Get the free ANIMAL BITE REFERRAL FORM - Madison County - healthymadisoncounty

MADISON COUNTY DEPARTMENT of HEALTH ANIMAL BITE REFERRAL FORM (Fax to 315-366-2207) Report received by LOG # Date of Referral: by of Phone Person Bitten: Age: Date of Bite Name of Guardian: Time of

How to fill out animal bite referral form

How to fill out an animal bite referral form:

1. Begin by filling out the personal information section, including your name, address, phone number, and date of birth. Make sure to provide accurate contact information to ensure that you can be reached if needed.
2. Next, provide details about the animal involved in the bite incident. Include the species, breed (if known), and any identifiable markings or tags on the animal. If the animal is owned by someone else, provide their contact information as well.
3. Describe the circumstances of the bite incident. Include the date, time, and location of the incident, as well as any pertinent details such as if the animal was provoked or if there were any witnesses present. Be as specific as possible to provide a clear picture of what occurred.
4. Indicate any injuries or symptoms resulting from the animal bite. If you sought medical attention, note the name and contact information of the healthcare professional or facility where you received treatment. If there are any photos or medical records related to the incident, mention that they are available upon request.
5. Provide information about the animal's vaccination status. If you know the animal's vaccination history, include details about the rabies vaccine specifically. If the animal was not vaccinated, this could be a cause for concern and may require additional follow-up.
6. If applicable, include details about any previous incidents involving the same animal or any known aggression issues. This information can be crucial in evaluating the risks associated with the animal and determining the appropriate course of action.
7. Finally, sign and date the referral form, acknowledging that the information provided is accurate to the best of your knowledge. Keep a copy of the completed form for your records.

Who needs an animal bite referral form?

1. Individuals who have been bitten by an animal and require medical attention.
2. Healthcare professionals who treat and care for patients with animal bites.
3. Animal control agencies or local authorities responsible for investigating and monitoring animal bite incidents.
4. Public health departments or agencies that track and analyze animal bite data to identify potential risks and develop prevention strategies.

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