Notice of removal of a human corpse from a facility 2025

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The document serves to officially record the removal of a deceased individual from a hospital, nursing home, or hospice, ensuring compliance with Wisconsin state laws.
Items 1-12 must be completed by the Administrator of the Hospital, Nursing Home, or Hospice, or their designee.
The form requires details such as the name, age, sex, date and time pronounced dead, and circumstances surrounding the death.
Items 13-17 are to be completed by a Wisconsin Licensed Funeral Director, Coroner/Medical Examiner, or a family member.
The facility or hospice must notify the person making the removal if there was a documented or suspected communicable disease at the time of death.
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