"California Rabies Strain Typing / Species Id Project Submittal Form" - California

California Rabies Strain Typing / Species Id Project Submittal Form is a legal document that was released by the California Department of Public Health - a government authority operating within California.

Form Details:

  • Released on September 27, 2007;
  • The latest edition currently provided by the California Department of Public Health;
  • Ready to use and print;
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  • Compatible with most PDF-viewing applications;

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the California Department of Public Health.

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Download "California Rabies Strain Typing / Species Id Project Submittal Form" - California

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California Department of Public Health - Viral and Rickettsial Disease Laboratory
California Rabies Strain Typing / Species ID Project Submittal Form
Note: This form is to be used only by Public Health Laboratories to submit laboratory confirmed, rabid animals for rabies virus strain typing or any bat for
speciation. The purpose of this study is to gather molecular epidemiology on rabies strains occurring in California and is not to be considered a diagnostic test.
NOTE: When requesting rabies strain typing, please send brain in a separate cryovial if possible.
Location Animal
Rabies
Local PHL
Date
VRDL Accession
Collected
Status
Type of Animal
Service Requested
Accession #
Collected
(completed by VRDL)
(County: Specific locality)
(+ / -)
[
] Cat
] Dog
[ ] Bat
[
] Strain typing
[
[
] Skunk
] Fox
[
] Bat ID
[
[
] Other:________________
[
] Bat ID & Strain typing
[
] Dog
[
] Bat
[
] Strain typing
] Cat
[
[
[
] Fox
[
] Skunk
] Bat ID
[
] Other:________________
[
] Bat ID & Strain typing
[
] Dog
[
] Bat
[
] Strain typing
] Cat
[
[
[
] Fox
[
] Skunk
] Bat ID
[
] Other:________________
[
] Bat ID & Strain typing
[
] Dog
[
] Bat
[
] Strain typing
] Cat
[
[
[
] Fox
[
] Skunk
] Bat ID
[
] Other:________________
[
] Bat ID & Strain typing
[
] Dog
[
] Bat
[
] Strain typing
] Cat
[
[
[
] Fox
[
] Skunk
] Bat ID
[
] Other:________________
[
] Bat ID & Strain typing
[
] Dog
[
] Bat
[
] Strain typing
] Cat
[
[
[
] Fox
[
] Skunk
] Bat ID
[
] Other:________________
[
] Bat ID & Strain typing
[
] Dog
[
] Bat
[
] Strain typing
] Cat
[
[
[
] Fox
[
] Skunk
] Bat ID
[
] Other:________________
[
] Bat ID & Strain typing
[
] Dog
[
] Bat
[
] Strain typing
] Cat
[
[
[
] Fox
[
] Skunk
] Bat ID
[
] Other:________________
[
] Bat ID & Strain typing
California Department of Public Health
Division of Communicable Disease Control
Viral and Rickettsial Disease Laboratory
850 Marina Bay Parkway, Richmond, CA 94804
Phone (510) 307-8575 Fax (510) 307-8599
rev 9/27/2007
.
Submitter, please
or
your complete mailing address in the box above
TYPE
STAMP
California Department of Public Health - Viral and Rickettsial Disease Laboratory
California Rabies Strain Typing / Species ID Project Submittal Form
Note: This form is to be used only by Public Health Laboratories to submit laboratory confirmed, rabid animals for rabies virus strain typing or any bat for
speciation. The purpose of this study is to gather molecular epidemiology on rabies strains occurring in California and is not to be considered a diagnostic test.
NOTE: When requesting rabies strain typing, please send brain in a separate cryovial if possible.
Location Animal
Rabies
Local PHL
Date
VRDL Accession
Collected
Status
Type of Animal
Service Requested
Accession #
Collected
(completed by VRDL)
(County: Specific locality)
(+ / -)
[
] Cat
] Dog
[ ] Bat
[
] Strain typing
[
[
] Skunk
] Fox
[
] Bat ID
[
[
] Other:________________
[
] Bat ID & Strain typing
[
] Dog
[
] Bat
[
] Strain typing
] Cat
[
[
[
] Fox
[
] Skunk
] Bat ID
[
] Other:________________
[
] Bat ID & Strain typing
[
] Dog
[
] Bat
[
] Strain typing
] Cat
[
[
[
] Fox
[
] Skunk
] Bat ID
[
] Other:________________
[
] Bat ID & Strain typing
[
] Dog
[
] Bat
[
] Strain typing
] Cat
[
[
[
] Fox
[
] Skunk
] Bat ID
[
] Other:________________
[
] Bat ID & Strain typing
[
] Dog
[
] Bat
[
] Strain typing
] Cat
[
[
[
] Fox
[
] Skunk
] Bat ID
[
] Other:________________
[
] Bat ID & Strain typing
[
] Dog
[
] Bat
[
] Strain typing
] Cat
[
[
[
] Fox
[
] Skunk
] Bat ID
[
] Other:________________
[
] Bat ID & Strain typing
[
] Dog
[
] Bat
[
] Strain typing
] Cat
[
[
[
] Fox
[
] Skunk
] Bat ID
[
] Other:________________
[
] Bat ID & Strain typing
[
] Dog
[
] Bat
[
] Strain typing
] Cat
[
[
[
] Fox
[
] Skunk
] Bat ID
[
] Other:________________
[
] Bat ID & Strain typing
California Department of Public Health
Division of Communicable Disease Control
Viral and Rickettsial Disease Laboratory
850 Marina Bay Parkway, Richmond, CA 94804
Phone (510) 307-8575 Fax (510) 307-8599
rev 9/27/2007
.
Submitter, please
or
your complete mailing address in the box above
TYPE
STAMP