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          _____________

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