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1 Ante Mortem Form

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0% found this document useful (0 votes)
63 views

1 Ante Mortem Form

Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 18

DISASTER VICTIM IDENTIFICATION (DVI)

HOW TO USE THE YELLOW ANTE-MORTEM (AM) FORM


Please write legibly.

I. GENERAL INSTRUCTIONS

The AM Form is designed for listing any information that may be obtained from
relatives, friends and/or physicians of the possible victim or missing person and
that may assist in an identification, in order to compare that information with the
data obtained from the dead bodies on the disaster site.

Important: Record all information obtainable on the form, since


it is impossible to know what data will be obtained
from the disaster site.

NOTE: It is important to obtain and forward detailed


information as rapidly as possible.

Where provided, use the appropriate figures for description.

EXAMPLE: Section C1: Fill in the figures "06" in the "No." column at
item 24 to designate a pullover and describe the material, etc.
In the space provided for this information.

Wherever appropriate, boxes that can simply be marked with a cross are provided.
Please use as many of them as possible. This will facilitate electronic processing
of the information and also make it possible to handle reports compiled in a
foreign language without translation (the Interpol Member States all use the same
forms). For this reason, the layout is the same for the AM and PM Forms. Because
of this identical layout, some numbered spaces are left blank (e.g. item 31 in
section D1: This is the space provided for the description of the state of the body
on the pink PM Form).

II. SPECIFIC INSTRUCTIONS

Sections A1 & A2 Personal data of the possible victim or


missing person.

Section B Not applicable here (section B of the pink


form is the report on the recovery of the
body from the site).

Sections C1 to C3 Description of effects (clothing, jewellery,


etc.).
Sections D1 to D3 Physical description.

Section D4 Record any distinguishing marks (tattoos,


etc.).

Sections E1 & E2 List any medical information that may assist in


identification.

Sections F1 & F2 Dental information (cf. instructions on the


back of Section F1).

Section G Record any further information that may


assist in identification, and/or continue
your description from a previous section
(C to F) if there was not enough space.

It should be born in mind that photographs of the clothing, jewellery, etc.


described in various sections may be of valuable help for comparison with
items found on the disaster site. Please attach such photographs, if available.
Ante Mortem (yellow) VICTIM IDENTIFICATION
MISSING PERSON
Family name : N :
°
Forename(s) :

Date of birth : Day Month Year Male Female

Nature of disaster :

Place of disaster :

Date of disaster :

Police force handling identification: NCB of (country)

Police file No:

Reasons for assuming that person concerned is victim of disaster:

Police officers evaluation Is above person probably a victim? No Yes

Enclosed Enclosed Lent to Returned


CHECKLIST OF CONTENTS complete Date Remarks
in part Name Date

A1 General information

A2 Gen. information cont.

C1 Clothing / Shoes

C2 Watch/Glasses/Papers

C3 Jewellery

D1 Physical description

D2 Physical desc. cont.

D3 Physical desc. cont.

D4 Body sketch

E1 Medical information

E2 Medical inform. cont.

F1 Dental information

F2 Dental inform. cont.

G Further information
Ante Mortem (yellow) VICTIM IDENTIFICATION FORM A1
MISSING PERSON
Family name : N :
°
Forename(s) :

Date of birth : Day Month Year Male Female

a = Data not available b = Photo c = Further information on page G


INFORMATION RELATING to MISSING PERSON a b c
00 Information given by... Date: 1 See item 12 2 See item 13
or:
Name
Address
Relationship Phone:

01 Family name

02 Family name at birth

03 Forename(s)
04 Nationality
05 National ID number

Country code

06 Chinese
Commercial Code
07 Date of birth Age at
Day Month Year
disappearance
08 Marital status Separated, widowed, single
Day Month Year
Engaged other:
Forename of partner:
Day Month Year
Married

09 Occupation
10 Full address
Street / No.
Postcode / Town
Country

11 Religion

12 Next-of-kin
Name
Address

Phone
Relationship

12 Blood relation (DNA) Close relatives known for DNA-comparison 1 No 2 Yes


A
13 For visual recognition
Name
Address

Phone
Relationship

Police Rank : Signature / Date


officer Name :
Address :
Phone number :
Ante Mortem (yellow) VICTIM IDENTIFICATION FORM A2
MISSING PERSON
Family name : N :
°
Forename(s) :

Date of birth : Day Month Year Male Female

a = Data not available b = Photo c = Further information on page G


INFORMATION RELATING to MISSING PERSON (cont.) a b c
14 Ever fingerprinted? Yes / Where: Date:
1 No 2

if not, are prints 3 No 4 Yes / Where:


obtainable ?

15 Family doctor
Name
Address

Phone

16 Family dentist
Name
Address

Phone

17 Distinguishing
features

18 Photographs 1 Enclosed 2 Obtainable

Taken on:

19 Documents
01 Official records 1 Enclosed 2 Obtainable

02 Police records 1 Enclosed 2 Obtainable

03 Doctors records 1 Enclosed 2 Obtainable

04 Hospital records 1 Enclosed 2 Obtainable

05 Hospital X-rays 1 Enclosed 2 Obtainable

06 Dental records 1 Enclosed 2 Obtainable

07 Dental X-rays 1 Enclosed 2 Obtainable


08 Dental plate
(specify):
ID-numbers
09 Other records (specify):

Continued item no 24 (item 20 - 23 in form PM only)

Police Rank : Signature / Date


officer Name :
Address :
Phone number :
Ante Mortem (yellow) VICTIM IDENTIFICATION FORM C1
MISSING PERSON
Family name : N :
°
Forename(s) :

Date of birth : Day Month Year Male Female

a = Data not available b = Photo c = Further information on page G


CLOTHING AND SHOES (carried on person or in luggage) a b c
No: 1 Material 2 Colour 3 Design 4 Label 5 Size
24 Clothing Items
01 Hat
02 Overcoat
03 Scarf
04 Gloves

05 Coat
06 Pullover
07 Tie
08 Shirt
09 Waistcoat
9A Vest
10 Trousers (men)
11 Underpants
12 Socks

13 Dress
14 Cardigan
15 Blouse
16 Skirt
17 Petticoat
18 Chemise
19 Brassiere
20 Panties
21 Girdle
22 Corset
23 Stockings
24 Tights
25 Trousers (women)

26 Belt
27 Belt buckle
28 Braces
29 Other

No: 1 Material 2 Colour 3 Design 4 Label 5 Size in cm


25 Shoes - Type
01 Light shoes
02 Heavy shoes
03 Boots
04 Other

Police Rank : Signature / Date


officer Name :
Address :
Phone number :
Ante Mortem (yellow) VICTIM IDENTIFICATION FORM C2
MISSING PERSON
Family name : N :
°
Forename(s) :

Date of birth : Day Month Year Male Female

a = Data not available b = Photo c = Further information on page G


PERSONAL EFFECTS a b c
No: 1 Material 2 Colour 3 Design 4 Make 5 Inscription
26 Watch - Type
01 Digital
02 Analog
03 Other
Left Right Outside Inside
04 If wrist watch, 1 2 3 4
worn on
Leather Metal Other (specify):
05 Watch strap 1 2 3

1 Material 2 Colour 3 Design 4 Make 5 Inscription


27 Glasses
01 Frame

Tinted Strength - Left / Right


02 Lenses (glass) 1 No 2 Yes (specify): 3 L 4 R
Round Oval Square / Half Rimless
03 Lenses / Shape 1 2 3 4 5
Coloured Strength - Left / Right
04 Contact lenses 1 No 2 Yes (specify): 3 L 4 R

No:
28 Identity Papers

01 Passport
02 Driving licence
03 Credit cards
04 Identity card
05 Donor card
06 Travellers cheques
07 Other

29 Other Effects

Police Rank : Signature / Date


officer Name :
Address :
Phone number :
Ante Mortem (yellow) VICTIM IDENTIFICATION FORM C3
MISSING PERSON
Family name : N :
°
Forename(s) :

Date of birth : Day Month Year Male Female

a = Data not available b = Photo c = Further information on page G


JEWELLERY a b c
No: 1 Material 2 Colour 3 Design 4 Inscription 5 Where worn
30 Rings, chains etc.
01 Wedding ring
02 Other finger rings
03 Earrings
04 Earclips
05 Neck chains
06 Necklace
07 Bracelets
08 Other chains
09 Pendant on chain
10 Other

Police Rank : Signature / Date


officer Name :
Address :
Phone number :
Ante Mortem (yellow) VICTIM IDENTIFICATION FORM D1
MISSING PERSON
Family name : N :
°
Forename(s) :

