Submission Form
Please fill all relevant fields in this form. You can move between fields with the tab function.
Species:	Age:	Study Animal No:
Breed/Strain:	Gender:	Study (type/No):
Treatment (dose group/ start date):
Type of death: Scheduled sacrifice Found dead Electively euthanased	Date of death:
Date of necropsy:
Owner/referring scientist (Surname, forename): Clinic/Company: Address: Postcode, city: Telephone no: Email:	Billing address: internal billing: PSP: / KST: Referring person for internal transfer: external billing: Billing address: Referring person for billing:
Return address (Surname, forename): Email:	Tissue to be returned: YES NO Cassettes to be returned: YES NO
Returned by (date):
CLINICAL FINDINGS and/or GROSS FINDINGS and OTHER RELEVANT INFORMATION
Carcases for diagnostic necropsy should ideally be provided immediately after death, to avoid post mortem changes. If timely submission is not possible (e.g. unscheduled deaths during the weekend), keep the carcase refrigerated at 4°C and send it through as soon as possible. If submission within 72 h is not feasible, freeze the carcase and submit frozen. However, this will lead to artifacts that impair the histological assessment. Carcases and organs that have been formalin-fixed after necropsy can be submitted at any time at room temperature.	For submission of organs for trimming, preparation of paraffin blocks and histological examination, refer to the table on the back and indicate which organs are provided and, if determined, the organ weight. Also provide information on the fixation method and length. For submission of samples, see address on the back.	For submission of cassettes* with organ specimens for preparation of paraffin blocks and histological examination, refer to the table on the back and indicate which organs are provided, how many sections of each organ, and in which cassette (1, 2, 3…) these are placed. Also provide information on the fixation method. * Please label the cassettes with a pencil or xylene-resistant pen.

Mit Einreichung des vorliegenden Formulars bzw. des Untersuchungsantrags anerkennt der Auftraggeber die Anwendbarkeit der Allgemeinen Geschäftsbedingungen des Instituts für Veterinärpathologie der Universität Zürich (AGB IVPZ), einsehbar unter http://www.vetpathology.uzh.ch/de/Diagnostik.html. Das IVPZ
ist berechtigt, nach Abschluss der Untersuchung noch vorhandenes Untersuchungsmaterial für Forschung und Lehre weiterzuverwenden.

Anatomic Site, Organ	Sampled	Anatomic Site, Organ	Sampled	Anatomic Site, Organ	Sampled
No. of sections	Cassette 1, 2…	No. of sections	Cassette 1, 2…	No. of sections	Cassette 1, 2…
Heart	Ovaries	Others (please specify)
Aorta	Epididymides	Bone marrow smear
Skeletal Muscle	Uterus
Diaphragm	Prostate gland
Larynx/ trachea	Seminal vesicles
Oesophagus	Vagina
Lungs	Thymus	Weights	Grams
Tongue	Bone marrow	Body weight
Salivary Glands	Bone and joint
Forestomach	Spleen	Organ weights
Stomach	Lymph node (mandibular)	Liver
Duodenum	Lymph node (mesenteric)	Brain
Jejunum	Pituitary gland	Kidneys (weigh together)
Ileum	Thyroid glands	Heart
Gut-associated lymphoid tissue	Parathyroid glands	Spleen
Adrenal glands	Thymus
Caecum	Brain	Testes / Ovaries (weigh together)
Colon	Spinal cord	Epididymides/ Uterus
Liver	Peripheral nerves	Prostate
Gall bladder	Eyes	Adrenal glands (weigh together)
Pancreas	Harderian glands	Thyroid glands (weigh together)
Kidneys	Optic nerves	Others (please specify)
Urinary bladder	Skin
Testes	Mammary gland

Fixation	Requests
10% formalin	Full post mortem examination with necropsy report
4% PFA (buffered)	Post mortem examination incl. histopathology evaluation with final report
Other (please specify):	Organs: trimming, paraffin embedding	No HE sections
HE sections
Fixation date:	HE sections with histological examination
Other requests (please specify)
Cassettes: paraffin embedding	No HE sections
HE sections
HE sections with histological examination

Please submit your material to:	Laboratory for Animal Model Pathology (LAMP)

Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich

Winterthurerstrasse 268, CH-8057 Zurich

Phone +41 44 635 85 83, Fax +41 44 635 89 34

Email: ivpzlamp@vetpath.uzh.ch

Please contact LAMP prior to submission, and in particular prior to submission of mice treated with infectious agents of BSL2 category or higher, should you wish to provide the carcases unfixed. Also contact LAMP if you wish to obtain prelabelled cassettes for trimming: ivpzlamp@vetpath.uzh.ch. For urgent matters, call LAMP at +41 44 635 85 83.