Montana State Medical Examiner’s Office
Postmortem Examination Request Form

By calling 406-329-1155 you will be automatically routed to the on-call forensic pathologist. Please notify the on-call pathologist of cases and to schedule postmortem examinations by calling 406-329-1155 between 7 AM and 10 PM. For routine cases after 10 PM please hold calls until the following morning; however, we are available 24 hours day, every day to help answer questions that need immediate answers. This form must be completed before a postmortem examination will be conducted. Thank you.

Today’s Date: Choose an item. Choose an item. Choose an item.

County Reporting Death: Choose an item.

Name of Coroner/Deputy Filing Report:Click here to enter text. Contact #: Click here to enter text.

Email: Click here to enter text.

Decedent Full Name: Click here to enter text. Gender: Choose an item. Race: Choose an item.

Date of Birth: Choose an item. Choose an item. Choose an item. Age: Choose an item.

Date of Death: Choose an item.Choose an item.Choose an item. Time of Death: Click here to enter text.

Name of Individual Pronouncing Death: Click here to enter text.Time Pronounced: Click here to enter text.

Location of decedent where death is pronounced. Be sure to add the address below if the decedent was not transported to a hospital: ☐ Hospital ☐ Residence or Business ☐ Other (i.e. field, river, roadway, dumpster) Click here to enter text.

Address where body was found or GPS location: Click here to enter text.

Hospital name if decedent was hospitalized: Click here to enter text.

When was the decedent last reliably known to be alive and by whom? Click here to enter text.

Who found the body? Click here to enter text. Who saw the decedent last? Click here to enter text.

Quick Medical History Selections:

☐ Tobacco use
☐Alcohol useAlcohol Quantity: Choose an item.
☐Drug use (if yes, explain) Click here to enter text.
☐Overweight
☐High Blood Pressure
☐Diabetes
☐Cancer
☐Coronary Artery Disease
☐No significant medical history known or reported.
☐Other Click here to enter text.

Law enforcement agency investigating case. List NA if no law enforcement agency is involved.
Click here to enter text.

Name of officer or trooper investigating case: Click here to enter text.
Case number: Click here to enter text.
Phone number: Click here to enter text.

Give a description of circumstances of the death.

Click here to enter text.