Phone: 541-737-3261 Fax: 541-737-6817 Email: vet.diagnostic@oregonstate.edu

Website: http://vetmed.oregonstate.edu

State: Zip:

Fax: Account # Submitter:

Address:

City:

Phone:

Email:

Choose One Reporting Method:

Zip: State:

Owner:

City:

NAME/ID:

SPECIES:

SEX:

BREED:

Cattle Horse Dog Cat

NAME/ID:

SPECIES:

SEX:

BREED:

Other:

Specimens Submitted - indicate number of each sample type Date Specimens Taken_____________ Date Specimens Submitted_____________

#___Whole Animal #____Blood, EDTA

#___Fresh Tissue #____Blood, Heparin

#___Formalin Fixed Tissue #____Serum

#____Blood, whole #____Plasma

#___Feces

#___Milk

#___Urine ___ voided___ catheterized___cystocentesis

___ STAT

#___Fluid (origin)

#___Swab (origin)

#___Other (origin)

History:(For a diagnosis) Include clinical presentation, feed/husbandry changes, onset and duration of illness, treatments (include antibiotics), vaccinations.

Number of animals in this submission______ Date of death____/____/____ Euthanized: Yes______ No______ Rabies Suspect Yes______ No______ Number of healthy animals housed together ______ Number of sick animals______ Number of dead animals______

Email Fax Mail

Submitting Veterinarian:

P h o n e:

Send Report To (Name):

ANIMAL IDENTIFICATION—Use Multiple Animal ID Form if necessaryM= Male, F= Female, MC= Castrated Male, FS= Spayed Female

AGE: AGE:M F MC FS

Other:

M F MC FS

Mark location of Biopsy or Cytology on animal in box below or back page

Yr. Mo. Wk. Dy. Yr. Mo. Wk. Dy.

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*If cremation is selected the OVDL must be notified of arrangements within 3 business days. Regular Disposal Cremation (Specify company Below)

*Routine disposal will be completed if no notification is received or no selection is made. ___________________________________________

Page 1 of 2

Is this Research? (If checked, blocks and slides will be returned to you and no diagnostic read out will be performed).

Previous Accessions:

Report To Fax/Email(s):

*Submitter is responsible for all fees associated with submission unless specific arrangements are made and approved by OVDL management**For OVDL purposes owners are not the client. Submitter is responsible for notifying OVDL if owner is approved to speak with and receive results*

*Submitter agrees and has permission from owner to submit and transfer ownership of specimens to OVDL and the University*

OVDL USE ONLY: Initial:_______ Date :____________ Shipping: ___After Hours ___Hand Delivered ___Courier ___US Mail ___FedEx ___UPS: PP Next 2nd

___Ice ___ No Ice ___NIS ___LIT ___BRK ___SNP ___FRZ ___CHC ___RMT ___WRM Tracking # Notes:

Shipping/Courier Address: 134 Magruder Hall Corvallis

OR 97331-8555

Cattle Horse Dog Cat

F-BUS-1.7 Active: 8/25/2020

Visit our website for a complete list of available tests, including test and sample information or call 541-737-3261

BACTERIOLOGY

HEALTH SCREENS____ Ruminant Diarrhea Health Screen ____ Equine Neurologic Health Screen ____ Equine Diarrhea Health Screen____ Abortion Screen

PARASITOLOGY

____ Aerobic Culture ____ Add Antibiotic Sensitivity – per bacterial organism

____ Anaerobic Culture (requires aerobic culture) ____ Campylobacter Culture____ Corynebacterium pseudotuberculosis Rule-Out Only ____ Clostridium Perfringens culture

____ Add PCR genotyping if positive ____ Dermatophyte Culture____ Fungal Culture____ Streptococcus equi ssp. equi Rule-Out Only____ Milk Culture - ____ Mastitis ____ Add Sensitivity____ Milk Culture - Mycoplasma only____ Milk Culture - Staph only____ Mycoplasma Culture____ Salmonella Culture____ Stain: __Clostridial FA __Gram Stain __ Other:

____ Cryptosporidium Exam____ Fecal Parasites - Baermann (Lungworms) ____ Fecal Floatation Exam: ____ McMaster's ____ Sugar Centrifugation____ Haemonchus Contortus Identification

**Species Dependent or by Request ____ Fecal Parasites - Sedimentation (Flukes) ____ Fecal Parasites - Wet Mount Microscopic ____ Fecal Parasites - Small Animal Panel

(Sugar Centrifugation, Baermann, Giardia FA, and Crytosporidium slide exam)

____ Giardia: ____ FA Exam ____ Iodine

VIROLOGY/SEROLOGY

F-BUS-1.7 Active: 8/25/2020 Page 2 of 2

MOLECULAR DIAGNOSTICS____ Influenza-A Virus (Universal) PCR____ BTV / EHDV PCR ____ BVDV PCR (Acute & Pooled - PI)____ EHV-1 & EHV-4 PCR

**Includes neurotropic rule out if EHV-1 positive ____ Johne's Disease (MAP) PCR____ Leptospira spp. PCR____ Mycoplasma haemolamae____ Salmonella spp. PCR

**Culture & serotyping are added if positive ____ Streptococcus equi, ssp. equi (Strangles) PCR____ WNV (West Nile Virus) PCRPCR PANELS: *(Offered for multiple species, see website for details)* ____ Respiratory PCR Panel ____ Diarrhea/Scours PCR Panel

____ Brucella canis RSAT____ Brucella ovis ELISA____ BTV ELISA____ BVD-PI ELISA____ Caprine Arthritis-Encephalitis Virus (CAE) ELISA ____ Ovine Progressive Pneumonia Virus (OPP) ELISA ____ Coccidioides IgG Screen ____ Coccidioides IgM Screen____ Cryptococcus Antigen Screen ____ Leptospira MAT- 6 serovars____ Rabies FA____ Serum virus neutralization assays *(please specify-see website)____ WNV IgM ELISA (Equine, Camelid)____ Virus Isolation

CLINICAL PATHOLOGYChemistry ____ Complete (SA/LA) ____ Liver (SA/LA) ____ Renal (SA/LA) ____ Lipid (LA) ____ Metabolic (LA) ____ Musculoskeletal (LA)

Miscellaneous ____ Avian CBC____ Avian/Reptile Health Screen____ Avian Hepatic Panel ____ Urinalysis

Hematology

____ CBC (Fibrinogen included for LA)

Endocrinology ____ ACTH (K9, EQ) ____Cortisol ____ Progesterone ____ T4 (K9,FE)

CytologyFluid Analysis (Source): Slide Only (Source):

Assess all lymph nodes as one site?

YES NO

BIOPSY/NECROPSY

____ Histopathology (Source):

____ Gross Necropsy

____ Complete Necropsy

OTHER

Gross Necropsy: Gross necropsy includes an external examination of the animal and an examination of the internal organs including those of the respiratory system, digestive system, cardiovascular system, urogenital system, endocrine system, and brain. The spinal cord and peripheral nerves may also be examined if indicated by the animal's history.

Complete Necropsy: Gross necropsy is performed, with ancillary testing be completed at the discretion of the pathologist.

Shipping/Courier Address: 134 Magruder Hall Corvallis

OR 97331-8555

Phone: 541-737-3261 Fax: 541-737-6817 Email: vet.diagnostic@oregonstate.edu

Website: http://vetmed.oregonstate.edu