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  1. Biting Animal Information

  2. Biting Animal Owner's Information

  3. Human Victim Information - If not human enter N/A

  4. Victim's Sex at Birth
  5. Animal Victim Information - If not an animal enter N/A

  6. Animal's Rabies Vaccination Record if Available
  7. Animal Victim Owner's Information

  8. Person or Facility Reporting

  9. Has the Victim Received Medical Care?
  10. Are You the Bite Victim?
  11. Leave This Blank:

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