Fill Out Your Minnesota Urolith Center Form
The Minnesota Urolith Center form facilitates the submission of uroliths for quantitative analysis. Designed for veterinary practitioners, this form includes essential data to ensure a thorough examination of urinary stones. Information such as the owner's and pet's details, the doctor's name, and specifics about the patient's condition are crucial in providing accurate results. Submissions must include dry stones in an unbreakable container, safeguarding the samples for analysis. The form also prompts the veterinarian to indicate any prior medical treatments, diets, and medication that may impact urolith formation. Key areas of focus include whether the urine was cultured, if antibiotics were administered, and dietary details prior to stone retrieval. Additionally, guidelines for submission of feline urethral plugs are included, ensuring clarity and precision. The comprehensive nature of the form aids veterinary professionals in understanding the background and conditions surrounding urolith formation, ultimately leading to informed recommendations and treatment options.
Minnesota Urolith Center Example
LAB USE ONLY
DATE REC'D
# SUBMITTED
MINNESOTA UROLITH CENTER
QUANTITATIVE UROLITH ANALYSIS FORM
PLEASE SUBMIT STONES DRY IN UNBREAKABLE CONTAINER (FOR PLUGS SEE BELOW)
**Please copy this form**
Date submitted
DOCTOR NAME:
CLINIC NAME:
ADDRESS:
PHONE NUMBER:
FAX NUMBER:
Owner's Name
Patient's Name/ID#
Species
Breed
Birth Date
If yes, date of detection:
Mineral composition?
Was the urine cultured before/during stone retrieval? . . . . . . . .
. . . . .Yes |
No |
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Bacterial growth? . . . . . . . Yes |
No |
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Isolates: |
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Were antibiotics given prior to stone retrieval? . . . . . . . . . . . .
YesNo
Type/dosage:
Were urine acidifiers or alkalinizers given prior to stone
retrieval?Yes No Type/dosage:
Gender: (circle one) |
M |
MC |
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F |
FS |
Unk |
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Source: (check all areas samples obtained from) |
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Upper Urinary Tract |
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Lower Urinary Tract |
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Kidneys |
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Bladder |
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Ureters |
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Urethra |
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Voided |
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Other
Date retrieved or voided
What brand of diet was fed prior to urolith retrieval/diagnosis?
How long was this diet fed?
Was a prescription diet fed? Yes No
If yes, which one? |
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(check one) |
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c/d(s) |
dry |
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canned ( |
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c/doxl |
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dry |
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canned ( |
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k/d |
dry |
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canned ( |
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l/d |
dry |
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canned ( |
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s/d |
dry |
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canned ( |
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u/d |
dry |
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canned ( |
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w/d |
dry |
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canned ( |
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z/d |
dry |
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canned ( |
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Other
How long was this diet fed?
Previous Uroliths? . . . . . . . .Yes |
No |
Unk |
Was allopurinol given prior to stone retrieval? . . . . . . . . . . . . .
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Yes |
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No |
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Dosage and duration: |
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Previous illness or injury: |
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Dx: |
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Date |
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Dx: |
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Date |
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FOR FELINE URETHRAL PLUGS ONLY
Preferred method for plug submission: 1/2 dry, 1/2 in formalin
How was the plug preserved? (check) |
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1. |
No preservative |
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2. |
10% buffered formalin |
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3. |
Other |
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If sample is very small, please submit dry.
MAIL TO:
MINNESOTA UROLITH CENTER
Dr. Carl Osborne
Dept. of Small Animal Clinical Sciences
College of Veterinary Medicine
Univ. of Minnesota, 1352 Boyd Avenue
St. Paul, MN 55108
Supported in part by an educational gift from Hill’s Pet Nutrition, Inc
MINNESOTA UROLITH CENTER
Hasan Albasan, DVM, MS |
• |
UNIVERSITY OF MINNESOTA |
• Carl A. Osborne, DVM, PhD |
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Kathleen Carpenter, CVT |
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College of Veterinary Medicine |
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Laura Pederson, BS |
Thomas F. Fletcher, DVM, PhD |
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1352 Boyd Avenue |
• David J. Polzin, DVM, PhD |
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Frédéric Jacob, DVM |
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St. Paul, MN 55108 |
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Sheri Ross, DVM |
Lori Koehler, CVT |
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Lab Phone (612) |
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Laurie L. Swanson, CVT |
Chalermpol Lekcharoensuk, DVM • |
Fax (612) |
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Lisa K. Ulrich, CVT |
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Jody P. Lulich, DVM, PhD |
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_______________________________________________________________________________
WHAT PREVENTATIVE MEASURES SHOULD I TAKE UNTIL I RECEIVE QUANTITATIVE MINERAL ANALYSIS RESULTS?
