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Death Certificate (Revised)

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Effective January 1, 2004

The State of Michigan developed a revised death certificate to be used for all deaths that occur on or after January 1, 2004. The revision was necessitated by a change to the national standard death certificate issued by the Centers for Disease Control. Michigan law, namely M.C.L. 333.2811, requires the national standard form be followed as nearly as possible.

Provided below are a sample a copy of the new form and three sets of instructions for completion, namely a set of detailed general instructions and specific instructions for physicians and for medical examiners. These instructions cover proper completion of these new forms along with other revisions designed to improve the registration process, particularly relative to review of the medical section.


General Instructions
Instructions for Funeral Directors
Instructions for Medical Examiners
Instructions for Physicians

Additional Information

A sample copy of the revised death certificate.
A listing of Michigan Place Names (for use in Item 8c. Unincorporated Places)

Summary of Changes

The following information provides a quick summary of nine key changes to this form.

Item 5. Name at Birth or Other Name Used for Personal Business

This field is intended to better identify the decedent to facilitate handling affairs after death and to create a better historical record. Entering alias names in this field is appropriate as is entering a name at birth for women who have changed their name after marriage. This is not a required field, but can be used to better document the decedent's alternate names when appropriate.

Item 8c. Unincorporated Places

With the current certificate listing an unincorporated place as the place of residence for the decedent can result in registration problems and can interfere with the families wishes for listing their residence at death. Adding a separate check box to indicate an unincorporated place will help avoid this problem. A listing of Michigan places and their incorporation status is enclosed and will be available through the state Web site to assist in clarifying this issue.

Item 11. Education

The format for reporting the decedent's education has been revised to require reporting years of school completed for less than high school and degrees earned for high school or higher levels of education. Entering the standard initials for a degree are appropriate, i.e. BA, MS or MD.

Item 13b. Hispanic Origin

While national standards require the collection of Hispanic ethnicity, Michigan continues to prefer an open ancestry item. Unfortunately, when the ancestry of the decedent is not known or is reported as American, their Hispanic status is lost. This item will compliment the ancestry item and eliminate the current "unknown" Hispanic problem.

Item 21b. Relationship

This item is intended to record the relationship of the informant to the decedent, as in husband, wife, son, daughter, etc.

Item 28c. Time Pronounced Dead

This item compliments the item actual time of death, item 28a, which has been collected historically.

Item 37. Did Tobacco Use Contribute to Death?

A medical determination on whether tobacco use played a role in this death. This item was added to the national standard form to provide a better opportunity for documenting when a death is tobacco related.

Item 38. If Female: Pregnancy Status

An item to insure better identification of all pregnancy related deaths as part of the ongoing national monitoring of maternal deaths.

Item 41f. If Transportation Injury

An item to report the involvement of the decedent in a car or other vehicle crashes. Indicate whether a driver, a passenger, a pedestrian or the like. This item was added to the national standard form to enable more accurate US coding of vehicular deaths following new international guidelines.