Docstoc

Blank Death Certificate - Excel

Document Sample
Blank Death Certificate - Excel Powered By Docstoc
					11/15/2010                                                   ACME Input Record Format                                                                          Page 1
                                                                      2003
                                                    Generated by MICAR200 or Manually Coded
   Position   Variable                           Item# Name             Format        Code Structure Description
     1-4      Date of Death--Year                     29 DOD_YR                  4    Year of Death (numeric)
     5-6      State of Death                          16 ST_OCC                $2     Alpha - see FIPS table 5-2; NCHS Part 8 Instruction Manual
    7 - 12    Certificate Number                         CERT_#                  6    left 0 filled; 000001-999999
      13      coder status                               CS                      1    Numeric, Valid codes: 0 - 9
                                                                                      NCHS ID Information. Numeric, 0001 - 9999. (States commonly use "book
    14 - 17   lot                                        LOT                     4    number"
      18      section number                             SECT                    1    NCHS ID Information. Numeric, 0 - 9
                                                                                      NCHS ID Information. Alpha\Numeric. Usually month of death or month of
    19 - 21   shipment number                            SHIP                  $3     receipts
              Receipt Date Inserted at NCHS
    22 - 23   NCHS receipt date --Month                    REC_MO                    $2         01-12, blank
    24 - 25   NCHS receipt date --Day                      REC_DY                    $2         01-31, blank
    26 - 29   NCHS receipt date --Year                     REC_YR                    $4         >=year of death, blank
    30 - 33   PGM version control - SuperMICAR             VER_SM                      4        Computer Generated. Version number of SuperMICAR
    34 - 37   PGM version control - MICAR200               VER_200                     4        Computer Generated. Version number of MICAR200
      38      Age: units                            4      AGETYPE                     1      1 Years
                                                                                              2 Months
                                                                                              3 Weeks
                                                                                              4 Days
                                                                                              5 Hours
                                                                                              6 Minutes
                                                                                              9 Unknown
    39-41     Age: number of units                  4      AGETYPE                     3        001 - 135, 999
     42       Manner of Death                           37 MANNER                    $1 N       Natural
                                                                                         A      Accident
                                                                                         S      Suicide
                                                                                         H      Homicide
                                                                                         P      Pending Investigation
                                                                                         C      Could not be determined
                                                                                                Blank
                                                                                                1 - 5, 9, or blank. See NCHS instruction Manual
      43      Intentional reject                           INT_REJ                   $1         Part 2b for code structure
      44      ACME system reject codes                     SYS_REJ                   $1       1 MICAR Reject - dictionary match
                                                                                              2 ACME reject
                                                                                              3 MICAR Reject - Rule Application
                                                                                              4 Reviewed
11/15/2010                                                                   ACME Input Record Format                                                                                  Page 2
                                                                                      2003
                                                                    Generated by MICAR200 or Manually Coded
   Position   Variable                                           Item# Name             Format        Code Structure Description
                                                                                                   0 Not Rejected
                                                                                                      blank
      45      Place of Injury (ICD10 codes)                           40 INJPL                 $1  0 Home

              Computer generated if file generated by MICAR200                                           1 Residential Institution
              Codes assigned manually or by system other then
              MICAR                                                                                      2 School, Other Institutions, Administrative Area
                                                                                                         3 Sports and Recreation Area
                                                                                                         4 Street/Highway
                                                                                                         5 Trade and Service Area
                                                                                                         6 Industrial and Construction Area
                                                                                                         7 Farm
                                                                                                         8 Other specified Place
                                                                                                         9 Unspecified Place
                                                                                                           Blank
                                                                                                           From Input; blank if not coded. 5th position reserved for use if ICD
    46 - 50   manual underlying cause code                               MAN_UC                  $5        becomes 5-digit code
                                                                                                           120 positions. For coding instructions, refer to Part 2b manual; for data
   51 - 170   Entity Axis Codes                                        32 EAC_FF               $120        entry instructions refer to Part 2d Instructional Manual
     171      Was an Autopsy Performed?                                33 AUTOP                  $1 Y      Yes
                                                                                                     N     No
                                                                                                     U     Unknown
     172      Were Autopsy Findings Available to                       34 AUTOPY                 $1 Y      Yes
                Complete the Cause of Death?                                                         N     No
                                                                                                     U     Unknown
                                                                                                     X     Not Applicable: Computer generated
     173      Did Tobacco Use Contribute to Death?                     35 TOBAC                  $1 Y      Yes
                                                                                                     N     No
                                                                                                     P     Probably
                                                                                                     U     Unknown
                                                                                                     C     Not on certificate
     174      Pregnancy                                                36 PREG                     1     1 Not pregnant within past year
                                                                                                         2 Pregnant at the time of death
                                                                                                         3 Not pregnant, but pregnant within 42 days of death
                                                                                                         4 Not pregnant, but pregnant 43 days to 1 year before death
                                                                                                         9 Unknown if pregnant within last year
11/15/2010                                                                 ACME Input Record Format                                                                         Page 3
                                                                                    2003
                                                                  Generated by MICAR200 or Manually Coded
   Position    Variable                                        Item# Name             Format        Code Structure Description
                                                                                                 8 Not Applicable: Computer generated
                                                                                                 7 Not on certificate
     175       If Female--Edit Flag: From EDR only                      PREG_BYPASS          $1  0 Edit Passed
                                                                                                 1 Edit Failed, Data Queried, and Verified
                                                                                                 2 Edit Failed, Data Queried, but not Verified
                                                                                                    Blank
    176-177    Date of Injury--Month                                 38 DOI_MO               $2     01 - 12, 99 blank
    178-179    Date of Injury--Day                                   38 DOI_DY               $2     01 - 31, 99, blank
   180 - 183   Date of Injury--Year                                  38 DOI_YR               $4     4-digit year, 9999, blank
   184 - 187   Time of Injury                                        39 TOI_HR               $4     0000 - 2359, 9999, blank
      188      Injury at Work?                                    41    WORKINJ              $1  Y Yes
                                                                                                 N No
                                                                                                 U Unknown
                                                                                                    Blank
                                                                                                 X Not Applicable: Computer generated
   189 - 218   Title of Certifier                                    45 CERTL              $30   D Certifying Physician
                                                                                                 P Pronouncing and Certifying Physician
                                                                                                 M Medical Examiner/Coroner
                                                                                                    Enter Full Text for Other Individual Legally Allowed to Certify
     219       Activity at Time of death: Computer Generated            INACT                $1  0 While engaged in sports activity
                                                                                                 1 While engaged in leisure activities
                                                                                                 2 While working for income
                                                                                                 3 While engaged in other types of work
                                                                                                 4 While resting, sleeping, eating, or engaging in other vital activities
                                                                                                 8 While engaged in other specified activities
                                                                                                 9 During unspecified activity
                                                                                                    blank
   220 - 231   Auxiliary State file number                              AUXNO              $12      000000000001-999999999999; blank
                                                                                                    Optional. Any information entered through SuperMICAR for state use
   232 - 261   State Specific Data                                      STATESP            $30      only.
11/15/2010                                           TRANSAX 2003 Record Format - Output                                                                               Page 4


