Luis A. Sanchez, M.D.
Main:
(713) 796-9292
Fax: (713) 796-6844
Chief Medical Examiner
HARRIS COUNTY INSTITUTE OF FORENSIC SCIENCES
Autopsy Information/Release and Funeral Director's Authorization to Claim Form
In accordance with state law, the Harris County Institute of Forensic Sciences will perform an inquest or
autopsy to determine the cause and manner of death of the decedent. If an autopsy is performed, certain organs
and tissue are removed for necessary examination and testing. Upon completion of examination and testing,
any organs and tissue kept by the Harris County Institute of Forensic Sciences will be disposed of in
accordance with health and safety guidelines.
RELEASE OF DECEDENT AND PERSONAL EFFECTS
:
Case number
Name of the decedent:
I,
, bearing the relationship of
,
acknowledge that I am the legal next of kin and authorize the Harris County Institute of Forensic Sciences to
release the decedent named below and his or her personal effects in the possession of the Institute of Forensic
Sciences to
(Funeral Home) or its agent upon presentation of a
current state-issued funeral director or embalmer license and valid government-issued identification.
THIS IS A GOVERNMENTAL RECORD AS DEFINED BY TEXAS PENAL CODE SECTION 37.10. BY SIGNING THIS
DOCUMENT, I REPRESENT THAT I KNOW THE IDENTITY OF THE DECEDENT AND THE DECEDENT'S RELATIVES,
THAT DECEDENT LEFT NO DIRECTIONS IN WRITING FOR THE DISPOSITION OF THE REMAINS, AND THERE IS NO
OTHER PERSON WITH A PRIORITY OF RIGHT TO THE REMAINS LISTED BEFORE ME IN TEXAS HEALTH & SAFETY
CODE SECTION 711.002. I RELEASE ANY PERSON WHO ACTS IN RELIANCE ON A COPY OF THIS DOCUMENT FROM
ANY LIABILITY, AND ACKNOWLEDGE THAT I AM LIABLE UNDER TEXAS HEALTH & SAFETY CODE SECTION
711.002. FOR ALL DAMAGES THAT RESULT, DIRECTLY OR INDIRECTLY, FROM MY REPRESENTATIONS AND
SIGNATURE. ANY DISPUTE AMONG THE DECEDENT'S NEXT OF KIN CONCERNING THE RIGHT TO CONTROL THE
DISPOSITION OF DECEDENT'S REMAINS MUST BE RESOLVED AMONG THOSE PERSONS BY A COURT OF
COMPETENT JURISDICTION.
Printed Name and Signature of Next of Kin
Next-of-kin printed name
Signature:
:
Street Address:
Date signed:
City:
State:
Zip Code:
Phone #:
***
Witness printed name:
Signature:
Street Address:
Date signed:
City:
State:
Zip Code:
Phone #:
***
FD/Emb Lic. #: ______________
Decedent transported by:
* All persons arriving to transport decedents will be required to present a valid state-issued funeral director or embalmer license and valid
government-issued identification.
1885 Old Spanish Trail, Houston, Texas 77054
Revised 1/24/2011
Member Institution of the Texas Medical Center
1
