Medical Certification of Cause of Death Delayed Registration

Dr. Christie Luz Rosal May 25, 2022 ● Affidavit for delayed registration
● Authenticated copy of the certificate
Learning Objectives of burial, cremation, or other means
1. Discuss the overview of Medical of corpse disposal
Certification of Cause of Death ● Approval for registration by the
2. Discuss the Guidelines for reporting health officer
causes of death in specific
conditions Uses of Certificate of Death
3. Discuss the Civil Registration and 1. Prima facie evidence of death
Vital Statistics (CVRS) 2. Claims benefits, pensions,
insurance, or tax exemption
Overview of MCCOD 3. Evidence for settlement of the estate
Who certifies the certificate of death? 4. Remarriage purpose of surviving
- If there is a medical attendant at spouse
death, the certifying officer is the 5. Designation of a guardian or foster
parent for minor
attendant at death.
6. Determine health priorities for the
- If there is no medical attendant at
prevention of deaths due to similar
death, the certifying officer is the causes in the future
local health officer. 7. Awareness of the family members
- If there is no medical attendant at
Uses of the Death Certificate
death and the local health officer is
1. Provide indicators of existing
not available, the Mayor, any
infectious diseases and epidemics
member of the Sangguniang Bayan, that need immediate control
or the municipal secretary may issue measures
a certificate of death for burial 2. Basis of designing programs to
promote public safety and strategies
purposes only.
for disease prevention and
- In medico-legal cases, the certifying
eradication
officer is the medico-legal officer. 3. Serve administrative reasons
4. For the control of infectious diseases
Who reviews the cause of death? 5. Basis for design of programs in
- In all cases, the medical certificate of public safety, accident, prevention,
death shall be reviewed and signed and crime eradication
by the local health officer 6. Mortality surveillance health, and
(municipality/city) epidemiologic research, health
planning
When can registration of death be denied? 7. Printing and issuance of certified
- the local civil registrar cannot deny copies of encoded civil registry
registration EXCEPT for documents
insufficiency of information

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Guidelines for Reporting Causes of death in Early Decedent
Specific Condition - Senility
1. Death involving women of - Old age
child-bearing age - Senescence
2. Elderly decedent - Advanced age
3. Infant death ○ Entry for the age of the
4. Death involving external injuries deceased is already
5. Death from Infectious diss recorded somewhere else
6. Death from neoplasms ○ The cause-of-death entry
7. Fetal Death must have a specific, clear,
8. Periprocedural Death and distinct etiological
sequence
Death Involving women of child-bearing
age - Sample Case
- A maternal death refers to a “death A 95-year-old man was found dead
of women while pregnant or within on the bed by his wife. H had
42 days of termination of pregnancy, chronic mild hypertension controlled
irrespective of the duration and the by medication. His previous chest
site of pregnancy, from any cause x-ray shows mild cardiomegaly,
related to or aggravated by the consistent with chronic hypertension.
pregnancy or its management, but There was no suspicious or
not from accidental or incidental evidence of foul play. No specific
causes cause of death could be identified

- Sample case:
A 36-year-old G5P3A1 woman who
delivered a full-term baby boy at
home was brought to the Emergency
Room because of placental
retention. The woman apparently
had severe bleeding and was
hypotensive on her arrival at ER.
She was transfused whole blood and
manual extraction of the placenta
was performed. However, the
woman died four hours after
delivery.

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Infant Death
- The single most important or main
disease/condition in the infant is
entered in line (a) and the
remainder, if any, in line (b).
- The mode of dying (asphyxia, heart
failure, anoxia, including prematurity,
is not entered in line (a) unless it is
the only known condition.
- Sample
A 38-year-old G3P0A2 was admitted
to a birthing facility while 24 weeks
pregnant. She has been having
premature labor for six hours. She
subsequently delivered 700g infant
who was treated t the intensive
neonatal care unit but subsequently
died after 24 hours. Chest x-ray of
the infant shows dense lung fields
consistent with severe hyaline
membrane disease
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Death involving external injuries
- report the external cause or events
as the underlying cause
- Identify the bodily trauma caused by
the external event and report it as an
antecedent cause
- Report the fatal derangement
resulting from the bodily trauma as
the immediate cause
Death from Infectious disease
- For deaths due to infections, the
certifier has to report the:
- Manifestation or body site
(e.g. pneumonia,
pyelonephritis, meningitis,
hepatitis)
- Causative agent, if known;
write “cause unknown” if
unknown
- Source and route of infection
(e.g. food poisoning,
contaminated blood product,
health-care-associated
infection), if known
- Any underlying disease that
may have suppressed the
patient’s immunity that made
him susceptible to the
infection that led to his death
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Death from neoplasms
The certifier must always indicate
on the Certificate of Death the following:
● Site of Neoplasm, including
primary site (whether known
or unknown)
● Laterality, if applicable
● The behavior of the tumor
(whether benign or
malignant)
● Nature or histological type, if
known
Fetal Death
- fetal death is a death prior to the
complete expulsion of a product of
conception, irrespective of the period
of pregnancy
- The death is indicated by the fact
that after such separation, the fetus
does not breathe nor show any other
evidence of life, such as the beating
of the heart, pulsation of the
umbilical cord, or definitive
movement of voluntary muscles
- Sample
A 38-year-old G3P2 was admitted at
a birthing facility while 34 weeks
pregnant. After six hours of
premature labor, she delivered a
stillborn baby boy with the cord
around his neck. The fetus is
cyanotic with no gross fetal
movement or heartbeat.
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Periprocedural Death
- periprocedural death refers to death
that is known or suspected as
having resulted in whole or in part
from diagnostics, therapeutic, or
anesthetic procedures
- Misadventure
- Iatrogenic
- Errors and accidents in
medical care
- Maybe categorized into the
following:
- Peridiagnostic ( related to a
diagnostic agent, procedure
or device)
- Perianesthetic ( related to
an anesthetic agent,
procedure or device)
- Peritherapeutic (related to a
therapeutic agent, procedure
or device)
- Perioperative (related to a
surgical procedure or device)
- Intraoperative
- Postoperative
- Natural Periprocedural Death
- A periprocedural death is
considered natural if death
was imminent and that it
would have occurred anyway
even if the procedure was
not done to the patient
- Accidental Periprocedural Death
- A periprocedural death is
considered accidental, on the
other hand, if death would
not have occurred in the
procedure’s absence
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Civil Registration System
- the entire administration which
includes all institutional, legal,
technical settings needed to perform
the civil registration functions in a
technical, sound, coordinated and
standardized manner throughout the
country, taking into account cultural
and social circumstances particular
to the country
Registration Function Includes
1. recording vital events
2. Storing
3. Safekeeping and retrieval of
vital records
4. Protection of confidentiality
certificate issuing and other
customer services
5. Recording and reporting
information on vital events for
statistical purposes
6. Providing liable and timely
information and data to other
government agencies;
population registers; pension
fund systems, electoral
service; personal
identification services; and
research institutions
- continuous permanent, compulsory
and universal recording of the
occurrence and characteristics of
vital events pertaining to the
population as required
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Civil Registration and Vital Statistics (CRVS)
Civil Registry Law - Act No. 3753
- Civil registration in the Philippines
was made compulsory with the
enactment of the Civil Registry Law
(Act No. 3753) approved on
November 26, 1930, and took effect
on February 27, 1931.
- This act mandates the registration of
all facts and acts concerning the civil
status of persons from birth to death,
including the changes in civil status
taking place therein in appropriate
civil registry books.
- Civil registration is defined as the
continuous, permanent, compulsory,
and universal recording of the
occurrence and characteristics of
vital events pertaining to the
population." This is carried out
primarily for the purpose of
establishing legal documents.
The Philippine Statistical Act - Republic
Act No. 10625
- Article 6 (e) of RA 10625 mandates
the Philippine Statistics Authority
(PSA) to carry out, enforce, and
administer civil registration functions
in the country as provided for in Act
No. 3753, the Law on Registry of
Civil Status.
Code on Sanitation of the Philipines -
Presidential Decree No. 856
- Based on Presidential Decree No.
856, approved on December 23,
1975, the burial or cremation of
remains is subject to the following
requirements: a) No remains shall
be buried without a Certificate of
by khayla
 Death, which shall be issued by the
attending physician. If there has
been no physician in attendance, it
shall be issued by the mayor or the
secretary of the municipality where
the death occurred. The death
certificate shall be forwarded to the
local civil registrar within 48 hours
after death (Sec. 91).
- Local Government Code - Republic
Act No. 7160
- Civil registration is a function
of the local government
through the city/ municipal
registrar but is under the
technical supervision of the
Civil Registrar General
(CRG).
- Republic Act 3753, Section 6,
Circular No. 4, Series of 1973, April
6, 1973 states that "In all cases of
death or fetal death even with
medical attendance, the death or
fetal death certificate must be
reviewed and signed in any vacant
space below the certificate by the
local health officer before it shall be
accepted for registration.
Data Quality
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Health Information System
- PhilCRIS is an information system
that would address the needs at the
local civil registrars, hospitals,
churches, attendants, at births and
deaths, solemnizing officers, and
those who are involved in the
preparation and recording of vital
events
- Features of PhilCRIS
- Enables encoding of relevant
information from civil registry
documents
- Storage of vital data
- Query and retrieval of
encoded records
- Maintenance of the local civil
registry database
- Benefits of integrating DOH
Information Systems and PhilCRIS
- Faster generation of reports
and efficient registration of
births and deaths
- Improved quality data in
terms of accuracy, validity,
completeness, and
timeliness
- Improved national, regional,
provincial, and municipality /
city-wide consolidation of
data
- Better control and flow of
information
- Faster and more efficient
processing of documents,
particularly birth and death
certificates
- The best way to obtain high-quality
mortality statistics is to have deaths
certified by a qualified medical
doctor. Death certification by doctors
is the gold standard for procuring
cause of death data
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 References:
1. Medical Certification of Death:
Handbook for Filipino Physicians,
Department of Health, 2nd edition.
2. Alinea, MC.,Abellera, JM, Tupas,
ML.,400 Ways to Die: Medical
Certification of Cause of Death
(Workbook for Filipino Physicians),
2021.
3. Civil Registration and Vital Statistics
Handbook for Health Workers,
Philippine Statistics Authority, 2nd
edition.
4. Civil Registration and Vital Statistics
Technical Guide: Assessing the
ICD-10
Quality of Death Certificate:
International Statistical Classification of
Guidance for the Rapid Tool,
Diseases and Related Health Problems
University of Melbourne, Bloomberg
Revision 10
Philanthropies Data for Health
Initiative, 2020.
History:
5. Philippine ICD-10 Modifications
- The international list of causes of
Second Edition May 2014
death was adopted by the
International Statistical Institute in
1893.
- WHO was entrusted with the ICD at
its creation in 1948 and published
the 6th version, ICD-6, that
incorporated morbidity for the first
time
- The WHO Nomenclature
Regulations, adopted in 1967,
stipulated that Member States use
the most current ICD revision for
mortality and morbidity statistics
- ICD-10 was endorsed in May 1909
by the Forty-third World Health
Assembly.
- Philippines ICD-10 Modifications
- Not intended to replace but
to complement WHO ICD-10

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