# Nursing home wrongful death: the records that prove the cause

> Nursing home wrongful death cases turn on the chart: the death certificate, rare autopsies, hospice and DNR records, the final admission and Medicare liens.

Canonical page: https://medrecords.ai/guides/nursing-home-wrongful-death-records/

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Field guide, September 2026. 14 chapters.

## Nursing home wrongful death: proving the chain from care to cause of death

For plaintiff and defense attorneys, legal nurse consultants and the physicians and nurses who testify in long-term care death cases. You walk away with a way to read the death certificate, a map of the records across the facility, the hospital and hospice, the causal patterns and the records that test them, a decline timeline worksheet and a records request for a deceased resident.

By [Ahmed Jemaa](https://medrecords.ai/authors/ahmed-jemaa/), Co-Founder and CEO, Medrecords AI. Published 26 September 2026.

Nursing home wrongful death claims ask whether a facility's care failure caused or hastened a resident's death. Autopsies are rare in the very old, so the proof usually comes from records: the facility chart and MDS assessments, the transfer packet, the final hospital admission, hospice and code status documents, and the causal chain on the death certificate. A survival claim for the resident's own losses usually runs alongside it under state law.

Most nursing home residents who die were old and sick, and every death case starts from that fact. The question for both sides is narrower: did a specific failure in care cause the death, or bring it sooner than the illness would have? There is rarely an autopsy to answer it. The answer sits in 4 sets of records, the facility chart, the transfer packet, the final hospital admission and the hospice file, and in a death certificate that is often wrong in ways that can help or hurt either side.

Built from 42 CFR Parts 483 and 418, CMS State Operations Manual Appendix PP (revision 225, 2024), the MDS 3.0 RAI Manual (v1.20.1, October 2025), the CDC physicians' handbook on death certification, NCHS autopsy data, 2 peer-reviewed studies of death certificate accuracy, 45 CFR 164.502, 42 CFR 411.24 with the CMS MSP Recovery Manual, Social Security Act section 1150B and Florida Statutes 400.0233. Case examples are labeled hypotheticals. Nothing here is legal or medical advice. Who may sue, what they recover, the notice and expert rules, and whether a care failure caused a death are questions for counsel and qualified experts in your jurisdiction.

9 numbers

### Nursing home death cases in 9 numbers

0.8%
of US deaths at age 85 and over, in all settings, were autopsied in 2007, against 8.5% of deaths at all ages
NCHS Data Brief 67, 2011
51%
of 601 Vermont death certificates reviewed had a major error
McGivern and colleagues, Public Health Reports, 2017
85%
of death certificates in 179 autopsied cases had at least 1 error, and none was amended after the autopsy
Schuppener and colleagues, Clinical Medicine and Research, 2020
7 days
after a death in the facility to complete the MDS death tracking record, which holds no clinical items
MDS 3.0 RAI Manual v1.20.1, chapter 2
2 hours
to report an alleged violation involving abuse or serious bodily injury; 24 hours otherwise
42 CFR 483.12(c)(1)
6 months
or less of life expectancy, if the illness runs its normal course, defines terminal illness for the Medicare hospice benefit
42 CFR 418.3
75 days
of pre-suit notice before a Florida nursing home injury or death suit can be filed, with the limitations period tolled
Fla. Stat. 400.0233
60 days
to repay Medicare after a settlement or judgment is received
42 CFR 411.24(h)
50 years
after death that HIPAA continues to protect the resident's health information
45 CFR 164.502(f)
Chapter 1 Everyone

### Survival claims and wrongful death claims

When a resident dies, most states allow 2 claims that are easy to blur. They have different plaintiffs, different damages and sometimes different deadlines.

A **survival claim** is the resident's own claim, carried on after death. It belongs to the estate and is brought by the personal representative: the executor named in a will or an administrator appointed by the probate court. It recovers what the resident could have recovered had they lived, which depending on the state can include medical expenses caused by the negligence and conscious pain and suffering before death.

A **wrongful death claim** is the family's claim for its own losses. A statute creates it and names who benefits, usually a spouse and children, then parents or other relatives. The damages are the survivors' losses, which in many states include lost support, lost services, loss of companionship and funeral expenses.

**The 2 claims side by side** — general pattern — States vary on every row. Check the governing statute and case law.

##### Survival claim

Who brings itThe personal representative of the estateTypical damagesPre-death medical expenses; conscious pain and suffering, where allowedWhere the money goesInto the estateRecords that carry itPain scores, wound measurements and photos, mood and behavior notes, pain medication on the MAR, the resident's awareness before death

##### Wrongful death claim

Who brings itThe statutory beneficiaries, or the representative for themTypical damagesSupport, services, companionship, funeral costsWhere the money goesTo the beneficiaries the statute namesRecords that carry itCausation records first, then visit logs, care conference notes and the social history
Both claims need proof that a care failure caused an injury. The survival claim then turns on what the resident experienced; the wrongful death claim turns on the death and what it cost the family.

#### Why the survival claim often carries a nursing home case

A resident in their 80s or 90s usually had no earnings and no dependents, so the economic side of a wrongful death claim can be small, and some states cap noneconomic damages against medical or long-term care defendants. Where the state allows pre-death pain and suffering, the survival claim can be the larger part of the case. That puts weight on records most reviewers skim: pain scores on every shift, the resident's words charted in quotes, grimacing during wound care. For the defense, the same records can show pain was assessed and treated, or that the resident was not aware in the final days.

#### The pattern across states

- **Standing.** Some states require a probate appointment before suit. A family member who files without letters of administration may face a standing challenge.
- **Merged or separate.** Some states merge the claims into 1 action; others keep separate verdict lines.
- **Deadlines.** The survival claim may run from the injury and the wrongful death claim from the death. Nursing home statutes may add pre-suit steps (chapter 9).
- **Medicare.** Whether the statute allows the resident's medical expenses decides whether Medicare can recover from the wrongful death payment (chapter 10).

If you remember one thing
Decide early which claim each record supports. Pain and awareness records build the survival claim; causation records build both. A case that proves cause but not what the resident went through may leave much of its value unclaimed.

Chapter 2 Everyone

### Reading the death certificate

The death certificate is the first document both sides read and the one they should trust least. It is completed by the attending physician or another certifier, who may not have seen the resident in the final days, and it is a public health form, not a causation opinion. Still, juries see it and every expert report starts from its wording.

The [CDC physicians' handbook on medical certification of death](https://www.cdc.gov/nchs/data/misc/hb_cod.pdf) explains the structure. Part I is a causal chain: the immediate cause on line (a), each condition that led to it on the line below, and the underlying cause, the disease or injury that started the sequence, on the lowest line used. Each line takes 1 condition and an approximate interval from onset to death. Part II lists other conditions that contributed to the death but did not cause the underlying cause.

