Fillable AHL Swine %282019-02-07%29 FILLABLE

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AHL Swine %282019-02-07%29 FILLABLE

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SWINE SUBMISSION FORM
Lab use only
# 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
_____________________
VIROLOGY
Influenza A, matrix - PCR inflpcr
Influenza A - PCR typing H1N1/H3N2 infltyp
Influenza A - H gene sequencing inflseq
Influenza A - ELISA aifem
Influenza A - HI H1N1 h1n1hi
Influenza A - HI H3N2 h3n2hi
PEDV/TGEV/PDCoV - PCR pcovpcr
PEDV sequencing pedvse
PRRSV - PCR prtqn
PRRSV - IDEXX Ab ELISA, oral fluids prrx3of
PRRSV - IDEXX Ab ELISA, serum prrx3
PRRSV - ORF5 gene sequencing - PCR prrse
Porcine circovirus 2 (PCV-2) - PCR pcv2rt
Porcine parvovirus - PCR ppvrt
Porcine respir. corona (PRCV) - PCR prcvpcr
Rotavirus group A, B, C - PCR rotapcr
Porcine HEV - PCR hevrt
Seneca Valley virus - PCR svvpcr
Swine cytomegalovirus - PCR scmvrt
TGEV/PRCV - Ab ELISA pcve2
BACTERIOLOGY
Site: _______________________________
Culture and suscept (swine) cults
Culture aerobic & anaerobic ancultf
Culture anaerobic - food ancuf
Culture, abortion case bcabo
Brachyspira pilosicoli - PCR bppcr
B. hyodysenteriae - PCR bhpcr
Brachyspira - PCR profile brpcr
C. difficile toxins - ELISA clodf
C. difficile - culture cdiff
C. perfringens - toxin typing (PCR) cperf
E.coli ETEC (enterotoxigenic)(PCR) ecolf
Lawsonia intracellularis - PCR lapcr
Leptospira - MAT, serum leptmatf
Leptospira spp - PCR leptpcr
Leptospira - MAT, fetal fluid lepff
MIC, porcine, aerobes micbp
Pasteurella multocida, toxin - ELISA pmt
Pasteurella multocida, toxin - PCR pmtpcr
MYCOPLASMOLOGY
Haemoplasma - PCR hapcr2
M. hyo., IDEXX ELISA (1st ) mheiadx
M. hyo., OXOID ELISA (2nd) meia
M. hyopneumoniae - PCR mhpcr
M. hyo., p146seq typing p146seq
M. hyorhinis - PCR hrhpcr
M. hyosynoviae - PCR hsypcr
Mycoplasma culture mculf
TOXICOLOGY
Mineral panel, salt screen salsc
(Ca Mg Na K P S)
Selenium, serum tsems
PARASITOLOGY
Fecal flotation fflot
Sucrose wet mount sucwt
HISTOPATHOLOGY
Histopathology hist
IHC - PRRSV prrvi
IHC - Influenza A virus iavif
IHC - PCV-2 cir2i
IHC - respiratory panel ihcpr
IHC - TGEV tgeh
CLINICAL PATHOLOGY
CBC, food animal cbcf
Biochemistry profile, porcine pprf
EXTERNAL LABS
Actinobacillus pleuropneumoniae
(APP) serotyping xapp
Serotypes:__________________
OTHER TESTS REQUESTED
(See Fee schedule for complete listing)
Species: PORCINEBreed_____________
Age____ d w m y
Sex (circle) M F
barrow
Case type
Diagnostic Monitoring
Research Other
Herd size/sows ___________________
Nursery/weaner ___________________
Finisher __________________________
Boars ___________________________
Other ___________________________
No at risk ________________________
No sick _________________________
No dead _________________________
Weight ________________________kg
Duration of problem ________________
Animal ID
• __________________________
• __________________________
• __________________________
• __________________________
• __________________________
• __________________________
• __________________________
• __________________________
• __________________________
• __________________________
• __________________________
• __________________________
• __________________________
• __________________________
• __________________________
• __________________________
• __________________________
• _________________________
For additional animals please
use back page or send Excel
spreadsheet in 1 column,
specroom@uoguelph.ca
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
History (treatments, vaccinations, management, including all current drug therapy)
Special Instructions
STAT (additional charges apply)
Rabies suspect?
Insurance claim?
Possible litigation?
Resubmission?
Previous case #
Page 1 of 2
NOT to be used for
OSHIP or PM
submissions
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.
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
*DEMOGRAPHIC INFORMATION IMPORTANT***
SAMPLES TAKEN Date: _________/_____/_____(yyyy/mm/dd) Time of day _____:_____ Date sent________/____/____ (yyyy/mm/dd)
SUBMITTED BY Veterinarian Owner Other BILL Veterinarian Other
AHLSwine (2019-02-07)
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
__________________________________
__________________________________
__________________________________
ANIMAL HEALTH LABORATORY
ADDITIONAL ID WORKSHEET
Comments/History (Continued)
Page 2 of 2
ID# Identification ID # Identification
AHLSwine (2019-02-07)
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Completed 18 May 2020

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