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Autopsy Request-Authorization

This form is for submitting information required for requesting and authorizing an autopsy. Please be sure to contact someone from the Crawford County Coroner's office before starting this form so you will have the date and time of arrival information. If you have any questions, need an acceptance date/time, or need to schedule transport, please call our office at 573-775-4250. After hours, call 573-775-4912.

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Hawaiian"},{"label":"Guamanian or Chamorro","value":"Guamanian or Chamorro"},{"label":"Samoan","value":"Samoan"},{"label":"Other Pacific Islander","value":"Other Pacific Islander"},{"label":"Unknown","value":"Unknown"}]},{"type":"select","required":true,"label":"Biological Sex","placeholder":"Select Sex","name":"Biological-Death","className":"col-lg-4","values":[{"label":"Male","value":"male","selected":true},{"label":"Female","value":"female"},{"label":"Unknown","value":"unknown"}]},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"date","label":"Date of Birth","name":"Date-of-Birth","className":"col-lg-4"},{"type":"date","required":true,"label":"Date of Death","name":"Date-of-Death","className":"col-lg-4"},{"type":"text","label":"Age","placeholder":"Age at 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Alcoholic ","value":"Known Alcoholic "},{"label":"Sex in exchange for money or drugs","value":"Sex in exchange for money or drugs"},{"label":"Inmate (incarceration) more than 72 hours in last 12 months","value":"Inmate (incarceration) more than 72 hours in last 12 months"},{"label":"Male has had sexual relations with other males within last 5 years","value":"Male has had sexual relations with other males within last 5 years"},{"label":"Homeless - Unhoused","value":"Homeless - Unhoused"}]},{"type":"radio-group","label":"Alerts to Pathologist","name":"Alerts-to-Pathologist","className":"col-md-6","values":[{"label":"Objection to autopsy","value":"Objection to autopsy"},{"label":"Strong desire for autopsy","value":"Strong desire for autopsy"},{"label":"Infectious disease","value":"Infectious disease"},{"label":"Reported body fluid exposure","value":"Reported body fluid exposure"},{"label":"Suspicious circumstances","value":"Suspicious circumstances"},{"label":"History of accident-falls-fractures","value":"History of accident-falls-fractures"},{"label":"Other (see case brief)","value":"Other (see case brief)"}]},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h3","label":"Incident Summary and Special Instructions ","className":"d-block"},{"type":"textarea","required":true,"label":"Brief Summary of Incident ","name":"Summary-of-Incident-","subtype":"textarea","maxlength":400,"className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"textarea","label":"Special Instructions","name":"Special-Instructions","subtype":"textarea","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"header","subtype":"h3","label":"Exam Type Requested","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"select","required":true,"label":"Autopsy Type","placeholder":"Choose one","name":"Autopsy-Type","className":"col-md-6","values":[{"label":"Full Forensic Autopsy","value":"Full Forensic Autopsy","selected":true},{"label":"External Only with Toxicology","value":"External Only with Toxicology"},{"label":"External Only with  Head and Toxicology","value":"option External Only with  Head and Toxicology-3"},{"label":"Toxicology Only","value":"Toxicology Only"}]},{"type":"select","label":"Additional Testing","placeholder":"Chose one","name":"Additional-Testing","className":"col-md-6","values":[{"label":"Hair Samples","value":"Hair Samples","selected":true},{"label":"DNA testing","value":"DNA testing"},{"label":"Sexual Assault Kit","value":"Sexual Assault Kit"},{"label":"Other or multiple - describe in special instructions","value":"other"}]},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"Transportation Information ","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"header","subtype":"h4","label":"Arrival","className":"d-block"},{"type":"paragraph","subtype":"p","label":"🚩Please verify arrival time with CCCO staff before submitting this form","className":"d-block"},{"type":"date","required":true,"label":"Arrival Date","placeholder":"Monday - Friday","name":"Arrival-Date","className":"col-lg-4"},{"type":"select","required":true,"label":"Arrival Time","placeholder":"Arrival Time","name":"Arrival-Time","className":"col-lg-4","values":[{"label":"Morning (after 0800)","value":"Morning","selected":true},{"label":"Afternoon (before 1600)","value":"Afternoon"},{"label":"Evening - Special Request Only","value":"Evening - Special Request Only"}]},{"type":"select","required":true,"label":"How will body arrive","placeholder":"Choose One","name":"How-will-body-arrive","className":"col-lg-4","values":[{"label":"I will be transporting","value":"I will be transporting","selected":true},{"label":"Contracted Transport Company","value":"Contracted Transport Company"}]},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"text","required":true,"label":"Have you contacted CCCO to verify acceptance time","placeholder":"Yes - No","name":"have-pre-scheduled","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"Who did you speak to","placeholder":"Name of CCCO staff you spoke with","name":"CCCO-staff-you-spoke-with","className":"col-md-6","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"header","subtype":"h4","label":"Release","className":"d-block"},{"type":"select","required":true,"label":"Release Disposition ","placeholder":"Chose one","name":"Release-Disposition-","className":"col-lg-4","values":[{"label":"Release to Funeral Home","value":"Release to Funeral Home","selected":true},{"label":"We will arrange for pick up","value":"We will arrange for pick up"},{"label":"Unknown at this time","value":"Unknown at this time"}]},{"type":"text","label":"Funeral Home Name","placeholder":"Funeral Home if Known","name":"Funeral-Home-Name","className":"col-lg-4","subtype":"text"},{"type":"text","label":"Funeral Home Phone Number","placeholder":"Funeral Home Phone Number","name":"Funeral-Home-Phone-Number","className":"col-lg-4","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h3","label":"Authorization for Autopsy","className":"d-block"},{"type":"paragraph","subtype":"p","label":"By submitting this form, you authorize the Crawford County Coroner's office to complete the autopsy requested for the above-named person. ","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"text","required":true,"label":"Name of person completing this request","placeholder":"Your Name","name":"Authorizer-Name-","className":"col-md-6","subtype":"text"},{"type":"date","required":true,"label":"Date authorized ","placeholder":"Today's Date","name":"Date-authorized-","className":"col-md-6"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"header","subtype":"h4","label":"Supporting Documents Upload","className":"d-block"},{"type":"file","label":"<div>Upload any documents, photos, or medical information that may be useful</div>You may upload up to 20 files (35 Mb max). Files can be PDF, JPG, JPEG format. To upload multiple files, please hold control while clicking on multiple files before clicking \"Open\".<div><br></div><div>.</div><div><br></div>","name":"File-upload","subtype":"file","multiple":true,"className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<div class=\"clear\"></div>","className":"d-block"}]

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Map showing the location of Crawford County in Missouri