12160 W Parmer Ln, Ste 130-108
Cedar Park, TX 78613
(512) 887-3294




 I. Parties

I, (printed name)
the (relationship to the deceased)
of the deceased (name of the deceased)
being entitled by law to control the disposition of remains, hereby request, ISDP Consulting LLC or its designees to perform a postmortem examination on the body of said deceased. I    understand that any diagnostic information gained from the postmortem examination will become part of the deceased’s medical record and will be subject to applicable laws. 
 II. Retention of Organs/Tissues
I authorize the removal, examination, and retention of organs, tissues, prosthetic and implantable devices, and fluids as ISDP Consulting LLC or its designees deem proper. I agree to the eventual disposition of these materials as required by law. This consent does not extend to the removal or use of any of these materials for transplantation or other similar purposes. I understand that organs and tissue not needed will be sent to the funeral home or disposed of in an appropriate manner. I understand that I may place limitations on both the extent of the postmortem examination and on the retention of organs, tissue, and prosthetic and/or implantable devices. I understand that any limitation may compromise the diagnostic value of the postmortem examination and may also limit the usefulness of the postmortem examination. I have been given the opportunity to ask any questions that I may have regarding the scope and/or purpose of this postmortem examination. 
 III. Retention of Blood/Tissue Samples 

During the autopsy procedure, small sections of normal tissue and abnormal tissue are retained in formalin in a 24-ounce container. This tissue is preserved for one year from the date of the autopsy and then discarded following appropriate protocols. Blood samples, if taken, are also stored/preserved for one year and then discarded following proper protocols. The tissue and blood samples are stored in the rare instance that the pathologist would need to evaluate additional material to gain more information.

If you would like the tissue and/or blood samples retained for more than a year please indicate by checking the appropriate boxes below:
 Yes, retain tissue
 No, do not retain tissue
 Yes, retain blood specimens
 No, do not retain blood specimens
If you choose to have our facility retain tissue and/or blood, there will be a monthly fee of $50.00 per sample (tissue, blood). You will be invoiced monthly until we receive your authorization to discard the samples.

  IV. Limitations
None. Permission is granted for a complete postmortem examination, with removal, examination, and retention of materials as ISDP Consulting LLC or its designees deem proper for the purposes set forth above, and for disposition of such material as ISDP Consulting LLC or its designee determines is appropriate.  
Permission is granted for a postmortem examination with the following limitations and conditions (specify):  

Clear Signature

Signature of person authorizing autopsy (drag with mouse/finger to sign)


Printed name of person authorizing autopsy

Clear Signature

Signature of witness (drag with mouse/finger to sign)

Printed name of witness
V. Indemnity and Release Agreement
The undersigned, individually and as a representative of Decedent’s family, hereby agrees to indemnify and hold ISDP Consulting LLC and its designees harmless from any and all claims, losses, cost, damages, expenses and liabilities (including, but not limited to, reasonable attorney’s fees) directly resulting from the postmortem examination performed. The indemnity set forth herein specifically includes any claim, suit, action or proceeding which may be initiated by a third party against ISDP Consulting LLC or its designees. This indemnity is binding upon the successors, assigns, heirs, and principals of the undersigned. The undersigned has had an opportunity to review and consider this Indemnity and Release and to discuss this document with the advisors of the undersigned. The undersigned executes this Indemnity and Release voluntarily for the purposes set forth herein.

IN WITNESS WHEREOF, the undersigned has executed this Indemnity and Release


Clear Signature

Signature (drag with mouse/finger to sign)

Printed name


Name of deceased:
Date of birth:  
Location of death:  
Date of death:   
Time of death:  
Physician (s):  
Brief medical history:
Concerns or reasons for postmortem examination:




Funeral Home:
Funeral Home Address:
Funeral Home Phone Number:
Funeral Home Contact Person: 




Unless otherwise specified by the decedent, the next of kin has full legal right to authorize or refuse consent for the postmortem examination procedure. The person who has the legal right to authorize postmortem examination also has the right to state the limits within which it shall be performed and the postmortem examination must be performed within those limits. The person obtaining permission for the postmortem examination should provide a full explanation as to what will be done. 
 The following order of authority to give consent must be observed when obtaining signed authorization for the postmortem examination: 
•    Legally designated and court-appointed Power of Attorney, if none, then
•    Surviving spouse or domestic partner; if spouse/domestic partner is deceased or incompetent, then
•    Adult children; if none, then
•    Parents; if none, then
•    Brothers or sisters; if none, then
•    Adult grandchildren; if none, then
•    Grandparents; if none, then
•    Nephews or nieces; if none, then
•    Uncles or aunts; if none, then
•    Cousins; if none, then
•    Stepchildren; if none, then
•    Relatives or next of kin of previously deceased spouse; if none, then
•    Any other relative or friend who assumes custody of the body for burial.

NOTE: If two or more persons who are entitled to authorize the postmortem examination assume responsibility for the burial, the written authorization of one is sufficient. ISDP Consulting LLC or its designees explicitly do not recommend proceeding with a postmortem examination when there is known opposition by one next of kin of the same class as the one signing the postmortem examination consent form. 

If there is more than one person of the same relation entitled to give consent to a postmortem examination or autopsy, consent may be given by a member of the same relationship unless another person of the same relationship files an objection with the physician, medical examiner, justice of the peace, or county judge. If an objection is filed, the consent may be given only by a majority of the persons of the same relationship of the class who are reasonably available. An example of this would be multiple surviving adult children.