Animal Disease Laboratory Sample Submission Form

Samples from animals can be submitted to the Nevada Department of Agriculture (NDA) Animal Disease Laboratory for analysis and testing. Please follow the instructions to create an Animal Disease Laboratory Sample Submission form and submit samples.  

Sampling and Submission Instructions         

Please create one submission form per sample species. The submission form will be emailed to the Animal Disease Laboratory. For questions, please contact the ADL at (775) 353-3709.

  1. Samples can be shipped or hand-delivered to the following address:

         NDA Sparks Office:
         Nevada Department of Agriculture
         ATTN: Animal Disease Laboratory – Veterinary Services Entrance
         405 S. 21st Street
         Sparks, NV 89431

        In person deliveries can also be made at the following addresses:

         NDA Elko Office:
         Nevada Department of Agriculture
         ATTN: Animal Disease Laboratory
         4780 East Idaho Street
         Elko, NV 89801-4672  

 

Field      Instruction Notes
 Examinations or Tests Requested* 
 I’m a veterinarian  Check the I’m a veterinarian box if you are ordering as the veterinarian or you are   ordering on behalf of a veterinarian or clinic. A Veterinarian is required for all   Trichomoniasis testing.
 Type of Sample Source  Click in the field or use the drop-down box to select the type of sample that is being   submitted for testing. (Make a required* field?)
 Source Details  Enter specific details about the sample source. Examples: Right ear, chest, eye, etc.
 Tests Requested  Check the box to indicate which test(s) are required.
• If Trichomonas testing is selected, a supplemental section will appear. To view this   section, go to Trichomonosis Specimen Information, only.
• If Rabies testing is selected, a supplemental section will appear. To view this section,   go to Rabies Specimen Submitter Information.
 Contact Information 
 Veterinarian’s Name  Enter the submitting veterinarian’s name.
 Clinic Name  Enter the name of the clinic, practice or agency submitting the sample.
 Address  Enter the address of the veterinarian, clinic or agency submitting the sample.
 City  Enter the city of the veterinarian, clinic or agency submitting the sample.
 State  Enter the state of the veterinarian, clinic or agency submitting the sample.
 ZIP  Enter the ZIP code of the veterinarian, clinic or agency submitting the sample.
 Primary/Preferred   Phone#  Enter the primary or preferred phone number of the veterinarian, clinic or agency   submitting the sample. of the clinic, practice or agency submitting the sample.
 Mobile Phone #  Enter the mobile phone number of the veterinarian, clinic or agency submitting the   sample.
 FAX  Enter the fax number of the veterinarian, clinic or agency submitting the sample.
 Email  Enter the email address where you would like the completed report delivered.
 Owner’s Name*  Enter the first and last name of the owner. This field is required.
 Ranch Name  If available, enter the name of the ranch related to the specimen collection.
 Address *  Enter the owner’s mailing street address and number.
 City *  Enter the city where the sample was collected.
 State *  Enter the state where the sample was collected.
 ZIP   Enter the ZIP where the sample was collected.
 Primary/Preferred     Phone #  Enter the owner’s preferred phone #.
 Mobile Phone #  Enter the owner’s mobile #.
 Email  Enter the email address where you would like the completed report delivered.
 Specimen Information
 Species*  Only one checkbox selection is allowed. This field is required. Submit a new order for   each type of species.
 Animal/Herd Information – This section is important for necropsy and microbiological submissions.
 Number in herd  Enter a number detailing the total number of animals in a herd.
 Number sick  Enter a number defining how many animals are sick.
 Number dead  Enter the number of dead animals.
 Duration of illness  Detail the duration of illness. Example: 48 hrs., 3 days, 1 week
 Age of dam  Enter the age of the calf’s mother or cow.
 Euthanized  Click in the field and select Yes or No.
 Date of Death  Click in the field to select a date from a calendar.
 Disease/Condition   suspected  Enter the disease or condition suspected of the animal.
 History and treatment  Detail information related to any past history or treatment.
 Abortion Fetal   Trimester  Click in the field and select 1 for the first stage of pregnancy up to the third month;   select 2 for the fourth through sixth month; or select 3 for the stages that include seven   months or greater.
 Trichomonosis Specimen Information, only
 Reason for testing*  Click in the field or use the drop-down to select one of the reasons for testing.
 Cows in herd  Enter the number of cows in the herd.
 Bulls in herd  Enter the total number of bulls in the herd.
 Reason for Testing (if   other)  Detail reason for testing if not found in the original field, Reason for testing.
