अनुसूची–१५ (दफा २० को उपदफा (५) सँग सम्बन्धित) शव परीक्षण प्रतिवेदनको ढाँचा

अनुसूची–१५ (दफा २० को उपदफा (५) सँग सम्बन्धित) शव परीक्षण प्रतिवेदनको ढाँचा

अनुसूची–१५
(दफा २० को उपदफा (५) सँग सम्बन्धित)
शव परीक्षण प्रतिवेदनको ढाँचा

AUTOPSY REPORT

  1. Case registration number:
  2. Police Office sending for autopsy (letter date and reference number):
  3. Name of the deceased:
  4.   Address:
  5. Gender:
  6.  Age, Date of Birth:
  7. Dead body identified by:
  8. Name of the accompanying Police Personnel:
  9. Date and time of death:
  10. Date and hour of receipt of inquest papers and dead body:
  11. Date and hour of starting autopsy:
  12. Date and hour of concluding autopsy:
  13. Name of the Experts conducting autopsy:

(1)……………       (2) ……………         (3) ………..         (4) …..……

  1. Name of the Hospital:

RELEVANT   DETAILS (Mention brief history of the case regarding circumstances of death and other sources of information):

 EXTERNAL EXAMINATION (General observation of the dead body):

(1) Height:           (2) Weight:                (3) Physique:                 (4) Hairs:

(5) Clothes and conditions:

(6) Special identifying features (Huliya):

(7)  Post-mortem changes present:

(a) Rigor mortis:

(b) Livor mortis:

(c) Algor mortis/Cooling:

(d) Different signs of decomposition:

(8)  Natural orifices:

Eyes:                    Mouth:                Vagina/penis:

Nose:                    Ears:                   Anus:

Urethra:

(9)  Injuries:  Name, size and site (Ante mortem /post-mortem /old /fresh)

 

INTERNAL EXAMINATION

Head and Neck:

  • Scalp, skull:
  • Brain and vessels:
  • Orbital, nasal and aural cavities:
  • Mouth, tongue:
  • Neck (larynx, thyroid and other neck structures) :
  • Other relevant details:

 

 Chest (Thorax)

  • Ribs and chest wall:
  • Diaphragm:
  • Oesophagus:
  • Trachea and bronchi:
  • Pleural cavities:
  • Lungs:
  • Heart and pericardial sac (any content in pericardial sac, condition of three coronary arteries, valves and chambers and myocardium must be observed):-

 Abdomen

  • Peritoneal and Pelvic cavity :
  • Stomach and content :
  • Small intestine:
  • Large intestine:
  • Liver, gall bladder, pancrease :
  • Spleen:
  • Kidney, renal pelvis :
  • Genital organs:
  • Urinary bladder and urethra:

 Spinal Column:

 

 Specimen Collected For Analysis (Mention preservative also)

Toxicology

  • Stomach with contents:
  • Part of liver:
  • Kidney:
  • Blood:
  • Others; if any:

Histopathology :

Others (Specify):

Special Examination (Procedures like neck dissection, pelvic dissection, flotation test of lungs etc. must be done in relevant cases and findings should be documented):

 Items Handed Over (when and who received?)

  • Autopsy report:-
  • Viscera and other Samples :-
  • Clothes and other articles:-

 Opinion or Conclusion

  1. Opinion on cause of death: ……………………………………………………………

मृत्युको कारण (नेपालीमा समेत)ः

  1. Opinion on time since death:
  2. Opinion on probable type of objects or weapon causing injuries:

 

  1. Opinion on live birth or still birth:

 

  1. Other Opinion; if any:

     Signature of Medical Officer / Expert

1.                 …………

Signature:

Date:

Name:

Special Qualification,

Training and Experience:

N.M.C. Reg. No.:

2 . …….

Signature:

Date:

Name:

Special Qualification,

Training and

Experience:

N.M.C. Reg. No.:

3 . …….

Signature:

Date:

Name:

Special Qualification,

Training and Experience:

N.M.C. Reg. No.:

Seal of the Hospital:

Date :

द्रष्टव्यः

  • घाउ जाँच कार्यसम्भव भएसम्म Forensic विषयको विशेषज्ञले र त्यस्तो विशेषज्ञ नभएमा तालिम प्राप्त चिकित्साकर्मीले गर्नु पर्नेछ ।
  •  घाउ जाँच गर्ने विशेषज्ञ वा चिकित्साकर्मीले नै प्रतिवेदन तयार गर्नु पर्नेछ ।
  • सम्भव भएसम्म कम्युटर टाइप गरी प्रतिवेदन तयार गर्नु पर्नेछ, सो नभएमा स्पष्ट बुझिने गरी उल्लेख गर्नु पर्नेछ । साथै परीक्षण प्रतिवेदनको सक्कल प्रति नै संलग्न गर्नु पर्नेछ ।
  •  निर्धारित स्थानमा विवरण उल्लेख गर्न नपुग भएमा छुट्टै पानामा समेत विवरण उल्लेख गर्नु पर्नेछ ।