PHI stands for "Protected Health Information" (Y = Yes, N = No)
| Display | Field | Phi | Field type | Condition choices | Field note | Header | |
|---|---|---|---|---|---|---|---|
| 41b. Time Of Injury | bplc_injury_time | N | text | - | Military Time | - | |
| 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 | - | - | - | |
| 6a. Age - Last Birthday (Years) | bpldc_age | N | text | - | - | ||
| 13a. Ancestry | bpldc_ancestry | N | text | - | - | ||
| 14. Ever in the U.S. Armed Forces? | bpldc_armedforces | N | yesno | - | - | ||
| 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 | - | - | - | |
| 9. Birth Place | bpldc_birthplace | Y | text | - | - | ||
| 16. Kind of Business or Industry | bpldc_business_type | 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 | - | - | ||
| 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 | - | - | ||
| 7b. City, Village or Township of Death | bpldc_city | Y | text | - | - | - | |
| Was the case referred to a coroner? | bpldc_coroner | N | text | - | - | ||
| 7c. County of Death | bpldc_county | Y | text | - | - | - | |
| 39. Manner of Death | bpldc_death_manner | N | dropdown | 1, Natural | 2, Accident | 3, Suicide | 4, Indeterminate | - | ||
| 30. Place Of Death | bpldc_deathplace | Y | text | - | - | ||
| 21b. Relationship To Decedent | bpldc_decedent | N | text | - | - | - | |
| 23b. Location | bpldc_deposition_location | Y | text | - | -City or Village, State | - | |
| 22. Method Of Deposition | bpldc_deposition_method | N | text | - | - | DISPOSITION | |
| 23a. Place Of Deposition | bpldc_deposition_place | Y | text | - | - | ||
| 2. Date of Birth | bpldc_dob | Y | text | - | - | ||
| 4. Date of Death | bpldc_dod | Y | text | - | On or After | ||
| 11. Decedent's Education | bpldc_education | N | text | - | - | ||
| 19. Father's Name | bpldc_father_name | Y | text | - | - | PARENTS | |
| 13b. Hispanic Origin | bpldc_hispanic | N | yesno | - | - | - | |
| 31. If Hospital | bpldc_if_hospital | Y | text | - | - | ||
| 21a. Informant's Name | bpldc_informant_name | Y | text | - | - | INFORMANT | |
| 41a. Date Of Injury | bpldc_injury_date | Y | text | - | On Or After | MEDICAL EXAMINER | |
| 41c. Describe How Injury Occurred? | bpldc_injury_description | Y | notes | - | - | - | |
| 41g. Location | bpldc_injury_location | Y | text | - | - | - | |
| 41e. Place Of Injury | bpldc_injury_place | Y | text | - | - | - | |
| - | bpldc_injury_time_unknown | N | checkbox | 1, Time of Injury Unknown? | - | - | |
| 7a. Location of Death/Facility Name | bpldc_location | Y | text | - | - | ||
| 21c. Mailing Address | bpldc_mailing_add | Y | notes | - | - | - | |
| 17. Marital Status | bpldc_marital_status | N | text | - | - | ||
| 20. Mother's Name Before First Married (First, Middle, Last) | bpldc_mother_maiden_name | Y | text | - | - | ||
| 1. Decedent's Name (First, Middle, Last) | bpldc_name | Y | text | - | - | DECENDENT | |
| 18. Name of Surviving Spouse | bpldc_name_spouse | Y | text | - | If wife, given name before first married | ||
| 15. Usual Occupation | bpldc_occupation | N | text | - | - | ||
| 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 | - | - | ||
| 5. Name at Birth or Other Name Used for Personal Business | bpldc_othername | Y | text | - | If blank, leave blank | ||
| 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 | - | ||
| 28b. Pronounced Dead On | bpldc_pronounce_dead | Y | text | - | - | - | |
| 12. Race | bpldc_race | N | text | - | - | ||
| 8b. County | bpldc_residence_county | Y | text | - | - | - | |
| 8c. Locality | bpldc_residence_locality | Y | text | - | - | - | |
| 8a. Current Resident - State | bpldc_residence_state | N | text | - | - | ||
| 8d. Street and Number | bpldc_residence_street | Y | text | - | - | - | |
| 8e. Zip Code | bpldc_residence_zipcode | Y | text | - | - | - | |
| 3. Sex | bpldc_sex | N | radio | 1, Male | 2, Female | 3, Other | - | ||
| 28c. Time Pronounced Dead | bpldc_time_pronounce_dead | N | text | - | Military Time | - | |
| - | bpldc_time_pronounce_dead_unknown | N | checkbox | 1, Time Pronounced Dead Unknown? | - | - | |
| 37. Did Tobacco Use Contribute To Death | bpldc_tobacco_death | N | radio | 1, Yes | 2, No, | 3, Probably | 9, Unknown | - | ||
| 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? | - | - | |
| 41f. If Transportation Injury | bpldc_transport_injury | N | text | - | - | - | |
| 41d. Injury At Work | bpldc_work_injury | N | yesno | - | - | - |