Accidental death certificate:
proof of death
Name: * * Citizen ID number: * * died on * * * * * on * * * * *, this is to certify!
* * police station * * * year * * month * * day.
Accidental death certificate:
proof of death
This community, * * * Village, with a name of * * and an ID card of * * * * *, died in * * * * on * * * * in * * *.
Hereby certify that
Nanhu community
Xx year x month x day
Accidental death certificate Fan Wensan:
This is to certify that the resident of the former jurisdiction * * * *, gender * * * *, address * * *, ID number * * * * *, died on * * * * * of * * *.
Hereby certify that
Organizer:
Police station (seal)
time
?
1. system for receiving and issuing medical certificates of death
First, the medical department is responsible for the collection and distribution of the medical certificate of death of residents, and the medical department has designated personnel to be responsible for this work. The collection work is managed by the service desk. The report is completed by the Information Section.
Two, the medical department to establish a "death certificate" recipients, issuing registration records.
Three, clinical departments designated by the director of our hospital personnel recipients, recipients of the number, number, time, recipients of the project registration.
Four, the clinical departments of recipients of the medical certificate of death for special management, shall not be lost.
2. Use the death medical certificate registration system.
I. Deaths in our hospital (including in-hospital deaths and pre-hospital emergency deaths) are issued by the Ministry of Health and the Ministry of Public Security.
Two, the clinical departments to establish a "death certificate" registration records.
Three, the contents of the record include name, gender, age, diagnosis of the cause of death, time of death, and the number of the medical certificate of death.
Four, the medical department and clinical departments to check, review and assessment of registration records.
3 death certificate audit system and death case self-examination and reward and punishment system.
First, the issuance, reporting and statistics of death certificates in our hospital, under the leadership of the leading group for cause of death management, implement the responsibility system of the hospital.
Second, the functional responsibility department is responsible for the issuance, reporting and statistical inspection and supervision of the death certificate of the whole hospital, checking it once a month and conducting regular spot checks, and urging it to correct when problems are found; The director of clinical discipline himself or a designated person is responsible for the inspection and supervision of the issuance, declaration, reporting and registration of undergraduate death certificates; Information management network direct reporting personnel are responsible for network direct reporting and statistics, and regularly contact the Center for Disease Control (epidemic prevention station).
Three, reward individuals or collectives who have made remarkable achievements in the declaration of medical certificates of death.
Four, where one of the following acts, the hospital and the city and county health bureau should be ordered to correct, to be informed criticism; If the circumstances are serious, the directly responsible person in charge or other directly responsible personnel may be given administrative sanctions according to law:
1, falsely reporting, concealing, forging or tampering with the medical certificate of death;
2, there are death cases refused to fill in or delay the death certificate for many times;
Five, in violation of the "Statistics Law" constitutes a crime, criminal responsibility shall be investigated by judicial organs according to law.
4. Basic requirements for filling in death certificates
1, according to the basic format and filling requirements of the national unified death certificate, carefully fill in item by item, without missing or wrong items.
2, the application of black or blue-black pen writing, clear handwriting, shall not be written with a ballpoint pen, red pen or pencil.
3, the cause of death fill in the name of the disease in applied medicine, and written in Chinese, not in English or English abbreviations.
4, the positive content of the death certificate shall not be altered, there must be a doctor's signature and official seal of the hospital.
5. If the cause of death is unknown, the death certificate must fill in the investigation records at that time, including the name of the deceased's previous diseases, onset time, diagnosis unit, diagnosis basis, a series of related chronic diseases, etc.
6. If there is any doubt about the cause of death (homicide or suicide), you can report it to the police department, which will assist in determining the cause of death. Anyone who reports accidental injury or poisoning death shall further report the external cause of the accident on the death certificate.
5. Fill in the requirements of basic projects
1. Medical certificate number: it shall be uniformly numbered by the public security and health departments.
2. domicile of the deceased: rural township street. Current address: Fill in the street number, lane number or building unit number in the city, and fill in the villagers' group or natural village in the administrative village in the countryside.
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; You can write down your mother's name if you haven't named it yet, press? Son of so-and-so or? Record the investigation of the daughter of someone;
4. Gender: male or female.
5. Nationality: Han nationality, Hui nationality, Zhuang nationality, Uygur nationality, Tibetan nationality, Bai nationality, etc.
6. Main occupation and type of work: fill in the occupation with the longest working hours, and try to fill in the occupation and specific work. Fill in unqualified information, such as: workers, cadres, operators or retired.
7. ID number: fill in 15 digit ID number or 18 digit ID number, and pay attention to the date of birth.
8. Marital status: According to the legal marital status, it can be divided into five situations: unmarried, married (including remarriage, remarriage and separation), widowed, divorced and unknown.
9. Education level: Fill in according to the highest education level of the deceased. Illiteracy refers to illiteracy, and semi-illiteracy refers to a little literacy. Middle schools include technical secondary schools and universities include junior colleges.
10. Work unit before one's death: refers to the unit that worked before one's death or worked for the last time before one's death, and worked for a long time.
1 1. Date of birth and date of death: fill in according to the Gregorian calendar year, month and day.
12, full-time age: calculated as one year old. If there is no birthday in that year: year of death-year of birth-1; Birthday: year of death-year of birth. For infants under the age of l, fill in the full moon age; For newborns within 28 days, fill in the number of days of survival; /kloc-for newborns under 0/day, fill in the survival hours.
13, place of death: fill in five cases on the death certificate; The place of death after coming to the hospital should be at home, on the way to the hospital.
14. Name of family members to contact: refers to the immediate family members or relatives and friends who know the illness or other conditions of the deceased best.
15. Address or telephone number or work unit: refers to the permanent address, telephone number and work unit of the contact person.
6. Fill in the requirements of special projects
1. Cause of death: fill in the disease, injury or complication leading to death.
The first part: It is the main content of the medical certificate of death, and it is necessary to fill in the diseases leading to death and the earlier reasons.
① Fill in the order of death, (a) caused by (b), (b) caused by (c), (c) caused by (d);
② Only one disease can be filled in each line; 、
③ At least one disease must be filled in line (a);
④ Fill in the time interval from onset to death as far as possible, and the time length from (a) to (d) must be from short to long.
⑤ There is no limit to the number of lines to be filled in, and lines (e) and (f) can be added according to the situation. ⑥ Don't just fill in the death mode/situation, such as? Respiratory failure? 、? Circulation failure? 、? General failure? Wait a minute.
The second part is a supplement to the first part, which is used to fill in other meaningful circumstances that promote death, but it has nothing to do with the disease or situation that causes death. According to the specific situation to fill in.
(1) fill in all diseases that promote death, but have nothing to do with the first part of the order of death; (2) Fill in according to the severity, and the number is unlimited.
2. Approximate time interval between onset and death: refers to the time interval (time unit: minutes, hours, days, weeks, months or years) when the onset and death of diseases are reported in Part I.. If the query is not clear, you can leave it blank.
3. The hospital with the highest diagnosis of diseases before death refers to the unit with the highest diagnosis of major diseases reported in the first part. ..
4. The highest diagnostic basis: according to the actual diagnostic basis; If diagnostic grading is implemented, take the highest diagnostic basis and put in special examinations such as B-ultrasound, X-ray and electrocardiogram? Clinical+physical and chemical? A column;
5. Hospitalization number: not filled in for those who are not hospitalized;
6. Doctor's signature: signed by the doctor who fills in the death certificate and bears legal responsibility;
7. Seal of the unit: filled in with the official seal of the unit where the doctor works;
8. Date of declaration: indicate the date of issuance of the certificate; -Generally, it should be on the day or a few days after the death of the deceased. If the interval is too long, the reason should be explained.
7. Requirements for filling in investigation records
If you come to the hospital and die, the doctor who treated the deceased will fill in the investigation record.
1, medical history and symptoms and signs of the deceased: summary of medical records and family information; The contents shall include:
(1) Symptoms and signs of this disease; Including acute onset, duration of the disease, severity of the disease, complications and secondary conditions of the primary disease, laboratory results, evolution and treatment of the disease, and whether there are sequelae or not.
(2) onset time;
(3) a diagnosis unit;
(4) diagnostic basis;
(5) Past medical history and related materials: including diseases suffered by the deceased before his death and various factors that may affect his health, such as growth and development history, family history, genetic history, occupational history, contact history, etc. And the daily life, diet, customs, tobacco and alcohol hobbies of the deceased.
2. Name of the investigated person: refers to the signature of the cause of death of the investigated person;
3. Relationship with the deceased: refers to the relationship between the respondent and the deceased, such as immediate family members or neighbors;
4. Contact address or work unit: refers to the specific address of the respondent and the telephone number of the work unit;
5. Telephone number: refers to the contact telephone number of the respondent;
6. Inference of cause of death: it should be a clear name for disease diagnosis, and should not be filled in as symptoms, signs or death in hospital.
7. Signature of investigator: signed by the doctor who fills in the investigation record and assumes legal responsibility.
8. Date of investigation: the investigation time of death cases.
8. Death medical certificate code
1, the fundamental cause of death of ICD code: refers to ICD? 10, coded with 4 digits;
2. Statistical classification number: refers to the classification number of the annual report on the cause of death of residents due to illness and injury (such as Table 8 of the health system).
9. The cause of death registration information collection
1. Report object
All deaths in hospitals are the targets of death registration reports, including registered and unregistered China residents who died in hospitals, 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 responsible for reporting the cause of death information.
(2) reporter:
1) All clinical medical staff are reporters of death information.
2) Only medical and health personnel with the qualification of practicing doctors can fill in the death medical certificate.
3. Report of death cases
All deaths occurred in the hospital (including death on arrival, death during pre-hospital emergency treatment and death during in-hospital diagnosis and treatment) should be diagnosed by the attending doctor, and the medical certificate of death should be carefully filled out item by item. Patients with unexplained pneumonia or unknown cause of death must record the symptoms, signs, main auxiliary examination results and diagnosis and treatment of the deceased in the investigation record column on the medical certificate of death.
10. Data storage and management
1. The hospital disease prevention and control institutions shall properly keep the original data of the cause of death registration, and the medical certificate of death shall be kept by the disease prevention and control institutions for a long time according to the requirements of file management.
2. Hospital disease prevention and control institutions should regularly download the case data and store the original database of the network report of the unit, and take effective measures to back up the data for a long time.
3. The management and use of death statistics or analysis information shall be implemented by the relevant units in accordance with relevant laws and regulations and the relevant provisions of the national and provincial health administrative departments, and shall not be published without authorization.
4. If death information needs to be used, it shall be examined and approved by the applicant in accordance with the relevant administrative examination and approval procedures, and the application shall specify the purpose, scope, time period and category of the information.
1 1. network report
1. Death cause information reporting method
The death medical certificate and supplementary card are directly reported through the national death registration report information system on the platform of China Disease Prevention and Control Information System.
2. Reporting procedures and time limits
Our hospital should complete the network report within 5 working days after receiving the death medical certificate filled out by the doctor.