   Position   Variable                               Item#      Name                Format           Code Structure Description
     1-4      Date of Death--Year                            29 DOD_YR                 4             Year of Death (numeric)
     5-6      State of Death                                 16 ST_OCC                $2             Alpha - see FIPS table 5-2; NCHS Part 8 Instruction Manual
    7 - 12    Certificate Number                                CERT_#                 6             left 0 filled; 000001-999999
      13      coder status                                      CS                     1             Numeric, Valid codes: 0 - 9
                                                                                                     NCHS ID Information. Numeric, 0001 - 9999. (States commonly use
    14 - 17   lot                                               LOT                   4              "book number")
      18      section number                                    SECT                  1              NCHS ID Information. Numeric, 0 - 9
                                                                                                     NCHS ID Information. Alpha\Numeric. Usually month of death or
    19 - 21   shipment number                                   SHIP                 $3              month of receipts
              Receipt Date Inserted by NCHS
    22 - 23   NCHS receipt date --Month                         REC_MO               $2              01-12, blank
    24 - 25   NCHS receipt date --Day                           REC_DY               $2              01-31, blank
    26 - 29   NCHS receipt date --Year                          REC_YR               $4              >=year of death, blank
    30 - 33   PGM version control - SuperMICAR                  VER_SM                4              Computer Generated. Version number of SuperMICAR
    34 - 37   PGM version control - MICAR200                    VER_200               4              Computer Generated. Version number of MICAR100\200
    38 - 41   PGM version control - ACME\TRANSAX                VER_ACTR              4              Computer Generated. Version number of ACME\TRANSAX
      42      Manner of Death                                37 MANNER               $1      N       Natural
                                                                                             A       Accident
                                                                                             S       Suicide
                                                                                             H       Homicide
                                                                                             P       Pending Investigation
                                                                                             C       Could not be determined
                                                                                                     Blank
                                                                                                     1 - 5, 9 or blank. See NCHS Instruction
      43      Intentional reject                                INT_REJ              $1              Manual 2b for code structure
      44      ACME system reject codes                          SYS_REJ              $1          1   MICAR Reject - dictionary match
                                                                                                 2   ACME reject
                                                                                                 3   MICAR Reject - Rule Application
                                                                                                 4   Record Reviewed
                                                                                                 0   Not Rejected
                                                                                                     Blank
      45      Place of Injury - Computer Generated           40 INJPL                $1          0   Home
                                                                                                 1   Residential Institution
                                                                                                 2   School, Other Institutions, Administrative Area
                                                                                                 3   Sports and Recreation Area
                                                                                                 4   Street/Highway
                                                                                                 5   Trade and Service Area
                                                                                                 6   Industrial and Construction Area


                                                                           2003TR
11/15/2010                                                   TRANSAX 2003 Record Format - Output                                                                                  Page 5


   Position    Variable                                      Item#     Name               Format         Code Structure Description
                                                                                                       7 Farm
                                                                                                       8 Other specified Place
                                                                                                       9 Unspecified Place
                                                                                                         Blank
                                                                                                         From Input; blank if not coded. 5th position reserved for use if ICD
    46 - 50    manual underlying cause code                            MAN_UC               $5           becomes 5-digit code
                                                                                                         ACME selected underlying cause. 5th position reserved for future
    51 - 55    ACME underlying cause code                              ACME_UC              $5           use of ICD becomes 5-digit code.
                                                                                                         Maximum of 20 codes. 8 positions each. Format for each 8
    56 - 215   Entity-Axis Codes                                       EAC                 $160          positions:
               1. Part\line number                                                                     1 Part I. Line a
                                                                                                       2 Part I. Line b
                                                                                                       3 Part I. Line c
                                                                                                       4 Part I. Line d
                                                                                                       5 Part I. Line e
                                                                                                       6 Part II
               2. Sequence within line                                                      1            1 - 8 maximum number of codes per line
               3 - 6. ICD code                                                              4
                                                                                                            Used for NCHS "created" codes; blank for all other codes. NOTE:
                                                                                                           created codes should be converted to actual ICD-10 code if the EA
               7. Reserved position                                                         1              field is moved to the final mortality data record
               8. E-code indication                                                         1      &       Ampersand
                                                                                                           blank
                                                                                                           The value coded in the 8th position should not be moved to the final
                                                                                                           mortality data record.
      216      TRANSAX conversion flag: Computer Generated             TRX_FLG              $1         3   conversion using non-ambivalent table entries
                                                                                                       4   Conversion using ambivalent table entries
                                                                                                       5   Duplicate entity-axis codes deleted; no other action involved
                                                                                                       6   Artificial code conversion; no other action
                                                                                                           No Action: blank

   217 - 316   Record-Axis Codes                                       RAC                 $100            Maximum of 20 codes, 5 positions each: format for each 5 positions
               1 - 4. ICD code                                                               4
                                                                                                           5th position blank. Reserved for use if five digit codes are
                                                                                                           implemented. (NCHS "created" codes are converted to actual ICD-
               5. Reserved position                                                          1             10 codes.)
      317      Was an Autopsy Performed?                             33 AUTOP               $1     Y       Yes
                                                                                                   N       No


                                                                                 2003TR
11/15/2010                                                     TRANSAX 2003 Record Format - Output                                                                                   Page 6


   Position    Variable                                        Item#        Name               Format              Code Structure Description
                                                                                                           U       Unknown
     318       Were Autopsy Findings Available to                      34 AUTOPF                $1         Y       Yes
                 Complete the Cause of Death?                                                              N       No
                                                                                                           U       Uknown
                                                                                                           X       Not Applicable: Computer generated
     319       Did Tobacco Use Contribute to Death?                    35 TOBAC                 $1         Y       Yes
                                                                                                           N       No
                                                                                                           P       Probably
                                                                                                           U       Unknown
                                                                                                           C       Not on certificate
     320       Pregnancy                                               36 PREG                   1             1   Not pregnant within past year
                                                                                                               2   Pregnant at the time of death
                                                                                                               3   Not pregnant, but pregnant within 42 days of death
                                                                                                               4   Not pregnant, but pregnant 43 days to 1 year before death
                                                                                                               9   Unknown if pregnant within last year
                                                                                                               8   Not Applicable: Computer generated
                                                                                                               7   Not on certificate
     321       If Female--Edit Flag: From EDR only                          PREG_BYPASS         $1             0   Edit Passed
                                                                                                               1   Edit Failed, Data Queried, and Verified
                                                                                                               2   Edit Failed, Data Queried, but not Verified
                                                                                                                   Blank
   322 - 323   Date of Injury--Month                                   38   DOI_MO                    $2           01 - 12, 99, blank
   324 - 325   Date of Injury--Day                                     38   DOI_DY                    $2           01 - 31, 99. Blank
   326 - 329   Date of Injury--Year                                    38   DOI_YR                    $4           4-digit, 9999, blank
   330 - 333   Time of Injury                                          39   TOI_HR                    $4           0000 - 2359, 9999, blank
     334       Injury at Work?                                   41         WORKINJ                   $1       Y   Yes
                                                                                                               N   No
                                                                                                               U   Unknown
                                                                                                                   Blank
                                                                                                               X   Not Applicable: Computer generated
    335-364    Title of Certifier                                      45 CERTL                 $30            D   Certifying Physician
                                                                                                               P   Pronouncing and Certifying Physician
                                                                                                               M   Medical Examiner/Coroner
                                                                                                                   Enter Full Text for Other Individual Legally Allowed to Certify
     365       Activity at Time of death: Computer Generated                INACT               $1             0   While engaged in sports activity
                                                                                                               1   While engaged in leisure activities
                                                                                                               2   While working for income
                                                                                                               3   While engaged in other types of work


                                                                                      2003TR
11/15/2010                                  TRANSAX 2003 Record Format - Output                                                                            Page 7


   Position   Variable                      Item#   Name               Format     Code Structure Description

                                                                                4 While resting, sleeping, eating, or engaging in other vital activities
                                                                                8 While engaged in other specified activities
                                                                                9 During unspecified activity
                                                                                  Blank
    366-377   Auxiliary State file number           AUXNO                 $12     000000000001-999999999999; blank
                                                                                  Optional. Any information entered through SuperMICAR for state
    378-407   State Specific Data                   STATESP             $30       use only.




                                                              2003TR
11/15/2010                                                TRANSAX Input Record Format                                                                     Page 8
                                                                       2003
                                                        Temporary File Generated by ACME
   Position   Variable                               Item#     Name            Format    Code Structure Description
     1-4      Date of Death--Year                           29 DOD_YR                4   Year of Death (numeric)
     5-6      State of Death                                16 ST_OCC              $2    Alpha - see FIPS table 5-2; NCHS Part 8 Instruction Manual
    7 - 12    Certificate Number                               CERT_#                6   left 0 filled; 000001-999999
      13      coder status                                     CS                    1   Numeric, Valid codes: 0 - 9
                                                                                         NCHS ID Information. Numeric, 0001 - 9999. (States commonly
    14 - 17   Lot number                                       LOT                   4   use "book number"
      18      Section number                                   SECT                  1   NCHS ID Information. Numeric, 0 - 9
                                                                                         NCHS ID Information. Alpha\Numeric. Usually month of death
    19 - 21   Shipment number                                  SHIP                $3    or month of receipts
              Receipt Date Inserted at NCHS
    22 - 23   NCHS receipt date --Month                         REC_MO                   $2          01-12, blank
    24 - 25   NCHS receipt date --Day                           REC_DY                   $2          01-31, blank
    26 - 29   NCHS receipt date --Year                          REC_YR                   $4          >=year of death, blank
    30 - 33   PGM version control - SuperMICAR                  VER_SM                     4         Computer Generated. Version number of SuperMICAR
    34 - 37   PGM version control - MICAR200                    VER_200                    4         Computer Generated. Version number of MICAR200
    38 - 41   PGM version control - ACME\TRANSAX                VER_ACTR                   4         Computer Generated. Version number of ACME\TRANSAX
      42      Manner of Death                                37 MANNER                   $1 N        Natural
                                                                                             A       Accident
                                                                                             S       Suicide
                                                                                             H       Homicide
                                                                                             P       Pending Investigation
                                                                                             C       Could not be determined
                                                                                                     Blank

