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41 Rabies Exposure Notice 2009 • 1t � I . R-13-2009 05:44P FROM: TO:5871221 Northampton Veterinary Clinic 227 South Street Northampton, MA 01(160 (413) 584-6309 Notice of Possible Exposure To Rabies P.1'1 The Following animal was seen at our practice and presented with wounds from: 1) A confirmed rabid animal (tested positive at State Lab) 2) A suspected rabid animal (raccoon, skunk, woodchuck, fox, bat, etc.) X 3) An unknown source(likely to he another animal) 4)No wounds,but was in proximity to an animal that tested positive for rabies at the State Lab Date of Exposure(or date seen): Y I 13/O f Owners Name: ..0 h M tit nI/I c1 y Phone: (d))CSY-4in Address: Y1 Pitot byt #3? • Town: f44rsyM._ zip: O(O G0 Type of Animal: [Dog((Jj_l [Cat 1 [Other_Rspecify) Age: /6 )'tS Name of Animal: �i f0 LL Breed: l04 Colors:_�a rzy Date of last vaccination- t'l�ttAiti Duration: (lyr_[ [3yrr_) [unknown[ Date of booster vaccination (given to current vaccinates only): /tai .6j ifie!'� Name of Veterinarian: f `ij dIne. bL4& Phone: SI? `36 1 DECcomE1 APR 142109 I NORTHAMPTON BOARD OF HEALTH