F.
08 MEDICAL CERTIFICATION OF DEATH REGISTRABLE ACTS & VITAL EVENTS
Dr. Tubera-Panes | May 7, 2019
Outline
I. Death Registration
A. Place of Registration
B. Persons Responsible to Report, Prepare and Certify Death
II. Guidelines in Filling out and Completing a Death Certificate
III. Guidelines for Reporting Causes of Death in Specific Groups and
Conditions
“We have to be careful in filling up a death certificate because only a
doctor can certify the cause of death.”
I. DEATH REGISTRATION
Importance of Vital Statistics for Health Sector
Primary source of public health information on births and causes of infant,
neonatal and maternal deaths in a defined population.
1. Data on prevalence and distribution of mortality by cause
2. Identification of health inequalities
3. Resource allocation
4. Assessment of health systems performance
5. Understanding emerging health challenges
Act. No 3753
CIVIL REGISTRY LAW
 Approved on November 26, 1930 and took effect on February 27,
1931
 Made compulsory the registration of all facts and acts
concerning the civil status of persons from birth to death,
including the changes in civil status taking place therein in
appropriate civil registry books
 Sec. 6: Death Certificate and Register:
No human body shall be buried unless the proper death
certificate has been presented and recorded in the office of the local
civil registrar.
PD 856
CODE OF SANITATION OF THE PHILIPPINES
 Approved on December 23, 1975
 The burial or cremation of remains is subject to the following
requirements:
a) No remains shall be buried without a Certificate of
Death, which shall be issued by the attending
physician.
b) If there has been no physician in attendance, it shall be
issued by the mayor or the secretary of the
municipality where the death occurred.
c) The death certificate shall be forwarded to the local civil
registrar within 48 hours after death (Sec. 91).
d) For Muslim Filipinos,
In accordance with Islamic law and jurisprudence,
the dead body may be buried without a Certificate
of Death provided that the death shall be reported by
the person who performed the burial rites (or by the
nearest kin) to the local health officer within 48 hours
after the date of burial.
- It is their tradition that the body has to be buried
within 24 hours.
Transcribers: AQUINO, VARGAS, BALINO
 DEATH
 refers to the permanent disappearance of all evidence of life
at any time after live birth has taken place, or
 the postnatal cessation of vital functions without capability of
resuscitation
 For those patients whom you will make a death certificate, it
means that they also have a birth certificate. You cannot
make a death certificate without a birth certificate.
 FETAL DEATH
a. death prior to the complete expulsion or extraction from its
mother of a product of conception, irrespective of the
duration of pregnancy
b. the death is indicated by the fact that after such separation the
fetus does not breathe nor show any other evidence of
life, such as beating of the heart, pulsation of the umbilical
cord, or definite movement of voluntary muscles.
c. If the fetus has an intra-uterine life of less than 7 months, it is
not deemed born if it dies within twenty-four hours after
its complete delivery from the maternal womb.
Guide to when to register the fetus and what form to use.
** COBD: Certificate of Live Birth; COD: Certificate of Death
THE CIVIL REGISTRATION PROCESS
DEATH
↓
Person Responsible
Attendant at Death/ Local Health Officer/ Informant
(Within 30 days from the time of occurrence)
↓
Local Civil Registrar (City/ Municipal)
Registers event and combines events on a monthly basis;
Should be done and submitted within 10 days following the month
of registration
↓
PSA-Provincial Office
Should submit within 60 days after the reference month
↓
PSA-Central Office
Page 1 of 7
A. PLACE OF REGISTRATION
As a general rule, the place of registration is the city or
municipality where the event occurred.
For example, a vehicular accident happened in Tuba, Benguet.
Where will they report the death? In Tuba. Not in Baguio General
Hospital even if the patient was brought there.
Reporting of Vital Events of Filipinos Occurring Abroad
(Living permanently or temporarily)
 shall be reported to the Philippine Foreign Service Establishment of
the country of residence; or
 where the vital event took place; or
 where none is located thereat, in the Philippine Foreign Service
Establishments of the country nearest the place of residence of
the party concerned; or
 where the vital event occurred
B. PERSONS RESPONSIBLE TO REPORT, PREPARE & CERTIFY
DEATH
HOSPITAL DEATH
 The physician who last attended the deceased or the
administrator of the hospital or clinic where the person died
is responsible to prepare the Certificate of Death and certify as to
the cause of death.
 The certificate is forwarded, within 48 hours after death, to the
local health officer who will review the certificate and affix his
signature in the “Reviewed By” portion and direct its
registration at the Office of the LCR within 30 days.
o DEATH IN HOSPITAL EMERGENCY ROOM (ER)
 Refers to deaths of patients occurring in the ER, including
patients who were revived by initial resuscitative measures at the
ER but eventually died there, regardless of the time of stay in
ER.
 In such cases, the Certificate of Death shall be accomplished
by the ER Officer if he can provide a definite diagnosis.
 Otherwise, the death should be referred to the medico-
legal officer of the hospital or the local health officer who shall
cause the issuance of the Certificate of Death.
 If the ER doctor cannot come up with a definite diagnosis,
then the medico-legal officer of the hospital will prepare the
certificate.
o DEATH IN THE AMBULANCE
When a death occurs in the ambulance while the patient is being
transferred to another healthcare facility, the attending physician
during the transport of the patient shall accomplish the Certificate
of Death.
 Death Registration Process
Death in a Hospital
↓ (48 hours)
Local Health Officer
↓ (28 days)
Local Civil Registrar
CERTIFYING DISMEMBERED BODY PARTS
 In cases when a dismembered body part which is non-viable for
attachment is brought to the ER, such body part shall be
forwarded to the surgical pathology section of the
laboratory for gross and microscopic examination and
documentation.
Transcribers: AQUINO, VARGAS, BALINO
 The surgical pathology report signed and issued by the pathologist
shall serve as the Certificate of Dismembered Body Part
which may be used for burial purposes or proper disposal.
 The practice of issuing a Certificate of Death by the attending
physician for the dismembered body part is not necessary.
DEATHS THAT OCCURRED OUTSIDE THE HOSPITAL
 If the deceased died without medical attendance, the nearest
relative or any person who has knowledge of the death is
responsible for reporting the event to the local health officer
within 48 hours.
 The local health officer is the one who will prepare the Certificate
of Death, certify the cause(s) of death, review and direct its
registration at the Office of the Local Civil Registrar (LCRO)
within 30 days.
 When the death occurs in the ambulance while a patient is being
transferred to another healthcare facility, the attending
physician during the transport of the patient shall
accomplish the death certificate.
 In the absence of the local health officer, the death should be
reported to the mayor, or to any member of the Sangguniang
Bayan, or to the municipal secretary who shall issue the
Certificate of Death for burial purposes.
 Issue the death certificate for burial purposes only and not to
certify the death. It will just ascertain that death has occurred
for burial purposes.
DEATH UNDER MEDICO-LEGAL EXAMINATION
 When faced with the duty of completing the Medical Certificate
portion of the Certificate of Death, the physician has to determine
first and foremost whether the death is reportable or not and then,
determine whether another physician is more qualified to
complete the certificate especially if the deceased was attended by
another physician prior to his death.
For a medico legal case and there is someone is more competent
than you then you let that someone (medico-legal officer) fill that up.
 If the physician has reasons to believe or suspect that the cause
of death was due to violence or crime (or that he is dealing with a
medico-legal case), then he is duty-bound to immediately report
to the authorities of the Philippine National Police (PNP) or
the National Bureau of Investigation (NBI) concerned.
DEATH OF A MUSLIM OR INDIGENOUS PEOPLE
 For Filipino Muslim, Indigenous Cultural Communities/Indigenous
Peoples (ICCs/IPs), the dead body may be buried even without a
Certificate of Death provided that the death shall be reported to the local
health officer within 48 hours after the date of burial.
 The local health officer shall prepare the COD, certify the cause
of death and submit the COD to the LCR for registration.
 Aside from the COD/COFD, it is required to have an attachment
which shall constitute the facts of occurrence of the event.
Municipal Form 103 - Attachment for Muslim Death
IP Form 2 – Attachment for death of ICCs/Indigenous Peoples
REMINDER:
Entries in the Medical Certificate must be accomplished by
the attending physician/local health officer/medico-legal officer
correctly and completely before registration since there is
prohibition against change or correction of entries without
judicial order.
*Art. 412, Civil Code of the Philippines
Page 2 of 7
 Please do not sign a blank death certificate just because you are in III. GUIDELINES FOR REPORTING CAUSES OF DEATH IN
a hurry. There was an instance where a blank death certificate was SPECIFIC GROUPS OR CONDITIONS
signed and they placed the name of a living criminal so the criminal
is at large but registered that he died.  It is a legal document so Specific Groups/Condition
you can lose your license because of that. 1. Elderly
2. Maternal Death
3. Fetal Death
PERSON/S RESPONSIBLE TO CERTIFY DEATH 4. Infant Death
5. Death involving External Injuries
 If there is a medical attendant at death, the certifying officer is the
6. Death from Infection
attendant at death.
7. Death from Neoplasm
 If there is no medical attendant at death the certifying officer is the
Local Health Officer
 In medico-legal cases, the certifying officer is the medico-legal 1. ELDERLY DECEDENT
officer  Some elderly people may have several established medical
 In ALL cases, the cause of death shall be reviewed and signed by conditions and they seem not to die from them but from “old
the Local Health Officer age”
 Most of the elderly apparently die “with the disease” and not from
the disease
USES OF CERTIFICATE OF DEATH
Old age
 Prima facie evidence of death
Senility Little value on public
 Claim of benefits, pensions, insurance, or tax exemption
Senescence health planning and
 Evidence for settlement of estate
Advanced age research
 Remarriage purpose of surviving spouse
Multi-organ failure
 Designation of a guardian or foster parent for minor
 Determine health priorities for prevention of deaths due to similar
causes in the future
These are not accepted as a cause of death. If you place one of
 The information is also important for family members so that they
these diagnoses, then it becomes a garbage code. It will not
know what caused the death and are aware of conditions that may
be part of our statistics. You can put it in other causes.
occur or could be prevented in other family members

