EQUINE SUBMISSION FORM
Rabies suspect?
Insurance claim?
Possible litigation?
Resubmission?
Previous case #
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
# SPECIMENS
Sent Received
Whole blood
Serum
EDTA
Cit. Na.
Urine
Feces
Fresh tissue
Fixed tissue
Fluid
Scrapings
Slide
Swab
Other:
List:
VIA
Courier
Drop-off
Mail
Other
RECEIVED BY
________________
CLINICAL PATHOLOGY
Biochemistry
Biochem. profile equine eprf
Hepatic health profile hplmp
Pre-surgical profile pslmp
Renal health profile rnlmp
Albumin alb
ALP sap
AST ast
Bile acids, single bilss
Bilirubin, conjugated cbil
Bilirubin, total tbil
Calcium ca
Cholesterol chol
Creatine kinase (CK) ck
Creatinine creat
GGT ggt
Glucose gluc
GLDH gldh
Iron & TIBC fetib
Magnesium mg
Na, K, Cl lyte
serum urine
Osmolality osm
serum urine
Phosphorus p
Total protein tp
Triglycerides trig
Urea (BUN) urea
Coagulation
Profile1 (PT, PTT) ptptt
Profile 3 (PT, PTT, Fib) coag3
Fibrinogen fib
Endocrinology, Special Chemistry
ACTH acth
Cushing’s profile 3 cuft
(ACTH, glucose, fT4d)
Equine PPID (Cushing’s ) profile - cuin
ACTH, glucose, insulin
(Cushing’s panel = frozen EDTA plasma & serum)
Electrophoresis elphr
serum urine
Foal IgG - CITE ELISA c-igg
Insulin ins
Insulin & glucose insgluc
Progesterone p4
Serum amyloid A (SAA) saa
Thyroid, total T4 tt4
Thyroid profile 1 (ft4d, tt4) tprf1
Thyroid, free T4 by dialysis ft4d
Urinalysis
Type: free flow cystocentesis
catheterized
Routine urinalysis urin
Na, K, Cl creat., Ca, P uchem
Urine protein: creatinine. ratio upcr
Myoglobin electrophoresis urmye
Fecal occult blood foc
Hematology
CBC, comprehensive cbc
Coombs’ test, direct coomd
Crossmatch, setup crx
# ____donors (Crossmatch) crxeq
Cytology
Site: ________________________________
Cytology smears cytsm
Cyto. fluids (inc. CSF) cyto
Cytology, bone marrow bm
WNV - PCR wnvpn
WNV - IgM ELISA xwnveq
MYCOPLASMOLOGY
Lyme disease - PCR lyPCR
Mycoplasma culture mculn
Potomac horse fever - PCR phfpc
TOXICOLOGY
Feed additives screen scrfa
(monensin, narasin, salinomycin)
Min. panel, heavy metal hmsc
(Sb As Be B Cd Co Cr Cu Fe
Pb Hg Mg Mn Mo Ni Se Sn TI Zn)
Selenium, serum tsems
Vitamin E, serum vite
HISTOPATHOLOGY
Histopathology histem
Tumor margin evaluation histt
(biopsy > 2cm)
Lesion location:
___________________________
View
Dorsal
Ventral
OTHER TESTS REQUESTED
(See Fee schedule for complete listing)
________________________________
Weight ______kg.
Duration of problem:
___ days
___ weeks
___ months
___ years
History and lesion description (Clinical signs, lesion location/distribution/size/appearance, onset/duration of problem, current drug therapy,
vaccinations)
Clinical diagnosis
STAT (Additional charges apply)
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AHLEQUINE (2019-02-07)
Lab use only
BACTERIOLOGY
Site:___________________________
Anaerobic culture ancun
Anaerobic & aerobic culture ancultn
Bacterial culture, fecal cultnf1
Culture & susceptibility cultn
C. difficile toxins - ELISA clodn
C. perfringens - ELISA clop
C. difficile - culture cdifn
Gram stain gram
Lepto. screen - MAT leptmatn
Leptospira spp - PCR leptpcr
Lawsonia intracellularis - PCR lapcn
Mycology - fungal culture myc
Streptococcus equi - PCR sequi
PARASITOLOGY
Fecal egg count (McMas) fecm
Fecal egg count (Wisc.) fecw
Fecal flotation flote
VIROLOGY
Eq. arteritis virus - PCR eavrt
Eq. arteritis virus - VN eav
EEEV IgM ELISA xeeevme
EEEV - PCR eeepn
Eq. herpesvirus 1 - PCR ehv12
Eq. herpesvirus 1/4 - VN evr
Eq. herpesvirus 2 - VN eh2
Equine rhinitis A virus - VN er1
Equine rhinitis B virus - VN er2
Influenza A antibody - ELISA aifem
Influenza A, matrix - PCR inflpcr
Respiratory panel - VN respe
(evr, eh2, er1, er2, h7n7hi, h3n8hi)
Rota/coronavirus - PCR rocopcr
Species EQUINE Animal ID _________________________
Breed ______________
Age: _______ d w m y Sex M F
M/N
Clinic No.
Clinic
Address Postal code
City Phone
Veterinarian
Email
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.
Owner unique ID (max. 40 characters) ___________________________________________
Premises ID ________________________ Farm postal code _____________________
AHL - Guelph Courier Address
UoG Animal Health Lab-PAHL
419 Gordon Street-Bldg 89
Guelph, ON N1G 2W1
Attn: Specimen Reception
Animal Health Laboratory
Laboratory Services Division
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
ANIMAL HEALTH LABORATORY
ADDITIONAL ID WORKSHEET
Comments/History (Continued)
ID# Identification ID # Identification
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AHLEQUINE (2019-02-07)
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