Rules on Medical Certification of Cause of Death (MCCOD)

February 13, 2020

DOH ADMINISTRATIVE ORDER NO. 2020-0008

 

I. RATIONALE

On August 20, 2015, Proclamation No. 1106 was passed, declaring 2015 to 2024 as the Philippines' Civil Registration and Vital Statistics (CRVS) Decade and enjoining all agencies and instrumentalities of the national government and local government units to actively support programs relevant to the "Get every Pinoy and Pinay in the Picture!" initiative. HTcADC

The Philippines committed to achieve the following goals by 2024: (1) at least 90 percent of all deaths are registered; (2) at least 85 percent of all deaths have a medically certified cause of death; (3) the proportion of deaths coded to ill-defined codes will have been reduced by 50%; and (4) at least 85 percent of deaths taking place outside of a health facility and without the attention of a medical practitioner have their most likely underlying cause of death determined through verbal autopsy in line with international standards. This is cognizant to Act No. 3753, otherwise known as Civil Registry Law which upholds the continuous and compulsory recording of vital events, to include deaths. This is further supported by Presidential Decree No. 856, otherwise known as The Code on Sanitation of the Philippines which states that no remains shall be buried without a certificate of death.

The Department of Health (DOH) is also guided by FOURmula One Plus for Health (F1 Plus) that intends to ensure generation and use of evidence in health policy development, decision-making, and program planning and implementation. Mortality statistics, particularly cause of death data, has long been used as basis for health program management and policy development. However, to date, ill-defined and unknown causes of death still ranked 10th in the leading causes of death in the Philippines.

Pursuant to these goals and to effectively accomplish its mandate, the DOH issues this Administrative Order to establish procedures and to define roles and responsibilities for reporting, certification and review of cause of death.

II. OBJECTIVES

A. General Objective

To describe and clarify rules on medical certification of cause of death (MCCOD).

B. Specific Objectives

1. To provide a standard procedure for reporting, certifying, and reviewing the cause of death;

2. To standardize the procedure for referring cases of deaths which warrants medico-legal investigation;

3. To clarify the roles and responsibilities of the different key actors in reporting, certifying, and reviewing cause of death;

4. To establish the use of verbal autopsy in specific cases for cause of death determination; and

5. To monitor compliance and violations of existing CRVS laws and regulations in reporting, certifying, and reviewing the medical certification of cause of death.

III. SCOPE AND COVERAGE

This Order shall apply to the Department of Health, Ministry of Health Bangsamoro Autonomous Region in Muslim Mindanao (MOH-BARMM), all public and private health facilities, local government units, concerned entities, and to all licensed physicians, particularly those identified as certifiers and reviewers under these Rules.

IV. DEFINITION OF TERMS

1. Certificate of Death/Death Certificate — The form used for the declaration of facts and circumstances surrounding the death of a person for purposes of registration, as prescribed by the Philippine Statistics Authority.

2. Certifier — a licensed physician authorized by law to certify the fact of death or fetal death and to certify the circumstances (accident, suicide, homicide, natural causes) and the specific disease, injury, or other cause(s) of death.

3. Death — The permanent disappearance of all evidence of life at any time after live birth has taken place, or the postnatal cessation of vital functions without capability of resuscitation.

4. Medical Certification of Cause of Death (MCCOD) — the completion by a licensed physician of the medical certification of the death certificate.

5. Verbal Autopsy (VA) — a process for determining the most likely cause of death based on the responses of reliable family members and/or person/s who has knowledge of the death to a series of structured questions regarding signs and symptoms experienced by the deceased before his death.

For more definition of terms, refer to ANNEX A.

V. GENERAL GUIDELINES ON CAUSE OF DEATH CERTIFICATION AND REPORTING

A. All certifiers are mandated to indicate in the MCCOD portion of the death certificate the cause of death, as determined based on his/her best medical opinion and available medical records and information.

B. Medical confidentiality shall not supersede compliance to Act No. 3753, Philippine Statistics Authority (PSA) Administrative Order No. 1, Series of 1993, otherwise known as Implementing Rules and Regulations of Act No. 3753 and other Laws on Civil Registration, and this Administrative Order. This Order adheres to Republic Act 10173, otherwise known as Data Privacy Act of 2012 which states that personal information must be collected for specified and legitimate purposes.

