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Vital Statistics Summary of a Workshop (2009) / Chapter Skim
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Appendix D: 2003 Revisions, Standard Certificates of Death and Live Birth
Pages 117-124

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From page 117...
... –D– 2003 Revisions, Standard Certificates of Death and Live Birth This appendix reproduces the standard certificates of death and of live birth as of the 2003 round of revisions. Electronic files of the form of the certificates and additional details and instructions are available at http://www.cdc.gov/nchs/vital_certs_rev.htm.
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From page 118...
... White 8th grade or less Black or African American American Indian or Alaska Native 9th - 12th grade; no diploma (Name of the enrolled or principal tribe) _______________ No, not Spanish/Hispanic/Latino Asian Indian High school graduate or GED completed Chinese FUNERAL DIRECTOR Yes, Mexican, Mexican American, Chicano Filipino To Be Completed By: Some college credit, but no degree Japanese Korean Associate degree (e.g., AA, AS)
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From page 119...
... CHANGES TO CAUSE OF DEATH Should additional medical information or autopsy findings become available that would change the cause of death originally reported, the original death certificate should be amended by the certifying physician by immediately reporting the revised cause of death to the State Vital Records Office. ITEMS 33-34 - AUTOPSY •33 - Enter "Yes" if either a partial or full autopsy was performed.
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From page 120...
... If the infant is under 1 year of age, no cause of death is determined after scene investigation, clinical history is reviewed, and a complete autopsy is performed, then the death can be reported as Sudden Infant Death Syndrome. When processes such as the following are reported, additional information about the etiology should be reported: Abscess Carcinomatosis Disseminated intra vascular Hyponatremia Pulmonary arrest Abdominal hemorrhage Cardiac arrest coagulopathy Hypotension Pulmonary edema Adhesions Cardiac dysrhythmia Dysrhythmia Immunosuppression Pulmonary embolism Adult respiratory distress syndrome Cardiomyopathy End-stage liver disease Increased intra cranial pressure Pulmonary insufficiency Acute myocardial infarction Cardiopulmonary arrest End-stage renal disease Intra cranial hemorrhage Renal failure Altered mental status Cellulitis Epidural hematoma Malnutrition Respiratory arrest Anemia Cerebral edema Exsanguination Metabolic encephalopathy Seizures Anoxia Cerebrovascular accident Failure to thrive Multi-organ failure Sepsis Anoxic encephalopathy Cerebellar tonsillar herniation Fracture Multi-system organ failure Septic shock Arrhythmia Chronic bedridden state Gangrene Myocardial infarction Shock Ascites Cirrhosis Gastrointestinal hemorrhage Necrotizing soft-tissue infection Starvation Aspiration Coagulopathy Heart failure Old age Subdural hematoma Atrial fibrillation Compression fracture Hemothorax Open (or closed)
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From page 121...
... For Asians check Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, or specify other Asian group; for Pacific Islanders check Guamanian or Chamorro, Samoan, or specify other Pacific Island group. If the decedent was of mixed race, enter each race (e.g., Samoan Chinese-Filipino or White, American Indian)
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From page 122...
... White No, not Spanish/Hispanic/Latino Black or African American _________________________ 8th grade or less American Indian or Alaska Native Yes, Mexican, Mexican American, Chicano (Name of the enrolled or principal tribe) ________________ 9th - 12th grade, no diploma Asian Indian Mother's Medical Record Yes, Puerto Rican High school graduate or GED Chinese completed Yes, Cuban Filipino Some college credit but no degree Yes, other Spanish/Hispanic/Latino Japanese ________________ Korean Associate degree (e.g., AA, AS)
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From page 123...
... Anencephaly Assisted ventilation required immediately Meningomyelocele/Spina bifida ______________________ following delivery Cyanotic congenital heart disease 9 grams 9 lb/oz Congenital diaphragmatic hernia Assisted ventilation required for more than Omphalocele 50. OBSTETRIC ESTIMATE OF GESTATION: six hours Gastroschisis NICU admission Limb reduction defect (excluding congenital _________________ (completed weeks)
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Key Terms

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  • american indian
  • zip code
  • underlying cause
  • alaska native

  • legal name
  • injury occurred
  • asian indian
  • cardiac arrest
  • standard certificate

  • live birth
  • job premises
  • name prior
  • heart failure
  • medical examiner

  • mexican american
  • medical record
  • premises injury
  • respiratory arrest
  • renal failure

  • prenatal care
  • usual occupation
  • certified copy
  • manner stated
  • autopsy findings

  • school graduate
  • college credit
  • infant death
  • medical certifier
  • accident pending


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