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EDCC Disease Alert Request Form
Please provide as much information as possible. Specific locations and names are omitted from public alerts.
Date of case submission
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Name of DVM *
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Source *
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Location of Index Case (County, State) *
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Disease (Select from dropdown) *
Date of onset of clinical signs
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YYYY
Has this case resulted in a quarantine? *
If yes, date the quarantine was established.
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YYYY
Location of index case/facility type (select "Other" if unknown) *
Was this case diagnostically confirmed with laboratory testing? *
If yes, which laboratory confirmed the test results?
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Number of horses affected
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Number of horses exposed
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Number of horses in isolation/quarantine
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Breed, age, and gender of horses affected (if known)
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Was/were the affected horse/s vaccinated against this disease (if applicable)?
Clinical signs observed *
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Number of horses affected and alive
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If alive, is/are the horse/s receiving treatment?
Number of horses affected and deceased
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Number of horses affected and euthanized
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Status of the outbreak (check one) *
Email address (not to be published, for follow-up questions only)
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Phone number (not to be published, for follow-up questions only)
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Link to press release or news page (N/A if not available) *
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Additional contact information
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Has this outbreak resulted in any travel restrictions or state regulations? If so, please outline below or provide a link to information
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