This pre-admission certificate must be completed by the veterinarian referring the case to the CHUV.
(*) Required fields.
Name of the stable:
Horse name : *
Influenza : this horse is vaccinated against influenza (primary vaccination and
booster in the last 6 months, at least one week before admission). For the moment, elective unvaccinated cases are not admitted.*
Name of vaccine if known, and date of last vaccine booster :
Herpes virus : this horse is vaccinated against herpes (EHV) (primary vaccination
and booster in the last 6 months, at least one week before admission).*
GENERAL HISTORY (BIOSECURITY)
Has the horse shown any cough, fever, nasal discharge or diarrhea in the past 2 weeks?*
If yes, date of the last signs:
Have the horses in the stable shown any signs of respiratory illness, fever or diarrhea during the past 2 weeks?*
I confirm that the information is correct.*
Your name (veterinarian): *
Your email (a copy of this certificate will be sent to you):*