Profile on Observation documenting autopsy information as recorded in Frame B of the WHO Medical Certificate of Cause of Death (MCCoD).

Form fields captured:

1. "Was an autopsy requested?" → Observation.valueCodeableConcept
2. "If yes were the findings used in the certification?" → Observation.component[findingsUsed].valueCodeableConcept

LOINC code note: LOINC 85699-7 ("Autopsy was performed") is used as the closest internationally recognised code. The WHO MCCoD form asks whether an autopsy was "requested" rather than "performed" — this semantic distinction is documented here and member countries MAY define a more precise national code in their implementation guides.

Conditional logic: The findingsUsed component is applicable only when the autopsy was requested (value = Yes). When value is No or Unknown, the findingsUsed component SHOULD be absent. This is documented as guidance; a warning-level invariant is defined on this profile.

Yes/No/Unknown pattern: Both the value and the findingsUsed component use the mccod-yes-no-unknown ValueSet consistently across Frame B.

Profile on Condition representing a single line entry (a, b, c, or d) in the causal chain of the WHO Medical Certificate of Cause of Death (MCCoD) Frame A, Part 1.

One instance of this profile is created for each line of the causal chain that is documented by the certifying practitioner. The line position (a = immediate cause, b/c/d = antecedent causes) is identified by the mccod-cause-of-death-line-position extension.

Mandatory constraints:

• Line position extension SHALL be present and coded (a/b/c/d)
• Condition.code.text SHALL always be present (free text of cause)
• Condition.subject SHALL reference the deceased Patient
• Condition.clinicalStatus SHALL be #inactive (patient is deceased)

Causal chain ordering: The ordering obligation (line a required; line b required if line a present and chain continues, etc.) is enforced by invariants in the MCCoDComposition profile, not here. A single Condition profile cannot enforce cross-instance ordering.

Coding: Condition.code.coding is optional. When present, it SHALL use ICD-10 or ICD-11 system URIs as declared in the mccod-cause-of-death-codes ValueSet. Text is always required regardless of whether a coded value is provided.

Country extensions: Member countries MAY extend this profile to add national identifiers or additional coding requirements. Extensions SHALL NOT remove or relax any constraint defined here.

Profile on Composition representing a complete WHO Medical Certificate of Cause of Death (MCCoD) document.

This is the top-level resource of the MCCoD document. It ties together all mandatory (Frame A) and optional (Frame B) profiles defined in this IG, and enforces cross-resource constraints through invariants.

Document type: LOINC 64297-5 (Death certificate) is used as the Composition.type.

Participants:

• subject: the deceased Patient (base FHIR, unconstrained)
• author: certifying Practitioner or PractitionerRole
• custodian: certifying Organization All three reference base FHIR resources without further constraint, allowing member countries to extend per national requirements.

Sections:

• Frame A (1..1 MANDATORY): Cause of death chain, underlying cause, and contributing conditions
• Frame B General (0..1 OPTIONAL): Surgery, autopsy, manner of death, external cause
• Frame B Fetal/Infant (0..1 OPTIONAL): Fetal/infant death details; SHOULD be populated for infant deaths and stillbirths
• Frame B Pregnancy (0..1 OPTIONAL): Pregnancy status; SHOULD be populated for female deceased aged 15-49

Mandatory constraints (error-level):

• Frame A SHALL contain exactly one Condition with linePosition=a
• If line c present, line b SHALL be present
• If line d present, line c SHALL be present
• Frame A SHALL contain exactly one UnderlyingCauseOfDeath
• If a Frame B fetal/infant or pregnancy section is present but contains no entries, emptyReason SHALL be present

Conditional guidance (warning-level):

• If manner of death is an external cause, MCCoDInjuryIncident SHOULD be present in frameBGeneral
• If deceased was infant/newborn (age < 28 days), frameBFetalInfant SHOULD be populated
• If deceased was female aged 15-49, frameBPregnancy SHOULD be populated

Profile on Condition representing a condition listed in Frame A, Part 2 of the WHO Medical Certificate of Cause of Death (MCCoD): "Other significant conditions contributing to death".

Contributing conditions are clinically significant comorbidities or concurrent conditions that contributed to the death of the patient but were NOT part of the direct causal chain reported in Frame A, Part 1 (lines a–d).

Distinction from other Condition profiles:

• MCCoDCauseOfDeathCondition: causal chain entries (lines a–d), identified by the linePosition extension and problem-list-item category
• MCCoDUnderlyingCauseOfDeath: the single underlying cause, identified by underlying-cause-of-death category
• This profile: contributing conditions, identified by contributing-condition category. No line position. No DORIS flag.

