WPC& El%&pKVwЗ-!4a<{I& TP`]#!"9̰Zjdmqh<[rgѲ=[L1N; ی:PҮ0?b-'"VPKq0ˬc+ɻ v"nwJq0YR.…6N89GUO:^~2Phz Z3?+ks\iƻ"9+28HPYAkrR ܃vVǼx.0(HLYoAr0vt1U_KfVE{UP-l7fጀ=# BK" V=쮣!Yu0䶇䩈 #{+_7&ptkDȩż䧶46 #~OB2C}R}Oc$2O`78`VU* 0jU. 0~ 0$2 0hV B B B B D32 U2e f a D+  0 # UNg %M(N^ w4  m\  `Times' Accession No RARC,0RARC UW - Madison .   Hl [4Heading 1Heading 1C<6X9`(CourierC   XXX?\  `Times? <6X9`(CourierH 4Heading 2Heading 2       H_ p4Heading 3Heading 3  ,   ,"t t h!$,      J@HHP X`h!$J  h:Default ParaDefault Paragraph Font d d d d 'dxdKr`WingdingsTable_A'dxd#|x($HH..      XXXXXXXX 0&d9 Z6Times New Roman RegularX8Z Aq5SF\XfeU !HH..      XXXXXXXX  _         ̤XX AccessionNo.___________    XX̤COMPARATIVEPATHOLOGYLABORATORY  ResearchAnimalResourcesCenter,389EnzymeInstitute u      &    1710UniversityAvenue,UniversityofWisconsinB  Ԍ [ Ќ   Madison,WI537264087 Aq   ,  6"t t h!$X6    H%t t `h!$tt XH  ClinicalLab608/2636464@..@.._Histo_ԀLab608/2620933@..@..FAX608/2652698  Ԍ 'W Ќ ,  - Xtt `X-   EXXAVIAN  =  K (XBB IK  E1HHP X`h!$XE̤ESubmissionDate   P     X ProtocolNumber򀀀__________________________________________'[6 1 a  Directchargenumberrequiredforbilling :DEPTID____________FUND_______PROGRAMCODE_____  0 PROJECT____________(ifapplicable)   X InternalWorkOrderNumber:___________________(ifapplicable)    Nameofdepartmentalbillingofficer( required)  X      ` Telephone   h  !  $     ̤    & ]    0̤0 LabAnimalVeterinarian P  ______Investigator     ` Department   h  ! _______ $  }   Y Ԍ m  Ќ̤̤̤̤  ContactPerson   P    Dept.Address     `      h  !  $  < l   XTelephone P    Email X      ` FAX     h  !  $ ']m q   ;   XSpecies     P _______󀀀Strain/Breed     ` _󀀀Biolevel_________________________   No.    󀀀Age_________Sex   X ___󀀀ID   ` 󀀀AnimalRoomNo. h  !  $    SpecimenSubmitted:__________________________________________________________________________________ x  ЀLive N3 ̤_q _̤  N3  Dead N3 ̤_q _̤  N3Ԁ   P _Euthanized_Ԁ N3 ̤_q _̤  N3   X Methodanddrugused__________________  Date&timeofDeath___________________________________________________________________________________  Experimentalprocedures,drugs,dietand/or_transgene_/mutation:   `      h  !  $ _ 2 * ddd Xdd Xdd XH$H$,XZZ,ZZ,ZZ,ZZ+  5+   5 K(X!JJK9 ̤ ̤ 9Completebackgroundhistoryandlistofclinicalsigns._______________________________________________________ r 9 ̤̤ 9______________________________________________________________________________________________________  9 ̤̤ 9______________________________________________________________________________________________________ "R  FlockSize_____Birdspercage_____DateofArrival/Birth__________No.ofrecentdeathsinflock________________ =3   = > K(XKH4   P X`h!$HHXH̤   SEROLOGY ! L|  ! > K1HHP X`h!$   XK___  L|" BACTERIOLOGY 6,L|$  6K(X(K  '(%0 '  (&   '('0 'Tissuesdesired_______________________________________ 6,((  6  YK(XK  H4P X`h!$HHXH ')0 '  YK1HHP X`h!$XK  *   '+0 '___AntibioticSusceptibility 6,,  6K(XPK  'P-0 '  P.   ___ 'P/0 ' MYCOLOGY 6,P0  6  <K(X,K  H4P X`h!$HHXH ',10 '  <K1HHP X`h!$XK  ,2   ',30 'Tissuesdesired_______________________________________ 6,,4  6K(XK  '50 '  6   ___ '70 ' PARASITOLOGY 6,8  6  K(XTK  'T90 '    T:   'T;0 '____External___Cecal___Fecal 6,T<  6K(X0K  '0=0 '  0>   '0?0 '____Scotchtapeslide(cleartapeonly) 6,0@  6  <K(X K  H4P X`h!$HHXH 'A0 '  <K1HHP X`h!$XK  B   'C0 '_____Heartworm_Ԁ____(_Dirochek_)____(Capillary) 6,D  6K(XX  K  'X E0 '  X F   ___ 'X G0 ' SKINEXAMINATION 6,X H  6K(X!4 K  '!4I0 '  !4J   ___ '!4K0 ' CYTOLOGY :0!4L  :K(X! KOther ! !M !  ___ '!N0 ' HEMATOLOGY 6,!O  6 K(X\" K  ___ '\"P0 ' VIROLOGY  \"Q   '\"R0 'CBC(_RCB_,WBC,_PCV_,Hb,Differential,_platelets_) 6,\"S  6K(X#8 K  '#8 T0 '  #8 U   '#8 V0 '(Circleifonlyasingletestdesired.) 6,#8 W  6K(X# K  '# X0 '  # Y   ___ '# Z0 ' CLINICALCHEMISTRY 6,# [  6K(X`$!K  ___ '`$!\0 'Other________________________________________  `$!]   '`$!^0 'SpecificTest(s)_______________________________________ 6,`$!_  6K(X %<"K  ___ ' %<"`0 '    &  -  PCRASSAY-G.  #.Ԍ    %<"a   ___ ' %<"b0 ' URINALYSIS 6, %<"c  6K(X%"K  '%"d0 '  %"e   ___ '%"f0 ' NECROPSY 6,%"g  6K(Xd&#K  'd&#h0 '  d&#i   ___ 'd&#j0 ' _HISTOPATHOLOGY_ 6,d&#k  6K(X'@$K  ''@$l0 '  '@$m   ''@$n0 ' H4P X`h!$HHXH(tissue)____________________________________________ 6,'@$o  6 K1HHP X`h!$XKK(X'$K  ''$p0 '  '$q   ___ ''$r0 ' OTHER ____________________________________________$'$s   $K(Xh(%K9 ' %;.E 9 CHARGES: P     X   XXE AnimalWeight_____________EXX  h  !  )&u XXE