How to write a village committee death certificate sample (2)

Death Certificate Format Template Part 1 Xxx, female. Currently xx years old. ID number: Lived in room 302, third floor, xxxxxxxx, died of illness at 11:26 pm on May 29, 2213.

This is to certify

Hohhot xxxxxxx Neighborhood Committee

May 30, xx

Death Certificate Format Template Part 2

This is XXX, a villager from XX group in our village, ID number: Village Committee

November 18, xx

Death Certificate Format Template Part Three

Following notification from superiors, the original "Medical Certificate of Death for Residents" will be issued from June It will no longer be in use on the 1st and has been changed to the new version of the death certificate of 20xx. For the convenience of clinical practice and patients, it has been sent to the information platform? Medical Department? Learning and Exchange. Download the 20xx Resident Death Medical Certificate and save and print it. *** 4 copies 2 photos. No more having to ask the patient to pick up the form.

The patient’s immediate family members need to take copies of the deceased’s and his/her ID cards to the public health department to have them stamped.

Medical Department 20xx-05-30

Death Certificate Format Template Part 4

This is to certify that the gender is (), the year, month and day of birth, and the province and city where he lived during his lifetime () County) town (township) village (or street, lane) number, died of illness (cause of death) in the province, city (county) village on the year, month and day.

Person in charge: (signature)

Name of organization: (seal)

Year and month Date

Note: The content must be filled in by the person in charge with carbon ink.

Cause of death report management system

1. System for obtaining and issuance of medical certificate of death

1. Receipt and issuance of "Medical Certificate of Death for Residents" , is managed by the Medical Department, which has dedicated personnel responsible for this work. Collection is managed by the service desk. The reporting work is completed by the Information Department.

2. The Medical Department shall establish registration records for the receipt and issuance of the "Medical Certificate of Death for Residents".

3. For each clinical department, the department director will designate the in-service staff of our hospital to collect and register the number, number, time, recipient and other items of the "Medical Death Certificate of Residents".

4. Each clinical department shall conduct special management of the "Medical Certificate of Death of Residents" received and shall not lose it.

2. Registration system for the use of medical death certificates

1. Deaths that occur in our hospital (including those who have died at the hospital and died during pre-hospital first aid) should be issued by the Ministry of Health , the "Medical Certificate of Death of Residents" issued by the Ministry of Public Security.

2. Each clinical department shall establish a registration record of "Medical Certificate of Death of Residents".

3. The record content includes the deceased’s name, gender, age, cause of death diagnosis, time of death, number of the “Medical Certificate of Death for Residents” issued, etc.

4. The Medical Department and various clinical departments will inspect, review and assess the registration records.

3. Death certificate review system, death case self-examination and reward and punishment system

1. The issuance, reporting and statistics of death certificates in our hospital are under the leadership of the cause of death management leading group. , two-level responsibility system.

2. Each functional department is responsible for the inspection and supervision of the issuance, reporting and statistics of death certificates in the hospital. They conduct inspections once a month and conduct random inspections to supervise corrections when problems are discovered; the directors of each clinical department shall personally Or assign a special person to be responsible for the inspection and supervision of the issuance, filling, reporting and registration of undergraduate death certificates; the information management network direct reporting personnel are responsible for network direct reporting and statistical work, and regularly contact the Center for Disease Control (epidemic prevention station).

3. Reward individuals or groups who have made outstanding achievements in filling in the medical certificate of death.

4. If any of the following behaviors occur, the hospital and the city or county health bureau shall order corrections and report criticism; if the circumstances are serious, the directly responsible person in charge or other directly responsible personnel may be punished according to law Administrative sanctions to be imposed:

1. Falsification, concealment, forgery, or tampering of the medical certificate of death; 2. Refusal to fill in the medical certificate of death or repeated late reporting of death cases ;

5. Any violation of the Statistics Law that constitutes a crime shall be investigated for criminal responsibility by the judicial authorities in accordance with the law.

4. Basic requirements for filling in the death certificate

1. According to the basic format and filling requirements of the national unified death certificate, fill in the details carefully one by one, and no items are missed or wrong. .

2. Writing should be done with a black or blue-black pen and the handwriting should be clear. Ballpoint pens, red pens or pencils are not allowed.

3. For the cause of death, fill in the name of the disease in applied medicine and write it in Chinese. English or English abbreviations are not allowed.

4. The front of the death certificate must not be altered, and it must have the doctor’s signature and the official seal of the hospital.

5. If the cause of death is unknown on the death certificate, an investigation record must be filled in at the time, including the name of the deceased's past disease, time of onset, diagnostic unit, basis for diagnosis, and a series of related chronic medical history.

6. If there is any doubt about the cause of death (homicide or suicide), you can report it to the police department, who will assist in determining the cause of death. Where accidental injury or poisoning death is reported, the external causes of the accident should be further reported on the death certificate.

5. Requirements for filling in basic items

1. Medical certificate number: Unified by the public security and health departments.

2. The place of residence of the deceased: the unit is street in urban areas and township in rural areas. Current address: In cities, fill in the street, lane number or building unit number; in rural areas, fill in the villager group or natural village of the administrative village.

3. Name of the deceased: refers to the current name; if it is a baby, you can also fill in the name of the baby's mother; for those who have not yet been named, you can record the mother's name, press "son of so-and-so" or "son of so-and-so" Female? Record for investigation;

4. Gender: Fill in male or female.

5. Nationality: Fill in the information according to Han, Hui, Zhuang, Uyghur, Tibetan, Bai, etc.

6. Main occupation and type of work: Fill in the occupation with the longest employment time, and fill in the occupation and specific job at the same time as much as possible.

Fill in the form that does not meet the requirements, such as: worker, cadre, operator or retired.

7. ID card number: Fill in the 15-digit or 18-digit ID card number, making sure it is consistent with the date of birth.

8. Marital status: According to the legal marital status, it is divided into five categories: single, married (including remarriage, remarriage, and separation), widowed, divorced, and unknown.

9. Educational level: Fill in the form based on the deceased’s highest educational level. Illiteracy refers to being illiterate, semi-illiteracy refers to being slightly literate, middle school includes technical secondary school, and university includes junior college.

10. Work unit before death: refers to the place of employment or the last unit where the person worked for a long time before death.

11. Date of birth and date of death: Fill in the year, month and day of the Gregorian calendar.

12. Chronological age: Calculated by one year old. For those who have not yet celebrated their birthday in the current year: year of death - year of birth - 1; for those who have passed their birthday: year of death - year of birth. For infants under 1 year old, fill in the actual age in months; for newborns under 28 days old, fill in the number of days alive; for newborns under 1 day old, fill in the hours alive.

13. Place of death: Fill in the five conditions on the death certificate; the place of death for those who died at the hospital should be at home or on the way to the hospital.

14. Names of family members who can be contacted: refers to the immediate family members or relatives who know the most about the illness or other conditions of the deceased.

15. Address or telephone number or work unit: refers to the contact person’s permanent address, contact number and work unit.

6. Requirements for filling in special items

1. Cause of death: fill in the disease, injury or complication that caused death.

Part I: It is the main content of the "Medical Certificate of Death". It is necessary to fill in the disease that caused the death and the earlier causes. It is a must-fill part.

① Fill in the order of causing death, (a) caused by (b), (b) caused by (c), (c) caused by (d);

② ) Each line can only fill in one disease;

③ (a) Line must fill in at least one disease;

④ The time interval between onset and death should be filled in as much as possible, (a) to The length of time in (d) must be from short to long.

⑤The number of lines to fill in is not limited. You can add lines (e), (f) and other lines according to the situation. ⑥Don’t just fill in the way/circumstances of dying, such as respiratory failure, circulatory failure, physical failure, etc.

Part II: is a supplement to Part I. It is used to fill in other meaningful situations that promote death but have nothing to do with the disease or condition that caused death. They should be filled in according to the specific circumstances.

①Fill in all diseases that promote death but have nothing to do with the order of causes of death in Part I; ②Fill in order of severity, no limit on number

2. Approximate time from onset to death Interval: refers to the interval between onset and death of the disease reported in Part I (time unit: minutes, hours, days, weeks, months or years). If the question is unclear, you don’t need to fill it in.

3. The hospital with the highest diagnosis of the deceased’s disease during his lifetime: refers to the unit with the highest diagnosis of the major diseases reported in Part I.

4. The highest diagnostic basis: mark according to the actual diagnosis basis; if diagnostic grading is implemented, the highest level of diagnostic basis will be used, and special examinations such as B-ultrasound, X-ray, and electrocardiogram will be placed in the clinical setting. +Physical and Chemistry? column;

5. Hospitalization number: do not fill in if you are not hospitalized;

6. Physician’s signature: signed by the physician who fills in the death certificate and assumes legal responsibility;

7. Seal of the unit: The official seal of the unit where the doctor works is stamped; 8. Date of completion: indicate the date when the certificate is issued; - generally it should be the day of the deceased’s death or later. Within a few days, if the interval is too long, it should be explained.

7. Requirements for filling in investigation records

If a deceased person comes to the hospital, the doctor who treated the deceased person will fill in the investigation record.

1. The deceased’s medical history, symptoms and signs: summary of medical records and information provided by family members; content should include:

(1) Symptoms and signs of this illness; including rapid onset, slow onset, The duration of the disease, severity of the disease, complications and secondary effects of the primary disease, laboratory test results, evolution of the disease and treatment process, whether there are any sequelae or late effects, etc.

(2) Time of onset;

(3) Diagnostic unit;

(4) Diagnostic basis;

(5) Past history History and related information: including diseases that the deceased suffered from before his death and various factors that may affect health, such as growth and development history, family history, genetic history, occupational history, contact history, etc. As well as the deceased’s daily diet, living habits, tobacco and alcohol habits, etc.

2. Name of the person under investigation: refers to the signature of the subject under investigation for the cause of death;

3. Relationship with the deceased: refers to the relationship between the person under investigation and the deceased, such as direct collateral Relatives, neighbors, colleagues, etc.;

4. Contact address or work unit: refers to the specific address of the person under investigation and the telephone number of the work unit:

5. Telephone number: refers to Contact phone number of the person under investigation;

6. Inference of cause of death: It should be a clear diagnosis name of the disease, and should not be filled in with symptoms, signs, or the situation of death at the hospital.

7. Investigator’s signature: signed by the physician who fills in the investigation record and assumes legal responsibility.

8. Investigation date: the time of investigation of death cases.

8. Coding of medical certificate of death

1. ICD code of underlying cause of death: refers to ICD?10, using 4-digit coding;

2. Statistical classification number: refers to the classification number of the annual report on causes of illness, injury and death of residents (such as the 8th form of the health system)

9. Collection of cause of death registration information

1. Reporting objects

All deaths that occur in the hospital are subject to cause-of-death registration reports, including registered and non-registered Chinese residents who died in the hospital, as well as compatriots from Hong Kong, Macao, and Taiwan, and foreign citizens.

2. Reporting unit and reporter

(1) Reporting unit: Each clinical department is the responsible unit for reporting cause of death information.

(2) Reporter:

1) All clinical medical staff are the reporters of death information.

2) Only medical and health personnel with practicing physician qualifications can fill in the "Medical Certificate of Death".

3. Filling in death cases

All deaths that occur in the hospital (including death when arriving at the hospital, death during pre-hospital first aid, and death during in-hospital diagnosis and treatment) will be reported. The diagnosis should be made by the treating doctor and the "Medical Certificate of Death" should be carefully filled out item by item. For those with unexplained pneumonia or unknown cause of death, the symptoms, signs, main auxiliary examination results and diagnosis and treatment process of the deceased must be recorded in the investigation record column on the "Medical Death Certificate".

10. Data preservation and management

1. The hospital disease prevention and control institution should properly preserve the original data of the cause of death registration information, and the completed "Medical Certificate of Death" shall be processed by the disease prevention and control institution. Archive management requires long-term preservation.

2. Hospital disease prevention and control institutions should regularly download case data and store the original database reported by the unit’s network, and adopt effective methods for long-term backup of data.

3. Relevant units shall manage and use death statistics or analysis information in accordance with relevant laws, regulations and relevant provisions of national and provincial health administrative departments, and shall not publish them without authorization.

4. If death information needs to be used, the applicant should be approved according to the relevant administrative approval procedures. The application should clearly specify the purpose, scope, time period and category of the information.

11. Online reporting

1. Method of reporting cause of death information

The "Medical Certificate of Death" and supplementary card are passed through the "China Disease Prevention and Control Information System" platform The National Cause of Death Registration and Reporting Information System is available for direct online reporting.

2. Reporting procedures and time limit

After our hospital receives the "Medical Certificate of Death" filled out by the doctor, the online report should be completed within 5 working days.