20____ RABIES EXPOSURE REPORT

____________________________________
GENDER

AGE

QUARTER
M

TOTA
L

Age
>15

Age
<15

REPORTING ANIMAL BITE TREATMENT CENTER:

BITING ANIMAL

TOTA
L

Dog

Cat

Other
s

CATEGORY OF
EXPOSURE

TOTA
L

Cat
1

Cat
II

Cat III

POST EXPOSURE
PROPHYLAXIS
Total
CAT II
AND
CAT III

TCV

HRI
G

ERI
G

Treatment
Outcome
Completed
up to day 7

Contd
up to
day 28

REFERRALS
Day
0
only

Day
0
and
day
3

Referre
d to
other
ABTC

Transfer
red
from
other
ABTC

HUMAN
RABIES
CASE

PRE EXPOSURE
PROPHYLAXIZ
OTHER
SCHOOL
S
CHILDR
EN

FIRST
2ND

2721

2853

5574

3382

2192

5574

3928

1609

37

5574

5163

411

5574

5574

10

199

34

3RD
4TH
ANNUAL
TOTAL
For columns under TCV, HRIG & ERIG- compute for the total number of patients who received PEP regardless of the dose

PREPARED BY: __________________________________________

DESIGNATION

NOTED BY: ___________________________________________________

SUPERVISOR