VIRTUAL MICROSCOPY SLIDE SUBMISSION
Complete the Information Below When Submitting Slides For Scanning
Category (PLEASE CIRCLE)	Viral Infections, Non-Viral Infections, White Matter Disease, Trauma, Toxic, Developmental, Metabolic/Genetic, Glial-Neuronal Tumors, Non-Glial Tumors, Muscle/Nerve, Malformations, Fetal/Perinata,l Neurodegenerative, Pediatric Tumors, Ophthalmic Pathology, Vascular, Normal Anatomy
Diagnosis
Further Descriptor
Tissue Type (PLEASE CIRCLE)	Muscle Nerve Brain Eye SC Other
Stain
Type of Prep (PLEASE CIRCLE)	Touch Smear FZ Surgical Paraffin Autopsy Paraffin
UPMC Case #
Glass Slide Collection #
Other Number
Submitted by: ________________________			Date: __________________________
Revised: 3/17/06