C. All institutional and individual key actors in reporting, certifying, and registering deaths are directed to observe the following guidelines, and the procedures outlined in ANNEX B and ANNEX C of this Order:

i. Standardize procedures in the certification of in-facility and out-of-facility deaths (ANNEX B);

ii. Utilize verbal autopsy (VA) in determining the most likely cause of death in enumerated cases; comply with latest International Classification of Diseases (ICD) certification standards when certifying deaths; review all death certificates and certificates of fetal deaths for completeness and correctness prior to registration; and, follow proper procedures for delayed registration of death, compliant with the requirements stipulated in PSA Administrative Order No. 1, Series of 1993 (ANNEX C).

D. In cases where a deceased's family opt to process the registration of the death certificate themselves, the health facility shall require a signed waiver from the deceased's nearest relative, without prejudice to the obligation of the health facility to certify the cause of death.

E. A review of this Order, to be led by DOH-Knowledge Management and Information Technology Service (KMITS), shall be conducted every three (3) to five (5)-year period after its Effectivity.

VI. GENERAL GUIDELINES ON CAUSE OF DEATH CERTIFICATION BY TYPE OF DEATH

A. Fetal Deaths — Certification of causes of fetal death shall be mandatory for fetuses with at least 20 weeks of age of gestation or weight of more than 500 grams.

B. Deaths in Emergency Room (ER)/Emergency Department — For deaths that occurred or were brought to the hospital/infirmary ER, the ER Officer is duty-bound to certify and report the death, except for deaths requiring medico-legal investigation.

C. Deaths in an Ambulance — When a death occurs in the ambulance while the patient is being transferred to a health facility, the physician present in the ambulance during the transport of the patient or the administrator of the hospital or clinic where the person is pronounced dead shall certify and report the death. The death shall be considered a dead-on-arrival (DOA) case if it occurs in an ambulance without a physician present in the ambulance — with or without any referral from a health facility.

D. Deaths in Moving Conveyances — The driver/ship captain/pilot, as the case may be, shall report the death to the local health officer of the city/municipality where the death occurred, who shall certify the cause of death.

E. Dead-on-Arrival Cases — For DOA cases, the ER Officer shall conduct VA to certify the cause of death, unless the death requires medico-legal investigation.

F. Deaths Requiring Medico-Legal Investigation — The cases enumerated in ANNEX D (F) are considered medico-legal cases and shall be referred to Philippine National Police (PNP) or National Bureau of Investigation (NBI) by the last attending physician, hospital/clinic administrator, or the local health officer, as appropriate. aScITE

G. Death of Filipino Muslim or Indigenous Cultural Communities/Indigenous Peoples — The dead body may be buried even without a certificate of death provided that the death shall be reported to the local health officer within 48 hours after the date of burial. The local health officer shall prepare the certificate of death, certify the cause of death, and submit the certificate of death to the local civil registrar for registration.

For the specific guidelines and procedures, refer to ANNEX D.

VII. ROLES AND RESPONSIBILITIES

A. INSTITUTIONAL RESPONSIBILITIES

A.1. DOH Central Office — shall ensure standards, procedures and resources for medical certification of cause of death are provided in compliance with this Order.

A.2. DOH Centers for Health Development (CHDs) and MOH-BARMM — shall assist and monitor health facilities and local health offices in the implementation of this Order.

A.3. Health Facilities — shall facilitate reporting, certification, and transmittal of certificate of death, formulate internal policies, and capacitate hospital staff in certifying cause of death.

A.4. Local Health Offices — shall facilitate reporting, certification, and transmittal of certificate of death and reviewing of correctness and completeness of the death certificate.

A.5. Funeral Parlors — shall report the death to the local health officer for the deceased conveyed to the funeral parlor without a death certificate, unless the death requires medico-legal investigation.

For further details on the institutional responsibilities, refer to ANNEX E.

B. INDIVIDUAL ROLES

B.1. Last Attending Physician — shall certify cause of death for medically attended deaths.

B.2. Hospital/Clinic Administrator — shall certify the cause of death in case the last attending physician in the health facility is not available.

B.3. ER Officer — shall be responsible for reporting and certifying deaths that occurred or were brought to the hospital/infirmary's emergency room (ER).

B.4. Local Health Officer — shall certify cause of death for medically unattended deaths and conduct review of all death certificates.

