How to fill medical part of a
Death Certificate ?
Filling the medical part of a Death Certificate
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The person certifying the cause of death has to enter the sequence of events leading to death on the International Death Certificate specified by W.H.O.
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There are 2 parts in this certificate
A. Part 1
B. Part 2
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This is used for diseases related to the sequence of events leading directly to the death
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It has 3 - 4 lines to record the sequence of events leading to death, in reverse order
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Each event in the sequence should be recorded on a separate line
Filling the medical part of a Death Certificate
A. Part 1
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In a given case, construction of a chronological sequence of events will help you identify the underlying, antecedent and immediate cause of death. The order of writing these in a death certificate is
| Underlying CoD |
|---|
| Intermediate CoD |
|---|
| Immediate CoD |
|---|
A. Part 1
Example 1
Patient A is admitted with Acute Gastroenteritis and dehydration and then develops acute renal failure and dies in the ward.
The chronological sequence of events for example 1 is as in the picture
| Underlying CoD |
|---|
| Intermediate CoD |
|---|
| Immediate CoD |
|---|
| Acute Gastroenteritis |
|---|
| Dehydration |
|---|
| Acute Renal failure |
|---|
As per the sequence of events, Acute Gastroenteritis is the Underlying cause of death in example 1.
Accordingly, the death certificate is filled as below
I(a) Acute Renal Failure
(b) Dehydration
(c) Acute Gastroenteritis
II
Example 2
Patient B is admitted with Acute Gastroenteritis and dehydration and dies in the ward.
The chronological sequence of events for example 2 is as in the picture
| Underlying CoD |
|---|
| Intermediate CoD |
|---|
| Immediate CoD |
|---|
| Acute Gastroenteritis |
|---|
|
|
|---|
| Dehydration |
|---|
I (a) Dehydration
(b)
(c) Acute Gastroenteritis
II
I (a)
(b) Dehydration
(c) Acute Gastroenteritis
II
I (a) Dehydration
(b) Acute Gastroenteritis
(c)
II
As per the sequence of events, Acute Gastroenteritis is the Underlying cause of death in example 2.
Accordingly, the death certificate is filled in any of the 3 ways
Example 3
Patient C is admitted with Acute Gastroenteritis and dies in the ward.
The chronological sequence of events for example 3 is as in the picture
| Underlying CoD |
|---|
| Intermediate CoD |
|---|
| Immediate CoD |
|---|
| Acute Gastroenteritis |
|---|
|
|
|---|
|
|
|---|
I (a)
(b)
(c)Acute Gastroenteritis
II
I (a)Acute Gastroenteritis
(b)
(c)
II
I (a)
(b)Acute Gastroenteritis
(c)
II
As per the sequence of events, Acute Gastroenteritis is the Underlying cause of death in example 3.
Accordingly, the death certificate is filled in any of the 3 ways
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If there is a single cause of death, once it is filled in the death certificate, irrespective of whether you will fill it in a or b or c, it will be considered as Underlying cause of death
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If there are 2 causes of death, you can write it in multiple ways as shown in the earlier examples
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If there are 4 events in the sequence to death, write a, b, c and also add line d. The entry in line d will be considered as underlying cause of death
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This is used for co-morbid conditions or risk factors which have no direct connection with the events leading to death but which, by their nature, contributed to death
Filling the medical part of a Death Certificate
B. Part 2
Patient D is admitted with Pneumonia in a hospital. He is a chronic smoker for the past 10 years. This acute lung infection occurred on his underlying emphysema. His lung infection worsened and he finally expired. He also had hypertension.
The chronological sequence of
events for example 4 is as in
the picture
Example 4
| Underlying CoD |
|---|
| Intermediate CoD |
|---|
| Immediate CoD |
|---|
| Emphysema |
|---|
|
|
|---|
| Pneumonia |
|---|
The risk factors in example 4 are Hypertension and Smoking
As per the sequence of events in example 4, the death certificate is filled in 3 ways
I (a) Pneumonia
(b)
(c) Emphysema
II Hypertension
I (a)
(b) Pneumonia
(c) Emphysema
II Hypertension
I (a) Pneumonia
(b) Emphysema
(c)
II Hypertension
Note :
Hypertension being a risk factor is written in Part II.
Smoking is also a risk factor in this example. It can also be listed in Part II after Hypertension. It should not be written in Part I.
REMEMBER
The cause of death written on the lowest line of the death certificate is important and will be taken in as the underlying cause of death
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