Resources for Certifying Physicians

When the reported circumstances surrounding a death include a significant medical
history and atraumatic scene findings—such as no reported trauma, falls, fractures,
medication discrepancies, suspicious circumstances, or concerns for abuse or neglect—
the decedent does not fall under the Coroner’s jurisdiction. In these cases, the treating
physician is responsible for death certification as the final act of care for the patient.
Once the death certificate is presented by the funeral director, it must be completed and
signed within two (2) business days in accordance with RCW 70.58.170.

We understand that you may not have been present at the time of death and that
determining an exact cause of death can be challenging in these circumstances. We would
like to reassure you that the responsibility of completing the death certificate is based on
the standard of “to the best of my knowledge,” as stated in Box 48a of the Washington
State Certificate of Death. This language 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. Reviewing the problem list and medical history may provide sufficient information to
complete the death certificate accurately.

Remember, the cause-of-death should be YOUR best medical OPINION. If you should
have any questions, please contact the on-duty investigator at 360-416-1996.

Additional Resources

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