(1) A completed dead body removal authorization form must include, as a minimum:

(a) insofar as possible, the decedent's full name or, in the case of a fetal death, the full name of the mother;

(b) the place of death, including city, county, name and address of facility if applicable, address of a place which is not a named facility or the specific geographic location if an address does not exist;

(c) the date death occurred or was first discovered or date of delivery if a fetal death;

(d) a signed and dated authorization statement along with, if applicable, a signed and dated certification of oral authorization;

(e) a signed and dated statement of assumption of responsibility for filing the death or fetal death certificate; and

(f) social security number of the decedent.

(2) The physician, physician's designee, coroner having jurisdiction or mortician who authorizes the removal of a dead body or the remains of a fetal death from the place of death must complete a dead body removal authorization on the department's form and, before or at the time of removal, if the person authorizing removal is:

(a) a physician or physician's designee, give all three copies of the form to the person in charge of disposition;

(b) a coroner or mortician, retain a copy of the completed form and give the other two copies to the person in charge of disposition, unless (2) (c) applies; or

(c) also the person in charge of disposition, retain all three copies and comply with (3) .

(3) The person who removes a dead body or the remains of a fetal death from the place of death must retain a copy of the completed department dead body removal authorization form for that removal and mail or otherwise deliver the remaining copy or copies to the local registrar within 48 hours of the body's removal.

(4) If the registrar receives more than one copy of a completed dead body removal authorization form, he must retain one copy and provide the other copy to the coroner having jurisdiction.