DATA MANAGEMENT

Medical Certification of Cause of

Death (MCCOD)
COMMUNITY MEDICINE
DPF&CM, FMS, UST
AY 2021-2022
 Discuss the importance of the
MODULE correct certification of cause of
death and the role physicians
OBJECTIVES play in producing reliable causes
of death statistics
 • Understand the importance of correct
At the end of cause of death certification for accurate
mortality statistics, public health
this module, formulation, planning and resource
allocation.
medical • Discuss the critical features of the medical
seniors are certificate on the cause of death
expected to • Explain the role of physicians, as part of
the official civil registry system and for
demonstrate improving the quality of cause of death
certification
the following • Discuss the legal, ethical and
competencies: confidentiality issues related to cause of
death certification.
 • Prof. Alejandro Pineda, Jr MD
• Dr. Lynard D. Ignacio
MODULE
FACULTY
 i. Republic Act No. 3753 ‘Civil
Registry Law’
ii. Implementing Rules and
Regulations (IRR) of RA 3753
iii.DOH Administrative Order 2020-
MODULE CONTENT 0008 ‘Rules on Medical
Certification of Cause of Death
(MCCOD)
iv.Epidemiological Surveillance
v. Data Privacy
vi.Code on Sanitation
 a. The group output is worth 15 points.

Group membership:
a. With the group arranged in
Group alphabetical order, the overall leader
equally divides the class into five (5)
output: sub-groups
b. Each group selects a leader and a
secretary for this activity
c. Case-based analysis group work
d. Group presentations
Evaluation Rubrics for the Group Work

DEATH SCENARIO 1 – Correct 0 Not correct

Case definition
Type of death
Certifier
Cause of death
Additional 1 point for clear, logical, and concise reporting
Total points = 5
 • ongoing systematic collection,
analysis and interpretation of
health data essential to the
planning, implementation and
Epidemiologic evaluation of public health
Surveillance practice, closely integrated with
the timely dissemination of
these data to those who need to
know
Centers for Disease Control (CDC)
 • In most health departments,
routinely collected statistics provide
the key data for monitoring
morbidity and mortality trends
• Surveillance System – includes a
Surveillance functional capacity for data
collection, analysis and
dissemination linked to public health
programs
Epidemiology 4th Edition, 2009
 • Denotes a system in which the
project staff make periodic field
ACTIVE visits to health care facilities to
SURVEILLANCE identify new cases of dieases or
deaths arising (case finding).

Epidemiology 4th Edition, 2009

 • Denotes surveillance in which either
available data on reportable diseases
are used or reporting is mandated or
PASSIVE requested with the responsibility of
SURVEILLANCE reporting often falling on the concerned
public health officer

Epidemiology 4th Edition, 2009

 Undertaken to identify changes in
the distribution of diseases in
order to prevent or control these
conditions within a population

MEDICAL
SURVEILLANCE A comparison of incidence rates
across populations can help to
determine characteristics of
populations at higher risk

Medical Epidemiology, 2005

 Continuous data collection and
evaluation

ID target population (community,

workplace force, group of patients)

MEDICAL Standard definition of the outcome

SURVEILLANCE of interest

Activities Emphasis on timeliness of

collection and info dissemination

Use of data for purposes of

investigation or disease control

Medical Epidemiology, 2005

Death Certificate

An official document setting

forth particulars relating to a
dead person, including the
name of the individual, the
date of birth and the date of
death.
 •
Instructions Accurate cause-of-death information is important:
✓ To the public health community in evaluating and improving the
health of all citizens,
for ✓ Often to the family, now and in the future, and to the person
settling the decedent's estate.

Completing ✓ Two parts.

