Death Information

The Death Information screen allows users to capture detailed information regarding an individual's death. This screen only appears in the Final Section if the primary category of the incident is Death.

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
Was the individual in hospice care?	Select from the drop-down whether the individual was receiving hospice care.
Did the individual have a diagnosed terminal illness?	Select from the drop-down whether the individual was diagnosed with a terminal illness.
What is the diagnosed terminal illness?	If indicated in the previous question that the individual has a terminal illness, select the diagnosed terminal illness from the drop-down.
If other, please specify:	If ‘Other’ is selected, identify the diagnosed terminal illness.
Was a 'Do Not Resuscitate' order in effect?	Select from the drop-down whether a 'Do Not Resuscitate' or DNR order was in effect.
Did the provider initiate CPR?	Select from the drop-down whether the provider initiated CPR.
Did other parties perform CPR?	If other parties performed CPR, select from the drop-down the party who performed CPR.
If other, please specify:	If ‘Other’ is selected, identify the party who performed CPR.
Was the coroner contacted?	Select whether the coroner was contacted.
Was an autopsy performed or will an autopsy be performed?	Select from the drop-down whether an autopsy has or will be performed.
Did the family refuse an autopsy?	If an autopsy has not or will not be performed, select from the drop-down whether the family refused an autopsy.
Was medical intervention information recorded in another incident in relation to this death incident?	Select whether medical intervention information was recorded in another incident in relation to this death. Note: If medical intervention information was recorded in another incident in relation to this death, link the incident to this death incident.
Was this death a result of abuse or neglect?	Select whether this death was a result of abuse or neglect. Note: If this incident was a result of abuse or neglect, an abuse or neglect incident report must be filed and linked to this incident.
Please indicate what supplemental information exists for this report:	Select from the checkbox list the supplemental information (i.e. Autopsy report, Death Certificate, etc.) that exists for this report. Hard copies of available supplemental information should be forwarded to the County MH/ID Program and the ODP-ID/A Regional Office.
If other, please specify:	If 'Other' is selected as supplemental information, enter the information that exists.
Was there a Substitute Healthcare Decision Maker?	Select whether there was a Substitute Healthcare Decision Maker for the individual.
If yes, please specify their name:	If there was a Substitute Healthcare Decision Maker, specify their First and Last name.
Relationship to the deceased:	If there was a Substitute Healthcare Decision Maker, select from the drop-down their relationship to the deceased.
If other, please specify:	If ‘Other’ was selected as the relationship to the deceased, please specify the relationship.