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Death Certification

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The Department of Health Bureau of Vital Statistics, in cooperation with the Florida Medical Association and the Florida Association of Medical Examiners, has developed an online tutorial for physicians that provide information about properly completing the death certificate. 

The tutorial provides sample case histories, an explanation of the physicians, the medical examiner’s and the funeral director’s responsibilities in death certification, how mortality data is used and the importance of the death record. 

The Florida Medical Association approves this activity for AMA PRA Category 1 Credit. Visit www.doh.state.fl.us/planning_eval/vital_statistics/ for this free tutorial.  

The two essential elements of the death certificate are the cause of death and the manner of death. The immediate cause is the disease or the injury that causes the death of a person. The proximate cause is the disease or injury that initiates the series of events that eventually leads to death. The two may be the same, but not always. For example, a person may suffer a myocardial infarct due to arteriosclerosis. The immediate cause of death is the infarct, the proximate cause of death is arteriosclerosis, and the manner of death is natural. The initiating event is the most important factor in determining the cause of death.

A concept that is often misunderstood by physicians is the mechanism of death, such as ventricular fibrillation, cardiac arrest, pulmonary arrest, etc. The Office of Vital Statistics requests that these mechanisms of death not be entered as causes of death on the death certificate. The mechanism of death should not be confused with the cause of death.

Florida law states that attending physicians may only sign death certificates when the manner of death is natural. The death certificate shall be completed and signed by the physician in charge of the decedent’s care for the illness or condition that resulted in death, or by the physician in attendance either at the time of death or immediately before or after. The cause of death should be the physician’s best medical opinion and terms such as “possible” or “probable” can be used when the certifier is not comfortable making an exact diagnosis. The cause of death is best explained as a probability and the death certificate does not have to be completed with 100% certitude in all cases.

Physicians who come to Florida from other states often site the "24-hour rule" as the reason for reporting a death to the Medical Examiner. Florida does not have such a rule. A patient who dies less than 24 hours following admission to the hospital is not automatically considered a Medical Examiner's case, unless they meet other criteria outlined in F.S. 406.

A death certificate is a very important document for families, funeral directors, the State's Vital Statistics Office and the medicolegal community and should be easier to complete than the day to day diagnoses that is the responsibility of physicians. However, if the physician has a reasonable doubt about the manner of death or has concerns as to how to properly certify a death, we encourage him/her to contact the Medical Examiner for assistance.