Veterinary Reporting System

The Veterinary Reporting System allows veterinarians to report disease processes for communicable and zoonotic diseases. This is a voluntary reporting system that collects information from five Midwestern States and reports to veterinarians quarterly regarding emerging disease processes or epidemics

Veterinary Hospital Name (required) *

Veterinary Hospital Address

Veterinary Hospital City

Veterinary Hospital Zip Code (required) *

Disease Process

Diagnostic Modalities and Results: (Include serovariants, strain, or verified causative agent)

Species Affected (breed predilection?)

Age or Age Range of Affected

Date or Date Range of Presentation

(e.g. January 2015, or March 15, 2015)

Number Affected

Mortality?

Yes

If YES, were necropsies performed or tissue submitted?

Yes

If YES, what were the results?

Patient's Vaccination History

Patient's diet or other exacerbating environmental concerns

Any humans displaying signs, symptoms or complaints?

Yes

If YES, please explain.

Contact Information for follow up questions on this report: Contact Name

Contact Phone

Contact Email

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