More examples in Healthcare/Medical Examination Reports
Medical Examination of an Execution Example
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Text in this example:
EXECUTIONS NAME OF DECEDENT: This form is to be completed in addition to the ROD form in these guidelines DATE EXECUTION SCHEDULED: TIME: PLACE: MANNER OF EXECUTION IF BY LETHAL INJECTION, IDENTIFY DRUG(S) INVOLVED, QUANTITIES AND INTERVALS OF
INJECTIONS IF MORE THAN ONE: COMPLICATIONS, IF ANY: OMI ASSUMED CUSTODY OF REMAINS AT: DATE: TIME: PLACE: STAFF REPORT OF RECORD REQUEST ED: DATE: COPY OF EXECUTION RECORD REQUEST ED: DATE: COPY OF DECEDENT'S MEDICAL AND PRISON RECORDS REQUESTED: DATE: BODY TAGGED AND SEALED BY: DATE: TIME: BODY TRANSPORTED SEALED WITH SEALED RECORDS BY: DATE: TIME: TO OMI ALBUQUERQUE. NAME OF INVESTIGATOR DMI#
INJECTIONS IF MORE THAN ONE: COMPLICATIONS, IF ANY: OMI ASSUMED CUSTODY OF REMAINS AT: DATE: TIME: PLACE: STAFF REPORT OF RECORD REQUEST ED: DATE: COPY OF EXECUTION RECORD REQUEST ED: DATE: COPY OF DECEDENT'S MEDICAL AND PRISON RECORDS REQUESTED: DATE: BODY TAGGED AND SEALED BY: DATE: TIME: BODY TRANSPORTED SEALED WITH SEALED RECORDS BY: DATE: TIME: TO OMI ALBUQUERQUE. NAME OF INVESTIGATOR DMI#