Micro Seravet Elite SRL

Luni - Vineri : 9.​30​ - 18.​00

Sambata : 10​00 ​- 14​00

FISA RECEPTIE ANALIZE

Cod Proba* ______________________________________ Data receptie proba* _____________________________

*se va completa doar de personalul laboratorului

Informatii Cabinet / Clinica Informatii proprietar

Nume Cabinet / Clinica: _____________________________ Nume _________________________________

Nume doctor curant: _____________________________ Telefon / Email: _________________________________

Telefon / Email: _____________________________ _________________________________

Informatii Pacient
​ Caine ​ ​ Pisica ​ ​ Rozator ​ ​ Alta Specie: ​_______________________________________________________________

Rasa: ​_____________________________ ​Varsta:​ _________________ ​Nume:​ ___________________________________

​ Mascul ​ ​ Femela ​ Castrat ​ ​ Necastrat

Informatii Proba
Data recoltare: ​_______________________

Mediu / Recipientul de transport:

​ Tampon cu gel Amies Lichid ​ ​ Tampon cu gel Amies Solid ​ ​ Tampon fara mediu (dop albastru/rosu)
​ uriSwab (dop galben) ​ ​ fecalSwab (dop verde) ​ ​ eSwab (dop roz) ​ ​ tampon cu gel Stuart (dop albastru/rosu)
​ coprocultor ​ ​ urocultor ​ ​ eprubeta ​ ​ alt recipient: ​_______________________

Informatii anamnetice (istoric si tratament):

Diagnostic clinic / suspiciune:

F.R.A. ED.1 REV.1 5.09.2018

 Micro Seravet Elite SRL
Luni - Vineri : 9.​30​ - 18.​00
Sambata : 10​00 ​- 14​00

Examene Solicitate
Bacteriologie
Aparat respirator ​cultura exudat faringian + antibiograma
​cultura secretie nazala + antibiograma
​cultura secretii traheale + antibiograma
​cultura lavaj bronho-alveolar + antibiograma

Aparat digestiv ​cultura cavitate bucala + antibiograma

​coprocultura + antibiograma

Aparat urogenital ​ urocultura + antibiograma

​ cultura secretii uretrale + antibiograma
​ cultura secretii vaginale + antibiograma
​ cultura secretie preputiala + antibiograma
​ spermocultura + antibiograma

Alte probe biologice ​ cultura secretie oculara + antibiograma

​ cultura secretie auriculara + antibiograma
​ cultura secretie auriculara + examen microscopic direct pentru Malassezia spp + antibiograma
​ examen microscopic direct pentru Malassezia spp
cultura lichid punctie:
​LCR + antibiograma
​lichid sinovial + antibiograma
​lichid peritoneal+ antibiograma
​lichid cavitar (ascitic, toracal, pericardic) + antibiograma
​ cultura leziune cutanata + antibiograma
​ cultura organ + antibiograma
​ cultura colectie purulenta ​_______________________​ + antibiograma

Autovaccin ​Autovaccin
​Autovaccin + antibiograma

Altele ​Examen microscopic pe frotiu lichid de punctie (microbiologic - coloratie gram)

​Cultura anaerobi
​Hemocultura : ​ ​Aerobi ​ ​Anaerobi ​ ​Fungi

Micologie Examen Urina Altele

​ Cultura si identificare fungi (antifungigrama) ​Sumar urina ​ Examen coproparazitologic
​ Cultura si identificare dermatofiti (antifungigrama) ​Sediment urinar
​ Examen microscopic direct micologic ​Densitate urinara specifica

Tip antibiotic solicitat pentru antibiograma​ ​_________________________________________

____________________________________________________________________________________

Semnatura si parafa medicului

F.R.A. ED.1 REV.1 5.09.2018