PA 04-255—sHB 5628

Public Health Committee

Planning and Development Committee

Judiciary Committee


SUMMARY: This act authorizes advanced practiced registered nurses (APRNs) to make death determinations and pronouncements under certain conditions. It also expands the list of those licensed health care practitioners who can certify a death to include APRNs, physician assistants, and registered nurses (RNs) in addition to physicians, chief medical officers of health care institutions in which the death occurred, and pathologists.

The act gives local registrars of vital statistics the authority the Department of Public Health (DPH) commissioner already has to match birth and death certificates and to post the facts of death to the appropriate birth certificate in order to protect the integrity of vital records and prevent their fraudulent use.

The act also:

1. requires registrars of vital statistics to ensure that various certificates are complete before accepting them for filing;

2. amends the law on acknowledgment of paternity and changes to birth certificates;

3. clarifies existing provisions on completion of death certificates addressing time for filing and who may make actual filings;

4. requires funeral directors and embalmers to make certain filings concerning death certificates and requires an affidavit to be filed in the case of a communicable disease;

5. makes changes to cremation records and permit requirements;

6. requires burial transit removal permits in certain situations;

7. imposes penalties on sextons failing to make required reports on a timely basis;

8. allows for the issuance of a disinterment permit to the responsible licensed embalmer or funeral director as indicated on the death certificate or burial permit, or to a person designated on an order by a Superior Court judge;

9. allows unlicensed individuals to transport a body in certain situations; and

10. makes numerous technical and conforming changes.

The act repeals provisions concerning (1) temporary removal of a body to another town or state and (2) fines against registrars for failure to make marriage license applications available for public examination during office hours.

EFFECTIVE DATE: October 1, 2004, except for the provision requiring the birth mother’s name on birth and replacement birth certificates, which is effective upon passage.


The act requires registrars of vital statistics to ensure that all certificates of birth, marriage, death, and fetal death are fully completed before accepting the certificate for filing.

The law requires the registrar in a town where a birth, marriage, death, or fetal death certificate is filed to make a certified copy of it and send it to the registrar of another town when it appears that the child’s mother, either party to the marriage, or the deceased resided in that town. The act eliminates a requirement that a certified copy be sent when it involves an out-of-state location.


The act subjects the federal government to various fees for birth, marriage, and death-related records.


The act requires a birth certificate to be completed in its entirety containing such information that DPH requires.

Name of the Birth Mother

Existing law requires that each birth certificate contain the birth mother’s name, except by court order. The act requires that (1) the birth certificate be filed with the birth mother’s name recorded and (2) DPH seal it. It directs DPH to create a replacement certificate within 45 days after receiving a court order that includes all information as of the date of birth. DPH must transmit an exact copy of the replacement certificate to the registrar of vital statistics of the town of birth and to any other registrar as DPH finds appropriate, immediately after it has been prepared. When an eligible party requests a certified copy of a birth certificate, the act requires that the replacement certificate be provided.

Acknowledgement of Paternity

The law allows recording information on whether a child was born in or out of wedlock and the mother’s marital status on a confidential portion of the birth certificate. The name of the father is entered on the birth certificate after an acknowledgment of paternity is completed at a hospital, or in a town in the case of a home birth, and transmitted to DPH. If another father’s information is already recorded on the certificate it cannot be removed unless DPH receives a court order finding that (1) the person recorded on the birth certificate is not the child’s father or (2) a person other than the one recorded is the child’s father. The act requires that this court order be certified. It also requires DPH to restrict access to, and issuance of, certified copies of acknowledgements of paternity.

Prior law required DPH to include on, or amend, a child’s birth certificate to show paternity if it was not already shown or to change the child’s name, or both, upon receiving (1) a lawfully executed acknowledgment of paternity by both parents of a child born out of wedlock or (2) a certified order of a court establishing the paternity of such a child. If another man’s name was on the birth certificate, DPH could not remove or replace this information unless it was presented with a court order meeting the requirements cited above.

The act instead directs DPH to change the name of the child if so indicated on the acknowledgement of paternity form or in the certified court order as part of the paternity action. It also prohibits DPH from removing or replacing the father’s information on the birth certificate if another father is listed unless (1) presented with a certified court order meeting the requirements cited above or (2) upon proper filing of a rescission.

The act requires DPH to restrict access to and issuance of certified copies of acknowledgements of paternity to (1) parents named on the acknowledgement; (2) the person whose birth is acknowledged, if over 18; (3) an authorized Department of Social Services (DSS) representative; (4) an attorney representing the person or a parent named on the acknowledgment; or (5) agents of a state or federal agency, as approved by DPH. Access is not restricted for the “IV-D agency,” which refers to DSS’ Bureau of Child Support Enforcement, which is authorized to administer the child support program mandated by Title IV-D of the Social Security Act.


Under the act, an APRN can make a determination and pronouncement of death of a patient if the APRN (1) attests to the pronouncement on the death certificate and (2) signs it within 24 hours of the pronouncement.

By law, RNs in charge of a hospice or nursing home facility, or employed by a licensed home health care agency in a home or residence, can make a determination and pronouncement of death of a patient if certain conditions are met. The act eliminates a requirement that DPH notify all people and facilities affected by regulations it adopts to implement the law on death pronouncement. This includes hospices, nursing homes, physicians, home health care agencies, emergency medical technicians, funeral directors, and medical examiners.


