How To Download __FULL__ Certificate From Medscape

processing.... Drugs & Diseases > Pathology Medical Certification of Death Updated: Aug 05, 2019 Author: Randy L Hanzlick, MD; Chief Editor: Kim A Collins, MD, FCAP more... Share Print Feedback Close Facebook Twitter LinkedIn WhatsApp Email webmd.ads2.defineAd({id: 'ads-pos-421-sfp',pos: 421}); Sections Medical Certification of Death Sections Medical Certification of Death Introduction and History Epidemiology Definitions Common Misconceptions Basic Principles Issues Arising in Court Show All Tables References Introduction and History The World Health Organization (WHO), as part of its mission, develops standards for the collection and classification of mortality data so that international comparisons may be made. The United States is a signatory of the WHO and follows its policies, procedures, and regulations. The National Center for Health Statistics (NCHS) is part of the Centers for Disease Control and Prevention (CDC) and is responsible for the collection and analysis of mortality data in the United States. NCHS, through cooperative agreements with states, buys mortality data from the states.

To comply with WHO standards and to promote uniformity among the states, NCHS has developed and periodically revises the U.S. Standard Certificate of Death. To receive funds from NCHS for its data, each state must collect and provide death data in a format consistent with the U.S. Standard Certificate of Death, so the death certificate in each state appears somewhat similar to other states. Approximately 2.6 million deaths occur per year in the United States, and the NCHS receives information on virtually all of them.

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This chapter contains basic principles that can be used to certify deaths (complete the cause of death section of the death certificate) in a professional manner. These principles are based largely on guidelines published by the National Center for Health Statistics and the College of American Pathologists. [1, 2, 3]

Death certificates are a valuable source for state-based and national mortality statistics. The mortality data published regularly by NCHS are based on information from every death certificate completed in the United States. These data are used to prioritize funding and programs geared toward prevention of death and conditions which cause death, and allocation of federal dollars for these purposes is based in part on such mortality data. Therefore, making death certificate information as complete and accurate as information allows is important. The most current national mortality data usually is for the calendar year 2 years prior to the current year.

Many people view the death certificate as unimportant and just another piece of paper that must be completed when a death occurs. Nothing is further from the truth. The importance of the death certificate to mortality statistics and program prioritization has already been discussed. But on the individual case level, the death certificate is used to settle estate and other matters and may also be used in legal proceedings.

A second misconception is that signing a death certificate may impose liability if the certifier is incorrect in reporting the cause of death. First, the death certificate is an opinion based on information available at the time the death certificate is completed. Second, lawsuits against certifiers of death are rare, and, when they do occur, the certifier is usually upheld. Third, death certificates can be changed (amended) if needed.

The medical examiner or coroner who investigated the death when death is due to non-natural causes, is sudden and unexplained (even if apparently from natural causes), is suspicious or unusual, or when no physician is present who can certify the death or under other special circumstances such as death in custody.

Depending on the jurisdiction or institution, the autopsy pathologist may sign the death certificate in lieu of the clinician in the hospital setting, or the coroner may rely upon the autopsy pathologist or medical examiner to provide wording or opinion about the cause and manner of death.

The cause-of-death statement of the death certificate is reported using part I, in which a sequence of conditions leading to death may be reported, and part II, in which "Other Significant Conditions" may be reported if they contributed to death.

For each death, the manner of death must be specified. In some states, the manner of death is written in text form; in other states, a checkbox system is used. Familiarity with the death certificate form used in your state is important.

Terminal events are final common pathways of death and include such things as cardiopulmonary arrest, asystole, ventricular fibrillation, respiratory arrest, and electromechanical dissociation. In general, terminal events should not be reported on the death certificate because they are so common and nonspecific that they are essentially useless for mortality statistical purposes.

Nonspecific Processes (NPs) consist of anatomic or physiologic abnormalities and include such things as pneumonia, cirrhosis, hyperkalemia, and many other conditions, each of which has multiple possible underlying causes and may be reported on the death certificate using the guidelines below.

NPs may be reported on the death certificate if they contributed to death. Preferably, these should be reported as an immediate or intermediate cause of death rather than an underlying cause of death. Reporting of a NP helps to clarify how the underlying cause resulted in death in the present patient compared with other possible options. In rare instances, reporting a NP alone may be necessary, but only if a reasonably certain underlying cause of death cannot be identified know that this should be done only when absolutely necessary.

The cause-of-death statement for deaths due to external causes can be constructed in a way analogous to those involving natural causes, but instead reporting the nonspecific process that caused death, the bodily trauma that caused the nonspecific process, and the injury event that caused the bodily trauma. In a case of cardiac tamponade that occurred from a penetrating injury of the heart because of a stab wound to the thorax, the cause of death statement could be reported as follows:

"How injury occurred" is a concise statement of how the fatal injury occurred, using generic terms, such as "Driving small car, lost control, struck tree." A place exists to indicate whether an autopsy was performed and whether the autopsy findings were considered when the death certificate was completed. The autopsy question should be answered "Yes" even if only a partial (or limited) autopsy was performed, and the nature of the limited autopsy can be reported as shown in the example at the end of this chapter. Space exists to report the duration of each condition reported in part I of the cause-of-death statement but whether this is required depends on policy in the involved jurisdiction.

The cause of death and death certificate are not written in stone and can be changed (amended) if needed. [4, 5] In general, the time between an injury and death does not impact on the manner of death if the immediate cause of death resulted from the injury (eg, a man who dies 10 years after being shot by another person, and was quadriplegic with recurrent sepsis which ultimately caused death, would still be classified as homicide). The "but-for" paradigm can be used in most cases to determine manner of death (eg, "but-for the gunshot wound 10 years ago, the person would not have died at the time he did and of the causes stated"). In general, if an injury or poisoning caused, contributed, or hastened death, preference is given to the non-natural manner of death. Rarely, a condition that is separate and distinct from the presumed underlying event "breaks the chain" and serves as an intervening cause of death (such as someone in the hospital because of a traffic accident but is then euthanized by a "mercy killer.")

Whether or not to include statements such as "Collision of motor vehicles" in part I (in addition to other more specific causes) is a matter of space and personal preference, although for lay readers of the death certificate this method may be helpful.

The examples below are intended to represent well-written cause-of-death statements and death certifications, which should be complete and clear enough that the story of the death is apparent without a case history. The format is similar to the death certificate used in each state.

Typically, when a death certificate is introduced in a legal proceeding such as a court trial, the certifier of death is asked to verify that the certificate is authentic. The witness may be asked to indicate his/her opinion of the cause and manner of death as indicated on the death certificate. The death certificate, however, is used more to prove the fact of death (that death actually occurred) rather than serving as proof of the cause and manner of death.

As mentioned previously, occasional lawsuits arise regarding a cause or manner of death reported on the death certificate. [8] Usually these have involved suicides. Most often, the opinion of the certifier is upheld.

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