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Serial No.

In the body of    Name ___________TYPE NAME HERE ________________
Father’s Name:        TYPE FATHERS NAME
Husbands Name _____________________________________________
Caste ______________________________________________________
Residence __________________________________ ________________
Sex ____________________ Age _____________00/00 years_________

DISTRICT: _______________

Body brought by:    Police     Body Identified by:
1)    Type Names of the Relatives – Next to Kin,
2)    Type Names of the Relatives – Next to Kin

Whence brought Village
Thana, district     Emergency Ward, District Hospital,

DATE AND HOUR OF – Death:       Examination of Body     Dispatch of matter to chemical examination
06:15 PM / 01-12-10    10:20PM / 01-12-10    Part of bullet received from abdomen
Symptoms observed before death    Person in snack Gasping multiple firearm injuries with bleeding preparatory and …………. Collapse.
Information furnished by Police    Death due to firearm injury.


Mark of Ligature on neck and dissection, etc.     Body of young man lying on mortuary table. Eyes and mouth closed. No post mortem staining present. No rigor mortis visible. Wearing ……. Sky blue Shalwar Qameez and white Banyan, all stained with blood. Person is healthy looking. On examination following injuries noted.
Condition of Subject- $tout emaciated, deco m- posed, etc, Clothing     (1) Lacerated wound 1.5 cm x 2.5 …. Left side of epigastria, left to middle line, entry wound.
(2) Lacerated wound 1.5 cm x 1 cm left side of upper chest at level of nipple, in arm axiliary line. Exit wound of injury No.1, Entry (1).
(3) Lacerated wound 1.5 cm x 2.5 cm in right lumber region at mid exillary line. E……….
Wounds, bruises, position, size, nature.     (4) Lacerated wound 1.5cm x .5 cm interiorly above left elbow joint on left arm. Entry wound.
(5) Lacerated wound 1”x1” pastorally on left arm in armpit at upper end of arm exit wound of injury No.(4). Entry wound No.(3).
(6) Lacerated wound 5”x5”, interiorly in upper 1/3rd of Rt forarm. Entry No.(  ) ….
(7) Lacerated wound 5”x5” at lateral to injury No.6, Entry No.(5) wound
(8) Lacerated wound 1”x.5” posteriorly in middle of Rt forearm. Exit wound of Injury No.(6) and entry Wound No.(4).
(9) Lacerated wound 1”x.5” posteriorly at level of injury No.8 and 5 inches lateral to injury No.8. lt is exit wound of entry wound No.(5) of injury No. (7).
All Injuries are going deep into muscles and tracking into the Entry and Exit wound as described above in Injuries.


Injury         Disease of Deformity     Fracture    Dislocation


According to Post mortem examination, in my opinion, all the injuries are antimortam in nature and caused by some firearm weapon. Injury No.(1) and (3) caused damage to liver, spleen and left lung which are vital organs. These injuries to vital organs lead to sever hemorrhage Shock and ultimately death. These injuries are sufficient to cause death in ordinary court of life.

Probable time that elapsed

(a)    between injury and Death.                 Within 02 Hours.
(b)    between death and post-mortem    04 Hours and 05 minutes.

Station:  Hospital Name

Dated: Type Date Here

Signature & Designation of
Medical Officer.

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