Resources & Information

In situations where a person dies at home and is brought by ambulance to a hospital emergency department, it is common practice for hospital staff to check the person’s medical records to determine if he or she had an established relationship with a primary care doctor or other physician. If so, the hospital will generally ask the decedent’s physician to certify the death. It is the Board’s view that this is a reasonable practice, as physicians or other professionals who have examined and treated a patient in the past are arguably in the best position to make an educated guess about the probable cause of death, even if the patient had not been seen recently.

North Carolina law requires that when a death does not meet criteria for jurisdiction by the Medical Examiner (N.C. Gen. Stat. § 130A-383) the death certificate shall be completed and signed by the physician, physician assistant, or nurse practitioner (“clinician”) in charge of the patient’s care for the illness or condition that resulted in death. See N.C. Gen. Stat. § 130A-115(c).

The function of the North Carolina Medical Examiner system is to investigate deaths due to injury or violence, as well as natural deaths that are suspicious or unusual. Understand that, before a physician or other clinician is contacted about signing the death certificate, an assessment of the circumstances has almost always been made by EMS, law enforcement, or a medical examiner. If a death falls within the Medical Examiners’ jurisdiction, it will be referred accordingly.

The law requires a death certificate be filed within five days after the death. See N.C. Gen. Stat. § 130A-115(a).

Prior to being away from your office (either for vacation or some other extended period of time), you should designate someone (preferably with access to NCDAVE) who can act in your place.

Although N.C. Gen. Stat. § 130A-115(c) requires that the practitioner “state the cause of death in definite and precise terms,” clinicians are not expected or required to establish beyond a doubt the specific cause of death but should exercise their best judgment under the circumstances using available information. This may include reviewing the immediate past medical records of the deceased, talking with family members of the deceased, and if applicable, reviewing any reports or information available from first responders. Any physician who completes a death certificate in good faith is immune from both civil liability and professional discipline. See N.C. Gen. Stat. § 130A-115(f).

Under the law, the Board cannot pursue disciplinary action against clinicians who complete death certificates in good faith and to the best of their ability in accord with the information available — even if that information is limited. The law also grants immunity from civil liability to clinicians completing death certificates in good faith. (N.C. Gen. Stat. § 130A-115(f)) The clinician completing the death certificate is only asked to provide a cause of death “to the best of [his or her] knowledge,” not to a medical certainty.

Review of the patient’s medical history should provide adequate information to state a reasonable or likely cause of death. Furthermore, it is acceptable to use “probable” or “possible” to identify a suspected cause of death. In the end, a clinician’s determination of the cause of death is a medical opinion and is based on the best available medical evidence available at the time the certificate is being signed, which may include the cumulative effects of multiple risk factors or a previously known disease process.

Yes, physician assistants or nurse practitioners can complete death certificates as long as it falls within their scope of practice, which is outlined in their supervisory arrangement or collaborative practice agreement. If a physician assistant is registered with the NCMB as a team-based physician assistant, they may complete the death certificate if it falls within their scope of practice and complies with any processes required by their team-based setting.

The Board encourages clinicians to undertake completion of death certificates for patients (current, recent, or remote) under these circumstances as a professional, ethical, civic, and public health responsibility. Delaying the completion of a death certificate can cause unnecessary burdens on the surviving family members, including complications with funeral arrangements, estate proceedings, and other legal and personal matters. Failure or refusal to complete a death certificate, when the licensee clearly has a responsibility to do so, could lead the Board to consider disciplinary action.

All death certificates must be filed electronically with the Office of Vital Records via the North Carolina Database Application for Vital Events (“NCDAVE”) system. NCDAVE is a statewide online system used to electronically register death certificates and eliminates the need for physical transfer of paper certificates. Individuals responsible for completing death certificates who refuse to certify a death certificate via NCDAVE may be subject to administrative fines. To access NCDAVE, please visit: https://davenc.vitalchek.com/Web/Logon.aspx.

Legal requirements on completion of a death certificate may be found at N.C. Gen. Stat. § 130A‑115. Additional guidance on the proper completion of death certificates is available in the CDC’s “Physicians’ Handbook on Medical Certification of Death” and the Board has a resource page as well.

While there is no strict mandatory registration requirement, you are required to submit all death certificates via NCDAVE. The registration process may take several days, potentially delaying completion of the death certificate. Failure to complete a death certificate within the required five-day timeframe may constitute violation of a law involving the practice of medicine, which is grounds for discipline under N.C. Gen. Stat. § 90-14(a)(7).