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INCIDENT/BITE REPORT

  1. Who was bitten/exposed?*

  2. BITE VICTIM INFORMATION

  3. SKIN BROKEN?

  4. BITTEN THROUGH CLOTHING?

  5. ANTI-RABIES PROPHYLAXIS GIVEN?

  6. RABIES VACCINATION?

  7. ANIMAL CURRENTLY ALIVE?

  8. BITING ANIMAL INFORMATION

  9. STATUS*

  10. SEX

  11. RABIES VACCINATION?

  12. ANIMAL CURRENTLY ALIVE?

  13. Leave This Blank:

  14. This field is not part of the form submission.