Health 1328 - Medicolegal Autopsy Notification

1 & 2

Hospital & Case Number

1. Name of Hospital / Institution *

2. Post Mortem S/N *

4. Court Case / Inquest No. *

3

Inquirer Details

4.1 Inquirer Name *

4.2 Inquirer Designation *

4.2.2 Inquirer into Sudden Deaths 4.2.1 Magistrate

4.3 Area

5

Details of the Deceased

5.1 Full Name of Deceased *

5.2 Age (Years) *

5.3 Sex *

Male (M) Female (F)

5.4 Place of Death *

At the Scene On Admission Hospital Admission

Hospital Name

BHT No. (6 digits)

Ward No. (e.g. ETU)

5.5 Date of Death

5.6 Time of Death

6

Cause of Death / Probable Cause

Ia. Immediate Cause *

Ib. Antecedent / Underlying Cause

Ic. Antecedent Cause

Id. Antecedent Cause

II. Contributory Causes

7 & 8

Investigation & Maternal Details

7.1 Is the Cause of death under investigation?

No Yes

7.2 If Yes, specimens retained for further investigation?

No Yes

7.3 List specimens retained & institutions referred to

8. Maternal Death

No Yes

If yes, category of maternal death:

8.1 Direct 8.2 Indirect 8.3 Incidental

9

Comments & Opinions

9. Comments & opinions

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10

Autopsy Conducted By (Your Profile)

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10.1 Doctor Name *

10.2 Designation *

10.3 Date of Examination

🖋️ Signature & Rubber Stamp: Applied physically onto the printed report.

Hospital & Case Number

Inquirer Details

Details of the Deceased

Cause of Death / Probable Cause

Investigation & Maternal Details

Comments & Opinions

Autopsy Conducted By (Your Profile)

Official Health 1328 PDF Preview

Sample Report Reference (Health 1328)

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