Guidelines for writing death certificates

Registration of death certificates on paper - instructions

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The death certificate is divided into two parts. Administrative information is recorded on the front page, while medical information about the cause of death and how the death occurred is entered on the back page. After a medical doctor has completed a death certificate, it shall be folded and glued back, with the administrative side facing outwards but the medical part covered. The certificate may not be opened until it is in the possession of the Directorate of Health. The information on causes of death is coded according to ICD-10, the international statistical classification of diseases and related health problems, in accordance with the guidelines of the World Health Organization and entered in the Causes of Death Register.

The death certificate shall be written by the medical examiner or the person responsible for the examination. If the death has been reported to the police, a death certificate may not be written until the police have decided that there is no reason for a forensic medical examination or autopsy. In the case of a forensic medical examination, a death certificate shall be written by the doctor who participated in the examination. A medical doctor who performs an autopsy shall write a death certificate. A medical doctor called for forensic medical examination shall notify the police if: 1) it can be assumed that death is related to a criminal act, suicide, or death caused by accident, 2) a person has been found dead 3) the death is unexpected, 4) a person dies in prison or another similar place, or 5) death may be attributed to a mistake, neglect or accident during medical treatment.

The death certificate shall be filled out, and all information available when a death certificate is completed shall be entered in the relevant boxes on the certificate. The death certificate shall be in block letters.

Front page registration

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The ID number is registered in full. For persons who do not have an Icelandic ID number, the date and year of birth must be entered. A child who is stillborn after 22 weeks of pregnancy is registered in a special register based on notification from a health institution. The child does not receive an ID number, but a system ID number due to registration in the Birth Register.

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Employment information must be recorded as accurately as possible.

For example, an industrial worker should be written rather than a laborer, a nurse anesthetist rather than a nurse, and so on.
In the case of a pensioner, the job that the deceased held for most of his life should be recorded.
If the deceased was disabled, both the previous job and the disability must be recorded.
Always try to record the job that the person held for the longest time, but if it is unclear then record the last job the deceased had.

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The place of death is the place where death is confirmed. If, for example, a person is transported without signs of life to a hospital and resuscitation is attempted, the place of death is the hospital where resuscitation attempts were made.

The place of death must be specified with street name, house number, postal code, and municipality. In addition, it must be specified what kind of place it is, for example, the home of the deceased, a health institution (which one), a workplace, or another place. For a body that has been found, the place where the body was found must be recorded.

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The first signature field is intended for the doctor who fills in the death certificate. The doctor's name and number must be written in block letters, and the doctor must sign the certificate. The certificate must also be dated. The second and third signature fields are intended for the district commissioner to confirm the receipt of the death certificate and that a funeral authorization has been issued.

On the back of the certificate, medical information shall be recorded for the Causes of Death Register.

Back page registration

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The cause of death should be recorded as accurately as possible. The 10th edition of the ICD classification system should be used, but only text should be written, i.e. the name of the disease or condition, but not the codes. The coding of deaths is done by the Directorate of Health. It is not required that only Icelandic names of diseases are used, Latin or English names may also be entered. The main thing is that the most accurate diagnoses according to ICD-10 are used.

The information must be provided on the sequence of events from the diagnosis of the disease until death. Fields for recording underlying and contributing causes are divided into two parts, I and II. In Part I, the disease(s) or injury(s) that led to death must be recorded. It can be a simple direct cause of death, such as pneumonia, or a series of diagnoses, for example, breast cancer, liver failure, and pneumonia. A: Disease or condition that is considered the direct cause of death (eg pneumonia), B, C: Diseases that led to the direct cause of death (eg liver metastases and fluid in the abdominal cavity). D: Underlying cause of death (eg breast cancer). Conditions such as senile degeneration, vomiting, etc. can be listed in points A, B, C, or D, but then a diagnosis specifying the underlying diseases must be included.

If the doctor completing the certificate cannot specify the cause of death, and no further explanation is expected through additional tests, an unknown cause of death should be recorded. In the part marked II, the contributing causes of death must be recorded, ie. diseases or conditions that contributed to death, without being directly related to the disease process (eg rheumatoid arthritis). The cause of death registration will be better if this part is also filled out. For example, diseases that could have reduced the individual's resistance, eg dementia or kidney failure, could be recorded, which could have accelerated the disease process, although it cannot be demonstrated that they had a direct role in the causal chain that led to death. Accidents or abuse of alcohol or drugs, which may have contributed to death, can also be entered into that field.

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This information is necessary to be able to register the causes of death in accordance with the rules of the World Health Organization. The most accurate information must be obtained about all registered diseases or specific conditions. The period should be recorded as the number of hours (or fractions of hours), days, or years that passed from the diagnosis of the disease to death, or from the accident to death.

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In this field, a distinction is made between natural death, i.e. death due to disease, and death directly caused by external causes. In the latter case, it may be an accident, suicide, or homicide. Circumstances may also be such that a body is not found or the circumstances of death are different from what is assumed here, or not known, and then the appropriate box must be checked. When the field Other is checked, it must be explained in more detail.

If the death is not natural, it must always be reported to the police. Police may order a forensic medical examination or autopsy. Cause of death should be written as Accident when the injury resulting from the accident directly leads to death. In the case of an accident, fill in the fields about the scene of the accident, i.e. where the accident occurred and how it happened. In the field of the nature and circumstances of the accident, it is necessary to state exactly how the accident happened and under what circumstances. In the case of a traffic accident, it must be recorded whether the accident occurred in public traffic or off the road, whether the deceased was driving the car, or whether the deceased was a passenger in the front or back seat. If a person dies as a result of a fall, it must be specified whether the person fell on level ground or from a height (eg from stairs or a bed). In the case of suicide with a firearm, the type of firearm must be mentioned (eg shotgun, rifle), etc.

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The sources used by the doctor to fill out the death certificate shall be mentioned, such as whether the death has been reported to the police, and whether a forensic medical examination or autopsy has been carried out.

If a forensic medical examination has been carried out, the doctor who participated in the examination must write the death certificate. If an autopsy is performed following a forensic medical examination, a forensic autopsy must be performed and not a medical autopsy. The doctor who participated in the autopsy must then write the death certificate. If an autopsy is performed and the results are not available, the Directorate of Health will request information about the results of the autopsy later.

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If samples have been taken from a patient before death and the result is considered to be relevant to the determination of the cause of death, for example, toxicological results, information about the nature of the research must be entered in a specially marked field. The Directorate of Health will look at the results of the research if they have not already been taken into account when determining the cause of death.

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The results of research and autopsies shall be entered into this field and whether, and how, they changed the previously assessed causes of death. This information must be recorded by a pathologist, forensic pathologist, or a doctor commissioned by the Directorate of Health, and not by the doctor who otherwise wrote the death certificate. If the results are subject to change, the doctor concerned confirms them with his signature on the front page.

Service provider

Directorate of Health