1st Call Sheet (Fill Out Completely)

Deceased Name ____________________________________________________________________________

Informant/Person Calling: ____________________________________________________________________

Relationship: ________________________________ Phone Number: ______________________________

Released: Yes No By Whom:___________________________________

Date & Time of Call: __________________________

Prearranged: Yes No Maybe

Received by: _________________________________

Loc. Desired:_________________________________

Next of Kin/Contact: ________________________________________________________________________

Relationship: ________________________________ Phone Number(s): ____________________________

Location of Deceased/Address/Facility (INCLUDE ZIPCODE):

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Morgue Room #: ___________________ Time of Death: __________am/pm

Date of Birth: _______________ Date of Death: ______________

Veteran: Yes No Weight ___________

Family Present During Removal: Yes No PTE: Yes No

Cremation: Direct Other P & E Pick-Up Only Embalming Fa

Notes:_____________________________________________________________________________________

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Nurse/Family Sign: _________________________________________________________________________

Removal Personnel: _________________________________________________________________________

Funeral Home Requesting Removal/Transport:____________________________________________________