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See Frosch & Kaplan, supra note 141, at 291. See O'Connor et al., supra note 167, at 64. 309 See id. 310 Frosch, supra note 141, at 287; Pamela J. McCabe & Penny Kalpin, Bold Voices in Progressive Care Using Shared Decision Making to Implement Evidence-Based Practice in Progressive Care, 25 Critical Care Nurse 76, 2005 O'Connor et al., supra note 141, at 63-64. 311 See Natanson, 350 P.2d at 1104. 312 Cruzan v. Dir., Mo. Dept. of Health, 497 U.S. 261, 278 1990 ; . 313 Gonzales v. Oregon, 126 S. Ct. 904 2006.

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We believe Perrigo has created some unique opportunities by strategically investing in quality, customer service, low-cost supply, and growth. These investments have already contributed to our growth, while reinforcing our financial strength and providing the foundation for future growth in OTC pharmaceuticals, nutritional products, and generic R x drugs as the demand for more affordable health care grows.
The third of its kind in the recent times, the new delhi-based win medicare p ; ltd has signed another marketing tie-up with a foreign drug manufacturer, for instance, tranexamic acid. The federal rules on samples are effective in December of this year, and the Food and Drug Administration FDA ; apparently plans to consider each situation on an individual basis. An informal opinion letter issued by an FDA official for a community mental health program may be helpful to pharmacists understanding the situation.
Prepared by: Joseph M. Craver, M.D. Professor of Surgery Cardiothoracic Surgery Emory University School of Medicine Emory Clinic Atlanta, GA Francis L Shannon, M.D. Cardiovascular Surgeon and Director of CV Quality Assurance William Beaumont Hospital Royal Oak, Michigan David E. Haines, M.D. Director, Heart Rhythm Center William Beaumont Hospital Royal Oak, Michigan and cymbalta. 173. Hart RG, Halperin JL. Atrial fibrillation and thromboembolism: a decade of progress in stroke prevention. Ann Intern Med. 1999; 131: 688 Kearon C, Hirsh J. Management of anticoagulation before and after elective surgery. N Engl J Med. 1997; 336: 1506 Sindet-Pedersen S, Ramstrom G, Bernvil S, et al. Hemostatic effect of tranexamic acid mouthwash in anticoagulant-treated patients undergoing oral surgery. N Engl J Med. 1989; 320: 840 Souto JC, Oliver A, ZuaZu-Jausoro I, et al. Oral surgery in anticoagulated patients without reducing the dose of oral anticoagulant: a prospective randomized study. J Oral Maxillofac Surg. 1996; 54: 2732. Sbarouni E, Oakley CM. Outcome of pregnancy in women with valve prostheses. Br Heart J. 1994; 71: 196 Hanania G. Management of anticoagulants during pregnancy. Heart. 2001; 86: 125126. Montalescot G, Polle V, Collet JP, et al. Low molecular weight heparin after mechanical heart valve replacement. Circulation. 2000; 101: 10831086. McKenna R, Cole ER, Vasan U. Is warfarin sodium contraindicated in the lactating mother? J Pediatr. 1983; 103: 325327. Lao TT, de Swiet M, Letsky E, et al. Prophylaxis of thromboembolism in pregnancy: an alternative. Br J Obstet Gynecol. 1985; 92: 202206. Verhagen H. Local hemorrhage and necrosis of the skin and underlying tissues at starting therapy with dicumarol or dicumacyl. Acta Med Scand. 1954; 148: 455 Weinberg AC, Lieskovsky G, McGehee WG, et al. Warfarin necrosis of the skin and subcutaneous tissue of the male genitalia. J Urol. 1983; 130: 352354. Broekmans AW, Bertina RM, Loeliger EA, et al. Protein C and the development of skin necrosis during anticoagulant therapy. Thromb Haemost. 