In this article will discuss on how to write a death certificate in Forensic Medicine and Toxicology examination model proforma. Also beneficial for physicians.
Proforma of Death Certificate
Form 4 is the Proforma Death Certificate for death in indoor hospital patients (Admitted in ward). It is not for still birth cases. It is to be sent to death register with form no 2. And Proforma 4A is for using in other cases of death (Outpatient, Private Practictionar etc)
Step 1 of death certificate writing
Write down the full name of the Hospital along with complete adress.
Step 2
Write in form no 4 the ward no (eg- male orthopedic ward) along with date and time of death Proforma.
Step 3
Name the patient. In case infant with not yet named, write down Son /Daughter of Mr X and Mrs Y
Step 4
Write down Sex (Male/Female/Others)
Always write age for over 1 year, in month if below 1 year, in days if below 1 month and in hour if below 1 days in case of new borns.
Step 5
Cause of death
Line A
Immediate cause & antecedent cause.Let’s understand from an example –
Immediate Cause – Pulmonary embolism
Antecedent Cause – Fracture neck of femer
Antecedent Cause – Fall in bathroom
Line B
Other conditions related to morbidity
Eg – Diabetes mellitus & HTN
Point to remember
Don’t write the mode of dying is cardiac failure, respiratory failure like term. This term should not appear in the certificate because these are mode of dying not the cause. Also Old age or senility should also not be given as causes of death.
Step 6
Manner of death
Natural/Accident/Suicide /Homicide/Pending Investigation
Step 7
Pregnancy associated death? Yes/No
Delivery? Yes/No
Step 8
Signature of the issuing doctor.
Signature + Full name in capital letter + Registration Number + Date + Official Seal
The form also has a detachable portion separated below by perforations mark. It should be handed over to relative after filling properly.
