Form 89-878 Marine Mammal Rehabilitation Disposition Report

MARINE MAMMAL REHABILITATION DISPOSITION REPORT

FIELD #:__________________________

NMFS REGIONAL #_______________NATIONAL DATABASE#:_________________________________

(NMFS USE) (NMFS USE)

COMMON NAME: _________________________ GENUS: __________________________SPECIES: _______________________

REHABILITATION FACILTY: ________________________________________ Affiliation: _________________________________________________

Address: ____________________________________________ Phone: ___________________________________________

STRANDING/BIRTH HISTORY □ Restrand Date: Year: Month: Day: Location: State: County: City: Sex: □ 1. Male □ 2. Female Was this animal born in rehab? 1. NO □ 2. YES; Female’s ID #:	ADMISSION INTO REHABILITATION Date: Year: Month:_ Day: Received From: Straight Length: □ cm □ in □ Actual □ Estimate Weight: □ kg □ lb □ Actual □ Estimate Number of Times Previously Admitted to Rehabilitation: ________________
MEDICAL RECORD Pre-Release Health Screen Date: Year: Month: Day: Last Day of Antibiotics: Year: Month: Day:	SPECIMEN TRACKING SAMPLES COLLECTED (Check one or more) □ 1. Histology □ 2. Other Diagnostics □ 3. Life History □ 4. Other _____________ PARTS TRACKING (Check one or more) □ 1. Scientific collection □ 2. Educational 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 □ 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 □ Euthanized Year: Month: Day: Location: Cause of Death: Comments: NECROPSIED □ YES □ NO □ N/A □ Limited □ Complete Carcass Fresh □ Carcass Frozen/Thawed NECROPSIED BY: Date		6. Released Year: Month: Day: State: County: City: Locality Details: Latitude (DD): N Longitude(DD):_ W Released: □ Singly □ With Other Rehabilitated Animals
		TAG DATA Tags Were: Present at Time of Stranding (Pre-existing): □ YES □ NO Applied During Stranding Response: □ YES □ NO Applied During Rehabilitation/Release: □ YES □ NO Absent but Suspect Prior Tag: □ YES □ NO ID# Color Type Placement* Applied Present Removed (Circle ONE) D DF L R □ □ □ ________________________LF LR RF RR D DF L R □ □ □ ________________________LF LR RF RR D DF L R □ □ □ ________________________LF LR RF RR D DF L R □ □ □ ________________________LF LR RF RR * 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: __________________________________________

NOAA Form 89-864; OMB Control No.0648-0178; Expiration Date 03/31/2020 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 01/31/2017