Date of Birth of Deceased: {{patient.birthdate | bahmniDate}} Date of Admission: {{visitSummary.admissionDetails.date | bahmniDate}} Ward No: {{bedDetails.bedNumber}} |
Date and Time Of Death: {{dateAndTimeOfDeath | bahmniDateTime}} NID No:{{DeceasedNID}} ({{nidOf}}) NID No:{{SpouseNID}} ({{nidOf}}) NID No:{{ParentsNID}} ({{ParentsNID}}) |
2
Other significant conditions contributing to death (time intervals can be included in brackets after the condition) |
{{otherSignificantCondition.value}}
|
Was Surgery Performed Within The last four Week | {{frameBSurgeryPerformedLastWeek}} |
If Yes Please Specify Date of Surgery | {{frameBSpecifyDate| bahmniDateTime}} |
If Yes Please Specify Reason for Surgery Disease or Condition | {{frameBSpecifyReason}} |
Was an Autopsy Requested? | {{frameBAutopsyRequested}} |
If Yes, were the Findings used in the Certification | {{frameBCertification}} |
Manner of Death | {{mannerOfDeath}} |
If external cause or poisoning: | {{externalPoisoning}} |
Date of Injury | {{dateOfInjury | bahmniDate}} |
Please describe how external cause occurred
(If poisoning please specify poisoning agent) |
{{describePoisoning}} |
Place of Occurrence of the external cause | {{placeOfOccurrence}} |
Other Place (Please Specify): | {{otherPlace}} |
Multiple Pregnancy | {{multiplePregnancy}} |
Stillborn? | {{stillBorn}} |
If death within 24h specify number of hours survived | {{numberOfHour}} |
Birth weight (in grams) | {{birthWeight}} |
Number of completed weeks of pregnancy | {{weeksOfPregnancy}} |
Age of mother (years) | {{ageOfMother}} |
If death was perinatal, please state conditions of mother that affected the fetus and newborn | {{newBorn}} |
{{data.concept.shortName}} | {{data.value.shortName}} |