Appendix A - Sample Specimen History Form - Field Manual of Wildlife Diseases

< > Glossary & References / Book List / B36 Field Manual of Wildlife Diseases / Text Sections:
(LARGE PAGE - wait to load, then scroll down)

Field Manual of Wildlife Diseases
Click here for CONTENTS Page
For contact details see Title Page

Appendix A - Sample Specimen History Form

(To print this form - use the File>Print... command on your browser menu at the very top of your page)

Submitter's name:
Affiliation:
Address:
Telephone:
E-mail:
Date collected:
Method of collection: (found dead, euthanized (describe method) etc.)
Collector's name:
Specific die-off location:
	State:
	County:
	Latitude / longitude
Environmental factors: (Record conditions such as storms, precipitation, temperature changes, or other changes that may contribute to animal stress.)
Disease onset: (Your best estimate of when the outbreak started.)
Species affected: (The diversity of species affected may provide clues to the disease involved.)
Age/sex: (Any selective mortality related to age and sex.)
Morbidity/mortality: (Ratio of sick animals to dead animals.)
Known dead: (Actual pickup figures.)
Estimated dead: (Consider removal by scavengers or other means.)
Clinical signs: (Any unusual behavior and physical appearance.)
Population at risk: (Number of animals in the area that could be exposed to the disease.)
Population movement: (Recent changes in the number of animals on the area and their source or destination, if known.)
Problem area description: (Land use, habitat types, and other distinctive features.)
Comments: (Additional information/observations that may be of value such as past occurrences of disease in area)