Forensic Analysis Pathology Assessment
Comprehensive assessment form for forensic pathology case review and documentation.
Case Identification Number
*
Referring Agency
*
Examiner Name
*
Examiner Role/Title
*
Please Select
Forensic Pathologist
Medical Examiner
Assistant
Consultant
Other
Date of Examination
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Incident/Decedent Context
*
Specimen/Exhibit Details
Rows
Specimen/Exhibit Type
Description
Received Condition
Item 1
Intact
Damaged
Decomposed
Other
Item 2
Intact
Damaged
Decomposed
Other
Item 3
Intact
Damaged
Decomposed
Other
Observed Pathology Findings
*
Injury or Lesion Description
Rows
Location
Type
Severity
Lesion 1
Abrasion
Contusion
Laceration
Fracture
Stab
Gunshot
Burn
Other
Mild
Moderate
Severe
Fatal
Lesion 2
Abrasion
Contusion
Laceration
Fracture
Stab
Gunshot
Burn
Other
Mild
Moderate
Severe
Fatal
Lesion 3
Abrasion
Contusion
Laceration
Fracture
Stab
Gunshot
Burn
Other
Mild
Moderate
Severe
Fatal
Estimated Postmortem Interval (Time Since Event)
Please Select
< 6 hours
6-12 hours
12-24 hours
1-3 days
3-7 days
> 7 days
Indeterminate
Assessment of Cause of Death
*
Assessment of Manner of Death
*
Natural
Accident
Suicide
Homicide
Undetermined
Confidence in Assessment
*
Low
1
2
3
4
High
5
1 is Low, 5 is High
Reviewer Recommendations or Additional Notes
Submit Assessment
Should be Empty: