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Pathology Request System V 3.0
* Items in Green are Required
Principal Investigator
Institution
Tissue submitted by
Date submitted (mm/dd/yyyy)
Animal Number
Strain
if other, please specify
FVB
129
C57b6
CD1
Hybrid
Other
Experimental / Infections agent
if other please specify
West Nile virus
Dengue virus
Hantavirus
Lassa virus
Arenavirus
Burkholderia pseudomallei
Coxiella brunetti
Francisella tularensis
Brucella sp.
Botulinum toxin
Other Infectious agent
Knock-out
Transgenic
Cre-lox
TeT
Wild Type
Other
Gender
If Other please specify
Female
Male
Other
Date of Birth (mm/dd/yyyy)
Date of Sacrifice (mm/dd/yyyy)
Fixative
If Other please specify
Post Fix
If Other please specify
Days in fixation
Formalin
Paraformaldehyde
Gluteraldehyde
Omnifix
Alcohol
Bouin's
Other
Alcohol
Buffer
Other
Experimental Protocol/Gross Description