Please complete the following CCMS Comparative Pathology Lab - Request for Anatomic Pathology Service Form. The items marked with asterisk (*) are required. Comparative Pathology Lab hours are 9am to 5 pm Mondays through Fridays. We are located in Annenberg 26-92. Necropsies need to be scheduled with the comparative pathologist ahead of time, please call 4-1696 or 4-1498. Samples must be submitted before 3 pm. Please contact Dr. Virginia Gillespie (4-1696) or Ying Dai, lab manager, (4-1498) with questions.


Investigator Info

*PI Name *Fund #
*GCO # *Dept
Phone Fax
*Contact person * Email
*Veterinarian (Diagnostic only)

Animal Information

*Species / ID *Breed / Strain
Sex
* Age *Age Units
*Location (Building & room #) *Research / Diagnostic
*Found Dead / Euthanized If Euthanized, Method of Euthanasia
Date of Death
*Procedure
Specimen(s)

Sample Info

Clinical History: Clinical presentation (or N/A):

*Clinical History

Experimental History: Experimental manipulations, treatment, transgenes, etc.:

*Experimental History

Description of lesion(s): location, size, color, consistency:

*Description of Lesion(s)
Profiles





List specific tests


 
* Image Text:
Refresh