Multiplicity: Multiple instances are permitted. The MCCoDComposition allows 0..* contributing conditions in the Frame A section.

Time interval: The WHO MCCoD form notes that time intervals can be included in brackets after the condition. This is captured by the mccod-onset-to-death-interval extension as a free-text string.

Coding: Condition.code.text is always required. Condition.code.coding is optional, with extensible binding to mccod-cause-of-death-codes.

Country extensions: Member countries MAY extend this profile to add national identifiers or additional coding requirements.

Profile on Observation documenting fetal or infant death details as recorded in Frame B of the WHO Medical Certificate of Cause of Death (MCCoD).

Conditional guidance: This Observation SHOULD be present when the deceased was an infant aged less than 28 days at death, or when the death was a stillbirth. This is enforced as a warning-level invariant in MCCoDComposition. When intentionally omitted for a non-infant death, the corresponding Composition section SHALL carry an emptyReason.

Form fields captured as components:

• Multiple pregnancy (Yes/No/Unknown) → LOINC 57722-1
• Stillborn (Yes/No/Unknown) → local code
• Hours survived if death within 24h → local code
• Birth weight in grams → LOINC 8339-4
• Completed weeks of pregnancy → LOINC 11884-4
• Age of mother in years → LOINC 63900-5
• Perinatal maternal conditions → local code (free text)

LOINC code notes:

• 57722-1 (Birth plurality of Pregnancy) is used for multiple pregnancy — this captures the concept of multiple gestation which underlies the multiple pregnancy question.
• 63900-5 (Current age or age at death) is applied here to the mother's age at time of delivery/death of the infant.
• No LOINC codes exist for stillborn Y/N question, hours survived, or perinatal maternal conditions as discrete question concepts; local codes are used and documented for national IG authors.

Profile on Observation documenting the details of the external cause of death or poisoning, as recorded in Frame B of the WHO Medical Certificate of Cause of Death (MCCoD).

Form fields captured:

1. "Please describe how external cause occurred (If poisoning please specify poisoning agent)" → Observation.component[description].valueString
2. "Date of injury" → Observation.effectiveDateTime
3. "Place of Occurrence of the external cause" → Observation.component[placeOfOccurrence].valueCodeableConcept with required binding to mccod-place-of-injury-codes ValueSet

Context — when to use: This Observation SHOULD be present when MCCoDMannerOfDeath value is one of: Assault, Accident, Legal Intervention, Intentional Self Harm, or War. This conditional requirement is enforced as a warning-level invariant in MCCoDComposition.

Place of occurrence — 'other' handling: When the place of occurrence is coded as #other, a free-text description of the place SHALL be provided in the component valueCodeableConcept.text element. This is enforced as an error-level invariant on this profile.

Poisoning: When the external cause involves poisoning, the poisoning agent SHALL be specified in the component[description].valueString field, consistent with WHO MCCoD form guidance.

Profile on Observation documenting the manner of death as recorded in Frame B of the WHO Medical Certificate of Cause of Death (MCCoD).

The manner of death describes the circumstances under which the cause of death arose. It is distinct from the cause of death itself.

Value: Observation.valueCodeableConcept is required and SHALL be bound to the mccod-manner-of-death-codes ValueSet (required binding): Disease | Assault | Accident | Legal Intervention | Could Not Be Determined | Pending Investigation | Intentional Self Harm | War | Unknown

Observation code: LOINC 69449-7 (Manner of death) is used for Observation.code. This is the same LOINC code used by the US VRDR IG and is internationally recognised for this concept.

Relationship to external cause: When the manner is Assault, Accident, Legal Intervention, Intentional Self Harm, or War, the MCCoDInjuryIncident Observation SHOULD also be present. This conditional requirement is enforced as a warning-level invariant in MCCoDComposition.

Optionality: This Observation is optional (Frame B). When present, the value SHALL be coded from the required ValueSet.

Profile on Observation documenting pregnancy status at or near the time of death for women of reproductive age, as recorded in Frame B of the WHO Medical Certificate of Cause of Death (MCCoD).

Conditional guidance: This Observation SHOULD be present when the deceased was female and aged 15–49 years at time of death. This is enforced as a warning-level invariant in MCCoDComposition. When intentionally omitted, the corresponding Composition section SHALL carry an emptyReason.

Form fields captured as components:

1. "Was the deceased pregnant within past year?" (Yes/No/Unknown) → component[pregnantWithinYear] — required when Observation present
2. "If yes, was she pregnant: timing options" → component[pregnancyTiming] using LOINC 69442-2 (conditional on pregnantWithinYear = Yes)
3. "Did the pregnancy contribute to the death?" (Yes/No/Unknown) → component[pregnancyContributedToDeath] (conditional on pregnantWithinYear = Yes)

LOINC codes:

• Parent Observation code: 82810-3 (Pregnancy status)
• Timing component: 69442-2 (Timing of recent pregnancy in relation to death) — consistent with VRDR DecedentPregnancy pattern
• Local codes for pregnantWithinYear and contributedToDeath questions (no exact LOINC match for these as discrete Y/N questions)

Timing ValueSet: component[pregnancyTiming] is bound REQUIRED to mccod-pregnancy-status-codes ValueSet (Step 10):

• when-died
• within-42-days
• 43-days-to-1-year
• timing-unknown

Profile on Observation documenting whether surgery was performed within the 4 weeks preceding death, as recorded in Frame B of the WHO Medical Certificate of Cause of Death (MCCoD).

Form fields captured:

1. "Was surgery performed within the last 4 weeks?" → Observation.valueCodeableConcept (Yes/No/Unknown)
2. "If yes please specify date of surgery" → Observation.effectiveDateTime (conditional on value = Yes)
3. "If yes please specify reason for surgery (disease or condition)" → Observation.component[reason].valueString using LOINC 55752-0 (Clinical information)

Conditional logic: effectiveDateTime and component[reason] are applicable only when value = Yes. Warning-level invariants enforce this guidance.

Clinical relevance: Surgery within 4 weeks of death is clinically significant as it may contribute to or complicate the cause of death. This information supports mortality coding under ICD-10 and ICD-11 rules for postoperative complications.

Profile on Condition representing the underlying cause of death as documented on the WHO Medical Certificate of Cause of Death (MCCoD).

The underlying cause of death is defined by WHO as: (a) the disease or injury which initiated the train of morbid events leading directly to death, or (b) the circumstances of the accident or violence which produced the fatal injury.

This profile is MANDATORY — every MCCoD document SHALL contain exactly one instance of this profile (enforced in MCCoDComposition).

Distinction from MCCoDCauseOfDeathCondition: This profile does NOT carry a line position extension. It is conceptually separate from the causal chain (lines a–d). Per WHO DORIS methodology for ICD-11, the underlying cause may be a condition that does not appear on any line of the causal chain — for example, when a DORIS selection or modification rule identifies a different condition as the initiating cause.

DORIS flag: The mccod-doris-derived extension SHALL be present. When true, the Condition.code SHOULD use the ICD-11 MMS system URI.

Coding: Condition.code.text is always required. Condition.code.coding is optional, with extensible binding to mccod-cause-of-death-codes.

Country extensions: Member countries MAY extend this profile to add national identifiers or additional coding requirements.

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

Logical model representing the data elements of Frame B (Other Medical Data) of the WHO Medical Certificate of Cause of Death (MCCoD).

Frame B is OPTIONAL at the section level. However, certain sub-sections SHOULD be populated based on the clinical context of the death:

• The Fetal or Infant Death sub-section SHOULD be populated when the deceased was an infant or newborn (age at death less than 28 days), or when the death was a stillbirth.
• The Women of Reproductive Age sub-section SHOULD be populated when the deceased was female and aged 15–49 years at time of death.
• External cause elements SHOULD be populated when manner of death is Assault, Accident, Legal Intervention, Intentional Self Harm, or War.

These conditional requirements are enforced as warning-level invariants in the MCCoDComposition profile, not as hard errors, consistent with the optional nature of Frame B.

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

Identifies the position of this Condition in the WHO MCCoD Frame A causal chain. Line a is the immediate cause of death. Lines b, c, d are antecedent causes in order. This extension is required on all MCCoDCauseOfDeathCondition instances to enable unambiguous ordering of the causal chain.

Indicates whether the underlying cause of death was selected using the WHO DORIS (Death Registry and Outcomes Research Information System) tool for ICD-11 mortality coding. When true, the Condition.code SHOULD use the ICD-11 MMS system URI (http://id.who.int/icd/release/11/mms). This extension supports audit and transparency of the underlying cause selection process, consistent with ICD-11 implementation requirements.

The approximate interval between the onset of a condition and the time of death, as estimated by the certifying practitioner. Represented as a free-text string (e.g. "2 hours", "3 weeks", "5 years") rather than a structured FHIR Duration, because clinical estimates on death certificates are inherently imprecise and do not conform to structured duration semantics. Corresponds to the "Time interval from onset to death" column of the WHO MCCoD Form A, identified by LOINC 69440-6 (Disease onset to death interval).

Value set for cause of death coding on the WHO Medical Certificate of Cause of Death (MCCoD), applicable to all lines of Frame A (immediate cause, antecedent causes) and to the underlying cause of death.

ICD Version Agnostic Design: This value set supports both ICD-10 and ICD-11 to accommodate the range of coding systems in use across AeHIN member countries. The binding strength at the profile level is EXTENSIBLE, meaning:

• Codes from ICD-10 (WHO reference version) are preferred
• Codes from ICD-11 MMS are preferred
• Codes from national ICD-10 or ICD-11 variants are permitted
• Text-only entries (no code) are permitted for countries without electronic coding capability, subject to national policy

Text always required: Regardless of whether a code is present, the text representation of the cause of death SHALL always be provided. This is enforced by an invariant in the MCCoDCauseOfDeathCondition and MCCoDUnderlyingCauseOfDeath profiles.

ICD system URIs recognised by this IG:

Countries using national ICD variants not listed above SHALL declare the appropriate system URI in their national implementation guide.

DORIS and ICD-11: When ICD-11 is used with the DORIS tool for underlying cause selection, the underlying cause code SHALL use the ICD-11 MMS system URI. The underlying cause may differ from any code listed in lines a-d of Frame A — this is explicitly supported by the MCCoDUnderlyingCauseOfDeath profile.

Guidance for member countries: Countries SHOULD specify in their national IG which ICD system URI they use and whether text-only entries are permitted in their jurisdiction.

Value set for line position in the WHO MCCoD Frame A causal chain.

Value set for the manner of death as documented on the WHO Medical Certificate of Cause of Death (MCCoD), Frame B.

This value set includes all codes from the AeHIN MCCoD Manner of Death code system. It is bound REQUIRED to the MCCoDMannerOfDeath Observation profile, meaning only these codes are permitted.

Guidance for member countries: Countries wishing to map these codes to SNOMED CT or ICD-11 external cause codes for interoperability purposes SHOULD do so in their national implementation guide, which extends this IG. No additional codes SHALL be added at the regional level; extensions are national only.

SNOMED CT cross-reference (informative, not binding):

• Disease → 38605008 (Natural death)
• Assault → 27935005 (Homicide)
• Accident → 7878000 (Accidental death)
• Intentional Self Harm → 44301001 (Suicide)

Value set for the place of occurrence of the external cause of death, as documented on the WHO Medical Certificate of Cause of Death (MCCoD), Frame B.

This value set is applicable only when the manner of death involves an external cause. It SHOULD be populated when manner of death is one of: Assault, Accident, Legal Intervention, Intentional Self Harm, or War. This conditional requirement is enforced at the profile level in MCCoDInjuryIncident.

This value set includes all codes from the AeHIN MCCoD Place of Injury code system. It is bound REQUIRED to the MCCoDInjuryIncident Observation profile.

Special handling for 'other': When the code 'other' is selected, the certifying practitioner SHALL provide a free-text description of the place in the Observation.valueCodeableConcept.text element. This is enforced by an invariant in the MCCoDInjuryIncident profile.

Guidance for member countries: Countries wishing to map these codes to ICD-11 place of occurrence codes (ICD-11 Chapter 23, XS codes) or SNOMED CT location codes SHOULD do so in their national implementation guide. No additional codes SHALL be added at the regional level.

ICD-11 cross-reference (informative, not binding):

• At Home → XE266 (Home)
• Residential Institution → XE9DC (Residential institution)
• School or educational area → XE6TU (School or educational area)
• Sports and Athletics → XE7K0 (Sports and athletics area)
• Public highway, street or road → XE5NE (Public highway, street or road)
• Commercial area (non-recreational) → XE48U (Commercial area (non-recreational))
• Industrial and Construction → XE7T4 (Industrial and construction area)
• Farm or other place of primary production → XE9CS (Farm or other place of primary production)

Value set for the timing of pregnancy relative to death, as documented in the Women of Reproductive Age section of the WHO Medical Certificate of Cause of Death (MCCoD), Frame B.

This value set is applicable ONLY when:

• The deceased was female aged 15–49 years at time of death, AND
• The question "Was the deceased pregnant within past year?" is answered Yes

These timing categories are consistent with WHO maternal death surveillance definitions and ICD-11 Chapter 18 (Pregnancy, childbirth or the puerperium) coding rules.

Binding strength at profile level: REQUIRED When the pregnancy timing element is present, only these codes are permitted.

Relationship to maternal death classification:

• "When she died" → Direct or indirect obstetric death (ICD-11 Chapter 18)
• "Within 42 days" → Late maternal death (WHO definition)
• "43 days to 1 year" → Late maternal death surveillance window
• "Exact timing unknown" → Unspecified maternal death timing

Whether pregnancy contributed to death is a separate Yes/No/Unknown element in the MCCoDPregnancyStatus profile and is not covered by this value set.

SNOMED CT cross-reference (informative, not binding):

• Within 42 days → 59283008 (Death within 42 days of delivery)

ICD-11 cross-reference (informative, not binding):

• When she died → JA00–JB6Z (Pregnancy, childbirth or the puerperium)
• Within 42 days → JB60 (maternal death)
• 43 days to 1 year → JB61.0 (Death during pregnancy more than 42 days)
• Exact timing unknown → JB6Z (Unspecified obstetric condition)

Guidance for member countries: Countries SHOULD map these codes to their national maternal death surveillance system classifications in their national implementation guide.

Reusable value set for binary (Yes/No/Unknown) responses on the WHO MCCoD Frame B questions. Used consistently across all Frame B Observations that carry a Yes/No/Unknown answer.

• Yes → HL7 v2-0136 #Y
• No → HL7 v2-0136 #N
• Unknown → data-absent-reason #asked-unknown (the question was asked but the answer is not known)

This pattern follows standard FHIR practice for representing unknown responses without creating unnecessary local code systems.

Codes identifying the line position in the WHO MCCoD Frame A causal chain.

Local code system for identifying sections within the MCCoD Composition where no suitable internationally recognised code exists.

Code system providing category codes to distinguish the different types of Condition resources used in the AeHIN MCCoD IG. These codes allow systems to unambiguously identify the role of a Condition within a MCCoD document without relying on profile URL matching.

Local code system for MCCoD Observation types where no suitable internationally recognised LOINC code exists for the exact concept as defined in the WHO MCCoD form. These codes are used as Observation.code values in this IG. Member countries SHOULD map or replace these with appropriate national or LOINC codes in their national implementation guides.

Code system defining the manner of death categories as specified in the WHO Medical Certificate of Cause of Death (MCCoD) Form B. These codes align with the openEHR death_summary archetype (openEHR-EHR-EVALUATION.death_summary.v0) manner_of_death data element. Member countries SHALL use these codes without modification to ensure regional comparability. Local extensions, if needed, SHALL be defined in country-specific implementation guides that derive from this IG.

Code system defining the place of occurrence of the external cause of death, as specified in the WHO Medical Certificate of Cause of Death (MCCoD) Form B. This element is relevant only when the manner of death involves an external cause (Assault, Accident, Legal Intervention, Intentional Self Harm, War). When the code 'other' is used, the Observation SHALL include a text component specifying the place — this is enforced at the profile level. Member countries SHALL use these codes without modification to ensure regional comparability.

Code system defining the timing of pregnancy relative to death, as specified in the Women of Reproductive Age section of the WHO Medical Certificate of Cause of Death (MCCoD), Frame B. These codes are used only when the deceased was confirmed to have been pregnant within the year preceding death. Consistent with WHO maternal death surveillance definitions and ICD-11 Chapter 18 coding rules.

MCCoD Composition for the example scenario.

Autopsy was not requested.

Line a: Acute myocardial infarction (I21.9). Interval: 2 hours.

Line b: Coronary artery disease (I25.1). Interval: 10 years.

Part 2: Hypertension (I10). Present for 15 years.

Example MCCoD document bundle for a 45-year-old male who died of acute myocardial infarction due to coronary artery disease, with hypertension as a contributing condition. Demonstrates all mandatory Frame A elements and selected optional Frame B elements. ICD-10 codes used (non-DORIS country).

Manner of death: Disease.

Fictional hospital — all details illustrative only.

Fictional deceased patient — all details illustrative only.

Fictional certifying physician — all details illustrative only.

No surgery was performed within the last 4 weeks.

Underlying cause: Coronary artery disease (I25.1). Same as line b — ICD-10 mortality coding rules select the initiating disease. DORIS not used (ICD-10 country).