Baldwin County Coroner
Office: (251) 970-4051
Fax: (251) 947-0263
For Office Use Only
Case Number: __________________
Date/Time Received: _____________
Notification of Hospice Death
*NOTIFICATION OF THE DEATH OF (full name)
*Date of Birth
Next of Kin
*Primary Contact Phone #
Second Contact Phone #
*Date of Death
*Time of Death
*Place of Death
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.
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.
Circumstances Surrounding Death:
Cause of Death:
Doctor Certifying the Death:
Medical Facility/Practice Name:
Date of Report
Name of Hospice Representative:
Please type the code above