Urolith formation is a process that typically takes several weeks (eg. infection induced struvite), to months (eg. calcium oxalate)rather than days. The most common "cause" of rapid recurrence of uroliths is incomplete removal at the time of surgery.
Until quantitative mineral analysis on the urolith is completed, we recommend the following
steps.
1Osborne CA, Lulich JP, Unger LK: Nonsurgical retrieval of uroliths for mineral analysis. In Current Veterinary Therapy XI. pp
2Lulich JP, Osborne CA, Unger LK, et al: Nonsurgical removal of urocystoliths by voiding urohydropropulsion. In Journal of the American Veterinary Medical Association. Vol 203, pp.
Osborne CA, et al.: Canine and Feline Urolithiases: Relationship of Etiopathogenesis to Treatment and Prevention. In Canine and Feline Nephrology and Urology, Osborne and Finco 1995, pp
Form Characteristics
| Fact Name | Description |
|---|---|
| Purpose of the Form | This form is used for the submission of urolith samples for qualitative analysis at the Minnesota Urolith Center. It helps veterinarians determine the mineral composition of urinary stones. |
| Submission Requirements | Stones must be submitted dry and in an unbreakable container. For plugs, specific preservation methods are outlined. |
| Contact Information | Submissions are directed to Dr. Carl Osborne at the University of Minnesota, with detailed contact information provided for both phone and fax communications. |
| Veterinary Credentials | The form is supported by an experienced team of veterinarians and specialists in the Department of Small Animal Clinical Sciences. |
| Preventative Measures | The form provides recommendations for preventative measures to take until the mineral analysis results are received, ensuring proper care during waiting periods. |
Guidelines on Utilizing Minnesota Urolith Center
After completing the Minnesota Urolith Center form, you'll need to submit it along with the stone samples for analysis. Ensure that all sections are filled out accurately and comprehensively, as this will help the center provide the most accurate results. Here are the steps to fill out the form correctly:
- Date submitted: Write the date you are submitting the form.
- Doctor Name: Enter the name of the veterinarian overseeing the case.
- Clinic Name: Fill in the name of the veterinary clinic.
- Address: Provide the clinic's full address.
- Phone Number: Include a contact phone number for the clinic.
- Fax Number: Enter the clinic's fax number, if available.
- Owner's Name: Fill in the name of the pet owner.
- Patient's Name/ID#: Provide the name or identification number of the patient.
- Species: Specify the species of the animal (e.g., dog, cat).
- Breed: Fill out the breed of the patient.
- Birth Date: Enter the date of birth of the patient.
- Mineral composition: If known, indicate the mineral composition of the stones.
- Date of detection: If applicable, enter when the stones were detected.
- Was the urine cultured? Indicate 'Yes' or 'No'.
- Bacterial growth: Indicate if there was bacterial growth with 'Yes' or 'No'.
- Isolates: List any bacterial isolates found, if applicable.
- Were antibiotics given? Mark 'Yes' or 'No' with details on type/dosage if applicable.
- Urine acidifiers/alkalinizers: Indicate if these were given before stone retrieval, with details if applicable.
- Gender: Circle the appropriate option (M, MC, F, FS, Unk).
- Source: Check all areas samples were obtained from (e.g., Kidneys, Bladder).
- Date retrieved or voided: Write the date when the samples were collected.
- Diet brand before retrieval: Specify the brand of diet the patient was fed prior to stone retrieval.
- Duration of diet: Mention how long the diet was given.
- Was a prescription diet fed? Mark 'Yes' or 'No' and provide details if applicable.
- Previous Uroliths: Indicate with 'Yes', 'No', or 'Unk' if there were previous uroliths.
- Allopurinol given? Indicate 'Yes' or 'No' with dosage and duration if applicable.
- Previous illness or injury: Provide any relevant details along with dates if applicable.
- For Feline Urethral Plugs Only: Preferred method for plug submission (1/2 dry, 1/2 in formalin).
- Preservation method: Check one of the options for how the plug was preserved.
- Mail to: Confirm that the address for mailing is accurate.
What You Should Know About This Form
What information is required to complete the Minnesota Urolith Center form?
The Minnesota Urolith Center form requires various pieces of information to ensure accurate analysis and treatment recommendations. You will need to provide details such as the doctor's name, clinic name, and contact information. Additionally, the owner's name and the patient's specifics—including name, species, breed, and birth date—are necessary. Furthermore, record any previous medical history, nutritional details, and treatment methods related to uroliths. Accurately completing this form helps in diagnosing and managing the condition effectively.
How should I submit stones for analysis?
To submit stones for analysis, it’s important to ensure they are dry and placed in an unbreakable container. This helps in the preservation and integrity of the samples being analyzed. If you are sending feline urethral plugs, note that the preferred submission method is typically half dry and half preserved in formalin. Following these guidelines not only facilitates a thorough analysis but also increases the chances of obtaining valuable insights into the mineral composition of the stones.
