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DeathCertificate2008No.0055811Name:MaQinghongSex:MaleEthnicity:HanAge:56YearsoldIDNo.:140102195209793273HouseholdAddress:No.3-1-201,Chengdeli,GuangzhouDao,HangzhouDao,TangguDistrict,TianjinResidentAddressbeforeDeath:No.3-4-703,Nanyangli,SanhuaiRoad,TangguDistrict,TianjinReasonfordeath:LeukmiaDateofdeath:10/01/2009FamilymembernameandTel:MaPingping,13502197123Doctor’sSignature:HouseholdPoliceman’sSignature/Seal:YangZixiangSealforMedicalUnit:SealforPloliceStation:TianjinResidenceDeathMedicalIdentify(SpecialSeal)TianjinYongjiuHospital10/01/2009PrintedbyTianjinCenterForDiseaseControlandPreventionTianjinResidenceDeathMedicalIdentify(SpecialSeal)TianjinYongjiuHospitalThethirdpageissavedbytheHouseholdManagementDepartmentDeathCertificate2008No.0055811Name:MaQinghongSex:MaleEthnicity:HanCareer:ClerkIDNo.:140102195209793273HouseholdAddress:No.3-1-201,Chengdeli,GuangzhouDao,HangzhouDao,TangguDistrict,TianjinResidentAddressbeforeDeath:No.3-4-703,Nanyangli,SanhuaiRoad,TangguDistrict,TianjinMarriageStatus:MarriedEducation:GraduatedfromHighSchoolWorkingUnitbeforeDeath:BeijingRailwayBureauWaterandPowerSectionDateofBirth:29/09/1952Dateofdeath:10/01/2009Age:56YearsoldAddressofdeath:AthomeFamilymembername:MaPingpingTel:13502197123HomeAddressorworkaddressofFamilymember:Reasonfordeath:LeukmiaIntervalbetweenattackanddeath:3daysThehighestdiagnoseunitbeforedeath:LocalMunicipalHospitalThehighestdiagnosebasisbeforedeath:HospitalNo.:SealforMedicalUnit:Doctor’sSignature:TianjinResidenceDeathMedicalIdentify(SpecialSeal)TianjinYangZixiangYongjiuHospitalDate:10/01/2009Thefollowingcontentisfilledbythereportstatistician:1.Deathreason:2.ICDCode:Note:Theirregulardeathwithoutdoctor’sidentifyanddiseasewithoutmedicalorganization’sdiagnosesealedSpecialSealforTianjinResidenceDeathDiagnosewillnotprovidedeathdiagnosePrintedbyTianjinCenterForDiseaseControlandPreventionThesecondpageissavedbythefamilymemberandhandtohouseholdmanagementdepartmentatthetimeofc
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