                                                                                                     1 - 5, 9, or blank. See NCHS instruction
      43      Intentional reject                                INT_REJ                  $1          Manual Part 2b for code structure
      44      ACME system reject codes                          SYS_REJ                  $1      1   MICAR Reject - dictionary match
                                                                                                 2   ACME reject
                                                                                                 3   MICAR Reject - Rule Application
                                                                                                 4   Reviewed
                                                                                                 0   Not Rejected
                                                                                                     blank
      45      Place of Injury - Computer Generated           40 INJPL                    $1      0   Home
                                                                                                 1   Residential Institution
                                                                                                 2   School, Other Institutions, Administrative Area
                                                                                                 3   Sports and Recreation Area
                                                                                                 4   Street/Highway
                                                                                                 5   Trade and Service Area
11/15/2010                                                 TRANSAX Input Record Format                                                                                 Page 9
                                                                        2003
                                                         Temporary File Generated by ACME
   Position    Variable                               Item#     Name            Format    Code Structure Description
                                                                                        6 Industrial and Construction Area
                                                                                        7 Farm
                                                                                        8 Other specified Place
                                                                                        9 Unspecified Place
                                                                                          Blank
                                                                                          From Input; blank of not coded. 5th position reserved for use if
    46 - 50    manual underlying cause code                     MAN_UC              $5    ICD becomes 5-digit code
                                                                                          ACME selected underlying cause. 5th position reserved for
    51 - 55    ACME underlying cause code                       ACME_UC             $5    future use if ICD becomes 5-digit code.
                                                                                          Maximum of 20 codes. 8 positions each. Format for each 8
    56 - 215   Entity Axis Codes                             32                   $160    positions:
               1. Part\line number                                                      1 Part I. Line a
                                                                                        2 Part I. Line b
                                                                                        3 Part I. Line c
                                                                                        4 Part I. Line d
                                                                                        5 Part I. Line e
                                                                                        6 Part II
               2. Sequence within line                                                1   1 - 8 maximum number of codes per line
               3 - 6. ICD code                                                        4

                                                                                                       Used for NCHS "created" codes; blank for all other codes.
                                                                                                      NOTE: created codes should be converted to actual ICD-10 code
               7. Reserved position                                                           1       if the EA field is moved to the final mortality data record
               8. E-code indication                                                           1&      Ampersand
                                                                                                      blank
                                                                                                      The value coded in the 8th position should not be moved to the
                                                                                                      final mortality data record.
      216      Was an Autopsy Performed?                       33 AUTOP                     $1 Y      Yes
                                                                                               N      No
                                                                                               U      Unknown
      217      Were Autopsy Findings Available to              34 AUTOPF                    $1 Y      Yes
                 Complete the Cause of Death?                                                  N      No
                                                                                               U      Unknown
                                                                                               X      Not Applicable: Computer generated
      218      Did Tobacco Use Contribute to Death?            35 TOBAC                     $1 Y      Yes
                                                                                               N      No
                                                                                               P      Probably
                                                                                               U      Unknown
11/15/2010                                                          TRANSAX Input Record Format                                                                                 Page 10
                                                                                   2003
                                                                  Temporary File Generated by ACME
   Position    Variable                                        Item#     Name            Format      Code Structure Description
                                                                                                 C   Not on certificate
     219       Pregnancy                                              36 PREG                  1   1 Not pregnant within past year
                                                                                                   2 Pregnant at the time of death
                                                                                                   3 Not pregnant, but pregnant within 42 days of death
                                                                                                   4 Not pregnant, but pregnant 43 days to 1 year before death
                                                                                                   9 Unknown if pregnant within last year
                                                                                                   8 Not Applicable: Computer generated
                                                                                                   7 Not on certificate
     220       If Female--Edit Flag: From EDR only                       PREG_BYPASS         $1    0 Edit Passed
                                                                                                   1 Edit Failed, Data Queried, and Verified
                                                                                                   2 Edit Failed, Data Queried, but not Verified
                                                                                                     BLANK
   221 - 222   Date of Injury--Month                                  38 DOI_MO              $2      01-12, 99, Blank
   223 - 224   Date of Injury--Day                                    38 DOI_DY              $2      01-31, 99, Blank
   225 - 228   Date of Injury--Year                                   38 DOI_YR              $4      4-digit year, 9999, blank
   229 - 232   Time of Injury                                         39 TOI_HR              $4      0000-2359, 9999, blank
     233       Injury at Work?                                     41    WORKINJ             $1    Y Yes
                                                                                                   N No
                                                                                                   U Unknown
                                                                                                     Blank
                                                                                                   X Not Applicable: Computer generated
   234 - 263   Title of Certifier                                     45 CERTL              $30    D Certifying Physician
                                                                                                   P Pronouncing and Certifying Physician
                                                                                                   M Medical Examiner/Coroner

