1. The Medical Certification of Cause of Death (MCCD) form is an essential legal document that is used to dispose of dead bodies and for inheritance, insurance, and other legal purposes. 2. Properly completed MCCD forms are important for assessing public health programs, informing health policy, and deciding research priorities by providing data on disease-specific mortality rates and demographic information. 3. When filling out a MCCD form, the attending physician must certify the fact of death and identify the underlying cause, intermediate causes, and immediate cause of death. The cause of death must be written clearly and accurately without abbreviations to avoid errors.

1. Medical Certification of Cause
of Death
(MCCD)
Dr Ashutosh Potdar,
HOD, Dept of FMT,
D. Y. Patil Medical College, Kolhapur

2. Objectives – Why MCCD?
1. Essential document for disposal of dead body.
2. Important legal document for inheritance,
insurance & other legal purposes.
3. To know the disease specific mortality rates in
given population.
4. Essential component of demographic studies of
population.

3. Objectives – Why MCCD?
5. Assessing the effectiveness of public
health programs.
6. Provide feedback for future health policy
and its implementation.
7. Deciding the priorities of health & medical
research programs.

4. Legal Implications
Registration of birth & death acts (RBD)
act- 1969 :
Certification by medical practitioner who
has attended the deceased during his last
illness.

5. Legal Implications
Section 10(3) : In event of death
Medical practitioner should issue MCCD in the prescribed
form stating to the best of his knowledge & belief.
Issued without charging any fees.
Issued in:
- FORM No. 4: Deaths in Nursing home
- FORM No. 4A: Non institutional deaths

6. No MCCD should be issued in
case of
- Unnatural,
- Unexpected,
- Unexplained and
- Unattended deaths

7. Status in India
Only 20% of total deaths are certified
Most of the certificates are not properly
filled and gross wrong entries are made,
thereby hampering the very objective of
MCCD

8. Components of Death
Certification
Death Certification by a medical officer
comprises of two components:
1. Certifying the fact of death (or declaring
dead) &
2. Identifying the cause of death [this is
called Medical Certification of Cause of
Death (MCCD)]

9. 1. Certifying the fact of death (or
declaring dead)
As a minimum, a full set of observations
should be undertaken and documented
In particular placing a stethoscope on the
patient’s chest [Remember ABC = airway,
breathing and circulation]

10. 2. Identifying the cause of death [this is called
Medical Certification of Cause of Death
(MCCD)]
Identifying the cause of death is a vital step
in death certification

11. It is important to differentiate between the
Mode, Manner and Cause of death in an
individual
On a death certificate, only the Cause of
death and Manner of death are to be filled
and not Mode of death

12. Mode of death vs. Cause of
death
Cardiac failure (Syncope)
Respiratory failure (Asphyxia)
Brain function failure (Coma)
Absolutely wrong to use these three
phrases in MCCD.
Occasionally used with mentioning of the
underlying pathological cause.

13. Cause of death
Definition: A cause of death is a disease,
abnormality, injury or poisoning that contributed
directly or indirectly to death.
1.Immediate cause of death
2. Antecedent (or intermediate) cause of death
3.Underlying cause of death
4.Contributory cause of death

14. Immediate cause of death
The final complication resulting from the
underlying cause of death, occurring
closest to the time of death and directly
causing death

15. Antecedent (or intermediate)
cause of death
A disease or condition that occurred as a
result of the underlying cause of death but
was not the final complication or immediate
cause of death

16. Underlying cause of death
The condition that triggered the chain of
events leading to death; temporally, the most
remote condition; etiologically specific

17. Contributory cause of death
Person who has died may be suffering from
some other disease etc., but this condition has
certainly not set the chain of events leading to
his death, but might have contributed to his
death.
Such disease are known as contributory
cause of death which are entered in Part II of
MCCD. 17

18. Types of MCCD form
1. Institutional deaths to be filled in Form
No 4
2. Non-institutional deaths and all still births to
be filled in Form No 4(A)
Format conforms to the standard prescribed
by the World Health Organization (WHO)

19. 19

25. Medico legal cases
Brought dead or suspicious death
After declaring death, inform the police
Certificate should not to be issued to relatives
of deceased
Post-mortem examination is done
MCCD issued to police

26. Information on cause of death: confidential
Detachable portion of certificate: only
the fact of death without disclosing the
cause of death

27. Guidelines
Fill in the appropriate FORMS – 4 / 4A
(as per RBD Act 1969)
Write legibly to avoid being misread
Do not use abbreviations to state the cause
of death
Avoid indefinite or inadequate terms

28. Interval between onset & death
Space is provided against each condition
recorded on the certificate
If known- exact period should be written
Or approximate period : like
- From birth, Several years, Unknown

29. Female Death
Women of child bearing age group
( 15-49yrs) - Information on pregnancy and
delivery is needed in case of death
Even though pregnancy may have nothing
to do with death

30. Maternal death
Nature of complication.
Time of death in relation to delivery.
Abortion : Spontaneous
Induced - Legal
- Illegal

31. Special conditions
NEOPLASM:
- Morphological type – benign / malignant
- Site of origin of primary growth.
- Site of metastasis.
BLOOD DISORDERS:
- Type & nature of any deficiency.
- Whether hereditary. 31

32. Summary
MCCD form to be filled & signed by attending
physician only
Do not to sign MCCD in advance or without
viewing or examining personally
General information regarding sex & age at the
time of death is equally important
Completed certificates should be sent to local
Registrar of the area

33. Summary
In medico legal cases- certificate should be
given to the Police
Underlying cause should be given at the
bottom line of Part I
Avoid registering two or more conditions in
a single line

34. Summary
Write the name of the disease in full &
legibly
Do not use abbreviation

35. Points – you must know
Do not delay in issuing MCCD
Do not charge any fees
Do not withhold issuance even if dues are
not cleared

36. Thank You