Guidelines for writing death certificates

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Information about name, ID number, address, municipality, marital status, and gender is entered automatically in the case of an adult.

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Employment information is recorded as free text and must be recorded as accurately as possible.

For example, an industrial worker should be written rather than a labourer, a nurse anaesthetist rather than a nurse, and so on. In the case of a pensioner, the job that the deceased had 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 the person had for the longest time, but if it is unclear, record the last job the deceased had.

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The death certificate must be delivered to relatives according to Article 10 of Act no. 61/1998 on death certificates. In the field of Relatives, information about the relative who would have been delivered the death certificate if it had been written in paper form must be entered. This registration is necessary so the District Commissioners can send the next of kin information about the next steps. It is sufficient to register one relative.

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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 location. If a body is found, the place where the body was found must be recorded.

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The day of death is the day when death is confirmed. The time of death must be recorded with the date and as precise time as the circumstances allow. If a child dies within 24 hours of birth, write how many hours after birth the death occurred. If the time of death is not known, the date of the autopsy is recorded, and then recorded that the date of death is unknown.

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

The fields for recording underlying causes of death and contributing causes of death 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, (eg breast cancer, liver failure, and pneumonia.)

• A: A disease or condition that is considered a direct cause of death (eg pneumonia),

• B, C: Diseases that led to the direct cause of death (eg liver metastases and intra-abdominal fluid).

• 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 shall be recorded.

Part II shall list the contributing causes of death, i.e. diseases or conditions that contributed to death, without being directly related to the disease (eg rheumatoid arthritis). The registration of causes of death will be better if this part is also filled out. As an example, diseases that could have reduced the individual's resistance, eg dementia or kidney failure, could be listed there, 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. For example, accidents or abuse of alcohol or drugs, which may have contributed to death, can also be recorded in Part II. Diagnoses in Part II shall be ranked in order of priority according to the extent to which they are believed to be related to the death.

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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. It is therefore important that the most accurate information is obtained about all registered diseases or specific conditions. The period should be recorded as the number of hours (or fractions of an hour), days or years that passed from the diagnosis of the disease to death, or from the accident to death.

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If the deceased underwent an operation related to the cause of death, the reason for the operation and the type of operation must be specified. In addition, the time and place of the operation shall be recorded.

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If the deceased is female, record whether pregnancy occurred in the last 12 months before death. Choose the appropriate answer from a list that appears in a drop-down window. Pregnancy also includes termination of pregnancy.

This applies to all pregnancies, regardless of the outcome of the pregnancy. In this way, pregnancies, miscarriages, and terminations of pregnancy in the last 12 months before death are recorded.

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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 marked.

If the death is not natural, the death must always be reported to the police. Police may order a forensic medical examination or an autopsy. The cause of death shall be written as an accident when the injury, which is the result of 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 what 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 noted, for example, 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).

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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.

If the answer option Yes is checked, a window will open for further registration.

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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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When the doctor who fills in the death certificate has signed electronically, information is forwarded to the appropriate institutions, i.e. District Commissioners, Registers Iceland, and the Directorate of Health.

It is important to confirm the form and sign electronically, otherwise the form will not be forwarded.

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If the result of the autopsy or research changes after the death certificate is issued, you can go back into the form and change the certificate. Then only two tabs will open, Mortality and Result, where new information and changes must be entered. When the registration is complete and the form is confirmed, a field will appear asking for an electronic signature. Upon signature, the new information is sent to the Directorate of Health.

A medical examiner who performs an autopsy writes the death certificate and enters additional information.