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Source: [1]
| Information about the provider / about the doctor
|
| Health service provider identification number (IC)
|
| Device serial number (PCZ)
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| Department
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| Doctor's name
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| Doctor's surname
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| Doctor's phone number
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| Basic data about the deceased
|
| Stillborn child
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| Person with incomplete identification
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| Age for persons of unknown identity
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| Deceased's social security number
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| Insurance number
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| Health insurance
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| Name(s)
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| Surname(s)
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| Maiden name(s)
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| Birthdate
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| Sex
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| Citizenship
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| More information about the deceased
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| Place of birth
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| Permanent residence
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| Highest completed education
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| State
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| Spouse/partner
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| Information about the death and its circumstances
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| Date of death
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| Time of death
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| Estimated date of death
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| Place of death/discovery of the deceased's body
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| Non-removable prostheses or prostheses made of precious metals
|
| Examining/dissecting physician's proposal
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| Autopsy requested
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| Autopsy performed
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| Location of death
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| Site of examination/autopsy
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| Date of examination/autopsy
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| Causes of death
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| Immediate cause of death
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| Mediating causes of death
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| Underlying cause of death
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| Secondary causes
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| Drug-related deaths
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| Type of death
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| External cause of death
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| Deaths of mothers and children under 1 year of age
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| Mother's date of birth
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| Deceased pregnant women or women who gave birth or had an abortion in the 365 days before death: death during pregnancy
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| Death in pregnancy
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| Length of pregnancy
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| Death in childbirth/miscarriage
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| Death at six months of age
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| Death within 1 year after childbirth or abortion
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| Termination of pregnancy
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| Place of termination of pregnancy
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