Funeral Director’s Handbook On Death Registration And .
NATIONAL CENTER FOR HEALTH STATISTICSNational Vital Statistics SystemFuneral Director’s Handbook:Death Registration andFetal Death Reporting2019 RevisionU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION
Copyright informationAll material appearing in this report is in the public domain andmay be reproduced or copied without permission; citation as tosource, however, is appreciated.Suggested citationCurtin SC, Tolson G, Arias E, Anderson RN. Funeral director’shandbook: Death registration and fetal death reporting.Hyattsville, MD: National Center for Health Statistics. 2019.
Funeral Director’s Handbook:Death Registration andFetal Death Reporting2019 RevisionU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and PreventionNational Center for Health StatisticsHyattsville, MarylandMarch 2019DHHS Publication No. (PHS) 2019–1109
National Center for Health StatisticsJennifer H. Madans, Ph.D., Acting DirectorAmy M. Branum, Ph.D., Acting Associate Director for ScienceDivision of Vital StatisticsSteven Schwartz, Ph.D., DirectorHanyu Ni, Ph.D., M.P.H., Associate Director for Science
ContentsPreface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Importance of death registration and fetal death reporting . . . . . . . . . . . . . . . . . . . . . . . . . . .U.S. standard certificates and report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Confidentiality of vital records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Funeral director’s responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Procedures for handling certificates of death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Certification by physician . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Certification by medical examiner or coroner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Procedures for handling reports of fetal death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Information about disposition of body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Authorization for final disposition of body or fetus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Form of authorization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .When authorization is required . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Obtaining and using the authorization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Cremation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Disinterment and reinterment of body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Amending certificates and reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Part I. General Instructions for Completing Certificates and Reports . . . . . . . . . . . . . . . . .Part II. Completing Certificate of Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Electronic death registration systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Culture and language sensitivity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Items to be completed or verified by funeral director (1–23) . . . . . . . . . . . . . . . . . . . . . . . .Items to be completed by medical certifier (24–49) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Item to be completed by registrar (50) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Additional items to be completed or verified by funeral director (51–55) . . . . . . . . . .Part III. Completing Report of Fetal Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Items pertaining to fetus (1–4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Items pertaining to place of delivery (5–9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Items pertaining to mother (10 and 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Items pertaining to father (12a–c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Item pertaining to disposition of fetus (13) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Item to be completed by registrar (17) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Item pertaining to education of mother (19) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Item pertaining to Hispanic origin of mother (20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Item pertaining to race of mother (21) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Item pertaining to marital status of mother (22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Items pertaining to medical and health information (14–16, 18, and 23–40) . . . . . . 04041424344iii
Contents—Con.Appendix I. U.S. Standard Certificate of Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Appendix II. U.S. Standard Report of Fetal Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Appendix III. Decedent’s Formal Education Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Appendix IV. Race and Hispanic-origin Selection Cards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Appendix V. Definitions of Live Birth and Fetal Death . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Appendix VI. U.S. Vital Statistics Registration System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .iv464850515253
PrefaceThis handbook contains instructions for funeral directors on completing and filingrecords of death and fetal death. These instructions apply to the 2003 revisions of theU.S. Standard Certificate of Death and the U.S. Standard Report of Fetal Death, and the1992 revision of the Model State Vital Statistics Act and Regulations. This handbook isintended as a model that can be adapted by any vital statistics registration area.Note that funeral service licensees are known by several titles in the United States,including funeral director, undertaker, mortician, embalmer, mortuary science licensee,and mortuary science practitioner. For this handbook, the term “funeral director” includesall of these titles as they relate to persons who are responsible for the disposition of abody or fetus and for completing and filing death certificates and, in some states, fetaldeath reports.Other handbooks are available as references on preparing and registering death records: Physician’s Handbook on Medical Certification of Death Medical Examiner’s and Coroner’s Handbook on Death Registration and Fetal DeathReportingKeywords: death certificate guidelinesv
