Form CDS-31 "Out-of-State Animal Bite Report" - New Jersey

What Is Form CDS-31?

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

Form Details:

  • Released on August 1, 2012;
  • The latest edition provided by the New Jersey Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form CDS-31 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.

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Download Form CDS-31 "Out-of-State Animal Bite Report" - New Jersey

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New Jersey Department of Health
OUT-OF-STATE ANIMAL BITE REPORT
Report Received By (Name)
Date
Time
Reported By
Telephone Number
Animal Name (or ID)
Animal Type
Animal Age
Animal Sex
Animal Breed
Animal Color
Date of Bite
Geographic Location of Bite
PERSON BITTEN
Name of Person Bitten (First, Last)
Date of Birth
Telephone Number
Street Address
PO Box, Apt., Suite
Cell Phone Number
City
State
Zip Code
Email Address
Is patient a minor?
If Yes, Name and Telephone Number of Parent/Guardian
Yes
No
ANIMAL OWNER INFORMATION
Name of Animal Owner (First, Last)
Telephone Number
Street Address
PO Box, Apt., Suite
Cell Phone Number
City
State
Zip Code
Email Address
Name, Address and Telephone Number of Veterinarian
MEDICAL CARE PROVIDER
Name of Medical Care Provider
Telephone Number
Street Address
PO Box, Apt., Suite
Cell Phone Number
City
State
Zip Code
Email Address
Was rabies treatment started?
If Yes, Date Treatment Started
Yes
No
CIRCUMSTANCES OF THE BITE
Location on Body where Bite Occurred
NOTES
CDS-31
AUG 12
New Jersey Department of Health
OUT-OF-STATE ANIMAL BITE REPORT
Report Received By (Name)
Date
Time
Reported By
Telephone Number
Animal Name (or ID)
Animal Type
Animal Age
Animal Sex
Animal Breed
Animal Color
Date of Bite
Geographic Location of Bite
PERSON BITTEN
Name of Person Bitten (First, Last)
Date of Birth
Telephone Number
Street Address
PO Box, Apt., Suite
Cell Phone Number
City
State
Zip Code
Email Address
Is patient a minor?
If Yes, Name and Telephone Number of Parent/Guardian
Yes
No
ANIMAL OWNER INFORMATION
Name of Animal Owner (First, Last)
Telephone Number
Street Address
PO Box, Apt., Suite
Cell Phone Number
City
State
Zip Code
Email Address
Name, Address and Telephone Number of Veterinarian
MEDICAL CARE PROVIDER
Name of Medical Care Provider
Telephone Number
Street Address
PO Box, Apt., Suite
Cell Phone Number
City
State
Zip Code
Email Address
Was rabies treatment started?
If Yes, Date Treatment Started
Yes
No
CIRCUMSTANCES OF THE BITE
Location on Body where Bite Occurred
NOTES
CDS-31
AUG 12