OFFICE OF THE STATE CHIEF MEDICAL EXAMINER
STATE OF TENNESSEE, DEPARTMENT OF HEALTH
ANDREW JOHNSON TOWER, 7th FL
710 JAMES ROBERTSON PKWY
NASHVILLE, TN 37243
FAX: 615-401-2532 HEALTH.OSCME@TN.GOV
Autopsy Report Request Form
To obtain a copy of the autopsy report, email this form to Health.OSCME@tn.gov or mail to:
Office of the State Chief Medical Examiner, Andrew Johnson Tower, 7th Floor, 710 James Robertson Parkway, Nashville, TN 37243
Name of Deceased:
County of Death:
Date of Death:
Please mail a copy of the report to:
(Mailing address/print clearly):
_________________________________________
Printed Name of Requestor
_________________________________________
Street Address
_________________________________________
City, State and Zip Code
_________________________________________
Email Address
Check box if preferred method of autopsy report is electronic.
____________________________
Signature (REQUIRED)
______________________
Relationship to Deceased
______________________
Phone Number
PLEASE NOTE:
The requestor needs to send completed request via mail, email, or fax:
Office of the State Chief Medical Examiner
State of Tennessee Department of Health
Andrew Johnson Tower, 7th Floor, 710 James Robertson Parkway
Nashville, TN 37243
Office: (844) 860-4511 Fax: (615) 401-2532 Email: Health.OSCME@TN.Gov