REGIONAL AUTOPSY PROGRAM
To Be Completed by Referring Coroner's Office
All Fields are Mandatory. If the Field is Unknown, Describe as "unknown".
if your answer choice is "yes" to any questions below, please ensure that you fill out all fields related to that question.
IF YES, PLEASE FILL OUT LAW ENFORCEMENT OFFICIAL INFORMATION
IF YES, PLEASE FILL OUT LE OFFICIAL'S CONTACT INFORMATION
IF YES, PLEASE EMAIL SCENE PHOTOS WITH BODY TO CSEVANS@ebrcoroner.COM
Please fax applicable medical records and death summary to 225-389-3447 ASAP.
Scene photos will be required prior to autopsy.
if yes, SUIDI form will be required prior to autopsy.
if yes, fill in the information below:
if yes, Describe Circumstances.
if yes, How Often was Alcohol Used?
Thank you for your submission.