A death pronouncement note records how you confirmed a patient’s death, the time of death, and who you told, from the family to the coroner or medical examiner. Copy the free template, see an expected death on comfort care and an unexpected death after a failed resuscitation, and check what each part needs.
Blank death pronouncement note template
FreeDEATH PRONOUNCEMENT NOTE Patient: [Name] Date of birth or ID: [Identifier] Location: [Unit and room] Date: [Date] Pronounced by: [Name, credentials, role] Attending: [Name] CALL AND CIRCUMSTANCES Called by: [Name, role, and time of the call] Reason: [Breathing stopped, found unresponsive, or resuscitation stopped] Arrived: [Time] Expected or unexpected: [Diagnosis, recent course, and whether death was expected] Code status: [Do-not-resuscitate order, comfort care, or full code; any resuscitation, its length, and when it stopped] Identity confirmed: [Wristband, name, and date of birth checked] EXAMINATION Response: [No response to voice or to a painful stimulus, and which stimulus] Pupils: [Fixed and dilated, no response to light] Breathing: [No spontaneous breathing; no breath sounds, and how long you listened] Heart and pulse: [No heart sounds, and how long you listened; no carotid or femoral pulse] Monitor: [Rhythm on the monitor, or not attached] Observation: [Total time observed, per your policy] PRONOUNCEMENT Time of death: [Time pronounced; the time breathing was last seen, if different] Present: [Family, staff, chaplain, or no one] Presumed cause: [Immediate cause and underlying condition, or unknown] NOTIFICATIONS Family or decision-maker: [Name, relationship, time, in person or by phone, and who told them] Family response: [Questions asked, wishes about time with the patient, spiritual or cultural needs] Attending or primary physician: [Name, time, and how] CORONER OR MEDICAL EXAMINER Reportable: [Yes or no, and the reason under your jurisdiction's rules] Reported to: [Name or office, time, and case number] Instructions: [Lines and tubes left in place, samples kept, release of the body] DONATION AND AUTOPSY Donation referral: [Time called, reference number, outcome, and who will speak with the family] Autopsy: [Offered, and accepted or declined by whom; or for the coroner or medical examiner to decide] AFTER DEATH Death certificate: [Who will complete it, and when] Body: [To the morgue or the family's funeral home, and when] Belongings: [Listed, and given to whom] Support offered: [Chaplain, social work, or bereavement services] Signed: [Name, credentials, date and time]
Use it for
Each one follows the template. Use them to judge how much detail every part needs.
Medical ward, afternoon, family at the bedside
Called by her nurse, Ana Ruiz, RN, at 14:12: breathing stopped at about 14:05, with her daughter and son at the bedside. Arrived at 14:20. 84-year-old woman with metastatic pancreatic adenocarcinoma, admitted 6 days ago with a malignant bowel obstruction. Moved to comfort-focused care on hospital day 3 after a family meeting, with palliative care following and a hydromorphone infusion for comfort. Death expected. Do-not-resuscitate order and comfort care only; no resuscitation attempted. Identity confirmed by wristband.
Examined with the family’s permission; they chose to stay in the room. No response to voice or to a firm trapezius squeeze. Pupils fixed and dilated, no response to light. No spontaneous breathing; no breath sounds on listening for 2 minutes. No heart sounds on listening for 2 minutes, per hospital policy; no carotid pulse. Not on a monitor.
Pronounced dead at 14:24. Breathing last seen by her daughter and her nurse at about 14:05. Present at the death: her daughter, who is her health care decision-maker, and her son. Presumed cause: malignant bowel obstruction, due to metastatic pancreatic adenocarcinoma.
Her daughter and son were told by me at the bedside at 14:26. Her daughter said she was “peaceful at the end.” They asked for time alone with her and for the hospital chaplain; chaplain paged at 14:30 and with the family by 14:45. Attending, Dr. Lee, informed by phone at 14:35. Palliative care team informed by secure message. Dr. Lee will let her family physician know.
Not reportable: an expected death from a known natural disease, under ongoing care, with no injury, fall, or recent procedure. Not reported.
Referral called to the organ and tissue donation organization at 14:40, reference 4471-26. Not a candidate for organ donation. The coordinator will call her daughter this evening about eye donation, which the patient asked about at the family meeting. Autopsy offered; her daughter declined, saying her mother had not wanted one.
Death certificate: Dr. Lee will complete it today. Infusion stopped; IV and urinary catheter removed after the family’s time with her. Body to the morgue at about 16:00, then to the funeral home the family chose, named on the release form. Wedding ring left on at the family’s request; other belongings listed and given to her son. Bereavement information given; the palliative care team will call the family next week.
Medical ward, overnight, after a code blue
Code blue called by his nurse, Ben Okafor, RN, at 03:12: found unresponsive and without a pulse on hourly rounds. Last seen at 02:00, asleep and breathing normally. Arrived at 03:13 as night hospitalist and led the code. 58-year-old man, hospital day 2 for cellulitis of the left leg, improving on IV cefazolin and walking on his own; no chest pain or shortness of breath reported overnight. Death unexpected. Full code. CPR and advanced life support for 34 minutes, per the code record: pulseless electrical activity, then asystole; intubated; intraosseous access; 7 doses of epinephrine; no cardiac activity on bedside ultrasound at 03:40; no return of circulation at any point. Resuscitation stopped at 03:46 by team agreement. Identity confirmed by wristband.