What steps can I take to prevent urolith formation while waiting for analysis results?
While awaiting the results of the quantitative mineral analysis, there are several proactive measures you can take. First, it's advisable to perform post-operative radiographs to check for any residual stones. If small stones are found, they can sometimes be removed through non-surgical means after appropriate healing. Additionally, consider feeding a diet that minimizes the risk of further urolith formation. Diets that promote neutral urine pH and avoid mineral excess are typically recommended. It's also beneficial to monitor for any signs of urinary tract infections through urine samples.
How can I contact the Minnesota Urolith Center if I have more questions?
If you have further questions or need assistance, you can reach the Minnesota Urolith Center directly. Their lab phone number is 612-625-4221, and for fax communications, you may use 612-624-0751. Personnel there are well-equipped to provide guidance and support throughout the submission process and beyond.
Common mistakes
Filling out the Minnesota Urolith Center form can be straightforward, but there are several common mistakes that individuals often make. One frequent error is neglecting to provide the required submission date. Without this detail, the processing of the sample may be delayed, which can impact the treatment timeline.
Another common mistake involves the doctor's name and clinic name. Failing to include accurate formatting or complete names may lead to confusion or misidentification of the submission. Ensure that all relevant details are clearly printed.
Individuals sometimes overlook specifying the species and breed of the patient. This information is essential as it can influence the analysis and subsequent recommendations. A missing species designation may lead to misinterpretation of the findings.
The dietary history section also suffers from oversight. Frequently, submitters fail to clearly outline the brand of diet and the duration of feeding it. Providing this context is vital for understanding potential causes of urolith formation.
The section regarding previous uroliths and treatment history tends to be filled incorrectly. Submitters should accurately respond to questions about previous illnesses or injuries and the administration of any medications, including antibiotics. Incomplete answers can hinder interpretation of the analysis.
Another common mistake is the method of sample preservation. Sometimes, individuals do not check the appropriate method for preserving feline urethral plugs. This can impact the integrity of the sample and the reliability of the results.
The form asks if urine acidifiers or alkalinizers were used prior to stone retrieval. Occasionally, people miss answering this crucial yes or no question. This information is significant for understanding the urinary environment leading to urolith formation.
Additionally, missing contact information, particularly the phone number, can result in delays. Providing a valid phone number ensures that the Minnesota Urolith Center can reach out if there are follow-up questions regarding the submission.
Ultimately, attention to detail while completing the Minnesota Urolith Center form is essential. Avoiding these common pitfalls will facilitate a smoother submission process and enable more effective treatment based on the results.
Documents used along the form
The Minnesota Urolith Center form is an essential document for the submission of urolith samples for analysis. Alongside this form, several other documents and forms may also be utilized to ensure proper communication and data collection regarding the patient and conditions being evaluated. Below are some commonly used forms associated with urolith submission.
- Client Consent Form: This document captures the owner's approval for various procedures, including sample collection and analysis. It typically requires signatures from the pet owner and may include information about potential risks and alternative options.
- Veterinary Referral Form: A referral form is often used when a veterinarian refers a patient to a specialist for further evaluation and treatment. This form includes vital health history details and previous medical treatments relevant to the urolith issue.
- Medical History Form: This form is used to document the patient’s complete medical history, including past illnesses, medication history, and any previous incidents of urolith formation. It aids in providing context for the current diagnosis.
- Dietary History Form: Understanding a patient’s diet is crucial for evaluating urolith formation. This form collects detailed information about the pet's current and past diets, including any prescription diets, to help establish potential dietary influences on urolith development.
These additional forms complement the Minnesota Urolith Center form and ensure that vital information is collected and communicated effectively among veterinary professionals and pet owners. This holistic approach helps in diagnosing and recommending appropriate treatment for urolithiasis in pets.
Similar forms
- Veterinary Prescription Form: This form is utilized to document prescriptions for medications or diets. Similar to the Minnesota Urolith Center form, it collects details about the pet owner, the pet's medical history, and specific treatment plans, ensuring a comprehensive understanding of the patient’s needs.
- Veterinary Referral Form: Veterinary referrals help transfer a pet's care from one vet to another. Both forms gather crucial information about the pet's medical history, previous treatments, and the reason for the transfer, fostering effective communication between veterinary professionals.
- Surgery Consent Form: Before any surgical procedure, this document ensures that pet owners understand the risks and benefits involved. Like the Minnesota Urolith Center form, it requires relevant medical history and consent information, emphasizing informed decision-making.
- Pet Health History Form: This comprehensive form captures the pet's entire health background. It shares similarities with the Minnesota Urolith Center form by collecting information about previous illnesses, treatments, and dietary habits, providing a complete picture of the animal’s health.
