REPORTS RELEASE

Forensic Pathology Consultation

Forensic Pathologist kcshaw@forensisnoctuam.me Ph: 1-405-396-6886 Fax: 1-888-349-7134
REPORTS RELEASE
I,
, (relationship)
and authorized representative of the decedent
Date of birth

MonthDayYear
Date
), give Dr. Kyle C. Shaw and Forensis Noctuam, LLC, permission and
authority to release a copy of reports and related ancillary files for said decedent, as below.

Autopsy reportProcurement report(s)Autopsy photographsToxicology report(s)Microbiology report(s)Body diagram(s)Genetic analysis report(s)Consult report(s)Other
I request the above marked items be released to (please provide name, contact information, and email address for digital files)
Signature
Date

MonthDayYear
Date
Should be Empty: