Filling Out the Death Certificate

LINE-BY-LINE NUMBERED ITEM DIRECTORY
 

Click on the line numbers below to find information about filling out that line item on the Texas Certificate of Death.  Although the information needed to complete some items on the form seems as if it would be obvious, there are sometimes more complex considerations at issue than may first appear.    1. Name of Deceased 16. Father's Name 31. Signature of Certifier 2. Sex of Deceased 17. Mother's Name 32. Date Certifier Signed 3. Date of Death 18. Place of Death 33. Time of Death 4. Date of Birth 19. County of Death 34. Certifier's Name / Address 5. Age 20. City or Town 35. Cause of Death 6. Birthplace 21. Hospital or Institution 36. Autopsy 7. Social Security Number 22. Informant Name 37. Tobacco Use 8. Race 23. Informant Mailing Address 38. Alcohol Use 9. Hispanic Origin 24. Method of Disposition 39. Pregnancy 10. Service (U.S. Armed Forces) 25. Place of Disposition  40. Manner of Death 11. Education 26. Location of Disposition 41. Injury Information 12. Marital Status 27. Funeral Director 42. Registrar Information 13. Surviving Spouse 28. Date of Disposition 14. Occupation and Industry 29. Address of Funeral Home 15. Residence 30. Certifier of Cause of Death NOTE:  Typically, line 3 and lines 30 through 41 are the major responsibility of medical personnel, including the medical examiner or coroner.  Other portions of the form are generally completed by the funeral director, the county registrar, and other (nonmedical) persons.

 
Feedback | Return to CME Top Page | Return to Line-by-Line Item Menu Page

Last Revised: 5/2/99