10 CRR-NY 69-9.3NY-CRR
10 CRR-NY 69-9.3
10 CRR-NY 69-9.3
69-9.3 New York State Infant Autopsy Protocol.
New York State department Of Health
Infant Autopsy Protocol
| Decedent's name | Age | Sex | Race/Ethnicity |
| Local accession number | Date of birth | Date/time of death | Date of autopsy |
| Pathologist | County | ||
| 1) FINAL CAUSE AND MANNER OF DEATH | |||
| 2) STUDIES | ||||
| Routine Studies | Normal | Abnormal | Not Done | Findings |
| Photographs | □ | □ | □ | |
| Full-body X-Rays | □ | □ | □ | |
| Toxicology | □ | □ | □ | |
| Histopathology | □ | □ | □ | |
| Neuropathology | □ | □ | □ | |
| Metabolic Screening | □ | □ | □ | |
| Blood/Tissue for future studies | □ | □ | □ | |
| Studies, as indicated | Normal | Abnormal | Not Done | Findings |
| Viterous samples for glucose | □ | □ | □ | |
| Microbiology/Virology | □ | □ | □ | |
| Genetic Studies | □ | □ | □ | |
| Electrolytes | □ | □ | □ | |
| HIV Testing | □ | □ | □ | |
COMMENTS:
_____ DOH-4278 (9/30) p1
| 3) CLINICAL SUMMARY | ||||
| Maternal Age: | ||||
| Birth Weight (in grams): | Gestational Age: | |||
| Pregnancy Complications: | ||||
| Medical History | YES | NO | NOT AVAILABLE | COMMENTS |
| Maternal Smoking | □ | □ | □ | |
| Maternal Alcohol Use | □ | □ | □ | |
| Maternal Drug Use | □ | □ | □ | |
| Sibling with SIDS | □ | □ | □ | |
| Other Relative with SIDS | □ | □ | □ | |
| Other Infant or Child Deaths | □ | □ | □ | |
| Sleeping Position (put to sleep): | □ Supine | □ Prone | □ Side | □ Unknown |
| Co-Sleeping: | □ Yes | □ No | □ Unknown | |
| Describe sleep habits and bedding, if known: | ||||
| COMMENTS: | ||||
| 4) DEATH SCENE INVESTIGATION | ||||
| □ Indicated | If indicated, state date: | |||
| □ Not indicated | If not indicated, state reason: | |||
| COMMENTS: | ||||
| PATHOLOGIST | Date Form Completed | |||
| DOH-4278 (9/03) p2 | ||||
Autopsy Format
• Final Diagnoses
• Final Cause and Manner of Death
• External Examination
• Portmortem Changes
• Scars / Other Distinguishing Characteristics
• Clothing
• Weights and Measures
• General Appearance / Development
• Injuries (External and Internal)
• Therapeutic Procedures
• Resuscitation Evidence
• External Integument
• Internal Examination Head Neck Body Cavities Cardiovascular System Respiratory System Liver, Gallbladder and Pancreas Hemolymphatic System Genitourinary System Endocrine System Digestive System Musculoskeletal System
• Post-Mortem Studies Full body X-rays Histopathology Toxicology Metabolic Screen Neuropathology Cultures Blood/Tissue retained for future studies Other
_____ DOH-4278 (9/03) p3
10 CRR-NY 69-9.3
Current through August 15, 2021
| End of Document |
IMPORTANT NOTE REGARDING CONTENT CURRENCY: The "Current through" date indicated immediately above is the date of the most recently produced official NYCRR supplement covering this rule section. For later updates to this section, if any, please: consult editions of the NYS Register published after this date; or contact the NYS Department of State Division of Administrative Rules at [email protected]. See Help for additional information on the currency of this unofficial version of NYS Rules.