Autopsy Form

George R. Nichols, II, M.D.

WB01552_.gif (540 bytes)

COMMONWEALTH MEDICAL LEGAL SERVICES, INC.

AUTOPSY AUTHORIZATION FORM

FELLOW CAP, AAFS, ASCP

DIPLOMATE AMERICAN BOARD OF PATHOLOGY (AP, CP, FP)

AUTHORIZATION FOR POST-MORTEM EXAMINATION

 

I, ___________________________, hereby authorize George R. Nichols, II, M.D. to perform a Post-Mortem Examination on this deceased body, _______________________________, and to remove and retain such organs and tissues as may be necessary to determine the identification and/or the cause of death and/or the manner of death of this deceased person.

Signature  ___________________________

Date          _____________

Brownsboro Office Park * 6013 Brownsboro Park Blvd. Suite D * Louisville, KY 40207

Phone: (502) 899-9837 * Toll Free 1-877-333-2614 * FAX: (502) 899-9840

EMAIL: REAPERGRN@AOL.COM

WEBSITE: WWW.COMMONWEALTH-MEDICAL.WEB.IGLOU.COM

 

 
Home Abbreviated CV Curriculum Vitae Rule 26 Disclosure Services Autopsy Form Fees Directions Scene Article