Guidance for how to complete the Medical Certificate Cause of Death certificate correctly.
On this page:
- Cause of death Part 1
- Interval between onset and death
- Cause of death Part 2
- Infectious disease
- Place of death
- Incomplete or indefinite terms
- 1. Anaemia
- 2. Arteriosclerosis and atherosclerosis
- 3. Cancer (malignant tumour, malignant disease, etc)
- 4. Cardiac dysrhythmias, etc
- 5. Chronic liver disease and cirrhosis
- 6. Cor pulmonale
- 7. Diabetes mellitus
- 8. Encephalitis
- 9. Gastrointestinal haemorrhage
- 10. Heart disease or failure (or cardiac disease or failure)
- 11. Hemiplegia (paralysis, paresis)
- 12. Leukaemia
- 13. Malformation
- 14. Meningitis
- 15. Obstruction of bowel (intestinal obstruction)
- 16. Operation
- 17. Pneumonia / bronchopneumonia
- 18. Pulmonary embolism / deep-vein thrombosis
- 19. Respiratory disease
- 20. Septicaemia (bacteraemia, pyaemia, etc)
- 21. Accidents and injuries
- Background to classifying causes of death
Start at Part 1(a) with the direct cause of death, then go back in time to the preceding (antecedent) conditions until you get to the condition that started the sequence of conditions leading to death. This is the underlying cause of death.
Part 1 (a): Direct cause of death
- Enter the disease or condition that occurred as the last part of the sequence of events or conditions leading directly to death.
- It can be the sole entry on the certificate when only one condition, such as viral myocarditis or asthma, was present at death.
- Or it may be a complication (such as peritonitis, septicaemia or pneumonia) of another condition.
Note: Do not enter the mode of dying such as collapse, cardiac arrest or respiratory failure; that information is of little value.
Part 1 (b): Antecedent cause
If the direct cause entered in 1(a) arose as a consequence of any antecedent disease or injury, enter that antecedent cause at 1(b). For example, Perforation of colon.
- If no other condition led to the condition entered in 1(b) then the condition in 1(b) is the underlying cause of death and no entry is required in 1(c). For example Chronic bronchitis in 1(b) may have led to Bronchopneumonia in 1(a). Chronic bronchitis was the underlying cause of death.
Part 1 (c):
It could be that a further antecedent disease or condition may have caused the conditions in both 1(b) and 1(a) and was the underlying cause of death. In such cases that antecedent condition, which was the starting point in the chain of related events leading to the direct cause of death, should be entered at 1(c). For example Diverticulitis in 1(c) may have led to Perforation of the colon in 1(b) and Peritonitis in 1(a).
- On no account must the starting point of the sequence be entered in Part 2 because of lack of space in Part 1.
- If more than two antecedent conditions led to the direct cause of death entered at 1(a), the starting (underlying) condition should be entered at 1(c) and the most important of the intervening conditions entered first at 1(b), followed by the second intervening condition (if space allows).
- If two intervening conditions are entered in 1(b) they should be separated by a comma.
- Where the interval between the onset of each condition entered on the certificate and the date of death is known, even approximately, it should be entered in the column provided.
- This will provide a check on the sequence of causes in Part 1 and provide useful information about the duration of illness for certain diseases, especially cancers. It is also of critical importance to clinical coders when selecting the underlying cause of death for mortality statistics.
- The certifying practitioner has responsibility for deciding which condition led directly to death and what antecedent conditions, if any, gave rise to the direct cause.
- Part 2 is for entry of other conditions not directly related to the cause of death, but which have contributed to or have had an adverse effect on the conditions entered in Part 1 of the certificate.
- Conditions entered in Part 2 must not be directly related to the underlying cause of death.
- Below the section Cause of death Part 2 on the Medical Certificate of Cause of Death is a field requesting information about any infectious disease the deceased may have been suffering from at the time of death. This is to assist the funeral director to meet reporting obligations set out in section 85 of the Health Act 1956 and its Regulations.
- The infectious diseases to be reported on in certain circumstances under the Health Act 1956 are listed in Parts 1 and 2 of Schedule 1 of this Act.
- Providing this information also makes the funeral director and other professionals aware of the infection so they can take the necessary precautions to keep themselves safe when handling the body.
- State own home, lodgings, hotel, hospital, nursing home etc.
- If the deceased died in a medical facility ensure that both the name of the facility as well as the street address are entered.
Terms used on medical certificates should be as precise and specific as possible. Abbreviations should be avoided. These commonly used and non-specific terms should be avoided. Additional information is required in these cases for accurate classification purposes:
- State the type if primary; cause if secondary. If drug-induced, state the name of the drug involved, and the condition for which it was prescribed.
