Rabies Testing Submission Form

Instructions for Submitter: Use this form to submit animal specimens for rabies testing. Complete sections I, II and III below. Submit animal head in double heavy-duty plastic bags. Deliver to the Rhode Island State Health Laboratories 8:30 AM-4:30 PM, Monday through Friday (excluding holidays). RIDOH staff will provide results by telephone (usually within three business days).

Contact the Rhode Island Water Microbiology and Rabies Lab (401-222-5588) for submission questions.
Contact the RIDOH Center for Acute Infectious Disease Epidemiology (401-222-2577) for human exposure case management questions.
Contact the Rhode Island State Veterinarian (401-222-2781) for animal exposure case management questions.

I. Submitter Information

Name:
Organization (if applicable):
Street:	City:	State:	Zip Code:
Phone Number:
Email:
Are you completing this form at RISHL receiving?

II. Specimen Information

Animal Species (Type):

Ownership Status:

Wildlife Rehab ID Number (if applicable):

Law Enforcement Incident Number (if applicable):

If bat, note species:

Bat species, if other:

III. Exposure Information

*If exposure date is unknown, put today's date as the exposure date and include a note below.

Name of Person(s) and/or Pet(s) Potentially Exposed	Phone Number	Address of Exposure	City of Exposure	Date of Exposure

Please provide exposure details:

* must provide value

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Delivered By:
Print Name:	Signature:	Date:

IV. Lab Information and Test Results (For Lab Use Only)

Specimen ID #:	Central Services
	Date/Time Received:	Tech:
	Rabies Laboratory
	Date/Time Received:	Tech:
Results for Rabies:
Results Entered By:		Date/Time:
Reviewed By:		Date/Time:

Positive Result Called Out to RIDOH By:

Call Out Date/Time:

Note About Result:

V. For CAIDE Use

Rabies Called Out By:

Call Out Date:

Notes:

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Rabies Lab Form

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