COMPANION ANIMAL SUBMISSION FORM
PARASITOLOGY
Fecal flotation flotn
Giardia - antigen ELISA gia
Heartworm - Knott’s hwknt
Heartworm - ag ELISA hanti
Parasite identification idpr
HISTOPATHOLOGY
# of tissues/biopsies _________
*t/b=tissues/biopsies
Histopathology (1-2 t/b*)histcm1
Histopathology (3-6 t/b*)histcm2
Histopathology (7+ t/b*) histn
Tumor margin evaluation histt
(biopsy > 2cm)
Immunohistochemistry (IHC)-
Lesion location:
___________________________
View
Dorsal
Ventral
OTHER TESTS REQUESTED
(See Fee schedule for complete listing)
CLINICAL PATHOLOGY
Biochemistry
Biochem. profile, canine cprf
Biochem. profile, feline fprf
Geriatric profile geprf
Hepatic health profile hpsmp
Pre-surgical profile pssmp
Renal health profile rnsmp
Phenobarbital phbar
Potassium bromide kbrom
Phenobarb, K brom phkbr
Albumin alb
ALP sap
ALP steroid isoenzyme alkpi
ALT alt
Amylase amy
Bile acids, single sample bilss
Bile acids: pre, and post bile
Bilirubin, conjugated cbil
Bilirubin, total tbil
Calcium ca
Calcium (ionized) ica
Cholesterol chol
Creatine kinase (CK) ck
Creatinine creat
Fructosamine fruc
GGT ggt
Glucose gluc
Iron & TIBC fetib
Lipase lip
Na, K, Cl lyte
serum urine
Osmolality osm
serum urine
Total protein tp
Urea urea
Coagulation
Profile 1 (PT, PTT) ptptt
Profile 3 (PT, PTT, Fib) coag3
Fibrinogen fib
Endocrinology, Special Chemistry
ACTH, endogenous acth
ACTH stimulation corts
Cortisol, single cort
Cortisol, dex. suppression cortd
Thyroid, total T4 tt4
Thyroid prof.1 (TT4, fT4d) tprf1
Th.prof.2 (TT4, fT4d, cTSH) tprf2
OFA: (fT4d, TgAA, cTSH) tprf3
Free T4 ft4d
TSH, canine ctsh
Progesterone p4
Electrophoresis elphr
serum urine
FIV, FeLV - ELISA fivlk
Heartworm, Lyme, Ehrlic. hehly
Anaplasmosis - ELISA
Hematology
CBC, comprehensive cbc
Coombs’ test, direct coomd
Reticulocyte count ret
Blood typing, canine btypc
Crossmatch, setup crx
# ___donors crxk9
C. difficile - culture cdifn
C. perfringens -ELISA clop
Gram stain gram
Lepto. screen - MAT leptmatn
Leptospira spp - PCR leptpcr
Mycology - fungal culture myc
Brucella canis antibody test bcarsat
VIROLOGY
Canine adeno. - VN cav12
Canine herpesvirus - VN chv
CaHV1/CAdV2/ chappcr
CPIV - PCR
Influenza A virus - HI h3n8hi
Canine parvovirus 2 - HI cp2
Can. dist. virus - PCR cdvmb
Can. distemper virus - VN cdv
Feline calicivirus - VN fcv
Feline calicivirus/ fcfhpcr
Felid herpesvirus1 - PCR
Feline herpesvirus - VN fvr
Influenza A antibody - ELISA aifem
Influenza A, matrix - PCR
inflpcr
Parvovirus - PCR pv2mb
Rotavirus - PCR rotapcr
TOXICOLOGY
Convulsant screen - TLC scrcv
(strychnine, penitrem A, roquefortine)
Lead, blood - AAS tpbbca
Min. panel, heavy metals hmsc
(Sb As Be B Cd Co Cr Cu Fe
Pb Hg Mg Mn Mo Ni Se Sn TI Zn)
Min. panel, trace element icpse
Species
Breed
Age
Sex (check one) M F M/N F/S
Case type (please check)
Diagnostic Monitoring Research Other
Clinical diagnosis
STAT (additional charges)
Page 1 of 2
AHLCompanion (2019-02-11)
Lab use only
Animal Health Laboratory
Laboratory Services Division
79 Shearer Street
Kemptville, Ontario
K0G 1J0
Cytology
Site: __________________________
Cytology smears cytsm
Cyto. fluids (inc. CSF) cyto
Cytology, bone marrow bm
Urinalysis
Type: free flow
catheterized
cystocentesis
Routine urinalysis urin
Urine protein: creat. ratio upcr
Na, K, Cl, creat., Ca, P uchem
Cortisol: creatinine ratio uccr
Fecal occult blood foc
Myoglobin electrophoresis urmye
MYCOPLASMOLOGY
Lyme disease - PCR lyPCR
Mycoplasma culture mculn
M. haemofelis & hapcr
haemominutum - PCR
M.haemocanis & . hcpcr
haematoparvum - PCR
Tritrichomonas foetus - PCR tfpcr
BACTERIOLOGY
Site:___________________________
Culture & susceptibility cultn
Aerobic & anaerobic culture ancultn
Anaerobic culture ancun
Bacterial culture, fecal with cultnfe
C. perfringens ELISA
Culture <2mth follow up cultn2
Previous case# ______________
Bacterial culture, blood cultb
C.difficile toxins - ELISA clodn
Animal I D
Clinic No.
Clinic
Address
Phone
Email
Owner unique ID (max. 40 characters)
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
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.
History (clinical signs, lesion location/size/appearance, onset/duration of problem, current drug therapy, vaccinations)
AHL - Guelph Courier Address
UoG Animal Health Lab-PAHL
419 Gordon Street-Bldg 89
Guelph, ON N1G 2W1
Attn: Specimen Reception
SPECIMENS RECEIVED
Received by Courier Drop-off Mail Initial
SAMPLES TAKEN Date: _________/_____/_____/(yyyy/mm/dd) Time of day _____:_____ Date sent________/____/____/ (yyyy/mm/dd)
SUBMITTED BY Veterinarian Owner Other BILL Veterinarian Other
ANIMAL HEALTH LABORATORY
ADDITIONAL ID WORKSHEET
Comments/History (Continued)
ID# Identification ID # Identification
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AHLCompanion (2019-02-11)
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