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What role does NCMB play in the state’s death certification process?
NCMB is not involved in the death certification process in North Carolina. However, NCMB licenses physicians and physician assistants, who both may certify deaths under state law.
Who is authorized to certify deaths in the state of North Carolina?
Besides the medical examiner, a physician, physician assistant, or nurse practitioner may lawfully certify a death in North Carolina. See N.C. Gen. Stat. § 130A-115.
Does the clinician who certifies the death need to have seen the decedent as a patient recently, or at all, in order to complete the death certificate?
No. N.C. Gen. Stat. § 130A-115 states that any authorized medical certifier (e.g. physician, physician assistant, or nurse practitioner) who makes a reasonable attempt to ascertain the events surrounding the death. Typically, this is done by reviewing available medical records.
Must an autopsy be completed in order for a medical professional to determine cause of death?
No. In fact, autopsies are not completed routinely except in situations where the death is the result of foul play or otherwise “suspicious” causes. Review of available medical records is sufficient to determine a plausible probable cause of death.
Do I have the right to request that an autopsy be performed on my loved one?
Yes, but you will be responsible for the cost of the autopsy, which may cost a few thousand dollars as this is a service provided by private medical professionals.
The medical professional asked to certify a death certificate is not registered with the state’s online death certification portal NC DAVE. Can the medical professional submit a paper death certificate?
No. Since 2022, all death certificates completed in North Carolina are required to be submitted electronically using the state’s NC DAVE portal.
If a medical professional is willing to certify the death but not registered, they can register for NC DAVE and complete the death certificate once their account is approved. This can take several days, further delaying completion of the death certificate.
Ask the medical professional if any other physicians or physician assistants in the practice are currently registered to use NC DAVE and would be willing to certify the death. Remember, it is not necessary for the clinician who signs the death certificate to have seen the decedent as a patient. Any physician, physician assistant, or nurse practitioner willing to review available records and determine a reasonable probable cause of death may certify the death.
A physician or physician assistant has declined to sign/certify my loved one’s death certificate. What should I do?
Learning that a medical professional has refused to certify a loved one’s death can be a confusing and frustrating experience. It is NCMB’s position that physicians and physician assistants should sign death certificates if asked to do so.
If a request is refused, the family members or funeral professionals involved should check to see if the correct medical professional has been asked to certify. Per state law, the clinician who was managing the illness or condition that led to the death is responsible for certifying the death. If the decedent was not receiving treatment for any known illness, it is customary practice for the decedent’s primary care provider to be asked to certify the death. In situations where family or friends of the decedent are not available, it is not uncommon for EMS or others responding to the death to provide funeral professionals with the name of any medical professional they can determine has had any contact with the decedent. For example, the provider’s name may be copied from a prescription bottle, which can result in the death certificate being assigned to a medical professional who did not know the patient well.
Is the medical professional who declined to sign the appropriate choice to certify the death? In some instances, medical professionals who had only minimal contact with the decedent are asked to certify. Ideally, the medical professional who knew the decedent best, such as their primary care provider, is best suited to certify the death.
Are you aware of a medical professional the decedent was an established patient of who would be willing to sign? If yes, provide the name of the medical professional to the funeral professional and ask them to reassign the death certificate to this provider. If no, you may contact NCMB and provide the name of the physician or physician assistant who has declined to certify the death. A staff member will reach out to encourage them to sign the death certificate.
May I file a complaint against a physician or physician assistant who declines to sign a death certificate?
Yes, you may, but filing a complaint will not result in the clinician agreeing to sign the death certificate or help identify another clinician willing to do it.
Before filing a complaint, you may wish to contact the NCMB and ask to speak to a staff member about the situation. In many instances, staff are able to reach out to the clinician, the funeral home, or both and assist with getting the death certificate completed.