Form Waddl 001 8 – Fill Out and Use This PDF

College of Veterinary Medicine, Washington State University

Mailing address:

Web Site: http://waddl.vetmed.wsu.edu

Phone: (509) 335-9696

PO Box 647034

Shipping address:

FAX: (509) 335 7424

Pullman, WA. 99164-7034

Bustad Hall, Rm.155-N

E-Mail: waddl@vetmed.wsu.edu

Please type or use black ink and print clearly.

Pullman, WA. 99164-7034

Veterinarian or

WADDL VET CLIENT #:

Case Coordinator:

WADDL CLINIC CLIENT #:

Clinic:

Street:

City:

State:

Zip:

Phone:

Fax:

Date Shipped:

E-mail:

Owner:

WADDL OWNER CLIENT #:

Street:

City:

State:

Zip:

Phone:

Fax/E-mail:

Please fill out completely as possible:

Specimen(s)

Sampling Date:

Submitted

Aquatic

Necropsy

Virology

Bacteriology

PCR

Antibiotic of interest:

Tests

Histopathology

Fungal culture

Parasitology

Antibiotic Sensitivity

Requested:

Toxicology

Mycobacteria culture

Whirling Disease

Other

Species

Animal ID (name/tag#) or Lot #

Water Temperature

Animal Weight

Age

Location of Lesion(s)

No. in group

No. Dead

No. Sick

No. on Premises

Duration of Problem

* Was animal euthanized? If so, what method?

Water:

Marine / Brackish

System:

Flow-through

Other

Health Testing

Diagnostic Testing

Freshwater

Recirculating

Pathogen(s) of interest:

Net pen

Additional History:

Vaccinations, signs, stress factors, treatments, post mortem findings, pertinent feed or feed additives, clinical lab

results, previous WADDL Case Numbers. (Attach additional sheets as necessary.)

SAMPLE COLLECTOR:

Print Collector's Name

Collector's Signature

Veterinarian's or

Condition(s)

Clinician's Signature:

Suspected: