v· National Jewish 1'2 Health® Science Transforming Life ®

MYCOBACTERIOLOGY LABORATORY TEST RESULTS

1400 Jackson Street Denver, Colorado 80206 www.nj labs.org TBLab@njhealth.org 303-398-1339

Patient Name Page # Date/Time Report Printed

~I ____ ~B~I~~~TG~I~'~I~N~G~B~A~~~JK~O __ ~~~~ __________ ~] ~1 __ 1~ __ ~1 107/03/2014 11 -40 Sex DOB) MRUN # Account #

D C 1 ,I 0 1 ,I 1976 I l:. 01 891 77 I i-'I =1 ;;";;O:':';O~2:':"'2-2-7-3-4-0-----'

CENTER FOR ELEPHANT CONS / POLK CITY 12850 OLD GRADE RD POLK CITY, FL 33868 RINGLING BROTHERS 703 269 8212

W45609 COLL: 06 / 25 / 2014 08:00 REC: 06 /2 5/ 2014 19:41 PHYS: CENTER FOR ELEP

SPECIMEN SOURCE INFORMATION SPECIMEN SOURCE ACTUAL COLLECT DATE PATIENT'S PHYSICIAN

TRUNK WASHINGS 04/17 / 2014 DAN I ELLE GRAHAM 703/269/8212

TIIERESA SAVIDGE CLINICAL

TECHNOLOGIST PHYSICIAN'S PHONE PHYSICIAN'S FAX NO • 866/863/8201 MAX SAlF!NGER, M.D.

.. HOSP LAB FAX NO '. \CDMMENTS

RAPID ID OF MDR MDR AMPLIF ID

RIFAMPIN GENO

ISONIAZID GENO

• 850/410/0195 (FLORIDA STATE VETERINARIAN)

• 850.921.9906 FLORDIA STATE TB CONTROL ADDITIONAL TESTING OF SUSCEPTIBILITIES

REQUESTED BY DR GRAHAM ON 06 / 25 / 2014 VIA FAX. SEE NJH ACC/N H56088 FOR INITIAL TESTING REQUESTED. 400 MQ.

vi MOLECULAR TESTING DETECTED THE PRESENCE OF MTB COMPLEX.

TEST FREE OF CHARGE 07/03/2014. TECH 705.

J NO rpoB MUTATION DETECTED SUSCEPTIBLE TO RIFAMPIN

~ NO katG MUTATION DETECTED AND NO inhA MUTATION DETECTED

SUSCEPTIBLE TO ISONIAZID (NOTE)

The line probe assay only indicates those resistances of MTB complex that have their origins in the rpoB, katG, and inhA regions examined here. Resistances originating from mutations of other genes or gene regions as well as other rifampin and isoniazid resistance mechanisms

RINGLING,BANKO CONTINUED

Advanced Diagnostic Laboratories NATIONAL JEWISH HEALTH

1400 Jackson Street DENVER, CO 80206

1 PAGE

CAP #2178901

Client Services: 800-550-6227 Molecular TB Testing - 7 days a week CLiA #0600644307

LAB 105 (5.13)

v· National Jewish 52 Health"

Science Transforming Life '"

MYCOBACTERIOLOGY LABORATORY TEST RESULTS

1400 Jackson Street Denver, Colorado 80206 www.njlabs.org TBLab@njhealth.org 303-398-1339

Patient Name Page # Date/Time Report Printed

L.-~R';"' . .;QIH~JC~L~I,l:-:l?WJCb-r; -:l3Bo!-lZ\~d}J~K~;oi-----"-'~""""""--------I1 LI----..66.-_...Jllo 7 /03 /:2 014 11· 40 Sex FD...::O...::B=--____ .., MRUN # Account # o I 01 / 01 / 1976 1 I~~ 0189177 I 10::6:6:67340

CENTER FOR ELEPHANT CONS / POLK CITY 12850 OLD GRADE RD POLK CITY, FL 33868 RINGLING BROTHERS 703 269 8212

W45609 COLL: 06 / 25 / 2014 08:00 REC : 06 / 25 / 2014 19:41 PHYS: CENTER FOR ELEP

RAPID ID OF MDR (CONTINUED) will not be detected by this test. This test only screens the nucleic acid sequence and not the amino acid sequence. Therefore, it is possible that mutations that do not cause an amino acid exchange (silent mutations) will still produce the absence of one of the wild-type probes.

.MDR COMPLETION DATE 07 / 03 /2 014 GENOTYPIC RESULTS TO BE CONFIRMED BY CONVENTIONAL METHODS. - , \.

RINGLING,BANKO

CAP #2178901

This test uses a kit / reagent designated by the manufacturer as for research use, not for clinical use. The performance characteristics of this test have been validated by Advanced Diagnostic Laboratories at National Jewish Health. It has not been cleared or approved by the US Food and Drug Administration.

The results are not intended to be used as the sole means for clinical diagnosis or patient management decisions. This laboratory is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA-88) as qualified to perform high complexity clinical laboratory testing.

CONTINUED

Advanced Diagnostic Laboratories NATIONAL JEWISH HEALTH

1400 Jackson Street DENVER, CO 80206

Client Services : 800-550-6227

Molecular TB Testing - 7 days a week

2 PAGE

CLiA #0600644307 LAB 105 (5.13)

v· National Jewish 1'2 Health® Science Transforming Life ®

MYCOBACTERIOLOGY LABORATORY TEST RESULTS

1400 Jackson Street Denver, Colorado 80206

www.njlabs.org TBLab@njhealth.org 303-398-1339

Patient Name Page # Date/Time Report Printed

~1 ____ ~RwT~1~JG~I~!~T~N~G~B~A~1~JK~Q __ ~~~~ __________ ~I ~I __ 3~ __ ~1 107/03/2014 11:40 Sex DOB MRUN # Account #

D I 01 (01 11 976 1 LO.:s:.-01 89177 I I 1002227340

CENTER FOR ELEPHANT CONS/POLK CITY 12850 OLD GRADE RD POLK CITY, FL 33868 RINGLING BROTHERS 703 269 8212

w45609 COLL : 06/25/2014 08:00 REC: 06/25/2014 19:41 PHYS: CENTER FOR ELEP

RAPID ID OF MDR

TB SUSCEPTIBILITY

PZA MIC AT PH 6.0

RINGLING, BANKO

CAP #2178901

(CONTINUED)

PENDING

PENDING

END OF REPORT

Advanced Diagnostic Laboratories NATIONAL JEWISH HEALTH

1400 Jackson Street DENVER, CO 80206

Client Services: 800-550-6227 Molecular TB Testing - 7 days a week

3 PAGE

CLiA #0600644307 LAB 105 (5. 13)