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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.

Species Specific Requirements:

Wild animals, dogs, cats, and other domestic animals:

• Decapitate (or arrange with a veterinarian to decapitate) and submit the head.

Bats:

• Submit bats whole. Euthanize bats unless it cannot be performed without risk of escape of the bat or without risk of rabies exposure to the person performing the euthanasia. Ideally, arrange with a pest control company or veterinarian for euthanasia.

• When euthanasia cannot be performed, submit live bats in a small, clear plastic, and well-sealed container in a manner that the bat can be seen within the container. Also, place the container within a leak-proof bag. Make small ventilation holes in the container so the bat can breathe and conspicuously mark the container with "CAUTION-Live Bat".

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.

For testing, the following information must be included on the specimen container:

Name, address, and phone number of people exposed.
Specimen species (Ex. Raccoon)
Record ID of submission form. The Record ID can be found towards the top of the submission form.

Record ID (autogenerated)

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I. Submitter Information

Name:
Organization (if applicable):
Street:	City:	State:	Zip Code:
Phone Number:
Email:
Are you completing this form at RISHL receiving?
Is this specimen being submitted by a courier?

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:

Animal Owned (Y/N)

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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

Exposed County

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Exposed State

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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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Record is visible to RISHL

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Rabies Lab Form

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