Blood sample ____ heart __ jugular _ _ other _ 
Plasma analysis . ___ Tests: VI _ _ HT __ N 
Plasma virus report VI: negative ___ _„positive __ virus _ 
HI: ___ ______ _ _- 
HI:__ _ _ _ 
HI: _ ____ _ 
N: ____:_ _ 
Blood smear_Stain(s)____ 
Blood smear results ___ 
Remarks. .. ., ______ 
n— j t 
