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    RADDL New LH SUBMISSION FORM 2024 Ed

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    RADDL New LH SUBMISSION FORM 2024 Ed

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    genrixelejorde1998
    34 views2 pages
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    RADDL-new-LH-SUBMISSION-FORM-2024-ed

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    34 views2 pages

    RADDL New LH SUBMISSION FORM 2024 Ed

    Uploaded by

    genrixelejorde1998
    sample

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Republic of the Philippines

    REGIONAL FIELD OFFICE IX


    Zamboanga Peninsula
    Lenienza, Pagadian City 7016

    INTEGRATED LABORATORY DIVISION


    REGIONAL ANIMAL DISEASE DIAGNOSTIC LABORATORY IX
    LABORATORY EXAMINATION REQUEST FORM
    (GENERAL SAMPLE SUBMISSION)
    LABORATORY ACCESSION NUMBER: DATE SUBMITTED (MM/DD/YY):

    ORIGIN OF SAMPLES: SUBMITTED BY:


    Owner/Farm: Name:
    Barangay: Address:
    Municipality:
    Province:
    Tel. No. Tel. No.
    Email: Email:
    SPECIMEN /QUANTITY SUBMITTED
    Species: Bovine Bubaline Swine Caprine
    Ovine Feline Equine Canine
    Avian (specify) Others
    Breed: Sex: Male Female
    Age: yr/mo/wks/days)
    Specimen: Whole Animal Live Dead/Sacrificed (Hours since death)
    Others Swab Blood Serum Tissues/organs
    Feces Blood Smear Others
    CASE HISTORY
    Date Collected: (mm/dd/yy)
    Population: No. Sick: No. Dead:
    Start of Outbreak (mm/dd/yy):
    Clinical Signs:

    Vaccination:

    Treatment/
    Medication:
    Necropsy
    Findings:
    Disease/s
    Suspected:
    EXAMINATION REQUESTED
    PATHOLOGY
    Gross Examination Packed Cell Volume
    BACTERIOLOGY
    Isolation & ID RPT ELISA
    Bacterial Brucella spp. M. gallisepticum
    Others S. pullorum M. synoviae Others
    Other Tests:
    Antibiotic Sensitivity Test Others
    Water Coliform Count
    PARASITOLOGY
    Fecalysis Blood Parasite Examination
    Direct Smear Direct Smear
    Test Tube Flotation Method Stained Smear
    McMaster Flotation Method Hematocrit Centrifugation Technique (Surra)
    Sedimentation Technique
    Other Tests:
    Skin Scraping Method Examination
    Parasite Identification
    Card Agglutination Tests for Trypanosoma sp. Others
    RF-LE-00 Page 1/2
    January 30, 2024
    Republic of the Philippines
    REGIONAL FIELD OFFICE IX
    Zamboanga Peninsula
    Lenienza, Pagadian City 7016

    VIROLOGY
    Hemagglutination-Inhibition Test (HI) Agar Gel Immunodiffusion (AGID)
    Avian Influenza Avian Influenza
    Newcastle Disease
    Others
    Enzyme Linked Immunosorbent Assay (ELISA)
    Swine Avian
    African Swine Fever Avian Influenza
    Classical Swine Fever Newcastle Disease
    Porcine Reproductive and Respiratory Syndrome Infectious Bursal Disease
    Ruminants
    Small Ruminant Lentivirus
    Polymerase Chain Reaction (PCR)
    Swine
    African Swine Fever Others

    Avian
    Avian Influenza
    *Rabies examination: please refer to Laboratory Examination Request Form (RF-RL 00) for Rabies Sample Submission
    PURPOSE
    Diagnostics Local Shipment Imported Under Export
    Regulatory Surveillance Quarantine Farm Accreditation
    Others Disease Investigation
    REVIEW OF REQUEST
    I acknowledge that I have read, understand, and agree to the policies and procedures as defined in the Terms and
    conditions. In addition, all the details supplied in this Laboratory Request Form are true and correct.
    Conforme:
    ______________________
    __________________________ Client
    Receiving Staff Date:_________________________
    Terms and Conditions:
    A. Retrieval of Samples and documents received and signed by the laboratory will not be allowed for Biosafety and Biosecurity purposes
    unless sanctioned by Law.
    B. The Laboratory reserves the right to reject submitted samples not complying with the Terms and Conditions stated herein:
    1. Criteria for Sample Rejection (SOP-BS4-00)
    Unlabeled samples
    Mislabeled and undecipherable or illegible labels of the samples
    Insufficient/inadequate volume/quantity for the test requested
    Hemolyzed/decomposing sample depending on the test requested
    Samples collected in unsuitable containers, leaking containers or use of the wrong preservative or non-sterile
    container
    Submission of wrong samples
    Use of non-conforming containers for transport such as carton boxes. cellophane, plastic bags, and newspaper.
    Contaminated samples
    Lack of sample information/data and other required documents.
    C. Testing Schedule and Routine Turnaround Time
    1. Regular sample submission is from Monday to Friday 8:00am to 5:00pm, except for local and national holidays.
    2. Cut-off time for processing of samples depends on the requested test; Specimen received later than cut-off time will be preserved
    and processed on the next working day.
    • PCR test – Monday to Thursday, 8:00 am to 11:00 am
    • ELISA Test – Monday to Friday, 8:00 am to 11:00 am, (Minimum of 20 samples)
    • All other tests - Monday to Friday, 8:00 am to 11:00 am
    3. Outside regular submission hours, well-packed samples can be submitted to the laboratory assisted by the security personnel.
    These samples will be officially logged and processed on the next working day.
    4. Releasing of test results varies, depending on the complexity of the requested test as specified in the protocol on Releasing of
    Laboratory Report(SOP-PF4-00)

    REMARKS

    RF-LE-00 Page 2/2


    January 30, 2024

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