Dd Form 2341 - Report Of Animal Bite - Potential Rabies Exposure
Download a blank fillable Dd Form 2341 - Report Of Animal Bite - Potential Rabies Exposure in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Dd Form 2341 - Report Of Animal Bite - Potential Rabies Exposure with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2SEQUENCE NUMBER
REPORT OF ANIMAL BITE - POTENTIAL RABIES EXPOSURE
(Please read Privacy Act Statement on back before completing this form.)
1. FROM (Medical Treatment Facility)
2. THRU (Deputy Commander for Veterinary
3. TO (Chief, Preventive Medicine)
Services)
PART I - ANIMAL BITE HISTORY
(To be completed by Emergency Room Interviewer)
4. DESCRIPTION OF ANIMAL
5. TIME OF ATTACK
a. TYPE (Dog, cat, etc.)
b. BREED
c. SIZE
d. COLOR
e. SEX
a. DATE
b. HOUR
6. PRESENT LOCATION OF ANIMAL OR GEOGRAPHIC ADDRESS WHERE ATTACKED
ON POST
OFF POST
7. CIRCUMSTANCES LEADING TO BITE/SCRATCH INCIDENT
8. APPARENT HEALTH OF ANIMAL (Unusual Behavior)
9. OWNER
a. NAME (Last, First, Middle Initial)
c. PHONE NUMBER
d. ADDRESS (Street, City, State, Zip Code)
b. STATUS (X one)
(Include Area Code)
MILITARY
CIVILIAN
10. RABIES VACCINATION
a. VACCINATION STATUS OF ANIMAL
b. YEAR ANIMAL
c. TYPE VACCINE
VACCINATED
(If known)
11. PREPARED BY
a. NAME (Last, First, Middle Initial)
b. TITLE
c. SIGNATURE
d. DEPARTMENT/SERVICE/CLINIC
e. DATE PREPARED
PART II - MANAGEMENT OF ANIMAL BITE CASE
(To be completed by Medical Officer (Information from SF 600))
12. DESCRIPTION OF INJURY AND LOCATION ON THE BODY
13. DIAGNOSIS (Injury) (X, as applicable)
14. RABIES RISK ESTIMATE (X one)
ANIMAL BITE
CLAW WOUND
OTHER
MINIMAL
MODERATE
HIGH RISK
a. TIME
b. DATE
16. RECOMMENDED FURTHER PROPHYLACTIC TREATMENT
15. INITIAL TREATMENT
GIVEN
a. NONE
c. DEEP FLUSHING AND CLEANSING WITH SOAP AND WATER
b. *HUMAN RABIES IMMUNE GLOBULIN
c. HUMAN DIPLOID CELL RABIES VACCINE
d. TETANUS TOXOID (List dose given)
e. OTHER (Specify)
d. COUNSELED ON DF2 HAZARD
e. OTHER (Specify)
*Need to consult Rabies Board prior to treatment
17. PATIENT'S IDENTIFICATION (ID impression, if available.)
18. PHYSICIAN
(For typed or written entries give name (Last, First, Middle Initial);
a. NAME (Last, First, Middle Initial)
pay grade; SSN; unit; phone; date; hospital or medical facility.)
b. SIGNATURE
19a. DISCUSSED WITH AREA VETERINARIAN (X one)
YES
NO
b. NAME OF VETERINARIAN (Last, First, Middle Initial)
20. VERBAL REPORT TO (1) NAME
(2) PHONE NO.
a. VETERINARIAN
b. POLICE
c. OTHER
DD Form 2341, JUN 92 (EG)
PREVIOUS EDITION IS OBSOLETE.
WHS/DIOR, Jan 98
Reset
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business