Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 45 - Vital Records › Chapter 123 - Preparation of Certificates › Section V-12307 - Certificate of Death Preparation

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				  Section-Personal Data of Deceased
1. Last
				  Name (Item 1A). Enter the surname of the deceased. Identifications, e.g., Jr.
				  II, III, etc., shall appear immediately following and as a part of the surname.
				  The surname of a married women may be either her maiden name or that of her
				  husband.
2. First Name Enter the
				  first name of the deceased.
3.
				  Second Name Enter the second name of the deceased. If the name is not known or
				  cannot be determined, enter "unknown".
4. Date of Death.
a. Enter the month, day and year using the
				  following abbreviations: Jan., Feb., Mar., Apr., Aug., Sept., Oct., Nov., and
				  Dec.
b. Enter the complete spelling
				  for the months of May, June and July.
5. Hour of Death. Enter the hour of death
				  indicating A.M. or P.M. If the institution operates on 24 hour or military
				  time, the hour of death may be so expressed.
6. Sex Enter male or female.
7. Color or Race. Enter race as provided by
				  informant, e.g., White, Black, American Indian (indicate tribe if known). For
				  non-white groups other than black or American Indian, enter the national
				  origin, e.g., Chinese, Japanese, Puerto Rican, etc. Generic designations of
				  Oriental, Polynesian, European, etc., are not acceptable.
8. Marital Status Check the appropriate
				  blank.
9. Surviving Spouse. If the
				  decedent was legally married at death, enter the name (maiden name in the case
				  of a widow) of the survivor. If the deceased was single at death, enter
				  "none."
10. Date of Birth of
				  Deceased. Enter the month, day and year per instructions for Item 2A. If the
				  birthdays is not known, enter "unknown" in full. If the birth date represents
				  an approximation, enter birth date as "Approx." then date, example "Approx.
				  Mar. 12, 1935."
11. Age of
				  Deceased. Enter the age of the deceased in years, months and days. If the exact
				  information is not known, enter an approximation of age. If the deceased was
				  under 24 hours old, enter hours and minutes. Place dashes (-) in blocks that
				  are not applicable.
12. Birthplace.
				  Enter the city and state if full. If the deceased was born outside of the
				  United States, enter the name of country in full.
13. Citizen of What Country. If the deceased
				  was a citizen of the United States, enter "U.S.A." Enter the name of the
				  country in full if deceased was not a citizen of the United States. If
				  citizenship is not known, enter "unknown."
14. Usual Occupation. Notwithstanding the
				  decedent's occupation at the time of death or that the deceased was retired,
				  enter the type of occupation performed during the longest period of his/her
				  working life. If the deceased had never been employed, enter "never employed."
				  Enter "unknown" if the information is not available.If the deceased was under
				  14 years of age, a dash (-) should be entered.
15. Kind of Business or Industry. Enter as
				  specifically as possible the kind of business or industry in which the deceased
				  was employed. Do not enter the name of the company. Avoid unclear designations,
				  e.g., "factory" or "mill." Instead enter "paint factory" or "saw
				  mill."
16. Ever in U.S. Armed
				  Forces? Check the appropriate block.
17. Social Security Number. Enter the Social
				  Security Number; if it is not known, enter "unknown."