**A cause of death section for a nursing home death** — hypothetical — Part I and Part II wording from a worked example in the CDC handbook (2003); intervals and other fields illustrative
Certificate of death Cause of death section
Part I. Chain of events
(a) Immediate cause — Septic shock. Interval: 2 days1
(b) Due to — Infected decubitus ulcers. Interval: 3 weeks2
(c) Due to — Complications of cerebral infarction. Interval: 2 months
(d) Underlying cause — Cerebral artery atherosclerosis. Interval: years3
Part II. Other significant conditions
Contributing — Insulin-dependent diabetes mellitus4
Manner and circumstances
Manner of death — Natural Accident Pending investigation Could not be determined5
Autopsy performed — Yes No
Place of death — Nursing home or long-term care facility6
HYPOTHETICAL
1. 1
**Immediate cause** The final disease or complication. The handbook says a mechanism such as cardiac or respiratory arrest should not be reported as the immediate cause, because it only attests to the fact of death.
2. 2
**The line where a care case lives** An infected pressure injury in the chain is the certifier's statement that the wound helped cause the death. Plaintiffs quote it; the defense asks whether the certifier ever saw the wound.
3. 3
**Underlying cause** The condition that started the sequence. If a care-related complication sits in the chain, ask the certifier why they checked the manner box they did.
4. 4
**Part II** Diabetes here supports the defense theme of impaired healing and the plaintiff theme of a known risk that called for more prevention.
5. 5
**Manner** The handbook says all deaths from external causes must be referred to the medical examiner or coroner. A fall with a head injury in the chain and a manner of natural is a mismatch worth a question.
6. 6
**Place of death** The box records where death was pronounced. A resident pronounced dead in the hospital 2 days after transfer is a hospital death on the form, so the certificate alone will not show that the decline began in the facility.

Pin 2 is the line both sides fight over. Read it against the wound records and the hospital admission note before relying on it.

#### What the handbook says about vague certificates

The handbook says terms such as senescence, infirmity and old age have little value for public health or medical research. It lists conditions that need their cause stated, among them aspiration, decubiti, dehydration, sepsis, malnutrition, failure to thrive and pneumonia. Its own example of an incomplete statement could come from any nursing home file: pneumonia due to malnutrition, with nothing to say why the malnutrition developed. It also lists conditions that may be complications of an injury and should be reported to the medical examiner or coroner, including falls, hip fracture, subdural hematoma, sepsis, choking and pulmonary emboli.

A certificate that reads "failure to thrive" alone, or "cardiopulmonary arrest" alone, did not follow the handbook. That is evidence of a thin certification, not evidence that nothing happened.

#### How often certificates are wrong

Neither study below is limited to nursing home deaths, so treat the figures as the general reliability of the document.

**Vermont death certificates with a major error** — n = 601 certificates — McGivern and colleagues, Public Health Reports, 2017
About 1 in 2 — 51%
Medical examiners compared certificates written by other certifiers with the medical records. 53% had an error and 51% had a major error. Hospital deaths had more major errors than deaths at home, 59% against 39%.

A major error does not mean the cause was wrong. It means the form cannot be relied on without the chart behind it.

In the [Vermont study](https://pubmed.ncbi.nlm.nih.gov/29091542/), 93% of certificates had ICD-10 code changes after review, and 60% of those (348 of 580) changed the underlying cause code. In a [study of 179 autopsied cases at a Wisconsin academic center](https://pubmed.ncbi.nlm.nih.gov/31597655/), 85% of certificates had at least 1 error, grade IV errors on a 5-point severity scale appeared in 23%, and no certificate was amended after the autopsy was finalized, although the CDC handbook tells certifiers to file a supplemental report when an autopsy changes the cause.

##### How the plaintiff uses it

When the chain names the harm

- A pressure injury, fall injury, dehydration or aspiration in Part I is a physician's statement of cause
- A manner of natural after a fall supports a request for medical examiner review
- A vague certificate shows nobody looked closely

##### How the defense uses it

When the chain names the disease

- An underlying cause of dementia, heart failure or cancer supports death from the natural course of illness
- Part II conditions support a theme of competing causes
- The error studies cut against a plaintiff quoting a certifier who never saw the wound

If you remember one thing
The certificate is a starting hypothesis. Find out who signed it, what they reviewed and when they last saw the resident, then test every line against the chart.

Chapter 3 Deciding

### Why the chart carries causation

In most deaths of very old people, nobody examines the body. The [NCHS data brief on autopsy rates](https://www.cdc.gov/nchs/data/databriefs/db67.pdf) found that 8.5% of all deaths in 2007 were autopsied, down from 19.3% in 1972. For deaths from disease the rate fell from 16.9% to 4.3%; for deaths from external causes, such as injuries, it was 55.4% in 2007.

**Share of deaths autopsied, by age at death** — United States, 2007 — NCHS Data Brief 67 (2011), figure 3. Excludes Florida, Minnesota, New Mexico and Pennsylvania. Bars scaled to 11%.
Fewer than 1 death in 100 at age 85 and over was autopsied. The brief gives no rate for nursing home deaths as such, but most residents are in the oldest age groups.

The brief draws the conclusion itself: for people over 65, the cause of death rests on diagnoses and examinations made before death, not confirmed by autopsy. In a nursing home case, those diagnoses and examinations are the chart.

#### What stands in for an autopsy

- **Hospital labs and cultures.** Blood cultures growing the organism found in a wound culture tie the sepsis to the wound. Sodium, BUN and creatinine on arrival speak to hydration.
- **Imaging.** A head CT showing a subdural hematoma after a fall, or a new infiltrate in a dependent lung segment, can carry the chain alone.
- **The admitting exam.** A hospital skin exam documenting a Stage 4 sacral wound on day 1 is the closest thing to an independent examination the case will have.
- **The facility's trend data.** Weights, intake, temperature and pulse, pain scores and wound measurements over weeks show the decline and its timing.
- **Any medical examiner record.** Even a declined case may leave an intake form or investigator's note. Ask.

MythNo autopsy means no proof of cause.
RuleMost deaths over 65 are certified without autopsy. Experts on both sides routinely give causation opinions from the clinical record.
MythThe death certificate settles cause.
RuleIt is a certifier's statement on a public health form, often incomplete or wrong (chapter 2).
MythAn autopsy can still be ordered later.
RuleAfter burial or cremation the option is gone or nearly so. The decision belongs to the first days after death.

#### The first-week decision

Families sometimes call a lawyer before the funeral. If the death followed a fall, a sudden change or an unexplained injury, a private autopsy or a medical examiner referral is a decision for the family with counsel, weighing cost, religious and personal wishes and timing. If there was no autopsy, write down why, so an expert can explain it later. The [autopsy report guide](https://medrecords.ai/guides/how-to-read-an-autopsy-report/) covers what one adds, and the [toxicology report guide](https://medrecords.ai/guides/toxicology-report-litigation/) covers post-mortem drug levels in medication error deaths.

