Pathology Accession Form - DOC by v7166R

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									                                                                                 V2-228 Veterinary Academic Building
Laboratory of Comparative Pathology                                              College of Veterinary Medicine
P.O. Box 110880 Gainesville FL 32611                                             Lab: 352-294-4120
castlemanw@ufl.edu                                                               Fax: 352-392-9704
                                          Pathology Submission Form
__________________________________________________________________
Necropsy / Biopsy Date             Prosector:           Lab Accession#
Investigator/Dept             Contact Name            Contact tel#
Contact email                   IACUC #          Program Code:
Fund Code:             Project code:      Department code:       Fiscal contact:
__________________________________________________________________
Mouse Strain/Geno                  Mutant Y        / N      (If yes, complete mutant info form) Mouse ID#

Source                Sex F      / M            Color BLK      / Agouti      / ALB      :           Age / DoB

Found Dead Y          / N            Euth CO2         / Isoflurane        / Cerv. Disloc.       Other:

Ancillary Tests Requested(check ‘’ applicable boxes)
CBC /     Clin     UA     Serology Micro         Ecto-                Endo-
 diff    Chem                                  parasites             parasites

Bleeding Method/Site Retroorbital   / Saphenous     / Tail     / Cardiac     / Other:
History and Clinical Signs (Include background strains, special diets, drug treatments; reason(s) for
submission; clinical signs):




----------------------------------------Below To Be Completed During Necropsy--------------------------------------------
Fixative: Formalin               / Bouins       / Alcohol     / Other:
Gross Findings (Include weights/measurements for lesions, and diagrams to indicate external lesions whenever
        possible.):
Body Condition (circle): 1 (emaciated)   2         3 (normal)     4             5 (obese > 45g)
  Body Wt             Liver            Spleen            Heart            Kidneys


ID Tags/#’s (save with tissues if possible):      SubQ ID chip saved          Punch:    R                   L
Description of Gross Findings:
                                                             Mouse Lymph Nodes

                                                     1. Superficial Cervical Nodes
                                                     2. Deep Cervical Nodes
                                                     3. Mediastinal Nodes
                                                     4. Axillary Nodes
                                                     5. Branchial Node
                                                     A. Thymus
                                                     B. Spleen
                                                     6. Pancreatic Node
                                                     7. Renal Nodes
                                                     8. Mesenteric Nodes
                                                     9. Inguinal Node
                                                     10. Lumbar Nodes
                                                     11. Sacral Nodes
                                                     12. Sciatic Nodes
                                                     NS      Popliteal Node – Behind Knee

                                                     From Dunn 1954 JNCI

Additional information (continued from front page)
                                       V2-228 Veterinary Academic Building
Laboratory of Comparative Pathology    College of Veterinary Medicine
P.O. Box 110880 Gainesville FL 32611   Lab: 352-294-4120
castlemanw@ufl.edu                     Fax: 352-392-9704

								
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