More examples in Healthcare/Medical Examination Reports
Unreported OMI Case Medical Examination Example
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UNREPORTED OMI CASE NAME OF DECEDENT: This form is to be completed in addition to the ROD form in these guidelines FILL OUT THE PRELIMINARY REPORT OF DEATH WITH BASIC INFORMATION JUST AS YO U WOULD
IF YOU HAD RECEIVED A REPORT FOR THE FIRST TIME. DEATH CERTIFICATE JURISDICTION: IF THE CENTRAL OFFICE HAS PROVIDED YOU WITH A DEATH CERTIFICATE THAT HAS BEEN REVIEWED AT THE CENTRAL OFFICE AND WARRANTS FURTHER INVESTIGATION, TAKE ALL PERTINENT INFORMATION FROM THE DC FOR THE REPORT OF DEATH. INTERVIEW WITH THE PRIVATE PHYSICIAN IF THE DC INFORMATION INDICATES THAT THE DEATH WAS REPORTABLE (INJURY OR SUSPICIOUS CAUSE LISTED), CONTACT THE PHYSICIAN WHO SIGNED THE DEATH CERTIFICATE TO INQUIRE INTO THE CIRCUMSTANCES UNDER WHICH SUCH A DIAGNOSIS WAS MADE - IF IT TURNS OUT THAT THE INJURY OR CAUSE LISTED WAS A REPORTABLE DEATH, INFORM THE PHYSICIAN THAT THE DEATH CERTIFICATE WILL HAVE TO BE AMENDED TO REFLECT THE MANNER OF DEATH (ACCIDENTAL, SUICIDAL, HOMICIDAL, UNDETERMINED, ETC.). AT THAT TIME, GET AS MUCH INFORMATION FOR YOUR REPORT AS POSSIBLE INCLUDING WHEN THE ACCIDENT, SUICIDE, ETC., OCCURRED, AT WHAT TIME, WHERE, ETC., JUST AS YOU WOULD WITH ANY INVESTIGATION.
IF THE PRIVATE PHYSICIAN INDICATES THAT THE CAUSE OF DEATH LISTED (INCLUDING THE OTHER SIGNIFICANT SECTION) WAS NOT, IN FACT, CONTRIBUTORY TO THE DEATH, INFORM THE PHYSICIAN THAT THE DEATH CERTIFICATE WILL HAVE TO BE AMENDED TO DELETE THAT SECTION OF THE DEATH CERTIFICATE, BASED ON HI S/HER STATEMENTS. HOSPITAL OR PHYSICIAN'S RECORDS IF THE CAUSE OF DEATH IS OMI REPORTABLE, SUBPOENA ALL PHYSICIAN OR HOSPITAL RECORDS
PERTAINING TO THE INJURY (USUALLY CLINICAL SUMMARIES ARE SUFFICIENT, UNLESS THE HOSPITAL COURSE IS RELEVANT TO FINDINGS). LAW ENFORCEMENT NOTIFICATION IF COD IS OMI REPORTABLE, AND A CASE IN WHICH LAW ENFORCEMENT SHOULD BE INVOLVED,
INFORM LAW ENFORCEMENT FOR RECORD OR ACTION PURPOSES AND INDICATE WHO WAS NOTIFIED, WHEN, AND WHAT ACTION WAS TAKEN BY THEM. WITNESS' STATEMENTS IF COD IS OMI REPORTABLE, TALK WITH ALL FAMILY MEMBERS, WITNESSES, OR OTHER PARTIES WHO MAY HAVE DIRECT KNOWLEDGE OF THE INCIDENT SO THAT A THOROUGH INVESTIGATION CAN BE COMPLETED.
AFTER YOUR INVESTIGATION IS COMPLETED, COLLECT ALL DOCUMENTS AND SUBMIT YOUR COMPLETED ROD, SUPPLEMENTALS, COPIES OF RECORDS, AND OTHER MATERIAL GATHERED IN THE COURSE OF INVESTIGATION. NAME OF INVESTIGATOR DMI#
IF YOU HAD RECEIVED A REPORT FOR THE FIRST TIME. DEATH CERTIFICATE JURISDICTION: IF THE CENTRAL OFFICE HAS PROVIDED YOU WITH A DEATH CERTIFICATE THAT HAS BEEN REVIEWED AT THE CENTRAL OFFICE AND WARRANTS FURTHER INVESTIGATION, TAKE ALL PERTINENT INFORMATION FROM THE DC FOR THE REPORT OF DEATH. INTERVIEW WITH THE PRIVATE PHYSICIAN IF THE DC INFORMATION INDICATES THAT THE DEATH WAS REPORTABLE (INJURY OR SUSPICIOUS CAUSE LISTED), CONTACT THE PHYSICIAN WHO SIGNED THE DEATH CERTIFICATE TO INQUIRE INTO THE CIRCUMSTANCES UNDER WHICH SUCH A DIAGNOSIS WAS MADE - IF IT TURNS OUT THAT THE INJURY OR CAUSE LISTED WAS A REPORTABLE DEATH, INFORM THE PHYSICIAN THAT THE DEATH CERTIFICATE WILL HAVE TO BE AMENDED TO REFLECT THE MANNER OF DEATH (ACCIDENTAL, SUICIDAL, HOMICIDAL, UNDETERMINED, ETC.). AT THAT TIME, GET AS MUCH INFORMATION FOR YOUR REPORT AS POSSIBLE INCLUDING WHEN THE ACCIDENT, SUICIDE, ETC., OCCURRED, AT WHAT TIME, WHERE, ETC., JUST AS YOU WOULD WITH ANY INVESTIGATION.
IF THE PRIVATE PHYSICIAN INDICATES THAT THE CAUSE OF DEATH LISTED (INCLUDING THE OTHER SIGNIFICANT SECTION) WAS NOT, IN FACT, CONTRIBUTORY TO THE DEATH, INFORM THE PHYSICIAN THAT THE DEATH CERTIFICATE WILL HAVE TO BE AMENDED TO DELETE THAT SECTION OF THE DEATH CERTIFICATE, BASED ON HI S/HER STATEMENTS. HOSPITAL OR PHYSICIAN'S RECORDS IF THE CAUSE OF DEATH IS OMI REPORTABLE, SUBPOENA ALL PHYSICIAN OR HOSPITAL RECORDS
PERTAINING TO THE INJURY (USUALLY CLINICAL SUMMARIES ARE SUFFICIENT, UNLESS THE HOSPITAL COURSE IS RELEVANT TO FINDINGS). LAW ENFORCEMENT NOTIFICATION IF COD IS OMI REPORTABLE, AND A CASE IN WHICH LAW ENFORCEMENT SHOULD BE INVOLVED,
INFORM LAW ENFORCEMENT FOR RECORD OR ACTION PURPOSES AND INDICATE WHO WAS NOTIFIED, WHEN, AND WHAT ACTION WAS TAKEN BY THEM. WITNESS' STATEMENTS IF COD IS OMI REPORTABLE, TALK WITH ALL FAMILY MEMBERS, WITNESSES, OR OTHER PARTIES WHO MAY HAVE DIRECT KNOWLEDGE OF THE INCIDENT SO THAT A THOROUGH INVESTIGATION CAN BE COMPLETED.
AFTER YOUR INVESTIGATION IS COMPLETED, COLLECT ALL DOCUMENTS AND SUBMIT YOUR COMPLETED ROD, SUPPLEMENTALS, COPIES OF RECORDS, AND OTHER MATERIAL GATHERED IN THE COURSE OF INVESTIGATION. NAME OF INVESTIGATOR DMI#