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Death Certification & Cremation Forms

  

Interim Measures During COVID-19 Crisis


Bereavement Support During COVID-19 Pandemic

Follow link for local bereavement support pack

Important E mail addresses

Coventry Registration Office: RegisterOffice@coventry.gov.uk

Warwick Registration Office: warwickro@warwickshire.gov.uk

Nuneaton Registration Office: nuneatonro@warwickshire.gov.uk

Rugby Registration Office: rugbyro@warwickshire.gov.uk

Canley Crematorium: bereavement.services@coventry.gov.uk

Heart of England Crematorium: nuneaton.cremationpapers@thecmg.co.uk

Verification of Death during COVID-19 Emergency Period

National guidance has been published (follow link for full version).

See also helpful local guidance published in Warwickshire.

This guidance is intended for the verification of death outside of hospitals and to provide a framework for safe verification of death in this coronavirus (COVID-19) emergency period.

This helps avoid long delays in waiting for verification before the deceased person can be moved when medical practitioners are unavailable, which can be distressing for their families and those close to them.

Applies to verification of all expected deaths ie. the result of acute or gradual deterioration in the patient’s health and often due to advanced disease and terminal illness.

The coroner must be notified for any death that is unexpected, unnatural, violent or of an unknown cause ie. not anticipated or related to a known illness that has been previously identified, or unnatural or unexplained.

Procedures after Death (see below for full details)
  • Email death certificate direct to registrar with cover sheet (see right)
  • DO NOT ISSUE PAPER CERTIFICATES TO RELATIVES
  • Email Cremation form direct to your crematorium copying in the Funeral Director using their secure email (see right).
  • Email the Funeral Director separately with your fees.
  • Electronic signatures will suffice from a personal NHS email  adding “Please find attached Cremation form completed by me” (otherwise wet signatures may be requested)
  • Always add your mobile number as your contact number

Contacting the Registrar Out of Hours:

If you need to contact a registrar on a Saturday, Sunday or Public Holiday closure day you will need to telephone Coventry City Council out of hours number (024 7683 2222) between 9.00am – 10.00am and they will arrange for a registrar to ring you back.

Interim Changes to Registration of Death
Essential Summary
  • Cause of death must be acceptable after reviewing available information
  • COVID-19 is an notifiable infectious disease but does not normally require referral to the coroner
  • Proven COVID-19 is acceptable as a cause of death
  • Where COVID-19 is suspected, it can be used in 1b after 1a Bronchopneumonia (for example)
  • A medical practitioner should have visualised (virtually or in person) within 28 days of death, or after death. The certifying doctor does not have to be that person.
  • Seeing after death CANNOT be virtual.
  • The preferred certifying doctor is the attendant doctor where possible and practicable.
  • Death certificates can be amended to meet the new guidance.
  • Wet signatures are required
  • In exceptional circumstances where the deceased has neither been seen in the 28 days before death or seen after death, a discussion with the coroner may lead to an internal issue of a Form100A and approval of a death certificate.
  • Certificates (both sides -with certificate number added manually to the back) should be photographed or scanned and submitted electronically to the Registrar with an additional sheet (example attached) giving contact details for the next of kin and funeral intentions if known.
  • HARD COPIES ARE TO BE FORWARDED ON TO THE REGISTRAR AT LEAST MONTHLY- DO NOT DESTROY – IF AMENDED CERTIFICATES ARE REQUESTED STRIKE THROUGH THE ORIGINALS TO AVOID DUPLICATION
  • The Registrar will forward the Green Disposal sheet electronically to Coventry Bereavement Services for facilitate funeral arrangements with the funeral director.
Summary of Changes to Death & Cremation Regulations

Click on image below for larger flow chart

 

Initial Letter to Registrars

Dear Colleague,

Coronavirus Act 2020 27 March 2020

The provisions now in place allow the following:

MCCD for registration purposes

  • A medical certificate can be accepted from any medical practitioner so long as they are able to state to the best of their knowledge the cause of death.

Registrars can accept MCCDs without referral to the coroner, provided it contains

  • An acceptable cause of death, and indicates that a medical practitioner has seen the deceased either within the 28 days prior to death, or after death (this does not need to be the certifying medical practitioner).

While these provisions are in force, if it is indicated that a patient was seen in the 28 days prior to death by video link (such as skype) this should be accepted as seen.

This (video link) does not however meet the requirement for seen after death.

Signing of the MCCD

Provision for any registered medical practitioner to issue a MCCD without having personally attended the deceased, provided they are sufficiently able, from the available information, to ascertain the cause of death.

The declaration on MCCDs will be amended as necessary by certifying doctors.

This will show whether or not they have been in medical attendance and if not whether another doctor has seen the deceased after death and/or within 28 days prior to death.

The after-death requirement will be through the existing ringed boxes on the MCCD.

If there is no other reason for the death to be referred to the coroner, the MCCD should be accepted. If possible, registration officers should liaise with their local surgeries and hospitals to ascertain a list of possible signatories and their GMC numbers.

The Registration

Permission is granted to remove the requirement for a death or still-birth informant to attend and provide details in person and the requirement for them to sign the register where a local authority can no longer offer face to face service registrations or where this is needed by way of additional contingency.

This will enable the information for the registration to be collected by telephone. When registering by telephone, in the signature box (space 8 of the death entry) registrars should record the full name of the informant followed by the words ‘information given by telephone’ (the same wording should be used for still-birth registrations).

It is possible for telephone registration to be undertaken from the office or remotely and each authority should direct on practice for their area.

Remote registration

If working remotely registrars will still require secure e-mail links in order to receive and send information.

