PHI stands for "Protected Health Information" (Y = Yes, N = No)
| Display | Field | Phi | Field type | Condition choices | Field note | Header | |
|---|---|---|---|---|---|---|---|
| - | bpldc_tod_unknown | N | checkbox | 1, Actual Or Presumed Time Of Death Unknown? | - | - | |
| - | bpldc_time_pronounce_dead_unknown | N | checkbox | 1, Time Pronounced Dead Unknown? | - | - | |
| - | bpldc_injury_time_unknown | N | checkbox | 1, Time of Injury Unknown? | - | - | |
| 1. Decedent's Name (First, Middle, Last) | bpldc_name | Y | text | - | - | DECENDENT | |
| 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 | |
| 2. Date of Birth | bpldc_dob | Y | text | - | - | ||
| 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 | |
| 28b. Pronounced Dead On | bpldc_pronounce_dead | Y | text | - | - | - | |
| 28c. Time Pronounced Dead | bpldc_time_pronounce_dead | N | text | - | Military Time | - | |
| 3. Sex | bpldc_sex | N | radio | 1, Male | 2, Female | 3, Other | - | ||
| 30. Place Of Death | bpldc_deathplace | Y | text | - | - | ||
| 31. If Hospital | bpldc_if_hospital | Y | text | - | - | ||
| 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 | - | ||
| 4. Date of Death | bpldc_dod | Y | text | - | On or After | ||
| 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 | - | |
| 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 | - | - | - | |
| 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 | - | - | ||
| Approximate Interval Between Onset and Death in Minutes | bpldc_36a | Y | notes | - | - | - | |
| Approximate Interval Between Onset and Death in Minutes | bpldc_36b | Y | notes | - | - | - | |
| Approximate Interval Between Onset and Death in Minutes | bpldc_36c | Y | notes | - | - | - | |
| Approximate Interval Between Onset and Death in Minutes | bpldc_36d | Y | notes | - | - | - | |
| IMMEDIATE CAUSE (Final disease or condition resulting in death) | bpldc_chain_immed_cause | Y | notes | - | - | ||
| 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 | |
| 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 | - | - | ||
| Was the case referred to a coroner? | bpldc_coroner | N | text | - | - | ||
| 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 | |
| c. Enter the UNDERLYING CAUSE (disease of injury that initiated the events resulting in death) LAST | bpldc_chain_sequence_c | Y | notes | - | - | ||
| d. Enter the UNDERLYING CAUSE (disease of injury that initiated the events resulting in death) LAST | bpldc_chain_sequence_d | Y | notes | - | - |