Death Information

The Death Information screen allows users to capture detailed information regarding an individual's death. This screen only appears in the Final Section if the primary category of the incident is Death.

Note: Mandatory fields are marked with an asterisk. In addition, some fields are conditionally mandatory, or in other words, become mandatory based on the response to a previous field. All mandatory fields (including conditionally mandatory fields) must be completed on a screen.

Field Name	Field Description
What were the significant health conditions related to the death?	State the participant’s significant health conditions related to the death.
Was the individual in hospice care?	Select from the drop-down whether the individual was receiving hospice care.
Did the individual have a diagnosed terminal illness?	Select from the drop-down whether the individual was diagnosed with a terminal illness.
What is the diagnosed terminal illness?	If indicated in the previous question that the individual has a terminal illness, select the diagnosed terminal illness from the drop-down.
If other, please specify:	If ‘Other’ is selected as the diagnosed terminal illness, please provide an explanation.
Was a 'Do Not Resuscitate' order in effect?	Select from the drop-down whether a 'Do Not Resuscitate' or DNR order was in effect.
Did the provider initiate CPR?	Select from the drop-down whether the provider initiated CPR.
Did other parties perform CPR?	If other parties performed CPR, select from the drop-down the party who performed CPR.
If other, please specify:	If ‘Other’ is selected as the type of party who performed CPR, please provide an explanation.
Was the coroner contacted?	Select whether the coroner was contacted.
Was a toxicology screening performed?	Select whether a toxicology screening was performed.
Autopsy Status:	Select from the drop-down indicating the status of the autopsy for the participant.
If applicable please provide supplemental information that exists for this report (Forward hard copies of the available documents to OLTL):	Select from the checkbox list the supplemental information (i.e. Autopsy report, Death Certificate, etc.) that exists for this report. Hard copies of available supplemental information should be forwarded to OLTL.
If other, please specify:	If 'Other' is selected as supplemental information, specify the information that exists.
Was there a Substitute Healthcare Decision Maker?	Select whether there was a Substitute Healthcare Decision Maker for the participant.
If yes, please specify their name:	If there was a Substitute Healthcare Decision Maker, specify their first and last name.
Relationship to the deceased:	If there was a Substitute Healthcare Decision Maker, select from the drop-down their relationship to the deceased.
If other, please specify:	If ‘Other’ was selected as the relationship to the deceased, please specify what is the relationship.
How many times in the last 6 months was the participant hospitalized?	Enter the number of times in the last 6 months the participant was hospitalized.
How many times in the last 6 months was the participant in the Emergency Room?	Enter the number of times in the last 6 months the participant was in the Emergency Room.
Was hospitalization information recorded in another incident in relation to this death incident?	Select whether hospitalization information was recorded in another incident in relation to this death. Note: If hospitalization information was recorded in another incident in relation to this death, link the incident to this death incident.
Was this death suspected to be a result of abuse or neglect?	Select whether this death was suspected to be a result of abuse or neglect. Note: If this incident was a result of abuse or neglect, an abuse or neglect incident report must be filed and linked to this incident.