Fillable Dierential Diagnosis History DATE RECEIVED LAB REF Veterinary (London Institute of Management and Technology)

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Dierential Diagnosis History DATE RECEIVED LAB REF Veterinary (London Institute of Management and Technology)

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U.K. forms for London Institute of Management and Technology

BROWSE LONDON INSTITUTE OF MANAGEMENT AND TECHNOLOGY FORMS

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Abbey Veterinary Services Tel: 01626 353598
89 Queen St Fax: 01626 335135
Newton Abbot Email: admin@abbeyvetservices.co.uk
Devon TQ12 2BG www. nwlabs.co.uk
NationWide Laboratories, a trading business of National Veterinary Services Ltd. Reg. Co. in England and Wales (No 8489997). Registered Address: Unit 4, Jamage Industrial Estate, Talke Pits, Stoke-on-Trent, Staffs ST7 1XW
Dierential Diagnosis
History
Whole or part of lesion submitted
Time since last heat and recent therapy
DATE RECEIVED LAB REF
Veterinary Surgeon (Dr, Mr, Miss, Ms, Mrs)
Date Sampled
Previous Lab Reference
(if appropriate)
Practice Details (Full postal address please)
Species Breed
Age Sex
❑ M ❑ F ❑ N
Animals Name
(+/- Clinic medical record No.)
Your Reference (owners last name +/- unique ID)
No. of pieces submitted
No. of containers submitted
Distribution
of lesions
Cytology - Test Required - tick as appropriate
3
Test Code Test Name
ABCYT Cytology (up to 2 sites)
ABCYTA Additional Sites
ABCYB Body Cavity Fluids etc.
ABCYM Bone Marrow Smear
Urine
Fungal Culture
Bacterial Culture
Calculus Analysis
Skin Scrape
Histological Examination - Test Required - tick as appropriate
3
Test Code Test Name
HISTAB Histo Exam (<4cm)
HISTLAB Histo Exam (>4cm)
HISRAB Rapid Histology
HISCYT Histo & Cyto (same site)
HISCYD Histo & Cyto (dierent sites)
Skin Packages
Test Code Test Name
- tick as appropriate
3
Faecal Sample
LR L R
Internal use only
INTERNAL USE ONLY
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Dierential Diagnosis History DATE RECEIVED LAB REF Veterinary (London Institute of Management and Technology)

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Completed 16 March 2021

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