"Reportable Disease Case Report Form" - Colorado

Reportable Disease Case Report Form is a legal document that was released by the Colorado Department of Agriculture - a government authority operating within Colorado.

Form Details:

  • The latest edition currently provided by the Colorado Department of Agriculture;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Colorado Department of Agriculture.

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* Download form to computer prior to completing * Email completed form to animalhealth@state.co.us *
REPORTABLE DISEASE CASE REPORT FORM
Colorado Department of Agriculture
Phone: (303)869-9130
Animal Health Division
Fax: (303)466-8515
305 Interlocken Parkway
Hours: Mon – Fri 8am – 5pm
Broomfield, CO 80021-3484
Email: animalhealth@state.co.us
After hours: Phone message will indicate staff veterinarian on call
Veterinarian:
Clinic:
Date:
Veterinarian Phone:
Veterinarian Email:
Animal Owner Name:
Owner Phone:
Owner Address:
Owner Email:
Species:
Breed:
Age:
Sex:
Animal Purpose:
Animal Name
:
Official ID:
(if applicable)
Animal Address
:
County:
(if different than owner)
Clinical diagnosis or suspected condition:
Date of onset:
Clinical Signs/History:
Treatment:
Yes
No
If yes, summarize treatment:
Animal Status:
Dead
Alive
Euthanized
Recovering
Number (and species) of animals affected:
Other animals on premises:
Tests requested:
Laboratory:
Date Submitted:
* Download form to computer prior to completing * Email completed form to animalhealth@state.co.us *
REPORTABLE DISEASE CASE REPORT FORM
Colorado Department of Agriculture
Phone: (303)869-9130
Animal Health Division
Fax: (303)466-8515
305 Interlocken Parkway
Hours: Mon – Fri 8am – 5pm
Broomfield, CO 80021-3484
Email: animalhealth@state.co.us
After hours: Phone message will indicate staff veterinarian on call
Veterinarian:
Clinic:
Date:
Veterinarian Phone:
Veterinarian Email:
Animal Owner Name:
Owner Phone:
Owner Address:
Owner Email:
Species:
Breed:
Age:
Sex:
Animal Purpose:
Animal Name
:
Official ID:
(if applicable)
Animal Address
:
County:
(if different than owner)
Clinical diagnosis or suspected condition:
Date of onset:
Clinical Signs/History:
Treatment:
Yes
No
If yes, summarize treatment:
Animal Status:
Dead
Alive
Euthanized
Recovering
Number (and species) of animals affected:
Other animals on premises:
Tests requested:
Laboratory:
Date Submitted: