians performing euthanasia on animals.
02
Animal shelters and rescue organizations conducting euthanasia.
03
Clinics and hospitals involved in end-of-life care for pets.
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What is Euthanasia and Controlled Substances Record?
Euthanasia and Controlled Substances Record is a formal documentation used to track the use of euthanasia procedures and the controlled substances administered during these procedures in veterinary practices.
Who is required to file Euthanasia and Controlled Substances Record?
Veterinarians and veterinary technicians who perform euthanasia on animals and administer controlled substances are required to file the Euthanasia and Controlled Substances Record.
How to fill out Euthanasia and Controlled Substances Record?
To fill out the Euthanasia and Controlled Substances Record, practitioners should enter the date, animal identification, the controlled substances used, dosage administered, the reason for euthanasia, and the signatures of the personnel involved.
What is the purpose of Euthanasia and Controlled Substances Record?
The purpose of the Euthanasia and Controlled Substances Record is to ensure compliance with legal regulations regarding the use of controlled substances, promote accountability, and maintain accurate records for veterinary practices.
What information must be reported on Euthanasia and Controlled Substances Record?
Information that must be reported includes the date and time of euthanasia, pet identification details, type and quantity of controlled substances used, reason for euthanasia, and signatures of the veterinarian or technician involved.
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