Medicolegal Death Report Intake/Triage Note

Note status: [Initial / Addendum / Corrected]

ME/C office: [Office name]

ME/C case #: [Case number / Pending assignment]

Cross-agency identifiers: [LE case #; EMS run #; Hospital MRN; Other incident #] (List only identifiers provided; if none, state "None reported at intake.")

Notification Details

Notification received: [YYYY-MM-DD HH:mm timezone] (Use 24-hour clock.)
Notification method: [phone / radio / electronic / in-person]
Intake staff: [Name], [Role/Title]
Reporting party: [Name], [Role/Title], [Agency/Facility], [Callback phone], [on-scene / remote], [Reliability: first-hand witness / relaying from on-scene / unknown]

Intake Summary: [Single paragraph synthesizing: who called and from where; decedent identity or "unidentified adult/male/female"; current body location; trigger for medicolegal review; immediate plan status] (Use source attribution, e.g., "Per [source]...")

Decedent Information

Identification status: [identified / tentatively identified / unidentified] — Method: [government-issued ID / facial recognition by knowledgeable party / fingerprints / dental / DNA / unique features / other / Unknown at intake]
Name (legal): [Full name / Unknown at intake] — Aliases/AKA: [List / None / Unknown at intake]
Date of birth: [YYYY-MM-DD / Unknown at intake] — Age: [Years / Estimated / Unknown at intake]
Sex: [Male / Female / Intersex / Unknown at intake] — Race/Ethnicity (as reported): [Value / Unknown at intake]
Residence address: [Street, City, State, ZIP / Unknown at intake]
Next-of-kin: [Name, Relationship / Unknown at intake] — NOK contact: [Phone / Unknown at intake]

Location and Custody

Current body location: [Address or Facility name, unit/room] — Setting type: [private residence / hospital / nursing home / jail or prison / public location / outdoors / shelter / other]
Jurisdictional geography: [County], [City/Town]
Incident location (if different): [Address / Same as body location / Unknown at intake]
Custody of remains: [Agency/Facility/Person currently responsible / Unknown at intake]
Body moved: [Not moved / Moved: from (location) to (location) by (agency/person) at (time) / Unknown at intake]
On-scene contact: [Name, Role, Callback phone / Unknown at intake] (Complete if scene response planned.)

Timeline

(Distinguish reported times from confirmed times. Use 24-hour clock with timezone.)

• Last known alive: [YYYY-MM-DD HH:mm timezone / Unknown at intake] — Source: [Name/Role] — [Reported / Confirmed]
• Found unresponsive/deceased: [YYYY-MM-DD HH:mm timezone / Unknown at intake] — Found by: [Name/Role] — [Reported / Confirmed]
• EMS arrival: [YYYY-MM-DD HH:mm timezone / Unknown at intake / N/A] — [Reported / Confirmed]
• Pronounced dead: [YYYY-MM-DD HH:mm timezone / Unknown at intake] — By: [Name, Credentials] — [Reported / Confirmed]
• Notification to ME/C: [YYYY-MM-DD HH:mm timezone]
• Jurisdiction decision: [YYYY-MM-DD HH:mm timezone / Pending]

Time of death basis (if estimated): [Basis for approximation / Not applicable]

Circumstances of Death

[Chief circumstances narrative of 3–8 sentences using source attribution throughout (e.g., "Per Officer [Name]...", "Per facility staff..."). Summarize reported events, discovery context, and resuscitation attempts. Avoid conclusions not supported by available data.]

Suspected manner: [natural / accident / suicide / homicide / undetermined / pending] — Basis: [caller report / chart review / LE information / EMS report]
Suspected cause: [Brief phrase / Unknown at intake] — Basis: [Source]

Triage flags present: [List applicable: recent or remote trauma; death in custody or during LE interaction; infant/child death; suspicious circumstances; possible overdose; workplace-related; fire-related; known infectious disease risk; multiple decedents / None reported at intake]

Medical history (if material to triage): [Terminal diagnosis; hospice enrollment; recent hospitalization; treating physician availability and willingness to certify; relevant medication/substance context / None reported at intake]

(If pediatric: Include sleep environment, position found, last seen well, caregiver timeline, recent illness, and feeding history as reported.)

(If overdose suspected: Include reported substances/medications, paraphernalia described, naloxone administration and response, and preservation instructions given.)

(If death in custody or during LE interaction: Include facility type, unit, restraint or use-of-force context as reported, and chain-of-command contacts.)

Jurisdiction Decision

Decision: [Retain jurisdiction / Release jurisdiction / Defer pending more information]
Decision timestamp: [YYYY-MM-DD HH:mm timezone]
Decision-maker: [Name], [Role/Credentials] — Consulted via: [in person / phone / electronic]

Rationale: [Concise, auditable rationale referencing applicable jurisdiction triggers or release criteria with source attribution.]

If releasing jurisdiction:
— Certifier who will sign death certificate: [Name, Role/Title]
— Natural cause asserted with authorized certifier willing to sign: [Yes / No]
— No trauma/abuse/neglect/foul play/substance toxicity concerns: [Confirmed / Not confirmed]
— Instructions provided to reporter: [Details / None]

If deferring: [List specific missing elements required to decide, e.g., treating physician confirmation, EMS run sheet, scene photos, medical records.]

Response Plan

(Include when jurisdiction is retained or likely retained.)

Response determination: [Respond in person / Coordinate remote documentation / No scene response] — Reason: [Brief reason]
Response priority: [High / Standard / Low] — Assigned personnel: [Names/Roles] — ETA: [YYYY-MM-DD HH:mm timezone / TBD]

Instructions to partner agencies: [Body movement restrictions; scene security; photo/video requests; items to preserve (medications, paraphernalia, ID documents, devices)] (State exact instructions provided or "None given.")

Permission to move body: [Granted / Not granted / Not requested]
(If granted: Time: [YYYY-MM-DD HH:mm timezone] — To: [Name/Agency] — Conditions: [Details])

Safety hazards reported: [Weapons; hostile persons; environmental hazards; infection control concerns / None reported] — PPE plan reviewed: [Yes / No]

Contacts and Coordination

• [YYYY-MM-DD HH:mm timezone] — [Person, Agency] ([phone / electronic / in-person]): [Reached / Voicemail / No answer] — [Key information obtained or instructions given]
• (Add entries as applicable for: LE lead investigator, facility supervisor, EMS supervisor, prosecutor/DA notification, public health notification, organ/tissue donation referral.)

Follow-Up Tasks

• [Task description] — Responsible: [Person/Role] — Target: [Date/Timeframe]
• (For any required element marked "Unknown at intake," add a corresponding follow-up task here.)

Updates/Addenda

(Include only if Note status is Addendum or Corrected. Do not overwrite original entries.)

[Update per (source) on YYYY-MM-DD HH:mm timezone: (What changed and why)]

(If jurisdiction decision changed: Document prior decision, new decision, timestamps, rationale, and authorizing decision-maker.)