अनुसूची–१५
(दफा २० को उपदफा (५) सँग सम्बन्धित)
शव परीक्षण प्रतिवेदनको ढाँचा

AUTOPSY REPORT

1. Case registration number:
2. Police Office sending for autopsy (letter date and reference number):
3. Name of the deceased:
4.   Address:
5. Gender:
6.  Age, Date of Birth:
7. Dead body identified by:
8. Name of the accompanying Police Personnel:
9. Date and time of death:
10. Date and hour of receipt of inquest papers and dead body:
11. Date and hour of starting autopsy:
12. Date and hour of concluding autopsy:
13. Name of the Experts conducting autopsy:

(1)……………       (2) ……………         (3) ………..         (4) …..……

14. Name of the Hospital:

RELEVANT   DETAILS (Mention brief history of the case regarding circumstances of death and other sources of information):

 EXTERNAL EXAMINATION (General observation of the dead body):

(1) Height:           (2) Weight:                (3) Physique:                 (4) Hairs:

(5) Clothes and conditions:

(6) Special identifying features (Huliya):

(7)  Post-mortem changes present:

(a) Rigor mortis:

(b) Livor mortis:

(c) Algor mortis/Cooling:

(d) Different signs of decomposition:

(8)  Natural orifices:

Eyes:                    Mouth:                Vagina/penis:

Nose:                    Ears:                   Anus:

Urethra:

(9)  Injuries:  Name, size and site (Ante mortem /post-mortem /old /fresh)

INTERNAL EXAMINATION

Head and Neck:

• Scalp, skull:
• Brain and vessels:
• Orbital, nasal and aural cavities:
• Mouth, tongue:
• Neck (larynx, thyroid and other neck structures) :
• Other relevant details:

 Chest (Thorax)

• Ribs and chest wall:
• Diaphragm:
• Oesophagus:
• Trachea and bronchi:
• Pleural cavities:
• Lungs:
• Heart and pericardial sac (any content in pericardial sac, condition of three coronary arteries, valves and chambers and myocardium must be observed):-

 Abdomen

• Peritoneal and Pelvic cavity :
• Stomach and content :
• Small intestine:
• Large intestine:
• Liver, gall bladder, pancrease :
• Spleen:
• Kidney, renal pelvis :
• Genital organs:
• Urinary bladder and urethra:

 Spinal Column:

 Specimen Collected For Analysis (Mention preservative also)

Toxicology

• Stomach with contents:
• Part of liver:
• Kidney:
• Blood:
• Others; if any:

Histopathology :

Others (Specify):

Special Examination (Procedures like neck dissection, pelvic dissection, flotation test of lungs etc. must be done in relevant cases and findings should be documented):

 Items Handed Over (when and who received?)

• Autopsy report:-
• Viscera and other Samples :-
• Clothes and other articles:-

 Opinion or Conclusion

1. Opinion on cause of death: ……………………………………………………………

मृत्युको कारण (नेपालीमा समेत)ः

2. Opinion on time since death:
3. Opinion on probable type of objects or weapon causing injuries:

4. Opinion on live birth or still birth:

5. Other Opinion; if any:

     Signature of Medical Officer / Expert

Seal of the Hospital:

Date :

द्रष्टव्यः

• घाउ जाँच कार्यसम्भव भएसम्म Forensic विषयको विशेषज्ञले र त्यस्तो विशेषज्ञ नभएमा तालिम प्राप्त चिकित्साकर्मीले गर्नु पर्नेछ ।
•  घाउ जाँच गर्ने विशेषज्ञ वा चिकित्साकर्मीले नै प्रतिवेदन तयार गर्नु पर्नेछ ।
• सम्भव भएसम्म कम्युटर टाइप गरी प्रतिवेदन तयार गर्नु पर्नेछ, सो नभएमा स्पष्ट बुझिने गरी उल्लेख गर्नु पर्नेछ । साथै परीक्षण प्रतिवेदनको सक्कल प्रति नै संलग्न गर्नु पर्नेछ ।
•  निर्धारित स्थानमा विवरण उल्लेख गर्न नपुग भएमा छुट्टै पानामा समेत विवरण उल्लेख गर्नु पर्नेछ ।