Marine Mammal Rehabilitation Disposition Report

MARINE 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