Oregon Death Certificate Worksheet

Overview

The Oregon Death Certificate Worksheet (Form 32790100) is a standardized tool that funeral homes use to gather the information required by the Oregon Vital Records Office when a death occurs in the state. The worksheet simplifies data collection, ensures compliance with state law, and helps families obtain copies of the death certificate quickly.

Because the death certificate is a legal document, every detail entered must be accurate. The worksheet is intended for internal use by the funeral home staff and for submission to the medical examiner, physician, or coroner who will sign the final certificate.

Who Needs It?

• Funeral homes and crematoriums primary users for completing and filing the worksheet.
• Medical examiners, physicians, or coroners they review and sign the final death certificate based on the worksheet information.
• Family members or legal representatives they provide essential personal data and authorize the release of the certificate.

Key Elements of the Worksheet

The worksheet is organized into several sections. Below is a summary of the most important fields:

StepbyStep Completion Guide

1. Gather Primary Documents
   • Medical records or physicians statement.
   • Identification for the deceased (drivers license, state ID, passport).
   • Social Security card (if available).
2. Interview the Informant

   Ask a close relative or legal representative for personal details and causeofdeath information. Verify spelling of names and addresses.

3. Enter Deceased Information

   Fill out name exactly as it appears on the deceaseds legal documents. Use the full legal name; do not abbreviate.

4. Record Death Details

   Confirm the exact time of death from the attending physician or medical examiner report. If time is unknown, write unknown and note the reason.

5. Document Medical Causes
   • List the immediate cause first, then underlying causes.
   • Enter ICD10 codes where applicable; this aids statistical reporting.
6. Complete Funeral Home Section

   Include the licensed funeral directors name and license number. This is required for the states audit trail.

7. Obtain Informant Signature

   Have the informant sign and date the worksheet. Explain that the signature confirms the accuracy of the information.

8. Submit to Certifier

   Provide the completed worksheet to the physician, medical examiner, or coroner for review and signature. Allow sufficient time for any required corrections.

9. File with Oregon Vital Records

   Once signed, the funeral home submits the worksheet (electronically or by mail) along with any required supporting documents.

10. Provide Copies to Families

    Issue a certified copy of the death certificate to the nextofkin and retain the original according to state retention rules.

Common Errors to Avoid

• Misspelled Names Even a single letter error can cause delays in processing.
• Incorrect ICD10 Codes Verify codes against the latest coding manual or use an online lookup.
• Missing Signature Both the informant and certifier must sign; a missing signature will result in a returned form.
• Inconsistent Dates Ensure the date of death matches the date on the hospital or medical examiner report.
• Omitted Middle Initial Include middle names or initials when they appear on legal IDs.

Resources & Downloads

Below are links to official Oregon state resources that can help you complete the worksheet correctly.

• Oregon Health Authority Death Certificates
• Official Death Certificate Worksheet (PDF)
• CDC ICD10CM Guidelines
• Frequently Asked Questions