United States Department of Agriculture Marketing and Regulatory Programs Animal and Plant Health Inspection Service Veterinary Services

Similar documents
1 of 22 PA Dept. of Agriculture

1 of 18 PA Dept. of Agriculture

Brucellosis in Cervidae:

1.2. Administrator means The Administrator, Animal and Plant Health Inspection Service, or any person authorized to act for the Administrator.

For Health Requirement Information:

For Health Requirement Information:

For Health Requirement Information:

2017 EXHIBITION LIVESTOCK HEALTH REQUIREMENTS

NATIONAL BRUCELLOSIS STANDARD TESTING PROTOCOL MARK CAMACHO DVM, MPH CATTLE HEALTH EPIDEMIOLOGIST

National Bovine TB Eradication Program Update. Dr. Burke Healey Director Cattle Health Center

Kansas Department of Agriculture Division of Animal Health

NEW HAMPSHIRE DEPARTMENT OF AGRICULTURE, MARKETS & FOOD Division of Animal Industry 25 Capitol Street 2nd Floor P.O. Box 2042 Concord, NH

CATTLE Identification Illinois Cattle

G. "Owner means the person or entity owning the livestock and the owner s officers, members, employees, or agents.

2018 PENNSYLVANIA DEPARTMENT OF AGRICULTURE ANIMAL HEALTH REQUIREMENTS AND RECOMMENDATIONS FOR ANIMALS FOR EXHIBITION, INCLUDING COMMERCIAL EXHIBITION

RULES OF THE TENNESSEE DEPARTMENT OF AGRICULTURE ANIMAL HEALTH

4-H AND FFA LIVESTOCK HEALTH REQUIREMENTS

Article 3 This Directive shall enter into force on the day of its publication in the Official Journal of the European

2019 NATIONAL WESTERN STOCK SHOW (NWSS) LIVESTOCK HEALTH REQUIREMENTS

TENNESSEE DEPARTMENT OF AGRICULTURE DIVISION OF CONSUMER & INDUSTRY SERVICES ANIMAL HEALTH

RULES AND REGULATIONS GOVERNING THE IMPORTATION OF ANIMALS

EXPLANATION OF PROPOSED RULE

UNITED STATES DEPARTMENT OF AGRICULTURE FOOD SAFETY AND INSPECTION SERVICE WASHINGTON, DC

EXHIBITION HEALTH REQIDREMENTS FOR LIVESTOCK, POULTRY, AND EXOTIC ANIMALS

2018 NATIONAL WESTERN STOCK SHOW (NWSS) HEALTH REQUIREMENTS

Livestock Included in the Rule. Animal Disease Traceability. Traceability for Livestock Moving Interstate

Animal Disease Traceability

Exchange Club Fair of Southwest Georgia

Agriculture And Industries Chapter ALABAMA DEPARTMENT OF AGRICULTURE AND INDUSTRIES ANIMAL INDUSTRY ADMINISTRATIVE CODE

Section 38.1 is entitled Definitions and adds a definition for Official Laboratory Pooled Trichomoniasis test samples.

Animal Health Requirements For Admission to New York State and County Fairs New for 2015: General Prohibitions and Requirements

MATTILSYNET NORWEGIAN FOOD SAFETY AUTHORITY

Agency Profile. At A Glance

MATTILSYNET THE NORWEGIAN FOOD SAFETY AUTHORITY

ANIMAL HEALTH REQUIREMENTS FOR EXHIBITION

The Comprehensive Strategic Plan for the Eradication of Bovine Tuberculosis - May 2004

HEALTH REQUIREMENTS FOR ANIMALS EXHIBITED AT THE 2018 NEBRASKA STATE FAIR

June 2017 No histo compatible cases were found during routine slaughter inspection.

COMMITTEE ON NOMINATIONS AND RESOLUTIONS. Chair: Richard Breitmeyer, CA

Ch. 7 BRUCELLOSIS REGULATIONS CHAPTER 7. BRUCELLOSIS REGULATIONS

CERTIFICATES OF VETERINARY INSPECTION AND/OR TEST RECORDS MUST BE AVAILABLE FOR INSPECTION AT ANY TIME WHILE ANIMALS ARE ON THE FAIRGROUNDS.