✓ Part I is for reporting a chain of events leading directly to death,

the Cause-of- with the immediate cause of death (the final disease, injury, or
complication directly causing death) on Line a and the
underlying cause of death (the disease or injury that initiated the

Death Section chain of morbid events that led directly and inevitably to death)
on the lowest used line.
✓ Part II is for reporting all other significant diseases, conditions, or
of the Death injuries that contributed to death but which did not result in the
underlying cause of death given in Part I. The cause-of-death
information should be YOUR best medical OPINION. A condition
Certificate can be listed as “probable” even if it has not been definitively
diagnosed.
Example of a
properly
completed
medical
certification
Example of a
properly
completed
medical
certification
RATIONALE AO • Proclamation No. 1106, August 20, 2015
2020-0008 ‘ Philippines’ Civil Registration and Vital
Statistics (CRVS) Decade Declaration’
Rules on • Enjoining all agencies and
Medical instrumentalities of the national
Certification of government and local government units
to actively support programs relevant to
Cause of Death the “Get every Pinoy and Pinay in the
(MCCOD) Picture!“ initiative.
Philippine (1) at least 90 percent of
(2) at least 85 percent of
all deaths have a
Commitment all deaths are registered medically certified cause
of death
to Achieve
the following (3) the proportion of
(4) at least 85 percent of deaths
taking place outside of a health
Goals by deaths coded to ill-
defined codes will have
facility and without the attention of a
medical practitioner have their most
likely underlying cause of death
2021 been reduced by 50%; determined through verbal autopsy in
line with international lstandards.
 Republic Act Act No. 3753, otherwise
known as Civil Registry Law which upholds
the continuous and compulsory recording
of vital events, to include deaths.
Goals
Alignment Presidential Decree No. 856, otherwise
known as The Code on Sanitation of the
Philippines which states that no remains
shall be buried without a certificate of
death.
 Ensure generation and use of evidence
in health policy development, decision-
making, and program planning and
implementation.
DOH FOURmula
Mortality statistics, particularly cause
One Plus for of death data, has long been used as
basis for health program management
Health and policy development.

(Fl Plus) However, to date, ill-defined and

unknown causes of death still ranked
10" in the leading causes of death in
the Philippines.
AO 2020-0008
Rules on
Medical General Objective
Certification of
Cause of Death
(MCCOD) To describe and clarify
rules on medical
certification of cause of
death (MCCOD)
 To provide a standard procedure for reporting, certifying,
and reviewing the cause of death;
AO 2020-0008
Rules on To standardize the procedure for referring cases of deaths
Medical which warrants medicolegal investigation;

