DISEASE INVESTIGATION LABORATORY DIRECTORATE OF ANIMAL HUSBANDRY HIMACHAL PRADESH, SHIMLA-5 Phone: +91-177-2830164 (Extn. 231) HISTOPATHOLOGY SUBMISSION FORM (Please fill out this form completely) CHECK HERE IF URGENT For Laboratory Use Only Lab ID / Histopathology No.:- Date: Veterinarian................ Name of Institution............. .................... Contact No................ Owner's Name............... Address.................... ..................... Contact No................. Please submit the samples in 10% Formalin {1 part pure FORMALIN (40 %) and 9 parts water} Animal Name/ No......Species........Breed........Sex....Age..... Biopsy Post Mortem P.M. Interval.......... Date Specimen Taken........... History: Description of the lesion(s) (Describe location, distribution, size, color, consistency): (Use back of Form if more space is required) Clinical Diagnosis:................................... Tissues submitted:................................... Signature of Referring Veterinarian _____________________________________________________ For Lab Use Only No. of Blocks Made: Stains/ Special Stains Used____________________________________ Comments_________________________________________________ No. of Tissue Slides Made:
