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Medical certification of cause of death

The medical certificate

The format of the medical certificate of cause of death plays a role in facilitating the accurate capture of good-quality data. In practice, many countries adapt death certificates to incorporate information that they need for administrative purposes. However, the section on the COD – Frame A – should be identical world-wide. 

Instructions for completing the form should be provided and there should be enough space on the form to include the full sequence of the immediate and underlying causes of death. 

As noted in From cause of death certification to statistical coding, the death certificate is divided into three sections:

  1. Part 1 – report sequence/chain of events leading to death
  2. Part 2 – other significant conditions contributing to death
  3. Interval between onset of the condition and death – this is the most neglected part of the death certificate but is particularly important for establishing the sequence of events leading to death and for mortality coders to correctly select the UCOD. It also provides a check on the accuracy of the reported sequence of events. In a correctly completed certificate, time intervals should be in descending order from the bottom upwards. This means that the most recent event is reported in the first line and the original event that started the sequence is reported in the lowest used line of Part 1.

Frame B includes sections on:

  • Administrative data (such as the decedent’s sex and date of birth)
  • Other medical data, including
    • other medical data
    • manner of death
    • place of occurrence of the external cause
    • fetal or infant death
    • pregnancy.

It is important to record the additional information in Frame B to ensure that all available information is provided. This aids in the correct ascertainment of the UCOD. 

For reporting perinatal events, countries are encouraged to use the WHO form for perinatal deaths. 

World Health Organization (2016). International statistical classification of diseases and related health problems, 10th revision, vol. 2, 5th edition. Geneva, World Health Organization. 

Watch: Principles of medical certification of cause of death: Common errors and how to avoid them

This video, produced by the University of Melbourne, provides guidance for doctors on the basic principles of medical certification of cause of death, and highlights common errors made in certification. After watching this video, doctors will be equipped with the knowledge to avoid these common errors, and thus produce more accurate certificates

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