If you remember one thing
In most nursing home deaths, the chart is the autopsy. Every causation opinion on either side will be built from the admission labs, imaging, skin exams and trend data, so collect them completely before anyone forms a view.

Chapter 4 Building

### The record set from admission to death

A death file draws from at least 4 custodians, and none holds the whole story. The facility knows the months before, the hospital the last days, hospice the plan for comfort care, and the state what the facility reported. The [nursing home records pillar guide](https://medrecords.ai/guides/nursing-home-records-mds-cms-2567/) covers the facility chart in depth. This chapter covers what a death adds.

**Where each part of a death file lives** — general map — Regulatory cites checked at law.cornell.edu and cms.gov, September 2026
| Custodian | Records to request | Why they matter |
| --- | --- | --- |
| Facility, clinical | MDS assessments, care plans, progress notes, orders, MAR and TAR, wound records and photos, weights, intake, pain scores, labs | The months of decline. 42 CFR 483.70(h)(5) sets what the record must contain |
| Facility, administrative | Admission packet with any arbitration agreement, incident reports, staffing, reports to the state, policies in force | The system around the care. Incident reports may be claimed as quality assurance material |
| Facility, death records | Last notes, notifications, code status at death, MDS death tracking record, release of the body | The final hours. The tracking record holds no clinical items, so the notes carry the picture |
| EMS | Run report with times, the crew's measurements and scene narrative | An outside observer's first account on leaving the facility |
| Hospital | ED record, history and physical, skin assessment, labs, cultures, imaging, consults, death summary | The closest thing to an independent exam, usually within hours |
| Hospice | Election, certification narrative, plan of care, visit notes, medication profile | Prognosis, goals and the care in the final period (chapter 6) |
| State agency and death registrar | Surveys, complaint investigations, facility-reported incidents, the death certificate, any medical examiner file | Outside findings and the official cause and manner |
| Pharmacy and payers | Dispensing records, consultant pharmacist reviews, Medicare claims | Medication history and the lien figures (chapter 10) |

Hospital and EMS records are the ones both sides tend to underuse. They are written by people with no stake in how the facility's care is judged.

#### Who can get the records after death

HIPAA keeps protecting a deceased person's health information for 50 years after death under [45 CFR 164.502(f)](https://www.law.cornell.edu/cfr/text/45/164.502). Under 164.502(g)(4), an executor, administrator or other person with authority under applicable law to act for the deceased or the estate is treated as the personal representative. State law decides who that is, so a facility may refuse an adult child with no probate appointment. Plan the probate step and the records request together.

While the resident was alive, [42 CFR 483.10(g)(2)](https://www.law.cornell.edu/cfr/text/42/483.10) gave access within 24 hours, excluding weekends and holidays, and copies within 2 working days. If the family asked before the death and was refused, that request belongs in the file.

#### Retention, the MDS and the quality assurance wall

- **Retention.** [42 CFR 483.70(h)(4)](https://www.law.cornell.edu/cfr/text/42/483.70) requires the period state law sets, or 5 years from discharge where it sets none. Send a preservation letter early regardless.
- **The MDS death tracking record.** Under the [MDS 3.0 RAI Manual](https://www.cms.gov/files/document/final-mds-3-0-rai-manual-v1-20-1-october-2025.pdf), it is completed within 7 days after death and submitted within 14, with demographic and administrative items only. Ask for every prior assessment and the submission history.
- **Quality assurance records.** [42 CFR 483.75(h)](https://www.law.cornell.edu/cfr/text/42/483.75) limits what the state or CMS can make the facility disclose. Whether the same records are shielded from civil discovery is state privilege law. Expect the fight over incident reports and root cause analyses, and ask for the underlying facts separately.

#### What the facility had to report

[42 CFR 483.12(c)(1)](https://www.law.cornell.edu/cfr/text/42/483.12) requires the facility to report alleged abuse, neglect, exploitation or mistreatment, and injuries of unknown source, to the administrator and to other officials, including the state survey agency and, where state law gives it jurisdiction, adult protective services: immediately, but not later than 2 hours if the events involve abuse or serious bodily injury, and 24 hours otherwise. Investigation results go to the state within 5 working days under (c)(4). Section 1150B of the Social Security Act, at [42 USC 1320b-25](https://www.law.cornell.edu/uscode/text/42/1320b-25), separately requires covered individuals such as employees and contractors to report a reasonable suspicion of a crime against a resident to the HHS Secretary and to local law enforcement, within 2 hours if there is serious bodily injury and otherwise within 24, with civil money penalties up to $200,000, or $300,000 if the failure makes the harm worse.

A fracture or head injury of unknown origin shortly before death should have produced a report. If it did not, the absence helps the plaintiff. If it did, the 5-day investigation is often the most candid account the facility wrote, and the defense should read it first.

- **Probate appointment letters obtained** *Needed for personal representative access under 45 CFR 164.502(g)(4)*
- **Preservation letters to facility, hospital, hospice and EMS** *Include electronic data, photos and version history*
- **Complete facility chart, all admissions** *Not a date range chosen by the records clerk*
- **All MDS assessments and the death tracking record** *With submission history*
- **EMS run report** *Separate agency, separate request*
- **Final hospital admission, complete** *ED, H and P, skin exam, labs, cultures, imaging, death summary*
- **Hospice file** *Election, certification narrative, plan of care, visit notes*
- **Death certificate, certified copy** *Plus any amendment or supplemental report*
- **Medical examiner or coroner file** *Even if jurisdiction was declined*
- **State survey, complaint and incident records** *Public access rules vary by state*
- **Medicare conditional payment information** *Starts the lien work early (chapter 10)*

Collected 0 of 11.

##### 1. Records request for a deceased resident

Send 1 per custodian. Adjust the legal basis to your jurisdiction and attach the letters of appointment.

RESIDENT: [NAME], DOB [DATE], DATE OF DEATH [DATE]
FACILITY: [NAME] ADMISSION DATES: [ALL ADMISSIONS]
REQUESTER: [NAME], [EXECUTOR / ADMINISTRATOR] of the estate,
appointed [DATE] by [COURT]. Letters attached.
BASIS: Personal representative access, 45 CFR 164.502(g)(4)
and 164.524; [STATE STATUTE, IF ANY]

Please produce the complete record for all admissions, including:

[ ] Admission agreement, arbitration agreement (if any), and
 advance directive, POLST or code status documents
[ ] All MDS assessments, care plans and care plan meeting notes,
 and the death in facility tracking record
[ ] Physician and nursing progress notes, including late
 entries and addenda with their entry dates
[ ] Orders, telephone orders and diet orders
[ ] MAR and TAR, including held, refused and omitted doses
[ ] Wound assessments, measurements, staging and photographs
[ ] Weights, meal intake, fluid intake and output records
[ ] Temperature, pulse and blood pressure records, pain scores,
 neuro checks, fall and pressure injury risk scores
[ ] Change in condition, notification and SBAR records
[ ] Transfer forms and everything sent with the resident
[ ] Lab, radiology and consultant pharmacist reports
[ ] Hospice records held by the facility
[ ] Records of the final hours: last notes, code status,
 post-mortem care, release of remains

For any item not produced, state in writing whether it exists,
where it is kept and why it is not produced. Produce electronic
records in native format where available.
If you remember one thing
Request by category, not by date range, and send separate requests to EMS, the hospital and hospice. The facility chart alone will not show how the resident arrived at the hospital or what hospice was told.

