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Get MN Quantitative Urolith Analysis Form

* If yes, date of detection: Date submitted Mineral composition? DOCTOR NAME: Was the urine cultured before/during stone retrieval? . . . . . . . . CLINIC NAME: . . . . .Yes ADDRESS: No Bacterial growth? . . . . . . . Yes No Isolates: PHONE NUMBER: Were antibiotics given prior to stone retrieval? . . . . . . . . . . . . FAX NUMBER: Yes Owner's Name Type/dosage: Patient's Name/ID# Were urine acidifiers or alkalinizers given prior to stone Species retrieval? Breed Yes No T.

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