REMEMBER!
II. GUIDELINES ON FILLING OUT AND COMPLETING A
 Entry for the age of deceased is already recorded elsewhere
CERTIFICATE OF DEATH
and it serves no purpose repeating the apparent age of the
Be familiar with the form
deceased in the cause of death statement.
 Certificate of Death Form (light blue)
 To be useful, the cause-of-death entry must be specific,
o Municipal Form no. 103
clear and with distinct etiological sequence.
 Certificate of Fetal Death Form (pink)
o Municipal Form no. 103A
 If there is uncertainty in the entries for the causes of death,
** Green is for the birth certificate.
it is always acceptable to use qualifying terms such as
“probable” or “presumed”.
GENERAL GUIDELINES
 If the cause of death cannot be determined with reasonable
1. NO ERASURES/ALTERATIONS medical probability but seems to be due solely to a natural cause,
 Affect validity of the certificate the certifier may report “Undetermined Natural Cause” as
 Altered certificate may be rejected by the Local Civil Registry entry in the cause-of-death statement.

2. NO ABBREVIATIONS OR MEDICAL SYMBOLS CASE SAMPLE:

 No T/C, 2°, no NSVD, no TB, etc. A 95-year old man was found dead on bed by his wife. He had chronic mild
 The only acceptable abbreviations are HIV and AIDS. hypertension controlled by medication. His previous chest x-ray shows mild
cardiomegaly, consistent with chronic hypertension. There was no suspicion
3. Complete each item LEBIGLY of evidence of foul play. No specific cause of death could be identified.
 Computer printer (Black ink)
 Typewriter (Black ribbon)
 Print with pen (permanent Black ink)

 We do not already accept a hand written COD.

 When signing the document use black ink not blue. If you
use blue ink, the signatures cannot be seen once PSA
photocopies them.
 The certifier must also be aware of common complications that may cause
one to overlook and fail to report the underlying cause in elderly decedent

Transcribers: AQUINO, VARGAS, BALINO Page 3 of 7

 3. FETAL DEATH
 Death of a fetus prior to complete expulsion of a product of
conception irrespective of the period of pregnancy

 For fetus to have NO evidence of life:

2. DEATH INVOLVING WOMEN OF CHILD-BEARING AGE  No heart beat
 No Umbilical cord pulsation
o MATERNAL DEATH:  No voluntary movement
Death of woman while pregnant or within 42 days of
termination of pregnancy, irrespective of the duration and the
site of pregnancy, from any cause related to or aggravated by the
pregnancy or its management but not from accidental or incidental
causes

CASE SAMPLE 1
A 38 year old G3P2 was admitted at a birthing facility while 34 weeks
pregnant. After six hours of premature labor, she delivered a stillborn
baby boy with cord around his neck. The fetus is cyanotic with no gross
fetal movement and no heartbeat.

