Submission Form - Veterinary Diagnostic Laboratory - University of ...

Phone: (612) 625-8787Fax: (612) 624-8707Toll Free: 1-800-605-8787E-mail: vdl@umn.eduWeb site access/results:www.vdl.umn.eduSwine Health Test ChartContact Information - Owner/ProducerOwner NameCompanyAttending VeterinarianVeterinarianClinicFor officeuse onlyAddressAddressCityStateZipCityStateZipPhoneEmailAnimal LocationSite/FarmPremises/Reference IDCountryFaxRegulatory Premises IDPhoneEmailResult Reporting and BillingAffiliate (list codes)PhoneEmailFaxFaxFor Lab Use OnlySample /Specimen Arrived:Live Rm Temp Frozen Cold PkFixed Other_____________________Please complete animalidentification information on page 2State ZipCountyBill: Vet/Clinic OtherMolecular DiagnosticsTest Sample # 's Test Individually or in Pools of up to 5 SamplesTest Positive*PCR samples must be shipped on cold packsPools IndviduallyCircovirus, Type 2 PCR Serum TissueOral FluidIndividually or Pooled in groups of 2 3 4 5Lawsonia intracellularis PCRFeces Intestine Oral FluidIndividually or Pooled in groups of 2 3 4 5Mycoplasma hyopneumoniae PCR Lung Nasal Swab Oral FluidIndividually or Pooled in groups of 2 3 4 5PRRSV Herd Status: Positive NegativePRRSV NA/EU PCR - routine screening test, reported with cycle time (ct) valueBlood Swab Semen Serum Tissue Isolate Oral Fluid Lung LvgIndividually or Pooled in groups of 2 3 4 5PRRSV Sequencing/Genetic Typing - Not a routine screening testBlood Swab Semen Serum Tissue Isolate Oral Fluid Lung LvgIndividually or Pooled in groups of 2 3 4 5PRRSV Quantitative PCR (Detects only North American PRRSV), tested once a weekBlood Swab Semen Serum Tissue Isolate Oral Fluid Lung LvgIndividually or Pooled in groups of2 3 4 5Influenza Virus PCR - routine screening test, reported with cycle time (ct) value (*serum is not a valid sample for SIV PCR)Lung Nasal Swab IsolateIndividually orOral Fluid Lung LvgPooled in groups of 2 3 4 5Swine Influenza Virus (SIV) Genetic Typing (Sequencing)Lung Nasal Swab IsolateOral Fluid Lung LvgIndividually or Pooled in groups of2 3 4 5PED/PDCoV PCR Feces Intestine EnvironmentalIndividually or2 3 4 5OtherPooled in groups ofRotavirus PCR Feces Intestine Feedback Environmental SequencingIndividually or Pooled in groups of2 3 4 5TGE PCRFeces Intestine Environmental OtherIndividually or Pooled in groups of 2 3 4 5Serology (serum only)Test Sample # 's Swine Influenza Virus (SIV)Test Sample # 'sActino. pleuropneumoniae ELISASwine Influenza Virus Ab (IDEXX Multiscreen) ELISAIDEXX APX IV 1 2 3 5 7 10 12Standard NVSL H1 HI . . . . . . . . . . . . . . . . . . . . . . . .Brucella suis (default test is the Card test). . . . . . . . . . . . . .Standard Cluster 4 H3 HI . . . . . . . . . . . . . . . . . .. . . . .Circovirus type 2 ELISA . . . . . . . . . . . . . . . . . . . . . . . . . . .Standard Delta H1 HI. . . . . . . . . . . . . . . . . . . . . . . . .. .Encephalomyocarditis virus (EMCV) SN. . . . . . . . . . . . . . .Pfizer Gamma H1 with XP-012 HI .. . . . . . . . . . . . . . .Hemagglutinating Encephalomyelitis virus (HEV) HI. . . . . .Pfizer Delta H1 with XP-031 HI . . . . . . . . . . . . . . . . . .Leptospirosis 6 serovars (MA). . . . . . . . . . . . . . . . . . . . . . .Pfizer Cluster IV H3 with XP-069 HI . . . . . . . . . . . . .Lawsonia intracellularis IPMA Pos/Neg Titer. . .Homologous HI with Virus (name or #)Mycoplasma hyopneumoniaeTGE/PRCV Differential ELISA................... . . . . . . . . . . . .Dako ELISA IDEXX ELISA. . . . . . . . . . . . . . . . . . . . . .TGE SN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Test by Dako if IDEXX : Positive Suspect & PositiveVesicular Stomatitis SN New Jersey Indiana. .PEDV ELISA . . . . . . . . . . . . . . . . . . . . . . . . . . . .OtherPEDV IFA 1:40TiterPorcine Parvovirus HI. . . . . . . . . . . . . . . . . . . . . . .Virus Isolation *Samples must be shipped on cold packs Test Sample # 'sPRRSV IDEXX ELISA Oral Fluid SerumPRRSV IsolationTest all positive PRRS ELISA by IFA (serum only)Blood Swab Semen Serum Isolate TissueOral Fluid Lung LvgIf

Veterinary Diagnostic Laboratory - University of MinnesotaSwine Health - Animal IdentificationAnimal DemographicsSourceFlowLot IDReasons for TestsPrivate Sale Diagnostic Test ExhibitionExport toPseudorabies qualified herd OtherBuildingRoomDate BledNumber of SamplesCommentsSignature:Sample # Animal ID Age Gender Breed(Please circle:yr. mo. wk. dy.)1Sample #31Animal IDAge Gender Breed(Please circle:yr. mo. wk. dy.)2323334345356367378389391040114112421343144415451646174718481949205021512252235324542555265627572858295930SYS.FORM.064, Rev. 10, 9/29/201460Page 2