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pdfMARINE MAMMAL REHABILITATION DISPOSITION REPORT
FIELD #:__________________________
COMMON NAME:
NMFS REGIONAL #_______________NATIONAL DATABASE#:_________________________________
(NMFS USE)
(NMFS USE)
_________________________ GENUS: __________________________SPECIES: _______________________
REHABILITATION FACILTY: ________________________________________ Affiliation: _________________________________________________
Address:
____________________________________________ Phone: ___________________________________________
STRANDING/BIRTH HISTORY
ADMISSION INTO REHABILITATION
Date: Year:
Month:
Day:
Location: State:
County:
Sex:
□ 1. Male
□ 2. Female
Date: Year:
City:
Received From:
Straight Length:
Weight:
Was this animal born in rehab?
□ 1. NO □ 2. YES; Female’s ID #:
Day:
□ cm □ in □ Actual □ Estimate
□ kg □ lb □ Actual □ Estimate
□ Restrand
Number of Times Previously Admitted to Rehabilitation: ________________
MEDICAL RECORD
SPECIMEN TRACKING
SAMPLES COLLECTED (Check one or more)
Pre-Release Health Screen Date:
Year:
Month:
Day:
Last Day of Antibiotics: Year:
Month:_
Month:
Day:
□ N/A
□ 1. Histology □ 2. Other Diagnostics □ 3. Life History □ 4. Skeletal
□ 5.Other ____________
PARTS TRACKING (Check one or more)
2. Educational collection
□ 1. Scientific collection □
□ 3. Other:_________________
MORPHOLOGICAL DATA AT DISPOSITION
Animal Morphological Data at Time of Disposition:
Straight Length:
□ cm □ in □ Actual □ Estimate
Weight:
□ kg □ lb □ Actual □ Estimate
Estimated Age Class at Time of Disposition:
□ 1. Adult
□ 3.Yearling
□ 5. Unknown
□ 2. Subadult
□ 4. Pup/Calf
FINAL DISPOSITION
□ Releasable
□ Non-releasable
□ 6. Released
□ Not Applicable
□ 1. Transferred to Another Rehabilitation Facility
Year:
Month:
Day:
Facility:
Address:
Comments:
□ 2. Temporarily Transferred to Research Facility
Year: __________Month: ________ Day: _________
Facility:
Comments:
NMFS Permit #:
□ 3. Permanently Transferred for Research/Enhancement
Year:
Month:
Day:
Facility:
Comments:
NMFS Permit#:
NOAA ID #:
□ 4. Permanently Transferred for Public Display
Year:
Month:
Day:
Facility:
Comments:
NOAA ID #:
□ 5. Died
Year:
Month:
Location:
Cause of Death:
Comments:
□ Euthanized
Day:
NECROPSIED □ YES □ NO □ N/A □ Partial □ Complete
□ Carcass Fresh □ Carcass Frozen/Thawed
NECROPSIED BY:
Date
NOAA Form 89-864; OMB Control No.0648-0178; Expiration Date 03/31/2020
Year:
Month:
State:
County:
Locality Details:
Latitude (DD):
Longitude(DD):_
Released: □ Singly
Day:
City:
N
W
□ With Other Rehabilitated Animals
TAG DATA
Tags Were:
Present at Time of Stranding (Pre-existing):
Applied During Stranding Response:
Applied During Rehabilitation/Release:
Absent but Suspect Prior Tag:
ID#
Color
Type
Placement*
(Circle ONE)
D
________________________LF
D
________________________LF
D
________________________LF
D
________________________LF
DF
LR
DF
LR
DF
LR
DF
LR
L
RF
L
RF
L
RF
L
RF
□ YES
□ YES
□ YES
□ YES
Applied
R
RR
R
RR
R
RR
R
RR
□ NO
□ NO
□ NO
□ NO
Present
Removed
□
□
□
□
□
□
□
□
□
□
□
□
* D= Dorsal; DF= Dorsal Fin; L= Lateral Left Body R = Lateral Right Body
LF= Left Front; LR= Left Rear; RF= Right Front; RR= Right Rear
Post Release Monitoring
□ YES
□ NO
Data Disposition: __________________________________________
PLEASE USE THE BACK SIDE OF THIS FORM FOR ADDITIONAL REMARKS
ADDITIONAL IDENTIFIER: ______________________________________________________________________________________________
(If animal is restranded, please indicate any previous field numbers here)
ADDITIONAL REMARKS:
DISCLAIMER
THESE DATA SHOULD NOT BE USED OUT OF CONTEXT OR WITHOUT VERIFICATION. THIS SHOULD BE STRICTLY ENFORCED WHEN
REPORTING SIGNS OF HUMAN INTERACTION DATA.
DATA ACCESS FOR MARINE MAMMAL REHABILITATION DISPOSITION DATA
UPON WRITTEN REQUEST, CERTAIN FIELDS OF THE MARINE MAMMAL REAHBILITATION DISPOSITION DATA SHEET WILL BE RE
LEASED TO THE REQUESTOR PROVIDED THAT THE REQUESTOR CREDIT THE STRANDING NETWORK AND THE NATIONAL MARINE
FISHERIES SERVICE. THE NATIONAL MARINE FISHERIES SERVICE WILL NOTIFY THE CONTRIBUTING STRANDING NETWORK MEM
BERS THAT THESE DATA HAVE BEEN REQUESTED AND THE INTENT OF USE. ALL OTHER DATA WILL BE RELEASED TO THE RE
QUESTOR PROVIDED THAT THE REQUESTOR OBTAIN PERMISSION FROM THE CONTRIBUTING STRANDING NETWORK AND THE NA
TIONAL MARINE FISHERIES SERVICE.
PAPERWORK REDUCTION ACT INFORMATION
PUBLIC REPORTING BURDEN FOR THE COLLECTION OF INFORMATION IS ESTIMATED TO AVERAGE 30 MINUTES PER RESPONSE,
INCLUDING THE TIME FOR REVIEWING INSTRUCTIONS, SEARCHING EXISTING DATA SOURCES, GATHERING AND MAINTAINING THE
DATA NEEDED, AND COMPLETING AND REVIEWING THE COLLECTION OF INFORMATION. SEND COMMENTS REGARDING THIS BUR
DEN ESTIMATE OR ANY OTHER ASPECT OF THE COLLECTION INFORMATION, INCLUDING SUGGESTIONS FOR REDUCING THE BUR
DEN TO: CHIEF, MARINE MAMMAL AND SEA TURTLE CONSERVATION DIVISION, OFFICE OF PROTECTED RESOURCES, NOAA FISHER
IES, 1315 EAST-WEST HIGHWAY, SILVER SPRING, MARYLAND 20910. NOT WITHSTANDING ANY OTHER PROVISION OF THE LAW, NO
PERSON IS REQUIRED TO RESPOND, NOR SHALL ANY PERSON BE SUBJECTED TO A PENALTY FOR FAILURE TO COMPLY WITH, A
COLLECTION OF INFORMATION SUBJECT TO THE REQUIREMENTS OF THE PAPERWORK REDUCTION ACT, UNLESS THE COLLECTION
OF INFORMATION DISPLAYS A CURRENTLY VALID OFFICE OF MANAGEMENT AND BUDGET (OMB) CONTROL NUMBER.
NOAA Form 89-864; OMB Control No.0648-0178; Expiration Date 03/31/2023
File Type | application/pdf |
File Title | Rehab Dispo final acp |
Author | Angela.Collins-Payne |
File Modified | 2020-03-13 |
File Created | 2017-04-03 |