Transcription of Billing Party: Owner
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Billing Party: Owner
FOR LAB USE ONLY. Section(s): C B M N P S T V. Case Coordinator: Deliveries: 1490 Bull Lea Rd., Lexington, KY 40511 Carrier: M B D U F O V Other US Mail: PO Box 14125, Lexington, KY 40512-4125. Phone: (859) 257-8283 Fax: (859) 255-1624 Rec'd By / Ship Date: Comments: Billing Party: Veterinarian Owner Other: Owner : Veterinarian: Name: Clinic: Business: Address: Address: City: State: Zip: City: State: Zip: Phone: Fax: Phone: Fax: Email: Email: If additional copies of report are needed, please include E-mails or fax numbers here: General Information (Please provide as much information as possible): Field Necropsy (Submitted samples RABIES SUSPECT Diagnostic Necropsy Cremation Neurologic (Spinal Cord Removal).)
Export Sample: (Country of Destination) History (Attach additional history if provided space is inadequate). Duration of Illness: Date of Death: Insured (Insurance Company) Euthanized. Neurologic (Spinal Cord Removal) Animal ID / Name* Species
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