Clinical Animal Health Report

This is a requirement for all research and teaching animals managed by NC State not directly housed at the CVM within Veterinary Services. This form conveys information about animal health, behavior, well-being, appropriate treatments, and /or euthanasia. The veterinarian has the primary responsibility for this form but this responsibility can be delegated to the facility manager as applicable.

This document meets 2.33(a)(3)(b)(3) of the Animal Welfare Act and Regulations as a mechanism of direct and frequent communication so that timely and accurate information on problems of animal health, behavior, and well-being is conveyed to the attending veterinarian.

"*" indicates required fields

Name*

First Last

Email*

Date*

Please enter the date that the incident occured.

Is this a single animal, or a group of animals?*

Single

Group

Species*

Animal Identification(s) – i.e., cage card, number tattoo, tag number, etc.*

IACUC Protocol Number*

Principal Investigator*

Name of Clinician (DVM) or Title of Standard Operating Procedure (SOP) Being Followed*

Associated College*

Location (Animal Unit)*

If "Other" please describe*

Please describe the problem*

What is the diagnosis?*

What treatment(s) will be used?*

Please provide any other relevant information

Is an SOP needed to address this problem?*

Yes

Please explain

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