This document outlines the procedure for completing an Animal History Record (AHR) used to account for animals delivered to or impounded by the Orange County Animal Care Services when the electronic Chameleon system is unavailable. It details how to initiate an AHR, including collecting information on animal identification, owner details, field/shelter data, and medical/disposition notes. The AHR is to be completed legibly and in full to properly document the intake and handling of each animal.

1. COUNTY OF ORANGE
HEALTH CARE AGENCY
REGULATORY HEALTH SERVICES
ANIMAL CARE SERVICES
Number: 200.06
SUBJECT: INITIATION OF AN ANIMAL HISTORY RECORD Page: 1
Date: 10/5/05
Approved: Jennifer Phillips, Director Revised: 02/15/07
I. PURPOSE
To establish a uniform procedure for the completion of an Animal History Record used for the
accounting of all animals delivered by the public and/or impounded by Animal Control
Officers when the Chameleon system is not in service.
II. POLICY
When the Chameleon system is inoperable, an Animal History Record (AHR) shall be
completed for animals delivered to Orange County Animal Care Services (OCACS); deceased
animals buried in the field; animals delivered to a veterinary hospital prior to delivery to
OCACS; and for animals returned to their owners in the field.
III. SCOPE
Applicable to all personnel charged with receiving animals into the custody and care of
OCACS.
IV. FORMS
Animal History Record F272-12.2016.1 (R3/93)
V. REFERENCES
Not applicable.
VI. DEFINITIONS
Not applicable.
VII. PROCEDURE
Print all information legibly using black ink only, completing each section and the reverse side
(if information is known). An AHR with missing or incorrect information shall be routed to the
appropriate supervisor.
When updating the AHR, use black ink only and follow the instructions for completing that
section. To change any information, draw a single line through the information being changed

2. COUNTY OF ORANGE
HEALTH CARE AGENCY
REGULATORY HEALTH SERVICES
ANIMAL CARE SERVICES
Number: 200.06
SUBJECT: INITIATION OF AN ANIMAL HISTORY RECORD Page: 2
Date: 10/5/05
Approved: Jennifer Phillips, Director Revised: 02/15/07
and enter the latest data. Do not use correction fluid or tape (i.e. Whit-out) to remove
information, except for changes in the disposition section.
A. Initiate an Animal History Record
Impounding personnel shall mark X in the appropriate box for SPECIAL ATTENTION,
OWNER RELEASE, and/or OWNER INFORMATION, as applicable. If none of these
apply, the animal shall be considered a stray.
1. SPECIAL ATTENTION – mark X to identify animals that are:
a. Not to be released without prior approval from Operations or
Supervisory staff.
b. Found somewhere other than the impound location.
c. Vicious pending/under vicious declaration.
d. Police holds.
e. Requiring extreme caution or special procedures.
Instructions shall be written on the back of the AHR regarding the disposition of
these animals (P&P 400.31 Special Attention Animals).
2. OWNER RELEASE: mark X to identify animals released by the owner or legal
custodian to OCACS. The signature of the owner or custodian shall be affixed
to the reverse side of the AHR.
3. OWNER INFORMATION: (not applicable to owner released animals) – mark
X to identify animals requiring owner notification and/or retention as owned
animals, i.e., license, ID tag, rabies tag, possible owner information, etc.
a. Enter license and ID tag information in the appropriate section on the
front of the AHR.
b. All other owner information shall be written on the reverse side of the
AHR under SPECIAL ATTENTION/ADDITIONAL INFORMATION.
ANIMAL INFORMATION
4. Species: enter species, i.e., dog, cat, pig, horse, bird, etc.
5. Breed: enter breed, i.e., Collie, Siamese, Shepherd X, etc.
6. Sex: circle appropriate letter, M (male), F (female), N (neutered), S (spayed).

3. COUNTY OF ORANGE
HEALTH CARE AGENCY
REGULATORY HEALTH SERVICES
ANIMAL CARE SERVICES
Number: 200.06
SUBJECT: INITIATION OF AN ANIMAL HISTORY RECORD Page: 3
Date: 10/5/05
Approved: Jennifer Phillips, Director Revised: 02/15/07
7. Color: enter color (up to three) using accepted Chameleon choices, i.e., black
(B), white (W), etc.
8. Age: enter animal’s age, i.e., 5 month, 6 years, etc. (wks, mos, yrs).
9. Name: enter animal’s name, i.e., Lassie, Spot, Chia.
FIELD/SHELTER INFORMATION
10. Impounded by: enter first initial and last name of person authorized to impound
animals. OCACS Animal Control Officers (ACO) shall include their badge
number.
11. Fee: enter amount of fee received.
12. Receipt #: enter receipt number.
13. Impound Location: enter closest major cross streets where the animal was
picked up or enter OCACS for owner released animals impounded Station I.
14. Quarantine: Date of Bite: mark X and enter the date of bite/exposure, i.e., 12-
10-06.
15. Release Date: month, day and year are to be entered only by the Clinic
Veterinarian on the day the animal is impounded. The Veterinarian shall enter
his/her initials next to the date when the animal is actually released from
quarantine.
16. Victim: enter name of victim bitten/exposed as it appears on the Rabies Control
Investigation Report (Bite/Scratch Report).
17. Outside Vet: Hospital: mark X and enter the name of the veterinary hospital
where the animal has been admitted.
18. Phone: enter the telephone number of the veterinary hospital where the animal
has been admitted.
19. Date Received: enter the date the animals arrived at OCACS from an outside
veterinary hospital.
20. Treat Rec #: enter the control number shown on the Emergency Animal
Treatment Record from the outside veterinary hospital.
OWNER INFORMATION
21. ID Tag: mark and X if the animal is wearing an identification tag/rabies tag.
Enter owner information from an ID tag in the appropriate section on the front
of the AHR.
If the tag on the animal is a rabies tag, place all related information, i.e., name of
the animal’s hospital, address, telephone number, rabies tag number, in the

4. COUNTY OF ORANGE
HEALTH CARE AGENCY
REGULATORY HEALTH SERVICES
ANIMAL CARE SERVICES
Number: 200.06
SUBJECT: INITIATION OF AN ANIMAL HISTORY RECORD Page: 4
Date: 10/5/05
Approved: Jennifer Phillips, Director Revised: 02/15/07
SPECIAL ATTENTION/ADDITIONAL INFORMATION section on the
reverse side of the AHR.
22. Name: enter the first and last name of the animal owner.
23 CDL #: enter owner’s California driver’s license number when animal is
redeemed.
24 Street: enter complete address.
25. City: enter city name.
26. Zip: enter zip code.
27. Hm Phone: enter home telephone number.
28. Wk Phone: Enter work telephone number.
BOTTOM SECTION
29. IMPOUND DATE: enter the month, day and year, i.e., 12-10-06, the animal is
taken into possession as defined by policy method on page one.
30. LICENSE/CITY/STATE:
a. If there is an Orange Country license on the animal, enter the license
number.
b. If the license on the animal was issued by a city and/or state, circle the
word CITY and/or STATE. Enter the name of the city/state (no
abbreviations), color of the tag and year of issue.
c. If additional space is needed, write OVER and use the SPECIAL
ATTENTION/ADDITIONAL INFORMATION section.
d. If multiple tags, write OVER and list each one as above.
31. CITY/COMMUNITY: enter the complete name of the city or community where
the animal was impounded.
32. SCAN: mark X when the animal has been scanned for a microchip. If a
microchip is located, enter the microchip number. Veterinary staff will enter the
lost number and microchip number for microchips implanted at OCACS.
33. EAR TAG: enter the four digit number for a cat impounded wearing an ear tag.
34. KENNEL/CAGE NUMBER: enter the kennel/cage number in which the animal
is placed. If the animal is moved into another kennel or cage, enter that number
in the second box and place a single line through the prior pen assignment. If
the animal is deceased:
a. Without owner information, write MORGUE in the first box.
b. With owner information, write LIC BARREL in the first box.

5. COUNTY OF ORANGE
HEALTH CARE AGENCY
REGULATORY HEALTH SERVICES
ANIMAL CARE SERVICES
Number: 200.06
SUBJECT: INITIATION OF AN ANIMAL HISTORY RECORD Page: 5
Date: 10/5/05
Approved: Jennifer Phillips, Director Revised: 02/15/07
c. When the carcass will be used for head test purposes, necropsy, etc.,
write, TAG MORGUE in the first box.
d. If the animal was taken to a veterinary hospital, enter VET in the first
box.
IMPOUND INFORMATION
35. IMPOUND #: When the Chameleon system is operational, an Animal ID shall
be created and the Animal ID number shall be entered in this spot.
36. IMPOUND DATE: date stamp the month, day and year the animal is taken into
possession, either to be delivered to OCACS or an outside veterinarian for
emergency treatment.
37. PRIOR IMPOUND #: circle the word PRIOR if the animal is believed to have
been impounded previously. Office personnel shall verify if the animal has
prior impounds and enter the PRIOR IMPOUND #.
NOTE: for animals adopted and then returned, place the PRIOR IMPOUND # on the
reverse side of the AHR under SPECIAL ATTENTION/ADDITIONAL
INFORMATION section.
DISPOSITION
38. By: person responsible for the animal disposition shall enter his/her first initial
and last name. Enter badge number if applicable.
39. Date: enter the month, day and year, i.e., 12-10-06, of the disposition.
40. License Sold #: when an animal is redeemed or adopted, enter the license
number sold.
41. Redeemed RCPT #: enter receipt number issued when animal is redeemed.
42. Placed RCPT #: enter receipt number issued when animal is placed/adopted.
43. Euthanized: circle this box if euthanasia is authorized. The person performing
euthanasia will place an X in the circled box, initial line 38 and confirm the date
on line 39. If euthanasia is not performed on the date it was authorized, refer to
P&P 400.08 on euthanasia.
DOA: mark X in this box if the animal was deceased when delivered to OCACS
by a citizen or impounded dead in the field by an ACO.
Died: mark X in this box if the animal died at OCACS, enroute to OCACS or at
a veterinary hospital.