Chapter 5 Everyone

### 5 causal patterns and the records that test them

Most nursing home death claims follow 1 of a handful of chains: a harm that starts in the facility, a complication that brings the resident to the hospital, and a terminal event. Each has a standard defense: the harm was unavoidable, the resident was dying anyway, or the complication would have happened with perfect care.

**The common chains and the records that prove or break them** — reference table — F-tags from CMS State Operations Manual Appendix PP, revision 225 (2024)
| Chain | Federal standard (F-tag) | Facility records | Hospital and death records | Typical defense question |
| --- | --- | --- | --- | --- |
| Pressure injury, wound infection, sepsis | Skin integrity, 483.25(b)(1) (F686) | Risk scores, skin checks, turning records, support surface orders, wound measurements | Admission skin exam, wound and blood cultures, imaging for osteomyelitis | Unavoidable, or a Kennedy terminal ulcer in a dying resident? |
| Aspiration pneumonia | Depends on the failure alleged: diet orders, supervision, care plan | Swallow evaluations, diet texture orders, meal supervision, head of bed and tube feeding records | Chest imaging, sputum cultures, history of the choking event | Food the facility served, or the resident's own secretions? |
| Fall with head injury | Accidents, 483.25(d) (F689); notification, 483.10(g)(14) (F580) | Fall risk assessments, interventions, incident report, neuro checks, anticoagulant orders | EMS report, head CT, time from fall to imaging | Avoidable, and would earlier imaging have changed the outcome? |
| Dehydration, acute kidney injury | Nutrition and hydration, 483.25(g) (F692) | Fluid intake, weights, diuretic orders, labs, dietitian notes | Admission sodium, BUN, creatinine | Poor care, or end-stage disease and refusal? |
| Medication error | Significant medication errors (F760) | MAR, orders, pharmacy records, drug monitoring labs | Drug levels, INR, glucose, toxicology | Did the error cause the death, or was it harmless? |

Every chain runs through a change in condition. The gap between when it began and when anyone acted is usually the center of the case.

#### Pressure injury, infection, sepsis

The [State Operations Manual](https://www.cms.gov/medicare/provider-enrollment-and-certification/guidanceforlawsandregulations/downloads/appendix-pp-state-operations-manual.pdf) calls a pressure injury avoidable when the facility did not do 1 or more of these: evaluate the resident's condition and risk factors; define and implement interventions consistent with needs, goals and professional standards; monitor and evaluate them; or revise them as appropriate. It is unavoidable when the facility did all 4. That turns the argument into a document review.

The defense often raises the Kennedy terminal ulcer, which the manual describes as appearing suddenly, usually on the sacrum and coccyx, pear, butterfly or horseshoe shaped, and able to progress rapidly. The manual also expects the facility to classify it accurately and show that prevention was in place. A wound labeled Kennedy only after it was found at Stage 4, with no skin checks before, is a weak version of the defense; a sudden lesion charted hours after a clean skin check in an actively dying resident is a strong one. See the [pressure injury records guide](https://medrecords.ai/guides/pressure-injury-bedsore-lawsuit-records/).

#### Aspiration, falls, dehydration and medication errors

**Aspiration.** Common at the end of life, especially with advanced dementia or after a stroke. The case needs a specific lapse: a diet texture not followed, thin liquids served to a resident ordered thickened ones, a tube-fed resident kept flat, a choking episode with no assessment. Read the swallow evaluation, the diet order, the tray card and the timing of the first fever against the meal record.

**Falls.** The manual calls an accident avoidable when the facility failed to identify hazards and risk, reduce them, implement interventions such as supervision and devices, or monitor and modify them. For a resident on an anticoagulant, ask when neuro checks were charted, when the physician was told and when imaging happened. [42 CFR 483.10(g)(14)](https://www.law.cornell.edu/cfr/text/42/483.10) requires the facility to immediately inform the resident, consult the physician and notify the representative after an accident with injury or a significant change. See the [fall guide](https://medrecords.ai/guides/nursing-home-fall-lawsuit-records/) and the [change in condition guide](https://medrecords.ai/guides/nursing-home-change-in-condition/).

**Dehydration.** Very high sodium and a BUN far out of proportion to creatinine on arrival suggest days of poor intake, and the facility's intake records should show it too. The defense looks for documented refusals, end-stage disease, physician-set diuretic needs or comfort goals. See the [malnutrition and dehydration guide](https://medrecords.ai/guides/nursing-home-malnutrition-dehydration/).

**Medication errors.** The manual defines a significant medication error as one that causes discomfort or jeopardizes health and safety, judged by the resident's condition, the drug category and the frequency of the error, and it names narrow therapeutic index drugs such as warfarin, digoxin, phenytoin and lithium. A death case must link the error to the terminal event through levels, labs or the admitting diagnosis.

If you remember one thing
Name the chain before you read the chart. Each chain has 3 or 4 records that decide it, and a reviewer who knows which ones to find will reach them in hours instead of weeks.

Chapter 6 Everyone

### Hospice, DNR and POLST cut both ways

Many residents who die were on hospice, had a do-not-resuscitate order, or both. The defense reads those documents as proof the death was expected. The plaintiff reads them for when they were signed and what they did not cover. Both readings can be right in the same file, so dates and exact wording matter more than the headline.

#### What a hospice election means in the record

Under [42 CFR 418.3](https://www.law.cornell.edu/cfr/text/42/418.3), terminally ill means a prognosis of 6 months or less if the illness runs its normal course. [42 CFR 418.22](https://www.law.cornell.edu/cfr/text/42/418.22) requires a physician narrative explaining the clinical findings behind it, reflecting the patient's own circumstances, with no check boxes or standard language. The election under [42 CFR 418.24](https://www.law.cornell.edu/cfr/text/42/418.24) acknowledges the palliative nature of the care and waives other Medicare payment for the terminal illness. For elections on or after October 1, 2020, the patient is also told that the hospice should provide virtually all needed care.

The MDS item J1400 in the [RAI Manual](https://www.cms.gov/files/document/final-mds-3-0-rai-manual-v1-20-1-october-2025.pdf) records a condition that may result in a life expectancy under 6 months, coded only once a physician has documented it. Coded yes months before the death, it supports the defense. Coded yes only after the wound or fall at issue, it supports the plaintiff.

