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Armed Forces Autopsy Report Request Mobile App

The Armed Forces Autopsy Report Request mobile app allows family members to request an autopsy report using a mobile device. The app creates a PDF that can easily be emailed to the office of the Armed Forces Medical Examiner. GoCanvas can create an app to integrate with your backend system.

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Take a peek inside the Armed Forces Autopsy Report Request Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    DATA REQUIRED BY THE PRIVACY ACT OF 1974

  • Ico statictext

    Authority: Title 10 USC, Section 1471

  • Ico statictext

    Principal Purpose: To obtain records/reports/photos of remains by persons legally authorized acce...

  • Ico statictext

    Routine Uses: By Department of Defense and other agencies to document and authorize actions neces...

  • Ico statictext

    Disclosure: Disclosure of requested information is voluntary.

  • Ico textbox

    NAME OF DECEASED (Last, First, Middle Initial)

  • Ico textbox

    SERVICE / RANK OF DECEASED

  • Ico textbox

    SSN OF DECEASED

  • Ico textbox

    NAME OF REQUESTOR

  • Ico multiline

    RELATIONSHIP TO DECEASED / REASON FOR NEED TO KNOW

  • Ico textbox

    REQUESTOR DAYTIME PHONE NUMBER(S)

  • Ico textbox

    REQUESTOR EMAIL

  • Ico date

    FOR OAFME USE: RECEIPT DATE

  • Ico signature

    INITIALS

  • Ico statictext

    I, the undersigned, am requesting to receive a copy of the official autopsy report written and ma...

  • Ico statictext

    I wish to receive the following (select one or both):

  • Ico signature

    I would like to receive a copy of the official autopsy report written by the Office of the Armed ...

  • Ico signature

    I would like to receive the photographs taken by the Office of the Armed Forces Medical Examinerd...

  • Ico statictext

    I understand official federal business requests will be sent via a secure DoD file sharing system...

  • Ico statictext

    Please send the requested information to the following (select one):

  • Ico signature

    Official Business Request.

  • Ico textbox

    OFFICIAL GOVERNMENT EMAIL (MANDATOR

  • Ico signature

    Please deliver the requested material to my home address:

  • Ico multiline

    SHIPMENT ADDRESS (NOTE: FEDEX DOES NOT DELIVER TO P.

  • Ico signature

    Please deliver the requested material to the following individual on my behalf:

  • Ico textbox

    NAME OF ADDRESSEE

  • Ico textbox

    ADDRESSEE DAYTIME PHONE NUMBER(S)

  • Ico multiline

    SHIPMENT ADDRESS (NOTE: FEDEX DOES NOT DELIVER TO P.

  • ...and More!

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