Death Information

The Death Information screen allows users to capture detailed information regarding an individual's death. This screen only appears in the First 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
What were the significant health conditions related to the death?	State the participant’s significant health conditions related to the death.
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 as the diagnosed terminal illness, please provide an explanation.
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 as the type of party who performed CPR, please provide an explanation.
Was the coroner contacted?	Select whether the coroner was contacted.
Was a toxicology screening performed?	Select whether a toxicology screening was performed.
Autopsy Status:	Select from the drop-down indicating the status of the autopsy for the participant.
Was hospitalization information recorded in another incident in relation to this death incident?	Select whether hospitalization information was recorded in another incident in relation to this death.   Note: If hospitalization information was recorded in another incident in relation to this death, link the incident to this death incident.