Resources for Certifying Physicians

Dear Certifying Physician, 

When the reported circumstances surrounding a death have a combination of significant medical history and atraumatic scene findings (no reported trauma, falls, fractures, medication discrepancies, no suspicious circumstances, and no concerns for abuse or neglect) the decedent does not fall under the Medical Examiner's jurisdiction.  As the treating physician, you are responsible for certification as the final act of caring for this patient.  Once the death certificate is presented by the funeral director, it must be signed within two (2) business days per RCW 70.58.170.

We understand that your were likely not present at the time of death and that the exact cause of death may be difficult to determine, but hope to reassure you that the responsibility of certifying the death certificate is based solely on "...to the best of my knowledge," as stated in box 48a on the Washington State Certification of Death.  That wording is explicitly written on the certificate in order to give leniency and ability to the practitioner to give their medical opinion, to the best of their knowledge, in this type of circumstance.  Based on the decedent's medical history and your knowledge of their general health and medical compliance, we recommend that you issue a probable cause of death.

EXAMPLE: Consider phrasing such as "Probable" before stating the cause of death in box 34a (e.g. "Probable cardiac arrest due to hypertensive and atherosclerotic cardiovascular disease" or "Probable complications of congestive heart failure and chronic obstructive pulmonary disease").

If you are still unclear about pinpointing the patient's most significant health care problem, you may also certify "Death due to unspecified natural causes" in box 34a and in box 35 you may list the most significant conditions they suffer from as the contributing conditions.

In the event that you are not the patient's primary care provider and are a covering physician in that individual's absence, please attempt to access the decedent's medical chart that can provide you with the patient's problem list and/or medications in order to complete the death certificate.

Remember, the cause-of-death should be YOUR best medical OPINION.  If you should have any questions, please contact the on-duty investigator at (425) 438-6200.     

Additional Resources

To assist you further with the Center for Disease Control's reporting guidelines, we recommend the following educational materials:

Improving Cause-of-Death Reporting Training 

• The goal of the educational activity is to provide training on how causes of death information is used, how to fill out death certificates, when to refer a case to a medical examiner or coroner, and where to access additional resources.  CME credits offered.

Cause of Death Mobile Application 

• A quick reference guide for Apple or Android users.

Instructions for Cause of Death Section of the Death Certificate

• An easy to understand explanation of the cause-of-death sections of the death certificate.  This two-sided handout is ready to be laminated and used as a quick reference guide.

Writing the Cause-of-Death Statements Training

• How to complete the death certificate and when to refer cases to the coroner or medical examiner.

Guidance for Certifying Deaths Due to Coronavirus Disease 2019 (COVID-19)

• Provides guidance to death certifiers on proper cause-of-death certification for cases where confirmed or suspected COVID-19 infection resulted in death.
• Includes guidance for certifying deaths due to post-acute sequelae of COVID-19. 

You may also contact our office at (425) 438-6200 to set up in-house training for reporting guidelines and certifying death certificates.