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THE LABORATORY ANIMAL RESOURCE CENTER
Surgery/Anesthesia Notification and Animal Fasting Request Form
7/5/2008 10:30:34 PM
 
Principal Investigator:
Protocol Number:
HOUSING INFORMATION
Building:
Room #:
ANIMAL INFORMATION
Species:
Animal ID #:
 
SURGERY/ANESTHESIA NOTIFICATION:
   
Procedure Date:
 
Procedure Start Time:
a.m.
p.m.
Procedure End Time:
a.m.
p.m.
Location:
Procedure Type:
Survival or Terminal:
   
Does animal require fasting prior to the anesthesia/surgery?   Yes    No

If Yes, please complete all information below.
If No, fill out REQESTED BY section below and "Submit Form"
 

FASTING INSTRUCTIONS:
"Do not feed" means removing all food from cage (feeders, floors, and pans)
FOOD
Fasting Start Date:     Resume Feeding Date:
    
 
Fasting Start Time:
a.m.
p.m.
  Resume Feeding Time:
a.m.
p.m.
 
Special Instructions:
 
FASTING INSTRUCTIONS:
"Do not water" means removing all water from cage (feeders, floors, and pans)
WATER
Fasting Start Date:     Resume Feeding Date:
    
 
Fasting Start Time:
a.m.
p.m.
  Resume Feeding Time:
a.m.
p.m.
 
Special Instructions:
 
REQUESTED BY:
Name:
Phone:
Email:
Please enter the word displayed below for validation:
Submit Form

Page Updated: September 28, 2006
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