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 | |