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Reportable Disease Form West Virginia Department of Agriculture Animal Health Division 1900 Kanawha Blvd E Charleston WV 25305 Phone 304-558-2214 FAX 304-558-2231 Date Reporting Veterinarian Last Name First Name Clinic/Hospital Name County Telephone Fax Disease Information Disease Check one of the following Suspected Confirmed Species affected Number of animals affected Age of affected animals Gender Onset date Breed Diseased animal s location information Address Owner Name Diagnostic...
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