Kalpana Chawla Govt Medical College Hospital

Kalpana Chawla Govt Medical College Hospital

(Form-VI)
Post Mortem Examination Report

PMR No(Generated by Software) ___________________

PMR No(Given by Doctor) ___________________
CR No. _______________________________________________________________________
* Mandatory
Details of Doctor/'s who examined the patient:
Sr No. Doctor's Name Designation Registration No of Doctor with State
Council/MCI
1*

2.

3.

4.

5.

Date of receipt of Inquest papers ________________________________

Time of receipt of Inquest papers (in hrs) ________________________________

Date of commencement of Autopsy * ________________________________

Time of commencement of Autopsy(in hrs)* ________________________________

Whence brought/referral ________________________________

Case Particulars
Sh./Smt/Miss/Unknown* ________________________________

Name of Relative* ________________________________

Relation with Deceased* ________________________________

Age* ________________________________

Religion/Caste ________________________________

Gender* ________________________________

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 Kalpana Chawla Govt Medical College Hospital
Kalpana Chawla Govt Medical College Hospital
(Form-VI)
Post Mortem Examination Report

Marital Status* ________________________________

Occupation* ________________________________

Present Address
____________________________________________________________________________________
____________________________________________________________________________________
Police Station ________________________________
Permanent Address
____________________________________________________________________________________
____________________________________________________________________________________
Police Station ________________________________

Police F.I.R/DDR Detail

F.I.R/DDR No Date Time(in hrs)
______________ ____________ _____________

Body Brought By
SrNo. Name Rank Belt No Police Station, District, State

Person Identifying the body

SrNo. Name Address Relation with Police Station, District, State
Deceased

Magistrate Accompanied Details

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 Kalpana Chawla Govt Medical College Hospital
Kalpana Chawla Govt Medical College Hospital
(Form-VI)
Post Mortem Examination Report

SrNo. Name Magistrate Detail

In Case of unidentified bodies

SrNo. Identification Details
1*

In case of hospital death (Yes or No)* ________________

Date of Arrival in Hospital* ________________________________
Time of Arrival in Hospital(in hrs)* ________________________________
Date of Death* ________________________________
Time of Death(in hrs)* ________________________________
CR No.* ________________________________

Information Supplied by the Police and/or Hospital Record

As Per Information Provided by Police*
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
As Per Hospital Record
__________________________________________________________________________________
__________________________________________________________________________________

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 Kalpana Chawla Govt Medical College Hospital
Kalpana Chawla Govt Medical College Hospital
(Form-VI)
Post Mortem Examination Report

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

In case of Female
Unmarried/married ________________________________
Unmarried/married (Since) ________________________________
Divorcee/widow ________________________________
Primigravida/Multipara ________________________________
No. of children ________________________________
Youngest ________________________________
Eldest ________________________________

General Description
Length _______________________________
Weight(in Kgs) ________________________________
Physique* ________________________________
Description of clothes/jewellery and other items worn on the body*
(Important areas be encircled on the clothing whereever possible and handed over to the police)
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Rigor Mortis*
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Post mortem staining*

__________________________________________________________________________________
__________________________________________________________________________________

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 Kalpana Chawla Govt Medical College Hospital
Kalpana Chawla Govt Medical College Hospital
(Form-VI)
Post Mortem Examination Report

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Any Other*
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

External General Apperance

Ligature mark
State of eyes
Pupil(Rt) *
__________________________________________________________________________________
Pupil(Lt) *
__________________________________________________________________________________
Cornea/Conjunctiva(Rt) *
__________________________________________________________________________________
Cornea/Conjunctiva(Lt) *
__________________________________________________________________________________
Natural orifices *
(Please note presence of blood,froth etc in mouth,nose,ears(specify(Rt,Lt),anus,vagina and urethra)
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Any Other Finding
__________________________________________________________________________________
__________________________________________________________________________________

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 Kalpana Chawla Govt Medical College Hospital
Kalpana Chawla Govt Medical College Hospital
(Form-VI)
Post Mortem Examination Report

Examination of External Injuries

Sr No. Injuries

Internal Injury Detail (Note : In important cases, the Medical Officer may mention
weight/length of important organs.)

