TITLE 77: PUBLIC HEALTH
CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER e: VITAL RECORDS
PART 500 ILLINOIS VITAL RECORDS CODE
SECTION 500.APPENDIX G DEATH RECORDS
Section 500.APPENDIX G Death Records
Section 500.ILLUSTRATION B Necropsy (NEC)1
NEC 1 CORONER
Report of Coroner's Physician to the
Coroner of _______________________County, Illinois
body identified to me by the coroner of this county as being:
Name __________________________________________ Date of Death ___________________________________
Place of Death (city, village, or twp.) ____________________________________________________________________
Place of Examination (city, village, or twp.) ______________________________________________________________
In my opinion, the cause of death was as follows:
OTHER SIGNIFICANT CONDITIONS CONTRIBUTING TO DEATH BUT NOT RELATED TO THE TERMINAL CONDITIONS GIVEN ABOVE.
My conclusions are based on the following observations and findings.
INSTRUCTIONS: 1. Prepare this form in triplicate. Use typewriter for all entries except signature.
2. Sign original and first copy in pen and ink.
3. Mail original and first copy to the coroner. Retain last copy.
(Source: Added at 15 Ill. Reg. 11706, effective August 1, 1991)