More examples in Healthcare/Medical Examination Reports
Alcohol Related Death Medical Examination Form Example
SmartDraw includes thousands of professional-looking examples like this Alcohol Related Death Medical Examination Form that you can easily download, edit and customize to make your own in just minutes.
Text in this example:
ALCOHOL - RELATED DEATH NAME OF DECEDENT: This form is to be completed in addition to the ROD form in these guidelines SCENE HOW DOES ALCOHOL FACTOR INTO THIS INVESTIGATION? HOW MUCH (AND WHAT) IS THE DECEDENT ALLEGED TO HAVE BEEN DRINKING WHEN
OBSERVED? DESCRIBE CIRCUMSTANCES OF DECEDENT'S ALCOHOL CONSUMPTION (PARTYING, ALONE): IS THE AREA WHERE THE DECEDENT IS FOUND KNOWN TO BE INHABITED BY TRANSIENTS OR
ALCOHOLICS (EXPLAIN)? WERE ANY OTHER PERSONS WITH THE DECEDENT PRIOR TO HIS/HER DEATH? NO UNK IF YES DESCRIBE WHO AND INCLUDE THEIR RELATIONSHIP TO THE DECEDENT: WAS ALCOHOL FOUND ON THE PREMISES, IN THE AREA OF THE DECEDENT, OR ON THE DECEDENT? NO IF YES, DESCRIBE: HOW FAR IS THE DECEDENT FOUND FROM THE CLOSEST LIQUOR ESTABLISHMENT? FEET/YARDS/MILES DOES THE DECEDENT HAVE A HISTORY OF FALLING WHEN HE/SHE DRINKS? NO IF YES, IS THERE ANY INDICATION THAT THIS IS THE CASE IN THIS INVESTIGATION - EXPLAIN? NAME OF INVESTIGATOR DMI#
OBSERVED? DESCRIBE CIRCUMSTANCES OF DECEDENT'S ALCOHOL CONSUMPTION (PARTYING, ALONE): IS THE AREA WHERE THE DECEDENT IS FOUND KNOWN TO BE INHABITED BY TRANSIENTS OR
ALCOHOLICS (EXPLAIN)? WERE ANY OTHER PERSONS WITH THE DECEDENT PRIOR TO HIS/HER DEATH? NO UNK IF YES DESCRIBE WHO AND INCLUDE THEIR RELATIONSHIP TO THE DECEDENT: WAS ALCOHOL FOUND ON THE PREMISES, IN THE AREA OF THE DECEDENT, OR ON THE DECEDENT? NO IF YES, DESCRIBE: HOW FAR IS THE DECEDENT FOUND FROM THE CLOSEST LIQUOR ESTABLISHMENT? FEET/YARDS/MILES DOES THE DECEDENT HAVE A HISTORY OF FALLING WHEN HE/SHE DRINKS? NO IF YES, IS THERE ANY INDICATION THAT THIS IS THE CASE IN THIS INVESTIGATION - EXPLAIN? NAME OF INVESTIGATOR DMI#