Get Rabies Request Form 4110

Filling out the Rabies Request Form 4110 online is an important step in addressing potential rabies exposure. This guide provides clear and step-by-step instructions to assist users in accurately completing the form.

Follow the steps to successfully complete the Rabies Request Form 4110 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing submitter information. Indicate the reason for rabies testing by selecting either 'Human Exposure,' 'Animal Exposure,' or 'Other.' Based on your selection, complete the relevant sections accordingly.
3. For human exposure, complete section 2A, which requires exposure information such as the exposure date, name of the person exposed, and the physician's details, including their name, address, and phone number. Specify the type of exposure and anatomical site.
4. If animal exposure is involved, fill in section 2B. Provide the necessary exposure details, including whether the animal was vaccinated and the type of exposure. Additionally, include information about the owner of the exposed animal.
5. Proceed to sections 3, 4, and 5 for specimen submission information. In section 3, specify the number and species of animals submitted for testing, their age, vaccination status, and details about their signs.
6. Complete section 4 by entering the veterinarian's name, phone number, and address.
7. Finally, review all entered information for accuracy. You can then save the changes, download, print, or share the completed form as needed.

Complete the Rabies Request Form 4110 online today to ensure a thorough assessment of potential rabies exposure.