Date of birth : Day Month Year Male Female

a = Data not available b = Photo c = Further information on page G


PHYSICAL DESCRIPTION a b c
31

31
A
32 Height Method used ?
cm / Estimated height cm

33 Weight Method used ?


kg / Estimated weight kg

34 Build Light Medium Heavy


01 Bodily constitution 1 2 3

Oval Pointheaded Pyramidal Circular Rectangular Quadrangular


02 Head from front 1 2 3 4 5 6
(02-03 see Silhouette sketch) Shallow Medium Deep
03 Head in profile 1 2 3

35 Race Caucasoid Mongoloid Negroid Light Medium Dark


01 Group / Shade 1 2 3 / 4 5 6
02 Other (specify):

36 Hair of the head Natural Artificial Hair-piece Wig


01 Type 1 2 3 4
Short Medium Long
02 Length 1 2 3
Blond Brown Black Red Grey White
03 Colour 1 2 3 4 5 6
Light Medium Dark Turning grey
04 Shade 1 2 3 / 4
Thin Medium Thick
05 Thickness 1 2 3
Straight Wavy Curly Parted
06 Style 1 2 3 / 4 Left 5 Right
Beginning Advanced Total Forehead Sides Tonsure
07 Baldness 1 2 3 / 4 5 6
08 Other (specify):

Police Rank : Signature / Date


officer Name :
Address :
Phone number :
Ante Mortem (yellow) VICTIM IDENTIFICATION FORM D2
MISSING PERSON
Family name : N :
°
Forename(s) :

Date of birth : Day Month Year Male Female

a = Data not available b = Photo c = Further information on page G


PHYSICAL DESCRIPTION (cont.) a b c
37 Forehead Low Medium High Narrow Medium Wide
01 Height / Width 1 2 3 / 4 5 6
Protruding Vertical Receding / slightly or clearly
02 Inclination 1 2 3 S 4 C

38 Eyebrows Straight Arched Joining Thin Medium Thick


01 Shape / Thickness 1 2 3 / 4 5 6

39 Eyes Blue Grey Green Brown Black


01 Colour 1 2 3 4 5
Light Medium Dark Mixed
02 Shade 1 2 3 4
Small Medium Large
03 Distance betwen eyes 1 2 3
Cross-eyed Squint-eyed Artificial eye
04 Peculiarities 1 2 3 Left 4 Right

40 Nose Small Medium Large Pointed Roman Alcoholics


01 Size / Shape 1 2 3 / 4 5 6
Marks of spectacles Other (specify):
02 Peculiarities 1 No 2 Yes 3
(03 see Silhouette sketch) Concave Straight Convex Turned down Horizontal Turned up
03 Curve / Angle 1 2 3 / 4 5 6

41 Facial hair No beard Moustache Goatee Whiskers Full beard


01 Type 1 2 3 4 5
Blond Brown Black Red Grey White
02 Colour 1 2 3 4 5 6

42 Ears Small Medium Large Close-set Medium Protruding


01 Size / Angle 1 2 3 / 4 5 6
(02 see Silhouette sketch) Attached Perforated
02 Ear lobes 1 No 2 Yes 3 Left 4 Right

43 Mouth Small Medium Large Other (specify):


01 Size / Other 1 2 3 / 4

44 Lips Thin Medium Thick Made up Other (specify):


01 Shape / Other 1 2 3 / 4 5

45 Teeth (cf. page F1 / F2) Inlays Crowns Bridges


01 Cast restoration 1 2 3
Part. upper Part. lower Full upper Full lower ID-number (specify):
02 Dentures 1 2 3 4 5
03 Gaps (specify):
04 Other (specify): Latest treatment date:

46 Smoking habits No Yes Cigarettes Cigars Pipe Other


01 Type 1 2 / 3 4 5 6

Police Rank : Signature / Date


officer Name :
Address :
Phone number :
Ante Mortem (yellow) VICTIM IDENTIFICATION FORM D3
MISSING PERSON
Family name : N :
°
Forename(s) :

Date of birth : Day Month Year Male Female

a = Data not available b = Photo c = Further information on page G


PHYSICAL DESCRIPTION (cont.) a b c
47 Chin Small Medium Large Receding Medium Protruding
01 Size / Inclination 1 2 3 / 4 5 6
Pointed Round Angular Cleft chin Groove
02 Shape 1 2 3 4 5

48 Neck Short Medium Long Thin Medium Thick


01 Length / Shape 1 2 3 / 4 5 6
Goitre Prominent Adams apple Collar / Shirt No: Circumference
02 Peculiarities 1 2 4 6 in cm:

49 Hands Slender Medium Broad Small Medium Large


01 Shape / Size 1 2 3 / 4 5 6
Short Medium Long
02 Nail length 1 2 3
Bitten short Manicured Painted Artificial Nicotine
03 Peculiarities 1 2 3 4 5 Left 6 Right

50 Feet Slender Medium Broad Shoe size: Length in cm:


01 Shape / Size 1 2 3 / 4 5
Short Medium Long
02 Nail length 1 2 3
Manicured Painted Corns (specify toe):
03 Peculiarities 1 2 3

51 Body hair None Slight Medium Pronounced


01 Extent 1 2 3 4
Blond Brown Black Red Grey White
02 Colour 1 2 3 4 5 6

52 Pubic hair None Slight Medium Pronounced


01 Extent 1 2 3 4
Blond Brown Black Red Grey White
02 Colour 1 2 3 4 5 6

53 Specific details No: 1 Scars 2 Skin marks 3 Tattoo marks 4 Malformations 5 Amputations
01 Head
1A Neck / Throat
02 Right arm
03 Left arm
04 Right hand
05 Left hand
06 Body - front
07 Body - back
08 Right leg
09 Left leg
10 Right foot
11 Left foot Indicate specific details on body sketch, page D4.
54 Circumcision 1 No 2 Yes 3 Unknown

55 Other peculiarities

Police Rank : Signature / Date


officer Name :
Address :
Phone number :
Ante Mortem (yellow) VICTIM IDENTIFICATION FORM D4
MISSING PERSON
Family name : N :
°
Forename(s) :

Date of birth : Day Month Year Male Female

PHYSICAL DESCRIPTION (described in item 53)

Scars Please draw

Skin marks Please draw

Tattoo marks Please draw

Malformations Please draw

Amputations

RIGHT

LEFT
Ante Mortem (yellow) VICTIM IDENTIFICATION FORM E1
MISSING PERSON
Family name : N :
°
Forename(s) :

Date of birth : Day Month Year Male Female

MEDICAL CONDITIONS (as known to relatives or others)


56 General state of health
(Describe past and
present diseases
and / or treatment)

57 Medication
(What medicines are
kept at residence ?)

MEDICAL INFORMATION (provided by family doctor / specialist)


58 Address of No:
family doctor (see 15)
01 Regular / irregular
patient ?

MEDICAL RECORD lists:


02 Symptoms
03 Findings
04 Diagnoses
05 Treatment
06 Prescriptions
07 Ref. to specialist
08 Operation scars
09 Other scars
10 Fractures
11 Organs missing
12 Hospitalization
13 Other

ADDICTED to:
14 Smoking
15 Alcohol
16 Medicine
17 Narcotics

INFECTIOUS DISEASE:
18 Hepatitis
19 AIDS
20 Other

IN WOMEN:
21 Abortions
22 Births
23 Hysterectomy

59 Blood group
Continued item no 66 (item 60 - 65 in form PM only)

Police Rank : Signature / Date


officer Name :
Address :
Phone number :
Ante Mortem (yellow) VICTIM IDENTIFICATION FORM E2
MISSING PERSON
Family name : N :
°
Forename(s) :

Date of birth : Day Month Year Male Female

FURTHER MEDICAL INFORMATION


66 Forensic pathologist/
medical examiner's
extract from medical
records

Medical records
provided by:
Name
Address

Phone number

MEDICAL DATA OF SPECIFIC INTEREST


67 X-rays showing
specific conditions

68 Organs removed
69 Prostheses
70 Other artificial aids
Continued item no 76 (item 71 - 75 in form PM only)

Pathologist Signature / Date


Name :
Address :
Phone number :
The INTERPOL Victim Identification Form, Sections F1 and F2
GENERAL INFORMATION

The INTERPOL Victim Identification Form consists of several sections - divided in two groups:

1) YELLOW FORMS for listing latest known data concerning a missing person;
2) PINK FORMS for listing all findings concerning a dead body.

Identification of a dead body may become possible if data listed on the pink forms concerning this body can be compared
with, and shown to match, data listed on the yellow forms concerning one particular missing person. If an identification is
made, the experts involved will complete an Identification-Report - as a prerequisite to issuing a death certificate and
releasing the body for burial.

