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Click ‘Get Form’ to open it in the editor.
Begin by entering the name of the hospital at the top of the form. This identifies where the deceased was treated.
Fill in the details of the deceased, including their name, sex, and age at death. If under one year, specify age in months or days; if over one year, provide age in years.
In the 'Cause of Death' section, clearly state the immediate cause of death followed by any antecedent causes. Be specific about diseases or conditions rather than general terms.
Indicate any other significant conditions contributing to death that are not directly related to the primary cause.
Select the manner of death from options such as natural, accident, suicide, or homicide.
If applicable, answer questions regarding pregnancy and delivery for female deceased individuals.
Finally, ensure that a medical attendant certifies and signs the document before submission.
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