Clinical Pharmacology Laboratory Online Submission Form

  • Back
This submission form should work with most browsers, but some features may not be supported on Internet Explorer.
For the best experience, we recommend Chrome, Firefox, Safari, and Opera browsers.
Loading...
  1. Please complete this form.
  2. After clicking "Submit" you will see a confirmation page with a barcode.
  3. Print the barcode and include it in the package with your sample.
*Clinic Information
*Clinic Name
*Address
*City
*State *Zip code
*Country

Veterinarian Information
*Phone: Fax:
*Email (your confirmation will be sent to this address):
  Notify me by email when this sample is received?

*Report Method:


*Recommendations Needed? (No Additional Charge) Yes No

If recommendations are requested, dosing information is required.




Patient Information
Case/Ref Number:
*Patient (First) Name: *Owner (Last) Name:
*Species: Breed:
Sex: Weight: kg
lb 		Age (years):


Presentation Date of Most Recent Relapse:
*
Primary Diagnosis:
Pertinent History (Include secondary diagnoses): characters remaining.


Other Drugs in Use (Excluding any drugs being tested:
characters remaining.

*Abnormal Lab Results?
If Yes, Please List:

Monitoring Purpose:
*Clinical Signs Sufficiently Controlled?
Other control comments:

Please choose desired tests and then click 'Continue' for relevant submission information and questions.
Please provide as much information as you can.
*For detailed monitoring recommendations, click on a test name.*
For information regarding peak and trough sampling, click here.
Tests Requested
Test Name Single Sample Peak & Trough (2 samples)
Bromide (Potassium/Sodium)
Cyclosporine
Digoxin
Gabapentin
Leflunomide (Teriflunomide)
Levetiracetam (Keppra®)
Phenobarbital
Theophylline
Zonisamide

Bromide

  • Minimum Sample Required: 0.5ml Serum or Plasma (no serum separator tubes).
  • Due to the long half-life, sample can be drawn at any time.
  • Fasting recommended but not required.
  • No ice needed.
  • Run Tuesday and Thursday mornings. Sample must be received by day before to be included in run.
  • Method: Gold Chloride.
Preparation
*
Dose:
*
Every
Other Dosing:

How Many Months at Current Dose?
Was a loading dose given? Yes No
How many days elapsed between last loading dose and sample collection?

Cyclosporine

  • Recommend Peak and Trough first time to establish half-life.
  • Recommend single 2-hour peak sample for subsequent submissions.
  • Minimum Sample Required: 0.5ml EDTA Whole Blood (purple top tube).
  • No ice needed.
  • Peak sample: 1.5-2hrs post dose.
  • Trough sample: Just prior to next dose (12hrs post on 12hr dosing). If greater than 12 hour dosing interval, a 12hr trough may still be needed or concentrations may be non-detectable.
  • Run Wednesday and Friday Mornings. Sample must be received by day before to be included in run.
  • Method: Immunoassay
Preparation
*
Dose:
*
Every
Other Dosing:

*
How Long at Current Dose?
Single Sample (2 hours post-dose recommended) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Peak (2 Hours Post-Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Trough (Before Next Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Digoxin

  • Minimum Sample Required: 0.5ml Serum or Plasma (no serum separator tubes).
  • Do not store in rubber topped tube as some types of rubber may affect digoxin results.
  • Fasting recommended but not required.
  • No ice needed.
  • Peak sample: 1.5-2hrs post dose.
  • Trough sample: 12hrs post dose or prior to next dose.
  • Run as received (1-2 day turnaround time).
  • Method: Immunoassay
Preparation
*
Dose:
*
Every
Other Dosing:

*
How Long at Current Dose?
Single Sample Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Peak (2 Hours Post-Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Trough (Before Next Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Gabapentin

  • Recommend Peak and Trough first time to establish half-life.
  • Recommend single trough sample for subsequent submissions.
  • Minimum Sample Required: 0.5ml Serum or Plasma (no serum separator tubes).
  • Fasting recommended but not required.
  • No ice needed.
  • Peak sample: 2hrs post dose.
  • Trough sample: Just prior to next dose (8hrs post on 8hr dosing).
  • Run as received (1-2 day turnaround time).
  • Method: Immunoassay
Preparation
*
Dose:
*
Every
Other Dosing:

*
How Long at Current Dose?
Single Sample Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Peak (2 Hours Post-Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Trough (Before Next Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Leflunomide (Teriflunomide)

  • Minimum Sample Required: 0.5ml Serum or Plasma (no serum separator tubes).
  • Fasting recommended but not required.
  • Freeze sample after draw and ship overnight on ice
  • Run as received (2-3 week turnaround time).
  • Method: HPLC
Preparation
*
Dose:
*
Every
Other Dosing:

*
How Long at Current Dose?
Single Sample Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Peak (2 Hours Post-Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Trough (Before Next Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Levetiracetam (Keppra®)

  • Recommend Peak and Trough first time to establish half-life.
  • Recommend single trough sample for subsequent submissions.
  • Minimum Sample Required: 0.5ml Serum or Plasma (no serum separator tubes).
  • Fasting recommended but not required.
  • No ice needed.
  • Peak sample: 2hrs post dose.
  • Trough sample: Just prior to next dose (8hrs post on 8hr dosing).
  • Run Tuesday and Thursday mornings. Sample must be received by day before to be included in run.
  • Method: Immunoassay
Preparation *Extended Release: Yes No Unknown
*
Dose:
*
Every
Other Dosing:

*
How Long at Current Dose?
Single Sample Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Peak (2 Hours Post-Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Trough (Before Next Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Phenobarbital

  • Minimum Sample Required: 0.5ml Serum or Plasma (no serum separator tubes).
  • Fasting recommended but not required.
  • No ice needed.
  • Peak sample: 2hrs post dose.
  • Trough sample: Just prior to next dose (12hrs post on 12hr dosing).
  • Single sample: Trough recommended.
  • Run Tuesday, Wednesday, Thursday, and Friday mornings. Sample must be received by day before to be included in run.
  • Method: Immunoassay
Preparation
*
Dose:
*
Every
Other Dosing:

*
How Long at Current Dose?
Single Sample Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Peak (2 Hours Post-Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Trough (Before Next Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Theophylline

  • Minimum Sample Required: 0.5ml Serum or Plasma (no serum separator tubes).
  • Fasting recommended but not required.
  • No ice needed.
  • Peak sample: 1.5-2hrs post dose.
  • Trough sample: Just prior to next dose (12hrs post on 12hr dosing).
  • Run as received (1-2 day turnaround time).
  • Method: Immunoassay
Preparation
*
Dose:
*
Every
Other Dosing:

*
How Long at Current Dose?
Single Sample Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Peak (2 Hours Post-Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Trough (Before Next Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Zonisamide

  • Minimum Sample Required: 0.5ml Serum or Plasma (no serum separator tubes).
  • Fasting recommended but not required.
  • No ice needed.
  • Peak sample: 2hrs post dose.
  • Trough sample: Just prior to next dose (12hrs post on 12hr dosing).
  • Single sample: Trough recommended.
  • Run Tuesday, Wednesday, Thursday, and Friday mornings. Sample must be received by day before to be included in run.
  • Method: Immunoassay
Preparation
*
Dose:
*
Every
Other Dosing:

*
How Long at Current Dose?
Single Sample Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Peak (2 Hours Post-Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Trough (Before Next Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Other

  • Please call us at (334) 844-7187 for sample requirements and to confirm that we can run the test you request.
Preparation Manufacturer/Pharmacy
*
Dose:
*
Every
Other Dosing:

*
How Long at Current Dose?
Single Sample Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:
Peak (2 Hours Post-Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:

Trough (Before Next Dose) Previous Dose Given (Time)
: -
Sample Collected (Time)
: -
*
Hours post-dose:


Additional Comments:
characters remaining.




A FedEx shipping label for this sample can be created once your sample information has been submitted.

If you received an invoice, you can pay it online at https://aub.ie/clinpharmpay.


Need help? Let us know!

Phone: 334/844-7187
Fax: 334/844-7188
Email: clinpharm@vetmed.auburn.edu

Mailing Address:
Clinical Pharmacology Laboratory
212 Greene Hall
College of Veterinary Medicine
Auburn, AL 36849-5518

Shipping Address:
Clinical Pharmacology Laboratory
1500 Wire Road
Auburn University, AL 36849

GPS Address: