Zone 1, Zone 1 Andres Bonifacio St,

Baybay City, 6521 Leyte

Phone No. 0926-799-4147
Fb: rabiesbusterABC
Email: rabiesbusteranimalbiteclinic@gmail.com

Informed Consent for Anti-rabies Pre-Exposure Prophylaxis

As patient of Rabies-buster Animal Bite Clinic, you have the right to be informed about any recommended
Prophylaxis so that you may make the decision whether or not to undergo the vaccination. If you have any
questions about any of this information or need help completing this form please do not hesitate to ask any
member of our staff. It is important to us that you’re comfortable with all of this information. By signing you are
indicating that you understand each of the separate paragraphs set forth below and have been given a chance to
ask questions.

Anti-rabies PrEP (Pre-Exposure Prophylaxis) is recommended for anyone who is at continual, frequent or increased
risk for exposure to the rabies virus, as a result of their occupation or residence such as;

 Groups of persons at high risk of exposure to live rabies virus (laboratory staff, veterinarians, Veterinary
Students, animal handlers and wildlife officers)
 Children living in or visiting rabies affected areas may be immunized preventively on a voluntary individual
basis or in mass campaigns when there are no economic, programmatic or logistical obstacles
 Travelers to rabies-affected areas

Rabies-buster Animal Bite Clinic is using WHO recommended Intradermal route of PrEP administration. One
intradermal injection of 0.1 ml on deltoid area of the arm is given on each of days 0, 7, and 21 or 28.

In cases that patient is immunocompromised or has history of the following listed below, WHO recommended
Intramuscular route will be administered. One intramuscular dose is given on each of days 0, 7 and 21 or 28 on
deltoid area of the arm for adults; anterolateral area of the thigh is recommended for children aged less than 2 years.

 Diabetes
 Liver disease
 Kidney disease
 Cancer
 Steroid Intake
 Organ Transplant
 HIV/AIDS

Persons working with live rabies virus in diagnostic laboratories, research laboratories, vaccine production
laboratories at permanent risk of exposure to rabies should have:
 One serum sample taken every six months
 A booster dose when the titre falls below 0.5 IU/ml yearly
Others professions (veterinarians, animal handlers, wildlife officers etc) working in rabies endemic areas should have:
 One serum sample taken every two years
 A booster dose when the titre falls below 0.5 IU/ml yearly
By signing below you acknowledge that you understand that RB-ABC considers your protected health information
including your medication history and HIV testing results, to be confidential and will not share it with anyone
outside RB-ABC without your consent unless permitted or required by law or any ethical requirements that may be
applicable. You also acknowledge and understand that RB-ABC is entitled to share information about you in order
to bill for the services provided to you.

Printed name of patient: Date of Birth:

Signature: Date: