California Code of Regulations › Title 16 - Professional and Vocational Regulations › Division 12 - Cemetery and Funeral Bureau › Article 3 - Embalming › Section 1214 - Authorization to Accept or Decline Embalming

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Except as otherwise provided in Health and Safety Code
				  section 7304, human remains shall not be embalmed without the express
				  authorization of a person having the legal right to control disposition of the
				  remains. Such authorization, to either accept or decline embalming, shall be
				  secured by use of form 12-AUTH (rev. 11/14) prescribed by the bureau and made a
				  part of this regulation. The form shall be used in the exact form set forth
				  below, without additions, substitutions, or amendments, and may be either a
				  separate form or combined with another form.
AUTHORIZATION TO ACCEPT OR DECLINE EMBALMING
TO: _____________________________________________
(Funeral Establishment Name)
RE: ________________________________________
(Decedent)
Embalming is the addition to, or the replacement of, body
				  fluids by chemical preservatives or the application of chemical preservatives
				  for the temporary preservation of the body.
I understand that embalming
				  is not required by law.
I, ______________________________, do ___ do not ___ (check
				  one) request embalming.
I understand that for storage or embalming purposes the
				  decedent may be transported to the following location:
___________________________
(Location Name and Address)
The undersigned hereby represents that he/she has the legal
				  right to control disposition of the remains of the decedent.
Signed: _________________________ , Relationship to
				  Decendent:_________________________
Executed this __________ day of ____________________(Month),
				  __________(Year),
at ________________________________________ (City and
				  State)
This section is to be completed by the funeral establishment
				  if authorization to accept or decline embalming is obtained orally.
The above statement regarding embalming and storage was read
				  and/or provided to _________________________, Relationship to Decendent:
				  ____________________, who did ___ did not ___ (check one) authorize embalming
				  at the above named funeral establishment.
Telephone Number: _________________________
Date and time authorization granted:
				  ___________________________
This section is to be completed by the funeral establishment
				  representative who is executing this authorization to accept or decline
				  embalming.
I declare under penalty of perjury that the foregoing is true
				  and correct. Executed this __________ day of ____________________(Month),
				  _____(Year),
at ________________________________________ (City and
				  State)
___________________________
(Funeral Establishment Representative (Print Name)
___________________________
Funeral Establishment Representative (Signature)
12-AUTH (rev. 11/14)
1. New section
				  filed 6-22-79; effective thirtieth day thereafter (Register 79, No.
				  25).
2. Amendment filed 7-3-80; effective thirtieth day thereafter
				  (Register 80, No. 27).
3. Amendment of section and NOTE filed
				  10-31-97; operative 11-30-97 (Register 97, No. 44).
4. Change
				  without regulatory effect amending first paragraph filed 9-22-2011 pursuant to
				  section 100, title 1, California Code of
				  Regulations (Register 2011, No. 38).
5. Amendment of section heading
				  and section filed 11-25-2015; operative 1-1-2016 (Register 2015, No.
				  48).
Note: Authority cited: Sections
					 7606
					 and
					 7616,
					 Business and Professions Code. Reference: Section
					 7606,
					 Business and Professions Code.