Download OPEN JHU phenotyping Pathology Submission Form

Johns Hopkins Medicine - Phenotyping Core
Department of Molecular and Comparative Pathobiology
(rev 2014)
ANATOMIC PATHOLOGY SUBMISSION
MCP#
P
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To be completed by Submitter:
Contact
Date
Charge #
Investigator
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Species
Strain/Geno
Mutant Y/ N
Source
JH Room #
Color BL/ Ag/ AL/
Animal ID#
Sex F/ M Age
Found Dead Y/ N
Euth CO2/ CD /
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Additional Requests (complete separate forms): CBC/Diff
Clin Chem
Urinalysis
Micro/Parasit:
Serology
Culture
PCR
Parasit Fur Tape Float PCR
Behav
QNMR
Other:
Bleed Site: Retroorbital/ Facial/ Saphenous/ Tail/ Cardiac/
Volume:
ml.
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History and Clinical Signs (Include correct nomenclature, background strains, genetic manipulations/ mutation(s),
generations of backcrossing, experimental manipulations including bleeding, special diets, drug treatments e.g. Baytril,
Ivermectin, Fenbendazole; reason(s) for submission; clinical signs):
_____________________________________________________________________________________________
To be completed by Prosector:
Research / Diag / Teaching 
Body Condition:
1(emaciated)
2
3(normal)
4
5(morbidly obese)
Body Wt (g)
Liver (g)
Spleen(g)
♥(g)
Gross Findings (Include weights/measurements, diagrams whenever possible.):
ID Tags/#’s (save with tissues:
Ear Punch: R
More information + updates at http://www.hopkinsmedicine.org/mcp/PHENOCORE/
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