Sr. Component Remarks

No.
Cranium & spinal Cord (Brain must be exposed in every case, Spinal cord need not to be
1.
examined except in case of injury to vertebral column/Spinal Cord)
Scalp * ________________________________
Skull * ________________________________
Meninges and Vessels * ________________________________
Brain * ________________________________
Brain Weight ________________________________
Vertebrae and Spinal Cord * ________________________________
2. Mouth, Pharynx & Oesophagus. * ________________________________
3. Neck * ________________________________
Condition of neck tissues Thyroid * ________________________________
Hyoid bone * ________________________________
Larynx & Trachea * ________________________________
4. Thorax
Chest wall,Ribs/Sternum and Cartilage ________________________________
Pleura / pleural cavity. * ________________________________
Lung(Rt) * ________________________________
Lung(Rt) Weight ________________________________

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 Kalpana Chawla Govt Medical College Hospital
Kalpana Chawla Govt Medical College Hospital
(Form-VI)
Post Mortem Examination Report

Lung(Lt) * ________________________________
Lung(Lt) Weight ________________________________
Pericardium * ________________________________
Heart ________________________________
Heart Weight ________________________________
Coronary Arteries & Large Blood Vessel ________________________________
5. Abdomen
Peritoneum, Retroperitoneum * ________________________________
Stomach and its contents * ________________________________
Small intestine and its contents * ________________________________
Small intestine and its contents Length ________________________________
Large intestine and its contents * ________________________________
Large intestine and its contents Length ________________________________
Liver and gall bladder * ________________________________
Liver and gall bladder Weight ________________________________
Spleen * ________________________________
Spleen Weight ________________________________
Pancreas * ________________________________
Pancreas Weight ________________________________
Kidney(Rt.) * ________________________________
Kidney(Rt.) Weight ________________________________
Kidney(Lt.) * ________________________________
Kidney(Lt.) Weight ________________________________
Suprarenal(Rt.) ________________________________
Suprarenal weight(Rt.) ________________________________
Suprarenal(Lt.) ________________________________
Suprarenal weight(Lt.) ________________________________
Urinary Bladder * ________________________________
Organs of Generation. * ________________________________
In Case of Male :
Testes(Rt.)* ________________________________
Testes(Rt.) Weight ________________________________
Testes(Lt.)* ________________________________
Testes(Lt.) Weight ________________________________
In Case of Female : ________________________________

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 Kalpana Chawla Govt Medical College Hospital
Kalpana Chawla Govt Medical College Hospital
(Form-VI)
Post Mortem Examination Report

Uterus (empty or not) * ________________________________

Size * ________________________________
Products of conception * ________________________________
Ovary Rt. * ________________________________
Ovary Rt. Weight ________________________________
Ovary Lt. * ________________________________
Ovary Lt. Weight ________________________________
In case of Unknown or eunuch:
Detail *
________________________________________________________________
________________________________________________________________
________________________________________________________________

Muscles, bones and joints (Injuiry/Injuries,Diseases Deformity,Fractures,Dislocation)

SrNo. 1. Muscles
2.Bones
3.Injuiry/Injuries
4.Diseases/Deformity
5.Fractures
6.Dislocation
7.Joints
1

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 Kalpana Chawla Govt Medical College Hospital
Kalpana Chawla Govt Medical College Hospital
(Form-VI)
Post Mortem Examination Report

Full Body : Male -Anterior and Posterior Views (Ventral and Dorsal)

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 Kalpana Chawla Govt Medical College Hospital
Kalpana Chawla Govt Medical College Hospital
(Form-VI)
Post Mortem Examination Report

Full Body : Female -Anterior and Posterior Views (Ventral and Dorsal)

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 Kalpana Chawla Govt Medical College Hospital
Kalpana Chawla Govt Medical College Hospital
(Form-VI)
Post Mortem Examination Report

