Rabies Specimen Submission Form - Veterinary Diagnostic ...

Rabies Specimen Submission FormPhysicians and veterinarians may obtain information on rabies 24/7from the Minnesota Department of Health at 651-201-5414. Publiccalls are taken at the same number M-F, 8:00 a.m. to 4:30 p.m.MDHUse OnlySubmitterDate:_____/_____/_____Name of submitter: _______________________________________________________(check all that apply): Owner Veterinarian Exposed personOther: _____________________________________Clinic/Org. name: _________________________________________________________Address:_________________________________________________________________City/Zip: ________________________________________County:_________________Phone:______________________________ Fax:_______________________________VDL Use OnlySpecies:__________________________ Owned Stray Wild Animal name or ID:_______________________Date of death:_____/_____/_____ Tested animal was: Euthanized Killed Found deadTest AnimalOwner (if different from submitter):_____________________________________Phone:_______________________________Address/Location of tested animal:__________________________________________________________________________City/Zip:__________________________________________________________County:______________________________Explain situation:_______________________________________________________________________________________________________________________________________________________________________________________________Cremation: Mass (no remains returned)Individual (remains returned). Arranged by owner or veterinary clinic. An animal testing positive for rabiescannot be released. If the sample is untestable, remains may be released on a case by case basis.Laboratory VDL ExposureNo human exposureType of exposure:Human exposureDate of exposure:_____/_____/_____Bite (where on body): ____________________________Non-bitePerson(s) exposed: _________________________________________________________________ Age(s):______________Where did exposure occur?__________________________________________ County: ______________________________Phone 1 of exposed person:___________________________ Phone 2:_____________________________Live Dead: Whole bodyHeadBrain: HippocampusCerebellumBrain stemCondition:GoodFairAutolyzedTraumatizedDriedNo tissueDate sent to MDH:_____/_____/_____ Initials:________ Comments:_______________________________________________Form revised 01/2013

Instructions and Information:• Hand deliver specimens whenever possible; otherwise ship by a direct overnight delivery service. Specimensshould not be shipped by mail -- even priority mail.• Live bats will be accepted during normal business hours only. Hand deliver live bats and label containers: “Live Batfor Rabies Testing.” All other animals must be euthanized by a veterinarian prior to submission.• For next business day results, specimens must be received at the Minnesota Veterinary Diagnostic Laboratory(VDL) by 11:00 AM.• The fee is $26.25 for rabies testing. Add 10% for out of state. All costs associated with euthanasia, specimenpreparation, packing, shipping, and testing are the responsibility of the submitter.• Small rodents (hamsters, guinea pigs, squirrels, chipmunks, mice, gophers, etc.) and insectivores (moles and shrews)do not pose a risk for rabies in Minnesota. Please do not submit these species for rabies testing.• Questions regarding specimen submission should be directed to the VDL at 612-625-8787Deliver specimens to:Business hours (M-F, 8:00-4:30)Minnesota Veterinary Diagnostic LaboratoryUniversity of Minnesota-St. Paul Campus1333 Gortner AvenueSt. Paul, MN 55108Phone: 612-625-8787ORNon business hours and holidays*Veterinary Medical Center-Emergency ReceivingUniversity of Minnesota-St Paul Campus1365 Gortner AvenueSt. Paul, MN 55108Phone: 612-625-9711*Live bats will not be accepted after business hours.Specimen preparation and packing requirements:• Bilateral samples of brain stem, hippocampus, and cerebellum are required for rabies testing. If possible,submit the head of large animals and the entire body of small animals. When submitting only brain tissue,submit the entire brain.• Do not fix the brain in chemical preservatives. Submit fresh tissue only.• Refrigerate, do not freeze, specimens prior to shipping. If frozen, do not thaw. Samples that have been frozenmay yield satisfactory results and should be submitted.• Double bag specimens in heavy, leak-proof plastic bags, securely seal, and ship in a leak-proof container,preferably a Styrofoam box with a cardboard exterior.• Include leak-proof freezer packs in the shipping container to keep specimen cold. Do not pack in wet or dry ice.• Pack shipping container with paper or other absorbent material to ensure temperature stability and to absorbfluids in case of leakage.• Complete this submission form, place in a plastic bag and attach securely to the outside of the specimencontainer. The submission form is available at: www.vdl.umn.edu/ourservices/rabies/home.html.• Label the exterior of the box “Veterinary Diagnostic Specimen.” or “Live Bat for Rabies Testing”.Cremation services:Animal remains will be processed using mass chemical cremation unless arrangements for private cremation aremade by the client or the client’s veterinarian. Once the test result is known, animals testing negative for rabies maybe released to a private cremation service. Animals testing positive for rabies will not be released for cremation dueto the risk of human exposure. If the sample is untestable due to deterioration, remains may be released on a case bycase basis.Results:Rabies test results are reported to the submitter of the specimen by fax or you may call the VDL at 612-625-8787for results. Submitters of animals with positive test results will receive a follow-up phone call from the MinnesotaDepartment of Health and the Minnesota Board of Animal Health.Form revised 07/2012