DISTRICT HOSPITAL PARBHANI

PROVISIONAL POST MORTEM REPORT

PM NO:- ………………. Dated:- …………………
Post Mortem Examination on the Dead Body Of: ……………………………...........................
……………………………………………………………………………………………………..
AGE……………. SEX …………………
R/O…………………………………………………………………………………………………
……….…………………………………………………………………………………………….
Date And Time Of Beginning Post Mortem:- ……………………………………………….....
Date And Time Of Ending Post Mortem:-……………………………………………………...
Name of Autopsy Surgeon:- ……………………………………………………………………..

Provisional opinion as to the cause / probable cause of death

Name and signature of Autopsy surgeon

Copy Of Provisional Pm Report And Body Handed Over To Police Constable ……............
………………………………….B.No ……….With Clothes And Ornaments As Mentioned
In Panchnama At ……………..Date…………………
RECEIPT [by police official]
Received original copy of Provisional PM report along with clothes & ornaments.
Signature....................... Name of police..................................................................................
B.No..............Police station..............................................................
 District Hospital Parbhani
Final Opinion as to the Cause of Death
Ref :
1-Requisition from Police Station : ………………………………. Dt-……………
2-MLPM NO : ………………………………………… Dt……………………
3-Chemical analyzer’s report ML case no ……………… non(t) …………
Dt………………..
4-Histopathology report from Dept of Pathology ………………………………
………………………………..Dt…………….
5-
………………………………………………………………………………………
The Postmortem examination has been conducted on dead body of
…………………………………….. Age………...years, sex ………….. resident
of……………………… ………………………………………….... was involved
in Cr/A.D.No …………………………………….
Dated …………………… of
P.S……………………………………………………………………………………
.Following exhibits were preserved.
• Viscera for chemical analysis
1. Stomach and loop of intestine with their contents.
2. 1/3rd liver, 1/2 spleen, 1/2 of each kidney
3. Blood
4. Skin
5. Others
Findings of Chemical analysis: -
…………………………………………………………………………..
• For Histopathology:- Organs preserved for histopathology……......................
………………………………………………………………………………………
Findings of Histopathology:-
………………………………………………………………………………..
• Other findings:-
………………………………………………………………………………
Name of autopsy surgeon:-
……………………………………………………………………
Date of Postmortem examination: -
………………………………………………………
As per the best of my knowledge, the opinion as to the cause of death is as
follows:-
………………………………………………………………………………………
………………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………………
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Authorized signature with seal