VS Form 10-12: Equine Infectious Anemia Supplemental Investigation 



CASE ID 



Self-explanatory. 



LAB ACCESSION NO. 



Self-explanatory. 



INVESTIGATOR'S NAME 



Investigator's name and telephone number. 



INVESTIGATOR'S AFFILIATION 



Self-explanatory. 



INVESTIGATION DATE 



Self-explanatory. 



OWNER'S LOCATION 



Enter complete name, address, and telephone number 

 of the owner's location. 



NAME OF CONTACT PERSON 



Enter the complete name, address, and telephone 

 number of the local contact person (e.g., the stable 

 manager). 



All remaining blocks on this form are 

 self-explanatory. 



16-28 



