AJ/4 fJ /A DEATH DATE: !2f35' 5?,-7s3.amazonaws.com/janus-cloud2/www/lovelace/dcr/1566T.pdf ·...

CLIN !CAL SUMMARY

EXPOSURE DATE: AJ/4 AGE AT EXPOSURE: fJ /A DEATH DATE: "!2f35' AGE AT DEATH: 5?,-7

DAYS POST-EXPOSURE: IJ/�

TREATMENTS AND/OR DIETS OF DOG: 1566T

90247 Flagyl, 1/2 Tablet, Oral, Sid for 5 days 90260 Flagyl, I Tablet, Oral, Sid for 5 days 90288 Flagyl, I Tablet, Oral, Sid for 5 days 90338 Flagyl, I Tablet, Oral, Sid for 5 days 90356 Flagyl, I Tablet, Oral, Sid for 5 days 91007 Flagyl, l Tablet, Oral, Sid for 5 days 91351 Kaopectate, 10 ml, Oral, Bid for 5 days 91351 Placed on l/2 Can liD diet, Bid for 5 days 92035 Sacrificed

/adm WP FILE: c:\TREATMnl566T.tre

INHA�TiO'N TOxi'ColOGY RESEARCH INSTITUTE GROSS NECROPSY REPORT

1'5lot..T 15641 90191 F

Date Cl.;;tb�S Time �Weight lQ_,_S_kg . ..2/o-.!"iL

j5;a Sacrificed 0 Euthanized

Authodzed sv £. J2 �r4 D Died- Found By __________ _

IIUU UIIU \>c..:;\-l-.o\09<V\ � · 1 -l rD,. Lc'<.e '¥:-.-< <.. U J Clinical Diagnosis _.,1\,\0.,_,_r!.:M"'O,'-"',\�_,w"""'J"""'_-__ _

(fY qJ_-�) � � u��'JLo( __ S�6"'-''"'-< '-'-'S,_,c""-e:d�---=---cltnic•an Gross Diagnosis -------------Principal Investigator ----------

,=-------=--of Necropsy

Stains (circle)

Numbef of Shdes

�· lltOOOvt:SSt:l �•m

TONGUE

H&E A-R Specials

P(NISIVAGINA

EI'IOIOYMISOIIIOUCl'

PITUITARY

""

0 NOT SAMPLED FOR HISTOPATHOLOGY

WEIGHTS AND MEASUREMENTS

Ht. Wt. _gm LV+S_gm RT.V _gm

RAV _em L.AV _em PV _em AV __ cm

LVM _em RVM_em Lung ____ gm

TBLN __ gm Adrenal __ gm Thyroid __ gm

Kidneys __ gm Liver ___ gm Spleen ___ gm

Brain ___ gm Pane. __ X __ X __ em

Other ----------------

PROVISIONAL ANATOMIC DIAGNOSIS

Pathologist _________ Date ___ _

CENTRAl RECORDS

,.·

i.

1)66 l 90198

UNASSIGNED

SURGICAL RECORD :2} a..:. I"\ z._ Surg. Date: q:JO:)S Body wt. (kQ)Jk.S_ Time of anesthesia 9 . 3<\ Duration I h..Pre-anesthetic drugs: \ ·m I A ITD (2 •/\£!

C. • 7 &\ A., e p co 1''-".Q-£1 ap "??<,'.._

. Induction: >:>]0. �C=::r: lo; Ha1ntenance: d }, _ ·--�--P /(_._ Anesthetist: (\{\ A \t>kJ, yJ hc,\c\ R \l T Coi!Jilents: c?<Q() 00 1 L!2S I \) f\)C 1\\. f2.E: co,t £12 '-{ fRoct:ut.Rf

Surgical Procedure:· An/<2$6 'Je IQ ceJ-\r,ok .-: ,-c.:Hoa Description:__,==--------_)'---;---------,----,--- -------:----

1 l- C " � ,, I < � -�<Ac I" t-/ c

J

Samples submitted:_--''-'-""""-''""----------------'-------Co111!1ents: _____________________________ _