Rules and Regulations of the Department of Agriculture and Markets (Title 1 of the Official Compilation of New York Codes Rules and Regulations)

Contents AI-202 (1/17)

Contents AI-202 (1/19)

SCRAPIE: ERADICATE IT

Livestock Board. General Agency, Board or Commission Rules. Chapter 2: Vaccination Against and Surveillance for Brucellosis

Protocol between the General Administration of Quality Supervision, Inspection and Quarantine of the People's Republic of China and the

HEALTH REGULATIONS RELATED TO ANIMALS ADMISSION TO THE EUROPEAN HOLSTEIN CHAMPIONSHIP IN COLMAR, FRANCE, FROM 14 TO 19 JUNE 2016

2016 NATIONAL WESTERN STOCK SHOW (NWSS) HEALTH REQUIREMENTS

RULES OF THE TENNESSEE DEPARTMENT OF AGRICULTURE DIVISION OF ANIMAL INDUSTRIES CHAPTER BRUCELLOSIS TESTING AND QUARANTINE REGULATIONS

Exception: Cattle originating in Certified Free Herds when the herd number and date of last negative whole herd test are recorded on CVI.

VETERINARY CERTIFICATE FOR IMPORT OF GOATS INTO INDIA

State Animal Health Regulations for South Dakota

Epidemiology - Animal Tracing Exercise. Gregory Ramos DVM, MPVM Area Epidemiology Officer USDA/APHIS/VS

Wisconsin Bovine TB Update

Georgia Department of Agriculture

A New Approach for Managing Bovine Tuberculosis: Veterinary Services Proposed Action Plan

Import Health Standard

2 No GOVERNMENT GAZETTE, 21 DECEMBER 2009 IMPORTANT NOTICE The Government Printing Works will not be held responsible for faxed documents not r

Arizona State Laws Affected by H.R. 4879

Nebraska State Laws Affected by H.R I. Food a. None. a. None

USDA APHIS Role in the Transportation of Laboratory Animals. Dr. Carol Clarke Research Staff Officer USDA APHIS Animal Care

General Licence for the Movement of Cattle

The undersigned Official Veterinarian certifies that the animal/s described above and examined on this day:

Export Certification of Live Animal Commodities

Career Explosion! A Boom of Veterinary Paraprofessional Students

Animal Health Requirements for beef and beef offal to be exported to Japan from Norway

Standard Operating Procedures (SOP) for Yukon CWD Voluntary Herd Certification Program March 20, 2018

Import Health Standard. For. Bovine Semen

COUNTY OF SAN BERNARDINO 2007 DEVELOPMENT CODE

11/4/2016. Overview. History of Brucellosis. History of US Brucellosis program

Import Health Standard

NEW HAMPSHIRE DEPARTMENT OF AGRICULTURE

Wildlife Services, in partnership with other Federal agencies, provides Federal leadership and expertise to resolve wildlife conflicts that threaten p

BE IT ENACTED BY THE BUSINESS COUNCIL OF THE SHOSHONE-PAIUTE TRIBES THAT,

Introductory Course for Commercial Dog Breeders. Topic 10: Transportation and Minimum Age Requirements

South Dakota State Laws Affected by H.R I. Food a. None

SENATE, No STATE OF NEW JERSEY. 217th LEGISLATURE INTRODUCED MAY 26, 2016

UNITED STATES ANIMAL HEALTH ASSOCIATION 2012 Resolution 116 th Annual Meeting October 18-24, 2012 ~ Greensboro, NC

Providing Diagnostics to the International Veterinary Community

Agriculture And Industries Chapter ALABAMA DEPARTMENT OF AGRICULTURE AND INDUSTRIES ANIMAL INDUSTRY ADMINISTRATIVE CODE

DISEASE CONTROL (EPIDEMIOLOGY) ANIMAL CONTROL REQUIREMENTS

USDA, APHIS BSE Surveillance Program Overview

APPLICATION FOR PERMISSION TO IMPORT ANIMALS (NB. PLEASE COMPLETE ALL SECTIONS OF THE APPLICATION IN FULL)

2018 ANIMAL HEALTH REGULATIONS FOR FAIRS AND SHOWS IN WISCONSIN

Indiana State Laws Affected by H.R. 4879

Albania Inception workshop of the project

Elk Brucellosis Survey and Research Summary

Functional Exercise: Foot and Mouth Disease at the County Fair. Local Preparedness and Response for Animal Disease Emergencies

Guidance Document. Hides and Skins HIDESKIN.ALL. 7 August A guidance document issued by the Ministry for Primary Industries

Animal Health Regulations for Fairs and Shows in Wisconsin: 2017 Season

Colorado State Laws Affected by H.R. 4879

The infection can be transmitted only by sexual intercourse and not by the environment. Bovine trichomoniasis is not transmitted to people.

