Logical model representing the data elements of Frame A (Medical Data, Parts 1 and 2) of the WHO Medical Certificate of Cause of Death (MCCoD).

Frame A is MANDATORY in its entirety. At minimum, the immediate cause of death (line a) and the underlying cause of death MUST be present. Lines b, c, and d are required if the preceding line is present and a further antecedent cause exists. The underlying cause of death is captured as a separate mandatory element and may differ from any of lines a–d, consistent with WHO DORIS methodology for ICD-11.

This model is derived from:

• WHO International Form of Medical Certificate of Cause of Death
• openEHR-EHR-EVALUATION.death_summary.v0 (CKM archetype)
• WHO SMART Guidelines L2 DAK data dictionary pattern

The ordered chain of conditions leading to death, as reported by the certifying practitioner. Line a is always mandatory. Lines b, c, d are conditionally mandatory — required when the certifier identifies a further antecedent cause for the preceding line.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

The disease, injury, or complication that directly caused death. This is the condition that was the final step in the chain of events leading to death. Always mandatory.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Free-text description of the immediate cause of death as written by the certifying practitioner. Always mandatory regardless of whether a coded value is also provided.

Coded representation of the immediate cause of death. SHALL use ICD-10 or ICD-11 system URI. Text is always required even when a code is present. Extensible binding to mccod-cause-of-death-codes ValueSet.

Approximate time between onset of the condition and death, as reported by the certifying practitioner (e.g. "2 hours", "3 weeks", "5 years"). Represented as a string to accommodate the imprecise nature of clinician estimates.

The disease or condition that gave rise to the immediate cause (line a). Required when the certifier identifies a further antecedent cause. Conditionally mandatory: if present, line a must also be present.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Cause description (text)

Cause code (ICD-10 or ICD-11)

Approximate interval from onset to death

The disease or condition that gave rise to line b. Conditionally mandatory: if present, line b must also be present.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Cause description (text)

Cause code (ICD-10 or ICD-11)

Approximate interval from onset to death

The disease or condition that gave rise to line c. Conditionally mandatory: if present, line c must also be present.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Cause description (text)

Cause code (ICD-10 or ICD-11)

Approximate interval from onset to death

The disease or injury that initiated the train of morbid events leading directly to death, or the circumstances of accident or violence which produced the fatal injury (WHO definition).

This element is MANDATORY and is captured separately from the causal chain (lines a–d). Per WHO DORIS methodology for ICD-11, the underlying cause of death may be a condition that does not appear on any line of the causal chain — for example, when DORIS applies a selection or modification rule that identifies a different condition as the underlying cause.

The underlying cause is the primary basis for mortality statistics.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Free-text description of the underlying cause of death. Always mandatory regardless of whether a coded value is present.

Coded representation of the underlying cause of death. When ICD-11 and DORIS are used, this code is the DORIS-selected underlying cause and SHALL use the ICD-11 MMS system URI. When ICD-10 is used, this code is selected per ICD-10 mortality coding rules and SHALL use the appropriate ICD-10 system URI.

Indicates whether the underlying cause of death was derived using the WHO DORIS tool for ICD-11. When true, the causeCode SHALL use the ICD-11 MMS system URI. This element supports audit and transparency of the coding process.

Other significant conditions that contributed to the death but were not part of the direct causal chain reported in Part 1. Time intervals may be noted alongside each condition. Modeled as structured Condition resources, not free text.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Free-text description of the contributing condition as written by the certifying practitioner. Always mandatory.

Coded representation of the contributing condition. Extensible binding to mccod-cause-of-death-codes ValueSet.

Approximate time interval associated with this condition, as noted in brackets after the condition per WHO MCCoD guidance (e.g. "6 months", "2 years"). Represented as a string.

Logical model representing the data elements of Frame A (Medical Data, Parts 1 and 2) of the WHO Medical Certificate of Cause of Death (MCCoD).

Frame A is MANDATORY in its entirety. At minimum, the immediate cause of death (line a) and the underlying cause of death MUST be present. Lines b, c, and d are required if the preceding line is present and a further antecedent cause exists. The underlying cause of death is captured as a separate mandatory element and may differ from any of lines a–d, consistent with WHO DORIS methodology for ICD-11.

This model is derived from:

• WHO International Form of Medical Certificate of Cause of Death
• openEHR-EHR-EVALUATION.death_summary.v0 (CKM archetype)
• WHO SMART Guidelines L2 DAK data dictionary pattern

The ordered chain of conditions leading to death, as reported by the certifying practitioner. Line a is always mandatory. Lines b, c, d are conditionally mandatory — required when the certifier identifies a further antecedent cause for the preceding line.

The disease, injury, or complication that directly caused death. This is the condition that was the final step in the chain of events leading to death. Always mandatory.

Free-text description of the immediate cause of death as written by the certifying practitioner. Always mandatory regardless of whether a coded value is also provided.

Coded representation of the immediate cause of death. SHALL use ICD-10 or ICD-11 system URI. Text is always required even when a code is present. Extensible binding to mccod-cause-of-death-codes ValueSet.

Approximate time between onset of the condition and death, as reported by the certifying practitioner (e.g. "2 hours", "3 weeks", "5 years"). Represented as a string to accommodate the imprecise nature of clinician estimates.

The disease or condition that gave rise to the immediate cause (line a). Required when the certifier identifies a further antecedent cause. Conditionally mandatory: if present, line a must also be present.

Cause description (text)

Cause code (ICD-10 or ICD-11)

Approximate interval from onset to death

The disease or condition that gave rise to line b. Conditionally mandatory: if present, line b must also be present.

Cause description (text)

Cause code (ICD-10 or ICD-11)

Approximate interval from onset to death

The disease or condition that gave rise to line c. Conditionally mandatory: if present, line c must also be present.

Cause description (text)

Cause code (ICD-10 or ICD-11)

Approximate interval from onset to death

The disease or injury that initiated the train of morbid events leading directly to death, or the circumstances of accident or violence which produced the fatal injury (WHO definition).

This element is MANDATORY and is captured separately from the causal chain (lines a–d). Per WHO DORIS methodology for ICD-11, the underlying cause of death may be a condition that does not appear on any line of the causal chain — for example, when DORIS applies a selection or modification rule that identifies a different condition as the underlying cause.

The underlying cause is the primary basis for mortality statistics.

Free-text description of the underlying cause of death. Always mandatory regardless of whether a coded value is present.

Coded representation of the underlying cause of death. When ICD-11 and DORIS are used, this code is the DORIS-selected underlying cause and SHALL use the ICD-11 MMS system URI. When ICD-10 is used, this code is selected per ICD-10 mortality coding rules and SHALL use the appropriate ICD-10 system URI.

Indicates whether the underlying cause of death was derived using the WHO DORIS tool for ICD-11. When true, the causeCode SHALL use the ICD-11 MMS system URI. This element supports audit and transparency of the coding process.

Other significant conditions that contributed to the death but were not part of the direct causal chain reported in Part 1. Time intervals may be noted alongside each condition. Modeled as structured Condition resources, not free text.

Free-text description of the contributing condition as written by the certifying practitioner. Always mandatory.

Coded representation of the contributing condition. Extensible binding to mccod-cause-of-death-codes ValueSet.

Approximate time interval associated with this condition, as noted in brackets after the condition per WHO MCCoD guidance (e.g. "6 months", "2 years"). Represented as a string.

Logical model representing the data elements of Frame A (Medical Data, Parts 1 and 2) of the WHO Medical Certificate of Cause of Death (MCCoD).

Frame A is MANDATORY in its entirety. At minimum, the immediate cause of death (line a) and the underlying cause of death MUST be present. Lines b, c, and d are required if the preceding line is present and a further antecedent cause exists. The underlying cause of death is captured as a separate mandatory element and may differ from any of lines a–d, consistent with WHO DORIS methodology for ICD-11.

This model is derived from:

• WHO International Form of Medical Certificate of Cause of Death
• openEHR-EHR-EVALUATION.death_summary.v0 (CKM archetype)
• WHO SMART Guidelines L2 DAK data dictionary pattern

The ordered chain of conditions leading to death, as reported by the certifying practitioner. Line a is always mandatory. Lines b, c, d are conditionally mandatory — required when the certifier identifies a further antecedent cause for the preceding line.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

The disease, injury, or complication that directly caused death. This is the condition that was the final step in the chain of events leading to death. Always mandatory.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Free-text description of the immediate cause of death as written by the certifying practitioner. Always mandatory regardless of whether a coded value is also provided.

Coded representation of the immediate cause of death. SHALL use ICD-10 or ICD-11 system URI. Text is always required even when a code is present. Extensible binding to mccod-cause-of-death-codes ValueSet.

Approximate time between onset of the condition and death, as reported by the certifying practitioner (e.g. "2 hours", "3 weeks", "5 years"). Represented as a string to accommodate the imprecise nature of clinician estimates.

The disease or condition that gave rise to the immediate cause (line a). Required when the certifier identifies a further antecedent cause. Conditionally mandatory: if present, line a must also be present.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Cause description (text)

Cause code (ICD-10 or ICD-11)

Approximate interval from onset to death

The disease or condition that gave rise to line b. Conditionally mandatory: if present, line b must also be present.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Cause description (text)

Cause code (ICD-10 or ICD-11)

Approximate interval from onset to death

The disease or condition that gave rise to line c. Conditionally mandatory: if present, line c must also be present.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Cause description (text)

Cause code (ICD-10 or ICD-11)

Approximate interval from onset to death

The disease or injury that initiated the train of morbid events leading directly to death, or the circumstances of accident or violence which produced the fatal injury (WHO definition).

This element is MANDATORY and is captured separately from the causal chain (lines a–d). Per WHO DORIS methodology for ICD-11, the underlying cause of death may be a condition that does not appear on any line of the causal chain — for example, when DORIS applies a selection or modification rule that identifies a different condition as the underlying cause.

The underlying cause is the primary basis for mortality statistics.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Free-text description of the underlying cause of death. Always mandatory regardless of whether a coded value is present.

Coded representation of the underlying cause of death. When ICD-11 and DORIS are used, this code is the DORIS-selected underlying cause and SHALL use the ICD-11 MMS system URI. When ICD-10 is used, this code is selected per ICD-10 mortality coding rules and SHALL use the appropriate ICD-10 system URI.

Indicates whether the underlying cause of death was derived using the WHO DORIS tool for ICD-11. When true, the causeCode SHALL use the ICD-11 MMS system URI. This element supports audit and transparency of the coding process.

Other significant conditions that contributed to the death but were not part of the direct causal chain reported in Part 1. Time intervals may be noted alongside each condition. Modeled as structured Condition resources, not free text.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Free-text description of the contributing condition as written by the certifying practitioner. Always mandatory.

Coded representation of the contributing condition. Extensible binding to mccod-cause-of-death-codes ValueSet.

Approximate time interval associated with this condition, as noted in brackets after the condition per WHO MCCoD guidance (e.g. "6 months", "2 years"). Represented as a string.