Date of Bite/Scratch
Date Reported to Service Supervisor
Was This a
Location of Animal during Incident
Brief Description of Incident
(Include Location Bitten and/Or Scratched)
Name
Address
ZIP
Phone
City
Alt. Ph.
State
Name/ID #
Medical Record #
Color
University-Owned
Sex
Species
Other
Breed
Rabies Vaccine
Date Vaccinated
Department
Confirmed By
Animal Sent Home
Animal Euthanized/Died
Date Animal Discharged from VMTH Care
Date Animal Euthanized/Died
Rabies Testing
Is Owner/Resp. Party Known
Name
Address
City
State
ZIP
Phone
Alternate Ph.
Veterinarian on Case Notified
VMACS and Paper Medical Record Flagged with Quarantine Info
Quarantine Sign Posted on Cage/Stall
Yolo County (530-668-5288)
Print/Fax completed form:
Student Health (530-752-5587)
Name
Primary Phone
Secondary Phone
Contact Email
VMTH BITE/SCRATCH REPORT
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