0920-0004 Rabies Monthly Report (paper) 55.28

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STATE:

MONTHLY REPORT OF LABORATORY CONFIRMED CASES OF RABIES

REPORT
FOR:

PLEASE RECORD BY COUNTY: POSITIVE (POS) AND TOTAL EXAMINED (EXAM)

COUNTY

CDC
USE
ONLY
(7-9)

DOGS

CATS

CATTLE

OTHER
DOMESTIC

SPECIFY POSITIVE
“OTHER DOMESTIC”
ONLY

SKUNKS

FOXES

BATS

RACCOONS

(1-2)

MONTH (3-4)

RODENTS
AND
LAGOMORPHS

SPECIFY POSITIVE
“RODENTS AND
LAGOMORPHS” ONLY

YEAR (5-6)

OTHER
WILD

(10-13)

(14-17)

(18-21)

(22-25)

(26-29)

(30-33)

(34-37)

(38-41)

(42-45)

(50-53)

(54-57)

(58-61)

(62-65)

(66-69)

(70-73)

(74-77)

(78-81)

(82-85)

POS

EXAM

POS

EXAM

POS

EXAM

POS

EXAM

POS EXAM POS

EXAM

POS

EXAM

POS

EXAM

POS

EXAM

POS EXAM

(46-49)

CDC USE ONLY

SPECIFY POSITIVE
“OTHER WILD”
ONLY

(86-89)

TOTAL POS. and EXAM.

COMMENTS:
(Signature and Title of Reporting Official)

CDC 55.28 REV. 03/2001 (BACK)

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unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden to CDC, Project Clearance Officer, 1600 Clifton Road, MS D-24, Atlanta, GA 30333, ATTN: PRA (0920-0004). Do not send the completed form to this address.

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FORM APPROVED
OMB NO. 0920-0004

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CDC 55.28 REV. 03/2001 (FRONT)

Centers for Disease Control
and Prevention (CDC)
Atlanta, Georgia 30333
__________________________
Official Business
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HEALTH & HUMAN SERVICES

CENTERS FOR DISEASE CONTROL
AND PREVENTION
Viral and Rickettsial Zoonoses Branch
1600 Clifton Road M/S G-13
Atlanta, GA 30333

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