Submission Form - Veterinary Diagnostic Laboratory - University of ...
Submission Form - Veterinary Diagnostic Laboratory - University of ...
Submission Form - Veterinary Diagnostic Laboratory - University of ...
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<strong>Veterinary</strong> <strong>Diagnostic</strong> <strong>Laboratory</strong> - <strong>University</strong> <strong>of</strong> MinnesotaNecropsy and Sample <strong>Submission</strong> <strong>Form</strong>Specimens for Surgical Pathology1. Location2. Size and shape3. Color, texture and presence <strong>of</strong> capsule4. Growth pattern (expansion, invasion, pedunculation, etc.)5. Duration Rate <strong>of</strong> Growth6. Evidence <strong>of</strong> hemorrhage, necrosis or suppurationIndicate skin lesion site on above drawing7. History <strong>of</strong> recurrence? Previous Case no.<strong>Laboratory</strong> Procedures Requested (Please see current fee schedule for complete listing <strong>of</strong> services available)*I UNDERSTAND THE REMAINS CANNOT BE RETURNEDAs owner or agent <strong>of</strong> the animal(s) presented for this case, I authorize the <strong>Veterinary</strong> <strong>Diagnostic</strong> <strong>Laboratory</strong> (VDL) staff to proceed as follows:General <strong>Laboratory</strong> InvestigationParasitologyNecropsy/General Exam <strong>of</strong> Tissue (includes bacteriology, EM, histopathology,molecular diagnostics, nutrition, parasitology, serology, toxicology, and virology) on upto 2 mammals or 6 poultry with the same clinical problem.Bacteriology/MycologyAerobic CultureAnaerobic CultureClinical ChemistryBile AcidsLarge Animal Pr<strong>of</strong>ileOtherCSF ChemistryCKOtherUrine:Fungal Culture SusceptibilityPhenobarbitalSmall Animal Pr<strong>of</strong>ileGlucose ProteinComplete Urinalysis Urine protein/Creatinine ratioOtherCytologyCSF (cell counts & cytology)Cytology - tissuesCytology - urine sedimentFluid analysis, completeSourceSourceElectron MicroscopyCell / Tissue ultrastructureViral IdentificationEndocrinology (please use specific endocrinology form)HematologyCryptosporidiumOccult heartwormFecal flotationParasite identificationGiardiaQuantitative Fecal ExamOtherPathology - Histopathology/SurgicalsRoutine H&ESpecial StainsPathology - ImmunohistochemistryImmunological Markers Tissue MarkersInfectious AgentsBone marrow core & aspirate Complete Blood Count (CBC)VirologyBuffy coat smears Differential onlyRBC parasite screen Virus isolation - virus name(s)Coagulation pr<strong>of</strong>ilePlatelet countReticulocyte count MiscellaneousOtherNote: For supplies, including mailing cartons, contact the lab directly: Phone (612) 625-8787, Fax (612) 624-8707, Toll free 1-800-605-8787, Email vdl@umn.eduSYS.FORM.060, Rev. 4, 05/22//2012OtherRabies (please use Minnesota Department <strong>of</strong> Health Rabies form)Serology (Canine)Borrelia burgdorferi-Lyme disease (IFA)Brucella canis (card agglutination test)Brucella canis (tube agglutination test)Canine distemperOtherCanine influenza (HI)Canine parvovirus (HI)Leptospirosis, 6 serovars (MA)Toxoplasma gondii (LA)ToxicologyAnticoagulant ScreenToxic ElementsLeadTrace Nutrient ElementsMycotoxin ScreenOtherFor a detailed list <strong>of</strong> elements included in each panel, please visit our website:www.vdl.umn.edu/ourservices/toxicologyPage 3
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