The Last Thing You Do for Your Patients: Correctly Complete the Death Certificate
Of all the paperwork physicians fill out, what’s the most important?
Not many physicians would answer “death certificates,” yet these simple documents are vital to public health, epidemiology, and the deceased’s loved ones.
“Filling out death certificates is not often thought to be as important as it is. It is an important document, and it has a lot of consequences after the patient is buried,” said Erich Batra, MD.
The Lebanon County internist and pediatrician is the medical director of the Pennsylvania Child Death Review Team, which relies heavily on data from death certificates while working to reduce preventable child deaths.
Death certificates are used to identify public health problems, develop effective public health programs, and direct federal and state funding. They also can be used to identify disease etiology, evaluate diagnostic techniques, and estimate population size and growth.
The deceased patient’s family uses the death certificate when applying for insurance benefits, settling pension claims, and transferring real estate and personal property. In addition, a properly completed death certificate, with the appropriate amount of detail, can be very important emotionally to the family.
According to the Pennsylvania Department of Health, when filling out a death certificate:
- Keep in mind that physicians may only certify natural death. All other deaths must be certified by a coroner or medical examiner.
- Do not copy directly from the hospital record since primary diagnosis and underlying cause may be different.
- Use your best medical opinion. Consult others if they are more familiar with the case.
If you aren’t familiar with the patient, Dr. Batra recommends taking time to review the chart and contacting a physician who knows the patient’s medical history.
“It’s not always apparent from the hospital chart,” Dr. Batra said.
It’s also acceptable to use your best educated guess, especially with patients who have multiple medical conditions.
“A lot of times we’re not going to know with 100 percent certainty what events led to the death,” Dr. Batra said.
In Part I of the Cause of Death section, make sure to:
- Report the immediate cause of death on line A. Do not report the mode of dying, such as cardiac or respiratory arrest, on line A unless you list its cause on the lines below.
- Report all conditions that led to the immediate cause of death on lines B-D. The underlying cause of death should be listed last.
- Note how long these conditions were present in the right column of Part I.
- Make all efforts to determine the cause of death. If you are unsure, you may enter "probable," such as "probable liver cancer." If it is unknown, you may write that on line A.
- Additional lines may be added if necessary.
- The time interval from onset of symptoms to death may be estimated. If it is unknown, you may write that.
In Part II of the Cause of Death section:
- List all other important diseases or conditions that did not lead to the underlying cause of death.
- If there are multiple sequences that contributed to the death, choose one to report in Part I and report the others in Part II.
The Centers for Disease Control and Prevention offers many resources on completing a death certificate, including a handbook with detailed instructions.
For more information, contact David Mattiko at the Pennsylvania Department of Health’s Division of Statistical Registries at (717) 783-2548.
Last Updated: 5/15/2009