Who Must Sign a Death Certificate?

CAP member physicians frequently call our hotline with questions about completing a patient’s death certificate.  Sometimes, they are reluctant to sign the legal document since they were not in attendance at the time of death. Other times, they inquire if their nurse practitioner or physician assistant can sign the death certificate for them.

When a patient is admitted to the emergency room and expires, the ER physician routinely will ask the decedent’s primary care physician to sign the death certificate. California law states that the responsibility to sign a patient’s death certificate belongs with the attending physician---the physician in charge of the patient’s medical care for the illness or condition that resulted in death. Sometimes, the attending physician may be unavailable or on vacation at the time of the patient’s death. In this case, the physician who has agreed to cover for the attending physician is responsible for signing the death certificate.  It may be necessary for the covering physician to obtain medical records from the practice and/or have a conversation with the attending about the decedent’s medical history. In any case, nurse practitioners and physician assistant, in California, are not allowed to sign the death certificate.

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When completed properly, the death certificate should communicate essential information about the patient’s cause of death.  Here are a few important points to remember:

  • It must be completed by the attending within 15 hours after being presented the death record.
  • When unsure of the exact diagnosis, a physician may use terms such as: “approximately”, “possible”, “probable,” and “unknown.”
  • A death certificate can be amended at any time should additional information become available.
  • A physician may disclose private health information (PHI) to a coroner or medical examiner for the purpose of identification or determining the cause of death.
  • A death certificate is also required for a stillborn delivery when the fetus is twenty weeks gestation or more.

Authored by

Joseph Wager, MS, RCP

CAP Senior Risk Management & Patient Safety Specialist

If you have questions about this article, please contact us. This information should not be considered legal advice applicable to a specific situation. Legal guidance for individual matters should be obtained from a retained attorney.