Ariz. Admin. Code § R9-19-302 - Information for a Death Record

A. The information for a deceased individual's death record includes the following:

1. Demographic and final disposition information for the deceased individual's certificate of death registration:

a. The name, date of birth, and sex of the deceased individual;

b. Any other names by which the deceased individual was known, including, if applicable, the deceased individual's last name before first marriage;

c. The place of death including:

i. The county,

ii. Town or city, and

iii. Zip code;

d. If death was pronounced in a hospital, whether the deceased individual was:

i. An inpatient,

ii. An outpatient, or

iii. Dead on arrival at the hospital;

e. If death was pronounced somewhere other than a hospital, whether death was pronounced at:

i. The deceased individual's residence,

ii. A hospice inpatient facility,

iii. A nursing care institution, or

iv. Another location;

f. If death was pronounced at another location, a description of the location;

g. If death was pronounced:

i. In a health care institution, the facility name; or

ii. In a location other than a health care institution, the street address of the location;

h. The deceased individual's race;

i. Whether the deceased individual was of Hispanic origin and, if so, the type of Hispanic origin;

j. If the deceased individual was a member of a tribe recognized by the Federal Bureau of Indian Affair's Office of Federal Acknowledgement under 25 CFR Part 83, the name of the tribe;

k. Whether the deceased individual was ever in the U.S. Armed Forces;

l. The deceased individual's age:

i. If the deceased individual was one or more years old, in years since the deceased individual's birthday;

ii. If the deceased individual was one or more days old but less than one year old, in months and days; or

iii. If the deceased individual was less than one day old, in hours and minutes;

m. The deceased individual's marital status at the time of death;

n. The name of the deceased individual's surviving spouse, if applicable, and, if different, the spouse's last name before first marriage;

o. The state, county, and city of the deceased individual's birth or, if the birth did not happen in the United States, the name of the country where the birth occurred;

p. The deceased individual's Social Security Number;

q. The deceased individual's usual occupation;

r. The address, including the street address, town or city, state, zip code, and county, of the deceased individual's usual residence;

s. If the deceased individual's usual residence is not in the United States, the name of the country of the deceased individual's usual residence;

t. The name of the deceased individual's father;

u. The name before first marriage of the deceased individual's mother;

v. The following information about the individual providing the demographic and final disposition information about the deceased individual:

i. The individual's name;

ii. Relationship to the deceased individual; and

iii. The individual's mailing address, including street address, city or town, state, zip code, and, if outside the U.S., country;

w. The anticipated final disposition of the human remains, including one or more of the following:

i. Burial;

ii. Entombment;

iii. Cremation;

iv. Anatomical gift, except for an anatomical gift of a part;

v. Removal from the state; and

vi. Other final disposition of the human remains;

x. If an anticipated final disposition is anatomical gift, except for an anatomical gift of a part, another anticipated final disposition other than removal from the state;

y. If an anticipated final disposition is removal from the state:

i. Whether removal from the state includes removal from the United States; and

ii. Another anticipated final disposition specified in subsection (A)(1)(w)(i), (ii), (iii), or (vi);

z. If an anticipated final disposition of the human remains is another means of final disposition, a description of the anticipated final disposition;

aa. The name and location where each final disposition of the human remains took place, and the date of each final disposition;

bb. If applicable, the name and address of the funeral establishment; and

cc. As applicable:

i. The name and license number of the funeral director in charge of the final disposition of the human remains; or

ii. If a funeral director is not in charge of the final disposition of the human remains, the name of the responsible person and, if the responsible person is not the individual identified in subsection (A)(1)(v), the responsible person's:

(1) Relationship to the deceased individual; and

(2) Mailing address, including street address, city or town, state, zip code, and, if outside the U.S., country;

2. Other demographic and final disposition information for the deceased individual's death record:

a. Whether the deceased individual's usual residence was within city limits;

b. Whether the deceased individual's usual residence was in a tribal community at the time of death;

c. If the deceased individual's usual residence was in a tribal community at the time of death, the name of the tribal community;

d. How long the deceased individual resided in Arizona before the deceased individual's death;

e. The type of business or industry in which the deceased individual usually worked;

f. The name of the country of which the deceased individual was a citizen;

g. The highest educational grade completed by the deceased individual; and

h. If the anticipated final disposition of the deceased individual's human remains is cremation, documentation of the approval of the medical examiner of the county where the death occurred for the cremation of the human remains;

3. Medical certification information for the deceased individual's certificate of death registration:

a. The date of death and whether the date is the actual date of death or a date determined through a death investigation conducted under A.R.S. § 11-597;

b. The time death was pronounced;

c. The conditions leading to the immediate cause of death, including the underlying causes of death;

d. For each cause or condition listed according to subsection (A)(3)(c), the length of time from the onset of the cause or condition to the time of death;

e. Any other conditions contributing to the death;

f. Whether an autopsy was performed on the deceased individual;

g. Whether autopsy results were available to complete the cause of death;

h. The manner of death;

i. The name, title, and address of the medical certifier; and

j. The date the medical certifier signed the medical certification of death; and

4. Other medical certification information for the deceased individual's death record:

a. If the medical certifier is a health care provider, the health professional license number of the medical certifier;

b. If the medical certifier is a tribal law enforcement authority, the badge number of the medical certifier;

c. Whether tobacco use contributed to the cause of death;

d. If the deceased individual was female, whether:

i. The deceased individual was pregnant within the last year;

ii. The deceased individual was pregnant at the time of death;

iii. The deceased individual was not pregnant at the time of death, but pregnant within 42 days before death;

iv. The deceased individual was not pregnant at the time of death, but pregnant 43 days to one year before death; or

v. It is unknown whether the deceased individual was pregnant within the last year; and

e. Whether a notification required in A.R.S. § 11-593 was made.

B. If a medical examiner determined the manner of death in subsection (A)(3)(h) for a deceased individual, in addition to the information in subsections (A)(3) and (4), the medical certification information for the deceased individual's death record includes:

1. For the deceased individual's certificate of death registration, whether the:

a. Manner of death was due to:

i. Natural causes,

ii. An accident,

iii. Suicide,

iv. Homicide, or

v. An undetermined cause; and

b. Whether the death was as a result of an injury and, if so, whether the injury occurred while the deceased individual was working or at the deceased individual's workplace; and

2. The following other medical certification information for the deceased individual's death record:

a. If the death was as a result of an injury:

i. The date and time of the injury,

ii. The type of location where the injury occurred,

iii. The address of the location where the injury occurred, and

iv. A description of how the injury occurred; and

b. If the death was caused by a transportation accident, whether the deceased individual at the time of the transportation accident was:

i. The driver or operator of the transportation vehicle,

ii. A passenger in the transportation vehicle,

iii. A pedestrian, or

iv. Involved in another activity affected by the transportation accident.

Notes

Ariz. Admin. Code § R9-19-302

Amended effective March 30, 1976 (Supp. 76-2). Amended effective February 20, 1980 (Supp. 80-1). Amended effective July 31, 1989 (Supp. 89-3). Section repealed; new Section made by final rulemaking at 12 A.A.R. 4387, effective January 6, 2007 (Supp. 06-4). Adopted by final rulemaking at 22 A.A.R. 1783, effective 10/1/2016.