Canine Brucellosis Case Update Form
Use this form to update details of an existing canine brucellosis case. Please complete all sections accurately.
Case ID
*
Animal Identifier (Microchip, Tag, or Other)
*
Date of Update
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Person Completing Update
*
Current Clinical Status
*
Please Select
Asymptomatic
Symptomatic
Recovered
Deceased
Recent Exposure History
*
Please Select
No known new exposures
Contact with infected animals
Exposure at breeding facility
Other (specify in notes)
Most Recent Diagnostic Test Performed
*
Please Select
Serology
PCR
Culture
Other (specify in notes)
Diagnostic Test Result
*
Please Select
Positive
Negative
Pending
Not performed
Current Treatment Status
*
Please Select
Not treated
Treatment ongoing
Treatment completed
Treatment discontinued
Isolation or Quarantine Status
*
Please Select
Currently isolated/quarantined
Released from isolation/quarantine
Not isolated/quarantined
Follow-up Plan and Additional Notes
Submit Update
Should be Empty: