proof of death

In ordinary daily life, everyone will inevitably come into contact with proof. The function of proof lies in proof, which is a kind of certificate used by the holder to prove his identity, experience or the authenticity of something. Do you know the format of the certificate? The following is the death certificate I collected for you. Welcome everyone to learn from it, I hope it will help you.

Death certificate 1 xx A notary office:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ This is to certify that: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.

The city (or county) died of (cause of death).

Hereby certify that

Filled by: _ _ _ _ _ _ _ _ (signature)

Seal of relevant department:

date month year

Death Certificate 2 _ _ _ _ _ _ _ Notary Office:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ This is to certify that: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.

Hereby certify that

Filled by: _ _ _ _ _ _ _ _ _

Death certificate 3 This is to certify that the resident of our village: xxx, male, Han nationality, is a villager in Group X of xxX Village, xX Town, XX City, born on, month, id number: xxXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX, contact person of the family of the survivors who died of XXX disease on, month, month, and address and contact information of the deceased.

Hereby certify that

Signature of village director:

Xxxx，xxxx，xx，xx

Death Certificate 4 Instructions for Filling in Supplementary Card of Maternal Death Registration Report

Number: compiled and filled in by the reporting unit.

Name: Fill in the name of the deceased. If the ID number is registered, the name should be consistent with the name on the ID card. Inside and outside the plan: refers to whether pregnancy and childbirth have a birth permit, those with a birth permit are planned, and those without a birth permit are unplanned. Education: The graduation education shall prevail. If you went to high school but didn't graduate, take junior high school education as the standard. Economic level: this item is an estimate, which refers to the per capita monthly income, that is, the annual per capita income of the family112. Residential area: "Mountain area" includes the mid-level area, and the dam area belongs to other projects.

Number of pregnancies: every pregnancy, regardless of the location and outcome of pregnancy, is counted as a pregnancy time. Including delivery after 28 weeks of pregnancy. Twins and multiple births are only one child. Twins and multiple pregnancies count as one child. The frequency of induced abortion and induced labor: including drug abortion, excluding natural abortion and incomplete abortion with curettage.

Last menstruation: fill in according to the Gregorian calendar date. If you are pregnant again in the future after abortion or childbirth, fill in 0; If the last menstrual period is ominous, fill in 9 on the date of the month, that is, September 99, 9999.

Delivery time: according to the Gregorian calendar date, the time must be filled in, according to the format of 00~23 o'clock; The ominous person fills in 99; If there is no delivery or abortion before 28 weeks, fill in 0 in this item.

Place of delivery: refers to the place where the pregnant woman is at the time of fetal delivery. If there is no delivery or abortion before 28 weeks, fill in 0 for this item, and fill in 9 for those who are unknown. Provincial (prefectural) hospitals refer to provincial, prefecture-level hospitals and equivalent military, factory and mine hospitals; County (district) hospitals refer to county hospitals and equivalent military, factory and mine hospitals; Township, town and street hospitals also include factories and mines at the same level. Death location: the type definition is the same as the delivery location.

Mode of delivery: Hip traction, fetal head suction, forceps, fetal destruction and varus all belong to the scope of vaginal surgery. New mode of delivery: refers to the fourth disinfection: that is, the delivery bag, the hands of the midwife, the vulva of the parturient and the umbilical cord of the baby are disinfected, and the delivery is carried out by doctors, midwives, trained primary health workers or trained midwives.

Midwives: medical personnel refer to doctors, nurses and midwives above township hospitals; Rural doctors refer to rural doctors or individual practitioners; Midwife means a trained midwife; Others refer to untrained midwives and their families, as well as the surrounding neighborhoods.

Prenatal check-up: If yes, please fill in the gestational age of the initial check-up and the number of prenatal check-ups during pregnancy.

Cause of death diagnosis basis: fill in according to the highest diagnosis basis. If there are both clinical diagnosis and pathological diagnosis, fill in the pathological diagnosis. Clinical diagnosis includes laboratory and other auxiliary examinations.

Re-examination results of medical institutions at all levels and main factors affecting death: this item is not filled in for the time being. However, after the local maternal death registration report card is audited, the audit results can be filled back into the supplementary card.

Death certificate 5 Death certificate (stub)

This is to certify that the resident, gender, address and ID number of the original jurisdiction died on, and the account was cancelled.

Hereby certify that

Organizer:

Police station (seal)

time

- .

proof of death

This is to certify that the resident, gender, address and ID number of the original jurisdiction died on, and the account was cancelled.

Hereby certify that

time

Death Certificate 6 Zhong 'an Notary Office, Hefei City, Anhui Province:

(Name) needs to apply for notarization of (name) death because of going abroad (for the purpose of studying abroad and settling down, etc.). This is to certify that: _ (name), _ male (or female), was born in and lived in before his death.

, in the province.

The city (or county) died of (cause of death).

