Division of Laboratory Animal Medicine

Hematology Request Form

Requests should be submitted at least two days before submission date. At least 75ul of EDTA preserved blood is recommended for each sample. Samples should be collected and submitted the same day. A separate submission form for each species and strain is required. Please be sure to type or print clearly.

Each CBC is $13.00 and will be charged to the provided account at the end of the month. If 20 or more samples of the same strain are submitted on the same day by the same PI, a discount of $1 will be applied to each sample.

Contact Cassie Vorachek by phone at 5-8599 or email at cvorachek68@siumed.edu if you have any questions.

Lab Personnel: Fill out entire form and attach in an email to your fiscal officer.

Fiscal Officer: Please add AIS account number, approve charges, and forward to ResearchCores@siumed.edu.

Hematology Submission Form

Name
Principle Investigator
Species
Strain
Number of Sample(s)
Protocol #
Lab Room #
Phone #
Requested Submission Date
Requested Submission Time
AIS Account #

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