CLINICAL PATHOLOGY
Biochemistry
Profile: _________________
Avian/reptilian - Vetscan scana
Creatinine creat
Cortisol cort
Electrolyte profile lyte
Fructosamine fruc
Haptoglobin hp
NEFA nefa
Progesterone p4
Total T4 tt4
Other: __________________
Coagulation
Fibrinogen fib
Profile1 (PT, PTT) ptptt
Profile 3 (PT, PTT, Fib) coag3
GENERIC/EXOTIC SUBMISSION FORM
Lab use only
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.
Clinic No. Owner unique ID
(max. 40 characters)
Clinic Address
Address Postal code Premises ID Barn postal code
City Phone Phone Email
Veterinarian Fax Farm Fax
Email Barn/pen/floor/batch ID
# SPECIMENS
Sent Received
Whole blood
Serum
EDTA
Urine
Feces
Fresh tissue
Fixed tissue
Fluid
Scrapings
Slide
Swab
Other
List: ________________
VIA
Courier
Drop-off
Mail
Other
RECEIVED BY
_____________________
Any questions? Please contact the lab.
Email: ahlinfo@uoguelph.ca
Website: http://ahl.uoguelph.ca
AHL GUELPH: 519-824-4120 ext: 54530, Fax: 519-821-8072
AHL KEMPTVILLE: 613-258-8320, Fax: 613-258-8324
Rabies suspect
Insurance claim
Possible litigation
Previous case #
Herd size_____________
No. at risk _____________
No. sick_______________
No. dead______________
Weight________ kg lb
Duration of problem:
______ days ______ weeks ______ months ______ years
Species ___________________
Breed ________________
Age d w m y
Sex (circle) F M N mixed
Case type
Diagnostic
Monitoring
Research
Other
***DEMOGRAPHIC INFORMATION IMPORTANT***
History (treatments, vaccinations, management, including all current drug therapy)
Special instructions
Hematology
CBC, food animal cbcf
CBC, companion animal cbc
CBC, avian/reptilian avcbc
Platelet count plts
Reticulocytes ret
Urinalysis
Routine urin
Type: free flow catheterized
cystocentesis
Cytology
Site__________________________
Cytology smears cytsm
Cyto. fluids (inc. CSF) cyto
Cytology, bone marrow bm
BACTERIOLOGY
Culture and susceptibility, food cultf
Culture and susceptibility, comp. cultn
Anaerobic & aerobic ancultf/ancultn
Anaerobic culture ancuf/ancun
Chlamydia psittaci - PCR cppcr
Leptospirosis, food leptmatf
Leptospirosis, comp. leptmatn
Mycology - fungal culture myc
Other: _______________________
VIROLOGY
Aleutian dis., mink herd - CIE adhrd
Aleutian dis., mink - PCR advpcr
BTV/EHDV - PCR (deer) btvehdv
Canine distemper virus - PCR cdvmb
CWD - ELISA cwde
Elephant herpesvirus 1-7 - PCR eehvmb
PARASITOLOGY
Fecal flotation, companion flotn
Fecal flotation, wildlife flotw
MYCOPLASMOLOGY
Haemoplasma - PCR hapcr2
Mycoplasma culture, cell line mculc
Mycoplasma culture, food mculf
AHLGeneric (2018-05-01)
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STAT (additional charges apply)
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
MYCOPLASMOLOGY
Mycoplasma culture, comp. mculn
Ophidiomyces oph. - PCR oopcr
Trichomonas gallinae - PCR tgalpcr
Pseudo. destructans - PCR gdespcr
TOXICOLOGY
Anticoagulant screen scrac
Min. panel, heavy metal hmsc
(Sb As Be B Cd Co Cr Cu Fe
Pb Hg Mg Mn Mo Ni Se Sn TI Zn)
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
Histopathology, food hist
Histopathology, bird/pocket pet histp
Immunohistochemistry (IHC)-
Lesion location
_______________________________
View
Dorsal
Ventral
Fish Testing:
Fish processing incl. wet-mounts on skin and gill [ ]; Number of fish ____ fishpm Note: One charge for up to 4 fish.
Histology; Number of fish ____ (food fish) hist (pet fish) histpa Note: One charge per slide.
Bacterial culture; Number of fish ____ cultfsh
Note: One setup charge will be applied to each submission fsetup
ANIMAL HEALTH LABORATORY
ADDITIONAL ID WORKSHEET
Comments/History (Continued)
ID# Identification ID # Identification
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AHLGeneric (2018-05-01)
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