PHI stands for "Protected Health Information" (Y = Yes, N = No)
| Display | Field | Phi | Field type | Condition choices | Field note | Header | |
|---|---|---|---|---|---|---|---|
| 1. Decedent's Name (First, Middle, Last) | bpldc_name | Y | text | - | - | DECENDENT | |
| 2. Date of Birth | bpldc_dob | Y | text | - | - | ||
| 3. Sex | bpldc_sex | N | radio | 1, Male | 2, Female | 3, Other | - | ||
| 4. Date of Death | bpldc_dod | Y | text | - | On or After | ||
| 5. Name at Birth or Other Name Used for Personal Business | bpldc_othername | Y | text | - | If blank, leave blank | ||
| 6a. Age - Last Birthday (Years) | bpldc_age | N | text | - | - | ||
| 7a. Location of Death/Facility Name | bpldc_location | Y | text | - | - | ||
| 7b. City, Village or Township of Death | bpldc_city | Y | text | - | - | - | |
| 7c. County of Death | bpldc_county | Y | text | - | - | - | |
| 8a. Current Resident - State | bpldc_residence_state | N | text | - | - | ||
| 8b. County | bpldc_residence_county | Y | text | - | - | - | |
| 8c. Locality | bpldc_residence_locality | Y | text | - | - | - | |
| 8d. Street and Number | bpldc_residence_street | Y | text | - | - | - | |
| 8e. Zip Code | bpldc_residence_zipcode | Y | text | - | - | - | |
| 9. Birth Place | bpldc_birthplace | Y | text | - | - | ||
| 11. Decedent's Education | bpldc_education | N | text | - | - | ||
| 12. Race | bpldc_race | N | text | - | - | ||
| 13a. Ancestry | bpldc_ancestry | N | text | - | - | ||
| 13b. Hispanic Origin | bpldc_hispanic | N | yesno | - | - | - | |
| 14. Ever in the U.S. Armed Forces? | bpldc_armedforces | N | yesno | - | - | ||
| 15. Usual Occupation | bpldc_occupation | N | text | - | - | ||
| 16. Kind of Business or Industry | bpldc_business_type | N | text | - | - | ||
| 17. Marital Status | bpldc_marital_status | N | text | - | - | ||
| 18. Name of Surviving Spouse | bpldc_name_spouse | Y | text | - | If wife, given name before first married | ||
| 19. Father's Name | bpldc_father_name | Y | text | - | - | PARENTS | |
| 20. Mother's Name Before First Married (First, Middle, Last) | bpldc_mother_maiden_name | Y | text | - | - | ||
| 21a. Informant's Name | bpldc_informant_name | Y | text | - | - | INFORMANT | |
| 21b. Relationship To Decedent | bpldc_decedent | N | text | - | - | - | |
| 21c. Mailing Address | bpldc_mailing_add | Y | notes | - | - | - | |
| 22. Method Of Deposition | bpldc_deposition_method | N | text | - | - | DISPOSITION | |
| 23a. Place Of Deposition | bpldc_deposition_place | Y | text | - | - | ||
| 23b. Location | bpldc_deposition_location | Y | text | - | -City or Village, State | - | |
| 28a. Actual Or Presumed Time Of Death | bpldc_tod | N | text | - | Military Time | CERTIFICATION | |
| - | bpldc_tod_unknown | N | checkbox | 1, Actual Or Presumed Time Of Death Unknown? | - | - | |
| 28b. Pronounced Dead On | bpldc_pronounce_dead | Y | text | - | - | - | |
| 28c. Time Pronounced Dead | bpldc_time_pronounce_dead | N | text | - | Military Time | - | |
| - | bpldc_time_pronounce_dead_unknown | N | checkbox | 1, Time Pronounced Dead Unknown? | - | - | |
| 30. Place Of Death | bpldc_deathplace | Y | text | - | - | ||
| 31. If Hospital | bpldc_if_hospital | Y | text | - | - | ||
| Was the case referred to a coroner? | bpldc_coroner | N | text | - | - | ||
| PART 1. ENTER the chain of events- diseases, injury or complications - that directly caused the death. DO NOT enter terminal events such as cardiac arrest, respiratory arrest or ventricular If diabetes was an immediate, underlying or contributing cause of death be sure to record diabetes in either Part 1 or Part 2 of the cause of death section, as appropriate. | bpldc_chain | N | descriptive | - | - | CAUSE OF DEATH | |
| IMMEDIATE CAUSE (Final disease or condition resulting in death) | bpldc_chain_immed_cause | Y | notes | - | - | ||
| Approximate Interval Between Onset and Death in Minutes | bpldc_36a | Y | notes | - | - | - | |
| b. Enter the UNDERLYING CAUSE (disease of injury that initiated the events resulting in death) LAST | bpldc_chain_sequence_b | Y | notes | - | - | Sequentially list conditions, IF ANY, leading to the cause listed on line | |
| Approximate Interval Between Onset and Death in Minutes | bpldc_36b | Y | notes | - | - | - | |
| c. Enter the UNDERLYING CAUSE (disease of injury that initiated the events resulting in death) LAST | bpldc_chain_sequence_c | Y | notes | - | - | ||
| Approximate Interval Between Onset and Death in Minutes | bpldc_36c | Y | notes | - | - | - | |
| d. Enter the UNDERLYING CAUSE (disease of injury that initiated the events resulting in death) LAST | bpldc_chain_sequence_d | Y | notes | - | - | ||
| Approximate Interval Between Onset and Death in Minutes | bpldc_36d | Y | notes | - | - | - | |
| PART 2. OTHER SIGNIFICANT CONDITIONS contributing to death but not resulting in the underlying cause given in Part 1 | bpldc_oth_signif_condition | Y | notes | - | - | ||
| 37. Did Tobacco Use Contribute To Death | bpldc_tobacco_death | N | radio | 1, Yes | 2, No, | 3, Probably | 9, Unknown | - | ||
| 38. If Female | bpldc_pregnant | N | radio | 1, Not pregnant within past year | 2, Pregnant at time of death | 3, Not pregnant but pregnant within 42 days of death | 4, Unknown if pregnant within the past year | 5, Not pregnant but pregnant within 43 days to 1 year before death | - | ||
| 39. Manner of Death | bpldc_death_manner | N | dropdown | 1, Natural | 2, Accident | 3, Suicide | 4, Indeterminate | - | ||
| 40a. Was An Autopsy Performed? | bpldc_autopsy | N | yesno | - | - | ||
| 40b. Were Autopsy Findings Available Prior To Completion Of Cause Of Death? | bpldc_autopsy_finding | N | yesno | - | - | - | |
| 41a. Date Of Injury | bpldc_injury_date | Y | text | - | On Or After | MEDICAL EXAMINER | |
| 41b. Time Of Injury | bplc_injury_time | N | text | - | Military Time | - | |
| - | bpldc_injury_time_unknown | N | checkbox | 1, Time of Injury Unknown? | - | - | |
| 41c. Describe How Injury Occurred? | bpldc_injury_description | Y | notes | - | - | - | |
| 41d. Injury At Work | bpldc_work_injury | N | yesno | - | - | - | |
| 41e. Place Of Injury | bpldc_injury_place | Y | text | - | - | - | |
| 41f. If Transportation Injury | bpldc_transport_injury | N | text | - | - | - | |
| 41g. Location | bpldc_injury_location | Y | text | - | - | - |