MCCD Assessment

Demographics
Hospital name: Certificate number:
Place of death: Category:
Trained: Certification Date:
Sex of deceased: Age of deceased (Years): Age of neonate:

Assessment
Q1. Multiple causes of death per line Q2. Missing time interval from onset to death
Q3. Abbreviations were used in certifying the cause of death Q4. Illegible hand writing
Q5. Incorrect or clinically improbable chain of events leading to death Q6. The first condition entered in the lowest used line of part 1 cannot be an underlying cause.
Q7a. Was the death due to accident, violence, poisoning or other external cause?
Q7b. For deaths due to external causes, i.e. accident/violence/poisoning, were the circumstances missing? (how the death occurred, intent, activity, place of occurrence)
Q8a. Was the death due to a neoplasm?
Q8b. For deaths due to neoplasms, additional details were missing (Site, morphology, behaviour)
Place of death: Category: Trained:
Responses Yes No Not Assessed Total
Question N % N % N % N %

Collaborators and partners

© 2026 Department of Civil Registration and Vital Statistics, CDC Foundation - Data for Health Initiative