Arizona Administrative Code › Title 9 - HEALTH SERVICES › Chapter 19 - DEPARTMENT OF HEALTH SERVICES - VITAL RECORDS AND STATISTICS › Article 3 - VITAL RECORDS FOR DEATH › Section R9-19-302 - Information for a Death Record

Current through Register Vol. 30, No. 28, July 12, 2024
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;