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Oct 1 2011

PAs and NPs may now sign death certificates

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Effective October 1, physician assistants and nurse practitioners may legally complete death certificates.

Amendments to state law (NCGS 90-18.1) require that PAs and NPs be specifically authorized to complete death certificates by the supervising physician under the terms of the supervisory arrangement or collaborative practice agreement. As with any other delegated tasks, the supervising physician is ultimately responsible for ensuring that death certificates are properly filled out and filed.

Authorizing PAs and NPs to complete death certificates—the law previously named physicians as the lone type of clinician who could complete these important documents—could help reduce delays in getting completed certificates to the decedent’s family. Lack of a completed death certificate can hold up funeral arrangements, estate proceedings and other legal matters.

Death certificates: Some basics
Death certificates must be completed and filed no more than three days after the patient’s death. The certificate must state the cause of death in definite and precise terms. It is vital to distinguish between the underlying cause of death (which is required to be listed) and the mode of death (which should not be listed.) For example, "Cardiac or Respiratory Arrest" is not a legitimate cause of death, but "Acute Exacerbation of Chronic Obstructive Airway Disease" or "Chronic Bronchitis" is appropriate. Multiple causes should be listed in order of priority, with as much specificity as possible.

Clinicians may not decline to sign a certificate because they are uncertain of all causes of death. Clinicians are merely expected to exercise their best clinical judgment under the circumstances when assigning cause of death.

Deaths should be referred to the medical examiner's office only in extremely limited circumstances. For example, cases where it is more likely than not that a fatal injury, drugs or foul play was involved are appropriate referrals. Likewise, deaths involving patients less than fifty years of age without negative medical history should also be referred. Deaths should never be referred to the medical examiner's office because a clinician involved in a patient's care is not comfortable attributing a cause of death or believes it is another clinician's responsibility to complete the death certificate.

Detailed guidance on properly filling out a death certificate can be found in the Centers for Disease Control's, "The Physician’s Handbook of Medical Certification of Death,” available online.

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