Download allerton provincial veterinary laboratory

WESTERN CAPE PROVINCIAL VETERINARY LABORATORY : STELLENBOSCH
Private Bag X5020, Stellenbosch, 7599
Helderfontein, Helshoogte Road
tel: +27 21 887 0324 fax: +27 21 886 5341
www.elsenburg.com | www.westerncape.gov.za
SAMPLE SUBMISSION FORM
FOR LAB USE ONLY:
Fee:
Date
received:
Sender code
RPO:
LAB REF
Owner code
FOR STATE VETERINARY SERVICE USE ONLY: Indicate purpose for official testing for account purposes
Official surveillance:
Official Disease investigation:
Small holder farmer:
SENDER DETAILS
OWNER DETAILS
Sender Reference
Name
Contact person
Company / Clinic / Vet Practice
Physical address
Name
Contact person
Company
Farm name / Physical address
Postal code
Postal
code
Physical location
(GPS)
Postal Address
Postal Address
Longitude
Latitude
Postal
code
Tel
Cell
Email
REPORT TO:
Owner
* Account
to Other:
Name:
Postal address:
SPECIES
Postal code
Fax
BOV
OVI
RESULTS BY:
Sender
CAP
Tel
Cell
Email
Post
Tel
Fax
Fax
ACCOUNT TO:
Email
Tel:
Fax:
Postal
code:
POR
EQU
AVI
AVO
(poultry)
(ostrich)
AVX
(avian: other
species)
FEL
Owner
Sender
Other*
Cell:
Email:
CAN
Specify other
species:
Age of Animal:
Sex:
M
Type and number of specimens submitted:
F
Date collected:
TEST/S REQUIRED (PLEASE INDICATE BELOW)
SEROLOGY
Brucella abortus (MRT)
Brucella abortus (RBT, CFT)
Brucella ovis (CFT)
Brucella melitensis (CFT)
Dourine (CFT)
Influenza A ELISA
HI (Haemagglutination tests):
HI: NCD
HI: AI H5
HI: AI H6
BACTERIOLOGY
General aerobic culture and identification
General anaerobic culture and identification
Salmonella spp. only
Brucella spp. only
Antibiogram
FOOD SAFETY (VET PUBLIC HEALTH)
HI: AI H7
VIROLOGY
BIOCHEMISTRY
Serum / Plasma samples
Ca
P
Mg
Na
K
Cl
Cu
Fe
Zn
Protein (total, albumin, globulin)
Serum only
Gamma globulin
BUN (Blood Urea nitrogen)
Enzymes:
GGT
AST
CK
Whole Blood
Food / Feed
Aerobic plate count (APC)
Selenium (Se)
Organ (Liver; Kidney) samples
Cu
Fe
Zn
Mn
Se
Virus Isolation
E. coli
PCR (Molecular)
Avian Influenza Virus (AIV) (PCR)
Newcastle Disease Virus (NDV) (PCR)
HISTOPATHOLOGY
Process, stain & examine
Enterobacteriaceae (Ent.)
Listeria monocytogenes
Salmonella spp.
B. subtilis growth inhibition
Export List: (APC, E. coli, Ent, Salmonella)
Import List: (APC, E.coli, Salmonella)
Process & stain only
Feed list (Ent., Salmonella)
Haematocrit
Ca
P
Biopsy (Liver) samples
Cu
Fe
Mn
Zn
Feed samples
Cu
Fe
Zn
Mn
Se
Ca
P
Mg
Na
K
Bone samples (mineral analysis includes bone ash)
Ca
Mg
P
Cu
Fe
Zn
Mn
REPRODUCTION
Semen evaluation:
Sperm morphology only
Sperm morphology and motility
Cytology (bacteriology)
Water
Aerobic plate count (APC)
Faecal coliforms & E.coli
TOXICOLOGY
Faecal Streptococci
Nitrites / Nitrates spot test
Total Coliforms
Ryegrass toxicity screening
Export List (APC, Total Coliforms, Faecal
Semen: Total Bacterial Count
coliforms, E. coli, Faecal Streptococci)
POSTMORTEM (NECROPSY) *
* Additional laboratory testing and fees at external laboratories may be applicable for samples submitted to the laboratory for necropsy.
Adult large animal (e.g. cattle, horse, pig)
Small stock, dog, cat, immature large animal
Foetus
Poultry, Birds & Exotic animals
Ostrich: immature
Ostrich: adult
ADDITIONAL INFORMATION:
SPECIMEN INFORMATION (E.G. ANIMAL IDENTIFICATION / SAMPLE NUMBER); HISTORY; SPECIAL REQUESTS:
Document written / reviewed by & date: R. Pieterse 2017/03/31
Document approval by & date: FH Dreyer 2017/04/04
Document no.: P – SR – F - 001
Mg
Document authorisation by & date: R. Pieterse 2017/04/04
Effective date: 2017/04/05
EDITION 10
Page 1 of 1