6 Colo. Code Regs. § 1009-4-II

Current through Register Vol. 47, No. 11, June 10, 2024

Section 6 CCR 1009-4-II - Requirements for Reporting Medical Record Information to the Department

A. Within 30 calendar days of writing a prescription for medical aid-in-dying medication to end the life of a qualified patient, the attending physician or the attending physician's designee, shall submit, in the form prescribed by the Department, the following:

1. Patient's name and date of birth;

2. Dates of all oral requests made by the patient;

3. The prescribing attending physician's name, mailing address and phone number;

4. The patient's completed written request for medical aid-in-dying medication to end life that complies with Section 25-48-112, C.R.S.;

5. The attending physician's:

a. Diagnosis of a terminal disease;

b. Prognosis of six months or less;

c. Mental capacity determination that documents that the individual is making a voluntary and informed request;

d. Notation(s) of notification provided to the patient of the right to rescind a request made for medical aid-in-dying medication;

e. Notation of the medical aid-in-dying medications prescribed, dose and date prescribed to the patient;

f. If applicable:

i) Notation and date when the medical aid-in-dying medication was dispensed directly by the attending physician, or

ii) If the attending physician delivered a written prescription to a licensed pharmacist, the name and phone number of the pharmacist and the pharmacy, and a notation that the pharmacy was informed that medical aid-in-dying medication was prescribed pursuant to Article 48, Title 25, C.R.S., and the date of the notification, and;

g. Notation that all requirements under Article 48, Title 25, C.R.S. have been satisfied and indicating the steps taken to carry out the patient's request.

6. The consulting physician's name, mailing address and phone number and a copy of the consulting physician's written confirmation of the attending physician's diagnosis, prognosis, and mental capacity determination.

7. If obtained by the physician, a written confirmation of mental capacity from a licensed mental health provider.

B. All information submitted pursuant to this Section II will be submitted by mail or secure e-mail as directed by the Department.

6 CCR 1009-4-II

40 CR 10, May 25, 2017, effective 6/14/2017