Basic information template for email referral to our local coroner. NEW updated version 10 October 2019

Please READ and FOLLOW all of the directions on this form. If there is a clearly established cause of death, which was due to a disease (AND NOT to an accident / failure of care etc) THEN PLEASE - complete the Medical Certificate of Cause of Death, - turn the certificate over, circle "A" - "I have reported this death to the Coroner for further action," initial this AND - either fax the form to 020 7641 5351 OR email a scanned copy together with the referral form. Please ensure you upload a copy of the referral form to the patient’s Cerner (iCLIP) recrd using the instructions on page 3 of the form.

coroners referral form v10oct2019.doc — Microsoft Word Document, 80Kb