Case No.:….
OFFICE OF THE COUNTY MEDICAL EXAMINER
Republic of the Philippines
TOLEDO CITY, CEBU
REPORT OF INVESTIGATION BY MEDICAL EXAMINER
DECEDENT………………………………………………………………….......PAGE……SEX……AGE………
First Name Middle Name Last Name
HOME
ADDRESS…………………………………………………………………………. OCCUPATION……………....
TYPE OF DEATH: Violent Casualty Suicide Suddenly when in apparent health Found ◽ ◽ ◽ ◽
Dead◽
In Prison Suspicious, unusual or unnatural Cremation ◽ ◽ ◽
Comment………………………………………………………………………………………………………………………………………..
If motor Vehicle Accident: Check One: Driver Passenger Pedestrian Unknown ◽ ◽ ◽ ◽
Notification by……………………………………………………………………Address…………………………………………………
Investigation Agency………………………………
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Description of Body Clothed Unclothed Party Clothed ◽ ◽ ◽
Eyes……………….. Hair ………….……….. Mustache……………… Beard…………...
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Weight…………….. Length………..…….Body Temp……….……Date &
Time…………………
Pounds Feet Inches Fahrenheit
Rigor: Yes No Lysed Liver Color…………………..Fixed Non-Fixed◽ ◽ ◽ ◽ ◽
Marks and Wounds………………………………………
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PROBABLE CAUSE OF DEATH MANNER OF DEATH DISPOSITION OF CASE
(check one only)
Accident Natural ◽ ◽
Suicide Unknown ◽ ◽
Homicide Pending ◽ ◽
1.Not a medical examiner case ◽
2.Autopsy requested Yes No◽ ◽
Autopsy ordered Yes No◽ ◽
Pathologist…………………………….
