Forms

The donation process is simple, but there are two critical steps to ensure a timely donation.  There is a narrow window for donation (15 hours after time of death) so it is essential that the family organizes as much information as possible, prior to donation.  The Commonwealth of Virginia requires the completion of two forms prior to any autopsy.  The first step is to complete and return the autopsy consent form (see below) to the brain bank.  The autopsy consent form cannot be completed by the donor, but must be completed by the person designated by the Commonwealth as eligible to sign the form (please see tips for completing the autopsy consent form).  Once we receive a completed autopsy consent form, we can enter the donor information into our system.

The second critical step is to obtain a signed death certificate.  The DC is usually generated by the funeral director, so it is essential that he be involved in the donor process at an early step.  The DC does not need to be the state-embossed, formal form that can take up to a week to obtain.  However, the DC needs to be signed by the doctor (or NP/PA) that is overseeing the care of the donor. To facilitate the generation of the DC, is is advisable that the family of the donor meet with the funeral director and complete as much of the DC as possible ahead of time.  Both the consent for and DC can be faxed to the brain bank at (804) 828-2010.

For general information, please see the brochure, below.

 

Downloadable Forms:

1.   Information for Families    (Information for Families)

2.  Autopsy Consent Form  (Consent)

3.  Helpful Information to complete autopsy form   (Helpful Tips)

4. Patient Information Page (Patient Information)

5.  Information for Nursing Home or Hospice   (Nursing Facility)

6.  Information for Funeral Directors   (Funeral Directors)

7.  Brain Bank Brochure  (Brochure)