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REMEDY : BNSSG referral pathways & Joint Formulary

Death Certification and Cremation Forms

Checked: 14-10-2020 by Rob.Adams Next Review: 13-10-2021

Death Certification

The Coronavirus Bill has changed the law on death certification and cremation forms during the COVID-19 pandemic:

As well as other things this law says the following about death and cremation certificates during the current crisis:

  • A death certificate can now be signed by a doctor who was not the attending physician in the final illness provided the practitioner who attended cannot do so (or it is impractical to do so).

  • If a patient has not been attended to by a practitioner in their last illness then a certificate can still be issued as long as they can state to the best of their knowledge and belief the cause of death. However, the patient needs to have been seen by another medical professional within 28 days of death or after death, otherwise an emailed referral to the Coroner will be required. When completing the certificate the issuing doctor will need to add the name of the doctor who last saw them and the date that this occured.

  • Attendance before death can be visual (i.e. in person) or by video, but cannot be audio (i.e. telephone) only.

  • Attendance after death must be in person.

  • Death certificates should be signed, scanned (both sides) and emailed securely to the Registrar’s Office (see contact details below) and paper copies can be forwarded by post at a later date.

  • Please also print your name and GMC number on the certificate (this information used to be on the envelope so will not be picked up otherwise when the form is emailed).

Further information is on TeamNet

Death verification

Death verification is covered in the End Of Life Covid Community Guidance (Section 5, page 70, summarised in the appendices pages 80-83) and there is some specific government Covid guidance for remote verification in the Annex: Guidance for remote clinical support for verification of death (see the last link under the Contents on the left)

Information for Next of Kin

Please advise the NOK that the registry office building is closed and that they should ring the registry office rather than attend in person (see contact details below)

Also advise them that they should not collect the original paper death certificate from the surgery as this will be emailed to the registrar by the issuing doctor during the current COVID-19 pandemic.

Cause of Death

Please see the Cause of Death section below for further advice.

Cremation Forms

Cremation Form 4

The first part of the cremation certificate (Form 4) can now be submitted electronically – sending from the secure email account of the person completing the form directly to the crematorium is considered acceptable as an electronic signature.

If the doctor completing form 4 has not seen the patient within 28 days of death or after death, then they should complete the form as follows and make an email referral to the coroner:

  • Q 5 - answer 'No'

  • Q 6,7and 8 - answer N/A

  • Q 9 - give details of the attending doctor (Name and GMC number) and date, time and nature of their examination.

  • Q 20/21- detail outcome of coroner's referral

A completed cremation form 4 must then be sent directly to the crematorium (see contact details below). You may also copy in the email of the funeral director as long as they have a secure email address (note to is secure). Recent Ministry of Justice guidance states that unsigned emails are only acceptable if they are sent directly from the GP’s personal secure email address to the crematorium.

Cause of Death and Crem Form protocol

There is also the Cause of Death and Crem Form protocol which should now be embedded in EMIS systems. Once loaded this allows GPs to record cause of death and complete a cremation form (Form 4). This can then be saved and emailed via your personal email address (this will be taken accepted as a digital signature and removes the need to physically sign the document) directly to the local cremation authority.The Funeral Director dealing with the funeral can assist in identifying the relevant authority.

Instructions on how to upload the protocol are available here.

Alternatively a paper Form 4 can still be used and emailed or sent. There is also a downloadable version of Form 4 available below:

Form 4 

Guidance for completing the Cremation Form 4.

Cremation Form 5

The need for the second confirmatory part (Form 5) of the cremation form to be completed has been removed - with immediate effect.

Contact Details

Registrar Offices (send Death Certificates to the relevant local office as below):

  • Bristol Registrars Office:

Telephone number to ring  for NOK : 0117 922 2800

Email address where death certificates should be sent for Bristol patients:

  • North Somerset Registrars Office:

Email address where death certificates should be sent for North Somerset patients:

  • South Glos Registrars Office:

Email address where death certificates should be sent for South Gloucestershire patients  


Crematoriums (send Form 4 to the local crematorium dealing with the cremation - please ask the funeral director if you are not sure which crematorium to send it to)

Bristol Crematorium:

Form 4 can be emailed directly to the crematorium for Bristol patients:

Cause of Death

Please see some advice regards acceptable cause of death on a death certificate during COVID-19:

  • COVID-19 is an acceptable direct or underlying cause of death for the purposes of completing the Medical Certificate of Cause of Death
  • COVID-19 is not a reason on its own to refer a death to a coroner under the Coroners and Justice Act 2009.
  • It is acceptable to qualify mention of Covid-19 with words such as ‘possibly’ or ‘probably’ indicating the absence of a positive virology test or some ambiguity in clinical presentation, and such qualifiers do not in themselves imply sufficient doubt on the cause of death to require referral to a coroner. The recording of “probable Covid-19” or “possible Covid-19” as the cause of death is not acceptable on its own. However when accompanied by an acceptable cause of death in part 1 of the MCCD it can be accepted. For example 1a Bronchopneumonia, 1b Probable COVID-19.  
  • That COVID-19 is a notifiable disease under the Health Protection (Notification) Regulations 2010 does not mean referral to a coroner is required by virtue of its notifiable status.

For full guidance see Guidance for doctors completing Medical Certificates of Cause of Death  in England and Wales.