Full AB Report

AB:

Date of Arrival (Y/M/D):

Time of Arrival:

Unclaimed/Donor:

Status:

Last Name: First Name: Middle Name: Suffix:

Date of Birth(0M/0D/Year):

Date of Death(0M/0D/Year):

Cause of Death:

Age:
Race:
Race Other:
Personal Affects
Personal Affects Notes:

Body Condition:
Body Weight:
Body Location:
Status:
Donor/Unclaimed:

Infectious Diseases

Hep B
HIV/AIDS
Other Infections:

Death Location/Info

Date of Death(0M/0D/Year):
Time of Death:
Cause of Death:
Death Facility:
Death Address 1:
Death Address 2:
Death City:
Death State:
Death Zip:
Death MD County:

Usual Residence Location

Click if same as Death Location
Usual Residence Facility:
Residence Address 1:
Residence Address 2:
Residence City:
Residence State:
Residence Zip:
Residence MD County:

Transport Location

Click if same as Death Location
Transport Facility:
Transport Address 1:
Transport Address 2:
Transport City:
Transport State:
Transport Zip:
Transport MD County:
Reason for Different Site:

Body Information

Overweight
Approximate Weight
Stairs
Infectious

Death Report Information

Person Reporting Death:
Person Reporting Death Phone #(XXX-XXX-XXXX):
Police Complaint Number:
OCME Case Number:

Transporter Info

Transporter Company Contacted:
Transporter Area:
Specific Transporter Contacted:
Transporter Contacted date/time:

Primary NOK #: NOK# Getting Ashes:

Background

Date of Birth(0M/0D/Year):
Age:
Race:
Race Other:
Sex/Gender:
Birthplace (State):
Marital Status:
Surviving Spouse's Name:
Mother's Maiden Name
Father's Name:
U.S. Armed Forces?
Education:
Industry:
Usual Occupation:
SSN#:
Informant's Name:
Informant's Relationship:
Informant Mailing Address:
Veteran SAB-DD-214 Received

Veteran SAB-DD-214 Upload

Next of Kin 1

NOK1 Name:
NOK1 Address 1:
NOK1 Address 2:
NOK1 City:
NOK1 State:
NOK1 Zip:
NOK1 Phone:
NOK1 Email
NOK1 Relationship:

Next of Kin 3

NOK3 Name:
NOK3 Address 1:
NOK3 Address 2:
NOK3 City:
NOK3 State:
NOK3 Zip:
NOK3 Phone:
NOK3 Email
NOK3 Relationship:

Next of Kin 2

NOK2 Name:
NOK2 Address 1:
NOK2 Address 2:
NOK2 City:
NOK2 State:
NOK2 Zip:
NOK2 Phone:
NOK2 Email
NOK2 Relationship:

Next of Kin 4

NOK4 Name:
NOK4 Address 1:
NOK4 Address 2:
NOK4 City:
NOK4 State:
NOK4 Zip:
NOK4 Phone:
NOK4 Email
NOK4 Relationship:

1a. Death Facility:
1b. Decedent First Name:
1c. Decedent Middle Name:
1d. Decedent Last Name:
1e. Decedent Suffix:
2. Date of Death:
3. Time of Death:
4a Facility Name [Place of Death]:
4b. City/Town of Death:
4c. County of Death:
5. Social Security Number:
6. Sex/Gender:
7. Age:
8. Date of Birth:
9. Birthplace [State]:
10a. Usual Residence [State]:
10b. Usual Residence [County]:
10c. Usual Residence [City]:
10d. Residence in City?:
10e. Address [Number, Street, Apt]:
10f. Residence Zip Code:
11. Marital Status
12. Armed Forces:
13 Hispanic Origin:
14. Race:
15. Education:
16a Usual Occupation:
16b Business/Industry:
17. Father's Name:
18. Mother's Maiden Name:
19. Surviving Spouse's Name:
20a. Informant Name:
20b. Informant's Relationship:
20c. Informant's Mailing Address:

Death Certificate Status

Death Certificate Type:
Doctor's Name Signing DC:
Doctor's Name Phone Number:
SAB Certifying Physicians:
DC Status:

DC Completed Info

Date DC Completed:
Date DC Signed:
Date to DVR:

Comments

Employee Name	Death Cert Comments	Comment	Comment DateTime

Full AB Report

Death Location/Info

Usual Residence Location

Transport Location

Body Information

Death Report Information

Transporter Info

Background

Next of Kin 1

Next of Kin 3

Next of Kin 2

Next of Kin 4

Death Certificate Status

DC Completed Info

Comments

Body Assessment

Personal Affects

Flushed

Embalmed

Blood Draw

Specimen Request Body Usage

Embalming

RFID

Fluid Used

Body Details

Funeral Home

Cremation

Ashes Not Claimed

Veterans Ashes Burial

Ashes Claimed

Reimbursement

Fees

Discount/Waiver

Reimbursement Total:

Comments