Form 303 "Rabies Examination Submittal Form" - California

What Is Form 303?

This is a legal form that was released by the California Department of Public Health - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on February 23, 2016;
  • The latest edition provided by the California Department of Public Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form 303 by clicking the link below or browse more documents and templates provided by the California Department of Public Health.

ADVERTISEMENT
ADVERTISEMENT

Download Form 303 "Rabies Examination Submittal Form" - California

932 times
Rate (4.6 / 5) 65 votes
California Department of Public Health - Viral and Rickettsial Disease Laboratory
Rabies Examination Submittal Form
Date received and VRDL Specimen Accession #
Animal Species
PLACE VRDL ACCESSION LABEL HERE
Date Collected
Date Sent
Submitter ID
Human(s) Exposure?
Name(s)
Date
Exposure Type
Human body part(s) w/ bite/exposure
Comments
ANIMAL HISTORY
Animal Vaccine History
Nature of Contact/Attack
Animal Status When Found
SubsequentHistory
Were other animals bitten or exposed?
If yes, what species?
Date of Exposure
Exposure Type
Comments
SPECIMEN(S) SUBMITTED
Whole Animal
Brain stem and bilateral samples of the hippocampus and/or cerebellum
Whole Head
Stained & unstained slides
Other (describe):
Specimen Requirements and Shipping Instructions
SPECIMEN REQUIREMENTS - Whenever possible, the brain of the animal should be removed. The entire head
may be sent for bats or other small animals. Proper sampling of the brain consists of collecting 2-5 grams of brain
tissue, including cross section of brain stem and cerebellum. If the cerebellum is not available, bilateral cross
sections of the hippocampus may be sent. Brain stem and cerebellum must be clearly labeled and put into
separate containers so we can be sure that we are receiving the correct samples.
NOTE: Do not formalin fix the brain tissue. Freezing brain samples should be avoided whenever possible since it
damages the brain tissues and makes it more difficult to prepare satisfactory slides. Glycerol saline is no longer
acceptable to avoid bacterial contamination, because it can interfere with the staining reaction.
SHIPPING INSTRUCTIONS - Brain specimens, which should be received by the VRDL within 48 hours of sampling,
may be stored and shipped at 4 C. Call the VRDL at (510) 307-8585 for a consultation if these conditions cannot be
met. Specimens (whole bats, heads or cross section of the brain stem and cerebellum or hippocampus if
cerebellum is not available) should be sent via an overnight delivery service inside a tightly sealed inner
container(s) placed inside a shipping container certified for shipment of clinical samples. Add several cold packs
to keep the specimen cool during shipment. Place this form inside a plastic bag so it will not get moist and
include inside the shipping container.
For cases involving a human exposure to suspected rabid animal, call the VRDL at (510) 307-8585 before
shipping specimens.
The VRDL is required to initiate an animal rabies case report form for all animals positive for rabies. This case
report form will be mailed to the submitter for completion and an informational copy sent to the Department of
Health Services Veterinary Public Health Section (VPHS). The submitter is responsible for sending the completed
form to the VPHS. To obtain more information: Viral and Rickettsial Disease Laboratory (VRDL) Phone (510)
307-8585
Fax (510) 307-8599
California Department of Public Health - Viral and Rickettsial Disease Laboratory
Rabies Examination Submittal Form
Date received and VRDL Specimen Accession #
Animal Species
PLACE VRDL ACCESSION LABEL HERE
Date Collected
Date Sent
Submitter ID
Human(s) Exposure?
Name(s)
Date
Exposure Type
Human body part(s) w/ bite/exposure
Comments
ANIMAL HISTORY
Animal Vaccine History
Nature of Contact/Attack
Animal Status When Found
SubsequentHistory
Were other animals bitten or exposed?
If yes, what species?
Date of Exposure
Exposure Type
Comments
SPECIMEN(S) SUBMITTED
Whole Animal
Brain stem and bilateral samples of the hippocampus and/or cerebellum
Whole Head
Stained & unstained slides
Other (describe):
Specimen Requirements and Shipping Instructions
SPECIMEN REQUIREMENTS - Whenever possible, the brain of the animal should be removed. The entire head
may be sent for bats or other small animals. Proper sampling of the brain consists of collecting 2-5 grams of brain
tissue, including cross section of brain stem and cerebellum. If the cerebellum is not available, bilateral cross
sections of the hippocampus may be sent. Brain stem and cerebellum must be clearly labeled and put into
separate containers so we can be sure that we are receiving the correct samples.
NOTE: Do not formalin fix the brain tissue. Freezing brain samples should be avoided whenever possible since it
damages the brain tissues and makes it more difficult to prepare satisfactory slides. Glycerol saline is no longer
acceptable to avoid bacterial contamination, because it can interfere with the staining reaction.
SHIPPING INSTRUCTIONS - Brain specimens, which should be received by the VRDL within 48 hours of sampling,
may be stored and shipped at 4 C. Call the VRDL at (510) 307-8585 for a consultation if these conditions cannot be
met. Specimens (whole bats, heads or cross section of the brain stem and cerebellum or hippocampus if
cerebellum is not available) should be sent via an overnight delivery service inside a tightly sealed inner
container(s) placed inside a shipping container certified for shipment of clinical samples. Add several cold packs
to keep the specimen cool during shipment. Place this form inside a plastic bag so it will not get moist and
include inside the shipping container.
For cases involving a human exposure to suspected rabid animal, call the VRDL at (510) 307-8585 before
shipping specimens.
The VRDL is required to initiate an animal rabies case report form for all animals positive for rabies. This case
report form will be mailed to the submitter for completion and an informational copy sent to the Department of
Health Services Veterinary Public Health Section (VPHS). The submitter is responsible for sending the completed
form to the VPHS. To obtain more information: Viral and Rickettsial Disease Laboratory (VRDL) Phone (510)
307-8585
Fax (510) 307-8599
LOCAL LABORATORY RESULTS
Please send your controls, stained and unstained specimen slides along with the specimen so the
VRDL may look at the same slides that were observed in your laboratory.
Local Laboratory Test Results
Description ofreading
Select Conjugate(s) Used
Millipore 5100
Fujirebio
Millipore 6500
Millipore 5500
Other (describe):
Submitter Information
For a consultation, please contact the VRDL.
California Department of Public Health, Viral and Rickettsial Disease Laboratory, 850 Marina Bay Parkway,
Richmond, CA 94804
Phone (510) 307-8585 Fax (510) 307-8578
Rabies Examination Submittal Form 303 (Revised 02/23/2016)
Page of 2