Observed for 5 minutes after CPR stopped, per hospital policy. Asystole on the monitor throughout. No carotid or femoral pulse. At the end of that time, no heart sounds and no breath sounds on listening for 1 minute each. No spontaneous breathing; endotracheal tube in place. Pupils fixed and dilated, no response to light. No response to a firm trapezius squeeze.
Pronounced dead at 03:51. Present: the code team and his nurse; no family present. Cause of death unknown; pulmonary embolism and a primary arrhythmia are both possible. For the coroner or medical examiner to determine.
His wife, his emergency contact, called by me at 04:05. Confirmed I was speaking to her. She asked directly whether he had died, so I told her by phone, then explained that his heart stopped suddenly overnight and that the team tried to restart it for more than half an hour. Told her the coroner or medical examiner will review his death, as is required for a sudden, unexpected death. She is coming in with their son; the charge nurse will meet them, and I will speak with them when they arrive. Attending of record, Dr. Shah, informed by phone at 04:15.
Reportable: a sudden, unexpected death in a patient who was improving, with the cause unknown. Reported at 04:25 to the investigator on call, J. Ortiz; case 26-3318. Instructions: leave the endotracheal tube, intraosseous needle, and IV lines in place; keep his admission blood samples in the lab; do not release the body until the office calls.
Referral called to the organ and tissue donation organization at 04:10, reference 9025-26. Not a candidate for organ donation; may be a candidate for tissue donation if the coroner or medical examiner agrees. The coordinator will call his wife later this morning. Autopsy: for the coroner or medical examiner to decide; told his wife their office will contact her.
Death certificate: to be completed by the coroner or medical examiner if they take the case; if they decline it, Dr. Shah will complete it. Body to the morgue with all lines and tubes in place, labeled as a reportable case, pending release. Belongings listed and kept on the unit for his wife. Chaplain asked to be present when the family arrives. Referred for the hospital’s mortality review.
Who called you, when, and why, and the story that led to the death: the diagnosis, whether death was expected, and the code status.
Avoid: Leaving out whether the death was expected. It shapes much of what follows: reporting, donation, and what the family needs to hear.
The findings that confirmed death, and how long you watched. This note is for death after the heart and breathing stop. Death by neurologic criteria, or brain death, follows its own protocol and has its own documentation.
Avoid: “Exam consistent with death.” Record each finding and the time you listened. Most hospitals ask for at least a minute; your policy sets the exact time.
The time of death, who was there, and the presumed cause.
Avoid: Writing a cause you can’t support. If the cause is unknown, say so, and leave it to the coroner or medical examiner.
Who you told, when, how, and what they said. The family’s questions and wishes belong here too.
Avoid: Giving the news to whoever answers the phone. Confirm you are speaking to the right person, and ask whether they are somewhere they can talk.
Whether the death must be reported where you practice, and if so, what the office told you. Record the decision even when the answer is no.
Avoid: Removing lines and tubes before you know. In a reportable death, they usually stay in place until the office says otherwise.
The donation referral and the autopsy decision, and who made each one.
Avoid: Deciding yourself that the patient can’t donate. The donation organization screens each referral, and many people who can’t give organs can still give tissue, such as corneas.
What happens next: who completes the death certificate, where the body goes, and what support was offered. Pronouncing death and completing the death certificate are separate tasks, often done by different people.
Avoid: Leaving the death certificate with no one named. Funeral arrangements wait until it is done.
The note, the nursing record, and any monitor strip should show the same time of death. Agree on it with the nurse before you write, and record the last breath separately if someone saw it.
A saved phrase may say “family at the bedside” or “no resuscitation attempted” when neither is true. Read every line against this death before you sign.
Write whether the death is reportable and why, even when it isn’t. A missed report can mean an investigation after the body has been released.
Many hospitals set a time limit for the call, such as within an hour of death. Call before the body goes to the morgue, and record the time and reference number.
Write who told the family, who was told, when, and how. If you couldn’t reach anyone, record each attempt and who will keep trying.
Vero Scribe writes the death pronouncement note in your template from your dictation after you leave the bedside. You review and edit every section, then copy it into your record or export it to Word or PDF. Vero works in 60+ languages.
Record who called you and when, whether the death was expected, and the code status. Then write the exam that confirmed death and how long you listened, the time of death, and who was present. Add who you told: the family, the attending, and the coroner or medical examiner if the death is reportable. End with the donation referral, the autopsy decision, and who will complete the death certificate.
It depends on where you practice and your organization’s policy. Physicians and nurse practitioners can pronounce in most places. In some settings, registered nurses can pronounce an expected death, often in hospice, palliative care, or long-term care. Pronouncing death is separate from completing the death certificate, which may fall to the attending or to the coroner or medical examiner.
Most hospitals ask for at least one minute each, and some ask for longer. After a failed resuscitation, many policies ask you to watch for about five minutes after CPR stops before confirming death, because circulation very rarely returns on its own. When organ donation after circulatory death is planned, that protocol sets the time. Follow your organization’s policy, and write down how long you listened.
The rules differ by state, province, and territory. Most cover sudden or unexpected deaths; deaths from injury, falls, poisoning, or violence; deaths during or soon after surgery or a procedure; and deaths in custody. Some also cover deaths soon after admission. If you are unsure, call the office, and record what they told you.
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