6. COUNTY OF ORANGE
HEALTH CARE AGENCY
REGULATORY HEALTH SERVICES
ANIMAL CARE SERVICES
Number: 200.06
SUBJECT: INITIATION OF AN ANIMAL HISTORY RECORD Page: 6
Date: 10/5/05
Approved: Jennifer Phillips, Director Revised: 02/15/07
Other: mark X in this box for all other types of dispositions and enter the
appropriate abbreviation as follows:
FR: field release.
RV: redeemed at vet.
REHAB: wildlife released to a rehabilitation facility.
BOL: Bureau of Livestock.
ESC: animal escaped.
STOL: animal stolen.
IER: illegal exotic release (ferrets, etc.).
BIF: buried in the filed.
VACCINATION/LICENSE INFORMATION
44. Mark X for applicable vaccination(s) to be given. Veterinary staff shall initial
next to each vaccination when it is administered.
45. Other: mark X and enter other vaccinations requested, i.e., CDV (Ferret
distemper, BORD (Bordatella), etc. Veterinary staff shall initial line 45 when
vaccination is given.
46. VED: enter the month and year the current rabies vaccination expires.
47. Veterinarian: enter the veterinarian’s name found on the certificate.
48. Current License Not On Animal: enter the most current license number
according to records. Enter the license expiration date under line 48.
OFFICE INFORMATION
49. Owner Notified - Date/By: enter the first initial and last name of the person
making the notification. The notification is usually completed by office
personnel; except as follows:
a. An ACO shall enter X and the date notified when an owner known dead
animal is impounded from the owner/custodian or from a veterinarian for
rabies testing.
b. If applicable, the ACO shall write PER VET on line 50. Additional
comments are to be placed on the reverse side in the SPECIAL
ATTENTION/ADDITIONAL INFORMATION section.
50. Circle appropriate method of contact:

7. COUNTY OF ORANGE
HEALTH CARE AGENCY
REGULATORY HEALTH SERVICES
ANIMAL CARE SERVICES
Number: 200.06
SUBJECT: INITIATION OF AN ANIMAL HISTORY RECORD Page: 7
Date: 10/5/05
Approved: Jennifer Phillips, Director Revised: 02/15/07
a. Phone: circle only if the owner or custodian has been contacted (this
does not include minors). If the person contacted has a name that is
different than that listed under OWNER INFORMATION, enter this
name under SPECIAL ATTENTION/ADDITIONAL INFORMATION
section. If unable to reach owner by telephone, enter the date attempted
under line 49 and initial.
b. Mail: circle only if an Owner Notification Card has been mailed. Attach
duplicate of card (face up) on the reverse side of the AHR.
c. Person: circle only if you have made in-person contact with the owner
and he/she has been advised or has identified his/her animal as being
impounded.
RELEASE INFORMATION
51. Mark X in the appropriate box.
52. Read aloud to the owner/custodian. If owner/custodian chooses to release the
animal, mark X in this box for the animal to be released to OCACS.
53. Read aloud to an owner/custodian requesting euthanasia of their pet and mark X
in this box.
54. Owner/custodian must initial that they have read and agreed to line 53.
NOTE: Line 52, 53, and 54 can only be completed by owner/custodian.
55-56. Releasing citizen/owner/custodian must indicate, to the best of their knowledge,
if the animal has/has not bitten any animal or human within the past 14 days and
mark X in the appropriate box.
57-63. When any box 51-56 is marked, each item 57-63 must be completed.
SPECIAL ATTENTION/ADDITIONAL INFORMATION
64. This section shall be used for information pertinent to the animal that may
shorten or extend retention dates. The appropriate box must be marked on the
front of the AHR. Each entry is to be dated and initialed by the individual
making the entry. The following are examples of information to be placed under
SPECIAL ATTENTION/ADDITIONAL INFORMATION:
a. Door tagged.

8. COUNTY OF ORANGE
HEALTH CARE AGENCY
REGULATORY HEALTH SERVICES
ANIMAL CARE SERVICES
Number: 200.06
SUBJECT: INITIATION OF AN ANIMAL HISTORY RECORD Page: 8
Date: 10/5/05
Approved: Jennifer Phillips, Director Revised: 02/15/07
b. Not to be released for home quarantine - inadequate facilities.
c. Collar removed, tagged and placed in property cabinet.
d. Hold slip initiated.
e. Ownership verification attached.
f. Not to be released or dispositioned without prior approval of Operations
or Supervisory staff.
g. Police hold information to include: police department, police officer’s
name and badge number, DR number and if obtainable, brief reason for
impound, and what Kennel Services is to do with the animal.
h. Behavioral information about the animal.
i. Additional owner extension requests.
j. Animal found running with a second animal and both impounded.
k. PUFA: put up for adoption.
NOTE: Treatment information is not to be entered in this section. Treatment
information must be entered on the Animal Treatment Form.