NCI-Frederick PHL Hematology / Blood Chemistry Request: Step 1 of 4
Please complete the form below as completely as possible. Required fields are marked with an "*".
ACUC Protocol Number*
First Name*
Last Name*
Date*
Sp./Strain/Code*
Gender*
Male
Female
Both
Grp/Geno
Building
Room
Phone
Date Blood Sampled
When will sample be submitted?*
NCI-Frederick Center Number
Number of Animals*
Age (weeks)*
Is Sample Fresh or Frozen?
Fresh
Frozen
Type of Sample*
Whole Blood (EDTA) Hematology/CBC
Serum
Plasma
Urine
Blood Sampled From
Retro Orbital Sinus
Heart Puncture
Axilary
Saphenous
Other
If "Other", Please Specify
Anesthetic used
None
O2/Co2
Isoflurane
Ketamine/Rompum
Other
If "Other", Please Specify
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