cobraman
10-21-04, 10:32 PM
Feel free to copy and customize to your needs. Ray Hunter
POST SNAKEBITE PROTOCOL DATA
Table of Contents:
Post Bite Report
Patient Identification & Medical Information
Sources of Antivenom
Emergency Notifications
Past Labs & Medical Records
Copy of Venomous Permit
Antivenom Package Inserts
Living Will
Misc. Info & Contacts
POST SNAKEBITE REPORT
For:
NAME:__________________________ D.O.B.:________
ADDRESS:______________________________________
S.S.#:____________________ PHONE#:_____________
NEXT OF KIN:__________________________________
ADDRESS:______________________________________
PHONE:________________________________________
TREATING PHYSICIAN:________________________
------------------------------------------------------------------------
Date of Bite:____________ Time of Bite:_____________
Location of Bite:_________________________________
Type of Snake:___________________________________
Size of Snake:______________ Secured?:____________
-----------------------------------------------------------------------
ACTION TAKEN:
Time: / Action Taken
______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________
Medical & General Info for:
____________________
***Privileged Information***
Full Name:______________________________
D.O.B.:_________________________________
S.S.#:___________________________________
Address:________________________________
________________________________
Phone #:________________________________
Place Of Employment:___________________
________________________________________
Next of Kin:______________________________
Address:______________________________
_______________________________
Phone #:_____________________________
_______________________________
ALLERGIES:____________________________
Current Meds.:__________________________
___________________________
History of Illnesses:______________________
_______________________________________
________________________________________
Treating Physician:_______________________
Phone #:_______________________________
Other Info:______________________________
ANTIVENOM SOURCES
1) Miami Dade Antivenom Bank: 305-596-8576 Contact: Al Cruz
Miami, FL
2) Ray Hunter, Hunter Serpentology: 772-215-7625 Contact: Ray
Palm City, FL
3) Miami Serpentarium Labs: 941-639-8888 Contact: Bill Haast
Punta Gorda, FL
4) Reptile World Serpentarium: 407-892-6905 Contact: George VanHorn. St. Cloud, FL
5) Antivenom Index: 405-271-5454 Oklahoma City
SNAKEBITE TREATMENT EXPERTS
1) Bernard Kurecki, M.D. : 772-336-9600 off, 772-336-5094 hm
Port St. Lucie, FL (RAYS DOCTOR FOR SNAKEBITES)
2) Findley Russell, M.D. : 602-626-4047 Arizona
3) Bill Haast (Miami Serpentarium) 941-639-8888
4) Poison Control: 800-282-3171
5) Arizona Poison Control: 602-626-6016 Univ. of Arizona
6) Antivenom Index: 405-271-5454 Oklahoma City
EMERGENCY NOTIFICATIONS
NAME: RELATIONSHIP: PHONE #s
_______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________
OTHER ITEMS TO INCLUDE:
*Antivenom Index from AZA
Copy of most recent lab work
Copy of Photo ID
Antivenom Package Inserts
Venomous Permits
Living Will
POST SNAKEBITE PROTOCOL DATA
Table of Contents:
Post Bite Report
Patient Identification & Medical Information
Sources of Antivenom
Emergency Notifications
Past Labs & Medical Records
Copy of Venomous Permit
Antivenom Package Inserts
Living Will
Misc. Info & Contacts
POST SNAKEBITE REPORT
For:
NAME:__________________________ D.O.B.:________
ADDRESS:______________________________________
S.S.#:____________________ PHONE#:_____________
NEXT OF KIN:__________________________________
ADDRESS:______________________________________
PHONE:________________________________________
TREATING PHYSICIAN:________________________
------------------------------------------------------------------------
Date of Bite:____________ Time of Bite:_____________
Location of Bite:_________________________________
Type of Snake:___________________________________
Size of Snake:______________ Secured?:____________
-----------------------------------------------------------------------
ACTION TAKEN:
Time: / Action Taken
______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________
Medical & General Info for:
____________________
***Privileged Information***
Full Name:______________________________
D.O.B.:_________________________________
S.S.#:___________________________________
Address:________________________________
________________________________
Phone #:________________________________
Place Of Employment:___________________
________________________________________
Next of Kin:______________________________
Address:______________________________
_______________________________
Phone #:_____________________________
_______________________________
ALLERGIES:____________________________
Current Meds.:__________________________
___________________________
History of Illnesses:______________________
_______________________________________
________________________________________
Treating Physician:_______________________
Phone #:_______________________________
Other Info:______________________________
ANTIVENOM SOURCES
1) Miami Dade Antivenom Bank: 305-596-8576 Contact: Al Cruz
Miami, FL
2) Ray Hunter, Hunter Serpentology: 772-215-7625 Contact: Ray
Palm City, FL
3) Miami Serpentarium Labs: 941-639-8888 Contact: Bill Haast
Punta Gorda, FL
4) Reptile World Serpentarium: 407-892-6905 Contact: George VanHorn. St. Cloud, FL
5) Antivenom Index: 405-271-5454 Oklahoma City
SNAKEBITE TREATMENT EXPERTS
1) Bernard Kurecki, M.D. : 772-336-9600 off, 772-336-5094 hm
Port St. Lucie, FL (RAYS DOCTOR FOR SNAKEBITES)
2) Findley Russell, M.D. : 602-626-4047 Arizona
3) Bill Haast (Miami Serpentarium) 941-639-8888
4) Poison Control: 800-282-3171
5) Arizona Poison Control: 602-626-6016 Univ. of Arizona
6) Antivenom Index: 405-271-5454 Oklahoma City
EMERGENCY NOTIFICATIONS
NAME: RELATIONSHIP: PHONE #s
_______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________
OTHER ITEMS TO INCLUDE:
*Antivenom Index from AZA
Copy of most recent lab work
Copy of Photo ID
Antivenom Package Inserts
Venomous Permits
Living Will