Maternal death notification form 2026

1. Click ‘Get Form’ to open the maternal death notification form in the editor.
2. Begin by filling out the Reporting Facility Information section. Enter the name and type of the health facility, along with the region, zone, woreda, and date of reporting.
3. In the Deceased Information section, provide details such as the deceased ID, date of death, age at death, and residence. Specify whether the residence is urban or rural and select the place of death from the provided options.
4. Complete marital status, religion, ethnicity, level of education, gravidity, and parity fields. Indicate timing of death in relation to pregnancy and if applicable, specify postpartum timing.
5. For Antenatal Care (ANC), Delivery and Postnatal care (PNC) sections, answer questions regarding ANC attendance and delivery mode. Include dates and who assisted during delivery or abortion.
6. In the Cause of Death section, indicate direct and indirect obstetric causes. Assess if the death was preventable and note any contributory factors that apply.
7. Finally, ensure all information is accurate before submitting your completed form for processing.

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