DEATH/POSTMORTEM CARE CHECKLIST UT-Harris County Psychiatrie Center Department of Nursing Dat 13, 4 15, 16, 17, 18. te of Death: H+ To be completed by Nursing. (Check and Initial) Physician notified? Family notified? Head Nurse/Supervisor/ Director of Nursing notified? ‘Does family give permission to be contacted by LifeGift? If yes, fill out LifeGift Notification of Death form Is this an isolation patient? Disease/ Precautions Does deceased meet criteria of being a Medical Examiner's case? Body to go to Medical Examines? Medical Examiner notified? Medical Examiner released body to Authority for Release of Body Form signed with two witnesses? Family instructed to call Medical Records and/or ‘Nursing Supervisor when funeral home decided? Family advised that when body is ready to be released, Medical Records or Nursing Supervisor will notify designated funeral home? Body cleansed? Great right toe tagged? Identification tags on? Isolation tags on? ‘Body wrapped in shroud and tagged? If family consents to organ donation, is consent in chast? Signataze ‘Time of Death: AM/ PM. (ace om) Yes No Comments Date/Time