HHS-Request for Autopsy Findings

REQUEST FOR AUTOPSY FINDINGS
Department of Health and Human Services
State Forensic Examiner
SFN 60698 (10-2023)
Name of Requestor*
Date*

MonthDayYear
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Enter either your Telephone Number or Email Address in case we need to contact you for additional information.
Telephone Number
Please enter a valid phone number.
Email Address
example@example.com

23-01-05.5 Autopsy reports - Confidential - Exceptions.
The state forensic examiner or the examiner's designee upon request shall disclose a copy of the autopsy report to: the decedent's personal representative and to the decedent's spouse, adult child, or parent, upon proof of the relationship, if there is no active criminal investigation.

Send a copy of the decedent's autopsy findings to the requestor.
Relationship to Decedent (choose one)*
Choose Relationship to Deceased
Name of Decedent*
Date of Birth*

MonthDayYear
Date of Death*

MonthDayYear
North Dakota County of Death *
Comments
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