##### How the plaintiff reads them

Timing and scope

- Hospice elected after the harm: the prognosis may be the injury, not a defense to it
- A certification narrative that names the harm, or uses the standard language the rule forbids
- A DNR withholds CPR. It does not authorize withholding turning, fluids, wound care or transfer for a treatable problem
- Facility and hospice each assuming the other was handling a task

##### How the defense reads them

Prognosis and goals

- A physician certified 6 months or less before the events at issue
- Comfort-only goals explain why the resident was not hospitalized
- Refusals of food, fluids or turning near death were honored as the resident's wishes
- Skin failure and weight loss at the end of life can occur despite appropriate care

#### DNR, POLST and what they do not say

A DNR order tells staff not to perform CPR in an arrest. POLST and similar forms, under different names in many states, can also record choices about hospitalization, antibiotics and artificial nutrition. Read the actual form: a POLST that allows hospital transfer for treatable conditions does not support keeping a septic resident in the facility.

The manual's guidance at F678 expects staff to start CPR before EMS arrives unless there is a valid DNR order or obvious signs of irreversible death. On validity it is direct:

"Existence of an advance directive does not imply that a resident has a DNR order. The medical record should show evidence of documented discussions leading to a DNR order."

CMS State Operations Manual, Appendix PP, F678

So check 2 things. Is code status the same in the physician order, face sheet, care plan, MDS, hospice plan and transfer packet? And is there a documented discussion behind the order? An order signed on the day of a crisis reads very differently from one discussed at a care conference months earlier.

When hospice works inside a facility, the hospice services provisions of [42 CFR 483.70](https://www.law.cornell.edu/cfr/text/42/483.70) require a written agreement before care begins. It divides services between the 2, keeps the facility responsible for 24-hour room and board and the resident's personal care and nursing needs in coordination with the hospice, and requires the facility to notify the hospice immediately of a significant change, a transfer need or the death. Request it with the hospice plan of care: together they answer whose job a missed task was. The [hospice eligibility documentation page](https://medrecords.ai/solutions/hospice-eligibility-documentation/) covers the certification file.

If you remember one thing
Put the dates of the hospice election, the DNR or POLST, the J1400 coding and the alleged harm on 1 line. Which came first usually decides whose argument the end-of-life documents support.

Chapter 7 Building

### The transfer and the final hospital admission

Many residents who die after a care failure die in the hospital, or come back from it to die. At the transfer, 3 sets of people describe the resident within hours: the facility nurse, the EMS crew and the emergency department. When they disagree, the disagreement is evidence.

[42 CFR 483.15(c)(2)](https://www.law.cornell.edu/cfr/text/42/483.15) requires the facility to document the transfer and send the receiving provider, at a minimum, the responsible practitioner's contact information, the representative's contact information, advance directive information, special instructions or precautions, care plan goals, and all other information needed for a safe transition (F622). Ask the hospital, as well as the facility, for the packet as received. The hospital's scanned copy shows what actually arrived.

**The same resident described 3 hours apart** — hypothetical — Resident R.M., transferred from a nursing facility to an emergency department
**Facility transfer form** NF 001204 — written 06/11 14:20
Nursing facility, transfer to ED
Reason: increased lethargy, low grade temp.
Skin: small open area coccyx, dressing intact.
Intake: fair.
Code status: DNR.
Care plan goals: see attached.
Signed LPN, 06/11 14:25
**ED triage and skin exam** HOSP 000031 — written 06/11 17:05
Emergency department nursing assessment
Temp 39.1 C, HR 118, BP 84/50.
Sacral wound approx 7 x 6 cm, Stage 4, foul odor, bone palpable.
Mucous membranes dry. Na 154, BUN 88, Cr 1.9.
Code status per packet: DNR. Family confirms.
Care plan goals: not in packet.
Signed RN, 06/11 17:12
"Small open area" against a measured Stage 4 wound with exposed bone, 3 hours apart, decides credibility. The facility's wound records for the prior 2 weeks will show which description was accurate.

#### The hospital record, read for causation

- **ED triage.** How sick the resident was on arrival, before any hospital treatment.
- **History and physical.** Often records what the family said about the preceding days, and may be the first place the word "neglect" appears. Both sides should know it is there.
- **Skin assessment.** Hospitals commonly measure wounds on admission, and some photograph them.
- **Consults.** A surgical note declining debridement because the resident is too ill shows how advanced the wound was.
- **Goals-of-care notes and the death summary.** What the family was told about cause and prognosis, and the treating team's final account. Compare both with the death certificate.

The defense may argue the hospital's care was the real or an intervening cause: delayed antibiotics, a missed diagnosis, a treatment complication. A clean hospital course strengthens the link to the facility. The [causation apportionment graph](https://medrecords.ai/product/causation-apportionment-graph/) lays out contributing events across providers.

If you remember one thing
Compare the facility's transfer form with the first hospital assessment, line by line. The 2 are written hours apart about the same body, and the differences are often the most persuasive evidence in the file for whichever side they favor.

Chapter 8 Building

### Building the decline timeline across 3 providers

The core work product is 1 timeline from the facility through the hospital and hospice to the death certificate, every entry cited to its page. Built well, it shows the plaintiff the gaps and the defense where the record supports the care. The example is hypothetical and simplified.

**Decline timeline for resident R.M.** — hypothetical — Facility (NF), hospital (HOSP) and hospice (HSP) records; page numbers illustrative
1. 04/02
**Admitted after a stroke**
Needs 2-person assist to turn. Pressure injury risk high. Care plan: turn every 2 hours, pressure-redistributing mattress.

NF 000012 to NF 000031
2. 05/20
**Redness over sacrum**
Non-blanchable redness. No care plan change charted.

Skin check, NF 000388
3. 05/28
**Stage 2 measured**
2.0 x 1.5 cm. Treatment ordered. Weight down 3 kg since admission.

NF 000402; weights, NF 000611
4. 06/01 to 06/07
**No wound measurements**
Dressings signed daily, no weekly assessment. Turning record blank on 4 night shifts.

TAR, NF 000455 to NF 000461; NF 000690 to NF 000697
5. 06/08
**Wound worse, odor noted**
Note: "larger, dark tissue, odor." Physician fax sent. No response charted.

NF 000472; fax log, NF 000905
6. 06/11
**Transfer to ED**
Form: "small open area coccyx." ED: Stage 4, 7 x 6 cm, febrile, hypotensive, sodium 154.

NF 001204; HOSP 000031
7. 06/12
**Cultures and consults**
Blood and wound cultures grow the same organism. Probe to bone. Surgery declines debridement given condition.

HOSP 000188; HOSP 000204 to HOSP 000211
8. 06/13
**Hospice elected**
Palliative note: family told the wound infection was the main driver. Return to the facility.

HOSP 000240; HSP 000003
9. 06/16
**Death in the facility**
Hospice nurse pronounces. DNR in every document.

HSP 000044; NF 001260
10. 06/18
**Death certificate signed**
Part I: sepsis due to urinary tract infection. Part II: stroke, dementia. No mention of the wound.

Certified death certificate

The 06/01 to 06/07 gap, the unanswered fax and the 3-day delay form the plaintiff's theory. The defense will point to the stroke, the weight loss and the goals of care. Both must deal with a certificate naming a urinary source no culture supports.

#### Measure the same thing across sources

Wound as described — Size and stage — Source
Facility wound record, 05/28 — 2.0 x 1.5 cm, Stage 2 — hypothetical
Facility note, 06/08 — "Larger, dark tissue, odor," not measured — hypothetical
Transfer form, 06/11 — "Small open area" — hypothetical
ED assessment, 06/11 — 7 x 6 cm, Stage 4 — hypothetical
Wound consult, 06/12 — 7.2 x 6.1 cm, probe to bone — hypothetical
Death certificate, 06/18 — Not listed — hypothetical
Last measurement to ED — 14 days — Stage 2 to Stage 4 with nothing in between: log it as a gap

#### Rules for a timeline both sides can use

1. **Cite every line to a page.** An uncited entry will not survive a deposition.
2. **Record both times.** When a note was written and when the event happened often differ. The [altered records guide](https://medrecords.ai/guides/altered-medical-records/) covers late entries.
3. **Log gaps as entries.** Missing shifts, measurements and responses are facts.
4. **Keep sources separate.** Label each entry facility, EMS, hospital or hospice.
5. **Quote key entries.** "Small open area" and "bone palpable" work only in the original words.
6. **Include the other side's good entries.** An omitted refusal or blank turning record will be found by the opposing expert.

##### 2. Decline timeline and causation worksheet

1 row per event. Fill the causation block after the timeline is complete, not before.

RESIDENT: [INITIALS] DATE OF DEATH: [DATE] PLACE: [FACILITY / HOSPITAL]
CHAIN UNDER REVIEW: [PRESSURE INJURY / ASPIRATION / FALL / DEHYDRATION /
 MEDICATION ERROR / OTHER]

TIMELINE
DATE | TIME | SOURCE (NF/EMS/HOSP/HSP) | EVENT (QUOTE KEY WORDS) |
WRITTEN AT (IF DIFFERENT) | PAGE CITE | GAP? (Y/N)

KEY MEASURE ACROSS SOURCES: [WOUND SIZE / WEIGHT / SODIUM / CODE STATUS]
SOURCE | DATE | VALUE AS WRITTEN | PAGE CITE

END-OF-LIFE DOCUMENTS
Hospice election date: [ ] Certification narrative names: [ ]
DNR / POLST date: [ ] Discussion documented: [Y/N, PAGE]
J1400 first coded yes: [ ] Physician note supporting it: [PAGE]
Alleged harm first charted: [ ]

DEATH CERTIFICATE
Part I (a) [ ] (b) [ ] (c) [ ] (d) [ ]
Part II [ ] Manner [ ] Certifier [ ] Saw resident last: [DATE]
Autopsy: [Y/N] ME/coroner referral: [Y/N, WHY]
Consistent with hospital death summary? [Y/N, LIST DIFFERENCES]

CAUSATION QUESTIONS FOR THE EXPERT
1. When did the harm begin, per the record?
2. What should have happened, and when (cite the standard)?
3. What happened instead (cite pages)?
4. What would the outcome likely have been with timely care?
5. What competing causes does the record support?
If you remember one thing
Build the timeline before anyone writes a causation opinion. An expert who starts from a conclusion reads the chart for support; an expert who starts from a cited timeline reads it for what happened.

Chapter 9 Deciding

### Pre-suit notice, expert affidavits and arbitration

Before discovery, a death case may have to clear 3 gates: a pre-suit notice process, an expert affidavit or certificate of merit, and an arbitration agreement signed at admission. Each turns on state law and on documents.

**Pre-suit notice.** Florida is a clear example. Under [Florida Statutes section 400.0233](https://www.flsenate.gov/Laws/Statutes/2025/400.0233), a claimant alleging injury to or the death of a resident must notify each prospective defendant by certified mail, with a certificate of counsel that a reasonable investigation gave rise to a good faith belief that grounds exist. No suit may be filed for 75 days, during which the limitations period is tolled and the defendant must reject the claim or offer settlement; silence counts as rejection. Documents requested informally are due within 20 days, and pre-suit expert opinions are not discoverable or admissible. That reasonable investigation is a records review done before formal discovery. Other states differ, and some apply their medical malpractice pre-suit rules to nursing homes.

**Expert affidavits.** Many states require a qualified expert's affidavit or certificate of merit with the complaint or soon after. Whether it reaches a nursing home depends on how the state defines a health care provider and whether the claim sounds in medical or ordinary negligence. See the [certificate of merit by state page](https://medrecords.ai/solutions/certificate-of-merit-by-state/).

**Arbitration.** Under [42 CFR 483.70(m)](https://www.law.cornell.edu/cfr/text/42/483.70), in the version in force since September 16, 2019, a facility may not make an arbitration agreement a condition of admission or continued care, and must say so explicitly. The agreement must be explained in a form and language the resident understands, provide a neutral arbitrator and a convenient venue, allow rescission within 30 calendar days, and not discourage contact with surveyors or ombudsmen. Whether it binds wrongful death beneficiaries who never signed it is a state law question courts answer differently.

1
**Is there an arbitration agreement in the admission packet?**
YesGo to 2. Request the full packet and any rescission notice.
NoGo to 4.
2
**Who signed it, and with what authority?**
ResidentCheck capacity on that date against MDS cognitive scores and physician notes. Go to 3.
Family memberCheck for a power of attorney or guardianship covering the decision. Go to 3.
3
**Does it meet the federal content rules?**
YesEnforceability, and reach to the wrongful death claim, is for counsel. Go to 4.
NoList each missing element with its page.
4
**Does the state require pre-suit notice or an expert affidavit?**
YesCalendar both. Build the cited timeline now.
NoRun the limitations analysis for both claims.
If you remember one thing
Read the admission packet first. The arbitration agreement, the advance directive and the representative's authority all sit there, and each can change the forum, the claims or the damages before the clinical record is argued.

Chapter 10 Deciding

### Medicare conditional payments on a death settlement

Residents are commonly Medicare beneficiaries, and the final hospital stay and hospice are often billed to Medicare. Those payments are conditional. Under [42 CFR 411.24(h)](https://www.law.cornell.edu/cfr/text/42/411.24), a party who receives a settlement must repay Medicare within 60 days. Under (i)(1), if Medicare is not repaid, the primary payer must reimburse it even though it already paid the claimant, and under (c)(2) CMS may recover double if it has to sue. The defense has its own reason to confirm the lien is resolved.

Section 10.8 of chapter 7 of the [CMS MSP Recovery Manual](https://www.cms.gov/files/document/chapter-7-msp-recovery.pdf) addresses wrongful death, and treats survival statutes the same way:

- If the statute permits recovery of the deceased's medical expenses, Medicare may recover from the payment, even if the claimant asked only for the heirs' losses.
- If it does not, Medicare has no claim against a recovery obtained solely under it.
- If the statute caps medical expenses, Medicare recovers only up to the cap, or the settlement if less.
- The estate should keep the pleadings, amendments and the settlement agreement documenting its theory.

