DA Form 3894. Hospital Report of Death

The DA Form 3894, known as the Hospital Report of Death, is used to document and report deaths that occur within a hospital or medical facility. This form is typically utilized by healthcare professionals, such as physicians or nurses, who are responsible for certifying and reporting deaths.

The form consists of sections that capture important information related to the deceased individual and the circumstances surrounding their death. These sections include patient details, cause of death, time and date of death, and information about the attending physician. The form provides fields for recording the patient's name, age, gender, and other identifying information.

When filling out the DA Form 3894, it is crucial to accurately document the details of the deceased individual and the cause of death. Patient details, such as name and date of birth, should be recorded correctly to ensure proper.

The cause of death section allows for documenting the immediate cause of death, underlying causes, and any contributing factors. This information is essential for accurate reporting and statistical purposes.

The time and date of death section captures the exact time and date when the individual passed away. This information helps establish a timeline and is necessary for legal and purposes.

The attending physician section provides space to record the name and signature of the physician responsible for certifying the death. This ensures and accuracy in the certification process.

An example application of the DA Form 3894 would be in a hospital setting where deaths occur, and it is necessary to document and report them. By using this form, healthcare professionals can ensure proper documentation of the deceased individual's information, cause of death, and the attending physician's certification. The form serves as a tool for legal compliance, mortality reporting, and maintaining accurate records within the healthcare facility.