If death was pronounced at a licensed long-term care facility, check the
box that indicates Nursing home/Long term care facility. A long-term care
facility is not a hospital, but provides
patient care beyond custodial care
(e.g., nursing home, skilled nursing facility, long-term care facilities, con-
valescent care facility, extended care facility, intermediate care facility,
residential care facility, congregate care facility).
If death was pronounced in the decedent’s home, check the box that
indicates decedent’s home. A decedent’s home includes
independent living
units including private homes, apartments, bungalows, and cottages.
If death was pronounced at a licensed ambulatory/surgical center, orphan-
age, prison ward, public building, birthing center, facilities offering hous-
ing and custodial care, but not patient car e (e.g., board and care home,
group home, custodial c
are facility, foster home), check ‘‘Other (Specify).’’
If ‘‘Other (Specify)’’ is checked, specify where death was legally pro-
nounced, such as a prison ward, physician’s office, the highway where a
traffic accident occurred, a vessel, orphanage, group home, or at work.
If the place of death is unknown, but the body is found in a State, enter the
place where the body is found as the place of death.
15. FACILITY NAME (If not an institution, give street and number)
Institution deaths
If the death occurred in a hospital, enter the full name of the hospital.
If death occurred en route to or on arrival at a hospital, enter the full name
of the hospital. Deaths that occur in an ambulance or emergency squad
vehicle en route to a hospital fall in this category.
If the death occurred in another type of institution such as a nursing
home, enter the name of the institution where the decedent died.
Noninstitution deaths
If the death occurred at home, enter the house number and street name.
If the death occurred at some place other than those described above,
enter the number and street name of the place or building (if at a building)
where the decedent died.
If the death occurred on a moving conveyance, enter the name of the
vessel, for example, S.S. Olive Seas (at sea) or ‘‘Eastern Airlines Flight 296
(in flight).’’
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