Animal Health Trust
Diagnostic Laboratory Services
Lanwades Park, Kentford, Newmarket, Suffolk CB8 7UU
Tel: 01638 552993 Fax: 01638 555643 E-mail: [email protected]
Animal Health Trust
Microbiology
PLEASE COMPLETE IN BLOCK CAPITALS USING BLACK OR BLUE PEN
(PATHOLOGY ON REVERSE SIDE)
Veterinary Surgeon ____________________
Veterinary Practice ______________________
Address ______________________________
__________________________________
__________________________________
__________________________________
Tel No. ______________________________
Fax No. ______________________________
Email. ________________________________
Animal Name __________________________
Owner Name __________________________
Male
Castrate
Female
Spayed
Canine
Feline
Equine
(specify)
Others
Age ____________ Breed ______________
Date Sampled __________________________
Previous sample from this animal Yes
No
Results FAX
Previous AHT Lab. Number ______________
*State Site ____________________________
CLINICAL SIGNS/HISTORY
Nasal
Discharge
Coughing
EMAIL
VACCINATION HISTORY (if equine)
No. affected
Date
No. in contact
Type of Premises ______________________
Pre Vaccination Sample
Yes
Post Vaccination Sample
Yes
Date of Onset ________________________
No
Clotted blood/Serum
CSF
Faeces
Guttural
Pouch Wash
Heparin blood (Na)
(30ml required - unspun)
Plate/Slope
Other
Signs
Mucopurulent
Serous
At Rest
At Exercise
Inco-ordination
Abortion
Loss of performance
Pyrexia °F/°C ________________________
No
Semen
Swab*
Tissue* (Fresh)
Tissue* (Fixed)
Tracheal Wash
Urine
Other*
(Failing to tell us of a previous sample may delay serology results)
Influenza / Herpes / EVA / Strangles
Vaccine
Please indicate sample types submitted (4)
Profuse
Slight
Frequent
Occasional
Glandular
Swelling
Anorexia
OTHER HISTORY / CLINICAL INFORMATION
Have you spoken to a member of the AHT staff about this case?
SMALL ANIMAL
SEROLOGY
Toxoplasma
Neospora
FeLV/FIV
FeCoV/FIP
BACTERIOLOGY
Site Specific Profiles
Yes
Antibiotic sensitivities required
Culture
Culture (Continued)
No
Name if Known ________________________
Yes
No
Faeces
Faeces (Continued)
(See price list for details)
Ears/Eyes/Genital
Faeces
Respiratory
Skin/Hair
Sterile/Surgical
Strangles
Urine
EQUINE SEROLOGY
General Virus Screen
(not EVA,EHV-3 or Strangles)
EIA by Coggins
EIA by ELISA
EHV-1 and EHV-4
EHV-3 (coital exanthema)
ERV-A and B
EVA
PCR’S
Canine Respiratory Panel
(Bordetella, CAV, CRCV, Flu, PiV, S. equi, & S. zoo)
Canine Bacterial Respiratory Panel
(Bordetella, S. equi & S. zoo)
Canine Viral Respiratory Panel
(CAV, CRCV, Flu, PiV)
Equine Respiratory Screen
(EHV-1 & 4, Flu, S. equi & S. zoo)
Bordetella bronchiseptica
Aerobic
Anaerobic
Blood
Dermatophyte
Fungal
MRSA
Mycobacteria
(includes ZN stain)
Strangles
Yeast
Influenza and Adenovirus
Piroplasmosis cELISA
Rhodococcus equi ELISA
Strangles ELISA
Canine Adeno (CAV-1 & CAV-2)
Canine Distemper (CDV)
Canine Respiratory Coronavirus (CRCV)
Chlamydophila
EHV-1 & EHV-4
EHV-2 & EHV-5
EVA
Cryptosporidia & Giardia
Immunostat Test
Culture
(Campylobactor, Salmonella & Yersinia)
Entropathogenic E.Coli
Lungworm Larvae
Occult Blood
Parvovirus ELISA
Rotavirus Immunostat Test
Salmonella typing
Worm Egg Count
Other Tests
CEM with Certification
(includes Klebsiella & Pseudomonas)
Gram Stain
Isolate Identication
Microscopy
EQUINE VIROLOGY
SMALL ANIMAL VIROLOGY
EHV Clearance (fresh + fixed tissues)
Feline Herpes &
Calici Virus Isolation
EVA Clearance (fresh + fixed tissues)
EVA Isolation & PCR
Influenza NP ELISA
Virus Isolation in Cells
Feline Herpes (FHV)
Influenza
Klebsiella Capsule typing
Lawsonia Intracellularis
Mycobacteria
(Fast Track including ZN stain and culture)
Mycoplasma felis
Para-influenza (PiV)
Parvovirus
Strangles (S. equi equi)
Strangles Vaccine Strain
S. zooepidemicus
Trichomonas foetus
SPECIAL INSTRUCTIONS / ADDITIONAL ANTIBIOTICS AND TESTS
Please tick box if samples CANNOT be used for anonymous surveillance
FOR LAB USE:
Opened by:
Tests Assigned by:
Entered by:
Time Received:
Split by:
Bact
Clin Path
Cyto
Histo
Serol
Virol
Research
THE TERMS AND CONDITIONS ON WHICH LABORATORY TESTS ARE CARRIED OUT ARE AVAILABLE AT WWW.AHT.ORG.UK. SAMPLE SUBMISSION IS ACCEPTANCE OF THESE TERMS AND CONDITIONS.
F11b7

Cambridge • Newmarket • Bury St Edmunds

Typed by: apb Computer Name: LTP020