AGENCY: Southwest Utah Public Health Department (Utah)

SERIES: 13684
TITLE: Monthly nursing home death report
DATES: 1980-
ARRANGEMENT: Chronological.

DESCRIPTION: This three-part report form is submitted by nursing homes reporting deaths that occurred during the previous month. This report is required by UCA 26-2-23(3) (2009). It is used to determine whether certificates have been received for all deaths and to create state reports. The original record is kept by the local health department while the first copy is submitted to the State Health Department and the second copy is kept by the nursing home. The information includes the month of the report, the nursing home's name, death date, deceased's name, the age at death, medical attendant's name, and the name of the funeral home or funeral director.

RETENTION

Retain for 1 year(s)

DISPOSITION

Destroy.

RETENTION AND DISPOSITION AUTHORIZATION

Retention and disposition for this series is authorized by Archives general schedule Transitory tracking records, GRS-1720

AUTHORIZED: 06/21/2019

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then destroy.

APPRAISAL

Administrative

PRIMARY DESIGNATION

Public

---