Michigan State Laws Affected by H.R. 4879

IMPORT HEALTH STANDARD FOR THE IMPORTATION OF MALAYAN SUN BEARS Helarctos malayanus FROM AUSTRALIA INTO NEW ZEALAND

Mexican Wolves and Infectious Diseases

COMMITTEE ON CAPTIVE WILDLIFE AND ALTERNATIVE LIVESTOCK COMMITTEE ON TUBERCULOSIS

Cercetări bacteriologice, epidemiologice şi serologice în bruceloza ovină ABSTRACT

STATE OF NEW JERSEY. ASSEMBLY, No th LEGISLATURE. Sponsored by: Assemblyman ADAM J. TALIAFERRO District 3 (Cumberland, Gloucester and Salem)

Elite East Information 2015 updated 3/6/15

Transcription:

Surveillance and Testing Requirements for Interstate Transport of Wild Caught Cervids 1. Purpose and Background To establish new or augment existing free-ranging herds, States or Tribes may transport wild-caught cervids (elk, deer, moose, or other cervidae) from one State or Tribal location to another for release. The movement is subject to approval by the animal health officials of the receiving State and (VS). This document establishes a recommended minimum standard for testing and a uniform process of disease risk assessment that States or Tribes should follow to help prevent the spread of cervid diseases such as chronic wasting disease (CWD), bovine tuberculosis (TB), and brucellosis when wild cervids are captured for interstate movement and release. Cervid movements between, from, or to all American Zoological and Aquarium Association (AZA) accredited facilities and certified related facilities will follow all State and Federal movement requirements as stated in their current written policies. This guidance document represents the Agency s position on this topic. It does not create or confer any rights for or on any person and does not bind the U.S. Department of Agriculture (USDA) or the public. The information it contains may be made available to the public. While this document provides guidance for users outside VS, VS employees may not deviate from the directions provided herein without appropriate justification and supervisory concurrence. 2. Document Status A. Review date: 09/07/20. B. Replaces VS Guidance 8000.1 issued September 22, 2016. 3. Reason for Reissuance VS has revised this document to clarify the CWD surveillance requirements set forth within. 4. Authority and References A. Authorities (Code of Federal Regulations (CFR)): 7 CFR 371.4 9 CFR 77.32 9 CFR 77.38 9 CFR 81.2 9 CFR 81.3 1

B. References: 5. Audience VS Guidance Document 6701, Tests for TB in Farmed and Captive Cervids VS employees, other Federal and State agencies, and members of the public. 6. Guidance States or Tribes moving wild cervids interstate for release must document that the source population within a 50-mile radius of the capture site and the specific animals to be moved are low risk for infection with bovine TB, brucellosis, and CWD based on a combination of individual animal testing and surveillance in the source population. States or Tribes can document disease risk status through: Hunter harvest surveillance. Roadkill surveillance. Captive cervid surveillance. Other domestic livestock surveillance for TB and brucellosis. The regulations at title 9, Code of Federal Regulations (9 CFR) part 77 describe the TB testing requirements for moving cervids interstate. However, States and Tribes may find it impractical to meet the requirement for a whole-herd test in wild populations of cervids. In this situation, a State or Tribe may ask VS to waive the whole-herd test requirement with the concurrence of animal health officials in the receiving State. VS generally requires TB testing of the individual animals to be moved as a condition of the waiver. Currently, an importing State or Tribe may specify brucellosis testing requirements. Attachment 1 describes VS recommended minimum testing protocol for TB and brucellosis in wild-caught cervids moved interstate for release. States or Tribes receiving these cervids may impose additional testing requirements. Additionally, 9 CFR 81.3 requires that States or Tribes moving wild cervids interstate for release document that the source population is at low risk for CWD through wildlife surveillance. The movement is subject to approval by the animal health officials of the receiving State or Tribe and VS. A. Approvals 1) States or Tribes interested in capturing wild cervids and moving them interstate for release will submit the required documentation described below for review and approval to the following: 2

