PHI stands for "Protected Health Information" (Y = Yes, N = No)
| Display | Field | Phi | Field type | Condition choices | Field note | Header | |
|---|---|---|---|---|---|---|---|
| d. Enter the UNDERLYING CAUSE (disease of injury that initiated the events resulting in death) LAST | bpldc_chain_sequence_d | Y | notes | - | - | ||
| c. Enter the UNDERLYING CAUSE (disease of injury that initiated the events resulting in death) LAST | bpldc_chain_sequence_c | 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 | |
| Was the case referred to a coroner? | bpldc_coroner | 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 | - | - | ||
| 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 | - | - | - | |
| 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 | - | - | - | |
| 9. Birth Place | bpldc_birthplace | Y | text | - | - | ||
| 8e. Zip Code | bpldc_residence_zipcode | Y | text | - | - | - | |
| 8d. Street and Number | bpldc_residence_street | Y | text | - | - | - | |
| 8c. Locality | bpldc_residence_locality | Y | text | - | - | - | |
| 8b. County | bpldc_residence_county | Y | text | - | - | - | |
| 8a. Current Resident - State | bpldc_residence_state | N | text | - | - | ||
| 7c. County of Death | bpldc_county | Y | text | - | - | - | |
| 7b. City, Village or Township of Death | bpldc_city | Y | text | - | - | - | |
| 7a. Location of Death/Facility Name | bpldc_location | Y | text | - | - | ||
| 6a. Age - Last Birthday (Years) | bpldc_age | N | text | - | - | ||
| 5. Name at Birth or Other Name Used for Personal Business | bpldc_othername | Y | text | - | If blank, leave blank | ||
| 41g. Location | bpldc_injury_location | Y | text | - | - | - | |
| 41f. If Transportation Injury | bpldc_transport_injury | N | text | - | - | - | |
| 41e. Place Of Injury | bpldc_injury_place | Y | text | - | - | - | |
| 41d. Injury At Work | bpldc_work_injury | N | yesno | - | - | - | |
| 41c. Describe How Injury Occurred? | bpldc_injury_description | Y | notes | - | - | - | |
| 41b. Time Of Injury | bplc_injury_time | N | text | - | Military Time | - | |
| 41a. Date Of Injury | bpldc_injury_date | Y | text | - | On Or After | MEDICAL EXAMINER | |
| 40b. Were Autopsy Findings Available Prior To Completion Of Cause Of Death? | bpldc_autopsy_finding | N | yesno | - | - | - | |
| 40a. Was An Autopsy Performed? | bpldc_autopsy | N | yesno | - | - | ||
| 4. Date of Death | bpldc_dod | Y | text | - | On or After | ||
| 39. Manner of Death | bpldc_death_manner | N | dropdown | 1, Natural | 2, Accident | 3, Suicide | 4, Indeterminate | - | ||
| 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 | - | ||
| 37. Did Tobacco Use Contribute To Death | bpldc_tobacco_death | N | radio | 1, Yes | 2, No, | 3, Probably | 9, Unknown | - | ||
| 31. If Hospital | bpldc_if_hospital | Y | text | - | - | ||
| 30. Place Of Death | bpldc_deathplace | 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 | - | |
| 28b. Pronounced Dead On | bpldc_pronounce_dead | Y | text | - | - | - | |
| 28a. Actual Or Presumed Time Of Death | bpldc_tod | N | text | - | Military Time | CERTIFICATION | |
| 23b. Location | bpldc_deposition_location | Y | text | - | -City or Village, State | - | |
| 23a. Place Of Deposition | bpldc_deposition_place | Y | text | - | - | ||
| 22. Method Of Deposition | bpldc_deposition_method | N | text | - | - | DISPOSITION | |
| 21c. Mailing Address | bpldc_mailing_add | Y | notes | - | - | - | |
| 21b. Relationship To Decedent | bpldc_decedent | N | text | - | - | - | |
| 21a. Informant's Name | bpldc_informant_name | Y | text | - | - | INFORMANT | |
| 20. Mother's Name Before First Married (First, Middle, Last) | bpldc_mother_maiden_name | Y | text | - | - | ||
| 2. Date of Birth | bpldc_dob | Y | text | - | - | ||
| 19. Father's Name | bpldc_father_name | Y | text | - | - | PARENTS | |
| 18. Name of Surviving Spouse | bpldc_name_spouse | Y | text | - | If wife, given name before first married | ||
| 17. Marital Status | bpldc_marital_status | N | text | - | - | ||
| 16. Kind of Business or Industry | bpldc_business_type | N | text | - | - | ||
| 15. Usual Occupation | bpldc_occupation | N | text | - | - | ||
| 14. Ever in the U.S. Armed Forces? | bpldc_armedforces | N | yesno | - | - | ||
| 13b. Hispanic Origin | bpldc_hispanic | N | yesno | - | - | - | |
| 13a. Ancestry | bpldc_ancestry | N | text | - | - | ||
| 12. Race | bpldc_race | N | text | - | - | ||
| 11. Decedent's Education | bpldc_education | N | text | - | - | ||
| 1. Decedent's Name (First, Middle, Last) | bpldc_name | Y | text | - | - | DECENDENT | |
| - | 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? | - | - |