Form PHS-2 __ __ __ __    Request for Serological Testing    __ __           |             |
Farm:Code |__|__|__|__| Farm Name:________________  Company |__|__|_________ |B-   -       |
             __ __          __ __ __ __ __ __       __ __                        Lab.Ref.
Species/Type|__|__| Houses |__|__|__|__|__|__| Age |__|__| weeks/days  Date Hatched __/__/__
                                                                   

Strain _______  Sampled by :__________________ Date Sampled  __/__/__
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Procedures required :          CHOOSE CAREFULLY THE TESTS REALLY REQUIRED.
                    Number tests per House|                         Number tests per House
SAG Mycoplasma gallisepticum  - |___|     |   HI Newcastle - - - - - - - - - - - -  |___|
SAG Mycoplasma synoviae - - - - |___|     |   HI Infectious Bronchitis - - - - - -  |___|
SAG Mycoplasma meleagridis  - - |___|     |    - - - - - - - - - - - - - - - - - -  |___|
Elisa S.enteritidis - - - - - - |___|     |   HI Inf. Bron. Variant  793B- - - - -  |___|
Elisa Gumboro - - - - - - - - - |___|     |   HI Eds-76  - - - - - - - - - - - - -  |___|
Elisa TRT - - - - - - - - - - - |___|     |   Storage at Lab.  - - - - - - - - - -  |___|
CAA (Chick Anaemia Agent) - - - |___|     |   OTHER:_______________________________ |___|
Note: Multiple tests can be performed with the same sample.
Results will normally be reported to the person designated by the company for the type of bird                                            
Comments_:____________________________________________________________________________________
For Office Use Only : Date Received  __/__/__   Condition ____________________________________
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Form PHS-2      Blood for Serology          |      HINTS  FOR GOOD SERUM SAMPLES
                                            |      =============================
                                            |1. Plan for samples to arrive on a week-day.
                                            |
                                            |2. Use sample tubes provided.
URGENT      PATHOLOGICAL SPECIMEN     (B)   |
======      =====================           |3. Half-fill tube with blood and firmly cap.
    -------------------------------         |
To:|                               |        |4. Lay tube on side until blood coagulates
   | POULTRY HEALTH SERVICES       |        |    (If very cold leaving in a warm place for
   | Poultry Health Centre         |        |    about an hour will speed this.)
   | Main Site Lane                |        |
   | Dalton                        |        |5. Complete the upper half of this form, fold 
   | Thirsk                        |        |    in 4 and place in a "Documents Enclosed" 
   | North Yorkshire               |        |    pouch with the address visible. Peel off 
   | YO7 3JA                       |        |    backing and stick to outside of package.
    -------------------------------         |
____________________________________________|Good samples lead to good, prompt results