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Cords FAX 954-327-6581 • TTY 954-357-6100 AUTOPSY REPORT REQUEST NAME OF DECEASED MEDICAL EXAMINER CASE NUMBER (if known) DATE OF DEATH MEDICAL EXAMINER’S NAME (if known) PLEASE SEND A COPY OF THE FOLLOWING REPORT(S): AUTOPSY: _____ NARRATIVE SUMMARY: _____ TOXICOLOGY: _____ BODY DIAGRAM: _____ TO: NAME ADDRESS UNIT CITY STATE (ASSOCIATION OF REQUESTING PARTY (FAMILY, POLICE, ETC…) DATE OF REQUEST Submit DATE MAILED / REPLIED TO ZIP CODE .

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