INTEROFFICE MEMORANDUM

TO: FILE

FROM: Ms. M. A. Weinhold

SUBJECT: Assignment of dogs to study

DATE: January 20, 1992

(92020)

Effective immediately, the following dogs will be removed from "Immune

Memory: Lung Transplantation", project FY91-024:

!51ST

1546C

1566T

l573A

The following dogs should be newly assigned to the same project:

Dr. Bice

Dr. Muggenburg

Mr. Williams

15148

1514T

1515U

1557A


TO: FILE

FROM: Ms. M. A. Weinhold


DATE: January 20, 1992

(92020)

Effective immediately, please assign the following dogs to "Potential Pathology of the Lovelace Microspray Nozzle", Protocol FY91-042 (cost code 5680):

cc

Dr. A. R. Dahl Dr. B. A. Muggenburg

!51ST

1566T


TO: File

FROM: Dr. D. E. Bice �

SUBJECT: Reassignment of Dogs 1515T and 1566T

December 13, 1991

Dogs 1515T and 1566T assigned to Protocol FY91-024 "Memory of Local Immune Responses in the Lung" were inadvertently instilled with 1 mg KLH antigen rather than the correct dose of 10 rng KLH. Because of this mistake, these dogs can not be used in

this study. These two dogs will be returned to the unassigned dog colony and two additional dogs will be assigned to this study.

cc: .....-Dr. B. A Muggenburg Dr. D. G. Burt Ms. D. L. Harris

177

t566T tOt91

UNASSIGNED

INHALATION TOXICOLOGY RESEARCH INSTITUTE URINE/FECAL REPORT

HISTORY (Reason for submission)

F

REQUESTED BY DATE SUBMITTED 9 ,QQc:f\

0URINALYSIS COLLECTION METHOD

Compressionl ___________ _

Catheterization __________ _

Cage _____________ _ Other _____________ _

CHEMISTRY (chemstrip·B)

Sugar ____________ _::m2glc.e:dl

Albumin _ ___________ m:::g/!ce:d l

OMICRDSCDPIC COMMENTS: DIRECT

Hemoglobin EAY/ug CYTOCENTRIFUGE

Acetone ____________ _

Bilirubin ____________ _

Urobilinogen __________ _::m2g/c.e:dl

Occult bloo d ____ ______ ER'-Y'- /u=-"g

Nitrite

Sp. Gr -------------

pH __________________ _

Colorr _____________ _

Turbidity ____________ _

MICROSCOPIC

WBC _ _ _ _ _ _ _ _ _ _ _ _ __ RBC __ _ _ _______________ _

Casts·

Hyaline•-------------

Granular _______ _____ _

WBC or RBC. ___________ _

Other'--------------

Bacteria ____________ __

Renal Cells ------------

Crystals ____________ _

CENTRAL RECORDS

TECH/PATH Date

;IS[HcAL TEST REQUESTED �arasites 0 Trypsin OOther

Procedure Used' --------------

Results

TECH/PATHQ � 1-7-"JZ--Date---------

HOSPITAL ADMISSION a n d DISCHARGE

l. Attitude 2. Confonnation 3. Hydration 4. Nutritional status 5. Super. lymph nodes 6. Membrane color

1566! 90198

7. Skin and ears 8. Eyes

UNASSIGNED

tlom. Abnorm.

9. �lusculoskeletal sys. IO. Respiratory sys. 11. Cardiovascular sys.

Kennel 12. Alimentary sys. 13. Urinary sys. 14. Genital sys. 15. Nervous sys.

Temp Jo0.(o Pulse \32Resp�leight /U· � k:f

P t. bl j · h 16. Endocrine sys. resen 1n0ro em O\<lfYbeg. l7. Teeth and gums History l..lj;OJ,JlOc.. 1•/'lo. L"-"'0� ""� �W-1-<l-CoiTITlents: CS> DAiZ coo£

Date Released 9! 3'>�

Tentative Diagnosis � - �

DISCHARGE

Comp 1 ete phys i ca 1 � m cTJ-.o!Y) 'YX)IV Clinician � . c

SUMMARY

Final Diagnosis: _ _:_-.e.�==·;gt:�-)<!...lk�c'f'"'�o.c:� · =----------- -----Condition at Release· ----------------::---,-- --------

1. \�0 � qJ.,W�rne Clinician '-'/b (d�LVvc'f

-�-

lJ CLINICAL CHART

General Comments:

1 56 6 T 91195 F

UliASS !GNE D

Julian Appe Bowels Urine T p R COMMENTS Date tite

\1-"'i.- c. >.V.S (�c·'-"' \Lt'.d k rclc,t-L r)\.l-PI 1 '>'• I C� D /11• ti�i->"'- �J-dl Dec.•(

ff{o"-k..J

LLVJ V.<dl-'� "'-� ;,, t AI <lu' . L/I'YIP. G.�'S ') G- l))f, PJ .j u J _) '?!F > G ;J "'L

'1fV3 c. tJ lr-<-J �I c

'At-'>5(, {._ >--.] 'i)) '1 '-6/ G- N p \\..c\ ...... x.l -;tz,c \s . 1:'-. ' < tc�h- c. x-1

11.--., ,...)(. ( c•n., o lt>h-d di I

ABBREVIATIONS: Appetite: F•fair, G-good, P-poor, 0-none. Bowels: N-normal, D-diarrhea, DB-diarrhea with blood, 0-no feces. Urine: N-normal, A-abnormal, 0-none.

ORDER SHEtT

General Comments:

1 " ' HP f

l'' f..':! S I G �· f

Jul i an1 Date ; ORDER Clinician

)t;>' \ I kcw -p; . Ld. c I• , ,,, c \,., J r"' A ll :-:.· --��.} K ' A I \ct c ."-t l\ '(:,. c

l ! ��;: ... j ; ' II> I C. '

{t:" 'I i I _L""

v I

i ;

'

i

j I

i I

I

--------

rt<L r

' (

. .

�\ t

1/.:,l

( ''� (

0.).

- ..

IC\... (._ L-t'� /- l/ (j� Yl ,-

IJ ��' {' ,, ) /)'\,' I

Work Order Issued Co:-1pl eteC

'((?/:;/ j

' I/ v/\1,�

I

I

I I

I

1

1566T

INHALATION TOXICOLOGY RESEARCH INSTITUTE

BRONCHOSCOPY REPORT

Anesthesia: n1111JJ lnnovar-Vet & Atropine

90198 Diabutal

UNASSIGNED Surital v

Dosage Route

/ / / L

v Halothane J {/' fs'/o �:t/o ' "''"!

Procedures

Rigid Bronchoscope

Flexible Bronchoscope

Photographs

RIGHT

Diagnosis

Clinician

k L

LEFT

Oth" f\ce pr�""-"-C•-"'

WHITE- CENTRAL RECORDS CANARY- CLINICAL PINK PATHOLOGIST

' '2 '"' \ -:s&


Pile

FROM: Ms. H. A. Weinhold


DATE: December 5, 1991 (91339)

Effective immediately, the following dogs should be assigned to "Immune

Memory:Lung Transplantation", project FY91-024, anunendment 2:

TATTOO:

lSlST

1517U

1521A

1523S

1523V

1524C

1546C

1558C

1566T

1573A

Their use in the study will be as follows:

�:

1517U

1521A

15235

1524C

Dr, Bice

Dr. Muggenburg

Mr. Williams

LUNG DONORS:

!51ST

1566T

1523V

LUNG RECIE'IENTS:

1546C

1573A

1558C

PHYSICAL EXAM! NATION (AN}

(Short Form) W.O. (/lio�"-1 Tattoo Number t5U,z- (N-Nonnal)

A. Date 2- (lr'11 �,_,\ B. Weight //K9:J gm c. Height (Shoulder) __ ._

D. Body Temp. (rectal l..LQL • .f:.. E. Pulse Rate (femoral)£ f. Respiration (rate/min.)....£_ G. General Condition:

1. Comatose 2. Poor 3. Fair 4._Go�

� . COMMENTS:

Tefhnfcfan

1. 2. 3. 4. 5. 6. 7. B. 9.

