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Get No Jurisdiction Assumed (NJA) Request Form

Email: randyg sanjuanco.com INSTRUCTIONS: 1. This form is to be completed by, or at the direction of, the attending physician. 2. Complete Part I and fax to San Juan County Prosecutor/Coroner at (360) 378-3180. Keep original. 3. Upon death of patient: Call 378-4151 and notify sheriff dispatcher of death. Complete Part II and fax to Prosecutor/Coroner at 378-3180. Mail original to Prosecutor/Coroner at the address above. PART I NAME PATIENT INFORMATION (LAST, FIRST, MI) SOCIAL SE.

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