1983; 49: 244 Zauber NP, Stark MW. Successful warfarin anticoagulation despite protein C deficiency and a history of warfarin necrosis. Ann Intern Med. 1986; 104: 659 Samama M, Horellou MH, Soria J, et al. Successful progressive anticoagulation in a severe protein C deficiency and previous skin necrosis at the initiation of oral anticoagulation treatment. Thromb Haemost. 1984; 51: 332333. Grimaudo V, Gueissaz F, Hauert J, et al. Necrosis of skin induced by coumarin in a patient deficient in protein S. BMJ. 1989; 298: 233234. Mohr JP, Thompson JLP, Lazar RM, et al. A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med. 2001; 345: 1444 Sevitt S, Gallagher NG. Prevention of venous thrombosis and pulmonary embolism in injured patients. Lancet. 1959; II: 981989. 189. Francis CW, Marder VJ, Evarts CM, et al. Two-step warfarin therapy: prevention of postoperative venous thrombosis without excessive bleeding. JAMA. 1983; 249: 374 Powers PJ, Gent M, Jay RM, et al. A randomized trial of less intense postoperative warfarin or aspirin therapy in the prevention of venous thromboembolism after surgery for fractured hip. Arch Intern Med. 1989; 149: 771774. Taberner DA, Poller L, Burslem RW, et al. Oral anticoagulants controlled by the British comparative thromboplastin versus low-dose heparin in prophylaxis of deep vein thrombosis. BMJ. 1978; 1: 272274. Poller L, McKernan A, Thomson JM, et al. Fixed minidose warfarin: a new approach to prophylaxis against venous thrombosis after major surgery. Br Med J. 1987; 295: 1309 Bern MM, Lokich JJ, Wallach SR, et al. Very low doses of warfarin can prevent thrombosis in central venous catheters: a randomized prospective trial. Ann Intern Med. 1990; 112: 423 Poller L, MacCallum PK, Thomson JM, et al. Reduction of factor VII coagulant activity VIIC ; , a risk factor for ischaemic heart disease, by fixed dose warfarin: a double blind crossover study. Br Heart J. 1990; 63: 231233. Dale C, Gallus A, Wycherley A, et al. Prevention of venous thrombosis with minidose warfarin after joint replacement. BMJ. 1991; 303: 224. Fordyce MJF, Baker AS, Staddon GE. Efficacy of fixed minidose warfarin prophylaxis in total hip replacement. BMJ. 1991; 303: 219 Poller L, Thomson JM, MacCallum PK, et al. Minidose warfarin and failure to prevent deep vein thrombosis after joint replacement surgery despite inhibiting the postoperative rise in plasminogen activator inhibitor activity. Clin Appl Thromb Hemost. 1995; 1: 267273. Family members and health care professionals need to stay alert to this possibility and duloxetine, for example, tranexamic acid.

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Potential Financial Conflicts of Interest: None disclosed. Requests for Single Reprints: Peter Zimetbaum, MD, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Boston, MA 02215.
2. If the manifestations of the second more serious disease are known to run through the manifestations of the first disease, and this assumption reliably substantiated was not confuted, then the activity of a medicament against the more serious disease would already strongly suggest an effect also against the less serious one and cytotec. Though this sur~ey as not designed as an ol sprll survey, a w i few questions weraddedabauttheqnlltofindout how the spill lffected visitors actual travel plans. Thc major analysis of t n patiems from this data has not yet been conducted.

