Republic of the Philippines

Department of Health
SAN LAZARO HOSPITAL
Manila, Philippines

REPORT FORM ON ANIMAL BITE/HUMAN RABIES

WITH COHORT ANALYSIS

YEAR: QUARTER: REGION:

NCR
ANIMAL BITE CASES TOTAL HR
POST EXPOSURE
SEX AGE BITING ANIMAL Cat II
AB PROPHYLAXIS
& III
NEW MALE FEMALE <15 >15 DOG CAT OTHERS Cat I Cat II Cat III No. PR TCV ERIG HRIG
TOTAL NCR
OUTSIDE NCR
TOTAL
Manila
Quezon City
Kalookan City
Pasay
Valenzuela
Paranaque
Las Pinas
Mandaluyong
Marikina
Malabon
Navotas
Taguig
Pasig
San Juan
Muntinlupa
Makati
Others:

FM-MS-OPD-001
Date Effective: October 12, 2018, Rev. 0 Page | 1
 Republic of the Philippines
Department of Health
SAN LAZARO HOSPITAL
Manila, Philippines

REPORT FORM ON ANIMAL BITE/HUMAN RABIES

WITH COHORT ANALYSIS

YEAR: QUARTER: REGION: OUT SIDE

NCR
ANIMAL BITE CASES TOTAL HR
POST EXPOSURE
SEX AGE BITING ANIMAL Cat II
AB PROPHYLAXIS
& III
FEMAL
NEW MALE <15 >15 DOG CAT OTHERS Cat I Cat II Cat III No. PR TCV ERIG HRIG
E
Bulacan
Cavite
Rizal
Pampanga
Pangasinan
Laguna
Nueva Ecija
Tarlac
Batangas
Camarines Sur
Davao del Sur
Palawan
Ilocos Sur
Isabela
Bohol
Visayas
Cagayan
Antipolo
Leyte
Zambales
N. Occidental
La Union
Iligan
Misamis Occidental
Negros Oriental
Others:

FM-MS-OPD-001
Date Effective: October 12, 2018, Rev. 0 Page | 2
 Republic of the Philippines
Department of Health
SAN LAZARO HOSPITAL
Manila, Philippines

REPORT FORM ON ANIMAL BITE/HUMAN RABIES

WITH COHORT ANALYSIS

Quarter:
Number
Category of Exposure Number with RIG Outcome of Category II & III
Registered
TOTAL: NCR & OUTSIDE NCR Complete(Day 0,3,7) Incomplete None Died
Category II
Category III
Total

Number
Category of Exposure Number with RIG Outcome of Category II & III
Registered
TOTAL: NCR Complete(Day 0,3,7) Incomplete None Died
Category II
Category III
Total

Number
Category of Exposure Number with RIG Outcome of Category II & III
Registered
TOTAL: OUTSIDE NCR Complete(Day 0,3,7) Incomplete None Died
Category II
Category III
Total

Prepared by: __________________________________ Approved by:

Noted by:

______________________________________ ______________________________________

Chief Resident, Department of Family Medicine Head, Out Patient Department

San Lazaro Hospital San Lazaro Hospital

FM-MS-OPD-001
Date Effective: October 12, 2018, Rev. 0 Page | 3