The identification of a dead body may be accomplished in several ways, depending upon the type of data used. The
INTERPOL Victim Identification Form has been set up in such a way, that sections listing the same type of data are marked
with the same capital letter in the upper right-hand corner. For dental identification, the forms to use are Sections F1 and F2
(yellow), and Sections F1 and F2 (pink); because of the specialised vocabulary, they must be filled in by a forensically
trained dentist.

INSTRUCTIONS FOR USE - SECTION F1 AND F2 AM (yellow)

These forms are designed for listing all dental information collected from dental practitioners records or other
sources.

In Section F1, make sure that the reference number is clearly shown - and that the sex is clearly indicated (boxes at the top).
Fill in all the details requested further down. Under "Circumstances of the Disappearance", give the shortest possible extract
of the police report. Under "Dental information", list any supplementary information obtained by the police from family
members and/or others. Request from the police - and list - exact name, address and telephone number of the
dentists/institutions from which records etc. have been obtained; also list the respective periods covered (whole years).
Written records should be originals or good Photostat copies. Ensure that all record X-rays, models, and photographs are
clearly marked with patient’s name, dentist’s name, and date of exposure or production; if they are not, you must do it
yourself.

In Section F2, the missing person's latest known dental status is to be listed. The status can only be established by extraction
from - and re-arrangement of - the data listed in one or more dental records - or apparent from X-ray, models, photographs,
or other material produced. Start with the latest entry in the written record and work your way backwards; in this way, all
previous treatment now covered by later treatment can be left out. Indicate surfaces by using Capital-Letter System: M =
mesial, 0 = occlusal, D = distal, V = vestibular, L = lingual; if other abbreviations are used, please explain them in one of the
boxes further down. (NOTE: there will be a notation only for treatment/conditions actually described or seen in the material)
- Next, sketch on the dental chart the location and extent of all fillings and other conditions listed as present according to
your re-arrangement of data. For colour distinction, use black for amalgam, red for gold, and green for tooth-coloured
material. For teeth extracted or not formed, put large cross (X) over the appropriate tooth square. If the practitioner’s record
includes an dental chart, compare it with your own and make sure they tally. Do not hesitate to contact practitioner for
clarification of dubious points. If X-rays and/or other material are available, indicate - in the appropriate boxes - type, year
of exposure or production, and teeth concerned. Finally, record age at time of disappearance.

Once Section F2 has been completed, type your name, address and telephone number (or use your professional stamp) in the
box at the bottom of Section F1. Finally, enter the date of completion above your personal signature. Remember - this is a
legal document, so keep a full copy for your own file. Likewise, make copies of all original record material, before returning
it to the practitioner.
Ante Mortem (yellow) VICTIM IDENTIFICATION FORM F1
MISSING PERSON
Family name : N :
°
Forename(s) :

Date of birth : Day Month Year Male Female

DENTAL INFORMATION
76 Missing Persons
address (see 10)

77 Reported missing Day Month Year

78 Circumstances
of the disappearance

79 Dental information
Obtained from family
members and/or others

01 Data in item 45 1 No 2 Yes

DENTAL DATA PROVIDED BY


80 Dentist / Institution
Address

Phone

Period covered From To Records X-rays Models Photos

DOCUMENTS filed with

81 Dentist / Institution
Address

Phone

Period covered From To Records X-rays Models Photos

DOCUMENTS filed with

82 Dentist / Institution
Address

Phone

Period covered From To Records X-rays Models Photos

DOCUMENTS filed with

Continued item no 86 (item 83 - 85 in form PM only)

Odontologist Signature / Date


Name :
Address :
Phone number :
Ante Mortem (yellow) VICTIM IDENTIFICATION FORM F2
MISSING PERSON
Family name : N :
°
Forename(s) :

Date of birth : Day Month Year Male Female

86 DENTAL INFORMATION
11 21
12 22
13 23
14 24
15 25
16 26
17 27
18 28
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28

48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
48 38
47 37
46 36
45 35
44 34
43 33
42 32
41 31
87 Specific data
Crowns, bridges and
dentures

88 Further data
Occlusion, attrition,
anomalies, smoker,
periodontal status,
etc.

89 X-rays available

90 Further material

91 Age at time of disapp.


Ante Mortem (yellow) VICTIM IDENTIFICATION FORM G
MISSING PERSON
Family name : N :
°
Forename(s) :

Date of birth : Day Month Year Male Female

FURTHER INFORMATION (if referring to data given on a previous page, please indicate item number)
92

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