Death certificates

At some point, you will get formal instruction on this. Do the best you can, and don’t worry about making mistakes. From the North Carolina Medical Board’s Forum newsletter (March 2023):

There is no penalty for “getting it wrong”. In the rare circumstance that a family arranges to have their loved one privately autopsied after the death is certified, and the cause of death is determined to be something other than what the certifying clinician listed on the death certificate, the clinician cannot be disciplined by the medical board or be held civilly liable.

North Carolina uses an electronic death registration system; get your credentials set up before you need them, not at 9 p.m. on the night a hospice patient dies. The cause-of-death section is a causal chain, not a list: the immediate cause on the top line, the conditions leading to it below, and the underlying cause on the last used line. “Cardiac arrest,” “respiratory arrest,” and “old age” alone are rejected as mechanisms rather than causes. Anything sudden, unexpected, violent, or possibly related to injury or overdose goes to the medical examiner, and that includes falls in the elderly — a hip fracture death after a fall is an injury death. Timeliness matters enormously to families: nothing in the estate can move until the certificate is filed.