FORMULAR RECEPIE PROBE ANATOMIE

PATOLOGIC
Caz nr. __________________ *strict pentru personalul laboratorului
Data recepiei: ___________ *strict pentru personalul laboratorului

Datele
Istoric, ultimul vaccin, ultima deparazitareDatele proprietarului:
clinicii:
(intern/extern), tratament:
Nume:
Nume _______________________________________
clinic:
__________________________________
Nr. telefon: ___________________________________
Nume medic:
E-mail: _______________________________________
__________________________________

Datele pacientului:
Cine Nume:
_______________________________________
Pisic Ras:
Diagnostic clinic diferenial (suspiciune):
________________________________________
_______________________________________________________
Roztor Vrst: __________ Femel
Mascul

Datele probei:
Tip prob: Tumor (n intregime) Tumor (fragment) Biopsie incizional Organ
Raclat
Lichid Secreie Materii fecale Urin Raclat cutanat Raclat
conjunctival
Amprent Snge Fire de pr Badijonare Lame (frotiuri)
Aspirat Lavaj

Localizare: Descriere leziune:

1. _______________________________________
______________________________________________________
2. _______________________________________
______________________________________________________
3. _______________________________________
______________________________________________________

D
S
Fixat (formol 10%) Proaspt Data recoltrii:
_________________________________________

DS

_______________________________________________________________________________________________________________
Str. Paleologu nr. 3A, cod 023956, Sector 2, Bucureti
Telefon: +40 733 974 923 Fax: - E-mail: laboratorhistovet@gmail.com www.histovet.ro
EXAMENE SOLICITATE:
Citologie

Citomorfologie sange (+ hemoparazii)

Coloraie special reticulocite
Citologie urin (sediment)
Raclat cutanat (preparat nativ parazitologie)
Trichograma
Coproparazitologic
Test Adler (hemoragii oculte materii fecale)
Prob digestie (materii fecale)
Microfilarii (Knott + lam-lamel)
Examen complementar Distemper (snge venos + raclat conjunctival)
Histopatologie
Histopatologie Coloraii speciale ( _________________________ )
Histopatologie - Evaluare margini
Imunohistochimie Factor de prognostic Mastocitom (C-kit + Ki-67)
Imunohistochimie Diagnostic Intra-vitam Peritonita Infectioasa Felina
Imunohistochimie __________________________________________

Semntura i
parafa medicului,

_______________________________________________________________________________________________________________
Str. Paleologu nr. 3A, cod 023956, Sector 2, Bucureti
Telefon: +40 733 974 923 Fax: - E-mail: laboratorhistovet@gmail.com www.histovet.ro