AcknowledgmentsThis publication was originally prepared by staff of the Division of Vital Statistics,led by George Tolson of the Registration Methods Staff (RMS). Donna L. Hoyert,Ph.D., of the Mortality Statistics Branch (MSB) also contributed to this effort. Julia L.Kowaleski, formerly of RMS, reviewed and commented on the contents, and CharlesJ. Rothwell, former Director of the Division of Vital Statistics, provided input andreview. This handbook updates the previous version (2003 revision). Information onelectronic death registration has been added to this version, along with instructions forobtaining death certificate information in a culturally and linguistically sensitive manner.Sally C. Curtin, M.A., of MSB led the revision effort with contributions from GeorgeTolson of RMS; Elizabeth Arias, Ph.D., of MSB; and Robert N. Anderson, Ph.D., MSBbranch chief. This handbook was edited and produced by NCHS Office of InformationServices, Information Design and Publishing Staff: Jane Sudol edited the publication, andtypesetting was done by Simon McCann.vi
IntroductionThis handbook is designed to acquaint funeral directors with the vital registration systemin the United States and to provide instructions for completing and filing records of deathand fetal death. The responsibilities of the funeral director are detailed on managingthese certificates and reports and obtaining proper authorization for final disposition ofthe body. Background information is included on the importance of these documentsfor legal and statistical purposes, as well as specific instructions for obtaining necessaryinformation.The funeral director is responsible for filing an accurate and complete death certificatewith the proper registration official, although state laws vary in specific requirements.The current death certificate (Appendix I) contains personal information about thedecedent, medical certification, the signature of the physician or the medical examiner orcoroner, and information on disposal of the remains. The fetal death report (Appendix II)contains information about the fetus and parents, the cause of fetal death, and othermedical and health information relating to the pregnancy and delivery. Appendixes III–VI provide selection cards on certain death certificate items, definitions, and NationalVital Statistics System information.Importance of death registration and fetaldeath reportingThe death certificate is a permanent legal record of the fact of death of a person. As apermanent legal record, the certificate is extremely important to the decedent’s family. Itis also needed for a variety of medical and health-related research efforts.The death certificate provides important information about the decedent (e.g., age, sex,race and ethnicity, education, date of death, names of parents, and, if married, name ofspouse), the circumstances and cause of death, and final disposition. This information isused in the application for insurance benefits, settlement of pension claims, and transferof title of real and personal property. The certificate is considered prima facie evidenceof the fact of death and can be introduced in court as evidence when a question about thedeath arises. An accurate death record is the responsibility of the funeral director, both asa service to the decedent’s family and as the cornerstone of the nation’s death registrationsystem.Statistical data from death certificates are used to identify public health problems andmeasure the results of programs established to alleviate these problems. These dataare a necessary foundation on which to base effective public health programs. Healthdepartments could not perform their duties without such data.Mortality statistics are of considerable value to physicians and medical science becausethey can be used to identify disease etiologies and evaluate diagnostic techniques.1
Demographers use mortality statistics in combination with natality statistics to estimateand project population sizes, which are important in forecasting and program planning.Statistical data derived from death certificates can only be as accurate as the informationprovided on the certificate. All persons concerned with the registration of deaths muststrive for: Accuracy Promptness in reporting CompletenessFurthermore, detailed information is of greater use than more general information.The fetal death report is recommended as a legally required statistical report designedprimarily to collect information for statistical and research purposes. In most states,these reports are not maintained in the official files of the state health department, andcertified copies of these reports are rarely issued. However, in a number of states, thefetal death record is a legal certificate. The record, whether a certificate or a report,provides valuable health and research data. The information is used to study the causes ofpoor pregnancy outcomes, and to examine the consequences of possible environmentaland occupational exposures of the parents on the fetus. These data are also essential inplanning and evaluating prenatal care services and obstetrical programs.U.S. standard certificates and reportThe registration of deaths and fetal deaths is a state function supported by each state’slaws and regulations. The original records are filed in the states and stored in accordancewith state practice. Each state has a contract with the National Center for Health Statistics(NCHS) that allows the federal government to use information from the state records toproduce national vital statistics. This national data program is called the National VitalStatistics System (NVSS).To ensure consistency in NVSS, NCHS provides leadership and coordination in thedevelopment of standard certificates and reports that the states then use as models. Thesecertificates and reports are revised periodically to ensure that the data collected relate tocurrent and anticipated needs. In the revision process, stakeholders review and evaluateeach item on the standard certificate for its registration, legal, genealogical, statistical,medical, and research value. Each item is evaluated thoroughly, with emphasis onanswering the following questions: Is the item needed for legal, research, statistical, or public health programs? Is the item collectible with reasonable completeness and accuracy? Is the vital statistics system the best source for this information?2
