Death registration

Physician guide for completing the death certificate

It is the responsibility of the physician in attendance to complete a death certificate within 15 hours of a patient’s death. The death certificate must include:

• Time of death
• Direct cause of death (immediate cause)
• Conditions, if any, that gave rise to the cause of death (underlying cause or “due to”)
• Other medical and health section data required on the certificate (including the existence of cancer, substance or tobacco use, if appropriate)
• Signature on the certification statement in attesting to the facts listed (first review the certificate)
• Additionally, the physician must:
  • Deliver the certificate to the attending funeral director or otherwise attest certificate via fax or voice
  • Cooperate with state and local registrars and respond to questions about certificate entries
• Immediate cause of death

The direct cause of death is the disease, abnormality, or injury that directly led to the death. In many instances, the immediate cause of death is also the underlying cause of death (arteriosclerotic heart disease, diabetes mellitus, tuberculosis, carcinoma of the colon, etc.). If the immediate cause of death is trivial, vague, or cannot stand alone, an underlying cause of death is needed. Some terms simply describe the condition of being dead (brain dead, cardiac arrest, cardiorespiratory arrest, pulmonary arrest, etc.). These types of mechanistic terminal events should not be used.

Underlying cause

The underlying cause of death must have an etiologic or pathologic relationship to the immediate cause of death. It can also be an antecedent condition that prepared the way for the subsequent cause. It must have initiated the lethal chain of events, no matter how long the time interval. The time intervals between causes must be listed in chronological order and must be supported by etiological sequence.

Deaths known or suspected as having been caused in whole or in part by injury or poisoning should be reported to the Medical Examiner-Coroner (MEC) and the death certificate should not be completed by the physician unless the MEC instructs to do so.

If the physician will be unavailable to provide the causes of death and sign the death certificate within the required timeframe, advise the funeral director of the physician who will be filling-in so that the death registration process and burial arrangements are not delayed.