AVIAN SUBMISSION FORM
Lab use only
Animal ID:
________________________
________________________
Please send an excel spreadsheet
to specroom@uoguelph.ca if
more than 20 samples are
submitted.
# SPECIMENS
Sent Received
Whole blood
Serum
EDTA
Urine
Feces
Fresh tissue
Fixed tissue
Fluid
Scrapings
Slide
Swab
Other
List:
VIROLOGY
ABV - PCR abvrrt
AEV - ELISA aev
AEV - PCR aevrrt
AIV - AGID aif/aifn
ALV Ag - ELISA alve
AMPV - PCR ampvpcr
Astrovirus - PCR astrrt
CAV - ELISA cav1
CAV - PCR cavrrt
Duck adenovirus 1 - PCR dadvrrt
FAdV - PCR (chicken only) fadvrrt
FAdV microneutralization mnt811
Genotyping for:________________
(Only PCR Positive samples )
HEV AGID het
IBDV - PCR ibdvrrt
IBDV-XR - ELISA ibdxr
IBV - ELISA ibv
IBV - PCR ibvrrt
ILTV - PCR iltvrrt
Influenza A, matrix - PCR inflpcr
Influenza A, antibody - ELISA aifem
MG/MS combo,chicken-ELISA mgmsc
MG/MS combo, turkey-ELISA mgmst
M. meleagridis - ELISA mme
NDV - ELISA ndvc/ndvt
NDV matrix-PCR apmvmpf/apmvmpn
Paramyxovirus 3 HI pm3
Reovirus - ELISA reove
Reovirus - PCR reorrt
Poxvirus - PCR poxrrt
S. Pullorum - typhoid - tube salmh
S. Enteritidis - tube salme
WNV - PCR wnvpn
MYCOPLASMOLOGY
C. psittaci - PCR cppcr
Coxiella-like organism ID acloid
Mycoplasma culture mculf
M. gallisepticum - PCR mgpcr
M. iowae - PCR iowrt
M. meleagridis - PCR mmqpcr
M. synoviae - PCR mspcr
16S rRNA sequencing (partial) 16srp
16S rRNA sequencing (full) 16sr
PARASITOLOGY
Fecal flotation fflot
Saline wet mount salwt
Tissue search parasites tisp
Fecal oocyst count focmm
CLINICAL PATHOLOGY
Avian profile aprf
Avian/reptile - Vetscan scana
Glucose gluc
CBC avcbc
Leukocyte diff., avian difav
Cytology, fluids cyto
FNA, synovial
Cytology, smears cytsm
Site:
HISTOPATHOLOGY
Histopathology hist/histp
IHC -
OTHER TESTS REQUESTED :
(See Fee schedule for complete listing)
Breed:_________________
Age: _______ d w m y
Sex (circle): M F Mixed
Flock size: _______________________
No at risk: _______________________
No sick: _________________________
No dead_________________________
Weight: _______________________ kg
Duration of problem:________________
______ d ______ w _____ m ____ _y
Case: Diagnostic Monitoring
Research Other
BACTERIOLOGY
Site:_________________________
Aerobic & ancultf/ancultn
anaerobic culture
Anaerobic ancuf/ancun
Culture and suscept. cultf/cultn
Botulism - MIT (serum) mibts
Botulism - MIT (tissue/feed) mibst
Culture, environmental 1 acule
Culture, environmental 2 acule2
Culture, environmental 3 acule3
TOXICOLOGY
Cholinesterase-blood che
Cholinesterase-brain cheb
Feed additive screen scrfa
(monensin, narasin, salinomycin)
Mineral panel, heavy metals hmsc
(Sb As Be B Cd Co Cr Cu Fe Pb
Hg Mg Mn Mo Ni Se Sn Tl Zn)
Mineral panel, salt screen salsc
(Ca Mg Na K P S)
Mineral panel, trace, tissue icpti
(Co Fe Mn Mo Se Zn)
Selenium, serum tsems
History: (treatments, vaccinations, management, including all current drug therapy)
Special Instructions:
STAT (Additional charges apply)
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AHL AVIAN (2019-02-07)
Insurance claim?
Possible litigation?
Resubmission?
Type of analysis:
Disease problem
Vaccination evaluation
Other
Important. Please read. Contact Information must be supplied with all samples submitted for testing to the Animal Health Lab (“AHL”). Agricultural animal testing carried out through AHL is
subsidized by the Government of Ontario. By submitting samples for testing to AHL, the Submitter acknowledges that s/he is the owner or is a duly authorized agent of the owner. The
Submitter acknowledges and agrees that AHL may share test results and Contact Information as it deems necessary for the purposes of relevant legislation regarding reportable or notifiable
diseases and for the purpose of surveillance of animal or public health in Ontario.
***DEMOGRAPHIC INFORMATION IMPORTANT***
AHL - Guelph Courier Address
UoG Animal Health Lab-PAHL
419 Gordon Street-Bldg 89
Guelph, ON N1G 2W1
Attn: Specimen Reception
Animal Health Laboratory
79 Shearer Street
Kemptville, Ontario
K0G 1J0
SAMPLES TAKEN Date: _________/_____/_____(yyyy/mm/dd) Time of day _____:_____ Date sent________/____/____(yyyy/mm/dd)
SUBMITTED BY Veterinarian Owner Other BILL Veterinarian Other
Clinic No. Owner Unique ID (max. 40 characters)
Clinic
Address Postal code Address
City Phone Premises ID Barn postal code
Veterinarian Fax Phone Email
Email Farm Fax
Barn/pen/floor/batch ID
Any Questions? Please contact the lab.
Email: ahlinfo@uoguelph.ca
Website: http://ahl.uoguelph.ca
AHL GUELPH: 519-824-4120 ext: 54530, Fax: 519-827-0961
AHL KEMPTVILLE: 613-258-8320, Fax: 613-258-8324
RECEIVED BY: Initial ________
Courier Mail
Drop-off Other
Chicken: Broiler Broiler-Breeder
Layer Layer-Breeder
Exhibition Small Flock
Turkey Meat Breeder
Exhibition Small Flock
ANIMAL HEALTH LABORATORY
ADDITIONAL ID WORKSHEET
Comments/History (Continued)
ID# Identification ID # Identification
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AHL AVIAN (2019-02-07)
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