When a New Jersey patient starts rabies post-exposure treatment, the treating provider reports it on this form. It records the exposure type, body part, animal, circumstances, the animal's rabies status and the treatment given, and goes to the Health Officer of the patient's municipality, who forwards a copy to NJDOH's Communicable Disease Service. Here 'CDC' is New Jersey's own prefix, not the federal agency.
The treating health care provider completes the patient, exposure and treatment fields and signs. The local Health Officer adds their name, the health department and the date initially reported.
Download the current version from the source each time; forms change without notice.
Report of Rabies Post-Exposure Treatment
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The Health Officer of the municipality where the patient resides, by fax, mail or phone. The Health Officer retains a copy and forwards the completed form to the New Jersey Department of Health, Communicable Disease Service. The current version's footer reads 'CDC-2 NOV 15'.
The species, from bat, cat, dog, raccoon, skunk and fox to groundhog, ferret and horse; the circumstances, from unprovoked attack to feeding, handling or skinning the animal; and its rabies status: tested positive, tested negative, under confinement, not available, unsatisfactory for testing or other.