EFTA00130095 NAME OF DECEDENT: Epstein, Jeffery MEDICAL EXAMINER: DR. M. E. CASE #: M-19-019432 ☐ HOMICIDE ☐ PRISONER ☐ MVA (Driver/Operator) ☐ OTHER RUSH ___ DATE OF DEATH: 08/10/2019 TODAY'S DATE: 08/11/2019

COMPONENTS OF MEDICOLEGAL CASE RECORD NEEDED	FOR CERTIFICATION	FOR FILE COMPLETION
TOXICOLOGY REPORT
HISTOLOGY SLIDES
NEUROPATHOLOGY OR CARDIAC PATHOLOGY
REPORT(S): POLICE FIRE MARSHAL MLI
CULTURES: BLOOD TB OTHER:
CONSULTANTS ANTHRO RADIOLOGY OTHER:
HOSPITAL OR MEDICAL RECORDS
INFANT DEATH SCENE INVESTIGATION
OTHER: possible quenchery

For Pediatric Cases: Is there suspicion of abuse at this time? # AUTOPSY INVENTORY | CONSULT SERVICE | BRAIN HEART THRO | X-RAYS: YES NO | PHOTOS: YES NO | | :--- | :--- | :--- | :--- | ## HISTOLOGY: STOCK JAR(S): 1 2 3 4 BOTTLE(S) REQUESTING SLIDES: YES NO 1 2 3 ## MICROBIOLOGY: □ YES □ NO SPECIMEN SOURCE OTHER STUDIES: ## EVIDENCE: □ YES NO CLOTHING BALLISTICS X_(#) PERSONAL PROPERTY OTHER: ## FBIO: ☐ BLOOD ☐ HAIR SCALP-PUBIC ☐ SWABS O-A-V ☐ RNA LATER ☐ BONE ☐ FINGERNAILS ☐ OTHER ## FBIO SEXUAL ASSAULT KIT: ORAL SWABS/SMEAR BUCCAL SPECIMEN TRACE EVIDENCE CLOTHING/UNDERWEAR DEBRIS DRIED SECRETIONS FINGERNAIL SCRAPINGS/CLIPPINGS PULLED HEAD HAIRS PUBIC HAIR COMBINGS PULLED PUBIC HAIRS PERIANAL AND ANAL SWABS AND SMEAR VULVAR OR PENILE SWABS AND SMEAR CERVICAL SWABS AND SMEAR OTHER **SIGNATURE:** EFTA00130096 M19019432

NAME OF DECEDENT: Epstein, Jeffery	Age 66 Years	Race White	SEX × M □ F		AUTOPSY □ NO AUTOPSY (Exam) □ PURSUANT TO LAW
MEDICAL EXAMINER	DATE 08/11/2019			TIME □ AM □ PM

PART I: DEATH WAS CAUSED BY:		Pending Further Studies
a.	Immediate cause
b.	Due to or as a consequence of
c.	Due to or as a consequence of
PART II: Other significant conditions contributing to death but not resulting in the underlying cause given in part 1:
d.
MANNER OF DEATH: PENDING STUDIES NATURAL THERAPEUTIC COMPLICATION ACCIDENT SUICIDE HOMICIDE UNDETERMINED

PLACE OF DEATH: (Name of hospital, facility or street address)	Any Hospice care in last 30 days Yes No Link	TYPE OF PLACE:
Hospital in-patient		Nursing home/long term care
Hospital ED / outpatient		Hospice facility
Hosp DOA		Decedent's residence
DATE AND HOUR OF DEATH: 08/10/2019 7:36 AM		Other, specify:

INJURY: Date Time: AM PM	AT WORK ☐ YES ☐ NO	TYPE OF PLACE:(Home, Street, etc.)
LOCATION:
HOW INJURY OCCURRED:
IF TRANSPORTATION INJURY: ☐ DRIVER/OPERATOR ☐ PEDESTRIAN ☐ PASSENGER ☐ OTHER,SPECIFY

# IF FEMALE: - Not pregnant within one year of death - Pregnant at time of death - Not pregnant at time of death, but pregnant within 42 days of death - Not pregnant at time of death, but pregnant 43 days to 1 year before death - Unknown if pregnant within one year of death If within one year of death, outcome of pregnancy - Live birth - Spontaneous termination - Induced termination - None Date of outcome mm/dd/yyyy / /

Did tobacco use contribute to death?						For infant under 1 year: Name and address of hospital or other place of birth
U	Yes	U	No	U	Probably