Filing Periods

The act requires completion of death certificates in their entirety and filing them with the registrar of vital statistics in the town where the death occurred within (1) five days of death, if filing a paper certificate and (2) three days of death, if filing through an electronic death registry system.

Completion of Death Certificate; Affidavit Concerning Communicable Disease

The law requires licensed funeral directors or embalmers, including those from another state who comply with DPH reciprocal agreements, to complete a death certificate when they are in charge of the burial. The act allows their designees to file the certificate.

By law, only a licensed embalmer can take charge of the burial of a person who died from a communicable disease; the embalmer must file the death certificate and a signed and sworn certificate stating that the body has been disinfected according to the Public Health Code. The act requires the embalmer to file an affidavit, on a DPH form, concerning the disinfection when the person who died had a communicable disease. It also eliminates the option in prior law of another embalmer, other than the one filing the death certificate, filing the document about disinfection.

Medical Certification Portion of Death Certificate

Existing law requires the physician in charge of the patient’s care to complete, sign, and return the medical certification portion of the death certificate to the funeral director or embalmer within 24 hours after death. The act allows an APRN to fill out the medical certification portion of the death certificate. Under existing law, in the absence of the physician, or with his consent, the medical certification can be filled out by an associate physician, chief medical officer of the institution in which the death occurred, or the pathologist who performed the autopsy. The act broadens this by (1) allowing an APRN to make the delegation and (2) allowing an APRN, RN, or physician assistant to make the certification.

The act prohibits any of these health care practitioners from signing and returning the medical certification unless he has personally viewed and examined the body and is satisfied that death has occurred. The act specifies that an additional viewing of the body is not required if the practitioner who completed the certification was not the one who made the death determination. This exception already applies if an RN makes the pronouncement.

Under the act, any practitioner listed above, rather than just physicians, refusing or otherwise failing to complete, sign, and return the medical portion of the death certificate within 24 hours can be reported to DPH by the funeral director or embalmer. DPH can fine the person up to $250 a day, following notification and investigation.

The act requires an APRN, as the attending physician must already do, to give the funeral home or embalmer notice of the reason for delay when the cause of death cannot be determined within 24 hours of death and the chief medical examiner does not require an inquiry. Final disposition of the body cannot be made without the signed medical certification from the physician or APRN.


The act requires that the final disposition of a cremated body be recorded at the crematory. The law requires that the chief, deputy chief, associate, or authorized assistant medical examiner complete the cremation certificate stating that no further inquiry is needed and file it with the registrar of vital statistics of the town in which the person died, or if not known, of the town where the body was found or with the registrar of the town of the funeral director who has the body.

The act requires the registrar, after receiving the certificate, to authorize it and keep it on permanent record. But if the certificate is submitted to the registrar of the town where the funeral director is located, the certificate must be forwarded to the registrar of the town where the person died and kept on permanent record.

The law requires crematory managers to keep record books that include information (name, age, sex, residence) on each person cremated, together with the authority for the cremation and the disposition of the ashes. Prior law required the owner or superintendent of the crematory to forward to the registrar receiving the cremation permit a certified duplicate of the record. The registrar had to keep this duplicate on file and record it with other vital statistics.

The act instead requires the crematory manager or superintendent to complete the required cremation permit, retain a copy for record keeping, and immediately forward the original permit to the registrar of the town in which death occurred. The registrar must keep the cremation permit on file.


Burial Transit Removal Permit

The act requires a DPH-licensed embalmer or funeral director, or one licensed in a state with a reciprocal agreement with the state, who takes custody of a dead body to obtain a burial transit removal permit from the registrar of the town in which death occurred. It appears a “burial transit removal permit” takes the place of a “removal permit” under the act. This must be done within five calendar days after death and before final disposition or removal of the body from the state. The law requires a registrar to appoint people as subregistrars authorized to issue burial transit removal permits after receiving a completed death certificate. The act limits the subregistrar’s authority to those hours when the registrar’s office is closed and establishes a fee of $3 for a burial transit removal permit.

The act requires that, before any body is removed to any universities in the state for anatomical purposes, the person contemplating removal must get a burial transit removal permit. Prior law required a burial or transit permit.

Duties of Sextons

By law, the burial permit must note the place of burial by section, lot, grave, or other place of interment. The act requires the sexton to do this. It specifies that no additional burial transit removal permit is required for a body that is placed temporarily in a receiving vault of any cemetery and subsequently buried in the same cemetery.

The law requires each sexton in charge of any burial place to provide a monthly list of all interments, disinterments, and removals of bodies to the registrar of the town. He must also file with the registrar permits he received when a body was brought into the town from another town or state for burial.

The act establishes a fine of up to $100 per day on any sexton failing to make the appropriate filings described above within 14 days after the first week of the month.

Transporting a Body

The law allows state-licensed embalmers and funeral directors to remove a body from one town to another or to another state. It also allows embalmers and funeral directors from another state who comply with a reciprocal agreement with DPH to remove bodies from one town to another or to another state. The act allows embalmers and funeral directors to authorize an unlicensed employee to transport the body once it has been embalmed or prepared according to the Public Health Code. For removal of a body from this state to another, the act requires a burial transmit removal permit instead of a death certificate as under prior law.