| GOVERNMENT HOSPITAL …………………………… Hospital Code No………
POSTMORTEM EXAMINATION
PM No. : Date :
On the body of a M/F named : …………………………………………….
Age : …………………………………………….
Conducted by Dr. : …………………………………………….
On : …………………………………………….
at : ……………………………………………..
Residence : ……………………………………………..
Caste : …………………………………………….
Height : …………………………………………….
Identification Marks : (1) ………………………………………………………
(2) ………………………………………………………
(3) ……………………………………………………….
Found Dead At ………………………………… on ………………… at …………….
Sent By ……………………………………………………………………………………..
With Cr.No. …………………… Dated …………….. Through…………………………
Requistion Received at …………………………………………. on ……………………
Clothes:
The body first seen by the undersigned at …………………….. on ………………….
Its condition then was …………………………………………………………………….
The Examination was conducted by ………………………………. On……………
and was begun at ………………………………………………………………………..
P.T.O.
-Page 2-
Body Identified by P.C. : …………………………………………….
Condition of Clothes : …………………………………………….
Surrounding of Body : …………………………………………….
Attitude of Body : …………………………………………….
State of Nutrition : …………………………………………….
Symmetry of Body : …………………………………………….
Color of Skin : …………………………………………….
Color of Hair, Length :
Head : …………………………………………….
Arm Pits : …………………………………………….
Pubis : …………………………………………….
Mustache : …………………………………………….
External Injuries : …………………………………………….
……………………………………………………………………………………….
……………………………………………………………………………………….
Signs of Decomposition : …………………………………………….
General Appearance : …………………………………………….
Time of Death : …………………………………………….
Features :
Scalp: ……………………………. Eye Lids: …………… Nose: ………….
Mouth and Lips:………………… Tongue: ……………. Teeth: …………
Ears: ……………………………. Thorax: ………………
Abdomen: ………………………………………………………………………….
Generative Organs : ……………………….. Scrotum: …………………………
Extremities : ………………………………………………………………………..
………………………………………………………………………………………
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INTERNAL EXAMINATION
Abdomen : …………………………………………….
Peritoneal Cavity : …………………………………………….
Ribs : …………………………………………….
Heart: ( 150 to 360 gms.) : …………………………………………….
Lungs: (Right 540/Left 480 gms.) : …………………………………………….
Hyoid Bone : …………………………………………….
Stomach and Contents : …………………………………………….
Liver: ( 1200 to 1800 gms.) : …………………………………………….
Spleen: ( 90 to 210 gms.) : …………………………………………….
Kidney: ( 90 to 150 gms.) : …………………………………………….
Intestines : …………………………………………….
Bladder : …………………………………………….
Uterus : …………………………………………….
Head : ………………………………. Skull : ……………………………………..
Membranes : …………………………………………….
Brain ( M.1440 gms./F.1320 gms.) : …………………………………………….
Spinal Cord : …………………………………………….
Viscera Preserved or not :
Postmortem Concluded at : on:
Opinion :
Medical Officer ( With Name in BLOCK Letters and Seal) |