5-C:62 Death Registration Forms. –
I. For every death that occurs in the state of New Hampshire, a death record shall be filed electronically by a funeral director, certifying physician, APRN, physician assistant, next of kin, designated agent, or clerk of the town or city with the division within 36 hours of death and prior to final disposition or entombment.
II. The funeral director, next of kin, or designated agent pursuant to RSA 290:1 shall provide the following information for the death record:
(a) The decedent's full name, sex, date of death, and social security number.
(b) The decedent's age on his or her last birthday in years or, if under one year old, the person's age in months or days lived and, if under one day old, the number of hours or minutes lived. The date of the person's birth by month, day and year.
(c) The person's place of birth, by city or town and state or foreign country.
(d) Whether the decedent was ever in the United States Armed Forces, indicated as yes or no.
(e) If the place of death is a hospital, the record shall indicate: whether the person was an in-patient or whether the person was an outpatient or emergency room patient, in which case the person shall have arrived alive at the hospital's emergency room and died while in the emergency room as an outpatient. The record shall also indicate whether the person was transported while alive to the hospital but determined by a physician, APRN, or physician assistant to be dead at the time the hospital received the body. The city or town where the hospital is located shall be shown as the city or town of death occurrence.
(f) If the place of death is a facility other than a hospital, the record shall indicate: whether the facility is a nursing home, residential, or other facility, the exact location of the facility, and the name of the facility.
(g) If the place of death is not a facility, the record shall indicate: the street name and number; the city, town, or location and the county.
(h) In the case of deaths as described in RSA 611-B:11, when the deceased had died at the scene but was transported on the instructions of the medical examiner to another place for viewing and pronouncement of death, the city or town of death shall be shown as that place where the death actually occurred. If the place of death is unknown but the body is found in the state of New Hampshire, the city or town where the body is found shall be shown as the place of death. When death occurs in a moving conveyance in the United States and the body is first removed from the conveyance in the state of New Hampshire, the death shall be registered in New Hampshire, and the city or town where the body is first removed shall be considered the place of death.
(i) When a death occurs on a moving conveyance while in international waters or air space or in a foreign country or its air space and the body is first removed from the conveyance in the state of New Hampshire, the death shall be registered in the state of New Hampshire, and the certificate shall show the actual place of death insofar as can be determined.
(j) The decedent's marital status.
(k) The name of the decedent's spouse and wife's maiden name, if applicable.
(l) Vocational information, including the decedent's usual occupation, which shall mean the kind of work done during most of the decedent's working life. The type of business or industry, if applicable, such as manufacturing, wholesale or retail and the name of the employer.
(m) Decedent's residence, as identified by the informant, which shall be identified by state; county; city, town or other location; street number; and zip code.
(n) The facility if the decedent has been living in a facility where an individual usually resides for a long period of time, such as a group home, a mental institution, a nursing home, a penitentiary, a hospital for the chronically ill, or another location otherwise identified by the informant.
(o) The decedent's ancestry and race, educational level, and the father's full name and the mother's full maiden name.
(p) The informant's full name and mailing address by street, city or town, state and zip code.
(q) How the body is to be disposed of, to be specified as: burial, cremation, temporary entombment, mausoleum, donation, or other.
(r) Information regarding the place of burial or place cremated, including the name of the cemetery or crematory, the location of cemetery or crematory by city or town and state and the date of disposition; the location of final burial; and information regarding the funeral director, next of kin or designated agent, and the individual issuing the burial permit.
III. The pronouncing physician or pronouncing registered nurse, pursuant to RSA 290:1 and RSA 290:1-b, shall register the following information:
(a) The name of the deceased person.
(b) The date and time of death. If the exact date of death is unknown, it shall be approximated by the person completing the medical certification and noted as approximated or estimated on the death record. If the exact time of death is unknown, it shall be approximated by the person who pronounces the body dead and noted as approximated or estimated on the death record. If it is not possible to make an estimation of the time of death, the time shall be indicated as "unknown." "Unknown a.m." or "unknown p.m." shall not be an acceptable entry.
(c) The official capacity of the registered nurse or physician, which shall be: attending/associate physician or APRN or physician assistant; non-attending physician or APRN or physician assistant; pronouncing registered nurse; medical examiner/deputy medical examiner; temporary/assistant medical examiner; or assistant deputy medical examiner, non-physician.
(d) The date pronounced.
(e) Certification that the above information provided is true, which shall include but not be limited to the pronouncing person's signature; the name and title of the individual who pronounced death; the New Hampshire license number of the physician, APRN, if applicable, or physician assistant, if applicable; whether the death was referred to the medical examiner; and the name and address of the physician, APRN, or physician assistant responsible for determining the cause of death. The individuals listed above shall provide or verify for the death record whether or not the death was referred to the medical examiner.
IV. The individuals listed in paragraph III, except the pronouncing registered nurse, shall provide the following information:
(a) The immediate cause of death and the interval between onset and death; other factors or conditions of which death was a consequence, when applicable, and the interval between onset and death; other significant conditions contributing to death but not related to the immediate cause of death.
(b) Whether or not an autopsy was performed and whether or not autopsy findings were available prior to the determination of the cause of death.
(c) The manner of death, indicated as natural, accidental, suicidal, homicidal, pending investigation, or undetermined.
(d) If the death involved an injury, the month, day, year, and time of injury shall be provided. If the exact date of injury is unknown, it shall be approximated by the person completing the medical certification, noted as approximated or estimated on the death record, and, if it is not possible for the physician, APRN, or physician assistant to make an estimation, the date of injury shall be indicated as "unknown". If the exact time of injury is unknown, it shall be approximated by the person completing the medical certification and noted as approximated or estimated on the death record. If it is not possible for the physician, APRN, or physician assistant to make an estimation, the time shall be indicated as "unknown." "Unknown a.m." or "unknown p.m." shall not be an acceptable entry. The record shall also indicate whether the injury occurred while at work, a description of how the injury occurred, and the physical location or place of injury.
(e) The name, address, title, and license number of the certifier and the date certified.
V. The certifying physician, APRN, or physician assistant shall indicate whether he or she is or is not the same individual who pronounced the death. The certifying physician, APRN, or physician assistant shall indicate whether he or she is the medical examiner. He or she shall sign the form, attesting to the veracity of the information as follows:
(a) A certifying physician, APRN, or physician assistant shall attest to the veracity of the stated time, date, and place that the death occurred.
(b) A medical examiner shall attest to the veracity of the stated time, date, place, cause, and manner of the death.
VI. The attending or certifying physician, APRN, or physician assistant shall provide the following information for a supplemental death certificate: the deceased's name; the date of death; the time of death; the place of death; the name of the pronouncer; the New Hampshire license number of the pronouncer; the official capacity of the pronouncer; the date pronounced dead; the signature of the pronouncer; the date signed; whether this death was referred to the medical examiner; the cause of death; the performance of autopsy, indicated as yes or no; the availability of autopsy findings prior to determination of cause of death, indicated as yes or no; the manner of death; the time, date, and place of injury; whether or not the injury occurred at work; the description of how the injury occurred; the location specified as street and number or rural route number, city or town, and state; the name of the certifier; the signature and title of the certifier; the New Hampshire license number of the certifier; the date signed; and the name and address of the person who determined the cause of death.
VII. The original paper death certificate shall be the official certificate and shall be filed with the division within 10 days from the date of death.