Medical Certifier Guide

Who can sign a death certificate?

The physician in charge of the patient’s care for the illness or condition which resulted in death is primarily responsible. “In the absence of such physician or with his approval, the certificate may be completed and signed by the following: (i) another physician employed or engaged by the same professional practice; (ii) a physician assistant supervised by such physician; (iii) a nurse practitioner practicing as part of a patient care team; (iv) the chief medical officer or medical director, or his designee, of the institution, hospice, or nursing home in which death occurred; (v) a physician specializing in the delivery of health care to hospitalized or emergency department patients who is employed by or engaged by the facility where the death occurred; (vi) the physician who performed an autopsy upon the decedent; or (vii) an individual to whom the physician has delegated authority to complete and sign the certificate, if such individual has access to the medical history of the case and death is due to natural causes.

What if I don’t know the exact cause of death?

Virginia law clearly states that if a death is natural, the health care providers are to determine the most likely cause of death to the best of their ability. If they are uncertain about the cause of death, they should use their best medical judgment to certify a reasonable cause of death. While not mandatory, an autopsy may be performed, with authorization of the decedent’s next of kin, by any hospital or private pathologist to document disease processes when the death is natural.

Can I be sued for incorrect certification of cause of death?

According to Virginia law, a physician, nurse practitioner, or physician assistant who determines the cause of death and signs the death certificate, in the absence of gross negligence or willful misconduct, is immune from civil liability (§32.1-263).

Links to additional resources.

Completion of Death Certificates

Death Certification – Your Final Act of Patient Care