**Where a death settlement goes** — hypothetical — Illustration only. Assumes the statute permits recovery of medical expenses; Medicare's share of fees and costs deducted under 42 CFR 411.37(c)
Gross settlementsurvival and wrongful death — $300,000
Attorney fee1/3 — -$100,000
Case costsrecords, experts, filing — -$25,000
Medicare recovery$48,000 conditional payments less its $20,000 share of fees and costs — -$28,000
Net to estate and beneficiaries49% of gross — $147,000
Hypothetical figures, not a typical or expected result. Under 42 CFR 411.37, Medicare reduces its recovery by its proportional share of procurement costs when those costs were paid to obtain the settlement. Charges for unrelated care, such as a chronic condition, can be disputed, and the medical records are the evidence for that dispute.

The records work is a relatedness review: matching each line of the conditional payment summary to the injury, or showing it treated something else. See the [medical liens guide](https://medrecords.ai/guides/medical-liens-letters-of-protection/) and the [lien resolution page](https://medrecords.ai/solutions/lien-resolution-conditional-payments/).

If you remember one thing
Find out early whether the wrongful death statute allows recovery of the resident's medical expenses. The answer decides whether Medicare has a claim at all.

Chapter 11 Everyone

### Where AI helps and where it fails on a death file

A death file is large and uneven: months of flowsheets, scanned faxes, handwritten notes, and hospital and hospice charts in other formats. Firms and legal nurse consultants on both sides now use AI medical record review and medical chronology software for the first draft of the timeline. The failures are specific, and they tend to erase the details a death case turns on.

#### Where it helps

- **Hard pages.** [OCR](https://medrecords.ai/product/ocr/) and [handwritten record extraction](https://medrecords.ai/product/handwritten-medical-record-extraction/) make faxed transfer forms and night notes searchable.
- **A first draft across providers.** An AI medical chronology places facility, EMS, hospital and hospice entries on 1 line in hours. A person checks it.
- **Gaps and comparisons.** Software can flag weeks with no wound measurements and set wound size, sodium or code status from every source side by side.
- **Liens and testimony.** AI document review matches Medicare claim lines to diagnoses, and a cited deposition summary sets staff testimony against the chart.

#### Where it fails

- **Flattening the discrepancy.** A summary that merges the transfer form and ED exam into "transferred with a sacral wound" erases chapter 7's key fact.
- **Copied text.** A large language model can read 30 identical "skin intact" entries, common with [charting by exception](https://medrecords.ai/guides/charting-by-exception/), as 30 assessments.
- **Negation and dates.** Clinical NLP must tell "no signs of infection" from "signs of infection," and late entries and fax stamps can move a gap by days.
- **Causation and hallucination.** Generative AI will answer "what caused the death?" That answer is not evidence. It can also invent entries or citations: in *Mata v. Avianca* (S.D.N.Y. 2023), lawyers were sanctioned over case citations ChatGPT made up, and Rule 11 applies whatever tool drafted the filing.

2 issues come from the records themselves. Some hospitals use ambient AI scribe tools that draft notes for the clinician to sign; if a key note reads oddly polished or contains statements the family denies, ask in discovery. And the Vermont study found ICD-10 coding changes in 93% of certificates after review; AI medical coding of certificate text cannot fix a certifier's error, but comparing it with the chart can reveal one.

By hand
First timeline — Days of indexing 4 record sets
Transfer versus ED — Found if someone happens to compare
Missing weeks — Noticed when an expert asks
With AI and a human reviewer
First timeline — Draft across all sources, checked by a person
Transfer versus ED — Set side by side for a person to judge
Missing weeks — Flagged with the pages on either side

#### What to ask any vendor

1 —

##### A citation on every line

An entry with no source page should not be used.

2 —

##### A signed BAA, SOC 2, no training on your data

A deceased resident's records stay protected for 50 years.

3 —

##### Sources kept separate

Entries labeled by provider, key words quoted.

4 —

##### Scans and handwriting handled

Test it on your worst faxed transfer form.

5 —

##### Gaps flagged, not filled

A missing week appears as a gap, never smoothed over.

6 —

##### A person signs the work

Human-in-the-loop review: the tool drafts, a qualified person checks and signs.

See the [guide on AI accuracy in court](https://medrecords.ai/guides/is-ai-accurate-enough-for-court/) and the [HIPAA compliant AI guide](https://medrecords.ai/guides/hipaa-compliant-ai-medical-record-review/).

If you remember one thing
Judge legal AI tools on a death file by whether they preserve disagreement between sources. A tool that produces a smooth story from contradictory records has removed the evidence.

Chapter 12 Publisher

### What Medrecords AI does on a nursing home death file

Medrecords AI is medical record review software for attorneys, legal nurse consultants and experts on plaintiff and defense files. On a death case it builds the first drafts this guide describes, and a person on your side reviews and signs them.

- **A cited [medical chronology](https://medrecords.ai/product/chronology/) across providers.** Facility, EMS, hospital and hospice entries on 1 timeline, labeled by source, with [page-level citations](https://medrecords.ai/product/citations/).
- **Scans and handwriting.** [OCR](https://medrecords.ai/product/ocr/) and handwritten note extraction put faxed forms in the timeline, not an appendix.
- **Gaps.** [Missing records identification](https://medrecords.ai/product/missing-records-identification/) and [undated document flagging](https://medrecords.ai/product/undated-document-flagging/).
- **Questions.** [Q and A](https://medrecords.ai/product/qa/) answers "every wound measurement from May 1 to death," with citations.
- **Liens and testimony.** A [medical billing summary](https://medrecords.ai/product/medical-billing-summary/) for relatedness review and a [deposition digest](https://medrecords.ai/product/deposition-digest/) cited to page and line.

It does not decide causation, the standard of care or the merits, and it does not replace the expert. It works on the files you upload, under SOC 2 and HIPAA with a signed BAA (see [security](https://medrecords.ai/security/) and [HIPAA](https://medrecords.ai/hipaa/) ). Self-Service bills 10 cents a deduplicated page, down to 5 cents at volume, duplicates free; Enterprise On-Prem is an annual license. See [pricing](https://medrecords.ai/pricing/).

The offer

#### See a cited decline timeline from your own death file.

Book a demo on a nursing home death file you are working, then run your first case free on us. Every line comes back cited to its source page. You review, you revise, you sign.

[Book a demo](https://medrecords.ai/demo/) [See the medical chronology](https://medrecords.ai/product/chronology/)
Scheduling only. No records move from a public page.

Chapter 13 Everyone

### Frequently asked questions

Who can file a nursing home wrongful death lawsuit?It depends on the state statute. Usually the personal representative of the estate, or the statutory beneficiaries, typically a spouse and children. Many states require a probate appointment before the representative can sue or get the records.
What is the difference between a survival action and a wrongful death claim?A survival action continues the resident's own claim, such as pre-death medical expenses and, where allowed, conscious pain and suffering. A wrongful death claim recovers the survivors' own losses. Many cases plead both.
What records are needed for a nursing home wrongful death case?The complete facility chart with all MDS assessments, the admission packet, incident reports, the EMS run report, the final hospital admission, the hospice file, the death certificate, any medical examiner record, and state survey records. Chapter 4 has a request letter.
Can you prove cause of death without an autopsy?Usually yes, and usually that is how it is done. Fewer than 1% of deaths at 85 and over were autopsied in 2007. Experts rely on hospital labs, cultures, imaging, skin exams and the facility's trend data.
What if the death certificate says natural causes?That does not end the analysis. Studies find major errors in about half of certificates reviewed. Compare Part I with the chart and ask who signed it and what they reviewed.
Does hospice or a DNR order defeat the claim?Not by itself. Both can support the defense when they predate the harm, and the plaintiff when they followed it or when care short of CPR was not given.
Does Medicare have to be repaid from a wrongful death settlement?If the statute allows recovery of the deceased's medical expenses, Medicare may recover, and repayment is due within 60 days. If not, the CMS manual says Medicare has no claim against a recovery obtained solely under it.
How long does a nursing home keep records after a death?The period state law sets, or 5 years from discharge where it sets none. Send a preservation letter early.
Can AI build a medical chronology for a nursing home death case?AI medical chronology tools can draft a timeline across facility, hospital and hospice records, including scans and handwriting. The draft must cite every entry, keep sources separate and flag gaps, and a person must check it.
Is it HIPAA compliant to upload a deceased resident's records to AI software?It can be. The records stay protected for 50 years after death, so require a signed business associate agreement, a SOC 2 report and no training of models on your records.
Can ChatGPT or another LLM decide whether neglect caused a death?No. A large language model can organize records, but causation is an expert opinion, and generative AI can invent citations, as *Mata v. Avianca* showed.

Chapter 14 Everyone

### Sources and method

Every regulation, figure and quotation was checked against the sources below in September 2026: regulations in current text on Cornell's Legal Information Institute, CMS manuals in the versions named, study figures against the published abstracts. The timeline, transfer comparison, wound ledger, certificate fields other than the CDC wording, and settlement figures are hypothetical. State law is described as a pattern, with Florida the only statute quoted. Nothing here is legal or medical advice.

- [42 CFR 483.10](https://www.law.cornell.edu/cfr/text/42/483.10), [483.12](https://www.law.cornell.edu/cfr/text/42/483.12), [483.15](https://www.law.cornell.edu/cfr/text/42/483.15), [483.70](https://www.law.cornell.edu/cfr/text/42/483.70) and [483.75](https://www.law.cornell.edu/cfr/text/42/483.75): records access, notification, reporting, transfer, retention, arbitration, hospice agreements, quality assurance.
- [42 USC 1320b-25](https://www.law.cornell.edu/uscode/text/42/1320b-25) (Social Security Act section 1150B): crime reporting and penalties.
- [42 CFR 418.3](https://www.law.cornell.edu/cfr/text/42/418.3), [418.22](https://www.law.cornell.edu/cfr/text/42/418.22) and [418.24](https://www.law.cornell.edu/cfr/text/42/418.24): terminal illness, certification narrative, election.
- [45 CFR 164.502](https://www.law.cornell.edu/cfr/text/45/164.502): 50-year protection at (f); personal representatives at (g)(4).
- [42 CFR 411.24](https://www.law.cornell.edu/cfr/text/42/411.24), [42 CFR 411.37](https://www.law.cornell.edu/cfr/text/42/411.37) and [CMS MSP Recovery Manual, chapter 7](https://www.cms.gov/files/document/chapter-7-msp-recovery.pdf), section 10.8.
- [CMS State Operations Manual, Appendix PP](https://www.cms.gov/medicare/provider-enrollment-and-certification/guidanceforlawsandregulations/downloads/appendix-pp-state-operations-manual.pdf) (revision 225, 2024): F580, F622, F678, F686, F689, F692, F760.
- [MDS 3.0 RAI Manual v1.20.1](https://www.cms.gov/files/document/final-mds-3-0-rai-manual-v1-20-1-october-2025.pdf) (October 2025): death tracking record, item J1400.
- [CDC NCHS, Physicians' Handbook on Medical Certification of Death](https://www.cdc.gov/nchs/data/misc/hb_cod.pdf) (2003) and [Hoyert, NCHS Data Brief 67](https://www.cdc.gov/nchs/data/databriefs/db67.pdf) (2011).
- [McGivern and colleagues](https://pubmed.ncbi.nlm.nih.gov/29091542/), Public Health Reports 2017;132(6):669 to 675, and [Schuppener, Olson and Brooks](https://pubmed.ncbi.nlm.nih.gov/31597655/), Clinical Medicine and Research 2020;18(1):21 to 26.
- [Florida Statutes section 400.0233](https://www.flsenate.gov/Laws/Statutes/2025/400.0233) (2025).

#### Terms used in this guide

Survival actionThe resident's own claim, continued after death by the estate.
Wrongful death claimA statutory claim for the survivors' losses from the death.
Underlying cause of deathThe disease or injury that started the chain, on the lowest line used in Part I.
Kennedy terminal ulcerA lesion CMS guidance describes as appearing suddenly near the end of life, usually over the sacrum and coccyx.
Conditional paymentA Medicare payment another party may owe, recovered from a settlement or judgment.

#### Related guides

- [Nursing home records: MDS, care plans and CMS-2567](https://medrecords.ai/guides/nursing-home-records-mds-cms-2567/)
- [Pressure injury lawsuit records](https://medrecords.ai/guides/pressure-injury-bedsore-lawsuit-records/) and [nursing home fall records](https://medrecords.ai/guides/nursing-home-fall-lawsuit-records/)
- [Elder abuse and financial exploitation records](https://medrecords.ai/guides/elder-abuse-financial-exploitation-records/)
- [How to get medical records for a lawsuit](https://medrecords.ai/guides/how-to-get-medical-records-for-a-lawsuit/)
- [Wrongful death record review](https://medrecords.ai/solutions/wrongful-death-record-review/) and [nursing home neglect record review](https://medrecords.ai/solutions/nursing-home-neglect-record-review/)

### More guides

- [**Nursing notes: what they contain and how to read them after the fact** — What goes in nursing notes and flowsheets, the federal rules behind them, charting formats, a worked example, a…](https://medrecords.ai/guides/nursing-notes/)
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- [**Reconciling a defense record production: the page-level method for medical malpractice teams** — Why the defense production never matches your pre-suit medical records, and a page-level method to reconcile…](https://medrecords.ai/guides/reconciling-defense-record-production/)