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Coroner

Report a Death

Welcome to the Douglas County Coroner’s Office online death reporting form.

Forms are to be submitted by hospice agency personnel only, and the death must be of a natural occurrence.

Before submitting the form, please verify that the death has occurred within the Douglas County boundaries.

Once the form has been successfully submitted, please contact the designated funeral home for decedent transfer.

 

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Coroner Jurisdiction

Did the decedent suffer any falls in the last 30 days, fractures in the last 6 months or significant injury/trauma that may be related to death?(Required)
If you answered yes, please call 303-814-7150.
After completion of your physical assessment, were there any concerns?(Required)
If you answered yes, please call 303-814-7150.
Did the decedent have any (1) medical equipment malfunctions, or (2) recent surgeries, that may be related to death?(Required)
If you answered yes, please call 303-814-7150.
Do you have any concerns such as (1) unusual death, (2) unnatural death, (3) suspicious/violent or unexpected/unusual circumstances?(Required)
If you answered yes, please call 303-814-7150.

Reporting Party Information

Reporting Party:(Required)
Reason Reported:
Select date MM slash DD slash YYYY
Please enter the time the death. Example 07:30 a.m.

Decedent Information:

Decedent's Name:(Required)
Date of Birth:
Gender:(Required)
Home Address:(Required)
Marital Status:(Required)

Legal Next of Kin

Name:(Required)
Address:(Required)
Has been notified of the death?(Required)

Medical History

Select date MM slash DD slash YYYY
Select date MM slash DD slash YYYY
Please enter the time the death. Example 07:30 a.m.
Select date MM slash DD slash YYYY
Please enter the time the death was pronounced. Example 07:30 a.m.
Place of Death:(Required)

Was last breath witnessed?(Required)

Funeral Home Information