This document discusses proper completion of medical certificates of cause of death. It begins by defining death and explaining the importance of death registration for public health data and benefits to families. Causes of death are defined as diseases or injuries directly leading to or contributing to death. The underlying cause is the initial disease/injury in the chain leading to death. Common errors in completing certificates include listing multiple causes per line, omitting time intervals, incorrect sequences, and abbreviations. Examples are provided of properly completed certificates for different causes of death like injuries, poisoning, and cancer.

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3. MedicalCertificationof Causeof
Death: Notaseasyasitseems
DrAbdurRazzakKhan
SeniorAssistantDirector,
ChattagramInternationalMedicalCollegeHospital

4. Objectives:
 To explain the importance of death registration.
 To define what is meant by causes of death and
the underlying cause of death.
 To identify & properly complete the form of the
medical certificate of the cause of death (death
certificate).
 To alert about the common mistake during
certification of death.

5. Definition of Death
• Somatic death : complete cessation of the vital
functions of the heart, the brain and the lungs.
• Molecular death : death of the tissue and the cells
individually.

6. Death certificate is permanent record of the
fact of death
Legal definition
• Death means the permanent disappearance of all
evidence of life at any time after live-birth has
taken place.

7. Legal definition
• “Deceased person” means a person in whom permanent
disappearance of all evidence of life occurs, by reason of
brain-stem death or in a cardio- pulmonary sense, at any
time after live birth has taken place.
• "Brain-stem death” means the stage at which all
functions of the brain stem have permanently and
irreversibly ceased.

8. Importance of Death Certificate
 Useful in providing data for mortality statistics
 Useful in surveillance of specific diseases particularly in
countries where registration is complete
 Useful in evaluation of disease control programs
 Rise in certified deaths from a particular cause is an
indicator for a serious outbreak.
 The completed death registration form is a permanent
legal record of the fact of death of an individual.

9. Data used by Govt. agencies, Researchers,
clinicians, educational institutions for
• To assess the health status of the population and
determine changes in status over
time;
• To identify regional differences in death rates and
investigate reasons for these differences;
• To monitor trends in public health issues such as
infant and maternal mortality, infectious diseases, and
accidents and suicides;

10. Data used by Govt. agencies, Researchers,
clinicians, educational institutions for
• To identify risks associated with environmental and
occupational factors and lifestyle;
• To determine health research and health care priorities
and allocate resources;
• To plan health facilities, services and manpower;
• To plan prevention and screening programmes and
assess the results of these programs; and
• To develop health promotion programmes and
evaluate their results.

11. Benefits of death registration to family
• Hospital reimbursement
• LIC claims
• Settling Property claims
• To obtain succession certificates
• Releasing gratuity & Provident fund claims
• Deleting deceased’s name from ration card, voter
list etc.

12. Cause of death is defined as:
 All those diseases, morbid conditions or injuries which
either resulted in or contributed to death and the
circumstances of the accident or violence which
produced any such injuries.
- Twentieth World Health Assembly, 1967

13. Underlying cause of death is defined as:
 The disease or injury which initiated the train of
morbid events leading directly to death, or the
circumstances of the accident or violence which
produced the fatal injury.
- WHO, 1994

14. International Form of Medical Certificate of
Cause of Death
Frame A: Medical data: Part 1 and 2
1
Report disease or condition
directly leading to death on
line a
Report chain of events in
due to order (if applicable)
State the underlying cause
on the lowest used line
Cause of death Time interval
from onset to
death
a
b
c
d
2 Other significant conditions contributing to
death (time intervals can be included in
brackets after the condition)

15. • The death certificate is divided into three
sections:
1. Part-1 – Diseases or conditions directly
leading to death and antecedent causes.
2. Part 2 – Other significant conditions
3. A column to record the approximate interval
between onset and death.

16. Example of a correctly filled-out death
certificate
Frame A: Medical data: Part 1 and 2
1
Report disease or condition
directly leading to death on
line a
Report chain of events in
due to order (if applicable)
State the underlying cause
on the lowest used line
Cause of death Time interval
from onset to
death
a renal failure 1 year
b Nephritic syndrome 3 years
c Diabetes mellitus 20 years
d
2 Other significant conditions contributing to
death (time intervals can be included in
brackets after the condition)
Ischaemic right foot(3
months)

17. Some common errors in cause of death
certification
1. Documenting Multiple causes per line
Frame A: Medical data: Part 1 and 2
1
Report disease or
condition directly leading
to death on line a
Report chain of events in
due to order (if applicable)
State the underlying cause
on the lowest used line
Cause of death Time interval
from onset to
death
a Cardiovascular bleed
and community
acquired pneumonia
b
c
d
2 Other significant conditions contributing to
death (time intervals can be included in
brackets after the condition)

18. A correctly completed certificate with multiple
cause per line
Frame A: Medical data: Part 1 and 2
1
Report disease or condition
directly leading to death on
line a
Report chain of events in
due to order (if applicable)
State the underlying cause
on the lowest used line
Cause of death Time interval
from onset to
death
a Cerebral compression 30 minutes
b Extradural hemorrhage 3 hours
c Fractured temporal
bone
3 hours
d Blunt trauma due to car
collided with a pick- up
truck on public
highway
3 hours
2 Other significant conditions contributing to
death (time intervals can be included in brackets
after the condition)

