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Death Pronouncement Note From Your Exam
Your exam findings, times and notifications written up as a complete pronouncement note, with any missing notification flagged before you sign.
River's death pronouncement note writer turns your exam findings, times and notifications into a complete note for the record. It covers the clinical context, the examination you performed, the time of death as pronounced, who was notified and when, the medical examiner decision, the organ procurement referral and the autopsy discussion if there was one.
It records only what you found. It does not fill in a standard set of findings you did not check, because a pronouncement note is a legal record of what was examined. Anything a complete note usually contains that your notes do not mention, such as the procurement call or the family notification, is flagged for you rather than assumed.
This is for residents and hospitalists pronouncing overnight, and for nursing facility and hospice clinicians who pronounce regularly.
Death Pronouncement Documentation
Death pronouncement documentation includes essential elements: date and time of death pronouncement (when you examined patient and confirmed death), exam findings confirming death (absence of heart sounds, absence of breath sounds, absence of pulse, fixed and dilated pupils, absence of response to stimuli), who pronounced death, who was notified (attending physician, family, nursing supervisor, medical examiner if applicable), and circumstances of death (expected vs unexpected, resuscitation attempted or not, advance directives in place). Some institutions require specific exam elements or timing of exams. Know your facility's requirements.
Document what you assessed: response to verbal and painful stimuli, pupils fixed and unreactive to light, absent heart sounds on auscultation for at least a minute, absent breath sounds and absent pulse, or whatever your institution's policy specifies. Pupils are often mid-sized rather than dilated after death, so record what you saw rather than a stock phrase. Some institutions use an ECG strip showing asystole. This is a legal record of death, and it may be used for the death certificate and the medical examiner's decision.
Medical examiner or coroner referral criteria vary by jurisdiction, and commonly include unexpected deaths, trauma, possible homicide or suicide, overdose or poisoning, and deaths during or soon after procedures; check your local rules rather than a general list. Hospitals must also notify their organ procurement organization of every death or imminent death in a timely manner under the Medicare conditions of participation, whatever the likelihood of donation. Document the attending, family and procurement notifications with their times.
How it works
Paste your notes
Your exam findings, the times, and who has been told, with names removed if needed.
Get the note
A complete pronouncement note with every gap marked in brackets for you to fill.
Close the gaps
Make any outstanding calls, then update the note in chat before you sign.
What you get
- A complete pronouncement note in plain text, ready to paste into the record
- Exam findings exactly as you recorded them, never a filled-in default set
- Notifications with times: attending, family, organ procurement organization and medical examiner decision
- Missing notifications and decisions flagged before you sign
Common questions
What exam findings are required to pronounce death?
Commonly documented findings are no response to verbal or painful stimuli, pupils fixed and unreactive to light, no heart sounds and no breath sounds on auscultation for at least one minute, and no palpable pulse. Some facilities require a second examination or an ECG strip showing asystole. Record exactly what you assessed and follow your institution's policy, since this is the legal record of death.
How do I determine time of death?
Time of death is typically when you examined patient and confirmed death, not when patient actually died (which may be unknown if patient found unresponsive). Document: 'Patient pronounced dead at [time] on [date].' If death was witnessed and time of arrest known, you might note: 'Patient suffered cardiac arrest at 14:15. Resuscitation attempted without success. Patient pronounced dead at 14:45.' Be clear about what time represents (pronouncement time vs arrest time).
When do I need to call the medical examiner?
Requirements vary by jurisdiction. Generally contact medical examiner for: unexpected deaths, trauma deaths, deaths within 24 hours of admission, possible homicide or suicide, deaths without recent physician contact, deaths under anesthesia or during procedures, possible overdose or poisoning, suspicious circumstances. When in doubt, call medical examiner and let them decide if they'll take case. Document that medical examiner was contacted and their decision. If case is accepted, body becomes evidence and medical examiner determines disposition.
What do I document about family notification?
Document who was notified of death, when, and by what method (in person, phone call). Example: 'Patient's daughter Jane Smith notified of death by phone at 15:30, expressed understanding.' If family was present at bedside, note that. If unable to reach family, document your attempts. This documentation shows appropriate communication occurred. Remember to be compassionate when notifying family, and give them time to process. Offer to answer questions and provide support resources.
Do I need to call the organ procurement organization?
In a hospital, yes, whatever the likelihood of donation. The Medicare conditions of participation require hospitals to notify their organ procurement organization, or its designee, of every death and imminent death in a timely manner, and the procurement organization decides suitability. The note should record the time of the call and the referral number if you were given one.
Can I paste real patient details?
Follow your organization's policy first. If your organization has a business associate agreement with River, work within its terms. If not, remove names, record numbers, addresses, exact dates and other identifiers before pasting. Bracketed placeholders keep the note complete until you fill them in your own record system.
Death Pronouncement Note From Your Exam
Describe what you need, add any files you have, and your workspace opens with the work already underway.