Form CF.ACC.8.4 "Poultry/Avian Submission Form" - Alabama

What Is Form CF.ACC.8.4?

This is a legal form that was released by the Alabama Department of Agriculture and Industries - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2019;
  • The latest edition provided by the Alabama Department of Agriculture and Industries;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CF.ACC.8.4 by clicking the link below or browse more documents and templates provided by the Alabama Department of Agriculture and Industries.

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Download Form CF.ACC.8.4 "Poultry/Avian Submission Form" - Alabama

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AVDL
Alabama Veterinary
ACCESSION #:
Diagnostic Laboratory System
Regional Lab
Auburn Lab
DATE
www.labs.alabama.gov
RECEIVED:
 J. B. Taylor
CASE
 Thompson Bishop Sparks
 Mitchem-Sparks
 Hinton Mitchem
State Diagnostic Lab.
Diagnostic Lab.
Poultry Diagnostic Lab.
Diagnostic Lab. 495
COORDINATOR:
890 Simms Rd.
1833 Industrial Blvd
1001 College Dr.
State Road 203
CHARGE
N/C PAID: $
CASH
CHECK #
Elba, AL 36323
Auburn, AL 36832
Boaz, AL 35957
Hanceville, AL 35077
Regional Lab
Auburn Lab
Ph: (334) 897-6340
Ph: (334) 844-4987
Ph: (256) 593-2995
Ph: (256) 352-8036
Tech Initials
Tech Initials
Fax: (334) 897-0272
Fax: (334) 844-7206
Fax: (256) 593-2996
Fax: (256) 352-8038
Poultry/Avian Submission Form
USPS UPS FEDEX OTHER:
Submitted by:
Company
Owner
Other:
Please check
www.labs.alabama.gov
for submission recommendations and our current fee schedule.
Some tests may be subcontracted/referred to qualified laboratories. Submitter will be contacted for permission if this will incur additional charges.
All submitted samples and sample data become property of ADAI. Remains of animals cannot be returned to clients, but cremation can be arranged by the client if desired.
Submitter
Owner
House #
Company
Farm
Premise ID
Complex
Account#
County
Address
Address
City
State
Zip
City
State
Zip
Phone
Fax
Phone
Fax
Email
Email
Report to:
Company
Company Rep
Other:
Bill to:
Company
Other:
email
fax
mail
email
fax
mail
Report preference:
Bill preference:
*For multiple animals use the Poultry Multi flock form
Specimen:
#Live Birds
#Dead Birds
#Swabs
#Plates
Fresh Tissue
Fixed Tissue
Serum
Feed
Other
Species
(Lab. Use Only)
Test Sections
Broiler
Broiler Breeder
Breeder
Layer
Chicks
Backyard
Quail
Necropsy
________________
Turkey
Pheasant
Duck
Goose
Psittacine
Raptor
Other:
Disposal Only
________________
Sex
Males#
Females#
M & F
Age
Weeks
Years
Months
Days
Histopathology
________________
Animal ID:
Bacteriology
________________
Flock Information
Regional Lab Tests
Mycology
________________
#Houses
#Birds/house
Necropsy
Virology
________________
Bacteriology
________________
Molecular/PCR
Mortality Today:
Yesterday:
3 Days ago:
Mycology
Serology
________________
Serology
Toxicology
________________
Vaccines:
HOLD
Parasitology
________________
Parasitology
AUCVM
________________
Problem Description:
Other:
HOLD
________________
MG/MS Plate Test
Other:
________________
________________
Other:
________________
Parasitology
E. acervulina
_______________
Histomonas
________________
E. maxima
_______________
Ascaridia
________________
E. necatrix
_______________
Capillaria
________________
E. tenella
_______________
Heterakis
________________
Coccidia sp.
_______________
Other
________________
Tapeworms
_______________
Other
__________
Print Name
Signature
Date
AVDL Poultry Submission Form CF.ACC.8.4
1 of 2
NOV 2019
KS
AVDL
Alabama Veterinary
ACCESSION #:
Diagnostic Laboratory System
Regional Lab
Auburn Lab
DATE
www.labs.alabama.gov
RECEIVED:
 J. B. Taylor
CASE
 Thompson Bishop Sparks
 Mitchem-Sparks
 Hinton Mitchem
State Diagnostic Lab.
Diagnostic Lab.
Poultry Diagnostic Lab.
Diagnostic Lab. 495
COORDINATOR:
890 Simms Rd.
1833 Industrial Blvd
1001 College Dr.
State Road 203
CHARGE
N/C PAID: $
CASH
CHECK #
Elba, AL 36323
Auburn, AL 36832
Boaz, AL 35957
Hanceville, AL 35077
Regional Lab
Auburn Lab
Ph: (334) 897-6340
Ph: (334) 844-4987
Ph: (256) 593-2995
Ph: (256) 352-8036
Tech Initials
Tech Initials
Fax: (334) 897-0272
Fax: (334) 844-7206
Fax: (256) 593-2996
Fax: (256) 352-8038
Poultry/Avian Submission Form
USPS UPS FEDEX OTHER:
Submitted by:
Company
Owner
Other:
Please check
www.labs.alabama.gov
for submission recommendations and our current fee schedule.
