Anatomy of a Death Certificate - Crozer-Keystone Health System - PA

Anatomy of a Death Certificate

June 2012

Pennsylvania bases its death certificate on the U.S. Standard Certificate of Death. A Certificate of Death is required within 96 hours of death, or fetal demise, or finding a dead body, or remains (35 P.S. section 450.501).

There are three major categories of information contained on the death certificate:

  • Demographic and personal information, (Sections 1- 22b)
  • Details about the method and place of bodily disposition (Sections 23a-25)
  • Information about the cause and circumstances surrounding death (Sections 26-38)

The focus of this article will be the third category, cause and circumstances of death. This is referred to as the Cause of Death statement.

Section 31 of the Certificate of Death requires the manner of death to be identified. This includes both the cause and circumstances of death. In this section, a death is defined as “natural” ONLY IF it resulted solely from disease and/or aging process. It is acceptable to mark “undetermined” when there is insufficient information to otherwise classify the manner of death. “Pending” may be used as a manner of death provided that an amended or supplemental death certificate is forthcoming.

Along with indicating the manner of death, identify the physiological conditions that culminated in death. When possible, list the sequence of conditions that ultimately resulted in the death. Report the sequence by FIRST listing the condition that occurred closest to the time of death, the Immediate Cause. Then list the conditions going backwards in time, to the Underlying Cause of death, which is the condition that started the train of events that led to death.

It is important to note that words used for classifying a manner of death may be used differently than they would be used in court for the purpose of legal proceedings. Write your findings as related to clinical presentation not legal charges or definitions. Remember, the Certificate of Death is used legally as proof that a given person has died, but not necessarily as legal proof in court, as the cause and manner of death. The reported cause and circumstances of death are the OPINION of the certifier and are NOT legally binding. The findings may be changed or updated by the certifier if significant information becomes available, after the medical certification of death has been performed.

Made a mistake on the Certificate of Death?  The mistake can be corrected by filing an amendment with the appropriate vital records registrar. Usually the amendment must be done by the original certifier.

A distinction that raises confusion, especially in a hospital setting, is who may pronounce death versus certify a death?  Under 35 P.S. Section 45O.502 only a limited class of individuals may certify a death. The Certifier must be a licensed physician, Medical Examiner or Coroner. A dentist may act as a Certifier in a very limited scenario, if the dentist is a staff member of an approved hospital, and attending the deceased during the last illness, and only if the death occurs in a hospital and the deceased has been admitted on the dental service.

When do you call the Medical Examiner?  Even though the licensed physician is legally able to certify a death, 35 P.S. Section 450.503 requires that a referral is made to the Medical Examiner for a determination of the cause of death where the circumstance of the death was sudden, violent or suspicious or the result of other than natural causes.
The Medical Examiner may decline to take the case but the referral must be made.

Certify versus Pronounce Death. “Certifying” a death is distinct from “Pronouncing” a death.  Nurses CANNOT under any circumstances certify or determine the cause of death. However, a licensed nurse is empowered to pronounce a death, specifically, only in the case of a death from “natural cause” where a physician is unable to be present within a reasonable time period to certify the cause of death. The nurse may also release the body to a funeral director after notice is given to the attending physician.
Update:  Effective January 1, 2012, the Department of Health implemented a revised Certificate of Death (Form H105.143). The 2012 certificate paper is larger than past certificates. It is on 8 ½ by 14-inch paper. If you are making a photocopy, do not shrink the copy to 8 x11 inch. If you need to fold the certificate, FOLD ONLY FROM THE BOTTOM UP. Use black permanent ink. No gel pens or erasable ink.

If you have questions or need assistance, you can access The Certificate of Death Registration Manual online at

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Anatomy of a Death Certificate

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