- It is recognised that atherosclerosis will probably be generalised by the time of death. However, the site of arteriosclerosis or atherosclerosis which led to the direct cause of death, for example, coronary atherosclerosis, cerebral atherosclerosis, is needed. See example: Atherosclerosis
- State the exact site of the primary growth. If unknown, please state this. Record precisely the anatomical structure in which the primary site originated, for example:
(a) malignant neoplasm of trachea, bronchus or lung: primary main bronchus, primary upper lobe bronchus or lung, primary middle lobe bronchus or lung, primary lower lobe bronchus or lung
(b) malignant neoplasm of pancreas: primary head of pancreas, primary body of pancreas, primary tail of pancreas
(c) malignant neoplasm of colon: primary hepatic flexure, primary transverse colon, primary descending colon, primary sigmoid colon, primary caecum, primary ascending colon, primary splenic flexure. See example: Cancer
2. State the morphological type, if known.
3. Specify the sites of the principal secondaries, if present.
4. To avoid misinterpretation, if the term ‘metastatic cancer’ is used it should be qualified by identifying both the primary and secondary sites, for example, lung metastases from primary breast cancer. See example: Cancer
- Where the site of the primary cancer is not known, the sites of the secondaries should be stated and primary site specified as unknown.
- The term neoplasm or tumour should always be qualified with a statement as to whether it is benign, malignant, or indeterminate. If malignant, the notes on cancer should be applied; otherwise the site and type of tumour should be given. See example: Cancer
- The cause of the dysrhythmia should always be stated, if known. See also ‘Heart disease’.
- State underlying cause if known, for example, alcoholic cirrhosis.
- State underlying cause if known, for example, emphysema.
- Specify the type of diabetes mellitus, that is, Type 1 or Type 2. Conditions caused by the diabetes mellitus should be stated as such, For example. Diabetes mellitus with chronic kidney disease.
- State the cause. If acute infectious encephalitis:
- Name causal organism if known.
- State if death was due to late effects of the disease.
- State underlying cause, for example, duodenal ulcer, use of non-steroid anti-inflammatory drugs (NSAIDs) for 10 years for generalised rheumatoid arthritis. See example: Gastrointestinal haemorrhage
- State the pathology of the heart condition. Particularly:
(a) Was it due to arteriosclerosis? If so, were the coronary arteries involved?
(b) Was the condition due to rheumatic fever? If so, was it acute or chronic, (late effects)? If chronic, which valve or valves were involved?
(c) Was the heart failure caused by hypertension? Was there renal involvement?
- State the cause, e.g. cerebral infarction. If due to an old traumatic injury state the nature of the injury and details of the cause of the injury, e.g. Motorcyclist involved in collision with truck.
- How long has the condition been present? (that is, old or acute)
- State the type, for example lymphatic, myeloid, myelomonocytic.
- Was it acute, subacute or chronic?
- State the type of malformation present.
- Which part of the body was involved?
Note: If congenital, this fact should always be stated. In the case of congenital malformation of the heart, was the condition Tetralogy of Fallot, coarctation of the aorta, interventricular septal defect, tricuspid atresia, or some other defect?
- State type, for example, tuberculous, meningococcal.
- State the cause of the obstruction. Particularly:
(a) if cancer, state site and type. See example: Cancer – exact site of primary cancer
(b) if hernia, state type.
(c) if paralytic following operation, state condition for which operation was performed, the nature of the operation and when it was performed.
- State the condition for which the operation was performed.
- What was the underlying cause of this condition? For example:
(a) Peritonitis – 4 days; due to:
(b) Resection small intestine – 5 days; as a consequence of:
(c) Strangulated inguinal hernia – 5 days
Note: If death occurred during a procedure and/or whilst person was under anaesthetic, the death would need to be reported to the coroner.
- Specify type, for example, lobar, influenzal, viral.
- Is it primary or secondary to some other condition such as measles, whooping cough?
- If a terminal event, state antecedent condition leading to pneumonia.
See example: Pneumonia
- Specify origin and cause of embolism if known. If post-operative, state the condition for which surgery was performed and the nature of the operation.
- Was it associated with pregnancy, childbirth or abortion? The death would need to be reported to the coroner.
- State type, for example, emphysema, chronic bronchitis.
- Causative organism, if known.
- Antecedent condition leading to septicaemia, for example, acute appendicitis.
(When issuing a certificate under section 46C of the Burial and Cremation Act 1964.)
- In all cases of injury give the site and nature of the trauma. In addition, details of how and when the injury occurred are required as follows:
- How did the injury happen? For example, fell down stairs, fell from bed.
- Where? For example, at home, in a rest home, on the street, in a public building.
- When did the accident occur?
The 'underlying cause of death' is defined by WHO as: ‘the disease or injury which initiated the train of morbid events leading directly to death, or, the circumstances of the accident or violence which produced the fatal injury’.
The high quality of cause of death statistics in New Zealand is largely due to the cooperation of doctors, nurse practitioners and coroners in providing accurate particulars of cause of death.
Ensuring cause of death information is accurate is also important for the family of the deceased. This information appears on the legal death certificate that is issued by the Office of Births, Deaths and Marriages, and which is used for administering the deceased’s estate. Genetic Services agencies also use information from the BDM Death Register when assessing an individual’s risk of inheriting a familial genetic condition.