Notification of Hospice Death

2_revised



Baldwin County Coroner
Office: (251) 970-4051
Fax:      (251) 947-0263
Email: coroner@baldwincountyal.gov


For Office Use Only
Case Number: __________________
Date/Time Received: _____________

Notification of Hospice Death

(Ex: residence address, name of hospital, name of nursing home, hospice home, or specify other)

Pursuant to Code of Alabama 45-37-60 and 22-9A-14, the coroner’s office should immediately be notified if there is suspicion of criminal violence or criminal neglect, when death occurs in suspicious or unusual circumstances, when deaths are thought to result from trauma or violence, in any prison or penal institution, or when in police custody; whether the cause is known or suspected, primary or contributory, or recent, delayed, or remote.

Please initial:
To the best of my knowledge there have been no injuries, poisonings, or other suspicious circumstances since pre-registration and time of death.
 To the best of my knowledge all medications are intact and there is no evidence of poisoning or overdose.
 I certify that I have disposed of medications properly. 
To the best of my knowledge the death is of natural causes from the terminal diagnosis given. 
(Ex: disease, injury/trauma, motor vehicle collision, suspected overdose, etc.)
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