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Medico-Legal Examination

PNP sample request form for medico-legal examination

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(Autopsy)

Republic of the Philippines
Department of the Interior and Local Government
NATIONAL POLICE COMMISSION
PHILIPPINE NATIONAL POLICE
_________________________________________
___________________________
MEMORANDUM
FOR

:

FROM

:

SUBJECT

:

DATE

Director, PNP Crime Laboratory

:

Request for Autopsy Examination

1.
Request conducts medico-legal (autopsy)
accompanying specimen to determine the cause of death.
a)

VICTIM
SUSPECT

:

d)

TDPO

:

e)

the

:

c)

on

NATURE OF CASE :

b)

examination

SPECIMEN SUBMITTED :

2.
Further request that this Office be furnished a copy of medico-legal
examination result for our reference.
3.

For consideration.

____________________________
(CHIEF OF OFFICE)
 
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