10. 11. 12. 13. 14. 15. 16. 17.

I

Attitude Conformation Hydration Nutritional status Superficial lymph nodes-Membrane color =

· Skin and ears Eyes Musculoskeletal system Respiratory system Cardiovascular system Alimentary system Urinary system Genital system Nervous system Endocrine sys tern Teeth and gums

Clinician

(A-Abnonna 1)

7

�



REQUESTED BY DATE SUBMITTED I/; J' /q I Co. I :r) l ?

OURINALYSIS COLLECTION METHOD

Compression ___________ _

Catheterization __________ __

Cage _____________ _

Other _____________ _

CHEMISTRY (chemstrip-8) Sugar _ _ _ _ _ _ ______ ;c.m"'g/"'dl

Albuminr ___________ -"!m!!'.g/O!!d l

OMICROSCOPIC COMMENTS DIRECT·

Hemoglobin ERY/ug CYTOCENTRIFUGE Acetone _ ___________ _

Bilirubin ____________ _

Urobilinogen __________ �m::.!g�/dl

Occult blood _________

_:_ERc.Y:c/:c:ug

Nitrite Sp. Gr -------------pH ________________________ ___

Color _____________ _

Turbidity ____________ _ TECH/PATH Date

MICROSCOPIC �FECAL TEST REQUESTED )lJ Parasites D Trypsin DOther

WBC _____________ _ Procedure Used ______________ _

ABC _____________________ ___ Results Casts:

Hyaliner ____________ _

Granular ____ ________ _

WBC "ABC ___________ _

Other ____________ ___

Bacteria ____________ _

Renal Cells ______ _____ _ CrystalS ------------- TECH/PATH-jab>4<Wq�U:<-f=.-=::,.....,� Oat�

(Y-'A R'C0RJS

: •

-.. .- :!'

. ·:

·�-

-... _

, _

_

_

-

" I •.

� � . .:--��-

"1: - -·

• ___ !;_ ..... -· · ·· -�-

• .

A"-> -\--r-CQ�(\1\..QVJ,\ t="o< (ulec.-o(c... � 1(\re_cho" 1 JI\Je_ Mc.h--oVJI_clC\."C::(c...

s 5 � ) � "':"-::-,I .b )<._ $ C( I i- �I. ... Q.A'l rc::. s \...> tHVl � + F (. CC\.. I s OcYYl f) c

vj(): (-s+zz...-+ C"\10o7) [\;\e. h--·o0'1 d..�_:co t c::._ I T""--6 \e.;\- p D "5\il X ��

:: .. ,_sC\.x•1p lc ov, 't- � n n:.:s v b Y>-J i t-

t)l"6/'1/.



REQUESTED BY oATE suBMimo //"!I q / {ao0 0 URINALYSIS

COLLECTION METHOD

Compression'------------Catheterization _ _________ __

Cage _____________ _

Other _____________ _

CHEMISTRY (chemstrip-8)

Sugar ____________ .;:m2 g/_:::dl

Albumin _ _ _________ _:m::c g/<::: dl

OMICROSCOPIC COMMENTS DIRECT

Hemoglobin ERY/ug CYTOCENTAIFUGE

Acetone ____________ _

Bilirubin ____________ _

Urobilinogen __________ _cm2 gc.::/dl

Occult blood _________ __:_ER�Y:.:./:2"9

Nitrite

Sp Gr -------------

pH ________________________ _

Color _____________ _

Turbidity ____________ _

TECH/PATH Date

MICROSCOPIC

WBC ------------------------

�Parasites

Procedure Used ______________ _

OTry psin OOther

RBC. _______________________ _ Results Casts

Hyaliner ____________ _

Granular ____________ _

WBC or RBC ___________ _

Other _____________ _

Bacteria ____________ _

Renal Cells ___________ _

Crystals --------------TECH/PATH ___ .J.C...:.YJ'-L.. __ Dare /yqt

A� RrC.ORDS

/0!{-t



REQUESTED BY OATE SUBMITTED /;l.p I /90

0URINALYSIS COLLECTION METHOD

Compressionr ___________ _

Catheteriza tion ______ ____ _

Cage _____________ _

Other _____________ _

CHEMISTRY (chemstrip-8) Sugar ____________ _::mzg/.:::dl Albuminr ___________ ---'"m"'g/"'dl