                                                                                                              Enter Full Text for Other Individual Legally Allowed to Certify
     264       Activity at Time of death: Computer Generated              INACT                      $1     0 While engaged in sports activity
                                                                                                            1 While engaged in leisure activities
                                                                                                            2 While working for income
                                                                                                            3 While engaged in other types of work
                                                                                                              While resting, sleeping, eating, or engaging in other vital
                                                                                                            4 activities
                                                                                                            8 While engaged in other specified activities
                                                                                                            9 During unspecified activity
                                                                                                              Blank
    265-276    Auxiliary State file number                                AUXNO                      12       000000000001-999999999999; blank
                                                                                                              Optional. Any information entered through SuperMICAR for
    277-306    State Specific Data                                        STATESP                   $30       state use only.
11/15/2010                                                    MICAR200 Input Record Format                                                                              Page 11
                                                                           2003
                                                           Temporary File Generated by MICAR100
  Position    Variable                               Item# Name              Format         Code Structure Description
    1-4       Date of Death--Year                        29 DOD_YR                    4     Year of Death (numeric)
    5-6       State of Death                             16 ST_OCC                  $2      Alpha - see FIPS table 5-2; NCHS Part 8 Instruction Manual
   7 - 12     Certificate Number                            CERT_#                    6     left 0 filled; 000001-999999
     13       coder status                                  CS                        1     Numeric, Valid codes: 0 - 9
                                                                                            NCHS ID Information. Numeric, 0001 - 9999. (States commonly use "book
   14 - 17    lot                                           LOT                       4     number")
     18       section number                                SECT                      1     NCHS ID Information. Numeric, 0 - 9
                                                                                            NCHS ID Information. Alpha\Numeric. Usually month of death or month of
   19 - 21    shipment number                               SHIP                    $3      receipts
              Receipt Date Inserted at NCHS
   22 - 23    NCHS receipt date --Month                      REC_MO                         $2           01-12, blank
   24 - 25    NCHS receipt date --Day                        REC_DY                         $2           01-31, blank
   26 - 29    NCHS receipt date --Year                       REC_YR                         $4           >=year of death, blank
   30 - 33    PGM version control - SuperMICAR               VER_SM                           4          Computer Generated. Version number of SuperMICAR
   34 - 35    Date of Death--Month                        29 DOD_MO                           2          01-12, 99
   36 - 37    Date of Death--Day                          29 DOD_DY                           2          01-31 (based on month), 99
     38       Sex                                          2 SEX                            $1       M   Male
                                                                                                     F   Female
                                                                                                     U   Unknown
     39       Age: units                                   4 AGETYPE                          1      1   Years
                                                                                                     2   Months
                                                                                                     3   Weeks
                                                                                                     4   Days
                                                                                                     5   Hours
                                                                                                     6   Minutes
                                                                                                     9   Unknown
   40 - 42    Age: number of units                         4 AGE                              3          001 - 135, 999
     43       Maximum Conditions Flag                        MAX_COND                       $1       1   More than 20 conditions reported or incomplete in SuperMICAR
                                                                                                         Blank - not at maximum
  44 - 193    Condition Codes (ERN)                       32 COND                         $150           Maximum of 15 code, 10 positions for each code.
              Position 1 - 2                                                                  2          Line Number (01 - 10)
              Position 3 - 4                                                                  2          Position on the line (1 - 8)
              Position 5 - 10                                                                 6          Entity-Refernce Number (ERN)
  194 - 298   Duration Codes                              32 DUR                          $105           Maximum of 15 code, 7 positions for each code.
              Position 1 - 2                                                                  2          Line Number (01 - 10)
              Position 3 - 4                                                                  2          Position on the line (1 - 8)
              Position 5 - 7                                                                  3          Duration
    299       Did Tobacco Use Contribute to Death?        35 TOBAC                          $1       Y   Yes
11/15/2010                                                   MICAR200 Input Record Format                                                               Page 12
                                                                          2003
                                                          Temporary File Generated by MICAR100
  Position    Variable                              Item# Name              Format          Code Structure Description
                                                                                          N No
                                                                                          P Probably
                                                                                          U Unknown
                                                                                          C Not on certificate
                                                                                            Blank
    300       Pregnancy                                 36 PREG                    $1     1 Not pregnant within past year
                                                                                          2 Pregnant at the time of death
                                                                                          3 Not pregnant, but pregnant within 42 days of death
                                                                                          4 Not pregnant, but pregnant 43 days to 1 year before death
                                                                                          9 Unknown if pregnant within last year
                                                                                          8 Not Applicable: Computer generated
                                                                                            blank
                                                                                          7 Not on certificate

