Noaa Form 89-864 - Marine Mammal Rehabilitation Disposition Report
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1
2MARINE MAMMAL REHABILITATION DISPOSITION REPORT
FIELD #: __________________________ NMFS REGIONAL #______________NATIONAL DATABASE#: _________________________________
(NMFS USE)
(NMFS USE)
COMMON NAME: _______________________________ GENUS: _________________________ SPECIES: _______________________________
REHABILITATION FACILTY: ________________________________________ Affiliation: ______________________________________________
Address: ______________________________________________________ Phone:___________________________________________________
□ Restrand
STRANDING/BIRTH HISTORY
ADMISSION INTO REHABILITATION
Date: Year: _____ Month:______ Day: ______
Date: Year: ________ Month:_________ Day: _________
Location: State: _______ County: __________ City: ___________
Sex:
□ 1. Male
□ 2. Female
Received From: _________________________________
Straight Length:___________ □ cm □ in
□ actual □ estimate
Was this animal born in rehab?
Weight:_________________ □ kg
□ lb
□ actual □ estimate
□ 1. NO □ 2. YES; Female’s ID #: ________________________
MEDICAL RECORD
SPECIMEN TRACKING
Pre-Release Health Screen Date:
Samples Collected:
□ 1. YES □ 2. NO
Year:______ Month:______ Day:______
□ 1. Scientific collection
□ 2. Education collection
Last Day of Antibiotics: Year:______ Month:______ Day:______
□ 3. Other: _________________________________________________
MORPHOLOGICAL DATA AT DISPOSITION
Animal Morphological Data at Time of Disposition:
Age Class at Time of Disposition:
Straight Length:_____________ □ cm □ in □ actual □ estimate
□ 1. Adult
□ 3.Yearling
□ 5. Unknown
Weight:___________________ □ kg
□ lb □ actual □ estimate
□ 2. Subadult
□ 4. Pup/Calf
FINAL DISPOSITION
□ 6. Released
□ Releasable
□ Non-releasable
□ Not Applicable
Year: ________ Month:_______ Day: ________
State: ______ County:__________ City:__________________________
□ 1. Transferred to Another Rehabilitation Facility
Locality Details:_____________________________________________
Year: __________ Month:_______ Day: ________
Facility:_______________________________________________
Address:______________________________________________
Latitude (DD):_____________________________________________ N
Comments:____________________________________________
Longitude(DD):____________________________________________W
_____________________________________________________
Released: □ Singly
□ With Other Rehabilitated Animals
□ 2. Temporarily Transferred to Research Facility
Year: __________ Month:_______ Day: ________
Facility:_______________________________________________
TAG DATA
Comments:____________________________________________
NMFS Permit #: ________________________________________
Tags Were:
Present at time of stranding (Pre-existing):
□ YES
□ NO
□ 3. Permanently Transferred for Research/Enhancement
Applied during Stranding Response:
□ YES
□ NO
Year: __________ Month:_______ Day: ________
Applied During Rehabilitation:
□ YES
□ NO
Facility:______________________________________________
Comments:___________________________________________
ID#
Color
Type
Placement*
Applied
Present
NMFS Permit#: ______________NOAA ID #: ________________
(Circle ONE)
D DF L
□
□
□ 4. Permanently Transferred for Public Display
_________________________ LF LR RF RR
Year: __________ Month:_______ Day: ________
D DF L
□
□
Facility:______________________________________________
_________________________ LF LR RF RR
Comments:___________________________________________
D DF L
□
□
NOAA ID #: __________________________________________
_________________________ LF LR RF RR
□
□ 5. Died
Euthanized
* D= Dorsal; DF= Dorsal Fin; L= Lateral Body
Year: ________ Month:_______ Day: ________
LF= Left Front; LR= Left Rear; RF= Right Front; RR= Right Rear
Location:_____________________________________________
Cause of Death: ______________________________________
Comments:___________________________________________
□ YES
□ NO
Post Release Biomonitoring
NECROPSIED □ NO □ YES
□ Limited □ Complete
Data Disposition:
□
Carcass Fresh □ Carcass Frozen/Thawed
_______________________________________________
NECROPSIED BY: _______________________ Date _____________
NOAA Form 89-864; OMB Control No.0648-0178; Expiration Date 01/31/2017
PLEASE USE THE BACK SIDE OF THIS FORM FOR ADDITIONAL REMARKS
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