VS Form 10-4, Specimen Submission

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VS Form 10-4 (doc)

VS Form 10-4a (doc)

Electronic forms allow you to enter data and print the completed forms. Requires Adobe Reader.

VS Form 10-4 (pdf)

VS Form 10-4a (pdf)

VS Form 10-4 and 10-4a Printable Instructions

VS Form 10-4, Specimen Submission, is used to request a variety of tests from NVSL and approved laboratories. This form provides vital contact information, identifies tests requested, and lists the specimens enclosed. The ability of NVSL to provide accurate, timely, and interpretable data is dependent on the completeness and accuracy of the information supplied on VS Form 10-4 along with the specimen. VS Forms 10-4 routinely arrive to NVSL with errors such as:

1. Missing information
• Test requested
• Location of animals from which a specimen was collected
• When a specimen was collected
• Type of specimen(s) being submitted (e.g., brain, lymph nodes, blood)
• Clinical signs observed
• Animal identification
• Animal breed
• The age of each sampled animal
• Foreign animal disease (FAD) referral number
2. Incorrect information
• Requests to test a specimen for more than one disease
• Incorrect type of specimen submitted for the requested test
3. Forms containing specimens from different species (e.g., sheep and goat specimens submitted on a single form)
4. Illegible handwriting
• Submitter contact phone/FAX numbers
• Owner information
• Animal ID numbers
• Additional data
• Note: If possible, NVSL prefers to receive typed forms. VS Forms 10-4 and 10-4a are available in an MS Word format that can be edited, saved, and printed.

These types of errors increase man-hours required to process the form, delay specimen testing, and, in turn, delay reporting test results to the requestor.

Contact the Receiving Department of the laboratory to which you are sending specimens with specific documentation or shipping questions.

VS Form 10-4 Interactive Training

Examples of Correctly Completed VS Forms 10-4 (CWD)