Ariz. Admin. Code § R9-19-301 - Human Remains Release Form

A. Except as provided in subsection (B), the form required by A.R.S. § 36-326(B) to accompany a deceased individual's human remains removed from a hospital, nursing care institution, or hospice inpatient facility is in a Department-provided format and shall include:

1. The name and street address of the hospital, nursing care institution, or hospice inpatient facility;

2. The deceased individual's:

a. Name;

b. Date of birth;

c. Sex; and

d. Social Security number or, if the deceased individual's Social Security number is not available, the deceased individual's medical record number;

3. The date and time of the death;

4. The name, telephone number, and e-mail address of the health care provider expected to sign the medical certification of death;

5. The name, telephone number, and relationship to the deceased individual of the individual authorizing the hospital, nursing care institution, or hospice inpatient facility to release the human remains;

6. The most recent diagnosis in the deceased individual's medical record;

7. A list of the circumstances in A.R.S. § 11-593(A);

8. Whether a notification required in A.R.S. § 11-593 was made;

9. If the deceased individual's human remains are being released to a funeral establishment or a person authorized to receive the deceased individual's communicable disease related information under A.R.S. § 36-664, whether the deceased individual had been diagnosed with or was suspected of having, as stated in the deceased individual's medical record at the time of death:

a. Infectious tuberculosis,

b. Human immunodeficiency virus,

c. Creutzfeldt-Jakob disease

d. Hepatitis B,

e. Hepatitis C or

f. Rabies;

10. For a death that occurred in a hospital, if the deceased individual's human remains have been accepted for donation by an organ procurement organization under A R.S. Title 36, Chapter 7, Article 3, and the person authorized in A.R.S. § 36-843 has not made or refused to make an anatomical gift, whether the organ procurement organization has been notified that the deceased individual's human remains are being removed from the hospital; and

11. The name and signature of the individual representing the hospital, nursing care institution, or hospice inpatient facility who is releasing the human remains.

B. The form required by A.R.S. § 36-326(B) to accompany human remains from a fetal death removed from a hospital, nursing care institution, or hospice inpatient facility is in a Department-provided format and shall include:

1. The name and street address of the hospital, nursing care institution, or hospice inpatient facility;

2. The name of the mother;

3. The date of delivery;

4. The estimated gestational age or, if the gestational age is unknown, the weight of the human remains;

5. The name and telephone number of the parent authorizing the hospital, nursing care institution, or hospice inpatient facility to release the human remains;

6. A list of the circumstances in A.R.S. § 11-593(A);

7. Whether a notification required in A.R.S. § 11-593 was made;

8. For a fetal death that occurred in a hospital, if the human remains have been accepted for donation by an organ procurement organization under A.R.S. Title 36, Chapter 7, Article 3, and the person authorized in A.R.S. § 36-843 has not made or refused to make an anatomical gift, whether the organ procurement organization has been notified that the human remains are being removed from the hospital; and

9. The name and signature of the individual representing the hospital, nursing care institution, or hospice inpatient facility who is releasing the human remains.

C. An individual who removes human remains from a hospital, nursing care institution, or hospice inpatient facility shall sign and date the applicable human remains release form required in subsection (A) or (B), and note the time of removal when the individual removes the human remains from the hospital, nursing care institution, or hospice inpatient facility.

D. The individual in subsection (C) who removes human remains shall submit a copy of the applicable human remains release form required in subsection (A) or (B) to the local registrar or deputy local registrar of the registration district where the death or fetal death occurred within 24 hours after removing the human remains from a hospital, nursing care institution, or hospice inpatient facility.

Notes

Ariz. Admin. Code § R9-19-301

Amended effective March 30, 1976 (Supp. 76-2). Amended effective February 20, 1980 (Supp. 80-1). Amended effective July 31, 1989 (Supp. 89-3). Section repealed; new Section made by final rulemaking at 12 A.A.R. 4387, effective January 6, 2007 (Supp. 06-4). Amended by final rulemaking at 22 A.A.R. 1782, effective 10/1/2016. Amended by final expedited rulemaking at 26 A.A.R. 1534, effective 7/7/2020.