Get the free rabies request form 4110 - slh wisc

Rabies Requisition Form (1/06) FORM 4110 Submitter Information: 1. Reason for Rabies Testing Human Exposure (complete sections 2A, 3, 4, 5) Animal Exposure (complete sections 2B, 3, 4, 5) Other (complete

How to fill out rabies request form 4110

How to fill out rabies request form 4110:

1. Start by entering your personal information in the designated fields. This includes your full name, address, contact number, and email address.
2. Next, provide information about the animal for which you are requesting the rabies form. This includes the animal's name, species (e.g., dog, cat, etc.), breed, age, and color.
3. Specify the vaccination history of the animal. Indicate the date of the last rabies vaccination and the name and contact information of the veterinarian who administered it.
4. If the animal has ever had a reaction to a previous rabies vaccination, make sure to mention it in the appropriate section.
5. Fill out the section regarding the symptoms or reasons for requesting the rabies form. Provide a detailed explanation of why you need the form and what observations or concerns you have regarding the animal's health.
6. If applicable, provide any additional information or documentation that may support your request for the rabies form. This could include medical records, reports, or statements from witnesses.
7. Lastly, sign and date the form to certify that the information provided is accurate and complete.

Who needs rabies request form 4110:

1. Individuals who have recently witnessed or encountered an animal that could potentially exhibit symptoms of rabies may need to fill out form 4110. This could include people who have been bitten, scratched, or otherwise exposed to an animal that may be infected with rabies.
2. Animal control officers, veterinarians, or other professionals involved in handling and testing animals suspected of having rabies may also need to utilize the rabies request form 4110. This form helps document and track the necessary information for proper testing and follow-up procedures.

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What is rabies request form 4110?

Rabies request form 4110 is a form used for reporting instances of rabies exposure or suspected rabies cases.

Who is required to file rabies request form 4110?

Veterinarians, animal control officers, and healthcare professionals are required to file rabies request form 4110.

How to fill out rabies request form 4110?

Rabies request form 4110 must be filled out with details of the incident, including the animal involved, the location, and any individuals exposed to the rabies virus.

What is the purpose of rabies request form 4110?

The purpose of rabies request form 4110 is to track and control instances of rabies exposure in order to prevent the spread of the disease.

What information must be reported on rabies request form 4110?

Information such as date of exposure, animal species, vaccination status, and contact information of individuals involved must be reported on rabies request form 4110.