Upper Alimentary Ulcerative Syndrome (UAUS) study Request for Laboratory Examination – CASE HERD

OWNER Name:

Property Name …………………………………………………….

PIC Property address/geographic location of affected animals

....................................................................................... Postcode

Phone (….)………………………………………Fax (….) …………………………………………………….

Email: ……………………………………………………….

Office OnlyHerd No.

Date of Investigation

…..../….../…...

PRIMARY SUBMITTER: Jaimie Hunnam; Karen Moore

INVESTIGATOR/VETERINARIAN

Name:……………………………………………………………………………………..……………………………………..

Practice or District Office Name: …………………………………………..……………………………………………………………….

Postal Address:…………………….................................................................................................... Postcode…………………

Phone (….) ……………………….. Fax (….) …………………………….. Email: …………………………………………………..Species

BOVINE

Predominant breed(s) in the herd

………………………

Herd Size(Milkers)

………………….……

No. replacement heifer calves weaned to 1 yr

old on this farm

………………….……

Total No. Sick

…….………………

Total No. Dead

…….……………Additional history/Comments (Note: clinical details of sampled animals listed over page)

……………………………………………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………………

Number and nature of specimens(tick and indicate number of samples)

Investigations required (CASE HERD)

Blood ( Whole) x

UAUS CASE HERD PACK

Blood (EDTA) x Faeces x Faecal swab (in VTM) x Oral swab (in VTM) x Fixed tissue x Fresh tissue x

ANIMAL WELFARE REPORT (Note: this section must be completed)

Number of animals examined……………………………….Did any of the animals suffer undue stress during the collection of these samples? (tick one)

NO □YES □ (please provide details of remedial action)…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………………

Signature……………………………………….Date…………………………………….

Version 1.0 Page 1 of 3

Upper Alimentary Ulcerative Syndrome (UAUS) study – Request for Laboratory ExaminationCLINICAL ASSESSMENT OF SAMPLED ANIMALS

CLINICAL ANIMALSAnimaltagnumber

Age (months)

Breed Rectal temp

Bodyweight (kg)

Diarrhoea (Y/N)(If Y - volume/ colour/

consistency )

Oral/nasal ulcers (Y/N)

(If Y - describe)

Recent treatments- type, date of last

treatment, amount (ml)

Other clinical signs (e.g. drooling)

Samples collected(tick)

Post mortem

completed(Y/N)

Blood:EDTA □ Whole □Faeces □Faecal swab □Oral swab □Tissue Fresh/Fixed □

Blood:EDTA □ Whole □Faeces □Faecal swab □Oral swab □Tissue Fresh/Fixed □

Blood:EDTA □ Whole □Faeces □Faecal swab □Oral swab □Tissue Fresh/Fixed □

Blood:EDTA □ Whole □Faeces □Faecal swab □Oral swab □Tissue Fresh/Fixed □

Blood:EDTA □ Whole □Faeces □Faecal swab □Oral swab □Tissue Fresh/Fixed □

Please record NON-CLINICAL animals on the next page

Version 1.0 Page 2 of 3

Upper Alimentary Ulcerative Syndrome (UAUS) study – Request for Laboratory ExaminationCLINICAL ASSESSMENT OF SAMPLED ANIMALS

NON-CLINICAL ANIMALSAnimaltagnumber

Age (months)

Breed Rectal temp

Bodyweight (kg)

Diarrhoea (Y/N)(If Y - volume/ colour/

consistency )

Oral/nasal ulcers (Y/N)

(If Y - describe)

Recent treatments– type, date of last

treatment, amount (ml)

Other clinical signs (e.g. drooling)

Samples collected(tick)

Blood:EDTA □ Whole □Faeces□Faecal swab □Oral swab □

Blood:EDTA □ Whole □Faeces□Faecal swab □Oral swab □

Blood:EDTA □ Whole □Faeces□Faecal swab □Oral swab □

Blood:EDTA □ Whole □Faeces□Faecal swab □Oral swab □

Blood:EDTA □ Whole □Faeces□Faecal swab □Oral swab □

Please forward samples to – Veterinary Diagnostic Services, AgriBio Specimen Reception, 5 Ring Road, La Trobe University Bundoora, Victoria, 3083 Phone: (03) 9032 7515Fax: (03) 9032 7604 Email: vet.diagnostics@ecodev.vic.gov.auFor more information please contact the duty pathologist on (03) 9032 7515

Version 1.0 Page 3 of 3