Please fill out the form below to report the passing of a Froedtert & MCW patient. Patient Information First Middle Last Date of Birth MM/DD/YYYY Date of Death MM/DD/YYYY Additional Information Include any additional information, such as a link to or the location of the obituary. Contact Information of Person Filling Out This Form Please enter your information in case we need to contact you regarding this patient. First Last Relationship to Patient Contact Person Phone Contact Person E-Mail Submit Leave this field blank Patients & Visitors Patients & Visitors MyChart Appointments Medical Records Report a Deceased Patient COVID-19 Information Contact Us Billing & Insurance Health Resources International Patients On-Campus Amenities Patient & Family Services Visitor Information Support & Therapy Services Patient Rights and Responsibilities