cremation form 4 - medical certificate

Last reviewed 01/2018

Form Cremation 4 - Medical Certificate

QUESTION 5:"USUAL MEDICAL ATTENDANT"

• usual medical attendant is normally taken to be the deceased's GP
  • in cases where the deceased person has been an in-patient in hospital for a short period of time, that is less than 24 hours and if the death is not going to be investigated by a coroner it may be better to regard the patient's GP as the usual medical attendant, rather than the hospital medical practitioner who attended him or her
  • it is acknowledged that many patients in hospital are treated by a number of medical practitioners

QUESTION 6:"HOW LONG YOU ATTENDED THE DECEASED DURING THEIR LAST ILLNESS?"

• to complete form Cremation 4 you should have attended the deceased during their last illness
  • in the primary care setting, a demonstrable prior period of care or the presence of the certifying medical practitioner at the death will usually be enough. In exceptional circumstances, a general practitioner partner may be acceptable if he or she had seen the deceased outside the normally acceptable period (14 days) and the attending partner is unavailable although in such cases there will usually have been consultation with a coroner
  • minimum period of hospital care sufficient to meet the requirement should normally be 24 hours. When the period is less than 24 hours you must inform a coroner

QUESTION 7:"THE NUMBER OF DAYS AND HOURS BEFORE THE DECEASED'S DEATH THAT YOU SAW THEM ALIVE"

• normal expectation is that you will have seen the deceased during the course of the last illness within 14 days before death; otherwise you must refer the death to a coroner.

QUESTION 9: SYMPTOMS AND OTHER CONDITIONS

• complete this box with your observations of the deceased's symptoms in the period leading up to their death
  • if the deceased died in hospital it would be helpful if you added the date of admission as this will assist the medical referee when they scrutinise the forms.

QUESTION 10: HOSPITAL POST-MORTEM EXAMINATION

• if a non-coronial hospital post-mortem examination, (commonly referred to as a"consent post-mortem examination"), has been carried out or supervised by someone with the necessary 5 years' period of full registration, you should indicate this here and state that you are aware of the findings, before giving the cause of death at Question 11. In these cases form Cremation 5 (the confirmatory medical certificate) is not required. However if you are aware that a post-mortem examination has taken place and for some reason you are not aware of the findings from that examination, the medical referee will require the completion of a form Cremation 5. You should be aware that a delay in completing Cremation 5 in these cases this could cause delay to the funeral.

QUESTION 11: CAUSE OF DEATH

• cause of death should normally be that set out on the medical certificate of the cause of death sent to the Registrar of Deaths
  • your answer should indicate when this has been informed by other sources, e.g. patient history, operative procedures or medical or lay witnesses.

QUESTIONS 12 AND 13: OPERATIONS

• you should refer any operation which may have shortened the life of the deceased to a coroner for consideration and possible investigation.

QUESTIONS 14, 15 AND 16: THOSE NURSING THE DECEASED OR PRESENT AT DEATH

• the medical practitioner completing form Cremation 5 must be able to contact the people you name in your form. Therefore you must give full names and contact details.

QUESTIONS 20 AND 21: REFERRAL TO CORONER/CORONER'S OFFICE

• ensure that a coroner is notified of any suspicious circumstances that come to your attention
  • you must also inform the coroner if you suspect the death was unnatural, violent, sudden with unknown cause, to have taken place less than 24 hours since the deceased was admitted to hospital, or where no medical practitioner had attended the deceased in the last 14 days of their life
• in cases where either one of the form Cremation 4 or form Cremation 5 medical practitioners has consulted a coroner, but the coroner does not consider that his or her involvement is necessary, this should be clearly recorded by the medical practitioner concerned

QUESTION 23: IMPLANTS

• some implants cause a serious health and safety risk at the crematorium and must be removed

Reference:

• Huntingdon NHS Primary Care Trust (2005). Policy for death verification and certification, cremation formas and coroners referrals
• Ministry of Justince.The Cremation (England and Wales) Regulations 2008.