    301       If Female--Edit Flag: From EDR only             PREG_BYPASS                    1      0   Edit Passed
                                                                                                    1   Edit Failed, Data Queried, and Verified
                                                                                                    2   Edit Failed, Data Queried, but not Verified
    302       Manner of Death                            37 MANNER                         $1       N   Natural
                                                                                                    A   Accident
                                                                                                    S   Suicide
                                                                                                    H   Homicide
                                                                                                    P   Pending Investigation
                                                                                                    C   Could not be determined
                                                                                                        blank
  303 - 304   Date of Injury--Month                      38   DOI_MO                       $2           01-12, 99, blank
  305 - 306   Date of Injury--Day                        38   DOI_DY                       $2           01-31, 99, blank
  307 - 310   Date of Injury--Year                       38   DOI_YR                       $4           4-digit year, 9999
  311 - 314   Time of Injury                             39   TOI_HR                       $4           0000-2399, 9999, blank
    315       Injury at Work?                            41   INJWORK                      $1       Y   Yes
                                                                                                    N   No
                                                                                                    U   Unknown
                                                                                                        Blank
                                                                                                    X   Not Applicable: Computer generated
    316       Was an Autopsy Performed?                  33 AUTOP                          $1       Y   Yes
                                                                                                    N   No
                                                                                                    U   Unknown
                                                                                                        Blank
    317       Were Autopsy Findings Available to         34 AUTOPF                         $1       Y   Yes
11/15/2010                                                                           MICAR200 Input Record Format                                                                                        Page 13
                                                                                                  2003
                                                                                  Temporary File Generated by MICAR100
  Position    Variable                                                      Item# Name              Format          Code Structure Description
                Complete the Cause of Death?                                                                      N No
                                                                                                                    Blank
                                                                                                                  X Not Applicable: Computer generated
                                                                                                                    Blank
  318 - 347   Title of Certifier                                                45 CERTL                   $30    D Certifying Physician
                                                                                                                  P Pronouncing and Certifying Physician
                                                                                                                 M Medical Examiner/Coroner
                                                                                                                    Enter Full Text for Other Individual Legally Allowed to Certify
              Date of Surgery: Applicable to States with a surgery block,
              blank otherwise.
  348 - 349   Date of surgery -- month                                               SUR_MO                          $2         01-12, 99, blank
  350 - 351   Date of surgery -- day                                                 SUR_DY                          $2         01-31, 99, blank
  352 - 355   Date of surgery -- year                                                SUR_YR                          $4         4-digit year, 9999, blank
    356       Activity at Time of death: Computer Generated                          INACT                           $1       0 While engaged in sports activity
                                                                                                                              1 While engaged in leisure activities
                                                                                                                              2 While working for income
                                                                                                                              3 While engaged in other types of work
                                                                                                                              4 While resting, sleeping, eating, or engaging in other vital activities
                                                                                                                              8 While engaged in other specified activities
                                                                                                                              9 During unspecified activity
                                                                                                                                blank
    357       Place of Injury - Computer Generated                               40 INJPL                            $1      A Home
                                                                                                                              B Farm
                                                                                                                              C Residential Institution
                                                                                                                             D Military Residence
                                                                                                                              E Hospital
                                                                                                                              F School, Other Institutions, Administrative Area
                                                                                                                             G Industrial and Construction
                                                                                                                             H Garage/Warehouse
                                                                                                                              I Trade and Service Area
                                                                                                                              J Mine/Quarry
                                                                                                                             K Street/Highway
                                                                                                                              L Public Recreation Area
                                                                                                                             M Institutional Recreation Area
                                                                                                                             N Sports and Recreation Area
                                                                                                                             O Other building
                                                                                                                              P Other specified Place
                                                                                                                             Q Unspecified Place
11/15/2010                                             MICAR200 Input Record Format                                                                             Page 14
                                                                   2003
                                                   Temporary File Generated by MICAR100
   Position    Variable                       Item# Name             Format          Code Structure Description
                                                                                     Blank
   358 - 381   Number of codes on each line         CODE_LN                   24     12 2-digit codes
    382-383    Lowest Used Line in Part I           LULI                       2     Numeric, 01 - 09
    384-385    Absolute Lowest Used Line            ALUL                       2     Numeric, 01 - 12
      386      Instruction Flag (1)                 INS_1                    $1    1 Cancer Secondary
      387      Instruction Flag (2)                 INS_2                    $1    1 Part II Information from Manner of Death Box
      388      Instruction Flag (3)                 INS_3                    $1      Reserved
389-400        Auxiliary State file number          AUXNO                     12     000000000001-999999999999; blank
    401-430    State Specific Data                  STATESP                 $30      Optional. Any information entered through SuperMICAR for state use only.
 11/15/2010                                               MICAR100 Input Record Format                                                                          Page 15
                                                                      2003
                                                     Generated by SuperMICAR or Other System
Position   Variable                               Item# Name                     Format          Code Structure Description
  1-4      Date of Death--Year                      29    DOD_YR                          4      Year of Death (numeric)
  5-6      State of Death                           16    ST_OCC                        $2       Alpha - see FIPS table 5-2; NCHS Part 8 Instruction Manual
 7 - 12    Certificate Number                             CERT_#                          6      left 0 filled; 000001-999999
   13      Coder status                                   CS                              1      Numeric, Valid codes: 0 - 9
                                                                                                 NCHS ID Information. Numeric, 0001 - 9999. (States commonly use "book
 14 - 17   Lot                                            LOT                           4        number")
   18      Section number                                 SECT                          1        NCHS ID Information. Numeric, 0 - 9
                                                                                                 NCHS ID Information. Alpha\Numeric. Usually month of death or month of
 19 - 21   Shipment number                                SHIP                        $3         receipt
           Receipt Date Inserted at NCHS
 22 - 23   NCHS receipt date --Month                      REC_MO                        2        01-12
 24 - 25   NCHS receipt date --Day                        REC_DY                        2        01-31
 26 - 29   NCHS receipt date --Year                       REC_YR                        4        >=year of death
 30 - 33   PGM version control - SuperMICAR               VER_SM                        4        Computer Generated. Version number of SuperMICAR
 34 - 35   Date of Death--Month                    29     DOD_MO                        2        01-12, 99
 36 - 37   Date of Death--Day                      29     DOD_DY                        2        01-31 (based on month), 99
   38      Sex                                      2     SEX                         $1       M Male
                                                                                               F Female
                                                                                               U Unknown
   39      Age: units                               4     AGETYPE                       1      1 Years
                                                                                               2 Months
                                                                                               3 Weeks
                                                                                               4 Days
                                                                                               5 Hours
                                                                                               6 Minutes
                                                                                               9 Unknown
 40 - 42   Age: number of units                     4     AGE                           3        001 - 135, 999
                                                                                                 COMPUTER GENERATED: Information entered is incomplete. Reject record
   43      Incomplete data flag                          INC_DATA                       1      1 for manual review
                                                                                                 Blank
                                                                                                 Free format field, see MICAR Instruction Manual 2g. Information provided
44 - 343   Conditions and durations                32     COD                        $300        through use of Entity-Reference Numbers (ERN)
  344      Did Tobacco Use Contribute to Death?    35     TOBAC                        $1      Y Yes
                                                                                               N No
                                                                                               P Probably
                                                                                               U Unknown
 11/15/2010                                               MICAR100 Input Record Format                                                                          Page 16
                                                                      2003
                                                     Generated by SuperMICAR or Other System
Position    Variable                              Item# Name                     Format          Code Structure Description
                                                                                                 Blank
                                                                                               C Not on certificate
  345       Pregnancy                              36     PREG                        $1       1 Not pregnant within past year
                                                                                               2 Pregnant at the time of death
                                                                                               3 Not pregnant, but pregnant within 42 days of death
                                                                                               4 Not pregnant, but pregnant 43 days to 1 year before death
                                                                                               9 Unknown if pregnant within last year
                                                                                                 Blank
                                                                                               8 Not Applicable: Computer generated
                                                                                               7 Not on certificate
  346       If Female--Edit Flag: From EDR only           PREG_BYPASS                   1      0 Edit Passed
                                                                                               1 Edit Failed, Data Queried, and Verified
                                                                                               2 Edit Failed, Data Queried, but not Verified
  347       Manner of Death                        37     MANNER                      $1       N Natural
                                                                                               A Accident
                                                                                               S Suicide
                                                                                               H Homicide
                                                                                               P Pending Investigation
                                                                                               C Could not be determined
                                                                                                 Blank
348 - 349   Date of Injury--Month                  38     DOI_MO                      $2         01-12, 99, Blank
350 - 351   Date of Injury--Day                    38     DOI_DY                      $2         01-31, 99, Blank
352 - 355   Date of Injury--Year                   38     DOI_YR                      $4         4-digit year, 9999, blank
356 - 359   Time of Injury                         39     T0I_HR                      $4         0000-2359, 9999, blank
  360       Injury at Work?                        41     WORKINJ                     $1       Y Yes
                                                                                               N No
                                                                                               U Unknown: Computer generated
                                                                                               X Not Applicable: Computer generated
                                                                                                 Blank
                                                                                                 Free format field, see MICAR Instruction Manual 2g. Information provided
361 - 420   Describe How Injury Occurred           43     HOWIO                       $60        through use of Entity-Reference Numbers (ERN)
  421       Was an Autopsy Performed?              33     AUTOP                        $1      Y Yes
                                                                                               N No
                                                                                               U Unknown
                                                                                                 Blank
  422       Were Autopsy Findings Available to     34     AUTOPF                      $1       Y Yes
 11/15/2010                                                                       MICAR100 Input Record Format                                                                               Page 17
                                                                                              2003
                                                                             Generated by SuperMICAR or Other System
Position    Variable                                                      Item# Name                     Format          Code Structure Description
               Complete the Cause of Death?                                                                            N No
                                                                                                                       U Unknown
                                                                                                                         Blank
                                                                                                                       X Not Applicable: Computer generated
423 - 452   Certifier                                                      45     CERTL                       $30      D Certifying Physician
                                                                                                                       P Pronouncing and Certifying Physician
                                                                                                                       M Medical Examiner/Coroner
                                                                                                                         Enter Full Text for Other Individual Legally Allowed to Certify
            Date of Surgery: Applicable to States with a surgery block,
            blank otherwise.
453 - 454   Date of surgery -- month                                              SUR_MO                      $2         01-12, 99, Blank
455 - 456   Date of surgery -- day                                                SUR_DY                      $2         01-31, 99, blank
457 - 460   Date of surgery -- year                                               SUR_YR                      $4         4-digit year, 9999, blank
  461       Activity at Time of death                                             INACT                       $1       0 While engaged in sports activity