B.5. Relative(s) of the Deceased and Persons with Knowledge of the Death — shall report the death to the last attending physician for medically attended deaths or to the local health officer for medically unattended deaths.

B.6. Medico-legal Officer — shall perform autopsy and shall certify cause of death of all medico-legal cases referred.

For further details on the individual roles, refer to ANNEX E.

VIII. MONITORING COMPLIANCE

A. All public and private health facilities shall comply with the licensing requirements on information management of DOH-Health Facilities and Services Regulatory Bureau.

B. DOH-CHDs and MOH-BARMM, in coordination with DOH-KMITS and DOH-EB, shall monitor compliance of health facilities on:

1. Safekeeping of copies of all death certificates processed by the health facility.

2. Maintaining logbooks tracking death certificates processed by the health facility in compliance with these Rules including those submitted to the local health officer for review, those referred to medico-legal officers of the PNP or NBI for autopsy and those not processed by the health facility pursuant to a waiver signed by the deceased's nearest relative.

3. Safekeeping of all signed waivers by the deceased's nearest relative who opted to personally process the certificate of death, without prejudice to the obligation of the health facility to certify the cause of death.

4. Issuance and implementation of internal policies and procedures to:

a. Prohibit the practice of withholding death certificates for non-payment of medical bills, upon the execution of a promissory note covering the unpaid obligation, as aligned with RA 9439, otherwise known as the Act Prohibiting the Detention of Patients in Hospitals and Medical Clinics on Grounds of Nonpayment of Hospital Bills or Medical Expenses and its IRR.

b. Monitor and review the proper accomplishment and transmittal of death certificates.

c. Train licensed physicians, relevant medical staff and hospital/clinic administrators on reporting, certifying, and reviewing of MCCOD, latest ICD standards, and use of verbal autopsy.

IX. IMPLEMENTATION MECHANISM/PLAN

The implementation of this Order shall require various interventions including but not limited to development/revision of training modules/manuals, conduct of trainings and retrainings, and monitoring of health facility compliance. Activities related to the implementation of this Order shall be charged against the funds of KMITS or EB, as may be appropriate.

X. VIOLATIONS AND SANCTIONS

Violations on or related to cause of death certification and reporting of deaths shall be subject to the corresponding sanctions as provided by the relevant laws, rules, and regulations.

XI. REPEALING CLAUSE

All other related issuances inconsistent with or contrary to the provisions of this Order are hereby repealed, rescinded, revised or modified accordingly.

XII. SEPARABILITY CLAUSE

If any section or part of this Order is held unconstitutional or invalid, the other sections or provisions not otherwise affected shall remain in full force and effect.

XIII. EFFECTIVITY

This Order shall take effect fifteen (15) days after its publication in the Official Gazette or in two (2) newspapers of general circulation.

 

(SGD.) FRANCISCO T. DUQUE III, MD, MSc.Secretary of Health

ANNEX A

Definition of Terms

1. Certificate of Fetal Death (COFD) — The form used for the declaration of facts and circumstances surrounding the death of a fetus for purposes of registration, as prescribed by the Philippine Statistics Authority.

2. Death in Emergency Room (ER) — refers to deaths of patients at ER, including those who are dead-on-arrival and patients who were revived by initial resuscitative measures at the ER but eventually died there, regardless of the time of stay in the Emergency Room/Department.

3. Death under Medico-Legal Investigation — A case of death under investigation by the Philippine National Police, National Bureau of Investigation, or other investigative agency of the government where the body of the deceased is subject to autopsy or examination by medico-legal officers.

4. Dead-on-Arrival (DOA) — Patients brought to a health facility without cardio-pulmonary and brain functions, including patients who did not respond to initial resuscitation and patients with signs of Rigor Mortis, Livor Mortis, Algor Mortis but excluding cases of decapitation not susceptible for resuscitation and patients brought in an advanced state of decomposition.

5. Fetal Death — the 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 definite movement of voluntary muscles.

6. Emergency Room (ER) Officer — the physician-on-duty in the Emergency Department/Room in a health facility (e.g., pediatric department, OB-GYN department, etc.).

7. Health Facilities — A building or physical structure that has amenities, equipment, and staffing for the delivery of healthcare services.

8. Hospital/Clinic Administrator — for the purpose of this Order, a licensed physician who is charged with the day-to-day administration and/or management of the health facility.