a. VS District Office in the originating and receiving States. b. State or Tribal animal health officials in the originating and receiving States. 2) The shipping and receiving State or Tribal authorities and VS Assistant Director in the corresponding District Offices of both States will review the submitted documents for completeness. They will discuss problems with supporting documentation (i.e., missing, inadequate, or unclear documents) with the appropriate contact in the State or Tribe of origin. Once the State or Tribe of origin has provided all required documentation, the receiving States or Tribes and VS will complete their review. 3) The VS Assistant Director in the receiving State will forward the documentation with his or her recommendation for approval to the Cervid Health Program. 4) The Cervid Health Program will review the documentation. The Director overseeing the Cervid Health Program will notify the State or Tribe of origin and the receiving States or Tribes if VS approves interstate movement and release of wild-caught cervids. 5) Approval will not be granted for interstate movement and release of wild-caught cervids from States or zones having a recognized wildlife reservoir of bovine TB, brucellosis, or CWD as determined by the APHIS Administrator. 6) The State or Tribe of origin, the receiving States or Tribes, and VS will each sign the Agreement for Interstate Transportation of Wild Cervids (Attachment 2) to complete the approval process. A copy of this document should accompany the certificate of veterinary inspection. B. Required Documentation States and Tribes moving wild cervids interstate for release will submit a summary statement and supporting documentation that demonstrates that the source population and the specific animals to be moved are low risk for infection with bovine TB, brucellosis, and CWD. This documentation can be based on individual animal testing, surveillance in the source population, or both. VS requests the following documentation from the State or Tribe of origin to fully evaluate the potential risk of these diseases in the source population: 1) A description of the translocation project including cervid type, number of animals, capture sites, disease mitigation factors, active and passive surveillance activities, animal health testing protocols before and after movement, disposition of injured animals, and States or Tribes of destination. Additional supporting documentation should include: 3

a. Maps showing a 50-mile radius of the areas such as counties or game management units where wild cervids will be sourced for capture. Include the involvement of any adjacent State or Tribal area. b. Descriptions of the population density of wild cervids within those locations and methods used to estimate and define the source population, with emphasis on the cervid species to be translocated. c. Descriptions of previous or historic wild cervid translocations into or out of this geographic region (origin of the cervids, their species, when the movement occurred, destination). 2) Description of the area s disease history, surveillance, and epidemiology for CWD, including documentation that CWD has not been detected within the State, the source population, or within 50 miles of the capture site which could include adjacent States or provinces. Specifically, the summary should describe how the State or Tribe determined the origin population to be low risk for CWD by addressing: a. CWD surveillance of wild cervids within the 50-mile radius of the capture site. 1. Describe the surveillance design, detection limit, and surveillance streams ideally including both passive (e.g., hunter harvest surveillance, roadkill surveillance) and active surveillance (e.g., sharpshooting in a specified area). 2. Describe the tissues collected, type of CWD test used, and the laboratory that performed the testing. 3. Report annual surveillance results for at least the last 5 years (preferably for the last 10 years). Cumulative sampling over the most recent 3-year period should be sufficient to detect at least a 1 percent prevalence of CWD in the source population with 95 percent confidence. 4. Optionally, at the discretion of the receiving and/or source State or Tribe, a whole-herd rectal biopsy or other mutually agreed-on method of ante-mortem CWD test with concurrent genotyping may be performed on the assembled herd. Laboratory results must be not detected on all animals. Animals with untestable or incorrect location samples (i.e., samples that are autolyzed or of the wrong tissue type) may be retested. b. Captive/farmed herd participation and compliance in an approved State CWD Herd Certification Program (HCP) or CWD monitoring program (number of herds, number of animals) including documented escapes within the 50-mile radius. 4

c. Captive/farmed herds with less than 5 years CWD HCP status (number of herds, number of animals). d. Captive/farmed herds not enrolled in the CWD HCP program within the 50-mile radius. e. Any CWD-positive results or traced animals in farmed/captive or wild cervids in the State over the last 10 years, with emphasis on the 50-mile radius of the source population for translocation. f. Location of the nearest known case or cases of CWD in captive and wild cervids to the capture site. 3) Describe the disease history, surveillance, and epidemiology for TB and brucellosis in all species within 50 miles of the capture site (which could include adjacent States or provinces), including: a. TB and brucellosis surveillance of wild cervids in the 50-mile radius conducted per year, for the last 5 years. Include both passive and targeted surveillance, if applicable. b. Compliant participation in a captive/farmed cervid TB accredited herd program (number of herds, number of animals) within the 50-mile radius. c. Number of captive/farmed cervid herds in the 50-mile radius that are TB accredited and the number that are not accredited. d. Any TB- or brucellosis-positive results or traced animals in farmed/captive or wild cervids in the State or Tribe over the last 5 years with emphasis on the 50-mile radius region of the source population for translocation. e. Compliant participation in the captive/farmed Cervid Brucellosis Certification program (number of herds, number of animals). f. Number of captive/farmed cervid herds in the area that are certified brucellosisfree herds and the number that are not accredited. g. Number of captive/farmed cervid herds in the area that are brucellosis-monitored herds. h. Location of the nearest known case or cases of TB and brucellosis in captive and wild cervids to the capture site. 5

4) A description of the quarantine, testing protocol, and plan of action if animals have nonnegative test results for TB and/or brucellosis. The proposed testing protocol must meet or exceed the attached recommended minimum testing protocol (Attachment 1). Additional testing may also be performed. Official test results should be submitted on receipt. 7. Inquiries Please direct any inquiries to: VS Cervid Health Staff Officer USDA APHIS National Center for Animal Health Programs 2150 Centre Avenue, Bldg. B Fort Collins, CO 80526 Attachments 6

Attachment 1 A Recommended Minimum Quarantine and Testing Protocol for Tuberculosis and Brucellosis in Wild Caught Cervids for Interstate Movement 1. Pre-Movement Quarantine A. After the last trapped animal is added, the assembled group of cervids is considered to be the herd. The assembled herd should be quarantined and no other animals may be added. B. The assembled herd must be contained within an enclosure surrounded by a double 8- foot fence, with the two fences separated by at least 3 feet. C. All animals must have at least two forms of unique identification attached, one of which must be an official animal identification with a nationally unique identification number. D. Any animals that die at any time during capture, quarantine, or transport must be subjected to a full necropsy to rule out pathology that could indicate TB or brucellosis. Additionally, they must be tested for CWD at an approved National Animal Health Laboratory Network (NAHLN) CWD testing lab or the National Laboratories (NVSL). E. Receiving States or Tribes may also require additional quarantine requirements at their discretion. F. Receiving States or Tribes may also require additional testing or quarantine requirements at their discretion. 2. Testing Testing may begin on the assembled herd at least 30 days after the last wild trapped animal is added and the quarantine is placed. Receiving States or Tribes may also require additional testing, at their discretion. A. Brucellosis (Serology): 1) Screening test: Rapid automated presumption (RAP) or buffered acidified plate antigen (BAPA) If a non-negative result, then complete: a. Secondary test: Fluorescence polarization assay (FPA) If FPA test result is greater than 20mP, then complete: 7

b. Confirmatory test: Complement fixation (CF) If the CF is positive and the animal is a reactor, perform necropsy and culture. 2) If CF is positive the entire group may be disqualified for translocation. B. Tuberculosis VS recommends conducting serological and skin testing in parallel, with a positive of any one method taking precedence over negative results by other methods. 1) Skin testing: a. Single Cervical Test (SCT) If there is any response, one of the following will be done: b. Necropsy according to NVSL s cervid TB necropsy protocol. Submit appropriate tissues to NVSL for histopathology, polymerase chain reaction (PCR), and culture. If results are positive for M. bovis, the entire group is disqualified for translocation and must be euthanized. c. Comparative Cervical Test (CCT) If the animal is a suspect or reactor on the CCT, then euthanize the animal and perform a necropsy according to cervid TB necropsy protocol. Submit appropriate tissues to NVSL for histopathology, PCR, and culture. If the test is positive for M. bovis, the entire group is disqualified for translocation and must be euthanized. 2) Serology: Serum should be submitted to NVSL for a dual path platform (DPP) test. If the test is positive, the animal may be euthanized and necropsied at that time or it may be held and retested with the DPP no sooner than 30 days after the initial test. If the DPP test is positive the second time, the animal must be euthanized and necropsied according to cervid TB necropsy protocol and appropriate tissues submitted to NVSL for histopathology, PCR, and culture. If the necropsy results are positive for M. bovis, the entire group is disqualified for translocation and must be euthanized. 3. Transport Requirements Interstate transportation of quarantined animals must be in an approved solid enclosed conveyance with proper ventilation under official seal affixed by a State veterinarian or a VS Veterinary Medical Officer. This seal may only be opened by a VS Veterinary Medical Officer, State veterinarian, Tribal representative, or approved accredited veterinarian. 8