            Computer generated if file generated by SuperMICAR                                                         1 While engaged in leisure activities
            Codes assigned by system other then SuperMICAR                                                             2 While working for income
                                                                                                                       3 While engaged in other types of work
                                                                                                                       4 While resting, sleeping, eating, or engaging in other vital activities
                                                                                                                       8 While engaged in other specified activities
                                                                                                                       9 During unspecified activity
                                                                                                                         blank
  462       Place of Injury                                                       INJPL                       $1       A Home

            Computer generated if file generated by SuperMICAR                                                         B Farm
            Codes assigned by system other then SuperMICAR                                                             C Residential Institution
                                                                                                                       D Military Residence
                                                                                                                       E Hospital
                                                                                                                       F School, Other Institutions, Administrative Area
                                                                                                                       G Industrial and Construction
                                                                                                                       H Garage/Warehouse
                                                                                                                        I Trade and Service Area
                                                                                                                       J Mine/Quarry
                                                                                                                       K Street/Highway
                                                                                                                       L Public Recreation Area
                                                                                                                       M Institutional Recreation Area
     11/15/2010                                      MICAR100 Input Record Format                                                                           Page 18
                                                                 2003
                                                Generated by SuperMICAR or Other System
   Position    Variable                      Item# Name                     Format           Code Structure Description
                                                                                          N Sports and Recreation Area
                                                                                          O Other building
                                                                                           P Other specified Place
                                                                                          Q Unspecified Place
                                                                                             Blank
463 - 474      Auxiliary State file number          AUXNO                         12         000000000001-999999999999; blank

   475 - 504   State Specific Data                   STATESP                     $30         Optional. Any information entered through SuperMICAR for state use only.
11/15/2010                                                   SuperMICAR Record Format                                                                           Page 19
                                                                2003 Input and Export

Position    Variable                                   Item# Name      Format           Code Structure Description
  1-4       Date of Death--Year                          29 DOD_YR                4     Year of Death (numeric)
  5-6       State of Death                               16 ST_OCC              $2      Alpha - see FIPS table 5-2; NCHS Part 8 Instruction Manual
 7 - 12     Certificate Number                               CERT_#               6     left 0 filled; 000001-999999
   13       Coder status                                     CS                   1     Numeric, Valid codes: 0 - 9
                                                                                        NCHS ID Information. Numeric, 0001 - 9999. (States commonly use "book
 14 - 17    Lot                                              LOT                 4      number")
   18       Section number                                   SECT                1      NCHS ID Information. Numeric, 0 - 9
                                                                                        NCHS ID Information. Alpha\Numeric. Usually month of death or month
 19 - 21    Shipment number                                  SHIP               $3      of receipt
            Receipt Date Inserted at NCHS
 22 - 23    NCHS receipt date --Month                        REC_MO             $2      01-12, blank
 24 - 25    NCHS receipt date --Day                          REC_DY             $2      01-31, blank
 26 - 29    NCHS receipt date --Year                         REC_YR             $4      >=year of death, blank
 30 - 33    PGM version control - SuperMICAR                 VER_SM               4     Computer Generated. Version number of SuperMICAR
 34 - 35    Date of Death--Month                        29   DOD_MO               2     01-12, 99
 36 - 37    Date of Death--Day                          29   DOD_DY               2     01-31 (based on month), 99
   38       Sex                                          2   SEX                $1    M Male
                                                                                      F Female
                                                                                      U Unknown

   39       Age: units                                  4    AGETYPE             1    1 Years
                                                                                      2 Months
                                                                                      3 Weeks
                                                                                      4 Days
                                                                                      5 Hours
                                                                                      6 Minutes
                                                                                      9 Unknown
  40 - 42   Age: number of units                         4   AGE                3       001 - 135, 999
 43 - 162   Cause of Death--Line A, Part I              32   CODIa          $120        Literal information reported on Line a
163 - 182   Cause of Death--Interval, Line A, Part I    32   INTIa           $20        Duration Reported on Line a
183 - 302   Cause of Death--Line B, Part I              32   CODIb          $120        Literal information reported on Line b
303 - 322   Cause of Death--Interval, Line B, Part I    32   INTIb           $20        Duration Reported on Line b
323 - 442   Cause of Death--Line C, Part I              32   CODIc          $120        Literal information reported on Line c
443 - 462   Cause of Death--Interval, Line C, Part I    32   INTIc           $20        Duration Reported on Line d
463 - 582   Cause of Death--Line D, Part I              32   CODId          $120        Literal information reported on Line d
583 - 602   Cause of Death--Interval, Line D, Part I    32   INTId           $20        Duration Reported on Line d
603 - 842   Cause of Death--Part II                     32   CODII          $240        Literal information reported in Part II
   843      Did Tobacco Use Contribute to Death?        35   TOBAC            $1      Y Yes
11/15/2010                                              SuperMICAR Record Format                                                               Page 20
                                                           2003 Input and Export

