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Autopsy Report Request Form Template

Easily collect essential details for autopsy reports

Taking the guesswork out of sending autopsy report requests can be challenging. This template helps funeral homes and medical professionals efficiently gather critical information about the decedent, such as their name, date of birth, and date of death. Benefit from easy online submissions, timely processing of requests, and enhanced communication with clients, all while aligning with industry best practices for data privacy. Start using the live template to simplify your request process today.

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Your full name
Email address
Phone number
Organization (if applicable)
Your relationship to the decedent
If other, describe your authorization
Preferred contact method
Email
Phone
Postal mail
No preference
Decedent's legal name
Date of birth
Date of death
Place of death (city, state, and facility if known)
Medical examiner/coroner case number (if known)
County or jurisdiction handling the case
Additional details to help locate the record (optional)
Purpose of this request
Personal records
Family understanding or closure
Estate or probate
Insurance claim
Legal matter
Academic or research
Media or public interest
Prefer not to say
Other
Please Specify:
Records requested (select all that apply)
Complete autopsy report
Toxicology report (if available)
Death investigation summary
Photographs (may require special authorization)
Other related records
Delivery preference
Secure email (PDF)
Postal mail (printed copy)
Pick up in person
No preference
Email for delivery (if email selected or applicable)
Mailing address for delivery (if postal mail selected or applicable)
Do you require a certified copy?
Yes
No
Requested urgency
No urgency (standard processing)
Within 2 weeks
Within 1 week
As soon as available
I am legally authorized to receive these records in this jurisdiction.
True
False
I will provide proof of identity and any required documentation upon request.
True
False
I understand that pending investigations or privacy laws may limit what can be released.
True
False
I understand fees may apply and agree to pay any applicable fees.
True
False
Consent to be contacted about this request
Yes
No
Type your full legal name as your signature
Signing date
Additional notes or special instructions (optional)
{"name":"Your full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Your full name, Email address, Phone number","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Paper art illustration depicting an autopsy report request form for FormCreatorAI article.

When to use this form

Use this request when you need an official postmortem report for insurance claims, estate matters, clinical review, or legal proceedings. Healthcare staff, medical examiners, attorneys, and the legal next of kin benefit. Common scenarios include a hospital quality team reviewing a surgical death, an insurer verifying cause and manner of death to close a claim, and a family securing a certified copy for personal records. If you also require related toxicology, submit a Drug testing request form. To obtain prior clinical test outputs referenced in the file, request them through the Laboratory result form.

Must Ask Autopsy Report Request Questions

  1. What is your relationship to the decedent, and are you the legal next of kin?

    Only authorized parties can receive protected records. This confirms your authority and prevents delays due to missing consent.

  2. What are the decedent's full name, date of birth, date and place of death, and any case or file number?

    These identifiers ensure we match the correct case and avoid duplicate searches. Accurate details speed retrieval, especially for archived records.

  3. Which materials do you need (full report, toxicology summary, histology, photos), and in what format (PDF or certified paper)?

    Scoping the request helps us prepare only what you need, lowering costs and turnaround time. If you also need new laboratory work, submit a Laboratory requisition form.

  4. Where should we deliver the report, and what method do you prefer (secure portal, encrypted email, mail, or pickup)?

    Clear delivery instructions set expectations for timing and fees. It also protects privacy and chain-of-custody requirements.

  5. What legal basis authorizes release, and can you upload supporting documents (government ID, consent, or court order)?

    Stating the legal basis and adding proofs ensures compliance with statutes and agency policy. It reduces rejections and keeps the release defensible.

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