Changing the Medical Section of a Death Certificate

In order for Vital Registration to change the medical section of a death certificate, a fax must be received that meets the following rules.

• The request must be on the doctor's letterhead
• The doctor's requesting the change must be the same doctor who signed the death certificate
• The doctor's must sign and date the request
• The doctor's name must be printed or typed under his or her signature
• The following information concerning the decedent must be provided.
  • Decedent's Name
  • Date of Death
  • County of Death
  • Exact Instructions as what to add or remove
    Example:  Change line 27-A from CVA to MI

Please Note:  If the manner of death is accident, suicide or homicide, then blocks 30A - 30F must be completed
(30A-Date of Injury, 30B-Time of Injury, 30C-Injury at Work, 30D-Describe how Injury occurred, 30E-Place of Injury, and 30F-Location)
Fax the request to (304) 558-1051.