American Fancy Rat and Mouse Association
Seoul Hantavirus Survey
Names will be kept confidential

Do not press the ENTER or RETURN key!

Fields with a * are required fields.


Name*:
City*:   State*:
Country (if not U.S.A):

E-mail address*:   

Rattery Name (include prefix initials–up to 4 characters):

Web Site Address:

Was the owner tested? Y    N
If yes, what were the results and was there any illness:

Were any family members tested? Y    N    Number tested
If yes, the results, and was there any illness:

Any wild rat exposure or wild rat crosses you are working with? Y    N
If so, when was the exposure or when/where did you get the wild crossed stock:

Do you allow your rats to free-range indoors or outside? Y    N
Comments:

Do you participate in rat swap meets/parties/round-ups? Y    N
Comments:

Total number rats owned at time of testing

Number of rats tested     Date
(how many male, how many female, and ages)

If didn’t test all rats, which ones tested (1 from each cage, all adults, all new rats brought in, new rats plus ones they were exposed to, etc.)

Type of test: Serology (SEO IgG - antibodies)     PCR (RT-PCR - live virus)    Both IgG & PCR

Number tested POS
Number tested POS SEO IgG
Number tested POS RT-PCR

Number tested NEG

Relationship of POS to others (cagemates, came from same breeder, breeding partners, etc.)

Number rats killed    (# POS , # NEG )
Comments:

Number getting retested
(how many male, how many female, and ages)

Type of retest: Serology (SEO IgG - antibodies)     PCR (RT-PCR - live virus)    Both IgG & PCR

Retest results 1: number POS , number NEG    Date

Retest results 2: number POS , number NEG    Date

Retest results 3: number POS , number NEG    Date

Additional Comments:

Send a copy of your test results to: survey@afrma.org

Optional:
Fees incurred (test itself, vet charges)

Test facility used (CDC, IDEXX, Charles River, a university, etc.)

Vet used (name, vet hospital, address, web site)


Before sending this form, you should print it for your records.
After you press SEND, you should get a screen thanking you for sending your survey.




If you do not get the “Thank You” screen, then your survey didn’t go through and you will need
to copy this page and paste into a regular e-mail and send it to survey@afrma.org.

March 31, 2017