Each animal in the shipment must have at least two forms of unique identification attached, one of which must be an official animal identification with a nationally unique identification number. A certificate of veterinary inspection (CVI) must be issued for interstate movement. It must contain the following information: All identification numbers of each animal in the shipment. Total number of animals covered by the certificate. Purpose for which the animals are to be moved. Consignor and herd of origin with complete address(es). Consignee and point of destination with complete address(es). A statement by the issuing veterinarian that the animals were not exhibiting clinical signs associated with CWD, TB, brucellosis, or other contagious disease at the time of examination. A statement that the source population has been documented to be low risk for CWD based on a surveillance program in the wild cervid population. A copy of the signed Agreement for Interstate Transportation of Wild-Caught Cervids (Attachment 2) should accompany the CVI. Cleaning and disinfection of the conveyance will be performed at the animals destination under the supervision of a State, Tribal, or VS representative. 4. Destination Quarantine When the animals are offloaded at the destination, a VS or State animal health official, Tribal representative, or approved accredited veterinarian will be present to document any sick animals, injuries, or deaths. Any animals that die at any time during capture, quarantine, or transport must be subjected to a full necropsy to rule out pathology that could indicate TB or brucellosis. Additionally, they must be tested for CWD at an approved NAHLN CWD testing lab or the NVSL. The assembled herd will be held under quarantine for at least 120 days after initially being assembled (i.e., prior to movement). All animals should be confined in an enclosure of adequate size to provide for the animals welfare, and surrounded by a double 8-foot-high perimeter fence with at least 3 feet between the fences. Brucellosis testing may be repeated at the discretion of the importing State. A second TB test of the entire assembled herd should be performed at least 90 days or more following the date of arrival at the point of destination using DPP serological testing, SCT skin testing, or parallel testing using both methods. 9

Animals showing non-negative results to any serological or skin tests must be necropsied and tissues for TB and CWD testing submitted to NVSL. The entire group must be kept in quarantine until histopathology and culture results are finalized and reported to be negative for M. bovis and immunohistochemistry is reported as not detected for CWD. If the confirmatory testing at NVSL is negative for all euthanized animals, the remaining animals in the lot may be released. 10

Attachment 2 Agreement for Interstate Transportation of Wild-Caught Cervids Between: (State of Origin) and (Receiving State). This document indicates the review and agreement by the State of origin, the receiving State, and their respective State agencies having authority for wild cervids; and the USDA Veterinary Services (VS), in accordance with the Chronic Wasting Disease (CWD) rule (9 CFR 81.3(b)), that the summary statement and supporting documentation provided by (State of origin), from which wild cervids will be obtained for this interstate movement, are from a source population documented to be low risk for CWD based on the information provided. Further, and as applicable, that the wild cervids to be translocated either (check appropriate box): Meet the bovine tuberculosis testing requirements for interstate movement of captive/ wild cervids in 9 CFR 77.20 and 9 CFR 77.27, The States have requested and received from VS a waiver of the bovine tuberculosis testing requirements for interstate movement of the captive /wild cervids in accordance with 9 CFR 77.38. With the signature of the VS officials below, it is acknowledged that the waiver for bovine tuberculosis testing requirements for captive wild-caught cervids is granted in accordance with 9 CFR 77.38. In addition, each of the cervids captured from this wild population for interstate movement and release must have two forms of animal identification, one of which is USDA official animal identification, in accordance with 9 CFR 81.3(b). State of Origin/Agency: OR Signature: Date: Name/Title: State Veterinarian State of Origin/Agency: Signature: Date: Name/Title: Wildlife Veterinarian 11

Receiving State/Agency: Signature: Date: Name/Title: State Veterinarian USDA APHIS Signatures: District Assistant Director: Sheep, Goat, Cervid, and Equine Health Center Director: Date: Date: 12