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LAB USE ONLY
C NC Samples Received:
Contact Us by-- PHONE: (650) 723-3878 FAX: (650) 725-0928 EMAIL: [email protected] Drop Off: 300 Pasteur Drive, Edwards Bldg. R320, Stanford, California 94305
Diagnostic Lab Request Form Stanford University, Department of Comparative Medicine
Red outlined items must be provided.
Medical Emergency STAT (Clinical Staff Only)
End of day ASAP (Additional charges may apply)
List Chemistry Analyte Priorities:
Investigator (PI): Responsible Person:
Phone/contact: ACCOUNT NUMBER/PTA #:
Animal ID(S):
Animal Name:
SPECIES: Breed/Strain: Age: Sex: Bldg: Room: Cage/Barcode:
Medical Record #: Protocol #: Date Submitted: Collection Date/Time: Requested By: Need Results? Provide your email:
OK to dilute short samples? Y ☐ N ☐
Diagnostic Combo Profile Hematology Microbiology/Body Fluids Rodent/Hamster Panels CBC/Chem/Lytes 901-3 Source: CBC/Liver 970-2
CBC/Metabolic 964-6
CBC/Lipid 967-9
1018
1016
Chemistry 1006
2020 1028 Infectious Disease
Albumin ALTAlk. PhosASTBilirubinBUNCalciumChloride
Chemistry w/ lytes 2000, 2, 4
CO2 CreatinineGGTGlobulinGlucose Phosph.PotassiumSodium
Cholesterol T. Protein
1200 Serology PCR
Endocrinology (Pre 2300, Post 2302)Idx
2318Corn
2215 CSU
2322Anily
2310Corn
2307Corn
Mouse Parvovirus (MPV/MVM)
2295MSU MHV
2110 Urine MNV
Collection Method: LCMV
2005, 6, 9 (Cholesterol, Triglyceride, HDL, LDL)
EDIM
4000 Parasitology PVM
2013-15 5014 Rat Parvovirus (RPV,RMV, KRV, H-1)
RCV/SDA Virus
2010-12 (Na, K, Cl, CO2, BUN, Creat, Glu)
2138,39 5000, 10 Sendai Virus
2148 SV-5
922 2143 TMEV (GD-7)
910 2136 5028 Other:
2140 Additional Tests Biomarker Immunoassay 2241
2131 2165 Aub 2204
2074, 5, 7 Water Quality 2313 Aub
2050/2, 2113/7, 2115/9 2363
Temp Monochloramine
2164 Aub
2162 2210 MSU Additionally Available 2007 2194 Corn i-Stat Handheld Rental2175 2190 Corn Biological Material Pathogen Test
2084, 101, 85 Blood Gas Analyzer Use 2199 Custom Panels for your study
2048, 51, 49 … or Hundreds of Other Tests! Please contact us to serve you better 2082, 100, 83
Clinical Summary: Hx, clinical signs, Tx, experimental procedures and suspected diagnosis:
Mouse Phenotyping Profiling 947, 8Pre-Clinical Toxicity Profile 949
Chemistry No Lytes
Lipid Panel
Liver Panel(ALT, AST, ALKP, Bili, GGT)
Electrolyte Panel (Na, K, Cl, CO2, Na/K Ratio, AnGap)
Metabolic Panel
Avian Comprehensive ProfileReptile Profile
Amylase/Lipase 2086/8, 2102/3, 2087/9
Cardiac Biomarker Panel 2019
BNP cCRP Troponin ICK TotalHDL/LDLHemoglobin A1CTotal IronLactic AcidMagnesiumTIBCTriglycerideUric Acid
CBC (incl. diff, plt & retic) 1000-1004
Differential Only (Manual) 1050
Extra slide: Stained Y / N 1208 Type of stain:
HematocritHemoglobinHemogram onlyPlatelet CountReticulocyte Count
CortisolEstradiolFructosamineInsulinProgesteroneTestosteroneNonK9Thyroid (TT3, TT4, FT4) 2280MSU
TSH Stimulation
UrinalysisUrine Culture ID SensitivityUrine CreatinineUrine GlucoseUrine MagnesiumUrine ProteinUC, UP, RatioU. Electrolytes (Na, Cl, K) 2133UNa, UK, Ratio
Basic Panel (RO) pH Conductivity
Comprehensive (incl. Basic) 2360
Ammonia Copper ULR Cl.
Dissolved O2 Nitrate Nitrite
Total Cl. Alkalinity Hardness
Aerobic Culture ID SensitivityAnaerobic Culture IDBlood CultureCampylobacter Only CultureColony CountClostridium difficileCytologyCytospin OnlyEnteric CultureCampy/Salmonella/Shigella/Yersinia
Environmental Culture Fluid Analysis Cell CountFluid Analysis CytologyFungal CultureGram StainAcid-fast StainAcid-fast CultureOccult BloodRodac Plate
Mini Serology PanelMini Health Panel (no micro)Mini Health Panel (w/micro)Comp. Serology PanelComp. Health Panel (no micro)Comp. Health Panel (w/micro)Rederivation Profile (no micro)
Corneybacterium bovisHelicobacter spp.Mycoplasma polmonisPasteurella pneumotropicaPseudomas aeruginosaStaphylococcus aureusStaphyloccucus xylosus
Cecal ExamEctoparasite (skin scrape) 5046
Ova & Parasite Fecal Float OR SedimentParasitology Panel (NHP/Pig)Protozoal Stain
Blood Storage/SpinCyclosporineDigoxinPhenobarbitalSeleniumVitamin B12Vitamin 12Other
Mouse ProgesteroneMouse FerritinOther