**19c. Maternal Condition (if the deceased is female 15-19 y.o)

The fact that women died during pregnancy or within 42 days
of the termination of pregnancy should be clearly indicated under
Maternal Condition.
CASE SAMPLE 2
A 40-year old G8P7 was admitted at a District Hospital for induction of
Information from Maternal Condition labor. Ultrasound of the fetus at 36 weeks revealed the presence of
 Used in health research and statistics anencephaly. A stillborn anencephalic fetus weighing 1500g was
 Used to identify those cases that need to be included in the Maternal delivered.
Death Review

CASE SAMPLE:
A 36-year old G5P3A1 woman who delivered a full-term baby boy at home
was brought to the ER because of placental retention. The woman
apparently had severe bleeding and was hypotensive on her arrival at ER.
She was transfused whole blood and manual extraction of the placenta
was performed. However, the woman died four hours after delivery.

Transcribers: AQUINO, VARGAS, BALINO Page 4 of 7

4. INFANT DEATH
 Death involving infants aged 0-7 days
 Same form of COD (Municipal Form 103)
 Medical Certificate portion (item 19a) found at the back of the
form is filled out instead of the one in front
REMEMBER!
o Enter in narrative form, a brief but specific and clear
description of how the injury occurred
 Fell off ladder while painting house
 Driver of car ran off roadway
o Specify
 Type of gun (handgun, hunting rifle, etc.)
 Type of vehicle (car, bulldozer, train,…)

o For motor vehicle accident, indicate whether the decedent was a

driver, passenger, or pedestrian

o Activity in which the decedent was engaged during the injury (Playing
sports, working at house, hanging out of bar)

o Fill out all the blanks as much as possible. Always specify if autopsy
is done *Yes/No. The interval between the onset and death should
The mode of dying (asphyxia, heart failure, anoxia), including always be in hours or minutes (not the exact time).
prematurity, should not be entered in section (a) unless it was the only
known condition.

CASE SAMPLE:
A 38-year old G3P0A2 was admitted at a birthing facility while 24 weeks
pregnant. She has been having premature labor for six hours. She
subsequently delivered 700g infant who was treated at the intensive
neonatal care unit but subsequently died after 24 hours. Chest X-ray of
the infant shows dense lung fields consistent with severe hyaline
membrane disease.

CASE SAMPLE 1
A 21 year-old female was critically injured in an automobile accident and
died from a fractured skull causing cerebral contusion soon after 30 min
of being brought to the hospital. Police records show that she was the
driver in a two-car collision that occurred at 2:15 am at the corner of 21st
Street and Ash Street.

5. DEATH INVOLVING EXTERNAL INJURIES

External cause or events Underlying Cause

Identify the bodily trauma Antecedent Cause
caused by the external events
Fatal derangement from bodily Immediate Cause
trauma

CASE SAMPLE 2
A 25 year old male was admitted to the hospital with a gunshot wound
to the head. He had been home in his study cleaning his gun when the
External Events External agent or force, usually physical or shot was fired at approximately 9 pm. He died at 11:05 pm on the same
chemical in nature, that causes trauma. day. Autopsy showed contact gunshot of right temple.
Trauma Injury or damage to bodily tissues or its
functions.
Fatal The resulting anatomic or functional
derangement derangement that causes death.

Transcribers: AQUINO, VARGAS, BALINO Page 5 of 7

 o Help identify the underlying cause of death
o More often than not, the primary site is the underlying
cause of death.

