(नियम ७ को उपनियम (१) सँग सम्बन्धित)
शव परीक्षण प्रतिवेदन
(AUTOPSY REPORT)

प्रहरी कार्यालयले भर्ने
मुद्दा दर्ता नं. ः–
मिति ः–
प्रहरी कार्यालयको नामः–
मृतकको नाम, थर, ठेगाना, उमेर र लि·ः–
लास सनाखत गरिदिने व्यक्तिको नाम, थर, वतनः–
लास लिई आउने प्रहरी कर्मचारीको नाम, दर्जाः–
सम्बन्धित प्रहरी कार्यालयको छाप र कर्मचारीको दस्तखतः–

RELEVANT DETAILS:
EXTERNAL EXAMINATION:
INTERNAL EXAMINATION:
SPECIAL EXAMINATION:
VISCERA/ANOTHER SAMPLES:
www.lawcommission.gov.np
www.lawcommission.gov.np 21
CAUSE OF DEATH

(SEAL OF THE HOSPITAL) FULL NAME OF M.O.:-
SIGNATURE OF M.O.:-
DATE:-
HOSPITAL:-
FULL BODY-ANTERIOR AND POSTERIOR VIEWS (VENTRAL AND DORSAL)
GUIDELINES:
RELEVANT DETAILS:
Mention short history or circumstances of death.
EXTERNAL EXAMINATION:
WITH CLOTHES ON- List & describe clothings and ornaments etc. (Note if mud, grass
present)
AFTER CLOTHES ARE REMOVED : Take height, estimate weight, describe stature, hair,
and estimate age. See the body from all sides.
-Appearance of cornea, rigor mortis, PM Staining, if anything found on natural orifices,
findings related to decomposition.
Record old scars, tattoo, deformity in unidentified body,
Record details of injury, type, size, site.
Record bleeding, semen, faeces, urine if present.
INTERNAL EXAMINATION :
LARYNX, TROCHEA, PHARYNX, LUNGS :-
Note any injury, abnormality or change in physical character.
STOMACH:-
See what is inside, describe smell if present.
OTHER ORGANS:-
Describe injuries, if present.
Note abnormality or change in physical character.
SKETCHES: