ACCESSION #
PET ID
OWNER
AGE
Wilmington, OH
800-350-1122 Fax 937-383-3667
CBC (w/ Compl. Cell Analysis)
Single Chemistry _ _ __ _ _ _
Added Chemistry _ _ __ _ _ _
Microscreen -CBC + 1 Chem _____
Spec. Screen -CBC+
Chem 1_____ Chem 2 _____
010 Scan I - CBC & EpH
011 Scan II - CBC+ EpH + BileAcid
012 Scan III - CBC, Chlam IGG, DNA, EpH
NOTE: PLEASE DARKEN BOX OF SELECTED TESTS (ie.-
)
1 BACTERIAL TESTING
2 BASIC DIAGNOSTICS
021
21A
180
000
000
Protein Electrophoresis
EpH Added to ANY bloodwork
Mini EpH Profile
Avian Influenza
Serology
DNA
Newcastles
Serology
DNA
ASPERGILLUS TESTING
000 Asper. DNA/PCR 000 Asper. Elisa
000 Aspergillus Galactomannan
000 Asper. Panel 000 Asper. Panel +
AVIAN
001
98A
002
099
Complete Avian (Includes CBC)
Complete Avian Chem (w/o CBC)
Mini Avian (Includes CBC)
Mini Avian Chem (w/o CBC)
003
98B
004
99A
Complete Reptile (Includes CBC)
Complete Reptile Chem (w/o CBC)
Mini Reptile (Includes CBC)
Mini Reptile Chem (w/o CBC)
REPTILE
MAMMAL
114 Small Mammal (Includes CBC)
116 Small Mammal Chem (w/o CBC)
FERRET
Ferret Profile, Aleutians & EpH
Ferret Profile & Adrenal Panel
Ferret Profile & Insulin Test
Aleutians
804 Aleutians & EpH
Adrenal Panel (Tenn.)
Insulin
Urine Cortisol/ Creatinine
RABBIT
205 Encephalitozoan Cuniculi
037 Pasteurella Multocida Titer
810 Rabbit Profile, Past. Ab & E-cuniculi
SPECIES SPECIFIC PROFILES
African Gry I 061 African Gry II
Amazon I *
051 Amazon II *
Budgie I
045 Cockatiel I
Greycheek I * 070 Macaw I *
Toucan/Mynah 055 Conure I
* For Chlamydia test choose one:
020 IGG IFA 034 DNA PCR
ELECTROLYTES
108 Ionized Calcium Module
Includes CA++, Na, K+
000
195
018
000
196
000
034
198
200
Avian Adenovirus DNA
Av. Mycobaceria DNA
Av. Gastric Yeast/Mega
Aleutians DNA
B. Dragon Adeno DNA
Bornavirus DNA
Chlamydia DNA
Crypto DNA
Ferret Helicobacter DNA
4 PARASITE, CYTOLOGY, HISTO
3 CHEMS, SPECIES SPECIFIC PROFILES
060
050
040
075
048
SPECIES (DO NOT USE AVIAN, REPTILE, MAMMAL)
PRIORITY
STAT
SOURCE
Gram Stain—Source _ _ _ _ _ _ _ _
145 Gram Stain x2— A_ _ _ B_ _ _
998 Enteric Panel
Basic Aerobic C+S Includes Fungal Culture OR Gram Stain Source_ _ _ _ (1 Culturette & 1 bact. Smear if gram stain is chosen)
MUST BE
Combo C+S Includes Fungal Culture & Gram Stain Source _ _ _ _ (1 Culturette & 1 bacterial smear)
PROVIDED
Double C+S Includes Fungal Cultures OR Gram Stains — 2 Sources Cultured Separately Source A_ _ _ _ Source B_ _ _ _
Aerobic Culture Only - Sce _ _ _ 600 Fungal Culture Sce _ _ _ 611 Anaerobic Culture Sce _ _ _ 612 Aer. C+S, Fungal plus Anaerobic C+S
300
000
000
014
006
806
807
808
803
805
956
914
SEX
DOCTOR
SPECIAL INSTRUCTIONS/HISTORY (ALL REQUESTS MUST INCLUDE HISTORY):
AvianExoticLab.com
147
910
905
911
902
DATE TAKEN:____/____/____
532
985
130
809
131
526
500
983
PARASITOLOGY
Fecal Direct & Fecal Float
Fecal Direct, Float & Trichrome
Acid Fast for T.B. & Cryptosporidia
Complete Parasite Screen —
Includes Fecal direct, float,
trichrome & acid fast stain
Fecal Trichrome
Blood Parasite & IBD Screen
Urinalysis
Giardia/Crypto IFA
CYTOLOGY & HISTOPATHOLOGY
323
129
501
000
Chlamydia Stain **
Cytology **
Fluid Analysis (Includes Cytology)**
Histopath # of Tissues _ _ _ **
** THE ABOVE REQUIRE THE FOLLOWING
IN ORDER TO PROCESS:
SOURCE:__________ HISTORY:________
____________________________________
____________________________________
____________________________________
ORDER SUPPLIES
Mini Tip Culturettes @ 12.00/Dozen _____
Regular Tip Culturettes_______
Serum Transport Tubes _______
Hematocrit Tubes________
Coverslips_____ GTT @ 6.00/Doz ____
Fecal Trichrome Tubes_______
Forms_____ Bags_____ Boxes______
Saturday
FedEx Labels
Regular
049
201
000
000
035
000
005
020
000
Mycoplasma Avian DNA
Mycoplasma Agassizi DNA
Pachecos Serology DNA
Paramyxo Virus I DNA
PBFD DNA
Polyoma
Serology DNA
Sexing DNA
Chlamydia IGG IFA
Chlamydia DNA+IGG Combo
5 SPECIAL PROFILES, T-4, TOXICOLOGY
800
801
080
026
033
032
063
990
000
Comprehensive Chlamydia Screen
Comprehensive Viral Screen
New Bird I
081 New Bird II *
Featherpicking Profile I (w/ biopsy)
Featherpicking Profile II (w/ DNA)
URI/Sneezing Bird Profile *
Polyuria Profile
Lipoprotein Panel 000 Added Lipoprotein Panel
Microprotein/Creatinine Ratio (urine)
*For Chlamydia Test choose one: 020 IFA 034 DNA
THYROID TESTING
341 T-4 Single
022 Comp Av w/ T-4
023 Complete Reptile w/ T-4
024 Small Mammalian w/T-4
LIVER FUNCTION
066
071
072
073
Bile Acid
204 CBC w/ Bile Acid
Complete Avian w/ Bile Acid
Complete Reptile w/ Bile Acid
Small Mammal w/ Bile Acid
345
031
028
029
039
030
Total Iron
Complete Avian & Iron Assay
Blood Lead 027 Added Blood Lead
Blood Zinc Level
Blood Lead & Zinc Level
Blood Copper Level
TOXICOLOGY
For Office Use Only:
A/B ___ UPS___ FedX___ Exp Mail___ Mail___
TT ____ Serum____
TT____ Whole____
Hct W____ S____ S/S____ Micro____
Slide: GS____ BS____ AF____ FT____ C/S____
Swab____ Fec Tube____ FTT____ Histo/Cyto___
Comments________________________________
________________________________________
Anaerobic Culturettes @ 12.00/Dozen
FedEx Clinical Packs