Biopsy/necropsy Submission Form

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Oregon State University Veterinary Diagnostic Laboratory
For VDL Use
Only
Biopsy/Necropsy Submission Form
Phone: 541-737-3261 Fax: 541-737-6817
Address:
134 Magruder Hall
Email: vet.diagnostic@oregonstate.edu
Corvallis OR 97331-4801
Website:
VDL Account #
Owner Information – (if other than submitter)
Owner:
Submitter:
Address:
Address:
City:
State
Zip
City:
State
Zip
Phone:
Fax:
Phone:
Fax:
Email:
Previous Accessions:
Reporting: E-mail Report
Fax Report
Mail Report
Copy Results To:
Submitting Veterinarian:
Email/Fax:
ANIMAL IDENTIFICATION—Use Multiple Animal ID Form if necessary
SEX: F=Female, FS=Spayed Female, M=Male, MC=Castrated Male, U=Unknown—AGE: Y=Years, M=Months, W=Weeks, D=Days; DOB=Date of Birth
NO.
NAME/IDENTIFIER NO.
SPECIES
BREED
SEX
AGE/DOB
1
2
3
Specimens Submitted - indicate number of each sample type
Date Specimens Taken_____________ Date Specimens Submitted_____________
#___Whole Animal 
#____Blood, whole 
#___Milk   
#___Fluid  (origin)    
#___Fresh Tissue 
#____Serum 
#___Urine  
#___Swab (origin)    
___voided___catheterized 
#___Fixed Tissue 
#____Plasma 
                      
#___Other (origin)    
___cystocentesis 
___Histopathology on Biopsy (source):_______________________ 
Necropsy Only: Gross necropsy includes an external examina on of the animal and an examina on 
of the internal organs including those of the respiratory system, diges ve system, cardiovascular 
___Necropsy Only 
system, urogenital system, endocrine system and brain. The spinal cord and peripheral nerves may 
also be examined if indicated by the animal’s history.  
___Necropsy with Histology 
Necropsy with Histology: Gross necropsy along with microscopic examina on of organ  ssues. 
___Necropsy & Complete Diagnos c Work Up  
Necropsy & Complete Diagnos c Work Up: Gross necropsy is performed, with ancillary tes ng 
being completed at the discre on of the pathologist.  
___Other:_______________________________________________ 
History: Please include clinical presentation, feed/husbandry changes, onset and duration of illness, treatments (include antibiotics), vaccinations.
Number of animals in this submission______ Total number of animals______ Number of sick animals______ Number of dead animals_______
Date of death____/____/____ Euthanized: Yes______ No______ Rabies Suspect: Yes______ No______
Care of Remains (small animals only):
Post necropsy, remains will only be released to a licensed crematory service. Arrangements must be
made directly with the crematory service, prior to delivery to the OSU VDL. **If no selection is made, routine disposal will be completed**
Routine Disposal
Cremation (specify company)_______________________________
VDL USE ONLY 
 
 
SHIPPING   
 
 
 
COLD PACK     
 
SPECIMEN CONDITION 
Date Received:____________    
____Courier 
___Hand Delivered   
___Yes 
___No        
___No ID on Samples 
Rec’d By:_________________ 
 
____FedEx  
___US Mail  
 
___Frozen  
 
___Sample is leaking 
Overnight/Weekend:_______ 
 
____Greyhound 
UPS:   PP    Next    2nd  
___Thawed 
 
___Other__________________________
 
 
BUS.F-15.001, Effective: Page 1 of 1

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