Veterinary Care Notification

Date
MM slash DD slash YYYY
First and Last Name
Email
Date(s) of Health Event
Principal Investigator
Protocol Number
IACUC Protocol Number the animal(s) were on at the time of the health event.
Species
Animal ID(s)
If group of animals, leave blank and describe population below.
Animal Housing/Use Area Where Health Event Occurred
Name of dedicated lab animal facility, field study location, research unit name, or satellite facility.
Name of Veterinarian Providing Care
Describe Health Event/Problem
Please include animal IDs, names, and cage/tank IDs where applicable. Relevant information may include protocol specifics related to health event including a study timeline, agents administered, and procedure performed. It may also include information about the facilities or transportation process.
Cause of Health Event
Describe the definite or most likely cause for the health event.
Treatment
This may include medications and supportive care, admission to the CVM as a patient, facility/equipment repairs, and if any evaluation of other animals also occurred in response to this health event.
(If Applicable) Describe the Follow Up Plan and Continued Treatments
(If Applicable) Describe the corrective actions and preventive practices adopted to prevent similar health events from happening again.
(If Applicable) Describe Euthanasia Procedure
Describe where the euthanasia occurred, who conducted the euthanasia and the method of euthanasia.
(If Applicable) Describe Necropsy Procedure
Describe who performed necropsy and include any gross findings. If applicable, provide the CVM hospital patient ID so the necropsy report may be accessed.

The University of Tennessee, Knoxville

OLAC

Veterinary Care Notification