Dd Form 2341 - Report Of Animal Bite - Potential Rabies Exposure Page 2
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3PART II - MANAGEMENT OF ANIMAL BITE CASE
(To be completed by Medical Officer (Information from SF 600))
13. DESCRIPTION OF INJURY AND LOCATION ON THE BODY
14. DIAGNOSIS
15. RABIES RISK ESTIMATE
(Injury) (X as applicable)
(X one)
ANIMAL BITE
CLAW WOUND
OTHER
MINIMAL
MODERATE
HIGH RISK
16. INITIAL TREATMENT GIVEN
(X and complete as applicable)
17. RECOMMENDED FURTHER PROPHYLACTIC TREATMENT
a. TIME
b. DATE
(YYYYMMDD)
(X as applicable)
a. NONE
c. DEEP FLUSHING AND CLEANSING WITH SOAP AND WATER
b. HUMAN RABIES IMMUNE GLOBULIN
(Consult in accordance with Service/local policy prior to treatment)
d. TETANUS PROPHYLAXIS
(List dose given)
c. HUMAN DIPLOID CELL RABIES VACCINE
d. COUNSELED ON INFECTIOUS RISK OF ORAL FLORA
e. ASSESSMENT OF IMMUNOCOMPETENCE AND NEED FOR
ANTIBIOTIC USE
e. OTHER
(Specify)
f. OTHER
(Specify)
18. PHYSICIAN
a. NAME
b. SIGNATURE
(Last, First, Middle Initial)
b. NAME OF VETERINARIAN
19. ARMY VETERINARIAN
(If applicable) (Last, First, Middle Initial)
a. CONTACTED
(X one)
YES
NO
20. VERBAL REPORT TO
(1) NAME
(2) TELEPHONE
(1) NAME
(2) TELEPHONE
(Last, First, Middle Initial)
(Last, First, Middle Initial)
a. PM/PUBLIC
c. OTHER
(List)
HEALTH
b. POLICE
PART III - MANAGEMENT OF BITING ANIMAL
(To be completed by Veterinarian)
21. AUTHORITIES NOTIFIED
(Local public health authorities, law enforcement, etc.)
e. FOLLOW-UP
a. NAME
b. DATE
c. TIME
d. INITIALS
(Last, First, Middle Initial)
(YYYYMMDD)
(1) DATE
(2) TIME
(YYYYMMDD)
22. INITIAL ACTION
23. FORM RECEIVED BY VETERINARY SERVICES
a. TIME
b. DATE
c. INITIALS
(YYYYMMDD)
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 FROM QUARANTINE
(YYYYMMDD)
26. DATES OBSERVED
(YYYYMMDD)
a. FROM
b. TO
PATIENT'S IDENTIFICATION
(ID impression, if available.) (For typed or written entries give name (Last, First, Middle Initial); pay grade; SSN; unit; duty and home
telephone numbers; date; hospital or medical facility.)
DD FORM 2341, OCT 2007
Page 2 of 3 Pages
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