DD Form 1626: Veterinary Postmortem Examination Report Checklist and Guidelines

In 1. CONTRIBUTOR/PROSECTOR, enter the rank, full name and title of the contributing Veterinary Corps Officer and the military unit to which assigned.

Enter 2. DATE OF REPORT (YYYYMMDD).

Blocks 1 through 6 are the Name and Address of the Reporting Veterinary Unit. Station address, telephone number, and e-mail address are all important information.

Enter 3. NAME AND ADDRESS OF REPORTING UNIT, 4. GEOGRAPHIC LOCATION (Country), 5. TELEPHONE NUMBER and 6. E-MAIL ADDRESS.

Blocks 7 through 15 are Animal Identification. Enter Block 7, ANIMAL I.D. (Name and Tattoo Number), Block 8, SPECIES and Block 9, BREED.

Enter 10. DATE OF BIRTH (YYYYMMDD) and 11. AGE. For 12. SEX, mark M or F.

For 13. NEUTERED, mark YES or NO.

Enter 14. WEIGHT and 15. COLOR.

Block 16: Euthanized (Yes or No). Mark YES or NO.

Specify method and agent used: the brand name or the active agent of the euthanasia product, the amount given, and the route and site of administration.

In Block 17, CAUSE OF DEATH, concisely state the medical reason(s) leading to the death of the animal. In the case of euthanasia, state why the animal was euthanized.

Enter the military unit that is accountable for the MWD in Block 18, NAME AND ADDRESS OF UNIT ACCOUNTABLE FOR ANIMAL. Include the complete military unit designation and station address.

If the form is used for a privately owned pet, the owner's information should be indicated in Block 18.

Enter 19. DATE OF DEATH (YYYYMMDD) and 20. TIME BETWEEN DEATH AND POSTMORTEM EXAMINATION.

For 21. PRIORITY REQUIRED, mark ROUTINE or URGENT.

In Block 22, MATERIALS SUBMITTED, list categories such as tissues, culture results and advanced imaging, gross photographs, etc.

In Block 23, CLINICAL ABSTRACT, address the recent pertinent information regarding this case, and previous significant medical history. Continue in Block 30 or on a separate sheet if necessary.

The clinical abstract should include illnesses, recent treatments, laboratory and radiologic findings, surgeries, wounds, fractures, immunizations, working environment and recent TDY assignments.

In Block 24, CLINICAL DIAGNOSES, concisely list significant clinical conditions relating to the death of this animal.

In Block 25, GROSS POSTMORTEM EXAMINATION DIAGNOSES, list all postmortem examination diagnoses (interpretations).

In 26. GROSS PHOTOGRAPHS, list tissues and lesions photographed; photos can be sent to: dha.ncr.joint-path-center.mbx.askvetpath@health.mil.

In 27. MICROBIOLOGICAL CULTURE RESULTS, specify site.

In Block 28, CLINICAL PATHOLOGY TEST RESULTS, list tests and include a copy of the results.

29. ADVANCED IMAGING (CT, MRI, U/S, X-RAY) AND INTERPRETATIONS: relevant to the death of the animal, include a copy.

Block 30, REMARKS: list any additional information that supplements this report. This block can be used for a continuation of another information block.

Sign 31. SIGNATURE OF CONTRIBUTOR/PROSECTOR.

Use each block/diagram in SECTION III for a systematic examination and report. Describe all abnormalities in detail.

Enter "NGLR" (no gross lesions recognized) or an equivalent notation as appropriate.

If more space is needed in SECTION III - GROSS FINDINGS, identify the tissue and continue on a blank sheet.

Enter BODY WEIGHT (kg). Enter WEIGHT (gm) for the heart.

For any lesion, the description should include three-dimensional size, shape, color, consistency, and detailed location.

SECTION IV - TISSUE CHECKLIST: use this checklist to record all tissues collected for submission.

Enter 32. ANIMAL I.D. (Name and Tattoo Number).

In 33. ITEM, indicate cassette number (if applicable) and tissues submitted with checkmark.

In the "Other" section, list any additional tissues collected that are not on the checklist.

For the tissues marked * (lacrimal gland, mesenteric lymph node(s), axillary lymph node(s) (left/right), thyroid and parathyroid glands, thymus/thymic remnants, tonsils (left/right), medial retropharyngeal lymph node(s), pituitary gland, tracheobronchial lymph node(s) (L/R), iliac lymph node(s) (left/right)): identify these tissues by placing in labeled tissue cassettes (or other containers) prior to fixation and shipment.