Dental Health Status of 7-14 Year Old Children on the Register of the Irish National Haemophilia Treatment Centre. McKiernan, E. & Convery, L. * Department of Paediatric Dentistry, Dublin Dental School & Hospital, Trinity College, Dublin. Children attending for their annual check up at the N.H.T.C. in the National Children's Hospital [Harcourt Street] were evaluated clinically and a questionnaire was administered. The target population was 75 being those on the register at the commencement of the survey in 12.6.85. In that age group 57 76%] were examined. Caries was assessed using the criteria of the National Survey of Childrens Dental Health 1984. Gingival health was assessed using the P.M.A. index and plaque was measured using a modification of the Silness & Loe method. Average DMF scores for the group studied were 1.63 while the def score was 1.12, giving a combined DMF def score of 2.75. Water fluoridation status was investigated by means of a questionnaire directed to the parents. Fifteen point seven per-cent of children did not have a fluoridated water supply. Five per-cent of those studied had fluoride supplements prescribed. Forty-five per-cent had been seen by a dentist within the previous year and the service provided was: - [a] 26% preventive advice, [b] 7% fissure sealants, [cl 5% topical fluoride and [d] 44% operative procedures [including extractions]. When treatment was carried out 36% was done under local anaesthesia and the rest under general. All admitted to owning a toothbrush and the stated frequency of brushing was once daily [68%] or twice daily [31%]. Thirty-three per-cent complained that the guma bled when brushing but none ascribed lack of brushing to this factor and misoprostol. Via ivanhoe's medical breakthroughs comment. 1. Harstein G, Jansens M. Treatment of excessive mediastinal bleeding after cardiopulmonary bypass. Ann Thorac Surg 1996; 62: 1951-4. Woodman RC, Harker LA. Bleeding complications associated with cardiopulmonary bypass. Blood 1990; 76 : 1680-97. Mammen EF, Koets MH, Washington BC, Wolk LW, Brown JM, Burdrick M, et al. Haemostasis changes during cardiopulmonary bypass surgery. Semin Thromb Hemost 1985; 11 : 281-92. McLure PD, Izsak J. The use of epsilon aminocaproic acid to reduce bleeding after cardiopulmonary bypass in children with congenital heart disease. Anesthesiology 1974; 40 : 64-8. Hardy JF, Desroches J. Natural and synthetic antifibrinolytics in cardiac surgery. Can J Anesth 1992; 39 : 353-65. Verstraete M. Clinical application of inhibitors of fibrinolysis. Drugs 1985; 29 : 236-61. Horrow JC, Hlavacek J, Strong MD, Collier W, Brodsky I, Goldman SM et al Prophylactic tranexamic acid decreases bleeding after cardiac operations. J Thor Cardiovasc Surg 1990; 99 : 70-4 and calcitriol. Neglect--and they are understandably distrustful of government efforts to impose programs on their communities. Programs aimed at preventing ARBD need to emerge from within American Indian tribes in a way that shows real, long-term commitment to positive outcomes and is respectful of tribal sovereignty, heritage, spirituality, and cultural practices. ARBD and Hispanics Latinos: Patterns of drinking among Hispanics and Latinos are different not only from those of the general population, but also among the various ethnic groups comprising the Hispanic Latino population. Hispanic and Latino women are among the least likely of any racial, ethnic, or cultural group in the United States to drink alcohol at all, and they have the lowest rates of risk drinking. Women who are at greatest risk of having problems with alcohol include: women with a history of sexual assault, as children or adults; women born in the United States, with each generation more likely to drink or abuse alcohol and the greater the degree of acculturation to the dominant society, the more likely the risk of alcohol abuse; women who identify with Central and South American countries who are married on the other hand, Cuban American women who are married drink less than average young, Mexican American women who are current or former gang members and whose family members were drug users or had criminal records; and women whose partners use drugs or are heavy alcohol users, because tranexamic acid contraindications.

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Diagnosing whether someone has herpes or not is quickly done by a serology test because once you've become infected, an immune-competent individual will develop antibodies to the herpes that is infecting them, says thomas simms, a biologist in the fda's center for devices and radiological health and rocaltrol. Call to Order The meeting was called to order by President Mike Frontz at 8: November 8, 2002. He welcomed everyone to Galveston and introduced our host, Lori Speaker. Lori welcomed everybody to Galveston and mentioned that there were about 70 people in attendance along with 11 vendors. She encouraged those attending who are not members to join the organization. She ended by thanking everyone for their help. Secretary's Report Secretary Kathy Erwin made a motion to accept the minutes from the Wichita meeting as written in the newsletter. It was seconded by Rod McCutcheon and approved. Treasurer's Report Treasurer Robert Schoenfeld presented his report. As of October 23, 2002, our total net worth is $15, 619.45 with the Bank Book Balance at $9, 206.45 and the Fidelity Funds Balance at $6, 413.00. A motion was made that we accept the treasurer's report. It was seconded and approved. Committee Reports A. Meeting Grants Chris Heartsill reported that one meeting grant application was submitted for Monica Lopez, who is presenting a paper on "Toluene Artifact in a Medical Examiner Case". The board approved that Monica Lopez be granted the standard $300 award for being in a nonsupervisory position and presenting a paper. The board also approved deferring the award until the Albuquerque meeting as Monica requested. Chris also encouraged members to apply for meeting grants as SAT is able to grant 2 per meeting. B. Membership Councilor Phil Kemp presented the report. Brenda Snodgrass and the two councilors, Phil Kemp and Brad Hall, who make up the Membership Committee, recommended that the board present the following four applicants to the general membership for approval. They are: Colleen Corcoran, Orleans Parish Coroner's Office, New Orleans, LA Jay Hoppenwasser, Sam Houston State University, Huntsville, TX Denise Mire, Orleans Parish Coroner's Office, New Orleans, LA Kelsie Simons, Sam Houston State University, Huntsville, TX Mike Carlo moved that we accept all four applicants for membership. It was seconded by John Tarver and approved, because aprotinin tranexamic acid!

At 80C for 2 hours. Blots were exposed to UV light to visualize the ribosomal bands to verify equal loading and transfer in each lane. The RNA was hybridized with cDNA probes labeled by the random-primer extension method Amersham Corp, Arlington Heights, 111 ; with [32P]dCTP. Blots were then washed at 60C in two changes of 45 mmol L NaCl 4.5 mmol L sodium citrate 0.1% sodium dodecyl sulfate. Signals were detected by exposure to Hyperfilm-MP Amersham ; at -80C. Administration of Anti-PDGF Antibody A polyclonal antibody was raised by immunizing a goat with purified human platelet PDGF. 6 IgG was dialyzed against PBS and concentrated by ultrafiltration to a final protein concentration of 64.3 mg mL. Nonimmune goat IgG was prepared by the same techniques from commercially available goat plasma. Before use, the IgG was sterilized by filtration through a 0.22- .m filter and then stored at 4C. IgG was administered by intraperitoneal injection at a dose of 600 mg kg given 24 hours before balloon injury, immediately after balloon injury, and then every 24 hours. The last dose was given 24 hours before the animals were killed. Administration of Anti-Platelet Antibody A polyclonal antibody was raised by immunizing a goat with rat platelets.17 The IgG was dialyzed against PBS and used at a final concentration of 27.6 mg mL. A single intraperitoneal injection of 100 mg kg was administered approximately 12 hours before balloon catheter injury. A 20- u, L blood sample was taken from the tail vein into ammonium oxalate immediately before balloon catheter injury, and platelets were counted in a hemocytometer. The platelet count in normal rats was 1.090.05xl0 6 L meanSEM ; . Animals with platelet counts below 2xlO4 xL were considered to be thrombocytopenic, and animals injected with anti-platelet antibody but with platelet counts above this value were excluded from these studies. Administration of Trsnexamic Acid Trwnexamic acid acid; Sigma ; was administered simultaneously in the drinking water at a concentration of 15 mg mL and by gavage.18 For gavage, the drug was suspended in 2% sodium carboxymethyl cellulose Sigma ; at a concentration of 200 mg mL and administered once daily in a volume of 5 mL kg. The precise dose therefore depended on the rate of water consumption, which was measured daily. The mean dose was 2.73 g kg per day range, 2.36 to 3.00 g kg per day ; . The serum concentration of tranexamci acid was determined in rats that had received the drug for 4 days at an average daily dose of 2.98 g kg of body weight. Blood was drawn from the abdominal aorta under anesthesia with sodium pentobarbital. After clotting, it was centrifuged at 1300g for 20 minutes at 4C. The serum was diluted with an equal volume of 50 mmol L Tris-HCl, pH 9.0, and then heated at 75C for 30 minutes. After further centrifugation at 14 O for 5 Og minutes at room temperature, the denatured serum samples were passed through microconcentrators 104 molecular-weight cutoff; Amicon, Beverley, Mass ; by centrifugation at 7000g for 60 minutes at 4C. The filtrate was assayed for its ability to inhibit the genera and carbamazepine. Caverject alprostadil ; treatment of erectile dysfunction, commonly known as male impotence cyklokapron trsnexamic acid ; used to treat serious bleeding, especially when the bleeding occurs after dental surgery particularly in patients with hemophilia ; or certain other kinds of surgery. Veterinarian to devise a treatment protocol to help your rabbit. In most cases, medical management is sufficient in treating these patients. Depending on the physical examination, IV intravenous ; or subcutaneous fluids will be recommended. This helps to flush the bladder by increasing urinations and by diluting the sludge itself. Expressing the bladder multiple times a day, pain management, nutritional supplementation and long-term antibiotics depending on the urine culture results ; are all important factors of treatment to encourage a favorable outcome. Due to the chance of recurrence, the veterinarian will recommend radiographs every six months. It is possible to decrease the likelihood of recurrences with certain preventative measures. Dietary and weight management are extremely important. Limiting if not excluding ; pellets and offering free-choice timothy hay not alfalfa ; is the first step. Daily "salads" with a variety of fresh vegetables are needed to promote gastrointestinal and urinary tract health. Avoid veggies high in calcium such as kale, broccoli, turnips, watercress and Chinese cabbage. Fresh water changed and tegretol. Heavier and longer menstrual bleeding can be treated with non-steroidal antiinflammatory drugs mefenamic acid ; or antifibrinolytics ttanexamic acid ; . One RCT n 25 ; reported a significant reduction in mean total blood loss during treatment with mefenamic acid when compared with placebo. 158[EL 1] One RCT n 19 ; compared tranexamic acid, diclofenac sodium and placebo in the treatment of excessive blood loss in IUD users types not specified ; . It reported significant reduction by 54% in mean blood loss in IUD users treated with tranexamic acid when compared with placebo. Treatment with diclofenac sodium also reduced blood loss by 20% when compared with placebo. Neither treatment reduced pelvic discomfort during menstruation or shortened its duration.159[EL 1 + ] One crossover RCT n 20 ; reported significant reduction in menstrual loss in IUD users Copper 7, copper T220, copper T380 and Lippes Loop, all unlicensed ; treated with ibuprofen when compared with placebo.160[El 1-] Another crossover RCT n 34 ; reported significant reduction in menstrual bleeding in IUD types not specified ; users treated with high and low-dose naproxen when compared with placebo.161[EL 1-] A cohort study reported that complaints of bleeding are not associated with a misplaced device demonstrated by ultrasound scan but this should be considered in women with persistent bleeding.162[EL 3] WHOSPR recommends a short course of non-steroidal anti-inflammatory drugs NSAIDs ; , taken during the days of bleeding, to treat spotting or light bleeding. Gynaecological pathology, pregnancy and infection should be excluded if abnormal bleeding persists.76[EL 4]. School of healthcare spending of users reprisal and carbimazole and tranexamic, for example, tranexamic mefenamic acid.

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AND H . NlEMELA has not been studied [6-8]. It has been assumed that this enhancement of fibrinolytic activity is the explanation for the low incidence of deep venous thrombosis when a pneumatic tourniquet is used in orthopaedic surgery [8]. If the increased fibrinolytic activity has any effect on perioperative blood loss, this might be modulated by antifibrinolytic agents. In this prospective, randomized, double-blind study, we examined the effect of tranexamic acid Cyklokapron ; on blood loss and transfusion requirements during total knee arthroplasty. Patients and methods The study was approved by the institutional Ethics Committee. Written informed consent was obtained from 29 patients table 1 ; undergoing total knee arthroplasty during the first 6 months in 1994. Patients were instructed to stop taking medications containing acetylsalicylic acid 1 week before operation. Other non-steroidal anti-inflammatory drugs were allowed until the day before operation. Haemoglobin concentration, platelet count, Ivy's bleeding time, activated partial thromboplastin time APTT ; and prothrombin time TT-SPA, Diagnostica Stago, Franconville, France ; were measured on the day before operation table 2 ; . On the evening before surgery, patients were given enoxaparin 40 mg s.c. to prevent postoperative deep venous thrombosis Klexane, Rhone-Poulanc-Rorer, France ; . Enoxaparin was given once a day until patients were discharged or sufficiently mobilized. Surgery was performed under spinal anaesthesia with 0.5 % plain bupivacaine. During induction, an extradural catheter was also inserted to provide postoperative analgesia. After operation, a constant infusion of fentanyl lOugml" 1 ; at a rate of 4-6 ml h~', was started. If analgesia was unsatisfactory, bupivacaine was added to produce a 0.1 % solution. The blood volume of each patient was calculated using a formula based on weight, height and sex of the patient [9]. If transfusion was needed, Ringer's.

The intrinsic organization of the nucleus lentiformis mesencephali magnocellularis: a light- and electron-microscopic examination Zayats1 N., Eyre2 M.D., Nmeth1 A., Tmbl1 T. Semmelweis University, Dept.s of Anatomy, Histology and Embryology, Budapest; 2Hung. Acad. Sci., Inst. of Experimental Medicine, Budapest and cefadroxil. Hyperammonemia of 104.8 g dl normal 1148 g dl ; was found. Abdominal sonogram revealed multiple tubular structures in the liver, which demonstrated high velocity turbulent flow on color Doppler, and the hepatic artery was strikingly dilated. Similarly, the hepatic veins were markedly dilated, whereas the portal vein was normal in caliber. Angiography of the celiac, splenic, superior mesenteric and common hepatic arteries demonstrated multiple vascular lesions of different sizes in the liver and spleen, compatible with teleangiectasias and intrahepatic arteriovenous shunts [Figure B]. On gastroscopy, teleangiectasias without evidence of active bleeding were found in the stomach and duodenum. On the third day of hospitalization, hemoglobin decreased to 8.3 g dl and melena was detected. Tranexamjc acid as an antifibrinolytic agent was administered for 5 days. The patient was further treated with a low protein diet, neomycin 1 x 3 and lactulose. Thyroid antibody positive vs. an antibody positivity rate of only 17% 5 30 ; in the women who carried to term. The study is limited by lack of attention to other causes of recurrent miscarriage. Bussen and Steck 168 ; examined 22 nonpregnant patients with the diagnosis of recurrent abortion for the presence of antithyroid antibodies, comparing them with 22 multiparous patients and 22 nulliparous patients without known endocrine disorders. Thirty-six percent of those with a history of recurrent miscarriages were positive for antithyroid antibodies vs. 9% and 5% among the multiparous and nulliparous control groups. Markers for other immune disorders were not sought. The authors concluded that antithyroid antibodies may be a marker for autoimmune mediated recurrent miscarriage. In contrast, Esplin et al. 169 ; tested for TG-and TPO-Ab in 74 nonpregnant patients historically remarkable for recurrent miscarriage; the controls were 75 healthy women of similar gravidity. Samples were obtained at least 6 months after a pregnancy. Twenty-nine percent of recurrent miscarriage patients and 37% of the control group were positive for one or both of the antibodies tested P 0.05 ; . All were euthyroid. The authors concluded that those with a history of recurrent miscarriage were no more likely than the control population to test positive for antithyroid antibodies. Rush-worth et al. 170 ; examined the prevalence of thyroid autoantibodies in 870 patients with the diagnosis of recurrent miscarriage in whom normal parental karyotypes were established. In the euthyroid, antibody-positive group, the subsequent pregnancy success rate was 58%, as it was for the antibody-negative group. The authors also concluded that the risk of subsequent pregnancy loss in women with recurrent miscarriage was unaffected by their thyroid antibody status. De Carolis et al. 171 ; reported on 203 patients with APLAs and 162 with antithyroid antibodies, all of whom had a diagnosis of recurrent miscarriage. Upon further testing of the patients with APLA, 54 were found to also have antithyroid antibodies. Forty-eight to 74% of these patients achieved pregnancy. Pregnancy outcome was available in 46% of the. Javed nasir, a fourth-year medical student at usuhs and the military liaison to the acp council of student members, conducted the interview.

