Technical/Clerical errors can happen in the top part of the certificate

Technical/Clerical errors can happen in the bottom part of the certificate also

Certification errors happen in Part I and Part II of the certificate

1. Technical/Clerical Errors include:

2. Certification Errors - Based on the type of error, this can be further                                                                 classified into: 

Errors in this certificate -

1. Competing causes of death

2. Use of abbreviations

Cause of death written on the last line of the certificate [1(c)] is Underlying CoD. Here, in 1(c),the competing causes of death include low birth weight, RDS, perinatal asphyxia, ARF,RDS etc. It is important to write a single CoD and not multiple causes as Underlying CoD.

Errors in this certificate -

1. The entry in line (a) is illegible

2. ?diagnosis is  acceptable in the hospital while the              person is still alive; but once death has occurred,              clinical judgement is to be used to arrive at a                      single probable cause of death and therefore ?                    mark is not needed

Error in this certificate -

1. The entry in line (a) is illegible

Errors in this certificate -

1.  Incomplete details of accident

2. Use of abbreviations

Error in this certificate -

If only a single diagnosis is written, that will be taken as the underlying CoD [i.e. the last filled line among lines a, b or c in Part I is considered the uCoD]. So in this example, septicemia is the only filled diagnosis.                                        Septicemia is a non-specific cause (or) only an immediate CoD and not underlying CoD. For the death certificate to be valid/complete, the underlying CoD should be filled in line b or line c below.

Error in this certificate -

This is an example of Major error : Mechanism of death listed without an underlying cause. Failure to construct a chronological sequence of events and listing a mechanism/mode of death as the CoD (underlying, intermediate and immediate) is not useful.

Errors in this certificate -

1. ? Brain cannot be a uCoD

2. Brain causing intracerebral hemorrhage causing chronic         bronchitis leading on high BP, IHD & DM is not a                     biologically-plausible sequence of events

3. High BP, IHD & DM are competing causes of death (more       than one disease cannot be listed on same line; each                 disease should be listed on a separate line); IHD should be     listed in Part 1 while DM & HT should be listed in Part 2​  

Error in this certificate -

While the intermediate and immediate causes of death have been listed, the underlying cause (whether road accident or slip & fall on the same surface or fall from a height or crush injury, etc) has not been identified as uCoD in line c of Part I

Errors in this certificate -

1. Competing causes  with no biologically-plausible             sequence of events

2. Diabetes to be listed in Part 2

Errors in this certificate -

1. Wrong sequence

2. Use of abbrevation

Error in this certificate -

Mechanism of death with no Underlying Cause of death

This is a good example to show that 'Burns' is not a natural cause of death ; but should be checked as one of 2 to 5 under manner of death.

Lessons from previous examples

• These wrongly filled examples show us that these death certificates are not useful to:

1. Either the government/health authority in terms of identifying the causes of death in these hospitals in a region   
2. Or the doctors in terms of identifying the sequence of events for intervention at specific points along the biologic pathway with appropriate diagnostic/therapeutic interventions

• The public health objective is to prevent the precipitating cause from operating and hence the relevance of the underlying cause