Death pronouncement notes document patient death including time, circumstances, family notification, and disposition. This documentation has legal significance—death certificates, legal proceedings, and estate settlements rely on accuracy. AI-assisted templates ensure all required elements are documented during stressful moments when providers may be managing multiple concurrent issues.
12 Required Elements Checklist
Death Note Documentation
| # | Element | Example |
|---|---|---|
| 1 | Date and time of pronouncement | "Pronounced dead at 3:50 AM on 01/15/2026" |
| 2 | Physician performing pronouncement | "Pronounced by Dr. Smith, attending physician" |
| 3 | Examination confirming death | "No pulse, respirations, heart sounds, or response to stimuli" |
| 4 | Fixed dilated pupils | "Pupils fixed and dilated bilaterally" |
| 5 | Circumstances of death | "Patient found unresponsive by nursing staff at 3:40 AM" |
| 6 | Presumed cause of death | "Respiratory failure secondary to end-stage COPD" |
| 7 | Expected vs. unexpected | "Death expected given terminal diagnosis and DNR status" |
| 8 | DNR/code status | "Valid DNR order in place; no resuscitation attempted" |
| 9 | Medical examiner notification | "ME notification not required—expected death from natural causes" |
| 10 | Family notification | "Spouse notified by phone at 4:10 AM; expressed understanding" |
| 11 | Organ procurement notification | "OPO notified at 4:15 AM; patient not suitable donor candidate" |
| 12 | Body disposition | "Body released to Sunset Funeral Home per family request" |
Note Template
**DEATH PRONOUNCEMENT NOTE** **Date/Time:** [Date] at [Time] **Pronounced by:** [Physician name, credentials] **Examination:** Patient examined at [time]. No palpable pulse. No spontaneous respirations. No heart sounds on cardiac auscultation. Pupils fixed and dilated bilaterally. No response to verbal or tactile stimuli. **Circumstances:** [Patient found unresponsive by nursing staff at ___ / Patient expired during active resuscitation / Patient expired peacefully with family at bedside] **Cause of Death:** Presumed cause: [Primary cause] secondary to [Contributing factors] [Expected/Unexpected] death. **Code Status:** [Valid DNR order in place. No resuscitation attempted per patient wishes. / ACLS protocol initiated at ___. Resuscitation efforts continued for ___ minutes without ROSC. Resuscitation discontinued at ___.] **Medical Examiner:** [ME notification not required—expected death from natural causes / ME notified at ___ regarding unexpected death. ME accepted/declined case.] **Family Notification:** [Family member name] notified by [phone/in person] at [time]. [Family response/requests noted.] **OPO Notification:** Organ procurement organization notified at [time]. [Patient not suitable donor candidate / OPO reviewing case / Family declined donation.] **Disposition:** Body released to [Funeral home name] per family arrangement. [Physician signature and credentials]
When Medical Examiner Notification Is Required
ME Notification Criteria
| Requires ME Notification | Typically Does NOT Require ME |
|---|---|
| Unexpected death | Expected death from known terminal illness |
| Death from trauma or violence | Death in hospice care |
| Death within 24 hours of admission | Death with clear natural cause |
| Death from unknown cause | Elderly patient with multiple comorbidities |
| Suspicious circumstances | Family and physician agree on cause |
| Deaths in custody | DNR patient with documented terminal illness |
Note: Requirements vary by jurisdiction. When in doubt, call the medical examiner.
Family Notification Documentation
**Family present:** "Patient's children present at bedside at time of death. Family had opportunity to say goodbyes." **Phone notification:** "Spouse [name] notified by telephone at [time]. Spouse was aware death was imminent given hospice status. Expressed understanding and appreciation for care." **Unable to reach:** "Multiple attempts to reach next of kin unsuccessful. Messages left requesting urgent callback. Will continue attempts."
Frequently Asked Questions About Death Documentation
Who can pronounce death?
Physicians, and in some settings, nurses or advanced practice providers. Requirements vary by state and facility policy. Hospice settings may allow RN pronouncement for expected deaths. Hospital deaths typically require physician pronouncement.
What if cause of death is uncertain?
Document uncertainty honestly and notify ME. "Cause of death unclear. Patient found unresponsive with no obvious cause. Medical examiner notified for death investigation." Honesty protects you legally more than guessing.
How detailed should the examination be?
Document absence of pulse, breathing, heart sounds, and responsiveness. This establishes medical basis for death determination. For questionable cases, more detailed exam (EKG showing asystole, etc.) may be appropriate.
What about religious/cultural considerations?
Document family preferences and accommodations. "Family requested no autopsy for religious reasons. ME agreed autopsy not required. Body released promptly for religious burial requirements." Respectful documentation shows patient-centered care.
Can AI help with death notes?
Yes, AI tools like River's Death Note Generator create complete templates. Input circumstances, and the AI generates documentation with all required elements. Especially helpful during stressful situations when details might otherwise be missed. Always verify AI-generated content for accuracy.
Proper death documentation serves families, legal systems, and public health. Use River's Death Note Generator to ensure complete documentation during difficult moments.