Next of Kin (NoK) authorization for removal

Authorization for Removal
Generic Email Hub

Next of Kin/Legal Representative

First name

Last name

Relationship to decedent

Other: Please explain

Mailing address

City

State

Zip Code

Phone number

Confirm email

This is to certify that I, the above listed legal next of kin, having the relationship listed above, hereby authorize the stated funeral home to remove and care for the body of the above listed decedent from the Hennepin County Medical Examiner's Office for the purpose of funeral arrangements, embalming, shipping, cremation, burial or other means of final disposition.

Next of Kin/Legal Representative signature

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Date signed

Decedent information

First name of decedent

Last name of decedent

Name of funeral home

Funeral home mailing address

City

State

Zip Code

Phone number

Funeral home email

Confirm funeral home email

Identification verified by HCME and FH personnel at the time of removal

(FD initial and license # here)

All fields are required.
Do not change any of the field names within this panel.
If user entered values are used to complete one of these fields - that must be done via code.
All code for each field is found in the calculate event.

General settings

No reply email address

A dropdown is used - just in case you change these values when in different environments.

Submission title/process

This is used to fill in the body of the email. Something like "NOK Authorization for Removal" or "Tab Renewal"

DoR file name (include '.pdf')

Note: Make sure to add '.pdf' to your filename

Email settings - submitter

Email address - submitter

This value will normally be the email address of whomever is submitting the form. You can set this value to a value entered by the user.

Email subject - submitter

This value may be the same as the 'email subject - LOB'. Just code - or copy/paste the value as needed'

Email body - submitter

Email settings - LOB

Email address - LOB

This value will normally be the email address of an LOB general mailbox. Something like: ME.Operations@hennepin.us

Only one email per field.

Email address - LOB (cc)

(cc)

This value will normally be the email address of an LOB general mailbox. Something like: ME.Operations@hennepin.us

Only one email per field.

If this value should be left blank - noreplay@hennepin.us should be used as the default.

Email subject - LOB

This value may be the same as the 'email subject - submitter'. Just code - or copy/paste the value as needed'

Email body - LOB

Double check all of your settings to make sure the emails will look correct when sent.
Make sure to hide this panel before sending for review.