Wash. Admin. Code § 246-978-020 - Reporting
(1) To comply with the
act, within thirty calendar days of writing a prescription for medication to
end the life of a qualified patient, the attending physician shall send the
following completed, signed, and dated documentation by mail to the State
Registrar, Center for Health Statistics, P.O. Box 47814, Olympia, WA 98504:
(a) The patient's completed written request
for medication to end life, either using the Written Request for Medication to
End My Life in a Humane and Dignified Manner form, DOH 422-063, or in
substantially the same form as described in the act;
(b) Attending Physician's Compliance form,
DOH 422-064;
(c) Consulting
Physician's Compliance form, DOH 422-065; and
(d) Psychiatric/Psychological Consultant's
Compliance form, DOH 422-066, if an evaluation was performed.
(2) Within thirty calendar days of
a qualified patient's ingestion of a lethal dose of medication obtained under
the act, or death from any other cause, whichever comes first, the attending
physician shall complete the Attending Physician's After Death Reporting form,
DOH 422-068.
(3) To comply with the
act, within thirty calendar days of dispensing medication, the dispensing
health care provider shall file a copy of the Pharmacy Dispensing Record form,
DOH 422-067, with the State Registrar, Center for Health Statistics, P.O. Box
47814, Olympia, WA 98504. Information to be reported to the department shall
include:
(a) Patient's name and date of
birth;
(b) Patient's
address;
(c) Prescribing
physician's name and phone number;
(d) Dispensing health care provider's name,
address and phone number;
(e)
Medication dispensed and quantity;
(f) Date the prescription was written;
and
(g) Date the medication was
dispensed.
Notes
Statutory Authority: Chapter 70.245 RCW. 09-06-010, § 246-978-020, filed 2/20/09, effective 3/5/09.
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