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The sedative effect of the medication can possibly impair the mental and physical abilities required for driving or operating machinery, for example, topical tranexamic acid. PacifiCare Behavioral Health PBH ; ensures that Oregon members needing services are linked with an appropriate providers in a timely manner. PBH reports appointment access results to the Northwest Service Solutions Committee SSC ; . Relevant clinical information is consistently gathered to support all referral decisions through the use of structured Triage and Clinical Data Gathering instruments. The PBH Customer Service Associate CSA ; determines the nature of the request and acuity of the call using the Triage screening instrument in the PBH Clinical Management System. Depending upon the member's responses to the questions in the Triage application, the CSA either gives the member a referral to a participating PBH practitioner routine cases only ; or transfers the call to a licensed PBH Care Manager. The Care Manager assesses for acuity and the appropriateness of an urgent or emergent referral. The Care Manager then ensures that a referral is provided and that services are accessed with clinically appropriate timeliness. PBH provides behavioral health services to 90% of the commercial and Secure Horizons membership and cymbalta. Why it is used these medicines are used to treat certain bacterial and parasite infections.

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A. A duplicate certificate is a new registration certificate that is issued when the original has been lost or destroyed. It may be issued by the Association when sufficient proof of loss and proper identification of the horse has been submitted to the Association office. The current recorded owner must file the proper affidavit, duly notarized, completed in all respects and stating the circumstances under which the original certificate was lost or destroyed and pay the required fee see fee schedule at front of the rule book ; . Such affidavit must be accompanied by two current photographs, a direct right side view and a direct left side view of the horse. If it is determined that a duplicate has been issued based on false or inaccurate information, the applicant record owner affiant may be subject to disciplinary action and the duplicate certificate may be recalled. B. If the horse has been tattooed by an APHA representative and the owner can provide the APHA with the number tattooed in the horse's lip, the photographs of the horse will not be required. C. If the present owner is not indicated in the Association files to be recorded owner, he shall provide the Association with an affidavit from the last owner of record in order to obtain the duplicate registration certificate. The affidavit shall identify the person to whom he delivered the registration certificate. D. In regard to involuntary transfer of title situations, including but not limited to court judgments and stableman's lien or security interest foreclosure, when it is proven to the Association's satisfaction that a previous owner is unavailable for affidavit concerning the original certificate or refuses to implement the court's judgment by delivering the original certificate for transfer, at the Association's discretion and in the interest of equity, requirement of affidavit of the recorded owner may be waived and the current owner deemed eligible for duplicate certificate. E. In order to issue a duplicate certificate, when the recorded owner cannot be located to complete the affidavit required in Part C above, the following items are required: 1. Properly completed and signed transfer reports or acceptable bills of sale reflecting each ownership change beginning with the recorded owner; 2. Notarized statement signed by each party who had the original certificate in his or her possession after the record owner.

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