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The Board encourages clinicians to undertake completion of death certificates for patients (current, recent, or remote) under these circumstances as a professional, ethical, civic, and public health responsibility. The Board also recognizes that clinicians may believe, for a variety of reasons, they were not “in charge of the patient’s care for the illness or condition which resulted in death.” This is often because death has occurred weeks or months after the last contact with the patient. The clinician completing the death certificate is only asked to provide a cause of death “to the best of knowledge,” not to a medical certainty (which is not possible in many instances). The Board will not pursue disciplinary action against clinicians who complete death certificates in good faith and to the best of their ability in accord with the information available - even if that information is limited. Use of standard nomenclature without abbreviations and legible writing is encouraged. In the end, a clinician’s determination of the cause of death is a medical opinion and is based on the best available medical evidence available at the time the certificate is being signed, which may include the cumulative effects of multiple risk factors or a previously known disease process. Furthermore, it is acceptable to use “probable” or “possible” to identify a suspected cause of death. Examples of acceptable causes of death may include arteriosclerotic cardiovascular disease, hypertension, Alzheimer’s disease, or complications of diabetes mellitus. Review of the patient’s medical history should provide adequate information to state a reasonable or likely cause of death. Clinicians are not expected or required to establish beyond a doubt the specific cause of death but should exercise their best judgment under the circumstances using available information.* Less than 10% of deaths result in an autopsy. The Board recognizes that clinicians may not be comfortable with uncertainty, however, a clinician should not decline to sign a death certificate simply because the exact anatomic or physiologic cause of death is uncertain. Delaying the completion of a death certificate or refusing to sign a death certificate makes an already difficult time for surviving family members and other loved ones even more so and may result in unnecessary complications with funeral arrangements, estate proceedings, and other legal and personal matters. § 130A-383) the death certificate shall be completed and signed by the physician, physician assistant, or nurse practitioner (“clinician”) in charge of the patient’s care for the illness or condition which resulted in death. North Carolina law requires that when a death does not meet criteria for jurisdiction by the Medical Examiner ( N.C. Back to List 6.1.4: Clinician Obligation to Complete a Certificate of Death