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Hillspet.co.uk

Quantitative Urolith Analysis Submission Form
Visit our website at: www.cvm.umn.edu/depts/MinnesotaUrolithCenter
Urinalysis and urinary case history:
CLINIC INFORMATION
Date: ___________________________________________________ Date _________________Composition _________________________ Veterinary Surgeon: ______________________________________ Date _________________Composition _________________________ Clinic Name: _____________________________________________ Was the urine cultured within one month of urolith detection? Address: ________________________________________________ ________________________________________________________ Isolates ____________________________________________________ __________________________ Postcode: ____________________ Medication:
Telephone: ____________________ Fax: _____________________ Were antibiotics given within one month of urolith detection? Email: __________________________________________________ Type and dosage ____________________________________________ CLIENT AND PATIENT INFORMATION
___________________________________________________________ Owner’s Name:___________________________________________ Animal’s Name: __________________________________________ Species: _________________________________________________ Dosage and duration ________________________________________ Breed (specific): __________________________________________ ___________________________________________________________ Birth Date: ______________________________________________ Other previous illness or injury:
Does the patient have any of the following illnesses or injuries?
Source of urolith: (tick all areas samples obtained from)
If “Other”, please specify _____________________________________ Other ______________________________________________________ Sample retrieval method:
Surgical
Other ______________________________________________________ Date retrieved _____________________________________________ Date clinical signs first noted __________________________________ • CANINE and FELINE urolith samples only. • Send stones DRY (formalin or other liquid). Dietary history:
• DO NOT send urine samples or sediment.
What type of diet was primarily fed prior to urolith detection? • Label sample with the ANIMAL’S NAME and • Analysis is provided to your clinic at no charge. Commercial/Prescription Food If a commercial/prescription diet was fed, list the primary diet fed Post to: Urolith Analysis Service, Hill’s Pet Nutrition Ltd, Building 5, Croxley Green Business Park, Watford, Hertfordshire ___________________________________________________________ WD18 8YL, UK To avoid delay in the post please ensure correct postage is paid. Telephone 0800 282438 / 1800 626002 (ROI) Tick here if you wish to receive more submission forms. Alternatively, please visit www.hillspet.co.uk/urolith or www.hillspet.ie/urolith
™Trademarks owned by Hill’s Pet Nutrition, Inc. 2011 Supported in part by an educational gift from Hill’s Pet Nutrition. Version 2011

Source: http://www.hillspet.co.uk/urolith.pdf

Microsoft word - 2007%20hc%20mco%20questionnaire[1].doc

Name of MCO HEALTHCHOICE MCO DRUG USE MANAGEMENT PROGRAM ANNUAL ASSESSMENT February 2007 The Maryland Medicaid Pharmacy Program, Division of Clinical Pharmacy Services is responsible for monitoring and approving each MCO’s drug use management program. Approval of your MCO’s drug use management program for FY 2008 will be determined by a review of your formulary and your responses

Microsoft powerpoint - boehmer-sexualisierte-gewalt.ppt

Martina Böhmer Altenpflegerin für Geriatrische RehabilitationReferentin und Beraterin in der AltenarbeitGründerin , Mitarbeiterin bei Paula e.V., Martina Böhmer, Erfahrungen sexualisierter Gewalt in der Lebensgeschichte alter Frauen©, 2012, www.martinaboehmer.de, Zahlen zu sexualisierter Gewalt • Laut Kriminalstatistik werden in Deutschland jedes Jahr rund 20.000 Fäl e von sexue

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