Death Entry
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Sl #
003641
Date
22/05/2026
Patient ID
Register No.
Name
Address
Sex
Age
Yrs
Months
Days
Admission Date
Death Date
Next of Kin
---- Select ----
AUNTY
BROTHER
BROTHER IN LAW
DAUGHTER
DAUGHTER IN LAW
FATHER
FATHER IN LAW
FRIEND
GRAND DAUGHTER
GRAND FATHER
GRAND MOTHER
GRAND SON
HUSBAND
MOTHER
MOTHER IN LAW
OTHERS
SELF
SISTER
SISTER IN LAW
SON
SON IN LAW
UNCLE
WIFE
Name
Doctor Admitted
Death Declared By
Bed
Authority Informed Date
Type of Death
Brought Dead
MLC
Cause Of Death
Sl #
Diagnosis Name
ICD
Level
Type
Principal
Secondary
Final
Provisional
Patient ID
Name
Address
Sex
Age
Yrs
Months
Days