IU Health Pathology Laboratory 350 W 11th St Indianapolis, IN 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the deceased's name, date of birth, gender, and race in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Next, provide the address of the deceased, including street, city, state, and zip code. Indicate the county and marital status as well.
4. Enter the home phone number and social security number. Include the employer's name and contact number for additional context.
5. In the clinical diagnosis section, clearly state any relevant medical conditions. Use the space provided for specific questions that need to be addressed by the autopsy.
6. Select any ancillary services required by checking the appropriate boxes. Note that these may incur additional costs.
7. Fill out submitting facility information accurately and indicate whether a final report should be faxed.
8. Complete details for the submitting clinician and specify if they wish to receive a call post-procedure.
9. Finally, indicate who will pick up the decedent after the autopsy along with their contact number.

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