REQU IS T ON F M - Protatek International, Inc.

1 Protatek REFERENCE LABORATORY540 WEST IRON AVENUE SUITE 106 MESA, AZ 85210 TEL: (480) 545-8499 FAX: (480) 545-8409 SEROLOGYR ickettsia1. Ehrlichia canis (sst)2. Feline Ehrlichia (E. canis + N. risticii) (sst)3. Neorickettsia risticii (E. risticii) (sst)4. Anaplasma phagocytophilum (E. equi) (sst)5. Ehrlichia sennetsu (sst)6. Rickettsia rickettsii (RMSF) (sst)7. Chlamydia (sst)8. Bartonella henselae (sst)Viral9. Canine parvovirus (lgM / lgG) (sst)10. Canine distemper (lgM / IgG) (sst)11. Canine distemper smears (DFA) (sl)12. Feline leukemia (ELISA) (sst)13. Feline leukemia (IFA) (ltt)14. Feline infectious peritonitis (FIP) (sst)15. Feline immunodeficiency syndrome (FIV) (sst)16. Feline rhinotracheitis (sst)17. Feline panleukopenia (sst)18.

2 Equine rhinopneumonitis (sst)Bacterial19. Borrelia burgdorferi (Lyme) (IFA) (sst)20. Lyme Multiplex assay (sst)21. Brucella canis (IFA) (sst)22. Brucella canis (EXPORT) (sst)23. Leptospira (6 serovars) (sst)Protozoan24. Babesia canis (sst)25. Babesia gibsoni (sst)26. Babesia caballi (equine) (sst)27. Babesia bigemina (bovine) (sst)28. Toxoplasma gondii (IgM / IgG) (sst)29. Neospora caninum (IgM / IgG) (sst)30. Leishmania infantum (chagasi) (sst)Fungal31. Coccidioidomycosis (Cocci, Valley Fever) (sst)32. Blastomycosis (sst)33. Histoplasmosis (sst)34. Aspergillosis (sst)35. Cryptococcus antigen (sst)Helminthic36. Heartworm antigen (ELISA) (sst)37a. Knott s microfilaria test (ltt)37b. D. immitis microfilarial filtration test (ltt)Hormonal/Autoimmune38.

3 Progesterone assay (sst)39. Canine rheumatoid factor (sst)40. Coomb s test (direct) (ltt)41. Antinuclear antibodies (ANA) (sst)Microscopic Identification42. Mycoplasma haemocanis (ltt)(Haemobartonella canis) 43. Mycoplasma haemofelis (ltt)(Haemobartonella felis)44. Babesia spp. (sl, ltt)45. Trypanosoma spp. (sl, ltt)46. Brucella canis (sl,Itt)DISEASE PANELS47. TICK-BORNE DISEASE PANELE. canis, B. canis, RMSF, Lyme (sst)48. EHRLICHIA FUNGAL PANELE hrlichia canis, Coccidioides (sst)49. FUNGAL PANELC occi, Blasto, Histo (sst)50. CANINE HEMOLYTIC ANEMIA PANELB abesia canis (sst), Coomb s test (ltt)51. FELINE DISEASE PANELE. canis, N. risticii, FeLV, FIP, Toxo (sst)52. CANINE EXPORT PROFILE IB. gibsoni (IFA) (sst), Babesia spp. (sl)53. CANINE EXPORT PROFILE IIE.

4 Canis, Leishmania, Lepto, Brucella canis(agglutination) (sst)ANTI-FUNGAL DRUG LEVELS54. Fluconazole (sst)55. Ketoconazole (sst)56. Itraconazole (sst)57. Voriconazole (sst)HEALTH PROFILES AND PANELS58. CBC (ltt)22 parameters with 5-part differential59. Chemistry Profile 14 (sst): ALT, ALB, ALP, AMY, CA,PHOS, CRE, GLOB, GLU, K+, NA+, TBIL, TP, BUN60. T4/ Cholesterol (sst)61. Chemistry Profile 14 + CBC (sst, ltt) Profile 14 + CBC + T4 / Cholesterol (sst, ltt) canis + Chem Profile 14 + CBC (sst, ltt)64. Coccidioides + Chem Profile 14 + CBC (sst, ltt)65. E. canis + Cocci + Chem Profile 14 + CBC (sst, ltt)66. Tick-borne Disease Panel + T4 / Cholesterol (sst)67. Tick-borne Disease Panel + Chem Profile 14 + CBC(sst, ltt)PCR PANELS (submit 1ml whole blood in ltt)68.

5 Ehrlichia / Anaplasma / Neorickettsia (ltt)69. Rickettsia (ltt)70. Bartonella (ltt)71. Hemoplasma (Hemobartonella) (ltt)72. Babesia (ltt)OTHER TESTS:ANALYSIS REQUESTED (circle)sst = serum separator tube ltt = lavender top tube sl = slides (unstained)PRL Reference #Account CodeClinic NameBilling Info (if different)AddressNameAddressPhoneFaxPhon eEmail AddressFaxVeterinarianOwnerAnimal s Name / IDSpeciesBreedSexAgeCollection Date / /Clinical History / DDREQUISITION FORM