Dd Form 2341 - Report Of Animal Bite - Potential Rabies Exposure Page 3

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PART III - MANAGEMENT OF BITING ANIMAL
(Continued)
28. CONDITION OF ANIMAL DURING AND AT THE END OF 10-DAY QUARANTINE
(Explain fully - healthy, died, escaped, not located, etc.)
29. OTHER INFORMATION OR COORDINATION
(Including notification of animal status to ER or MTF; list names and dates)
30. LABORATORY FINDINGS OF ANIMAL SUBMITTED FOR RABIES DIAGNOSIS
a. TEST
b. DATE RECEIVED
c. RESULTS
(X one)
(YYYYMMDD)
(X one)
(1) FLUORESCENT ANTIBODY
NEGATIVE
POSITIVE
(2) CELL CULTURE
NEGATIVE
POSITIVE
31. VETERINARY OFFICER
a. NAME
b. SIGNATURE
c. DATE SIGNED
(Last, First, Middle Initial)
(YYYYMMDD)
PART IV - RABIES ADVISORY BOARD OR OTHER MEDICAL CONSULTATION/COORDINATION
32. DISCUSSED BY
(List names, or X box at right.)
NOT REQUIRED TO MEET
33. RECOMMENDATIONS
a. HUMAN RABIES IMMUNE SERUM
LOCAL
SYSTEMIC
BOTH
(X one)
b. VACCINE
c. OTHER
34. CHIEF, PREVENTIVE MEDICINE
a. NAME
b. SIGNATURE
c. DATE SIGNED
(Last, First, Middle Initial)
(YYYYMMDD)
35. FINAL DISPOSITION OF CASE
36. MEDICAL OFFICER REVIEW
(In accordance with Service/local policy)
a. SIGNATURE
b. DATE SIGNED
(YYYYMMDD)
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
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