P.A.W.S. Bite Report

P.A.W.S. Bite Report

Date
Was a statement taken?
BI Number
Patient First Name *
Patient Last Name *
Patient Address *
Patient City *
Patient State *
Patient Zip Code *
Phone Number *
Alt. Phone:
Email Address
Date of Birth *
Parent/Guardian
Date of bite *
Time of Bite
Address where bitten *
Circumstances of the bite?
Nature and location of injury
Was the bite verified by ACO *
Treatment Given
Treatment received at:
Owner's name
Address
City
State
Zip Code
Owner's Phone Number
Description of Animal
Species
Breed
Age
Color
Sex
Date Investigated
Is the animal vaccinated?
If Vaccinated, administering Vet
Date Commenced
Place of Quarantine
Disposition after/during Quarantine
Date Released
Investigator Signature