Certification of To clarify the roles and responsibilities of the different key

Cause of Death actors in reporting,certifying, and reviewing cause of
death;
(MCCOD) To establish the use of verbal autopsy in specific cases for
cause of death determination; and,
Specific
To monitor compliance and violations of existing CRVS laws
Objectives and regulations inreporting, certifying, and reviewing the
medical certification of cause of death.
 GENERAL • All certifiers are mandated to indicate in
GUIDELINES the MCCOD portion of the death
certificate the cause of death, as
ON CAUSE OF determined based on his/her best
medical opinion and available medical
DEATH records and information.
CERTIFICATION
AND DOH Administrative Order 2020-0008 ‘Rules on Medical
REPORTING Certification of Cause of Death (MCCOD)
 • Medical confidentiality shall not supersede
compliance to Act No. 3753, Philippine Statistics
GENERAL Authority (PSA) Administrative Order No. 1, Series of
1993, otherwise known as Implementing Rules and
GUIDELINES ON Regulations of Act No. 3753 and other Laws on Civil
CAUSE OF Registration, and this Administrative Order.
• This Order adheres to RepublicAct 10173, otherwise
DEATH known as Data Privacy Act of 2012 which states that
CERTIFICATION personal information must be collected for specified
and legitimate purposes.
AND DOH Administrative Order 2020-0008 ‘Rules on Medical
REPORTING Certification of Cause of Death (MCCOD)
 c. All institutional and individual key actors in reporting,
certifying, and registering deaths are directed to
observe the following guidelines, and the procedures
outlined in ANNEX B and ANNEX C of this Order:
GENERAL i. Standardize procedures in the certification of in-facility
and out-of-facility deaths (ANNEX B);
GUIDELINES ON ii. Utilize verbal autopsy (VA) in determining the most
CAUSE OF likely cause of death in enumerated cases; comply with
latest International Classification of Diseases (ICD)
DEATH certification standards when certifying deaths; review
all death certificates and certificates of fetal deaths for
CERTIFICATION completeness and correctness prior to registration; and,
follow proper procedures for delayed registration of
AND death, compliant with the requirements stipulated in
PSA Administrative Order No. 1 Series of 1993 (ANNEX
REPORTING C).
DOH Administrative Order 2020-0008 ‘Rules on Medical
Certification of Cause of Death (MCCOD)
 D. In cases where a deceased’s family opt
GENERAL to process the registration of the death
GUIDELINES ON certificate themselves, the health
facility shall require a signed waiver
CAUSE OF from the deceased’s nearest relative,
DEATH without prejudice to the obligation of
the health facilityto certify the cause of
CERTIFICATION death.
AND DOH Administrative Order 2020-0008 ‘Rules on Medical
REPORTING Certification of Cause of Death (MCCOD)
 GENERAL E. A review of this Order, to be led by
GUIDELINES ON DOH-Knowledge Management and
CAUSE OF Information Technology Service (KMITS),
shall be conducted every three (3) to
DEATH five (5) year period after its Effectivity.
CERTIFICATION
AND DOH Administrative Order 2020-0008 ‘Rules on Medical
REPORTING Certification of Cause of Death (MCCOD)
 A. Fetal Deaths
B. Deaths in Emergency Room (ER)/Emergency
GENERAL Department

GUIDELINES C. Deaths in an Ambulance

ON CAUSE OF D. Deaths in Moving Conveyances

DEATH E. Dead-on-Arrival Cases

F. Deaths Requiring Medico-Legal Investigation.
CERTIFICATION
G. Death of Filipino Muslim or Indigenous Cultural
BY TYPE OF Communities/Indigenous Peoples

DEATH DOH Administrative Order 2020-0008 ‘Rules on Medical

Certification of Cause of Death (MCCOD)
 • DOH Central Office
• DOH Centers for Health
Development (CHDs)
Roles and
responsibilities • MOH-BARMM .
• Health Facilities
institutional • Local Health Offices
• Funeral Parlors
DOH Administrative Order 2020-0008 ‘Rules on Medical
Certification of Cause of Death (MCCOD)
 Last Attending Physician
Hospital/Clinic Administrator
ER Officer
Local Health Officer
Roles and Relative(s) of the Deceased
responsibilities and Persons with Knowledge
of the Death
Individual Medico-legal Officer —
DOH Administrative Order 2020-0008 ‘Rules on Medical
Certification of Cause of Death (MCCOD)
 • DOH-Health Facilities and Services
Regulatory Bureau.
• DOH-CHDs
MONITORING • MOH-BARMM
COMPLIANCE • DOH-KMITS and DOH-EB,

DOH Administrative Order 2020-0008 ‘Rules on Medical

Certification of Cause of Death (MCCOD)
 • Prohibit the practice of withholding death
certificates for non-payment of medical bills,
upon the execution of a promissory note
covering the unpaid obligation, as aligned with
RA 9439, otherwise known as the Act
Considerations: Prohibiting the Detention of Patients in
Hospitals and Medical Clinics on Grounds of
Nonpayment of Hospital Bills or Medical
Implementation Expenses andits IRR

