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United States Government Work, uncopyrighted, public-domain,
DRAFT COPY ONLY. This document does not necessarily represent the views
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PRINCIPLE OF THE TEST.
Valid medicolegal documents are necessary,
in order for the autopsy to proceed.
SPECIMEN REQUIRED.
At the Veterans Affairs Medical Health Care System (VAMHCS),
autopsies are performed on deceased patients with a valid
Authorization for Autopsy
(U. S. Standard Form 523), a complete hospital chart,
and a death note signed by a physician
included in the chart.
REAGENTS, INSTRUMENTATION.
Valid medicolegal documents.
STEP-BY-STEP DESCRIPTION.
1. The three documents required for autopsy, namely
AUTHORIZATION FOR AUTOPSY, COMPLETE HOSPITAL
CHART, AND DEATH NOTE, should be obtained by the Medical Administration
Service (MAS) within a single shift (i.e., 8 hours), or on the morning
of the next day after the patient's death, and is delivered by MAS personnel
to the attention of the autopsy assistant in the autopsy suite.
2. At the time the documents are complete, MAS should issue
a MailMan (electronic mail) message to the Administrative
Officer, Laboratory Service, the Chief, Autopsy Section,
and the on-call attending pathologist. The email should be
addressed as PRIORITY MAIL to mailgroup G.AUTOPSY.
3. The Authorization for Autopsy
(U. S. Standard Form 523) should be obtained from the patient's
next-of-kin or guardian, in the following order of priority: (a) spouse;
(b) adult child; (c) parent; (d) adult sibling; (e) adult grandchild;
(f) adult nephew or niece; (g) grandparent; (h) uncle or aunt. THE CHIEF
OF STAFF MAY SIGN AN AUTHORIZATION ONLY IF THERE IS NO LEGAL NEXT-OF-KIN,
AND IF THE REMAINS ARE UNCLAIMED. In place of U. S. Standard Form 523,
there may be a transcribed telephone consent given by the next of kin
and prepared by the Medical Administration Service.
4. If the spouse does not sign the authorization, then the
DECEDENT AFFAIRS CLERK in MAS will include
a VistA® entry, with the autopsy alert, containing an explanation,
such as, 'spouse deceased' or 'patient never married'. Likewise, a written
explanation should be provided for each person in the above priority list who
does not sign the authorization, such as, 'patient has no children',
'parents deceased', etc. If authorization cannot be obtained from
next-of-kin or guardian, then this fact should be determined by MAS
within 48 hours of the patient's death, and authorization will be obtained
from the Chief of Staff. If there is a longer delay for authorization,
then MAS should include a signed, written explanation on the
authorization form. The hospital chart must be complete, in order for the
pathologist to determine the clinical events leading up to death, special
procedures taken at autopsy (e.g., infectious disease), and the
clinicopathologic questions to be addressed at autopsy. The death note,
usually included as part of the hospital chart, must contain the date
and time of the patient's death, and must be signed by a physician.
REFERENCE.
1. Hutchins GM, ed.
Autopsy Performance and Reporting.
Northfield, IL: College of American Pathologists. 1990.