9. In-facility death — refers to a death, which occurred in a health facility, including an emergency room death.

10. International Classification of Diseases (ICD) — refers to the version currently adopted and implemented by the Department of Health.

11. Out-of-facility death — refers to a death, which occurred outside of a health facility such as in a home, in public areas, buildings, and moving conveyances.

12. Last Attending Physician — The licensed physician who attended to the deceased during their last illness immediately prior to their death. Otherwise, the licensed physician who has treated the deceased through examination, medical advice, or medications within the 12 months preceding the death. HEITAD

13. Local Health Officer — refers to the provincial, city, or municipal health officer appointed by the relevant local government pursuant to Sections 443, 454, and 463 in relation to Section 478 of the Local Government Code.

14. Local Civil Registrar — The person in-charge of filing and accepting all registrable certificates and documents, affecting the civil status of persons, presented to them for entry.

15. Medical Attendance — refers to the presence of medical help or medical service by a licensed physician during the last illness immediately prior to his death or within the 12 months preceding death.

a. Medically attended death — the deceased was attended by a licensed physician during his last illness immediately prior to his death.

b. Medically unattended death — the deceased was not attended by a licensed physician during his last illness immediately prior to his death or within the 12 months preceding death.

16. Medico-Legal Officer — any licensed physician within the Philippine National Police (PNP), National Bureau of Investigation (NBI), or from any government health facility, who specializes or is involved primarily with medico-legal examination. Also known as medical jurist, medical examiner, or medico-legal expert.

ANNEX B

Specific Guidelines on Cause of Death Certification and Reporting

A. Certification of In-Facility Deaths

1. For in-facility deaths, the last attending physician, or in their absence, the hospital/clinic administrator, as provided in Annex E (B) (2), shall prepare the death certificate and certify the cause of death, except for ER deaths.

2. The health facility shall transmit the death certificate for the local health officer's review and final disposition.

B. Certification of Out-of-Facility Deaths

B.1. Medically Attended Deaths

1. For medically attended out-of-facility deaths, the deceased's nearest relative or in their absence, the person who has knowledge of the death, shall inform the deceased's last attending physician who shall certify the cause of death. The last attending physician shall transmit the death certificate for the local health officer's review and final disposition.

2. For medically attended out-of-facility deaths where the last attending physician is unavailable or could not be found, the procedures under Annex B (B.2)(1) shall be followed.

B.2. Medically Unattended Deaths

1. For deaths without medical attendance, the deceased's nearest relative or in their absence, the person who has knowledge of the death, shall report the death to the local health officer within forty-eight (48) hours from the time of death. The local health officer shall certify the cause of death through verbal autopsy. The local health officer shall refer to appropriate authorities if a medico-legal investigation is warranted.

2. In cases where the death is first reported to the PNP or NBI, the PNP or NBI shall determine whether the death requires medico-legal investigation. In case a medico-legal investigation is required, the procedure outlined under Annex D shall be followed. Otherwise, the death shall be referred to the local health officer who shall certify the cause of death through verbal autopsy in accordance with Annex C (A).

ANNEX C

Standardizing Procedures for Cause of Death Certification and Reporting

A. VERBAL AUTOPSY (VA)

1. Verbal autopsy shall be used to determine the most likely cause of death in the following cases:

• Medically attended out-of-facility deaths where the last attending physician is unavailable or could not be located in accordance with Annex B (B.1)(2).

• Medically unattended deaths in accordance with Annex B (B.2).

• Dead-on-arrival cases in accordance with Annex D (D).

• Delayed registration of medically unattended deaths in accordance with Annex C (D).

2. The certifier may choose not to do a verbal autopsy when sufficient medical records are available to identify the cause of death of the deceased.

3. The VA procedures and tools to be employed by the certifier shall follow the standards and rules issued by the Department of Health, which shall be guided by the standards and practices of the World Health Organization, United Nations, and other international institutions. At a minimum, VA tools must be compliant with the latest ICD certification standards and should employ structured questionnaires.

4. All deaths certified through VA must be registered with the local civil registrar within the reglementary period of thirty (30) days, except in cases of delayed registration as provided in Annex C (D).

5. In cases when the interviewee provides an improbable or inconsistent medical history suggesting a suspicious cause of death, the case shall be referred to the PNP or NBI for medico-legal investigation.

B. ICD COMPLIANCE

1. All certifiers shall ensure that the causes of death in the Certificate of Death are compliant with the latest ICD certification standards.

2. All health facilities shall ensure that its physicians, administrators, and relevant staff (e.g., medical records and coders) are trained on the latest ICD standards. The training curricula and courses shall follow standards set by the DOH for consistency in the level of skills.

C. MANDATORY REVIEW OF CERTIFICATES OF DEATH AND FETAL DEATH

1. In all cases of death or fetal death, the local health officer shall review the Certificate of Death and Certificate of Fetal Death before the local civil registrar accepts it for registration.

2. The local health officer shall review death certificates by checking for compliance with the following criteria:

a. Completeness of entries in the Certificate of Death

b. Correctness of entries on causes of death (e.g., no ill-defined underlying causes, errors in time interval, or logical sequence, etc.)

c. Absence of mechanical errors (e.g., abbreviations, unacceptable blank lines, etc.)

d. Compliance with the latest ICD certification standards

3. In case the local health officer determines that the cause of death does not comply with the above criteria, the death certificate shall be returned to the certifier for correction. The certifier must correct and return the certificate of death to the local health officer for approval within three (3) days from receipt, and within the reglementary period of thirty (30) days, prior to registration of the death, whichever is earlier.

D. DELAYED REGISTRATION OF DEATHS

1. Registration of death beyond the 30-day period shall be considered for delayed registration.

2. For in-facility deaths and medically attended out-of-facility deaths, certification and review shall follow the rules in Annex B (A) and Annex B (B.1) respectively.

3. For medically unattended deaths, the affidavit for delayed registration shall be executed by any of the nearest relatives of the deceased, or by any person having legal charge of the deceased when he was still alive. The local health officer shall accomplish the MCCOD following the procedures in Annex B (B.2).

ANNEX D

Specific Rules on Cause of Death Certification by Type of Death

A. Fetal Deaths

1. A Certificate of Fetal Death shall be accomplished within the reglementary period of thirty (30) days from the time of death.

2. The certification and review of the Certificate of Fetal Death shall follow the procedures in Annex B (A) and Annex B (B.1) for medically attended fetal deaths and Annex B (B.2) for medically unattended deaths. Provided, that, for fetal deaths without medical attendance, the local health officer shall certify the cause of death, with the information available, using their best medical opinion. The relative(s) shall submit medical records, when available.

B. Death in Emergency Room (ER)/Emergency Department

1. In cases where the deceased has no medical records, the ER Officer shall conduct VA to certify the cause of death or refer to appropriate authorities if a medico-legal investigation is warranted.

2. The health facility shall report the death to the local health officer and transmit the death certificate for review and final disposition within thirty (30) days from the time of death.

C. Death in an Ambulance

1. When a death occurs in an ambulance without an attending physician and/or without any referral form from a health facility, the death shall be considered as dead-on-arrival. In this case, Annex D (D) shall apply.

2. In case the deceased was being transferred by a referring hospital, the referring hospital shall be responsible for providing any necessary information and documents (e.g., medical chart, discharge summary) to the last attending physician or the administrator of the receiving hospital who shall certify and report the death.

3. The certifier shall report the death to the local health officer and transmit the death certificate for review and final disposition within thirty (30) days from the time of death.

D. Deaths in Moving Conveyances

1. The driver/ship captain/pilot, as the case may be, shall report the death to the local health officer of the city/municipality where the death occurred. In cases when there are no survivors, the owner of the moving conveyances shall report the death.

2. In cases where the locality/exact place of death cannot be determined, the local health officer of the place of burial/cremation shall certify the cause of death, with the information available and their best medical opinion within thirty (30) days from the time of death.

E. Dead-on-Arrival Cases

1. For dead-on-arrival cases that do not require medico-legal investigation, the ER Officer shall conduct VA to certify the cause of death as provided in Annex C (A). Registration shall be made within thirty (30) days from the time of death.

