Medium

Available on

Apple Android Windows

Autopsy Consent Form Mobile App

The Autopsy Consent Form mobile app offers a sample consent form to assist pathologists and hospitals in developing their own forms for use in securing consent for the performance of autopsies. This sample form should not be adopted without careful consideration of applicable state law, institutional policies, and local practice. It should be tailored to reflect all of these considerations as well as the drafting style of the particular pathology group and hospital. Please note that this sample does not cover obtaining consent for the removal or organs or tissue for transplantation. A separate form is required for that purpose. In any event, the College recommends that, prior to adoption, any autopsy consent form be reviewed by an attorney knowledgeable about governing law and sensitive to local practice. GoCanvas allows you to export your data in a CSV Format.

  • Lendlease
  • The Cooperative
  • PG&E
  • Toys R Us
  • Red Bull
  • Mirvac

Want to learn more about GoCanvas?

Request a Demo

Take a peek inside the Autopsy Consent Form Mobile App

Included Features

Our App Builder gives you the power to easily add and remove the ones you want. {{controller.show_all ? 'See included features.' : 'See more features.'}}

  • {{data.title}}

Included Fields

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

  • Ico textbox

    NAME OF DECEDENT:

  • Ico date

    DATE OF DEATH

  • Ico textbox

    NAME AND TITLE OF PHYSICIAN PERFORMING PROCEDURE:

  • Ico textbox

    LICENSE NUMBER:

  • Ico textbox

    NAME OF FACILITY AND DEPARTMENT WHERE THE PROCEDURE WILL BE PERFORMED:

  • Ico statictext

    The physician may be required to remove and retain organs, fluids, prosthetic devices, or tissue ...

  • Ico statictext

    Please indicate which, if any, restrictions or special limitations you would like to make on the ...

  • Ico checkbox

    None.

  • Ico checkbox

    Permission is granted for an autopsy with the following limitations and conditions (specify):

  • Ico checkbox

    Exam is restricted to brain and spinal cord

  • Ico checkbox

    E xam is restricted to the chest and abdomen only

  • Ico checkbox

    Exam is restricted to the chest cavity

  • Ico checkbox

    Exam is restricted to the abdominal cavity

  • Ico checkbox

    Other:

  • Ico textbox

    (Specify)

  • Ico statictext

    I authorize the release of the remains to the funeral services provider or person listed below af...

  • Ico textbox

    Name of Funeral Service Provider or Person:

  • Ico textbox

    Telephone Number:

  • Ico signature

    Authorizing Person’s Signature

  • Ico date

    Date

  • Ico textbox

    Authorizing Person’s Name and Relationship to Decedent

  • Ico signature

    Witness’s Signature

  • Ico date

    Date

  • Ico textbox

    Witness’s Name

  • Ico statictext

    Warning: It is a felony to falsify information on a Vital Statistics application, record or report.

  • ...and More!

Related Health Care & Social Services Apps... and they're all free for GoCanvas subscribers!

App Name

Autopsy Consent and Authorization

The Autopsy Consent and Authorization mobile app offers this sample form to assist pathologists and hospitals in developin...

App Name

Coroner's Report Request

The Coroner's Report Request mobile app makes it easy to request a coroner’s report using a Smartphone or tablet. This app...

App Name

Investigation and Assessment of Still...

The Investigation and Assessment of Stillbirths mobile app was designed to facilitate collection of information pertinent ...

App Name

Sherriff's Death Scene Checklist

The Sheriff's Death Scene Checklist mobile app was developed to assist sheriff departments with maintaining and documentin...

App Name

Checklist for Healthcare Providers re...

Medical providers are required to notify local or state public health department within 3 working days if CJD, variant CJD...

App Name

Final Pathology Diagnoses

Medical Examiners and Coroners can use the Final Pathology Diagnoses mobile app to report the following: Final Pathologica...

App Name

Homicide Scene Investigation: Investi...

When an investigator/prosecutor receives the first notice of the fact that a corpse has been found, or that a homicide has...

App Name

Homicide Scene Investigation: Interviews

Most of the time of a crime scene analyst/prosecutor/investigator is dedicated to talking, and then writing about his/her ...

More Information