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States and stored in accordance with State practice. Each State has a contract with the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS) that allows the Federal Government to use information from the State records to produce national vital statistics. This national data program is called the National Vital Statistics System (NVSS). 2 To ensure consistency in the NVSS, NCHS provides leadership and coordination in the development of standard certificates and reports to serve as models for use by States. These certificates and reports are revised periodically to ensure that the data collected relate to current and anticipated needs. In the revision process, stakeholders review and evaluate each item on the standard certificate for its registration, legal, genealogical, statistical, medical, and research value. Each item is evaluated thoroughly with emphasis on answering the following questions: + Is the item needed for legal, research, statistical, or public health programs? + Is the item collectible with reasonable completeness and accuracy? + Is the vital statistics system the best source for this information? The associations on the stakeholder panel that recommended the current U.S. Standard Certificate of Death included the National Funeral Directors Association, the American Medical Association, the National Association of Medical Examiners, the College of American Pathologists, and the American Hospital Association. For the U.S. Standard Report of Fetal Death, the stakeholder panel associations included the National Funeral Directors Association, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the Association of State and Territorial Health Officers (Maternal and Child Health Affiliate), the American Medical Association, and the American College of Nurse Midwives. Most State certificates conform closely in content and arrangement to the standard. Minor modifications are sometimes necessary to comply with State laws or regulations or to meet specific information needs. Having similar forms promotes uniformity of data and comparable national statistics. It also allows the comparison of individual State data with national data and data from other States. Uniformity of death certificates among the States also increases their acceptability as legal records. Although the death certificates in use in this country differ somewhat from State to State, they all contain the following types of information: + Information about the decedent and his or her family. + Information about the disposition of the body. + Certification by the physician, medical examiner or coroner, or some other person legally authorized to certify. 3 + Information about the cause of death. See ‘‘Appendix A’’ for a copy of the U.S. Standard Certificate of Death. The fetal death report is designed primarily to collect information for statistical and research purposes. In many States these records are not maintained in the official files of the State health department. Most States never issue certified copies of these records; the other States issue certified copies very rarely. Confidentiality of vital records To encourage appropriate access to vital records, NCHS promotes the development of model vital statistics laws concerning confidentiality. State laws and supporting regulations define which persons have authorized access to vital records. Some States have few restrictions on access to death certificates. However, there are restrictions on access to death certificates in the majority of States. Legal safeguards to the confidentiality of vital records have been strengthened over time in some States. Funeral director’s responsibility Funeral directors are responsible for getting the death certificate completed. Procedures for handling certificates of death In general, their duties are to: + Complete, or have completed, all items on the death certificate. + Obtain the cause-of-death information and certification statement from the attending physician or medical examiner or coroner. + Secure the signature of the person pronouncing death on the certificate, and review the certificate for completeness and accuracy. + File the certificate with the proper State or local official within the time specified in the vital statistics laws of the State. + Notify the medical examiner or coroner of any death that is believed to have been due to an accident, suicide, or homicide or to have occurred without medical attendance, unless this has already been done by the pronouncing or certifying physician or the police. + Obtain and use all necessary permits and other forms associated with the death registration system. 4 + Cooperate with State or local registrars concerning queries on certificate entries. + Cooperate with pathologists in cases involving postmortem examinations. + Be thoroughly familiar with all laws, rules, and regulations governing the vital statistics system. + Call on the local or State office of vital statistics for advice and assistance when necessary. Certification by physician—The procedure for obtaining the information and completing the death certificate varies in different locations. This may be regulated in part by State law and in part by local practice. The funeral director must be aware of the laws of the State or jurisdiction in which he or she operates. If the death occurred in a hospital or other institution, the institution may assist

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