S.L. 465.6 Art. 2Duty of medical practitioners.

Every medical practitioner shall, in every case of death, immediately report to the Police and Superintendent of Public Health the death and the cause thereof in writing and in accordance with the form set out in the Schedule. SCHEDULE

(Regulation 2)

CERTIFICATE OF DEATH AND CAUSE THEREOF

and Surname ......................................................... Legally Valid Identification Document Number. ............... male  female  unascertained 

.................................. of birth ......................................... infant and fetal deaths:

(g): .............. Gestation (weeks) .................. Time of birth ............. of birth ..................................................................... Nationality .........................................................................

Permanent residence .................................................................................. Employment status:  unemployed  pensioner  housekeeper  student  work  Occupation (if retired please write previous occupation) ..............................

and surname of Parents and whether living or dead ............................. ....................................................................................................................

Marital status: bachelor/spinster  married  widowed  other  (specify): .............................. applicable, name and surname of spouse ...........................................

day, month and year of death .............................................................. where death occurred ..........................................................................

Cause of death Approximate interval between onset & death condition leading to a ............................................... due to (or as a consequence of) causes b. .............................................. due to (or as a consequence of) conditions, if rise to the c. .............................................. stating due to (or as a consequence of) underlying

II. Other significant conditions contributing to death but not related to the disease or condition causing it: * This does not mean mode of dying e.g. respiratory failure. It means the disease, injury or complication that caused death.