PHI stands for "Protected Health Information" (Y = Yes, N = No)
| Display | Field | Phi | Field type | Condition choices | Field note | Header | |
|---|---|---|---|---|---|---|---|
| 41d. Injury At Work | bpldc_work_injury | N | yesno | - | - | - | |
| 41f. If Transportation Injury | bpldc_transport_injury | N | text | - | - | - | |
| - | bpldc_tod_unknown | N | checkbox | 1, Actual Or Presumed Time Of Death Unknown? | - | - | |
| 28a. Actual Or Presumed Time Of Death | bpldc_tod | N | text | - | Military Time | CERTIFICATION | |
| 37. Did Tobacco Use Contribute To Death | bpldc_tobacco_death | N | radio | 1, Yes | 2, No, | 3, Probably | 9, Unknown | - | ||
| - | bpldc_time_pronounce_dead_unknown | N | checkbox | 1, Time Pronounced Dead Unknown? | - | - | |
| 28c. Time Pronounced Dead | bpldc_time_pronounce_dead | N | text | - | Military Time | - | |
| 3. Sex | bpldc_sex | N | radio | 1, Male | 2, Female | 3, Other | - | ||
| 8e. Zip Code | bpldc_residence_zipcode | Y | text | - | - | - | |
| 8d. Street and Number | bpldc_residence_street | Y | text | - | - | - | |
| 8a. Current Resident - State | bpldc_residence_state | N | text | - | - | ||
| 8c. Locality | bpldc_residence_locality | Y | text | - | - | - | |
| 8b. County | bpldc_residence_county | Y | text | - | - | - | |
| 12. Race | bpldc_race | N | text | - | - | ||
| 28b. Pronounced Dead On | bpldc_pronounce_dead | Y | text | - | - | - | |
| 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 | - | ||
| 5. Name at Birth or Other Name Used for Personal Business | bpldc_othername | Y | text | - | If blank, leave blank | ||
| 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 | - | - | ||
| 15. Usual Occupation | bpldc_occupation | N | text | - | - | ||
| 18. Name of Surviving Spouse | bpldc_name_spouse | Y | text | - | If wife, given name before first married | ||
| 1. Decedent's Name (First, Middle, Last) | bpldc_name | Y | text | - | - | DECENDENT | |
| 20. Mother's Name Before First Married (First, Middle, Last) | bpldc_mother_maiden_name | Y | text | - | - | ||
| 17. Marital Status | bpldc_marital_status | N | text | - | - | ||
| 21c. Mailing Address | bpldc_mailing_add | Y | notes | - | - | - | |
| 7a. Location of Death/Facility Name | bpldc_location | Y | text | - | - | ||
| - | bpldc_injury_time_unknown | N | checkbox | 1, Time of Injury Unknown? | - | - | |
| 41e. Place Of Injury | bpldc_injury_place | Y | text | - | - | - | |
| 41g. Location | bpldc_injury_location | Y | text | - | - | - | |
| 41c. Describe How Injury Occurred? | bpldc_injury_description | Y | notes | - | - | - | |
| 41a. Date Of Injury | bpldc_injury_date | Y | text | - | On Or After | MEDICAL EXAMINER | |
| 21a. Informant's Name | bpldc_informant_name | Y | text | - | - | INFORMANT | |
| 31. If Hospital | bpldc_if_hospital | Y | text | - | - | ||
| 13b. Hispanic Origin | bpldc_hispanic | N | yesno | - | - | - | |
| 19. Father's Name | bpldc_father_name | Y | text | - | - | PARENTS | |
| 11. Decedent's Education | bpldc_education | N | text | - | - | ||
| 4. Date of Death | bpldc_dod | Y | text | - | On or After | ||
| 2. Date of Birth | bpldc_dob | Y | text | - | - | ||
| 23a. Place Of Deposition | bpldc_deposition_place | Y | text | - | - | ||
| 22. Method Of Deposition | bpldc_deposition_method | N | text | - | - | DISPOSITION | |
| 23b. Location | bpldc_deposition_location | Y | text | - | -City or Village, State | - | |
| 21b. Relationship To Decedent | bpldc_decedent | N | text | - | - | - | |
| 30. Place Of Death | bpldc_deathplace | Y | text | - | - | ||
| 39. Manner of Death | bpldc_death_manner | N | dropdown | 1, Natural | 2, Accident | 3, Suicide | 4, Indeterminate | - | ||
| 7c. County of Death | bpldc_county | Y | text | - | - | - | |
| Was the case referred to a coroner? | bpldc_coroner | N | text | - | - | ||
| 7b. City, Village or Township of Death | bpldc_city | Y | text | - | - | - | |
| 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 | |
| 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 | |
| 16. Kind of Business or Industry | bpldc_business_type | N | text | - | - | ||
| 9. Birth Place | bpldc_birthplace | Y | text | - | - | ||
| 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 | - | - | ||
| 14. Ever in the U.S. Armed Forces? | bpldc_armedforces | N | yesno | - | - | ||
| 13a. Ancestry | bpldc_ancestry | N | text | - | - | ||
| 6a. Age - Last Birthday (Years) | bpldc_age | N | text | - | - | ||
| Approximate Interval Between Onset and Death in Minutes | bpldc_36d | Y | notes | - | - | - | |
| Approximate Interval Between Onset and Death in Minutes | bpldc_36c | Y | notes | - | - | - | |
| Approximate Interval Between Onset and Death in Minutes | bpldc_36b | Y | notes | - | - | - | |
| Approximate Interval Between Onset and Death in Minutes | bpldc_36a | Y | notes | - | - | - | |
| 41b. Time Of Injury | bplc_injury_time | N | text | - | Military Time | - |