- Diagnostic Imaging Consent Form: Used when pets undergo X-rays or ultrasounds, this form seeks authorization for the procedures. It often includes details about the pet's health, akin to the Minnesota Urolith Center form, to inform veterinarians of any pre-existing conditions that may affect diagnostics.
- Vaccination Record Form: This document tracks a pet’s vaccination history. Both forms ask for specific pet identification details and history, ensuring that all relevant information is accessible for future health assessments and decisions.
- Feline Urethral Plug Submission Form: This specialized form is used solely for submitting plugs, similar to the Minnesota Urolith Center form which includes specific guidance on how to submit stones and plugs, reflecting the shared focus on accurate testing and results.
- Laboratory Submission Form: Generic lab submission forms are utilized for sending samples to diagnostic labs. They often require similar information about the pet and the nature of the submission, facilitating clear communication and appropriate handling of samples, much like the Minnesota Urolith Center form.
Dos and Don'ts
Filling out the Minnesota Urolith Center form accurately is crucial for the proper analysis of uroliths. Here are seven guidelines to help you navigate the process effectively.
- Do ensure all required fields are completed, including the owner's name, pet information, and clinical details.
- Don’t submit stones in breakable containers; use only unbreakable options to prevent damage during transportation.
- Do indicate whether antibiotics were administered prior to stone retrieval, as this information can influence the analysis.
- Don’t omit any previous medical history related to uroliths; past illnesses can be relevant to the current situation.
- Do include a detailed account of the diet fed prior to urolith retrieval; this can aid in understanding potential causes.
- Don’t forget to indicate whether urine was cultured before or during stone retrieval, as the presence of bacteria can be significant.
- Do carefully preserve the samples, especially for plugs, by following the preferred method indicated on the form.
By adhering to these recommendations, you can enhance the efficiency of the analysis and ensure that valuable information is not overlooked.
Misconceptions
- Misconception 1: The Minnesota Urolith Center form is only for veterinary professionals.
- Misconception 2: All stones need to be sent to the center in liquid preservatives.
- Misconception 3: The form is overly complicated and not user-friendly.
- Misconception 4: Results from the Minnesota Urolith Center take an excessively long time.
- Misconception 5: You need to identify the mineral composition before submitting a specimen.
- Misconception 6: Different sample types do not affect analysis outcomes.
- Misconception 7: Antibiotic use before stone retrieval alters the results significantly.
- Misconception 8: Past illness or injury doesn’t matter.
- Misconception 9: The Minnesota Urolith Center only analyzes uroliths for dogs.
This form can actually be submitted by animal owners as well. Properly collecting and submitting urolith samples greatly contributes to the analysis process, no matter who completes the form.
Contrary to popular belief, stones should be dry and placed in an unbreakable container. This ensures that the analysis is accurate and the stones remain intact.
While the form contains specific questions, it’s structured to gather essential information. This helps veterinarians provide the best possible care based on the analysis.
Most results are returned in a timely manner. Understanding the nature of uroliths is imperative for swift intervention, making expedited analysis a priority for the center.
It's perfectly okay if you don’t know the mineral composition when submitting the stones. The analysis is designed to identify various minerals and provide necessary insights.
In fact, the source of the sample—whether from the upper or lower urinary tract—can impact analysis. Specifying the sample source helps in obtaining accurate results.
While antibiotic treatment is noted on the form, it is one piece of a larger puzzle. The center takes multiple factors into account for a comprehensive analysis.
This is not true. Previous health issues can play a role in the formation of uroliths, so including this information is crucial for understanding the bigger picture.
This misconception overlooks that the center analyzes uroliths from both canines and felines. Cats and dogs can both suffer from urolithiasis, and the center is equipped to handle both species.
Key takeaways
The Minnesota Urolith Center form is essential for analyzing uroliths (stones) in pets. Properly filling out this form ensures accurate diagnosis and treatment. Here are key takeaways to consider:
- Submit uroliths in a dry, unbreakable container for best results.
- Ensure all fields are completed, including doctor and clinic information, pet owner details, and patient specifics.
- Indicate any previous urolith history, as it helps in understanding recurrence factors.
- Note whether urine was cultured before stone retrieval, as this can influence treatment options.
- Include detailed information on dietary history prior to urolith detection, especially prescription diets.
- Specify the method of plug preservation if submitting urethral plugs, which may affect the analysis.
- Be aware of preventative measures for urolith recurrence until analysis results arrive, such as feeding a suitable diet and monitoring for urinary tract infections.
- Clearly label the form with the date of submission to track the analysis efficiently.
Accurate completion of the form allows for better insights into the mineral composition and potential causes of urolith formation, guiding further veterinary care.
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