Survey
* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project
Download Word - Research Animal Resource Center
Document related concepts
no text concepts found
Transcript
Accession No.___________ COMPARATIVE PATHOLOGY LABORATORY Research Animal Resources Center, 389 Enzyme Institute 1710 University Avenue, University of Wisconsin Madison, WI 53726-4087 Clinical Lab 608/263-6464 • Histo Lab 608/262-0933 • FAX 608/265-2698 AVIAN AND REPTILE Submission Date Protocol Number Direct charge number required for billing: DEPT ID FUND PROJECT (if applicable) Internal Work Order Number: Name of departmental billing officer (required) Lab Animal Veterinarian Investigator Contact Person Dept. Address Telephone Email Species Strain/Breed No. Age Sex ID Specimen Submitted: Live Dead Euthanized PROGRAM CODE (if applicable) Telephone Department FAX Bio level Animal Room No. Method and drug used Date & time of Death Experimental procedures, drugs, diet and/or transgene/mutation: Complete background history and list of clinical signs. _______________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ Group Size _____ Animals per cage _____ Date of Arrival/Birth __________ No. of recent deaths in group _______________ SEROLOGY ___ ___ ___ ___ ___ ___ ___ Avian Influenza Chlamydia Newcastle Virus Infectious Bronchitis Salmonella _____________ Mycoplasma sp Other _______________________________________ OTHER ___ VIROLOGY Virus Requested _______________________________ ___ Tissues desired _______________________________________ ___ ___ ___ ___ ___ ___ ___ PCR ASSAY PCR Requested ________________________________ ___ Other ________________________________________ ___ ___ ___ ___ CHARGES: BACTERIOLOGY ___Antibiotic Susceptibility MYCOLOGY Tissues desired_______________________________________ PARASITOLOGY ____External ___Cecal ___Fecal ____Scotch tape slide (clear tape only) ____Heartworm ____(Dirochek) ____(Capillary) SKIN EXAMINATION CYTOLOGY HEMATOLOGY CBC (RCB, WBC, PCV, Hb, Differential, platelets) (Circle if only a single test desired.) CLINICAL CHEMISTRY Specific Test(s)_______________________________________ URINALYSIS NECROPSY HISTOPATHOLOGY (tissue)____________________________________________ OTHER____________________________________________ Animal Weight _____________
Related documents