Victorian Numbered Regulations

CORONERS COURT (AMENDMENT NO. 2) RULES 2014 (SR NO 202 OF 2014) - REG 11

r. 11

For Form 14 of the Principal Rules substitute —

" FORM 14

Rule 38(3)

Court Reference:

REQUEST FOR RELEASE OF PRESERVED TISSUE OR MATERIAL

Form 14 Rule 38(3)

Section 28 of the Coroners Act 2008

I, [ name and title of staff member ], acting in accordance with the wishes expressed on [ date ] by [ name ], the senior next of kin (or his or her delegate) of:

Details of deceased:

Surname:
Given names:
*Date of Birth/ *Age [ if known ]:

request that the following tissue(s) or other material(s) be released following the medical examination without the body:

•     [ list tissue(s) or other material(s) ]

to the Victorian Institute of Forensic Medicine to arrange to:

    *cremate, and return to the senior next of kin or the nominated funeral director

    *cremate, and scatter the ashes at a memorial park established for this purpose

    *inter in the deceased's burial plot

    *other method of disposal: [ please specify ]

*And I have informed the senior next of kin of the direction of the coroner to impose restrictions in relation to the tissue(s) or other material(s) because of public health and safety concerns or in the interests of justice.

Signature:

_______________________________________

Date:

Time:

*Delete if inapplicable

__________________".