19. Some common errors in cause of death
certification
2. Approximate interval between onset and
deathFrame A: Medical data: Part 1 and 2
1
Report disease or condition
directly leading to death on
line a
Report chain of events in
due to order (if applicable)
State the underlying cause
on the lowest used line
Cause of death Time interval
from onset to
death
a Pulmonary
hemorrhage
*
b Advanced pulmonary
tuberculosis
*
c
d
2 Other significant conditions contributing to
death (time intervals can be included in
brackets after the condition)

20. Some common errors in cause of death
certification
3. Presence of blank lines within the sequence of events
Frame A: Medical data: Part 1 and 2
1
Report disease or
condition directly leading
to death on line a
Report chain of events in
due to order (if applicable)
State the underlying cause
on the lowest used line
Cause of death Time interval
from onset to
death
a Cardiogenic shock
b
c Acute coronary
syndrome
d Pulmonary embolism
2 Other significant conditions contributing to
death (time intervals can be included in
brackets after the condition)

21. Some common errors in cause of death
certification
4. Abbreviations used in certifying the death
Doctors are encouraged not to use abbreviations when
certifying deaths as abbreviations can mean different things to
different people. There is a chance that coders may
misinterpret the abbreviation and code the death to a non
relevant code.
Here are some of the examples of abbreviations use:
MI DM
IHD ESRD
HTN BHP

22. Some common errors in cause of death
certification
5. Illegible Hand Writing

23. Some common errors in cause of death
certification
6. Incorrect/ clinically improbable sequence of events
leading to death
Frame A: Medical data: Part 1 and 2
1
Report disease or condition
directly leading to death on
line a
Report chain of events in
due to order (if applicable)
State the underlying cause
on the lowest used line
Cause of death Time interval
from onset to
death
a Diabetes
b Gangrene foot
c Chronic bronchitis
d
2 Other significant conditions contributing to
death (time intervals can be included in
brackets after the condition)

24. Some common errors in cause of death
certification
7. Ill-Defined condition entered as underlying cause of
death
Frame A: Medical data: Part 1 and 2
1
Report disease or condition
directly leading to death on
line a
Report chain of events in
due to order (if applicable)
State the underlying cause
on the lowest used line
Cause of death Time interval
from onset to
death
a Cardiorespiratory
failure
b
c
d
2 Other significant conditions contributing to
death (time intervals can be included in
brackets after the condition)

25. Some common errors in cause of death
certification
8. Other additional errors
8.1- External Causes of Death
For deaths due to injuries, the certifier should include details on
a. Site of the injury
b. Type of the injury (ie laceration, abrasion, fracture)
c. Intent of the injury (accidental, intentional, or undetermined)
d. Nature of the injury (ie death by hanging)
For deaths due to poisonings, the certifier should include details on
a. Substance used
b. Intent of the poisoning (accidental, intentional, or
undetermined)
c. Adverse effect in therapeutic use.

26. Some common errors in cause of death
certification
A correctly completed certificate for a death due to injury
Frame A: Medical data: Part 1 and 2
1
Report disease or condition
directly leading to death on
line a
Report chain of events in
due to order (if applicable)
State the underlying cause
on the lowest used line
Cause of death Time interval
from onset to
death
a Traumatic shock 1 hour
b Multiple fracture 5 hours
c Pedestrian hit by truck 5 hours
d
2 Other significant conditions contributing to
death (time intervals can be included in
brackets after the condition)

27. Some common errors in cause of death
certification
7. A correctly completed certificate for an
external cause of death due to poisoning
Frame A: Medical data: Part 1 and 2
1
Report disease or condition
directly leading to death on line
a
Report chain of events in due to
order (if applicable)
State the underlying cause on
the lowest used line
Cause of death Time interval
from onset to
death
a Carbon monoxide poisoning 30 minutes
b Suicidal inhalation of
automobile exhaust fumes
2 hours
c
d
2 Other significant conditions contributing to death
(time intervals can be included in brackets after the
condition)

28. Some common errors in cause of death
certification
8.2- Neoplasms
when reporting death due to neoplasm it is required to provide
detail information about the tumor. This should include :
Site of the neoplasm
Whether benign or malignant.
Whether primary or secondary.
Histological type.

29. A correctly completed certificate for a cause of
death due to a neoplasm
Frame A: Medical data: Part 1 and 2
1
Report disease or condition
directly leading to death on
line a
Report chain of events in
due to order (if applicable)
State the underlying cause
on the lowest used line
Cause of death Time
interval from
onset to
death
a Pulmonary
embolism
minutes
b Deep vein
thrombosis
2 days
c Carcinoma of the
sigmoid colon
6 months
d
2 Other significant conditions contributing to
death (time intervals can be included in brackets
after the condition)

31. 8.3 Surgical procedure
8.4 Pregnancy and maternal death.
8.5 Hypertension.
8.6 infectious and parasitic disease.
8.7 General errors.
Some common errors in cause of death
certification

37. Acknowledgement
• Ministry of health and family welfare
• Continuous professional development team.

38. References
• mspgh.unimelb.edu.au/dataforhealth/resources:
• Government of the People’s Republic of Bangladesh:
‘Improving cause of death information- Assessing the
quality of death certification- Guidance tool- October
2016