Death Circumstance Information

The Death Circumstance Information screen is the first screen in the Initial Mortality Review and allows users to capture details related to the circumstances of an individual's death. The Initial Mortality Review is only available when an incident with a primary category of Death is closed in EIM.

Note: Mandatory fields are marked with an asterisk. In addition, some fields are conditionally mandatory, or in other words, become mandatory based on the response to a previous field. All mandatory fields (including conditionally mandatory fields) must be completed on a screen.

Field Name	Field Description
Contributory Cause(s) of Death:	Select the contributory cause or causes of death from the drop-down list.
If other, please specify:	If ‘Other’ is selected, please identify the Contributory Cause of Death.
Contributory Cause(s) of Death Comments:	Enter comments related to the contributory cause or causes of death.
Date of Death:	Enter a new date of death if the pre-populated date is incorrect. Note: The pre-populated date is the date of occurrence for the Death incident.
Age at Death:	This read-only field is calculated using the individual’s date of birth and the original date of occurrence for the Death incident. If a new Date of Death is entered on the Death Circumstance Information screen, the individual’s age will be recalculated upon page save.
Location of Death:	Select the location of death from the drop-down list.
If other, please specify:	If ‘Other’ is selected, identify the location of death.
Name of Location:	Enter a name for the location of death.
Choking/Falling Indicator:	Select a new value from the drop-down if the pre-populated value is inaccurate. Note: This field is pre-populated from the Verification of Incident Classification screen.
Did the provider initiate CPR?	Select a new value from the drop-down if the pre-populated value is inaccurate. Note: This field is pre-populated from the Death Information screen (final section).
Did other parties perform CPR?	Select a new value from the drop-down if the pre-populated value is inaccurate. Note: This field is pre-populated from the Death Information screen (final section).
If other, please specify:	Enter a new information from the drop-down if the pre-populated data is inaccurate. Note: This field is pre-populated from the Death Information screen (final section).
Did the individual have a G-tube or J-tube?	Select from the drop-down whether the individual had a G-tube, J-tube or both.
Did the individual have a diagnosed terminal illness?	Select a new value from the drop-down if the pre-populated value is inaccurate. Note: This field is pre-populated from the Death Information screen (final section).
What is the diagnosed terminal illness?	Select a new value from the drop-down if the pre-populated value is inaccurate. Note: This field is pre-populated from the Death Information screen (final section).
If other, please specify:	Enter a new information from the drop-down if the pre-populated data is inaccurate. Note: This field is pre-populated from the Death Information screen (final section).
Is a copy of the Death Certificate available?	Select a new value from the drop-down if the pre-populated value is inaccurate. Note: This field is pre-populated from the Death Information screen (final section).
Was a ‘Do Not Resuscitate’ order in effect?	This read-only field is pre-populated with data indicating whether a ‘Do Not Resuscitate’ order was in effect. Note: This field is pre-populated from the Death Information screen (final section).
Was the individual in hospice care?	This read-only field is pre-populated with data indicating whether the individual was in hospice care. Note: This field is pre-populated from the Death Information screen (final section).
Was the coroner contacted?	This read-only field is pre-populated with data indicating whether the coroner was contacted. Note: This field is pre-populated from the Death Information screen (final section).
Was an autopsy performed or will an autopsy be performed?	This read-only field is pre-populated with data indicating whether an autopsy was or will be performed. Note: This field is pre-populated from the Death Information screen (final section).