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Invoice-Pathologist (CWHSP)
ICR 201403-0920-010 · OMB 0920-0020 · Object 45988001.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Invoice-Pathologist (CWHSP) |
| Author | CDC User |
| Last Modified By | Writer |
| File Modified | 2014-02-18 |
| File Created | 2026-10-30 |
| Conversion State | complete |
Extracted Text
Attachment 12
NCWAS Autopsy Checklist
NATIONAL COAL WORKERS’ AUTOPSY STUDY (NCWAS)
Checklist
The following items must be complete to insure payment for services and for the autopsy to be included in the NCWAS database.
_______ Death must have occurred on or after May 14, 1971.
_______ Case must be received within 180 days of autopsy.
_______ Deceased must have worked in an underground mine.
_______ Must include the following articles:
_______ 3 blocks of lung tissue
_______ 3 stained slides of lung tissue
_______ completed and signed Consent, Release, and History
Form (CDC/NIOSH 2.6)
_______ Social Security Number (optional)
_______ Signed invoice with statement ANo other form of compensation
has been received.@
_______ Autopsy protocol must include:
_______ heart and lung description and weights
_______ heart valve measurements
_______ heart ventricular measurements
_______ pathological diagnosis
_______ cause of death (optional on partial autopsies)
_______ clinical summary
_______ microscopic examination
_______ age, height, and weight
_______ Chest x-ray (PA) and interpretation made within 5 years
prior to death (optional)