 Comments  This field is provided to add comments related to sample storage, transport   temperatures   or other miscellaneous information. Example: collected on 11/11 and   frozen.
 Basic Sample Information 
 Number of Samples*   Enter the number of samples submitted. This field is required. Then click new for each   unique animal submissions. 
 New  Click on this prompt to add samples.
 Sample Date *  Click in the field and use the calendar to select the date the sample was collected. When   possible, send samples on the same day collected. This field is required.
 Animal ID/Name*  Enter the Animal identification, name or official identification. For Tritrichomonas   testing, please enter both the official identification and the Trich Tag #.
 Sex  Enter the sex for the animal. Examples: male, female, gelding, etc.
 Breed  Enter the breed for the animal.
 Age  Enter the age for the animal.
 Age units  Enter the age units. For example: days, months, year, etc.
 Comments  This field is provided for any additional details related to each sample. This may include   additional identification markers or tags.
 Rabies Supplemental Fields
 Agency/Clinic  Enter the submitting agency or clinic name
 Name (officer/individual)  Enter the contact’s name for the submitting agency, clinic or owner (if submitted by a   private citizen)
 Address  Enter the address for the submitting agency, clinic owner (if submitted by a private   citizen).
 City  Enter the City for the submitting agency, clinic owner (if submitted by a private citizen).
 State  Enter the State for the submitting agency, clinic owner (if submitted by a private   citizen).
 ZIP  Enter the ZIP for the submitting agency, clinic owner (if submitted by a private citizen).
 Primary/Preferred Phone   Number  Enter the primary phone number for the submitting agency, clinic owner (if submitted   by a private citizen).
 Mobile #  Enter the mobile number for the submitting agency, clinic owner (if submitted by a   private citizen).
 FAX  Enter the FAX for the submitting agency, clinic owner (if submitted by a private   citizen).
 Email  Enter the preferred email for the submitting agency, clinic or owner (if submitted by a   private citizen)
 Rabies Specimen Information 
 Rabies Vaccination  Use the drop-down box to indicate Yes, No or unknown. This field is required.
 Vaccination expiration   date  Click in the field or use the drop down to select the date and month. This field is   required.
 Symptom observation   date  Click in the field or use the drop down to select the date symptoms were observed
 Symptom observer  Enter the name of a person who observed symptoms.
 Did the animal show symptoms  Click on all fields that apply.
 Rabies Human Exposure Information 
 Human Exposure box  Click this box if human(s) were exposed.
 Bite ID #  This field is used by Animal Control locations, only. Enter the bite identification   number associated with this case.
 Total Number of Human   Exposed  Enter the number of humans potentially exposed to a rabid animal.
 Exposure Contact Person  Enter the name of the person potentially exposed to a rabid animal. This information is   for public health reporting, only.
 Exposure Contact Phone  Enter the phone number of the person potentially exposed to a rabid animal.
 Exposure Date  Enter the date of suspected exposure. Click in the field to select a date from the   calendar.
 Exposure Details  Detail the conditions or scenario of exposure. For example: bat found in house,   unknown if exposed. 
Rabies Animal Exposure Information 
 Animal Exposure box  Click this box if an animal or multiple animals were potentially exposed to a rabid   animal.
 Species  Click on the field to select the species of the animal potentially exposed to a rabid   animal. 
 Breed  Detail the breed of the animal exposed.
 Age  Enter the numerical age or approximate age of the animal exposed.
 Age Units  Enter the units of the exposed animal’s age. For example: months, years, etc.
 Rabies Vaccination  Click on the field or use the drop-down box to select Yes, NO or Unknown
 Vaccination Expiration   date  Click on the field or use the drop-down box to select the date of the rabies vaccination   expiration for the animal potentially exposed.
 Ownership   Click in this field or use the drop-down box to select the ownership type of wild, stray   or owned.
 Address  Enter the number and street address for the owner of the exposed animal
 City  Enter the city for the owner of the exposed animal
 State  Enter the state for the owner of the exposed animal
 ZIP  Enter the ZIP for the owner of the exposed animal
 Primary  Enter the Primary phone number for the owner of the exposed animal
 Mobile Phone #  Enter the mobile phone number for the owner of the exposed animal
 Fax  Enter the FAX number for the owner of the exposed animal
 Email  Enter the email for the owner of the exposed animal
 Exposure Details  Detail the conditions or scenario of exposure. For example: Dog found bat in yard