F. Deaths Requiring Medico-legal Investigation1

The following cases are considered medico-legal cases and shall be referred to the PNP or the NBI by the last attending physician, hospital or clinic administrator, or local health officer, as appropriate:

1. Deaths due to injuries (physical, thermal, chemical, and electrical) where the circumstances suggest commission of an offense by somebody, including but not limited to:

a. Vehicular accidents ATICcS

b. Unnatural accidents or disasters due to force majeure

c. Industrial accidents

d. Mauling

e. Firearm or Gunshot Injuries

f. Burns

g. Assault and battery, including domestic violence, child abuse, and sexual assault/offenses

h. Suspected self-inflicted injuries or suicide

2. Cases of suspected or evident criminal abortion, poisoning, or intoxication.

3. Cases referred from PNP/NBI or patients under police custody.

4. Cases of undiagnosed coma/unconsciousness.

5. Cases of death due to decapitation.

6. Cases of death where the deceased is in an advanced state of decomposition.

7. Cases brought dead with improbable or inconsistent medical history creating suspicion of an offense. Examples of which include but are not limited to:

a. Death due to external causes, including fetal death

b. Death due to animal bite

c. Unreasonable death in ER/OR

d. Deaths within 24 hours of hospitalization without diagnosis

e. Unidentified bodies

8. Cases when VA results are inconclusive, suggesting a suspicious cause of death.

9. Any other case not falling under the above categories but has legal implications.

For certifying the cause of death of medico-legal cases, the enumerated guidelines below shall be followed:

1. Medico-legal cases should be reported to the appropriate police station or precinct where the death occurred or where the body was found. Deaths requiring medico-legal investigation may also be reported to the NBI at the request of the next-of-kin of the deceased.

2. The medico-legal officer shall obtain the consent of the deceased's nearest relative before an autopsy is conducted, except in cases when an autopsy is mandated by law or when the death is under investigation. When the conduct of an autopsy is declined, the deceased's nearest relative shall execute a waiver as evidence of their refusal.

3. In areas where there is no PNP/NBI medico-legal officer available, the medico-legal officer of the government health facility or the local health officer shall conduct the medico-legal examination/autopsy. When the cause of death cannot be ascertained, VA shall be utilized.

4. The certifier shall transmit the death certificate for the local health officer's review and final disposition, within 48 hours.

5. If the cause or manner of death is still unknown or pending investigation after the 48-hour period has lapsed, the medico-legal officer shall indicate such fact by writing "pending investigation" on the MCCOD portion and submitting the death certificate to the local health officer within 48 hours after assignment of the case. Upon determining the cause of death and within 30 days from the date of death or discovery, the medico-legal officer shall submit an autopsy/post-mortem report and amended death certificate to the local health officer.

ANNEX E

Roles and Responsibilities

A. INSTITUTIONAL RESPONSIBILITIES

A.1. Department of Health-Central Office

A.1.a. DOH-KMITS

1. Provide standards, rules, procedures, and manuals on MCCOD other MCCOD-related processes.

2. Provide training and retraining to physicians, including local health officers, on reporting, certifying, and reviewing of MCCOD.

3. Ensure that MCCOD competencies are part of DOH long term human resource capacity building plan for the health sector.

4. Coordinate with relevant agency or authority for the integration of MCCOD with the pre-service education and training for doctors.

5. Identify interventions to improve coverage, completeness, and quality of MCCOD.

6. Implement mechanisms to ensure compliance of health facilities and local health offices with this Order.

A.1.b. DOH-EB

1. Provide standards, rules, procedures, and manuals on VA and ICD.

2. Provide training and retraining to physicians, including local health officers, on VA and ICD.

3. Identify interventions to improve coverage, completeness, and quality of VA and ICD.

4. Implement mechanisms to ensure compliance of health facilities and local health offices with this Order.

A.2. DOH Center for Health Development (CHD) and MOH-BARMM

1. Development Management Officers (DMOs) of CHD/MOH shall act as coordinators for MCCOD and verbal autopsy trainings.

2. DMOs of CHD/MOH shall oversee and monitor the implementation of this Order in local health offices and health facilities.

A.3. Health Facilities

1. Ensure compliance with standards, rules, and procedures on MCCOD by in-house licensed physicians and other relevant staff.

2. Ensure that their personnel are trained on reporting, certifying, and reviewing of MCCOD, ICD standards and use of VA.

3. Facilitate and ensure direct and timely transmittal of all death certificates originating from the health facility to the local health officer, for review.

4. For hospitals and infirmaries, formulate and implement an internal policy and review mechanism, such as random audits and regular reviews by the hospital administrator or the Medical Records Division, to ensure that death certificates are completely and correctly accomplished.

5. For health facilities where the hospital/clinic administrator is not a licensed physician, the health facility shall designate a licensed physician from its roster of employees to serve as certifier.