Hereby certify that

Completed by: (signature)

Seal of relevant department:

Xx，xx，XX，XX

Death certificate 7 This is to certify that the resident of our village: xx, gender, Han nationality, is a villager in Group X of xx Village, xx Town, xx City, with the date of birth, ID number: xxxxx, and the contact person and contact information of the family members of the person who died of xx disease on the date of the month.

Hereby certify that

Signature of village director: xx year X month X day

Death certificate There are XXX and XXX couples in Group X of XX Village, 8 XX Township. They gave birth to the X-th child in 20xx, named XXX, with a gender of X and X family, and have not yet registered in the public security household registration. On the morning of XX, XX, XX, XXX was seriously ill and failed to receive timely treatment.

Hereby certify that

XXX police station

20xx year x month x day

Death Certificate 9 "Medical Certificate of Cause of Death" is a legal proof filled out by doctors for people who died of illness, and it is kept by public security departments and health departments in China. It has a dual purpose:

1. It is a population management record of residents' death, which records the basic information of the deceased and the cause of death. The public security department can cancel the account accordingly, and can also be used as a funeral and cremation department.

The basis of corpse incineration.

2. It is the original data record of the cause of death statistics, and the health department can calculate a series of death statistics indicators based on it, so as to carry out special research on the health status of residents, put forward public health problems that need to be solved first, and provide reliable basis for formulating corresponding prevention and control measures.

3 can be submitted to the public security and judicial departments as a legal evidence.

4. At present, it is increasingly used for popular and socialized vouchers such as insurance, inheritance and death notarization.

It is worth noting that the medical certificate of the cause of death is only valid after it is stamped with the official seal of the medical unit.

Four, China medical proof of the cause of death.

The Medical Certificate of Death of China Residents was officially issued by the Ministry of Health in August 1990, and all parts of the country were notified to follow it (see attached table). 1992 Three ministries jointly issued a document (Ministry of Health, Ministry of Public Security and Ministry of Civil Affairs) reaffirming the format of medical certificate of death in China. The core part of medical death certificate adopted in China completely adopts the basic format of International Medical Death Certificate. The rest, try to keep and absorb the reasonable part of the death report (card) used before in all parts of China. The medical certificate of death used by China is in quadruplicate. The first copy is the stub of the issuing unit; The second copy is used for computer entry, and the issuing unit directly submits it to the local county (district) disease control institution; Third, the household registration management department cancels the household registration certificate; The fourth is the evidence of funeral and cremation. The style of each couplet is as follows:

Death Certificate 10 Chapter IV Attachment

Stub of death medical certificate

figure

Name and sex of the deceased 1 male 2 female 9 unknown.

If it is female, what kind of situation does it belong to:

1. Not pregnant within one year before her death. 2. Be pregnant when you die. 3. Not pregnant at the time of death, but pregnant within 42 days before death. 4. Not pregnant at the time of death, but pregnant within 43 days to one year before death. 5. You can't be sure whether you are pregnant within one year before your death.

nation

Main occupations and types of work

ID card number

The domicile of the street (township) in the province or city (county) where the household registration is located. The street (township) where the household registration is located in a province or city (county) is of sufficient age. The national identity card number is old enough. Marital status is 1. Unmarried 2 married 3 widowed 4 divorced 9 unknown household registration location.

Education level 1 University and above 2 middle schools 3 primary schools 4 illiterate or semi-illiterate 9 unknown

Work unit before death

Date of birth, date of death, date of death.

Exact age

Permanent address before death

Place of death

1 Hospital Ward 2 Emergency Room 3 Home 4 On the way to the hospital 5 Other unknown family members should contact.

Address or work unit of family members

The cause of death is the diagnosis of the main disease that causes death (please fill in the specific disease name, not the time interval from symptom appearance to death)

date of death

(a) A disease or condition that directly leads to death:

(b) The disease or condition leading to (a): MM DD YY.

(c) The disease or condition that caused (b): Name of family member (d) The disease or condition that caused (c):

And liaison office

Ⅱ*

Diagnosis of other diseases (promoting death, but not causing death)

Other important circumstances):

The doctor signed the above-mentioned diseases before the death of the deceased 1 provincial hospitals 2 prefecture-level hospitals 3 county-level hospitals.

The highest diagnostic unit: 4 hospitals, 5 village clinics, 6 did not see a doctor, and 9 other and unknown medical units stamped.

The highest diagnostic basis of the above diseases before death:

1 Autopsy 2 Pathology 3 Surgery 4 Clinical+Physicochemical 5 Clinical 6 Inference 9 Unknown date after death

Resident signature

Medical unit seal

Year, month, day and death root cause: ICD code: Remarks:

Style on the back of death medical certificate: location of registered permanent residence

Permanent address before death

cause of death

Date of death year month day.

Name and contact office of the third family member

Signature of doctor and seal of medical unit

date month year

Seal of police station

date month year

Completion date year month day

fourfold

make it clear

This copy is kept by the issuing authority.

make it clear

This copy shall be kept by the household registration authority.

make it clear

1. Go to the crematorium for cremation with this certificate.

2. This certificate is invalid without the signature of the doctor and the seal of the medical unit and the police station.

