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Rabies exposure form
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Rabies exposure form
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<br /> <br /> <br />Rabies Post-Exposure: 45-Day Control & Observation <br /> <br />ACTIVITY NO.________________ BITE NO. _____________________ <br />EXPOSURE DATE ____________ RELEASE DATE (45 days from Exp)__________ <br />ACO NAME _____________________________ ACO PHONE ____________________ <br /> <br />OWNER/KEEPER NAME__________________________ PHONE__________________ <br />ADDRESS_______________________________________________________ <br />ANIMAL NAME & DESCRIPTION____________________________________________ <br /> CURRENT VAX OR EXPIRED VAX (attach copy of approved documentation) <br />VET/CLINIC _______________________________ BOOSTER DATE _____________ <br /> <br />The above animal has had an exposure or suspected exposure to an animal <br />that tested positive for rabies, was unavailable for testing, or is a <br />known rabies vector. Because it has proof of a current or previous <br />vaccination and has received a booster vaccination within 96 hours of <br />exposure, it is eligible to stay at home, but must undergo a 45-day period <br />of control and observation with its owner. <br /> <br />During this period, the pet above must adhere to the following: <br />• No trips to areas outside of the house such as dog parks, camps, pet <br />stores, groomers, etc. <br />• Veterinary visits are permitted if needed, but must be arranged ahead of <br />time with veterinarian so that staff members know the animal is under <br />observation and can be kept away from other pets while at the clinic. <br />• If you must travel or go away during this period, contact Animal <br />Services immediately. Any person pet sitting or caring for this pet <br />during this period must be pre-approved by Animal Services. <br />• Dogs may be kept in a secured fenced yard with approval from Animal <br />Services upon inspection of the enclosure. <br />• Cats must be kept inside the home or in an approved enclosed area for <br />this period. Cats cannot be outdoors and allowed to roam during this <br />period. <br />If animal shows any signs of illness or behavioral change, you must <br />contact Animal Services immediately. <br />I understand the requirements of rabies control and observation and I <br />agree to comply with all of the above standards. <br /> <br />______________________________ ______________ _____________________ <br /> OWNER SIGNATURE DATE ISSUED BY <br /> <br />Mid Term Check _______________________________________________ <br /> <br />End Term Check________________________________________________ <br />Working Document <br />(must be administered by a vet) <br />DATE/TIME/METHOD <br />DATE/TIME/METHOD
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