Death Certificate CME-Table of Contents

rocedures for Filling Out the Certifier's Portion of a Certificate of Death:

Line-by-Line Instructions (Lines 21-42)
- Line 21-Hospital or Institution
- Line 22-Informant Name
- Line 23-Informant Address
- Line 24-Method of Disposition
- Line 25-Place of Disposition
- Line 26-Location of Disposition
- Line 27-Funeral Director
- Line 28-Date of Disposition
- Line 29-Address of Funeral Home
- Line 30-Certifier of Cause of Death
- Line 31-Signature of Certifier
- Line 32-Date Certifier Signed
- Line 33-Time of Death
- Line 34-Certifier's Name/Address
- Line 35-Cause of Death
- Line 36-Autopsy
- Line 37-Tobacco Use
- Line 38-Alcohol Use
- Line 39-Pregnancy
- Line 40-Manner of Death
- Line 41-Injury Information
- Line 42-Registrar's Information
Follow-ups to Filling Out the Form
- Amendations to the Death Certificate

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