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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
  • Red Bull
  • Mirvac

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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.'}}

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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.

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