If without print facilities, registrars will need to register manually, although information will still be able to be captured onto RON. In such cases the RON entry should be completed after the register page has been signed by the registrar and they have added their designation. After capturing to RON, the entry can be locked.

The disposal form can also be completed manually and as an option, once signed off, it can be photographed and sent on to the relevant authority as an email attachment with the original being retained.

Qualified Informants

The list of qualified informants is temporarily extended to include a funeral director (where they are acting on behalf of the family)

Funeral directors are an addition to the existing list of qualified informants rather than a replacement, family members are still allowed (and may be preferred).

Where a funeral director does act as informant their designation shall be recorded as “Causing the body………” and the words ‘Funeral Director’ should be recorded after their surname, in the informant surname field.

Electronic transmission of documents

  • The provisions also allow for the electronic transfer of documents relating to the certification and registration process (e.g. transfer of the MCCD from the medical practitioner to the registrar and the form for burial or cremation (the Green), from the registrar to the relevant authority).

It is not envisaged that scanned documents should be received via a third party.

Under this arrangement these documents can be scanned or photographed and sent as an attachment, though a wet signature is still required on the original.

For MCCDs medical practitioners should be provided with a secure (local authority) email address to send to.

Disposal forms can be completed manually and similarly scanned or photographed for onward sending. Registrars should engage to find an email address for the relevant authority (local burial and crematorium authority); which could be a local authority shared mailbox (as long as the relevant person at the crematorium or cemetery can access it) as well as an address for returning counterfoils.

After the emergency period, arrangements should be made to have all original forms sent to the register office to be processed in the normal manner.

Detailed guidance as to how the above modifications may be used is enclosed with this circular. Please also note that registration officers should advise their Compliance Officer, whether they intend to use some or all the modifications.

Yours faithfully Andrew Dent Deputy Registrar General

Interim Changes to Cremation Certification March 2020
Essential Summary
  • Cremation 5 (formerly Part 2) not needed
  • Cremation 4 (formerly Part 1) can be filled, signed and submitted electronically preferably from a secure personal NHS e-mail address rather than a generic practice email (otherwise a wet signature or other verification may be required)
  • Cremation 4 can be completed by a non attendant doctor (if the attendant doctor is unable practically) provide A MEDICAL PRACTITIONER has seen them in person or online in the 28 days before death OR in the period after death
  • The name of the attending doctor / GMC number / date and detail of last consultation or inspection of body is needed in the narrative section 9 of Cremation 4 if completing as a non attending doctor (ie will require detailed review of the records)
  • Please supply a mobile phone number when completing a Cremation 4 and be prepared to discuss its content with the Medical Referee at the crematorium
  • Please pay special attention to the presence of a pacemaker or other significant implant

Cremation Form 4 Click on image below to follow link

Click on the image below for detailed official guidance on completion of Cremation 4
Initial Letter from Ministry of Justice to Crematoria

From: Coroners <CORONERS@Justice.gov.uk>
Sent: 27 March 2020 11:28
Subject: Interim guidance on changes to cremations following Coronavirus Act 2020

Dear colleague

The Coronavirus Act 2020 which received Royal Assent on Wednesday 25 March 2020 has made changes to the regulation of cremations.

We will be issuing revised guidance very shortly but, in the meantime, here are the key changes.

a. The requirement to complete the confirmatory medical certificate (form Cremation 5) is suspended.  Cremations should be authorised on the basis of form Cremation 4 only.

b. Form Cremation 4 remains unchanged and a PDF version continues to be available on our website. It can be submitted electronically and an electronic signature includes being sent from the secure email account of the person completing the form Cremation 4.

c. The requirement for form Cremation 4 to be completed by the attending medical practitioner is suspended.  Any medical practitioner can now complete form Cremation 4, even if they did not attend the deceased during their last illness or after death, if the following conditions are fulfilled:

i.    The medical practitioner who did attend the deceased is unable to sign the form Cremation 4 or it is impractical for them to do so and,       

ii.    A medical practitioner has seen the deceased (including audiovisual/video consultation) within 28 days before death, or has viewed the body in person after death.

d. Examination of the body is not required for completion of form Cremation 4 if the deceased was seen by a medical practitioner (including audiovisual/video consultation) in the 28 days before death.

e. When a medical practitioner who did not attend the deceased completes form Cremation 4, the following applies:

i.     Question 5. ‘Usual medical practitioner’. Where the certifying doctor did not themselves attend the patient either during their illness or after death, the certifying doctor should provide the GMC number and name of the medical practitioner who did attend at Question 9. This should also include the date when the deceased was seen and a report of the record made by the attending doctor.

ii.     Question 6. ‘Not applicable’ is acceptable.

iii.     Question 7. ‘Not applicable’ is acceptable.

iv.     Question 8. ‘Not applicable’ is acceptable. As at (iii) above, if the form Cremation 4 is being completed on the basis of another medical practitioner having seen the deceased after death, the date, time and nature of their examination should be recorded at Question 9.

f. Any completed cremation forms 5 that you may receive will not form part of the application and there will be no duty to retain them.

g. There will be no need for a medical referee to re-authorise any cremation that they have already authorised under the arrangements which applied prior to implementation of the 2020 Act. If you require further advice before we issue our revised guidance, please emailcoroners@justice.gov.uk  Please note that we are dealing with a higher than usual number of queries but will aim to respond as quickly as possible.

Asmita Majumder Coroners, Burial, Cremation and Inquiries Policy Team

102 Petty France, Area 10.20, Westminster, London, SW1H 9AJ

Email: coroners@justice.gov.uk

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