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Bite/Scratch/Exposure Information Form

  1. Biting/Scratching Animal Information

  2. Biting/Scratching 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/Scratch Victim?
  11. Leave This Blank:

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