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Animal Bite New Front 1 New Card

The document outlines a registration form for individuals who have been exposed to potentially rabid animals, detailing personal information, exposure history, and post-exposure prophylaxis protocols. It includes vaccination schedules, reminders for observing the biting animal, and instructions for reporting any changes. The form is structured for two separate cases of exposure, ensuring comprehensive tracking of treatment and follow-up actions.

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rhu.libertad.anitque
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387 views1 page

Animal Bite New Front 1 New Card

The document outlines a registration form for individuals who have been exposed to potentially rabid animals, detailing personal information, exposure history, and post-exposure prophylaxis protocols. It includes vaccination schedules, reminders for observing the biting animal, and instructions for reporting any changes. The form is structured for two separate cases of exposure, ensuring comprehensive tracking of treatment and follow-up actions.

Uploaded by

rhu.libertad.anitque
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Registration No: Date Registered: Registration No: Date Registered:

Name: Age: Name: Age:


Address: Sex: Address: Sex:
History of Exposure History of Exposure

Date of Exposure: Place of Exposure: Date of Exposure: Place of Exposure:


Type of Exposure: Source of Exposure: Type of Exposure: Source of Exposure:

Category of Exposure: I II III Category of Exposure: I II III

Post Exposure Prophylaxis: Post Exposure Prophylaxis:


Washing of Bite Wound: Washing of Bite Wound:
Anti-Rabies Vaccine Anti-Rabies Vaccine
Brand Name: Brand Name:
Generic Name: Generic Name:
Route: ID IM Route: ID IM
RIG: RIG:

Day 0 Day 3 Day 7 Day 14 *Day28/30 Day 0 Day 3 Day 7 Day 14 *Day28/30

*Proceed with day 28/30 if biting animal is not alive after 14 days of observation *Proceed with day 28/30 if biting animal is not alive after 14 days of observation
Status of Biting Animal after 14 days: Status of Biting Animal after 14 days:
Remarks: Remarks:

Your Next Doses: Your Next Doses:


Day 3 Day 14(IM) Day 3 Day 14(IM)
Day 7 Day 28/30 Day 7 Day 28/30

Reminder: Reminder:
Observe the responsible animal for 14 days, and report to the veterinarian any Observe the responsible animal for 14 days, and report to the veterinarian any
changes noted in the animal during the observation period. changes noted in the animal during the observation period.

Tetanus Toxoid Tetanus Toxoid


HTIG HTIG

Registration No: Date Registered: Registration No: Date Registered:


Name: Age: Name: Age:
Address: Sex: Address: Sex:
History of Exposure History of Exposure

Date of Exposure: Place of Exposure: Date of Exposure: Place of Exposure:


Type of Exposure: Source of Exposure: Type of Exposure: Source of Exposure:

Category of Exposure: I II III Category of Exposure: I II III

Post Exposure Prophylaxis: Post Exposure Prophylaxis:


Washing of Bite Wound: Washing of Bite Wound:
Anti-Rabies Vaccine Anti-Rabies Vaccine
Brand Name: Brand Name:
Generic Name: Generic Name:
Route: ID IM Route: ID IM
RIG: RIG:

Day 0 Day 3 Day 7 Day 14 *Day28/30 Day 0 Day 3 Day 7 Day 14 *Day28/30

*Proceed with day 28/30 if biting animal is not alive after 14 days of observation *Proceed with day 28/30 if biting animal is not alive after 14 days of observation
Status of Biting Animal after 14 days: Status of Biting Animal after 14 days:
Remarks: Remarks:

Your Next Doses: Your Next Doses:


Day 3 Day 14(IM) Day 3 Day 14(IM)
Day 7 Day 28/30 Day 7 Day 28/30

Reminder: Reminder:
Observe the responsible animal for 14 days, and report to the veterinarian any Observe the responsible animal for 14 days, and report to the veterinarian any
changes noted in the animal during the observation period. changes noted in the animal during the observation period.

Tetanus Toxoid Tetanus Toxoid


HTIG HTIG

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