Local Examination of Eunuch

Full Body : Eunuch -Anterior and Posterior Views (Ventral and Dorsal)

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 Kalpana Chawla Govt Medical College Hospital
Kalpana Chawla Govt Medical College Hospital
(Form-VI)
Post Mortem Examination Report

Head-Lateral view

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 Kalpana Chawla Govt Medical College Hospital
Kalpana Chawla Govt Medical College Hospital
(Form-VI)
Post Mortem Examination Report

Skull Inner View

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 Kalpana Chawla Govt Medical College Hospital
Kalpana Chawla Govt Medical College Hospital
(Form-VI)
Post Mortem Examination Report

Body Figure

OPINION
Remarks of the medical officer / Board (Opinion as to the cause and manner of death) *
__________________________________________________________________________________

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 Kalpana Chawla Govt Medical College Hospital
Kalpana Chawla Govt Medical College Hospital
(Form-VI)
Post Mortem Examination Report

__________________________________________________________________________________
Antemortem/Postmortem
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Nature of Weapon/Force
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
How the Injury would be Caused
__________________________________________________________________________________
__________________________________________________________________________________
a.Between injury and death *
__________________________________________________________________________________
__________________________________________________________________________________
b.Between death and postmortem examination *
__________________________________________________________________________________
__________________________________________________________________________________
Probable time ( keep all factors including observations at inquest in mind)
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Any Other
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

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 Kalpana Chawla Govt Medical College Hospital
Kalpana Chawla Govt Medical College Hospital
(Form-VI)
Post Mortem Examination Report

Details including signature(s) of doctor(s) who conducted the post-mortem examination are given below
Error: Subreport could not be shown.

Kalpana Chawla Govt Medical College Hospital, Kalpana Chawla Govt Medical College Hospital

Handed over to the Police

- Dead Body after post-mortem examination - With its Belongings

- Belongings of the deceased : Sealed / Unsealed
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
- Postmortem Examination report
Police Inquest papers numbering 1 to _______________________ duly initialled.
- A Sealed Envelope for Chemical analysis with _____________________ seals containing
- A copy of post-mortem report
- Forwarding Letter ____________________________________________
- Inquest Paper Number 1 to _______________________________
- A sample of seal.
- A Sealed Envelope for _____________________ with _____________________ seals containing
- A copy of post-mortem report
- Forwarding Letter ____________________________________________
- Inquest Paper Number 1 to _______________________________
- A sample of seal.
A Sealed box bearing _______________________ seals containg following viscera for chemical analysis :
(1.) Stomach with contents
(2.) Part of small & large intestine with contents
(3.) Half of each kidney,Pieces of Spleen,Liver with gall bladder ________________________________
(4.) Sample of preservative
(5.) Blood
(6.) ____________________________________________________________________
A Sealed envelope with bearing _________________ seals containing
- a copy of the Postmortem Report
- forwarding letter _____________________ for Histopathology Examination.

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Following Tissues for histopathological examination by
______________ Sealed_____________ with_______________ seal(s) each containing following viscera for
histopathological examination ____________________________________________________
______________________________________________________________________
Following tissues kept for Histopathological examination _______________________________________
Sample of blood on a gauze piece in a sealed packet _______________________________________
Ligature material in a sealed packet _______________________________________
Skin of pulps of all 10 fingers, Individually Labelled in separate vials in a
sealed packet
Swabs in a sealed packet: ____________________________________________
Scalp hairs in a sealed packet ____________________________________________
________________Piece(s) of cloth bearing sample of seals with signature of the doctors.
________________X ray plates bearing numbers.
Video Cassette ____________________________________________
________________ photographs duly initialled.
Note:____________________ Photographs have been taken. IO to Collect when intimated.
Any Other Detail __________________________________________________________

Recieved

(Signature of Officer)
Officer Name : ___________________________
Date : ___________________________
Belt No.: ___________________________
Police Station: ___________________________

Police Person Detail

Sr. Name Rank Belt No Police Station, Signature
No. District,State
1

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