Instructions for completing VS Form 10-11 (version FEB 2018)

Last Modified: December 16, 2024

Completion of Blocks 2 - 22 is required; if none write none.

The NARRATIVE DESCRIPTION OF PERMANENT WHITE MARKINGS, BRANDS, TATTOOS, SCARS, AND WHORLS is required, regardless of whether photographs or line drawings are submitted.

Suggested nomenclature includes: Heel/s, Coronet, Half Pastern, Pastern, Fetlock, Half Canon, Canon, Carpus/Hock, above Carpus/Hock

Block 1: Accession Numbers 
Leave blank.

Block 2: Date Blood Drawn
Indicate the date the veterinarian obtained the sample from the animal. This is the official test date.

Block 3: Test Requested by Veterinarian
The veterinarian determines which test should be run by the laboratory - based on the reason for the testing.

Block 4: Reason for Testing
If more than one option applies, mark the most compelling reason for performing the test at this time.

  • Interstate Movement = movement between States.
    Within State Use/Annual = movement within a State (intrastate), shows/events, or any annual or routine testing.
    Change Ownership/Sale = includes tests run for private sales, markets or auctions whether required by state law or otherwise.
    International Import/Export = international movement into or out of the USA.
    Illness/Clinical Suspect = diagnostic testing of sick animals.
    Investigation/Exposure = official investigations by authorities.

Block 5: Location of current home premises at blood draw
Physical address of the current home premises or residence of the animal. This includes farms, stables or racetracks - where the animal lives at the time the blood is drawn. It may include a market location if the home address is unknown. It should NOT include a temporary location such as a veterinary clinic. DO NOT use a Post Office Box.

Block 6: County of current home premises of equine at blood draw
The county of the equine residence in Box 5.

Block 7: Name and Address of Owner
May be a market or auction.

Block 8a: Veterinarian Name
Name of veterinarian. DO NOT enter a practice name.

Block 8b: Veterinarian National Accreditation Number
National Veterinary Accreditation Number of Cat II accredited veterinarian who drew the blood sample.

Block 8c: Signature
Signature of the accredited veterinarian who drew the blood sample.

Block 8d: Signature Date 
The date the veterinarian signed the form.

Blocks 8e, f, g.: Veterinarian’s Mailing Address, Phone Number 
Mailing address and phone number for veterinarian. PO BOX is permitted for use.

Block 9: Tube Number 
If applicable, per accredited veterinarian.

Block 10: Tag/Tattoo/Brand Number
Enter all tattoo numbers and brand(s) present and any tag number used for ID. If none enter NONE.

Block 11: Name of Animal
If the animal does not have a name enter NONE however, a unique identifying number associated with the animal will be required in Block 14 or 20.

Block 12: Color 
Enter coat or hair color(s).

Block 13: Breed of Horse or Species
Enter the horse’s breed(s). If equid is not a horse enter the species. Ex: donkey, mule, hinny or zebra.

Block 14: Age or DOB
Record the animal’s age (XX) in years (Y); use months (M) if less than one year (Example: 01Y or 12M), or indicate the date of birth: MM/DD/YYYY.

Block 15: Sex 
Use abbreviations in the box to the right; indicate sex.

Block 16: Microchip, Breed, or Registration Number
Enter the microchip number, and/or breed registration number or other ID number. If none enter NONE.

Silhouette/Line drawing

  • Instructions: This section, while not required, complements the required narrative descriptions in Blocks 21 – 26. Show, draw or otherwise represent all permanent white markings, brands, tattoos, and scars. Mark whorls with an X. The animal should be uniquely identified. Non-descript animals require greater detail; use whorls and scars to properly identify the animal. Detailed brands can be drawn.

Blocks 17 - 22: Head, Neck & Body, Left Fore-limb, Right Fore-limb, Left Hind-limb, Right Hind-limb.

  • The narrative description is required; indicate all permanent white markings, brands, tattoos, scars, & whorls. Blank blocks are not acceptable - if none enter NONE. The animal should be uniquely identified. Non-descript animals require greater detail; use whorls and scars to properly identify. For the head suggested nomenclature includes any combination of star, strip, snip, lip, chin, blaze, bald; modified by “connected” if applicable. For limb markings describe the most proximal extent of the white area. Suggested nomenclature includes none, heel, heels, coronet, half pastern, pastern, fetlock, half canon, canon, carpus/hock, above carpus/hock.

Blocks 23 - 30: For Laboratory Use Only: Leave blank.

Equine Description Guide
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