www.padls.org
The Pennsylvania Animal Diagnostic Laboratory System Accession #:
General Submission Form
Pennsylvania Veterinary Laboratory Animal Diagnostic Laboratory New Bolton Center Date Received:
PA Department of Agriculture The Pennsylvania State University University of Pennsylvania
2305 North Cameron Street Wiley Lane 382 West Street Road
Harrisburg, PA 17110 University Park, PA 16802 Kennett Square, PA 19348 Page ______ of ______ (717) 787-8808 (814) 863-0837 (610) 444-5800
(Lab Use Only)
PD General Submission Form 01 (December 2014) All Requested Data Must Be Provided.
PADLS reserves the right to perform tests for any of the diseases regulated by the Pennsylvania Department of Agriculture on any specimen it receives.
PADLS reserves the right to perform any tests on animals submitted for necropsy that the case coordinator deems necessary for obtaining a diagnosis.
Your submission of specimens for diagnostic purposes constitutes your acknowledgement that some tests may be performed at other laboratories.
Bill To: (Lab Use Only) Shipping Method:
Vet Practice Drop Off US Mail
Courier: Ship Date: Owner Opened By:
Other:
Condition Upon Receipt:
Veterinarian/Submitter: Owner:
Clinic Premise ID
Address Address
City, State, Zip City, State, Zip
Phone Phone
Fax Fax
E-Mail E-Mail
Preferred Report Distribution Method: Preferred Report Distribution Method:
US Mail Fax E-Mail No Report US Mail Fax E-Mail No Report
Animal Information: Test(s) Requested:
Bovine Caprine Cervine Other:
Ovine Porcine Equine Program:
Animal Identification: (Additional space on page 2) SPECIMEN INFORMATION:
No. Official Animal ID/Name Breed Sex Age Collection Date: _________________
1 Specimen Type: Pool Specimens (If available)
2 Blood:
3 Whole Blood Serum
4 Feces
5 Feed
6 Milk Type: Bulk Tank / Composite / Quarter
7 Swab: Source ________________________
8 Tissue: Source ________________________
9 Fixed Fresh
10 Other: _________________________
History / Clinical Signs / Vaccination History / Special Requests:
SIGNATURE OF VETERINARIAN: _________________________________________
www.padls.org
The Pennsylvania Animal Diagnostic Laboratory System Accession #:
General Submission Form
Pennsylvania Veterinary Laboratory Animal Diagnostic Laboratory New Bolton Center Date Received:
PA Department of Agriculture The Pennsylvania State University University of Pennsylvania 2305 North Cameron Street Wiley Lane 382 West Street Road Harrisburg, PA 17110 University Park, PA 16802 Kennett Square, PA 19348 Page ______ of ______ (717) 787-8808 (814) 863-0837 (610) 444-5800
(Lab Use Only)
PD General Submission Form 01 (December 2014) All Requested Data Must Be Provided
PADLS reserves the right to perform tests for any of the diseases regulated by the Pennsylvania Department of Agriculture on any specimen it receives.
PADLS reserves the right to perform any test on animals submitted for necropsy that the Case Coordinator deems necessary for obtaining a diagnosis. Your submission of specimens for diagnostic purposes constitutes your acknowledgement that some tests may be performed at other laboratories.
Animal Identification: Animal Identification:
No. Official Animal ID/Name Breed Sex Age No. Official Animal ID/Name Breed Sex Age
11 46
12 47
13 48
14 49
15 50
16 51
17 52
18 53
19 54
20 55
21 56
22 57
23 58
24 59
25 60
26 61
27 62
28 63
29 64
30 65
31 66
32 67
33 68
34 69
35 70
36 71
37 72
38 73
39 74
40 75
41 76
42 77
43 78
44 79
45 80
