CLINICAL ANIMALS Animal Age Breed Rectal Bodyweight Diarrhoea (Y/N) Oral/nasal ulcers Recent treatments clinical signs (e.g. Samples collected Post tag (months) temp (kg) (If Y - volume/ (Y/N) drooling) (tick) mortem - type, date of last number colour/ consistency ) completed (If Y - describe) treatment, amount (ml) (Y/N) Blood: EDTA Whole □ □ Faeces □ Faecal swab □ Oral swab □ Tissue Fresh/Fixed □ Blood: EDTA Whole □ □ Faeces □ Faecal swab □ Oral swab □ Tissue □ Blood: EDTA Whole □ □ Faeces □ Faecal swab □ Oral swab □ Tissue Fresh/Fixed □ Blood: EDTA Whole □ □ Faeces □ Faecal swab □ Oral swab □ Tissue Fresh/Fixed □ Blood: EDTA Whole □ □ Faeces □ Faecal swab □ Oral swab □ Tissue Fresh/Fixed □ Please record NON-CLINICAL animals on the next page NON-CLINICAL ANIMALS
CLINICAL ANIMALS Animal tag number Age (months) Breed Rectal temp Bodyweight (kg) Diarrhoea (Y/N) (If Y - volume/ colour/ consistency ) Oral/nasal ulcers (Y/N) (If Y - describe) Recent treatments - type, date of last treatment, amount (ml) clinical signs (e.g. drooling) Samples collected (tick) Post mortem completed (Y/N) Blood: EDTA □ Whole □ Faeces □ Faecal swab □ Oral swab □ Tissue Fresh/Fixed □ Blood: EDTA □ Whole □ Faeces □ Faecal swab □ Oral swab □ Tissue □ Blood: EDTA □ Whole □ Faeces □ Faecal swab □ Oral swab □ Tissue Fresh/Fixed □ Blood: EDTA □ Whole □ Faeces □ Faecal swab □ Oral swab □ Tissue Fresh/Fixed □ Blood: EDTA □ Whole □ Faeces □ Faecal swab □ Oral swab □ Tissue Fresh/Fixed □ Please record NON-CLINICAL animals on the next page NON-CLINICAL ANIMALS
UAUS-CASE-Sample-Submission-Form.docx