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MissingPersonCaseIntakeFormVersion1.1UniversityofNorthTexasCenterforHumanIdentificationForensicServicesUnit

MISSINGPERSONCASEINTAKEFORM
Thispacketcanbegiventofamilymembersofmissingpersonstocompleteallknown informationand/oritcanbeusedbyinvestigatorstogathernecessaryinformationonamissing person.Theformsinthispacketwillassistingatheringallnecessaryinformationtoreporta missingpersoncasetotheNationalMissing&UnidentifiedPersonSystem(NamUs),the NationalCrimeInformationCenter(NCIC),theNationalCenterforMissing&ExploitedChildren (NCMEC),andothernonprofitgroups/missingpersonclearinghouses.
*indicatesafieldthatisrequiredforNamUsEntry

CaseInformation
*FirstName: MiddleName: *LastName: MaidenName: Nickname/Alias: DateofBirth: PlaceofBirth: Social Sec. #: NCICNumber: ViCAPNumber: NCMECNumber: *DateofLastContact: *AgeatDLC: *Race: Ethnicity: *Sex: *Height: *Weight: BloodType:

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MissingPersonCaseIntakeFormVersion1.1UniversityofNorthTexasCenterforHumanIdentificationForensicServicesUnit

Circumstances
TypeofAddress: Address1: Address2: *City: *State: ZipCode: *County: FoulPlayIndicated: Yes *CircumstancesofDisappearance: FinancialTransactions:

No

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MissingPersonCaseIntakeFormVersion1.1UniversityofNorthTexasCenterforHumanIdentificationForensicServicesUnit

PhysicalDescriptors
*HairColor: HeadHairComments: BodyHair: FacialHair: *Lefteyecolor: EyeColorComments:

*Righteyecolor:

DistinctiveBodyFeatures
Amputations: Deformations: ScarsandMarks: Tattoos: Piercings: ArtificialBodyParts: FingerandToeNails: OtherDistinctivePhysicalCharacteristics:

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MissingPersonCaseIntakeFormVersion1.1UniversityofNorthTexasCenterforHumanIdentificationForensicServicesUnit

MedicalInformation
MedicalImplants: ForeignObjects: SkeletalInformation: OrganAbsent: PriorSurgery: Medications: DrugsofAbuse: KnownAllergies: KnownIllnesses: MedicalConditionsandDisorders: OtherMedicalInformation:

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MissingPersonCaseIntakeFormVersion1.1UniversityofNorthTexasCenterforHumanIdentificationForensicServicesUnit

ClothingandAccessories
Clothing: Footwear: Jewelry: Eyewear: Accessories:

ElectronicCommunications
WirelessphoneCarrier(s)/Number(s): PagerCarrier(s)/Number(s): EmailAddress(es): ScreenNames: OtherInternetHistory:

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MissingPersonCaseIntakeFormVersion1.1UniversityofNorthTexasCenterforHumanIdentificationForensicServicesUnit

TransportationMethods
VehicleYear: Make: Model: Style: Color: VIN: TagNumber: State: ExpirationYear: VehicleComments: AirlineTravel: BusTravel:

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MissingPersonCaseIntakeFormVersion1.1UniversityofNorthTexasCenterforHumanIdentificationForensicServicesUnit

DentalInformation

Dentalinformation/chartingiscurrentlyunavailable Dentalinformation/chartingisavailableandwillbeenteredlater Dentalinformation/chartingisavailableandenteredbelow

Xraysavailable

Modelsavailable Implants Braces Retainer

Photographsavailable Upperjawhasnoteeth Lowerjawhasnoteeth

Baby/primaryteethpresent Fillingorcrownpresent Removabledentures

Bridgework Rootcanal NCICDENTALCODING(TOBECOMPLETEDBYAFORENSICODONTOLOGISTONLY)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17

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MissingPersonCaseIntakeFormVersion1.1UniversityofNorthTexasCenterforHumanIdentificationForensicServicesUnit

DNAInformation

Sampleiscurrentlynotavailable SampleavailableNotyetsubmitted SamplesubmittedTestsnotcomplete Complete(enteradditionalinformationbelow)

Directreferenceprofile(s)forMissingPersoncomplete DNAprofilescomplete: STR YSTR LaboratoryPerformingAnalyses: LaboratoryCase/Reference#: LaboratoryORI: Comments: Familyreferencesample(s)forMissingPersoncomplete: Name(s)andrelationship(s)ofDNAdonors: DNAprofilescomplete: LaboratoryPerformingAnalyses: LaboratoryCase/Reference#: LaboratoryORI: Comments:

mtDNA

STR

YSTR

mtDNA

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MissingPersonCaseIntakeFormVersion1.1UniversityofNorthTexasCenterforHumanIdentificationForensicServicesUnit

FingerprintInformation

Fingerprintinformationiscurrentlynotavailable Fingerprintinformationisavailableelsewhere Fingerprintinformationbelow RT LT FingerprintComments:

FamilyPointofContact

FirstName: MiddleName: LastName: RelationshiptoMissingPerson: Address1: Address2: City: HomePhone: EmailAddress: Notes:

State: WorkPhone:

Zip:

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MissingPersonCaseIntakeFormVersion1.1UniversityofNorthTexasCenterforHumanIdentificationForensicServicesUnit

LawEnforcementAgencyContact(s)

Agency: Jurisdiction: CaseNumber: Title: FirstName: LastName: Address1: Address2: City: Office: Email:

ORI:

DateReported:

AssignedInvestigator

State: Cell:

Zip: Fax:

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MissingPersonCaseIntakeFormVersion1.1UniversityofNorthTexasCenterforHumanIdentificationForensicServicesUnit

Addendum

Thefollowingadditionalinformationwillassistinproperlyreportingandinvestigationamissing personcase: Alloriginaldentalxrays AlltreatmentandbillingrecordsfromtheMissingPersonsdentist Alloriginalbodyxraysfrompriormedicalconditions(e.g.,xraysofbrokenbones) Colorphotographsofthemissingperson Colorphotographsdetailinganyscars,marksortattoos DNAreferencesamplesfromtwoormorefirstorderrelativesofthemissingperson AdirectDNAreferencesamplefromthemissingperson(e.g.,toothbrush)

Formoreinformationorassistancewithdentalrecordcollectionand/orcharting,visit:

TheNationalMissing&UnidentifiedPersonSystem(NamUs)

www.namus.gov
FormoreinformationorassistancewithDNAcollectionsandsubmissions,contact:

TheUniversityofNorthTexasCenterforHumanIdentification 18007633147 Email:MissingPersons@unthsc.edu Website:www.untfsu.com

Foradditionalformsandresources,visitwww.UNTFSU.com