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Athens Veterinary Diagnostic Laboratory

Athens Veterinary Diagnostic Laboratory College of Veterinary Medicine University of Georgia 501 Brooks Dr. Athens , Georgia 30602-7383 Veterinary License Number Required Tel: (706) 542-5568; Fax: (706) 583-0654. Website: Check one: Pick up Fax E-mail Report to: _____. Veterinarian Animal's ID Date Clinic Name Owner Address Address City, State, Zip City, State, Zip Telephone County Specimen _____Species_____Breed_____ Sex _____ Age _____. PLEASE FILL OUT THIS FORM COMPLETELY INCLUDING HISTORY ON REVERSE SIDE: By submitting Diagnostic specimens to the AVDL, clients are considered to have agreed to AVDL testing procedures and policies, including billing.

Form: Acc010.13 Rev. 4/8/2013 Athens Veterinary Diagnostic Laboratory College of Veterinary Medicine University of Georgia 501 D.W. Brooks Dr. Athens, Georgia 30602-7383

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Transcription of Athens Veterinary Diagnostic Laboratory

1 Athens Veterinary Diagnostic Laboratory College of Veterinary Medicine University of Georgia 501 Brooks Dr. Athens , Georgia 30602-7383 Veterinary License Number Required Tel: (706) 542-5568; Fax: (706) 583-0654. Website: Check one: Pick up Fax E-mail Report to: _____. Veterinarian Animal's ID Date Clinic Name Owner Address Address City, State, Zip City, State, Zip Telephone County Specimen _____Species_____Breed_____ Sex _____ Age _____. PLEASE FILL OUT THIS FORM COMPLETELY INCLUDING HISTORY ON REVERSE SIDE: By submitting Diagnostic specimens to the AVDL, clients are considered to have agreed to AVDL testing procedures and policies, including billing.

2 If tests not offered or temporarily out of service at AVDL are requested, specimens will be referred to other reputable laboratories and a shipping fee/test charges from the referral Laboratory will be added to the client's bill. Check the appropriate box(es) for requested test. *Call Laboratory or consult user manual for appropriate specimens. CULTURE & PATHOLOGY FELINE. SER FA PCR. IDENTIFICATION (Complete history on reverse side) SER FA PCR E. coli pilus antigen Biopsy Extended Routine Infectious peritonitis Other _____.

3 BACTERIOLOGY /. Cytology Leukemia MYCOLOGY SPECIAL PROCEDURES. Dermatopathology . Aerobic culture & Sensitivity Panleukopenia Avian Influenza PCR. Necropsy . Anaerobic culture Rhinotracheitis (FHVI) Clostridium difficile cytotoxic Mail-in Necropsy . Fungal/Yeast culture ANTIBODY, ANTIGEN &. Tularemia ELISA. Minimum Anitmicrobial Inhibitory Chlamydia/Chlamydophila Seal herpesvirus 1 SN. MOLECULAR DETECTION. Concentration (MIC) Check the appropriate box against each disease agent: spp. Mobillivirus SN PCR. Salmonella spp.

4 Culture SER: serology (= antibody detection). FA: fluorescent antibody staining (= antigen detection). spp. & Rhino. Newcastle disease PCR. Mycobacterium spp. culture PCR: polymerase chain reaction (=nucleic acid detection) Other_____ Pacheco's disease FA. Mycoplasma spp. culture BOVINE PORCINE Other _____. SER FA PCR SER FA PCR. PARASITOLOGY. Stains (Please select). Leukosis Influenza (H1N1 & H3N2).. *acid fast . Direct saline smear Bluetongue Parvovirus . *gram . Fecal egg count Bovine viral diarrhea Pseudorabies.

5 *other_____ . Fecal float Epizootic hemorrhagic dis. PRRS. Parasite ID. Other_____ . Infectious bovine rhino TGE. Other _____.. Respiratory syncytial virus Rotavirus VIROLOGY . Rotavirus Other_____ SPECIMENS. Virus Isolation (Specify Virus). Salmonella spp. MISCELLANEOUS _____. _____. Other_____ SER FA PCR. Electron Microscopy Brucella canis _____. Rabies CANINE Brucella abortus SER FA PCR Nec_____. Brucella spp. CLINICAL PATHOLOGY Coronavirus Vesicular stomatitis virus His_____. CBC (EDTA, 2 air-dried slides) Distemper Leptospira spp.

6 Chemistry profile (1 ml serum) Infectious canine hepatitis Toxoplasma spp. Urinalysis- Collection Method Parvovirus CP_____. _____ Canine herpesvirus Campylobacter spp. Amylase (serum) Other_____. Chlamydophila spp. Bac_____. Bile acid (serum) Clostridium (Blackleg, Blood parasites (2 air-dried smears) EQUINE Malignant Edema) Ser_____. Cortisol SER FA PCR Cryptosporidium spp. Lipase (serum) Equine Viral arteritis Giardia spp. Vir_____. T4 (canine, feline, equine; ml Influenza A type 2 Fungi (Specify) _____. serum) Rhinopneumonitis (EHV-1) _____ Par_____.

7 TSH (canine, feline, equine; ml Salmonella spp. Influenza type A. serum). Prescottia equi (Rhodococcus Listeria spp. EM_____. Urine ratio equi) spp. Mycobacterium spp. Other_____. Streptococcus equi spp. Mycoplasma spp. Oth_____. Other_____ Neospora spp. Office Use Only! Form: Rev. 4/8/2013. CLINICAL HISTORY: (For ALL Submitted Samples). Nutritional information (feed, water, minerals, supplements)_____. History (clinical signs, treatment, response; for dematopathology also describe skin lesions & lesion distribution).

8 _____. _____. _____. Has previous material been submitted for this problem?_____ Date _____ Case number _____. Deceased: Yes No Euthanasia: Yes No Vaccination/de-worming history BIOPSY / CYTOLOGY / DERMATOPATHOLOGY (Describe skin lesions above in Clinical History). LESION INFORMATION. Biopsy/Dermatology (CHECK ONE): R L L R. 0 1 2 3 4 cm Neoplasm size: (a)_____x_____x_____cm. (b)_____x_____x_____cm. Tissue(s) involved_____. Gross appearance_____. Duration / Rate of development_____. Is entire lesion submitted? Yes_____ No_____ Ventral Dorsal Is there evidence of metastasis?

9 Yes_____No_____. CYTOLOGY (CHECK ONE). Tissue Aspirate Tissue Scraping Tissue Imprint Tissue Discharge Cerebrospinal Fluid Body Cavity Fluid Synovial Fluid Tracheal Wash Bone Marrow (ALSO MUST SUBMIT EDTA BLOOD FOR CBC): NECROPSY HISTORY. Date and time of death_____ Duration of illness (this animal)_____. Duration of herd/group problem _____ Herd/group size _____. Number of animals affected _____ Number of animals dead _____. Please go to our website for fillable submission forms, interactive tests and fee schedule, and additional submission information.

10 Form: Rev. 4/8/2013.


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