DOH Administrative Order 2020-0008 ‘Rules on Medical

Certification of Cause of Death (MCCOD)
 • Prohibit the practice of withholding death
certificates for non-payment of medical bills,
upon the execution of a promissory note
Considerations: covering the unpaid obligation, as aligned with
RA 9439, otherwise known as the Act
Prohibiting the Detention of Patients in
Implementation Hospitals and Medical Clinics on Grounds of
Nonpayment of Hospital Bills or Medical
Expenses andits IRR
DOH Administrative Order 2020-0008 ‘Rules on Medical
Certification of Cause of Death (MCCOD)
Considerations: Implementation
• VERBAL AUTOPSY (VA) – MOST LIKELY CAUSE OF DEATH
• ICD COMPLIANCE
• MANDATORY REVIEW OF CERTIFICATES OF DEATH AND FETAL DEATH –
LOCAL CIVIL REGISTRARS
• DELAYED REGISTRATION OF DEATHS
DOH Administrative Order 2020-0008 ‘Rules on Medical
Certification of Cause of Death (MCCOD)
VERBAL AUTOPSY (VA) – MOST LIKELY CAUSE OF DEATH

• Medically attended out- of- facility deaths where the last attending physician is
• unavailable or could not be located in accordance with Annex B (B.1)(2).
• e Medically unattended deaths in accordance with Annex B (B.2).
• Dead-on-arrival cases in accordance with Annex D (D);
• e Delayed registration of medically unattended deaths in accordance with Annex
• C (D).
DOH Administrative Order 2020-0008 ‘Rules on Medical
Certification of Cause of Death (MCCOD)
• The underlying cause of death is the disease or
injury which initiated the train of morbid events
leading to death, or the circumstances of the
accident or violence which produced the fatal
injury.
• It is the most important entry in the certificate
since mortality statistics is based on this underlying
cause.
• All certification of death must include an
underlying cause in Part I.
Ill-defined or Nonspecific Causes of Death
• The ill-defined causes of death under ICD-10 are vague categories
and conditions that include signs and symptoms and abnormal
clinical and laboratory findings. Deaths assigned to ill-defined
causes are insufficiently detailed to be of value for public health
purposes. Hence, as a rule, ill-defined conditions should never be
entered on a Certificate of Death unless nothing else is known
about the deceased. The term septicemia in the absence of a more
specific condition is also ill-defined
• A common error is to report specific organ failure or the “mode of
dying” as the underlying cause of death. These conditions are also
considered ill-defined and should not be reported as the
underlying cause of death since they do not usually occur without
a precipitating cause.
• Therefore, if an organ failure is reported on the death certificate,
the underlying condition responsible for the failure should also be
reported. For example, acute renal failure due to diabetes mellitus
or liver failure due to hepatitis B infection.
• Part II of the Medical
Certificate portion of the
Certificate of Death
includes all other
significant or contributory
co-existing or pre-existing
diseases or conditions
that contributed to death
but do not directly lead to
the underlying cause of
death listed in Part I.
Items that must be filled out by the certifier of
death when completing the Medical Certificate
portion of the Certificate of Death:

Causes of death entry containing three lines marked (a), (b), and (c) with
the corresponding lines for the entry of interval between onset and death,
and a line for other significant conditions contributing to death.
19c. Maternal condition, if the deceased is female aged 15 to 49 years old
19d. Death by external causes which include manner of death and place of
occurrence of external cause, when applicable
20. Autopsy, whether done or not
21a. Attendant before death, whether by a private physician, public health
officer, hospital authority, none or others (specify)
21b. Dates for duration of time of attendance, if deceased was attended
before death
22. Certification of death containing the time of death and whether the
deceased was attended or not; signature, name, position and address of
the CERTIFIER and the date signed; and name and signature of Local
Health Officer as REVIEWER and the date signed.
Module
Summary
• The consolidated mortality statistics is
the foundation for the country’s health
policies, plans and programs. It informs
the policy makers and planners on the
leading causes of mortality and its
patterns and trends. Thus, it is of utmost
importance that the country’s mortality
data should be of good quality. The
road to good quality data starts with
the clinical diagnosis of the physician as
to the cause of death. This is followed
by precise manner of certifying the
cause of death with immediate,
antecedent, and underlying causes,
entered accurately and in correct order.
THANK YOU AND GOOD DAY AHEAD!

•avpineda@ust.edu.ph;
+639178821008

•ldignacio@ust.edu.ph

•Viber Group