1. If it is a female deceased, whether she was pregnant at the time of death or pregnant a year ago is very important for the calculation of maternal mortality.

2. Main occupation and job type: Fill in occupation and main job as much as possible. Such as: workers, farmers, cadres, students, soldiers, service industries, etc. ; You can also fill in the type of work in detail, such as lathe worker, fitter, electrician, textile worker, etc.

3. Permanent address: the address registered in the household registration book should be filled in completely, including the specific house number of the residence. 4. At least one year old: fill in according to one year old. If it is a baby, you can fill in the actual month, day and hour of survival. 5. Place of death: wards of medical institutions, including village clinics. Tick √ before the corresponding item.

6. The diagnosis of major diseases that lead to death can be divided into two parts: the first part (a) fill in the clinical manifestations of diseases that eventually lead to death, such as cor pulmonale, cerebral hemorrhage and skull fracture (do not fill in respiratory and circulatory failure); In (b), insert the disease or condition leading to (a); Such as emphysema, hypertension, external causes of trauma poisoning (collision between bicycle and car, suicide by jumping off a building, etc.). ); (c) Fill in the diseases or conditions that lead to (b), such as chronic bronchitis. Fill in other diseases or conditions that have nothing to do with the first part but have caused death in the second part.

7.ICD cause of death coding: Code the cause of death of the deceased according to the standard of the tenth edition of the International Classification of Diseases (ICD- 10), which shall be filled in by the reporting unit.

8. The highest diagnostic unit of diseases: generally refers to the last diagnostic unit of major diseases before death, and the highest diagnostic unit of diseases reported in Part I (a) can also be filled in. For example, provincial (city) hospitals include hospitals at or above the provincial level, and so on.

Attachment 1- 1: Supplementary Card for Maternal Death Registration Report

Supplementary card for maternal death registration report

(to be completed at the same time with the medical certificate of death of residents)

figure

Name and account 1. Local 2. Non-local 1 inside and outside the plan. Plan 2. Unplanned.

Education level 1. College degree or above. High school or technical secondary school. Junior high school 4. Primary school 5. Economic level 1. 200 yuan above 2. /kloc-more than 0/00 yuan 3. 50 yuan above 4. Living quarters below 50 yuan 1. Plain 2. Mountain area 3. Last menstrual delivery time in other areas.

Number of induced abortions and induced labor

Provinces, cities under the jurisdiction of provinces and districts (counties) of temporary residence

Place of delivery 1. 2 provincial (prefecture, city) hospitals. County (district) hospital. Township, town and street hospitals. Rural delivery room 5. Maternity home 6. On the way. Other 9. Unknown place of death 1. 2 provincial (prefecture, city) hospitals. County (district) hospital. Street hospital 4. Rural delivery room 5. Maternity home 6. On the way. Other 9. Unknown transfer mode 0. Unborn 1. Natural delivery 2. Vaginal surgery for delivery. A new method of cesarean section 1. It's two. number

Midwife 1. Medical staff 2. Country doctor 3. Midwife 4. Other personnel.

Prenatal examination 1. It's two. There were no prenatal examinations during the first pregnancy. Evaluation results of medical and health institutions at county (city, district) level 1. Avoidable 2. Creating conditions can avoid 3. The main factors that inevitably affect death 1 No.2 and No.3.

The evaluation result of municipal medical and health institutions is 1. Can be avoided. 2. You can avoid creating conditions. 3. The main factor that inevitably affects the number of deaths is 1. The doctor signs the card and the medical unit seals it.

Completion date year month day

Remarks:

Death certificate 1 1 Name: _ _ _ Gender: _ _ _ _ _ Nationality: _ _ _ _ _ Date of birth: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Died of illness. Cancel the account of _ _ _ _ _ _ _.

_ _ _ _ police station

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _

The death certificate 12 is from Fenshui Town, Anju District, Suining City, Sichuan Province. The husband and wife (son and daughter) were born in. Died some day this year.

Hereby certify that

Anju district fenshui town village village Committee

People's Government of Fenshui Town, Anju District

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Death certificate 13 xx county funeral home:

This is to certify that the residents of this village are: xx ××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××

Hereby certify!

Village Director (signature):

Xx Village Committee of xx Township (Seal)

Xx，xx，XX，XX

Death certificate 14 This is to certify that the resident of our village: ××××××, gender, Han nationality, is a villager of××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××

Hereby certify that

Signature of village director: ×××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××××

Death certificate 15 xx A notary office:

Xx (name) is going to xx (for the purpose of going abroad, such as studying abroad and settling down). ), so you need to apply for xx death notarization. This is to certify that xxxxx (name), male (or female), was born on xx, xx, and lived in this province on xx, XX.

The city (or county) died of (cause of death).

Hereby certify that

Filled by: xxxx (signature)

Seal of relevant department:

date month year