Hemoglobin ERY/ug CYTOCENTRIFUGE Acetone ____________ _

Bilirubin ____________ _

Urobilinogen __________ _::m::ogc::: /dl

Occult blood' _________ _::E.:_:R_::Y/�u g

Nitrite -------------Sp. Gr -------------pH ____________ _

Color __ ___________ _

Turbidity ____ ________ _

TECH/PATH

MICROSCOPIC wParasites

Date

OTrypsin OOther WBC _____________ _

RBC ___________ ___

Procedure Used ______________ _

Casts Hyaline•-------------

Granular _____ _______ _

WBC or RBC ___________ _

Other _____________ _

Bacteria ____________ _

Renal Cells ___ _ _______ _

Crystals -------------

�- T'l.A R£C<lR.)S

AeSl.Jits

xaw� e:il4Ad<J5_ � od ::?" <Jo 3 5/

TECH/PATH ___ __.(\....,..(()'"'--- Oat• qb1j2()

I(\( c c.r\--\o" 1 )1\J � Uch-or,,d_q_T-0\ z_ 'S"S � II� s 1 D X � d t-�" rtc_\1"'-L_,�

tv'\ (_ h- 0" ,c\ C(_ C:: c, ( c_ .

: ... \ t-c,_.\::Jk +- .Po .'� -s 1 D . X 'S d ( +-�r..



REQUESTED BY DATE SUBMITTED I I

0 URINALYSIS COLLECTION METHOD



Cage _____________ _

Other _____________ _


Sugar ____________ _::m2gic::dl

Album;n ____________ m:::g/!!c::dl


Hemoglobin ERY/ug CYTOCENTAIFUGE

Acetone'-------------Bilirubin ____________ _

Urobilinogen __________ _::m2gc:: /d l

Occult blood _________ _:::ER.:.Y::_/u::.:!g

Nitrite -------------

Sp Gr -------------

pH ________________________ _

Color _____________ _

Turbidity ____________ _

TECH/PATH

MICROSCOPIC �Parasites

cJ

Date

O Trypsin OOther WBC ________________________ __ Procedure Used ______________ _

ABC ________________________ __ Rerults Casts·

Hyaline ____________ _

Granular ___________ _ _

WBC" RBC ___________ _

Other ____________ _

Bacteria ____________ _

Renal Cells ___________ __

Crystals -------------

< ENTRAL ReCORDS

TECH/PATH ______ __..{1()2:<1..'----- Oatte.e ....I.Jrf'.j.!.:<'l!I:Oo/-�91.iu'---C(O:}; >f

�

� - ... .-··-· .. . 1 •• --

f'-�_.:, f'- /:!i_ :._,,__£'e� . ¥ cA· ;;L

f._ rG :;-t:,L ,�<�:_, (Ze �c"";J�<� 'a./7� .. .7c � ----<� -7 6 IU c,T-

· �

� c_tP Cl-(t�-- / !?(; C4-2(_

(-<:L•,;_./ _/-C. ��..-t� �� a n�.,< /

... . V: Sd111&ufLd �t�_ ccJ � o0 9a_q__y;

f{!A-

/5t:&-t



REQUESTED BY

0URtNALYSIS COLLECTION METHOD



Cage _ ____________ _

Other _____________ _


Sugar _ ___________ ::.:m!!g/.::Cdl

Albumin ___________ _:m::_:g/�d� l

OMICROSCOPIC COMMENTS: DIRECT

H emoglobin ERY/ug CYTOCENTRIFUGE:

Acetone ____________ _

Bilirubin ____________ _

Urobilinogen __________ _:m�g�/dl

Occult blood _________ _::_ER�Y:.'/�ug

Nitrite ------------

Sp Gr -------------

pH ________________________ _

Color _____________ _

Turbidity ____________ _

MICROSCOPIC

TECH/PATH

�FECAL TEST REQUESTED �Parasites

Date

OTrypsin DDther WBC ___________ _ Procedure Used ____ __________ _

RBC ______________________ _ Results Casts

Hyaline ____________ _

Granular ____________ _

WBC or RBC: ___________ _

Other ____________ _

Bacteria ____________ _

Renal Cells ___________ __

Crystals -------------TECH/PATH ____ __,tC"""''Q'- ----- Date ��ffi

CE'lTRAL R�CORDS

• ; ·.

... . '" .• · . :·"'-· ... -·- - - --

. .· " "To ·-�. - • . .. ·� . ..:.: ._ ___ :_��- . ·--!.--,;. . . _ . ... . _ .. _.;...

:Me h-an Ide_ cal�

:.,J T-�ld ?O

• .

15�(oB "\50c'oS

1-5Gtoi

SID 'f- 54 1 -t-[,.ex\ rc 0�6.,-h i+ kcR\ s C\.Y\1\_� I e...

aiiet,J3A M I� v�

/()lt,-/ fl-O!


HISTORY {Reason for submission)

REOUESTEO BY

0URINALYSIS COLLECTION METHOO



Cage _____________ _

Other _____________ _

CHEMISTRY (chemstrip-8) Sugar _____________

m-"g/.:::dl Albumin ___________ _:mc::g= /dl

0MICROSCOPIC COMMENTS: OIRECT:

A-6�1-G�Q�� n� clcz..,:co\e

:sib )( 5d\ Hemoglobin ERY/ug CYTOCENTRIFUGE Acetone ____________ _

Bilirubin ____________ _

Urobilinogen __________ _:m2g/c.::dl

O ccult blood _________ �ER.:_Y_:/"02g Nitrite

Sp G<. -------------pH ______ __ __ __ __ __ __ ______ _

Color _____________ _

Turbidity ____________ _

TECH/PATH Date

MICROSCOPIC WBC _______________________ __

f>ZIFECAL ""'\TEST REQUESTED �Parasites

Procedure Used ______ ________ _

0Trypsin ODther

RBC _______________________ _ Results Casts:

Hyaline ____________ _

Granular ____________ _

WBC or RBC ___________ _

Other _ _ ___________ _

Bacteria ____________ _

Renal Cells ___________ __

Crystals -------------

__ NTRAL RECORDS

.-:�-� .. ; �·- _.. - --�'-'-'--..:.:;.._. -----�---�·-· -· · - --

ee5£1VATIC*

�= 1? k ;�<18'0 h:\ -MJIW.ID: I___ �<

··�

1-Olte: ?fC1,) 7Q '1 b7/"\0

/ I I. c..� e__ --pvp-s

--:pas; -r; \J (. fz>• O'le. 0ceK were.. /\DT

I he_ �cCPJ\ 0'\

::,.Kc: tcs+- . qo;{r \

4/o2s(qo

k-s+cd

G�o.rdiCA.. LC\.V); s

Jb 4'!d

+v-c_a___.-\--.::d' wd\ �"- n:_-\--cs�


Joit:-r

j}-tJ J

HISTORY (Reason lor submission)

REQUESTED BY




Cage _____________ _

Other _____________ _

CHEMISTRY (chemstrip-8) Sugar ____________ _::m:::g/c::d l Albumin ___________ __:m� g� /dl

DATE SUBMITTED

OMICROSCOPIC COMMENTS DIRECT:

Hemoglobin ERY/ug CYTOCENTAIFUGE Acetone ____________ _

Bilirubin ____________ _

Urobilinogen _ _ ________ _::m:::gl c::d l

Occult blood __ _______ __;_E_RY'-' 1"'-ug

Nitrite

Sp Gr -------------pH _____________ _

Color·--------------Turbidity ____________ _ TECH/PATH

MICROSCOPIC ECAL TEST REQUESTED �arasites

Date

0 Trypsin OOther WBC _ _ _ __ _ _ _ _ ___ _ Procedure Used ______________ _

RBC. ___________ ___

Casts Hyaline'-------------Granular _ ___________ _

WBC or RBC ___________ _ Other ____________ _

Bacteria ____________ _


Crystals-------------

CENTRAL RECORDS

Results ' -

{)'ed::1.3-t CJt?.O.i} e:::k_a-t oft i:t � d

o.dJ

TECH/PATH ____ ,!:Q/)�-- Oate..e _:;�y�""'+'-'jf <JD"'--

\7'�

----�---c- -..,.-'--�

:.. - "' ·' ·:''�-· ... _, ____ -

GBSERVATION

tr: I, Ceqwa±u MIIW. ID: L I 1±e c \S(g fo Olte: 50& (e Ci ']/, 7 (16 I

f/le_...+-rof\ \ cl..c;_-=t:o k_ """'Sll) J. 'Sd..

Mc:.+-r-0 'l \ cl o .... :'C o l �

r +-ct.b \e...t j)o s l'D )<_ sci , --r-� .

\5G-0A \5(o0 l3 l5 w Cos l5Co<'oT

'Ye-S ubvnit- re....eoJ ScvYlf' \<:::..... , • / JN()lc�M.:<J JdJidl f/J1261(/J1'l)

<f%?


/Jt:t-1 )!- o I


REQUESTED BY




Cage _____________ _

Othec _____________ _


Sugar ____________ �m:!!g/�dl Albumin ____________ m::: g/= dl

DATE SUBMITTED

OMICROSCOPIC COMMENTS· DIRECT

)f\�-\--)Cl>'\ I}

3D) I�

Hemoglobin EAY/ug CYTOCENTAIFUGE

Acetone·-------------

Bitirubin ____________ _

Urobilinogen __________ _cm'-'g /c::;d l

Occult blood _________ __.:cE::_RY:_:/.:::!ug

Nitrite Sp Gr -------------pH _____________________ ___

Color _____________ _

Turbidity ____________ _ TECH/PATH

MICROSCOPIC �i�;�EQUESTEO warasites

Gla..rdt'o_ C9Y1Ls ------

lv\.c..-1--r--o"" idc..-o:> )c_ SlD x. S c\

Date

0Trypsin DO thee WBC ______________________ ___ Procedure Used ______________ _

RBC _______________________ _ Results Casts

Hyaline ____________ _

Granular ____________ _

WBC or RBC ___________ _

Other _____________ _

Bacteria ____________ _


Crystals -------------

CENTRAL RECORDS

.: . -� _: . . · -1-----'-""-7·�-"

_ _ ... _ .... ·'·· _-----�· -- ·:--��-·-�- 100 0 T · GBSEI!VATJCJI -

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REQUESTED BY


Compression' ------------Catheterization __________ __

Cage _____________ _

Other _____________ _


Suga< ____________ _::m::!!g/�dl Albumin'-----------�m�g/dl

DATE SUBMITTED

0MICROSCOPIC COMMENTS DIRECT

---;;frded c

\f)IM «

I l S rn)

Hemoglobin ERY/ug CYTOCENTRIFUGE

Acetone'-------------Bilirubin ____________ _

Urobilinogen __________ _:m::og�/ d l

Occult blood _________

_e:E::RY:_:

/� ug

Nitrite

Sp GL-------------pH ________________________ _

Color _____________ _

Turbidity ____________ _

TECH/PATH

MICROSCOPIC �FECAL

TEST REQUESTED &V?arasites O Trypsin OOther WBC _____________________ _ Procedure Used ______________ _

RBC ____________ _

Casts:

Hyal ine ____________ _

Granular ____________ _

WBC ot RBC; ______ _____ _

Other·-------------

Bacteria ____________ _

Renal Celts ___________ _

Ctystals -------------CENTRAL RECORDS

Results (MJ-go 0ajhpF)�

� (!.d3

TECH/PATH----t.C.l;;Q�.I--- Date �/ac/9/J

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