6. DEATH DUE TO INFECTIONS If a secondary growth is included in the sequence of events

The certifier has to report: leading to death, state the site of secondary growth as due to the site of
 Manifestation or body site primary growth.
 Causative agent (if known) / “Cause Unknown”
 Source and Route of Infection
E.g. food poisoning, contaminated blood product, health care
associated infection

o Behavior of the tumor – benign or malignant

o Nature or histological type (if known)

QUICK POINTS
CONDITION GUIDELINE
1. ELDERLY  SENILITY, OLD AGE, SENESCENCE, etc. are
Specify also any underlying disease that may have suppressed the DEATHS not causes of death
patient’s imunity that made him susceptible to the infection that led to  RULE OUT: abuse, neglect, suicides,
his death. (e.g. malnutrition -> Made the patient susceptible to inconspicuous injuries
gastroenteritis)  DETERMINE: if the conditions is a
COMPLICATION of the true underlying
cause
2. MATERNAL Fill out #19c: Maternal Condition
DEATHS
3. FETAL DEATHS Fill out C O F D
4. INFANT Fill our C O D
DEATHS BACK, for infants aged <7 days old
FRONT, for infants ages >8 days old
5. EXTERNAL FATAL DERANGEMENT is the ICOD
INJURY BODILY TRAUMA is the ACOD
EXTERNAL EVENT is the UCOD
o HIV Fill out #19d: Manner of death, Place of
HIV is accepted as underlying cause of death except death
when due to conditions requiring blood transfusion 6. INFECTION  Specify site/ manifestation
 Haemophilia and anaemia  Specify causative organism/ “cause
 Major injuries unknown”
 Surgeries  Specify if primary or secondary
 Drug addictions  If PRIMARY: specify if bacterial or viral
 If SECONDARY: specify primary infection
If the health care associated infection was part of the sequence  Specify ROUTE: community-acquired,
leading to death, it should be reported in Part I, then include all conditions hospital/heathcare-acquired, etc.
in sequence of events back to the original disease being treated.  Specify CONDITION causing
immunosuppresion
7. NEOPLASM/  Specify:
7. DEATH FROM NEOPLASM TUMOR  BEHAVIOR (Benign or Malignant)
 Specific site of neoplasm  LOCATION
Public health prevention strategies differ markedly from one  PRIMARY (if known) and/or SECONDARY
type of neoplasm to another  IF SECONDARY: identify the primary as the
UCOD
 Primary site must be stated  HISTOLOGY (if known)
o Even if it has long been removed before death
o If unknown, write “Primary Unknown”

Transcribers: AQUINO, VARGAS, BALINO Page 6 of 7

 PERSONS RESPONSIBLE QUICK POINTS CHECKPOINT:
DEATH REPORT PREPARE CERTIFY T/F:
Hospital Attendant Attending Attending 1. All death certificates must be hand written in blue ink.
at Death physician physician to 2. The color of the infant death certificate is pink while green for
be reviewed adults
by LHO 3. No remains shall be buried without a Certificate of Death, which
ER Attendant If can provide Attending shall be issued by the attending physician, regardless of race,
at Death definitive physician to religion and culture.
diagnosis: ER be reviewed 4. Filipinos who were born in the country but died outside the
officer by LHO country does not need to be reported to Filipino authorities
5. Identify the Cause of death:
If not: medico- A 25 year old male was admitted to the hospital with a gunshot
legal officer of the wound to the head. He had been home in his study cleaning
hospital his gun when the shot was fired at approximately 9 pm. He
Ambulance Attendant Attending Attending died at 11:05 pm on the same day. Autopsy showed contact
at Death physician during physician to gunshot of right temple.
the transport be reviewed
by LHO Answers: 1-4. F 5. Page 5
Dismembered Informant Surgical Pathology section will
Body Parts accomplish Certificate of
Dismembered Body Part for REMARKS:
disposal and burial purposes.  For more examples and step-by-step guide: Kindly refer to the
Outside Nearest Local Health Local Health Medical Certification of Death: Handbook for Filipino Physicians by DOH
Hospital, relative or Officer (LHO) Officer (LHO)
without any person https://www.doh.gov.ph/sites/default/files/publications/MEDICAL_CERT
medical who has If LHO is not IFICATION_OF_DEATH_0.pdf
attendance knowledge available: Mayor
of the or Sangguniang
death Bayan, or
Municipal
Secretary
Under Physician Physician has to Medico-legal
Medico-legal has to determine Officer
Examination determine whether another
if it is physician is more
reportable qualified to
or not complete the
certificate; OR
PNP/ NBI/ Medico-legal
LHO officer

Muslim Nearest Local Health Local Health

relative or Officer Officer
any person
who has
knowledge
of the
death

Transcribers: AQUINO, VARGAS, BALINO Page 7 of 7