The DHHS Office of the State Medical Examiner conducts the medical/legal investigative work of unanticipated, sudden or violent deaths. This includes determining cause and manner of death, consulting with law enforcement and the courts, and providing information about non-lethal injuries to children specific to child abuse and neglect.

North Carolina law requires the Medical Examiner to investigate the circumstances and determine cause and manner of death of all deaths that are sudden, when a person is apparent good health; not under a physician's care; suspicious, unusual or unexplained; the result of violence, or due to criminal neglect.

The Medical Examiner also has a significant role in public health emergency preparedness and response by investigating deaths that present a hazard to citizens, as with emerging infections, agents of bioterrorism and mass fatalities.