Some tests may be subcontracted/referred to qualified laboratories. Submitter will be contacted for permission if this will incur additional charges.
All submitted samples and sample data become property of ADAI. Remains of animals cannot be returned to clients, but cremation can be arranged by the client if desired.
Submitter
Owner
House #
Company
Farm
Premise ID
Complex
Account#
County
Address
Address
City
State
Zip
City
State
Zip
Phone
Fax
Phone
Fax
Email
Email
Report to:
Company
Company Rep
Other:
Bill to:
Company
Other:
email
fax
mail
email
fax
mail
Report preference:
Bill preference:
*For multiple animals use the Poultry Multi flock form
Specimen:
#Live Birds
#Dead Birds
#Swabs
#Plates
Fresh Tissue
Fixed Tissue
Serum
Feed
Other
Species
(Lab. Use Only)
Test Sections
Broiler
Broiler Breeder
Breeder
Layer
Chicks
Backyard
Quail
Necropsy
________________
Turkey
Pheasant
Duck
Goose
Psittacine
Raptor
Other:
Disposal Only
________________
Sex
Males#
Females#
M & F
Age
Weeks
Years
Months
Days
Histopathology
________________
Animal ID:
Bacteriology
________________
Flock Information
Regional Lab Tests
Mycology
________________
#Houses
#Birds/house
Necropsy
Virology
________________
Bacteriology
________________
Molecular/PCR
Mortality Today:
Yesterday:
3 Days ago:
Mycology
Serology
________________
Serology
Toxicology
________________
Vaccines:
HOLD
Parasitology
________________
Parasitology
AUCVM
________________
Problem Description:
Other:
HOLD
________________
MG/MS Plate Test
Other:
________________
________________
Other:
________________
Parasitology
E. acervulina
_______________
Histomonas
________________
E. maxima
_______________
Ascaridia
________________
E. necatrix
_______________
Capillaria
________________
E. tenella
_______________
Heterakis
________________
Coccidia sp.
_______________
Other
________________
Tapeworms
_______________
Other
__________
Print Name
Signature
Date
AVDL Poultry Submission Form CF.ACC.8.4
1 of 2
NOV 2019
KS
Accession #
Avian Specimens & Tests
Bacteriology/Mycology
Virology
Specimen
Tests
Specimen
Tests
Lung
Aerobic culture/sensitivity
Lung
Adenovirus
Trachea
Anaerobic culture
Liver
Enteric Virus profile
Liver
Fungal culture
Kidney
Astrovirus
Kidney
Salmonella culture
Spleen
Rotavirus
Spleen
Campylobacter culture
Brain
Reovirus (VA, Enteric)
Sm. Intestine
Listeria culture
Intestine
Pox
Lg. Intestine/Cecum
Listeria cold enrichment
Tendon
Respiratory Virus Profile
Brain
culture (brain only)
Trachea
(IBV, NDV, LTV, AIV)
Yolk sac
Avibacterium culture
Cecal tonsil
Other:
_
Swab
Other:
Swab:
_
_
Abscess/Lesion
Other:
Instructions:
_
Air sac
Stains
Yolk
Cryptosporidium:
Joint
Auramine-O acid fast stain
Chick box
Gram stain
Other:
_
_
Cytology/impression slide
Other:
Instructions:
_
Toxicology
Molecular/PCR
Specimen
Tests
Specimen
Tests
Liver
Cyanide
Selenium
Lung
Mycoplasma gallisepticum (MG)
Kidney
Ethylene glycol
Salt
Liver
Mycoplasma synoviae (MS)
Crop/gizzard
Insecticide screen
Zinc
Spleen
Avibacterium paragallinarum
contents
Rodenticide
pH
Brain
Respiratory Virus Profile
Serum
screen
Mycotoxins:
Intestine
Laryngotracheitis (LT)
Blood
Strychnine
Aflatoxin
Swab
Infectious Bronchitis (IBV)
Feed
Arsenic
Deoxynivalenol
Choanal/tracheal
Avian influenza (AI)
Other:
Cadmium
Fumonisin B1
(dry swab)
Newcastle Disease (NDV)
_
Calcium
Ochratoxin
Pharyngeal/tracheal
Enteric Virus profile
Instructions:
Phosphorus
Ionophores
(BHI broth)
Astrovirus
Chromium
Feed visual exam
Cloacal (dry swab)
Rotavirus
Copper
Bone ash
Cloacal (BHI broth)
Parvovirus
Iron
Urolith analysis
Other:
Reovirus
_
Lead
Other:
Brain, Heart, Spleen
Chlamydia
_
Magnesium
Other:
Chicken Infectious Anemia
_
Potassium
Avian Leukosis virus subgroup J
Instructions:
Adenovirus
Polyomavirus
WNV
Reticuloendotheliosis virus
Avian Serology
Histopathology (Necropsy)
Viral Serology
Bacterial Serology
Brain
Intestine
Bone marrow
Avian Encephalomyelitis
Mycoplasma gallisepticum
Lung
Cecum
Proventriculus
Avian Influenza
Mycoplasma synoviae
Liver
Colon
Gizzard
Chicken Infectious Anemia
Mycoplasma HI test
Kidney
Uterus
Eyelid
Infectious Bronchitis
Salmonella pullorum
Heart
Trachea
Thymus
Infectious Bursal Disease
Other:
Spleen
Bursa
Other:
_
_
Newcastle (PMV-1)
Reovirus
Other:
_
Parasitology
Fecal flotation (centrifugation)
Direct smear
Other:
_
Indicate all submitted samples and the appropriate test section(s).
If no tests are selected, tests will be performed at the discretion of the pathologist.
AVDL Poultry Submission Form CF.ACC.8.3
2 of 2
AUG 2019
KS
Page of 2