Position    Variable                              Item# Name      Format           Code Structure Description
                                                                                 N No
                                                                                 P Probably
                                                                                 U Unknown
                                                                                 C Not on certificate
                                                                                   Blank
  844       Pregnancy                              36   PREG                 1   1 Not pregnant within past year
                                                                                 2 Pregnant at the time of death
                                                                                 3 Not pregnant, but pregnant within 42 days of death
                                                                                 4 Not pregnant, but pregnant 43 days to 1 year before death
                                                                                 9 Unknown if pregnant within last year
                                                                                   blank
                                                                                 8 Not Applicable: Computer generated
                                                                                 7 Not on certificate
                                                        PREG_BY
  845       If Female--Edit Flag: From EDR only         PASS                 1   0 Edit Passed
                                                                                 1 Edit Failed, Data Queried, and Verified
                                                                                 2 Edit Failed, Data Queried, but not Verified
  846       Manner of Death                        37   MANNER              $1   N Natural
                                                                                 A Accident
                                                                                 S Suicide
                                                                                 H Homicide
                                                                                 P Pending Investigation
                                                                                 C Could not be determined
                                                                                   Blank
847 - 848   Date of Injury--Month                  38   DOI_MO              $2     01-12, 99, blank
849 - 850   Date of Injury--Day                    38   DOI_DY              $2     01-31, 99, blank
851 - 854   Date of Injury--Year                   38   DOI_YR              $4     4-digit year, 9999, blank
855 - 858   Time of Injury                         39   TOI_HR              $4     0000-2400,9999, blank
  859       Units of Time                                                   $1   A AM
                                                                                 P PM
                                                                                 M Military Time (24 hour clock)
                                                                                   Blank
860 - 909   Place of Injury--Literal               40   INJPLL             $50     Full text for Place of Injury
  910       Injury at Work?                        41   WORKINJ             $1   Y Yes
                                                                                 N No
                                                                                 U Unknown
                                                                                   Blank
                                                                                 X Not Applicable: Computer generated
 11/15/2010                                                                             SuperMICAR Record Format                                                                         Page 21
                                                                                           2003 Input and Export

 Position     Variable                                                            Item# Name    Format          Code Structure Description
 911 - 1160   Describe How Injury Occurred--Literal                                 43  LINJURY       $250      Literal information reported in How Injury Occurred Block
1161 - 1190   If Transportation Accident, Specify                                   44 TRANSPL         $30   DR Driver/Operator
                                                                                                             PA Passenger
                                                                                                             PE Pedestrian
                                                                                                                Enter Full Text
   1191       Was an Autopsy Performed?                                            33   AUTOP           $1    Y Yes
                                                                                                              N No
                                                                                                              U Unknown
                                                                                                                Blank
   1192       Were Autopsy Findings Available to                                   34   AUTOPF          $1    Y Yes
                Complete the Cause of Death?                                                                  N No
                                                                                                              U Unknown
                                                                                                                Blank
                                                                                                              X Not Applicable: Computer generated
1193 - 1222   Certifier                                                            45   CERTL          $30    D Certifying Physician
                                                                                                              P Pronouncing and Certifying Physician
                                                                                                              M Medical Examiner/Coroner
                                                                                                                Enter Full Text for Other Individual Legally Allowed to Certify, blank
              Date of Surgery: Applicable to States with a surgery block, blank
              otherwise.
1223 - 1224   Date of surgery -- month                                                  SUR_MO           2      01-12, 99 (for unknown), blank
1225 - 1226   Date of surgery -- day                                                    SUR_DY           2      01-31, 99, blank
1227 - 1230   Date of surgery -- year                                                   SUR_YR           4      4-digit year, 9999, blank
   1231       Incomplete data flag                                                      INC_DT           1    1 COMPUTER GENERATED: Information entered is incomplete
                                                                                                                Blank otherwise
   1232       Line Ib "due to" flag                                                     DUE2Ib           1    1 "Due to" deleted by certifier
                                                                                                                Blank otherwise
   1233       Line Ic "due to" flag                                                     DUE2Ic           1    1 "Due to" deleted by certifier
                                                                                                                Blank otherwise
   1234       Line Id "due to" flag                                                     DUE2Id           1    1 "Due to" deleted by certifier
                                                                                                                Blank otherwise
   1235       Part II "due to" flag                                                     DUE2II           1    1 "Due to" deleted by certifier
                                                                                                                Blank otherwise
   1236       Activity at Time of death: Computer Generated                             INACT            1    0 While engaged in sports activity
                                                                                                              1 While engaged in leisure activities
                                                                                                              2 While working for income
                                                                                                              3 While engaged in other types of work
                                                                                                              4 While resting, sleeping, eating, or engaging in other vital activities
     11/15/2010                                             SuperMICAR Record Format                                                                          Page 22
                                                               2003 Input and Export

    Position     Variable                               Item# Name     Format            Code Structure Description
                                                                                       8 While engaged in other specified activities
                                                                                       9 During unspecified activity
      1237       Place of Injury - Computer Generated        INJPL               $1   A Home
                                                                                       B Farm
                                                                                       C Residential Institution
                                                                                      D Military Residence
                                                                                       E Hospital
                                                                                       F School, Other Institutions, Administrative Area
                                                                                      G Industrial and Construction
                                                                                      H Garage/Warehouse
                                                                                       I Trade and Service Area
                                                                                       J Mine/Quarry
                                                                                      K Street/Highway
                                                                                       L Public Recreation Area
                                                                                      M Institutional Recreation Area
                                                                                      N Sports and Recreation Area
                                                                                      O Other building
                                                                                       P Other specified Place
                                                                                      Q Unspecified Place
                                                                                         Blank
1238 - 1249      Auxiliary State file number                 AUXNO               12      000000000001-999999999999; blank
                                                                                         Optional. Any information entered through SuperMICAR for state use
   1250 - 1279   State Specific Data                         STATESP            $30      only.

				
DOCUMENT INFO
Description: Blank Death Certificate document sample