JOSEPHINE DEUBLER GENETIC DISEASE TESTING LABORATORY

SCHIPPERKE MPS IIIB DNA TEST SUBMISSION FORM

Please print

Sample Submitter:

Owner Name ___________________________ _________ _

Veterinarian Street _________________________ _________

Owner’s Agent City _________________ State ______ Zip __ _____

Phone _____________________ Fax ______________________

Email ________________________________________________

Patient Information:

Dog’s Registered Name: _____________________ _

Dog’s Call Name: _________

Date of Birth: __/__/__ Sex: ? Female ? Male    Neutered: ? Yes ? No

AKC# or other registration # ___ __________________________________ _____

Sire ___________________ ________ AKC# _________ ____ ______

Dam __________________ _________ AKC# _________ _______ ___

Reason for Testing (select all that apply)

Breeding  General Genetic Screening  Showing

Suspicious Clinical Signs (explain) _____________________________________

Affected or carrier relative (registered name) ________________

Other (explain) ___________________________________________ ________

Sample submitted:

Date of sample collection: __/__/__ 1-2 ml EDTA Blood   2 Cheek Swabs

Cost of tests: $75/dog ($50 if postmarked by June 1st, 2003)

Please send this form with sample and a check payable to "Trustees, University of Pennsylvania" via two day delivery mail to:

Dr. Urs Giger/MPS IIIB

Veterinary Hospital Room 4006 Phone: (215)898-8894/3375

University of Pennsylvania Fax: (215)573-2162

3900 Delancey Street Email: penngen@vet.upenn.edu

Philadelphia, PA 19104-6010 Web: http://www.vet.upenn.edu/penngen/

You may copy this form if you are testing more than one dog. All information will be kept strictly confidential. Results are available approximately three to four weeks from receipt of samples and will be sent only to the person submitting the sample.

 

Check List For Sample Submission

1. Ensure that all samples, whether EDTA blood or cheek swabs are marked clearly on either the blood tube itself, or the cheek swab sleeve with:

Date

Animal’s Call Name

Owner’s Last Name

2. In the case of blood sample submission, package the blood so that tubes will not break. They should be sent by 2-3 day delivery and do not need to be refrigerated.

If you are submitting cheek swabs, please also label the ZiplocTM bag or envelope clearly with the information listed above. Cheek swabs can be sent via regular post.

3. Enclose a check for $75/dog, made out to the Trustees of the University of Pennsylvania ($50/dog if mailed on or before June 1,2003).

4. Enclose completed submission forms for each dog being tested.

5. If you wish to ensure that samples have arrived please do not contact the laboratory directly, but rather do one of the following:

Send the samples via a carrier that allows you to track shipments.

Include a stamped self-addressed card in your shipment.

Arrange for a return receipt.

 

Instructions for Collection of Cheek Swabs

Two swab brushes (included in kit) are needed for each animal tested. To avoid contamination by food, do not feed the animal for a minimum of 2 hours before you collect the sample. If you are collecting from a puppy or kitten do not collect within 2 hours of nursing.

If you plan to test more than one animal, remember to wash your hands in between them and submit each pair of brushes in separate bags or clean envelopes.

1. Wash your hands before you collect the cheek swab sample.

2. Clearly label the sleeves that contain the cheek swab brushes with the following information:

owner’s last name; animal’s name or ID#; date of collection.

3. Open the end of the swab package that shows the word "peel" printed on it. Be careful not to touch the brush ends as you remove the swab.

4. You may need to gently restrain the animal by using one hand to loosely grip a handful of skin at the nape of the neck as well as one ear (see figure below). This should give you a fair amount of control while collecting the sample. Another way to make the collection easier is to ask another person to assist you in holding the animal and positioning the head.

5. Insert the brush end horizontally between the animal’s upper gums and the inside of the lips on one side of the mouth. Holding the shaft of the brush between your finger and thumb, roll the brush back and forth for approximately 15-30 seconds (or at least 7-15 rotations).

Make sure the brush is in contact with the gum/inner cheek tissue and not just the saliva.

6. Return the brush to its original package. Let the brushes sit out for one hour to overnight and then tape the opened end of the package shut and place in a ZiplocTM bag or a clean envelope.

Alternatively, the cheek swab, in its sleeve, can be placed directly in a clean, new envelope, and sealed with tape. Please ensure that each bag or envelope contains the samples from only one animal each.

7. Repeat the above steps for the other brush, collecting from the opposite side of the mouth from the previous collection.

8. Complete the required submission forms for each animal (printed or typed) and mail with the sample to the address on the submission form.

9. The samples can be mailed by regular or express mail.

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