Associations on the stakeholder panel that recommended the current U.S. StandardCertificate of Death included the National Funeral Directors Association, AmericanMedical Association, National Association of Medical Examiners, College of AmericanPathologists, and American Hospital Association. For the U.S. Standard Report ofFetal Death, the stakeholder panel associations included the National Funeral DirectorsAssociation, American Academy of Pediatrics, American College of Obstetricians andGynecologists, Association of State and Territorial Health Officials (Maternal and ChildHealth), American Medical Association, and American College of Nurse-Midwives.Most state certificates conform closely in content and arrangement to the standard. Minormodifications are sometimes necessary to comply with state laws or regulations or tomeet specific information needs. Having similar forms promotes uniformity of data andcomparable national statistics. It also allows the comparison of individual state data withnational data and data from other states. Uniformity of death certificates among the statesalso increases their acceptability as legal records.Although the death certificates in use in this country differ somewhat from state to state,they all contain: Information about the decedent and his or her family. Information about the disposition of the body. Certification by the physician, medical examiner or coroner, or other person legallyauthorized to certify the death. Information about the cause of death.See Appendix I for a copy of the U.S. Standard Certificate of Death.Although the fetal death reports in use in this country differ somewhat from state to state,they all contain: Information about the mother and father. Information about the disposition of the body. Name and title of person completing the report. Information about the cause of death.See Appendix II for a copy of the U.S. Standard Report of Fetal Death.Confidentiality of vital recordsTo encourage appropriate access to vital records, NCHS promotes the developmentof model vital statistics laws concerning confidentiality. State laws and supportingregulations define which persons have authorized access to vital records. Some stateshave few restrictions on access to death certificates. However, the majority of statesrestrict access to death certificates. Legal safeguards on the confidentiality of vitalrecords have been strengthened over time in some states. After death records are received3
by NCHS, confidentiality is protected by two laws: the Privacy Act (5 U.S.C. 552a), aswell as Section 308(d) of the Public Health Service Act (42 U.S.C. 242m).Funeral director’s responsibilityFuneral directors are responsible for ensuring the completion of the death certificate.Procedures for handling certificates of deathIn general, funeral directors’ duties are to: Complete, or have completed, all items on the death certificate. Obtain the cause-of-death information and certification statement from the attendingphysician or the medical examiner or coroner. Secure the signature of the person pronouncing death on the certificate, and review thecertificate for completeness and accuracy. File the certificate with the proper state or local official within the time limit specifiedby the vital statistics laws of the state. Notify the medical examiner or coroner of any death that is believed to have been dueto an accident, suicide, or homicide, or to have occurred without medical attendance,unless the pronouncing or certifying physician or the police have already done so. Obtain and use all necessary permits and other forms associated with the deathregistration system. Cooperate with state or local registrars concerning queries on certificate entries. Cooperate with pathologists in cases involving postmortem examinations. Be thoroughly familiar with all laws, rules, and regulations governing the vitalstatistics system. Call on the local or state office of vital statistics for advice and assistance whennecessary. Where the place of death is unknown, complete and file the certificate of death inaccordance with the laws of the state in which the body was found.4
Certification by physicianThe procedure for obtaining the information and completing the death certificate variesin different locations. This may be regulated in part by state law and in part by localpractice. The funeral director must be aware of the laws of the state or jurisdiction inwhich he or she operates.If the death occurred in a hospital or other institution, the institution may assist thefuneral director in obtaining the information needed to complete the death certificate.In some cases, the funeral director will be provided a death certificate with all or part ofthe personal information about the decedent and the cause-of-death section completed.The funeral director is responsible for verifying the personal information with the family,obtaining and entering any information that has not been completed, and filing thecertificate within the statutory time limit. If the hospital or institution does not provide apartially completed certificate, the funeral director must initiate the process and obtain allrequired information.In
1992 revision of the Model State Vital Statistics Act and Regulations. This handbook is intended as a model that can be adapted by any vital statistics registration area. Note that funeral service licensees are known by several titles in the United States, including funeral director, undertaker, mortician, embalmer, mortuary science licensee,File Size: 1MB
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