Background on Completing the Death Certificate
Importance of Death Registration
- The death certificate is a permanent record of the fact of death and is needed to obtain a burial transit permit.
- The death certificate provides important personal information about the decedent and about the circumstances and cause of death. This information has many uses related to the settlement of the estate and provides family members closure, peace of mind, and documentation of the cause of death.
- The death certificate is the source for state and national mortality statistics and is used to determine which medical conditions receive research and development funding, to set public health goals, and to measure health status at the local, state, national, and international levels.
- These mortality data are valuable to physicians indirectly by influencing funding that supports medical and health research that may alter clinical practice and directly as a research tool. Research topics include identifying disease etiology, evaluating diagnostic and therapeutic techniques, examining medical or mental health problems that may be found among specific groups of people, and indicating areas in which medical research can have the greatest impact on reducing mortality.
Because statistical data derived from death certificates can be no more accurate than the information on the certificate, it is very important that all persons concerned with the registration of deaths strive not only for complete registration, but also for accuracy and promptness in reporting these events. Furthermore, potential usefulness of detailed specific information is greater than more general information.
The physician’s principal responsiblity in death registration is to complete the medical part of the death certificate. In fulfilling the role of the certifier, the physician performs the final act of care to a patient by providing closure with a well-thought-out and complete death certificate that will allow the family to close the person’s affairs. At the same time, the physician performs a service for the larger community.
- Be familiar with state regulations on medical certifications for deaths without medical attendance or involving external causes that may require the physician to report the case to the county coroner,
- Complete all relevant portions on the death certificate,
- Deliver the signed or electronically authenticated death certificate to the funeral director promptly so the funeral director can file it with the state,
- Help the state registrar by answering inquiries promptly.
In all cases, the attending physician is responsible for certifying the cause of death. In most cases, he or she will both pronounce death and certify the cause of death. Only in the instances when the attending physician is unavailable to certify the cause of death at the time of death, will a different physician certify the facts and cause of death.
Medical Certification of Death
If you are a physician and need access to the system, please click here. You will need to input your username and password provided by Vital Statistics Services.
If you need to register for the system please send an email to mailto: firstname.lastname@example.org. Be sure to include your name, title, and the facility/clinic name in which you are associated with.
Cause of Death Information – Click here to View Examples of Causes of Death
- When completed properly, the cause of death will communicate the same essential information that a case history would.
- The cause of death section is to be completed by the attending physician or the coroner.
- In Wyoming only a licensed medical provider may certify the cause of death.
- An important feature is the reported underlying cause death determined by the certifying physician and defined as
- the disease or injury that initiated the train of morbid events leading directly to death or,
- the circumstances of the accident or violence that produced the fatal injury.
- In addition to the underlying cause of death, this section provides for reporting the entire sequence of events leading to death as well as other conditions significantly contributing to death.
- If the cause of death was not a natural death, the County Coroner is to be notified for investigation and completion of the death certificate.
- The cause of death section is designed to elicit the opinion of the medical certifier. Causes of death on the death certificate represent a medical opinion that might vary among individual physicians. A properly completed cause of death provides an etiological explanation of the order, type, and association of events resulting in death.
- The initial condition that starts the etiological sequence is specific if it does not leave any doubt as to why it developed. For example “sepsis” is not specific because a number of different conditions may have resulted in sepsis, whereas human immunodeficiency virus syndrome is specific.
- For statistical and research purposes, it is important that the causes of death and, in particular, the underlying cause of death be reported as specifically and as precisely as possible. Careful reporting results in statistics for both underlying and multiple causes of death (i.e., all conditions mentioned on a death certificate) reflecting the best medical opinion.
- Every cause of death statement is coded and tabulated in the statistical offices according to the latest revision of the International Classification of Diseases (ICD-10). When there is a problem with the reported cause of death (i.e., when a causal sequence is reported in reverse order), the rules provide a consistent way to select the most likely underlying cause. However, it is better when rules designed to compensate for poor reporting are not invoked so that the rules are confirming the physician’s statement rather than imposing assumptions about what the physician meant.
- Statistically, mortality research focuses on the underlying cause of death because public health interventions seek to break the sequence of causally related medical conditions as early as possible. However, all cause information reported on death certificates is important and is analyzed.
Completing the Cause of Death Section
- Only one cause is to be entered on each line of Part I. For clarity, do not use parenthetical statements and abbreviations when reporting the cause of death. The underlying cause of death should be entered on the LOWEST LINE USED IN PART I.
- The underlying cause of death is the disease or injury that started the sequence of events leading directly to death or the circumstances of the accident or violence that produced the fatal injury.
Line (a) – Immediate Cause
- In Part I, the immediate cause of death is reported on line (a). This is the final disease, injury, or complication directly causing the death. An immediate cause of death must always be reported on line (a). It can be the sole entry in the cause of death section if that condition is the only condition causing the death.
- The immediate cause of death does not mean the mechanism of death or terminal event (for example, cardiac arrest or respiratory arrest). The mechanism of death should not be reported as the immediate cause of death because it provides no additional information on the cause of death.
Line (b), (c), and (d) due to (or as a consequence of)
- On line (b) report the disease, injury, or complication, if any, that gave rise to the immediate cause of death reported on line (a).
- If this in turn resulted from a further condition, record that condition on line (c).
- If the condition listed on line (c) was a result from a further condition, record that condition on line (d).
- Write the full sequence, one condition per line, with the most recent condition at the top, and the underlying cause of death report on the lowest line in Part I.
Approximate Interval Between Onset and Death
- Space is provided to the right of lines (a), (b), (c), and (d) for recording the interval between the presumed onset of the condition (not diagnosis of the condition) and the date of death. This should be entered for ALL conditions in Part I.
- These intervals usually are established by the physician on the basis of available information. In some cases the interval will have to be estimated. The terms “unknown” or “approximately” may be used. General terms such as minutes, hours, days, are acceptable, if necessary.
- If the time of onset is entirely unknown, please state the interval is “Unknown”. We ask that these items are not left blank. This information is useful in coding certain diseases and also provides a useful check on the accuracy of the reported sequence of conditions.
Doubt and Cause of Death
- In cases of doubt, it may be necessary to use qualifying phrases in either Part I or Part II to reflect uncertainty as to which conditions led to death.
- In cases where the certifier is unable to establish a cause of death based upon reasonable medical certainty, he or she should enter “Unknown” in the cause-of-death section. However, this should be shown only after all efforts have been made to determine the cause of death. An autopsy should be performed, if possible.
In fulfilling the role of the certifier, the physician performs the final act of care to a patient by providing closure with a well-thought-out and complete death certificate that will allow the family to close the person’s affairs.