RD409068
Form 9 Office use only
Births, Deaths and Marriages Registration Act 2003 (Section 30) TB: 2023 No 02459
29/11/2023
Date Rec: _______________________
CAUSE OF DEATH CERTIFICATE
Brisbane
District Code: ____________________
Please print clearly, using BLOCK letters
To the Registrar-General, Brisbane Registration No: 2023/02459
(Note: This certificate shall not be given without authorisation of the Coroner in relation to a reportable death. This certificate must also be completed for a stillborn child (see Note below).
are unknown, write "UNKNOWN". All items marked with an asterisk (*) are for statistical or administrative purposes only and will not appear in the Register of Deaths. Form distribution: Original (white) to
the Registrar-General or the person arranging for the disposal of the body; Duplicate (blue) to the person arranging for the disposal of the body; Triplicate (yellow) to be retained by Doctor. Form should
be completed within 2 working days of the death.)
I, Rebecca Mary Williams, a registered Doctor:
(a) For a stillborn child*: (b) For any other deceased person (including a neonatal death†)*:
was present at the stillbirth; or attended the deceased person when alive; or
examined the stillborn child's body. or
examined the deceased's body; or
X considered the deceased's medical history and the circumstances of the death.
and certify that: Abdi Rahman Rabi was aged: 63 years
and born on: 11/07/1960 sex: Male and I believe that he/she died on: 24/11/2023
at: Orpheus Island, Palm Island 4816 For stillborn or neonate: time of birth* time of death*
In my opinion, the probable cause of death is as stated below in section 'A' or 'B':
'A' – (for a stillborn child or neonate†):
1(a) Main disease or condition in foetus or neonate
1(b) Other diseases or conditions in foetus or neonate
1(c) Main maternal disease or condition affecting foetus or neonate
1(d) Other maternal diseases or conditions affecting foetus or neonate
2 Other relevant circumstances
Underlying Cause of Death*:
'B' – (for any other deceased person): Duration of last illness
(approximate interval
Disease or condition directly leading to death: 1(a) Coronary atherosclerosis
between onset and death)
(This means the final disease or condition which
caused death – NOT the mode of dying such as
Years
heart failure, respiratory failure, etc, UNLESS
explained by Antecedent Causes below.)
Antecedent Causes – morbid conditions, if any, 1(b)
giving rise to the above cause, stating the
underlying condition last.
1(c)
1(d)
1(e)
Other Significant Conditions – contributing to 2 Dyslipidaemia, hypertension and previous Years
the death, but not related to the underlying cause cerebrovascular accident
given in Part 1.
Date and type of operation in the last 4 weeks* - N/A
Pregnancy: Was the deceased pregnant within 6 weeks of death?* No X Yes
Was the deceased pregnant between 6 weeks and 12 months of death?* No X Yes
Does the body of the deceased pose a cremation risk under the Cremations Act 2003*? No X Yes
Is the death a reportable death under the Coroners Act 2003 (CA)*? Note: Please complete a Perinatal Supplement (to Cause of Death
No Certificate) (Form 9A) if the above information relates to a child
X No, Coroner has advised death not reportable under s.26(5)(a) of CA. who was stillborn (of at least 20 weeks gestation or 400 grams
Yes, issue of this certificate was authorised under s.12(2)(b) of the CA. weight at birth) or who died within 28 days after birth (neonate)†.
Coroner: Jessica Lambert, Coronial Registrar Date: 29/11/2023 Doctor's Signature: Rebecca Williams
_________________________________________________________________
Date: 29/11/2023
(Insert name of Coroner who advised or who authorised this Certificate and Date)
Non-Coronial Autopsy Consented by Next of Kin* Initials and Surname R. Williams
Carried out To be carried out X Not to be carried out
Professional Qualification(s)* BSc, MBBS (Hon 1), FRCPA
Was the deceased of Aboriginal or Torres Strait Islander origin?
(If of both Aboriginal and Torres Strait Islander origin, tick both 'Yes' boxes)* Address Townsville University Hospital, 100 Angus Smith
Drive, Douglas, QLD 4814
X No Yes, Aboriginal origin Yes, Torres Strait Islander origin
Telephone 30962794
Form 9 Ver. 29/11/2023
1 01/02/2004 Note: This Certificate must be issued without charge Department of Justice and Attorney-General
BDM 12190
