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The form requires detailed personal information about the deceased, including their full name, gender, social security number, date of birth, and date of death.
Information about the next of kin is essential, including their full name, relationship to the deceased, and contact details such as phone and cell numbers.
The form includes a section to indicate whether permission to embalm the deceased has been granted, which is crucial for funeral home procedures.
Various options are provided for the removal location of the deceased, including residence, nursing home, medical examiner's office, hospice, or hospital settings.
The form requests information about the attending physician who pronounced death, including their name and contact details.
There is a dedicated space for any special instructions regarding the handling or services for the deceased that may be important to note.
