HomeMy WebLinkAboutRabies - 1996VAQ&xWomy ex ows MMQ Kgrioniture
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Massachusetts Department of Food and Agriculture
Division of Regulatory Services
.t.'r Bureau of Animal Health
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NOTICE OF POSSIBLE EXPOSURE TO RABIES AND QUARANTINE ORDER
Your pet may have been exposed to rabies as a result of recent exposure to wildlife or
a high -risk domestic animal. If your animal is unvaccinated, you are strongly urged to have
it euthanized (unless animal was only exposed by proximity). If you do not, you are hereby
ordered to (check appropriate measure):
isolate your pet for 3 months, followed by 3 months of strict confinement. Vaccinate
the animal 1 month prior to release, and revaccinate between 9 and 12 months later.
strictly confine your pet for 6 months, and vaccinate the animal 1 month prior to
release, and revaccinate between 9 and 12 months later.
vaccinate your pet immediately and closely observe the animal for 6 months,
revaccinate between 9 and 12 months later.
If your animal is currently vaccinated, you are hereby ordered to:
vaccinate your pet immediately followed by 3 months strict confinement.
'/S bays
vaccinate your pet immediately and closely observe the animal for 3-mentxg ,
You are to inform your veterinarian immediately of any unusual behavior or change in
the health status of this animal, Any animal which dies for anv reason while under
quarantine must be submitted for rabies testing.
Animal was euthanized. DATE.OF EXPOSURE:
,
Name of Owner: uelG
�_Phone N--o .:
Address: =r,S'�rlzip:/nTown:/y
Type of Animal: _Dog Cat_ Other (specify)
Name of Animal: /'//SSy Breed: //S/"/-
Colors:�.
Age: &.n Date of last rabies vaccination prior to exposure: /G /0 1 Vaccination
Duration: 1 yvs 3 yr_ Unknown Date of post exposure vaccination
Date of Order of Quarantine(to be given to current vaccinates only)
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Name of Veterinarian: 'L,/lje,/i/y6y jt Phone No.:
Name of Animal Inspector: _.'Seery �,ni yt
Town: zZZ/I<OG//Q Phone No.: cy' �(a� i36
Signature of Animal Inspector
Date:
See back side of this form for explanation of Isolation, Strict Confinement, Close
Observation, Exposure by Proximity, Quarantine and Signs of Rabies.
I hereby certify that I have read both sides of this document and I agree to follow the
provisions described in it.
Signature of Owner or Other Responsible Person Refused to sign, but Order was Issued
Animal Inspector please initial if not signed
OWNER'S COPY --
This order is enforceable under MGL Chapter 129; section 21, 330 CMR 4,03.
"UpaxLaw"t ®z Y000 &no Agraculture
Division of Anima Health
Your pet may have been exposed to rabies as a result of recent
exposure to wildlife or a high -risk domestic animal. If your animal is
unvaccinated, you are strongly urged to have it euthanized. If you do not,
you are hereby ordered to (check appropriate measure):
isolate your pet for 3 months, followed by 3 months of strict
nfinement, and vaccinate the animal 1 month prior .to release.
strictly confine your pet for 6 months, and vaccinate the animal 1
month prior to release
If your animal is currently vaccinated, you are hereby ordered to:
vaccinate your pet immediately followed by 3 months strict confinement
vaccinate your pet immediately and closely observe the animal for 3
months
You are to inform Your veterinarian immediately of any unusual
behavior or change is the h ith status of this animal.
Name of Owner: k_,,N IIIL,O Phone No.:�
Address: �-�l�i zipJ:)-20 9
Type of Animal: Dog ® Cat ® other (specify)
Name of animal:Q
'AQ Breed: Colors:
Age:.te of last rabies vaccination: Date of booster:_Y�,.____
�(if given)
Name of veterinarian:, Phone No.:
Name of Animal Control Official:
Phone No.:
Town:
Signature of Animal control official:
Date:
Send 1 copy each to the Division of Epidemiology, 305 South Street, Jamaica
Plain, MA 02130, and to the Division of Animal Health, 100 Cambridge
Street - Floor 21, Boston, MA 02202