Referrer Details

Did the death occur in Newcastle or North Tyneside?

Yes No

PLEASE REFER TO THE CORONER WHERE THE DEATH OCCURRED, REGARDLESS OF HOME ADDRESS

Enter details on this page about the individual who is referring the case

Referrer category *

Upload and provide all supporting documents using the 'Upload File' button at the top of the page

Upload and provide a copy of the GP patient summary using the Upload File button above

Your Name *

Reason for referral *

Detailed reasoning for referral

Referrer code *

Referrer Details

Telephone number *

Mobile number

Email address

Bleep number / extension *

Hospital *

Ward *

Grade

GMC number

Patient number

Alternative Contact

Please provide contact details for alternative person to contact in the event you will be unavailable during Coroner's office opening hours 8am - 4pm. Otherwise please enter n/a.

Name *

Contact number *

Upload and provide all supporting documents using the 'Upload File' button at the top of the page

For medical referrals only

Have you discussed this referral with the on duty ME *

Yes No

If yes, please give their name *

For police referrals only

Did you activate your Body Worn Camera *

Yes No

If yes please provide DMR reference number

If no please give an explanation as to why

Please enter in your Supervising Sergeants email address for approval of the referral *

If known, please enter in your Duty Inspectors email address

Coroner referral