More examples in Healthcare/Medical Examination Reports
Non-Surgical Death Hospital Medical Examination Example
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Text in this example:
HOSPITAL - NATURAL/NON -SURGICAL DEATH NAME OF DECEDENT: This form is to be completed in addition to the ROD form in these guidelines ATTENDING PHYSICIAN: INFORMANT: PLACE OF PRONOUNCEMENT: ER/INPATIENT DEATH - NO SURGICAL INTERVENTION IF DECEDENT IS AN ER PATIENT, AND PRIMARY CARE PHYSICIAN IS AWARE OF ADMISSION, AND DIAGNOSIS OF NATURAL DEATH HAS BEEN MADE, THERE IS NO REASON FOR OMI TO GET INVOLVED IN THIS CASE. RELEASE THE BODY TO THE HOSPITAL FOR FURTHER ACTION. DO NOT SUBMIT A REPORT. IF OTHERWISE, CONTINUE: ADMITTING DATE: TIME: IF DECEDENT HAS BEEN ADMITTED, AND THE DIAGNOSIS OF NATURAL DEATH HAS BEEN MADE, THERE IS NO REASON FOR OMI TO GET INVOLVED WITH THE DEATH. RELEASE THE BODY TO THE HOSPITAL FOR FURTHER ACTION. DO NOT SUBMIT A REPORT. IF OTHERWISE, CONTINUE:
IF DECEDENT IS AN ER OR INPATIENT AND CAUSE AND MANNER OF DEATH HAVE NOT BEEN DETERMINED OR THERE IS A QUESTION THAT IT MIGHT FALL UNDER THE JURISDICTION OF THE OMI, CONTACT LAW ENFORCEMENT HAVING JURISDICTION AND BEGIN INVESTIGATION AT HOSPITAL AND AT SCENE. ER/INPATIENT DEATH - UNDETERMINED - PRESUMABLY NATURAL DISEASE IF DECEDENT IS AN ER PATIENT WHO IS ADMITTED WITHOUT MEDICAL HISTORY, WHAT IS
PRELIMINARY OR FINAL DIAGNOSIS, IF ANY? CONTACT PRIMARY CARE PHYSICIAN. IF EXPECTED NATURAL DEATH IS CONFIRMED, REPORT THE DEATH TO THE CENTRAL OFFICE FOR POSSIBLE TERMINATION OF JURISDICTION.
IF PRIMARY CARE PHYSICIAN IS NOT A NEW MEXICO PHYSICIAN AND THIS IS AN EXPECTED NATURAL DEATH, CONTACT THE CENTRAL OFFICE FOR FURTHER INSTRUCTIONS. OMI ASSUMES JURISDICTION CONTACT THE HOSPITAL LAB TO DETERMINE IF ADMISSION SAMPLES ARE STILL AVAILABLE -- IF THEY ARE, SUBPOENA THEM FOR OMI. IF NOT, INDICATE SO ON THE ROD . THE CENTRAL OFFICE WILL DETERMINE WHAT HOSPITAL RECORDS, IF ANY, ARE TO BE SUBPOENAED. (IF A PHYSICIAN REQUESTS OMI INVOLVEMENT AT ANY LEVEL, THIS INFORMATION SHOULD BE RELAYED TO THE CENTRAL OFFICE WITH THE PHYSICIAN'S CONCERN(S).) NAME OF INVESTIGATOR DMI#
IF DECEDENT IS AN ER OR INPATIENT AND CAUSE AND MANNER OF DEATH HAVE NOT BEEN DETERMINED OR THERE IS A QUESTION THAT IT MIGHT FALL UNDER THE JURISDICTION OF THE OMI, CONTACT LAW ENFORCEMENT HAVING JURISDICTION AND BEGIN INVESTIGATION AT HOSPITAL AND AT SCENE. ER/INPATIENT DEATH - UNDETERMINED - PRESUMABLY NATURAL DISEASE IF DECEDENT IS AN ER PATIENT WHO IS ADMITTED WITHOUT MEDICAL HISTORY, WHAT IS
PRELIMINARY OR FINAL DIAGNOSIS, IF ANY? CONTACT PRIMARY CARE PHYSICIAN. IF EXPECTED NATURAL DEATH IS CONFIRMED, REPORT THE DEATH TO THE CENTRAL OFFICE FOR POSSIBLE TERMINATION OF JURISDICTION.
IF PRIMARY CARE PHYSICIAN IS NOT A NEW MEXICO PHYSICIAN AND THIS IS AN EXPECTED NATURAL DEATH, CONTACT THE CENTRAL OFFICE FOR FURTHER INSTRUCTIONS. OMI ASSUMES JURISDICTION CONTACT THE HOSPITAL LAB TO DETERMINE IF ADMISSION SAMPLES ARE STILL AVAILABLE -- IF THEY ARE, SUBPOENA THEM FOR OMI. IF NOT, INDICATE SO ON THE ROD . THE CENTRAL OFFICE WILL DETERMINE WHAT HOSPITAL RECORDS, IF ANY, ARE TO BE SUBPOENAED. (IF A PHYSICIAN REQUESTS OMI INVOLVEMENT AT ANY LEVEL, THIS INFORMATION SHOULD BE RELAYED TO THE CENTRAL OFFICE WITH THE PHYSICIAN'S CONCERN(S).) NAME OF INVESTIGATOR DMI#