Dd Form 2341 - Report Of Animal Bite - Potential Rabies Exposure Page 2
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
2PRIVACY ACT STATEMENT
AUTHORITY:
Title 10, United States Code, Sections 3013, 5013, and 8013.
PRINCIPAL
Used by medical authorities to record the history, examination, and treatment of a person who has possibly been exposed to rabies; and to record
PURPOSE(S):
the follow-up medical care provided to the individual who was either bitten or scratched. Used by veterinarians to locate the animal, record
examination, observations, and disposition results, and possible laboratory findings for the animal.
ROUTINE
Information will be used as a basis for documenting the proper treatment and care of individuals who have potentially been exposed to rabies.
USE(S):
The information will be used to locate the animal, and record the vaccination and physical status of the involved animal. The information may
also be used to: aid in preventive health and communicable disease control programs; report medical conditions required by law to Federal, state
and local agencies; compile statistical data; conduct research; teach; assist in law enforcement, to include investigation and litigation; and to
evaluate the care provided.
DISCLOSURE:
Voluntary; however, if the information is not provided, it will delay the compilation of the data required for record keeping purposes.
PART III - MANAGEMENT OF BITING ANIMAL
(To be completed by Veterinarian)
21. AUTHORITIES NOTIFIED
e. FOLLOW-UP
a. NAME (Last, First, Middle Initial)
b. DATE
c. TIME
d. INITIALS
(1) DATE
(2) TIME
22. INITIAL ACTION
23. EMERGENCY ROOM NOTIFIED
a. TIME
b. DATE
c. INITIALS
24. LOCATION OF ANIMAL DURING OBSERVATION PERIOD (On or off post, list point of contact if not veterinary activity)
25. OBSERVED BY (Include name of military or civilian agency)
27. DATE ANIMAL RELEASED
26. DATES OBSERVED
a. FROM
b. TO
28. CONDITION OF ANIMAL DURING AND AT THE END OF 10-DAY QUARANTINE
29. OTHER DISPOSITION OF ANIMAL (Explain fully - died, escaped, not located, etc.)
30. LABORATORY FINDINGS OF ANIMAL SUBMITTED FOR RABIES DIAGNOSIS
a. TEST (X one)
b. DATE RECEIVED
c. RESULTS (X one)
(1) FLUORESCENT ANTIBODY
NEGATIVE
POSITIVE
(2) CELL CULTURE
NEGATIVE
POSITIVE
31. INFORMATION REPORTED TO RABIES BOARD BY
a. NAME (Last, First, Middle Initial)
b. SIGNATURE
c. DATE SIGNED
32. VETERINARY OFFICER
a. NAME (Last, First, Middle Initial)
b. SIGNATURE
c. DATE SIGNED
PART IV - RABIES ADVISORY TEAM ACTION/BOARD REVIEW
33. DISCUSSED BY (List names of members of team or board, or X box at right.)
NOT REQUIRED TO MEET
34. RECOMMENDATIONS
a. HUMAN RABIES IMMUNE SERUM (X one)
LOCAL
SYSTEMIC
BOTH
b. VACCINE
c. OTHER
35. CHIEF, PREVENTIVE MEDICINE
a. NAME (Last, First, Middle Initial)
b. SIGNATURE
c. DATE SIGNED
36. FINAL DISPOSITION OF CASE (Review by rabies board)
37. PRESIDENT OR SENIOR MEDICAL OFFICER OF BOARD
a. SIGNATURE
b. DATE SIGNED
DD Form 2341, JUN 92 (Back)
Reset
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business