(612) 625-8787 E-mail: vdl@umn.

edu
Phone:
MDH use
Fax: (612) 624-8707 Web site access/results:
Toll Free: 1-800-605-8787 www.vdl.umn.edu
ONLY
Necropsy and Sample Submission Form - Swine
Attending Veterinarian Billing Information
(Results* will be sent here unless otherwise noted)
Pay at drop off
Veterinarian Bill veterinarian
Bill owner
Clinic Contract/PO number
Specimen History
Address
Specimen(s)
City State Zip
Animal name/ID
For office
Phone Email:
Species Breed
use only
Send *results via: Email:
OR Ident/color
Fax:
Affiliate (list codes)
Age (Please circle: day wk mo yr )
Owner/Producer
Weight (Please circle: lb kg )
Owner Name
Sex: M F N/M S/F
Address Yes No
Date of Death Time of Death Purchased:
City State Zip
Euthanized: Yes No How Date
Phone Fax
Herd size No. in affected group No. sick No. dead
Email
Duration of problem in submitted animal(s) Duration in herd
Prem./Ref. ID County
Type of housing/environment Ration
Site/Farm Source/Flow

Lot Delivered By Vaccination Therapy

Laboratory Procedures Requested

Necropsy/General Exam of Tissue (includes bacteriology, EM, histopathology, molecular diagnostics, parasitology, serology, and virology, as determined by the pathologist to be
part of the investigation; nutrition, toxicology and other out-sourced tests will be charged at cost; fees may apply to additional tests;).
General Exam of Feces
0 -10 Days: Aerobic culture (Salmonella); Anaerobic culture; Clostridium difficile culture or ELISA; PEDv/PCoDv/TGE PCR; Rotavirus PCR; Senecavirus A PCR
10 days - 7 weeks: Aerobic culture (Salmonella); fecal float; PEDv/PCoDv/TGE PCR; Rotavirus PCR
8 weeks +: Aerobic culture (Salmonella); PEDv/PCoDv/TGE PCR; Brachyspira culture; Lawsonnia intracellularis PCR
Other: _______________________________________________________________________________________________________________________________________

History/Clinical Signs/Clinical Diagnosis/Necropsy Findings/Additional Information or Requests

Note: The MVDL reserves the right to subcontract any work required to complete testing of any and all submissions. Any subcontracted
work will be identified on the laboratory report. If applicable
FAD Number:
SYS.FORM.095, Rev. 4, 09/22/2017 Page 1
Narrative history/necropsy findings (continued)

Section below is for Laboratory use only.

Specimen
Fixed Unfixed
Specimen condition: Live Good Fair Poor Unsuitable
Necropsy/Gross findings:

SYS.FORM.095, Rev 4, 09/22/2017 Page 2