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Medical certification of cause of death

The International Form of Medical Certificate of Cause of Death

The World Health Organization (WHO) International Form of Medical Certificate of Cause of Death (2016 revision) is shown below. It consists of two parts, Frame A and Frame B.

Frame A

Frame A has two parts and a section to record the interval between the onset of each condition and the date of death (see form below).


Part 1 is used for diseases or conditions that form part of the sequence of events leading directly to death. 

The immediate (direct) COD is entered on the first line, 1(a). There must always be an entry on line 1(a), and this may be the only condition reported in Part 1 of the certificate. If there are two or more conditions that form part of the sequence of events leading directly to death, each event in the sequence should be recorded on a separate line. In any case, it is essential to record the disease, injury, or external cause that resulted in the death.

Duration is the interval between the onset of each condition entered on the certificate (not the time of diagnosis of the condition) and the date of death. Duration information is useful in coding certain diseases and provides a useful check on the order of the reported sequence of conditions. The time interval should be entered for all conditions reported on the death certificate, especially for the conditions reported in Part 1. These intervals are usually established by a physician on the basis of available information.

Part 2 is used for contributory causes of death, that is, conditions that do not belong in Part 1 but whose presence contributed to death. These do not form part of the sequence, so are listed on the death certificate as contributing causes.

Frame A should be completed and signed by a trained physician.
Frame B
Some detail is frequently forgotten in Parts 1 and 2 (Frame A). Therefore, separate questions ask for details such as previous surgeries, manner of death and place of death. It is important to record additional information in Frame B to ensure that all available information is provided to allow for the correct ascertainment of the underlying cause of death (UCOD).

For example, there is a question in Frame B on whether the deceased woman was pregnant, which would help improve reporting of maternal deaths. Similarly, information on surgery and reasons for the surgery would help in ascertainment of UCOD.

Frame B can be completed by nonphysicians who are familiar with the medical records of the decedent, but should be reviewed by the physician for accuracy and completeness.

In addition to the standard death certificate, WHO has produced an additional form for reporting detail on perinatal deaths (see below). Countries are advised to use the WHO definition of the perinatal period – that is, starting at 22 completed weeks (154 days) of gestation (the time when birth weight is normally 500 grams) and ending seven completed days after birth. Correct identification of the cause of perinatal deaths is particularly important in guiding the development of national policies on maternal and child health.
WHO Suggested additional detail of perinatal deaths (stillbirths and liveborn infants dying within 168 hours [1 week] of birth)

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