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Attending Physician End-of-Life Reporting Form

Attending Physician End-of-Life Reporting Form 2025

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The document is an Attending Physician End-of-Life Reporting Form from the Maine Department of Health and Human Services, designed to comply with the Death with Dignity Act. It outlines the necessary steps and requirements for physicians when a patient requests medication to self-administer for ending their life in a humane manner. The form includes sections for patient and physician information, documentation of oral and written requests, physician determinations regarding the patient's eligibility, prescribed medication details, and insurance coverage.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (276 Votes)
2019	4.4 Satisfied (56 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is an attending physician report?

An attending physician statement (APS) is a report by a physician, hospital, or medical facility that has treated, or is currently treating, a person seeking insurance. In traditional underwriting, an APS is one of the most frequently ordered additional sources of medical background information.

What is part of the physicians responsibility in end of life care?

Physicians have a responsibility to help patients define their goals for end of life care and to respect patients preferences.

What is the role of a physician in end of life care?

We identified 12 domains of physicians skills at providing end-of-life care: accessibility and continuity; team coordination and communication; communication with patients; patient education; inclusion and recognition of the family; competence; pain and symptom management; emotional support, personalization; attention

What is one role of the attending physician for hospice care?

If you are being cared for at home or in a care home, your GP has overall responsibility for your care.

What are the responsibilities of a physician?

Once the decision to refer to hospice is made, the family physician typically continues to be the patients primary attending physician. The attending physician is expected to remain in charge of the patients care, write orders, see the patient for office visits, and complete and sign the death certificate.

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