N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 69-9.3

Current through Register Vol. 46, No. 51, December 18, 2024

Section 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

N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 69-9.3

Amended New York State Register November 13, 2019/Volume XLI, Issue 46, eff. 11/13/2019