DEPARTMENT OF FORENSIC MEDICINE

AMALTAS INSTITUTE OF MEDICAL SCIENCE, DEWAS

No. …………/AIMS/FM/MLC/Case No. – 06/23 Raipur, Dated 18 /10 /2023

To,
The Superintendent of Police / The Station Officer
Distt. .- Dewas / P.S. – Kotwali, Dewas
Dewas (M.P.)

Subject :- Examination of ………………………………… S/o or D/o……………….……………. in

connection with marg No. ………………... of P.S. Kotwali, Dewas.
Reference :- Your Letter No. …………………………………. Dated 17/10/2023.

Name of a Person -
Age/Sex - ………………… (According to Police records or Documents made available)
Address –
Brought by –
Date & Time of Examination –
Place of Examination –

Consent –
Identification Marks – (Preferably on exposed parts of body).
1.
2.
General Examination –
General Condition –
Height –
Built –

Development of Secondary sexual Characters –

Menstruation Cycle (For Female) –

Dental Formula –

Right Side Left Side

0 √ √ √ √ √ √ √ √ √ √ √ √ √ √ 0
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
0 √ √ √ √ √ √ √ √ √ √ √ √ √ √ 0
P.T.O.

1
No. …………/AIMS/FM/MLC/Case No. – 06/23 Raipur, Dated 18 /10 /2023

Index :
(√ ) – Tooth present, fully erupted. Attrition/translucency of root.
(0) – Tooth within the Socket.
(x) – Tooth absent, sockets absorbed.

X Rays of teeth – X ray Plate No. ………………………………….. Date …………

Findings of X-ray –

Long Bones’ Ossification : X ray Plates No. ………………….. Date …………………..

Findings are as follows :-

Note:- All X-ray Plates bear my signature & name of person examined.

Opinion – On overall consideration of Physical Examination. Radiological

Examination. I am of the opinion that the person under examination could be of
age …………………………… years ± ……………….. years at the time of examination.

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