6. Prohibit the practice of withholding death certificates for non-payment of medical bills of patients consistent with RA 9439 and its Implementing Rules and Regulations for internment purposes.

A.4. Local Health Office

1. Ensure standards, rules, and procedures on MCCOD are strictly implemented.

2. Coordinate with the DOH to capacitate and provide in-depth training to local health officers and authorized representatives on reporting, certifying, and reviewing of MCCOD, and use of VA.

3. Implement VA in certifying the cause of death for medically unattended deaths and medically attended out-of-facility deaths where the last attending physician is not available.

4. Ensure that all death certificates are fully accomplished and facilitate direct and timely transmittal to the local civil registrar, for registration.

5. Preserve copies of death certificates and records of verbal autopsy, in accordance with relevant laws.

A.5. Funeral Parlor

1. For the deceased conveyed to the funeral parlor without a death certificate, report the death to the local health officer for the certification of cause of death.

2. Refer to PNP or NBI any death which requires medico-legal investigation.

B. INDIVIDUAL ROLES

B.1. Last Attending Physician

1. For medically attended deaths, whether these are in-facility or out of-facility deaths, for report and certify the cause of death the prescribed time, in accordance with Annex B (A).

2. For suspected medico-legal cases, determine, as early as possible and without unnecessary delay, whether medico-legal investigation is needed to certify and to report the death to the PNP or NBI in accordance with Annex D (F).

B.2. Hospital/Clinic Administrator

1. For medically attended in-facility deaths, immediately inform the last attending physician of the death.

2. Assume the responsibilities of the last attending physician in cases where the last attending physician is unknown or unavailable for justifiable reasons, as enumerated in Annex E (B.1).

3. Ensure their health facility has sufficient manpower to directly and timely transmit death certificates to the local health officer, for review.

B.3. Emergency Room (ER) Officer

1. For deaths that occurred or were brought to the hospital ER, report and certify the death within prescribed time, in accordance with Annex D (B).

B.4. Local Health Officer

1. For all medically unattended deaths, certify the cause of death and directly transmit the death certificate for registration to the local civil registrar within the reglementary period.

2. Review all death certificates and certificates of fetal death before registration with the local civil registrar in accordance with Annex C (C).

3. In cases where the cause of death is still pending investigation, await the autopsy or postmortem report and the updated death certificate in accordance with Annex D (F) before reviewing and transmitting the same to the local civil registrar for registration.

4. In areas where there is no PNP/NBI/government health facility medico-legal officer available, certify the cause of death in medico-legal cases through postmortem examination or VA, as may be applicable.

5. Authorize representatives, which may include rural health officers, city health officers, licensed physicians from inter-local health zones or service delivery networks (SDNs), chief of the district hospitals and doctors to the barrio (DTTB) or any licensed medical physician deployed by the local health office or Department of Health, to certify the cause of medically unattended deaths, and direct local registration thereof, in their absence.

6. Coordinate with DOH to provide training programs to its health personnel and authorized representatives on reporting, certifying, and reviewing the MCCOD, and the use of verbal autopsy.

7. Prevent duplication of death certificates prior to registration.

B.5. Relative(s) of the Deceased and Persons with Knowledge of the Death

1. For out-of-facility deaths,

a. Immediately informing the last attending physician who shall certify the death in accordance with Annex B (B.1), in case of medically attended deaths.

b. Report the death to the local health officer within 48 hours in case of medically unattended deaths in accordance with Annex B (B.2). If the local health officer is unavailable, the death shall be reported to his authorized representative.

2. Assist the local health officer or his authorized representative in certifying the cause of death in medically unattended deaths, by participating in the conduct of VA and submitting requested documentary requirements.

B.6. Medico-legal Officer

1. For medico-legal cases, certify the cause of death and accomplish the MCCOD and post-mortem certificate portion of the death certificate and, prepare and submit the autopsy or postmortem report, in accordance with Annex D (F).

2. Report deaths to the local health officer within prescribed time.

3. In cases where cause or manner of death is still pending investigation, conduct investigation and transmit results to the local health officer within the prescribed time, in accordance with Annex D (F). cSEDTC

ANNEX F

Process Flow for In-Facility and Out-of-Facility Deaths

A. In-facility deaths

B. Out-of-facility deaths

 

Footnotes

1. Pedro P. Solis, "Legal Medicine," (R.P. Garcia Publishing Company, 1987).