12230 Hatervme Editorial (FAXEOTBG19191 P00211005
08-10-318 10:30 Town of Corinna 2072785200 @834 HMS

f'
I

   



 

(c9197

arm REPORT
Rabies Management-Program.

Date: (9 Dispatch #3 Case #1 12?

HUMAN (Victim) IDENTIFICATION . .
903: 3?1 [?00 Male '8 Panda

 

  
 
 
   

Name: 
Address:  

     

 

 

 

 

 

    

 

if minnr, Parent'uala 1    . . Raia?cnahip:   
Address (ifdifferant): home . [w 

 

 

Did victim haw a rabies prevention immunization p?or ta incident? Yes NE: 

DOMESTIC AMMAL (Victimi (if-animal' coniact)

 

  
 
 
  

 

.Type ofanimai: (Pi? PM:  owned stray Dw?d  
Description: femma  a
Owner: Phone: home  .  fk -

 
 

 

 

 

i, ?5 n. I
Date ofcurrent rabies vaccinai SVe?a?narian; (km?ham:

License No.:  ta: Clinlu: Rabies Tag 35?? Exp. Date:

a?moreHwep m5-

SUSPECT AMMAL IDENTIFICATION

 

 

 

 

 

 

 

 

Typepf animal: owned stray wad -

Descripllon: . . male female age:

owner. I . - Phone: home I 

Address: . 

 

Veterinarian: - Phone:

I L. :1 ?Maw? 0130? Ros/Maj 

Dam of current rabies vaccination:

 

 

.?umr

gar! 





0611912016 32230 Naterville Editoriai

 

 

    
   

 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Passions
08?10316 10:30 Town of Corinna 2072786200 i-U4b
v}


Liceiisa?wo; - - Si'ate: .. Clinic: Rabies Tagii . Exp. Date} A

Date reamed: Reported by:  .. Daie ofbiia: 

Type o'iconimi: Mane scratch Bother (specify): 

Body pards) bitten audio: scratched: 

Medimlcarafequi?red? ?-yas Elna. ifyes. hospiiai&decior: i/idma L5 deceased

Was rabies exposiura prophylaxis given to victim? yes no unknown

Hes animal been acting strangaiy. or bitten anyone receniiy? Yes No

if yes. piease explain: 

Was attack provoked? yes no

Please dawiba incideni: 

15?"
OF ANIMAL

. Owner's po?session v? Euthanized I sent to HETL for testing a V?terinary Hespiiai - Unknewn-

Animai Shaiier - Ci Boarding Kennei [3 Other (specify): 
Name a location: "Bi/mgr Em: Va} 

 

 

 

 

 

 

 

Date Quarantine: Date of raiease:WVeie?naw checked? yes [3 no
3" .
suspecv . .
. Owner's possession - Ci Euihanized I sent to HETL for testing - Vet?rin?iy Hospital Unknown
 -  - - -- - -. 
Name of a in?ation; 
Date of Quarantine: Date a? :eiease: Veterinary checkad? Ci yes [3 no
x) arr-men
:g Mania: 

 

 

 

Enforcement: El Rabies Aciyisoiy Notice Ci Quaraqiine Notice [3 Summunses [3.0th

 

0611 012016 12:30 Haterville Editorial (FW078619191 P.004i005
05-10316 10:30 Town of Corinna 2072785200 F-O4B

nu

. Appendix .

ANIMAL BITE  '(page 1 of 2)
Data: (-9 (to be ?led with mumcupakw manage lb
VICTIM IDENTIFICATION (if human contact)
Name: Hm Bra 

 

    
  

. If minor,


Address, if di?'erem: 

Did Victim have rabies prev .

DOMESTIC ANIMAL IDENTIFICATION (mm CONTACT)

Me, ofAnimai:  8U I I Owned Sway Wild 


      
    
   
 

   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Duaorimim: Pi 
gga 
was: :90 i m- 1/ 6
Date of current :a'bies Vaudlna?oa:  Vctc?an?Tdephm
Lima ?State: WElinic: Tag Expiration date: 3

We: bias nm? Can ?rmed 36%? any #am ?i?lbr 49er
SUSPECTANMAL .
mac ofAnim! Owned WILDC 
We?; 3 AGEGFKNOWN)
?amed? ownemzeeper ?rciaphma: .
Addrw?
Date. of mutant rabiea vaccina?m Veterinarian Ted.
 .0.   
DESCRIPTION OF INCIDENT

Damepoxted: Rapunedby: 

Dana ofmnlaw 13in 8:33th 1 Other (specify):

Body Mailed we required? YesM NM 3
df?o! on seem.

 

SO

 

 

06!?012016 12:31 Hatervi?e Editorial PDOSIOOS
08~10-? 18 10:30 Town of Corinna 2072785200 T4334 F-046
- Appendix. 
ANIMAL BITE REPORT {page 2 z)
Beam:

Was rabies exposure givcn to victim? WM 1? No Unkgown 3
Date of ?rst prophylaxis immunization: second immunization:

Wh?re dldinnidemtake place? 2212 Provoked? Yes No i 

Description ufmc'den? (341 CW (1 
la;  on. e. 

 Ifowmr?s possession: Euthanized and aamtoHBTL fortee?ng: Unknown (not captured) 3

        

Vexexmaw Animal Shaker: Boarding Kennel: 3. .

?Nameoffaci?tyMocationLWD'Mne er?

Telephons:_

 

 
  
 



Dam of quaran?na:

 

 

Date of release: Veterinary exam? Yes No 

DISPOSITION OF SUSPECT ANIMAL

In owners possessienx Budwdzed?andeanttoHETL {attesting Unknawn:( Nutoaptured:()
Veterinary hOSpital:( Ar?ma! ahelter? Boarding kcnneM)

 

 

 

Other (spasm/L :54

Name Bf facility 85 location: 0

Data of quarantine: Date of release: Vete?uary email?- Yes No 
GFFICER

 Signature: K77

 

 

.. I 
I?StWD24rTill?gu . Mr.-
?immw  ?nial, -

eemenn bias Ad '35 Netj?zquamine No?c? CiviUCrimina1 3

 

 


Hes animal been or him anyanereaently? Yes No Ifyes,
expfain: .A 



51