I.Medical certification shall consist of the pronouncement of death and the medical certification of the cause of death.
II.The medical certification on the death record shall be completed by the attending physician, APRN, or physician associate or certifying physician, APRN, or physician associate and made available to the funeral director, next of kin, or designated agent as soon as possible but no later than 36 hours after the time of death.
III.Medical certification of the death record shall be the direct responsibility of the attending physician, APRN, or physician associate unless the death is referred to the medical examiner pursuant to RSA 611-B:12.
IV.For cases where a death is not within the jurisdiction of the medical examiner, the attending physician's, APRN's, or physician
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I. Medical certification shall consist of the pronouncement of death and the medical certification of the cause of death.
II. The medical certification on the death record shall be completed by the attending physician, APRN, or physician associate or certifying physician, APRN, or physician associate and made available to the funeral director, next of kin, or designated agent as soon as possible but no later than 36 hours after the time of death.
III. Medical certification of the death record shall be the direct responsibility of the attending physician, APRN, or physician associate unless the death is referred to the medical examiner pursuant to RSA 611-B:12.
IV. For cases where a death is not within the jurisdiction of the medical examiner, the attending physician's, APRN's, or physician associate's responsibility to complete the death certificate shall be as follows:
(a) For deaths occurring in a hospital, the attending physician, APRN, or physician associate shall be that physician, APRN, or physician associate who had been responsible for the treatment of the patient while the deceased had been hospitalized.
(b) For deaths occurring in a nursing home or in a similar non-acute care hospital or institution, the attending physician, APRN, or physician associate shall be the physician, APRN, or physician associate who regularly attends to the medical needs of the nursing home residents or the resident's personal physician, APRN, or physician associate if the resident was under the care of such physician, APRN, or physician associate.
(c) For deaths occurring at home, the attending physician, APRN, or physician associate shall be the deceased's own physician, APRN, or physician associate.
V. In all instances, medical certification shall include the cause of death information and contain the pronouncement of death.
VI. In the absence of the deceased's attending physician, APRN, or physician associate or with the attending physician's, APRN's, or physician associate's approval, the medical certification of a death due to natural causes shall be completed by one of the following individuals: the attending physician's, APRN's, or physician associate's associate physician, APRN in medical practice, or physician associate, the chairperson of the applicable clinical department, the chief medical officer of the hospital, the physician, APRN, or physician associate or designee who performed an autopsy upon the decedent, or the physician, APRN, or physician associate on duty if the death occurred in the hospital emergency room. The person determining the cause of death shall attest to its accuracy.
VII. In the absence of the attending physician, APRN, or physician associate, a physician or a registered nurse in accordance with RSA 290:1-b, shall pronounce that death has occurred without any reference to the cause of the death by indicating his or her official status as the pronouncing physician or as pronouncing registered nurse; attesting to the accuracy of the time, date, and place of death either by signature or by an electronic process as outlined in RSA 290:1; and providing the name and address of the physician, APRN, or physician associate who will complete the medical certification.
VIII. When the death has not occurred in a hospital and circumstances require the death certificate to be certified by a medical examiner as provided by RSA 611-B, the following procedure shall be followed:
(a) When the cause of death cannot be determined within 36 hours, the medical examiner shall indicate the word "pending" in the cause of death section.
(b) When the manner of death cannot be determined within 36 hours, the medical examiner shall be authorized to show "pending investigation" in the manner of death section of the medical certification.
(c) If the procedure in subparagraphs (a) or (b) is followed, then the medical examiner shall provide to the division updated information on the cause of death and manner of death, as applicable, within 90 days of the date of death, or as soon as practicable in cases of missing persons, accidental deaths, or homicides.
IX. In cases where an autopsy is to be performed, the cause of death shall not be deferred pending a full report of microscopic and toxicological studies. Supplemental death certificate information shall be submitted by the medical examiner to the division as additional information becomes available and when autopsy results or other investigation indicates a need to correct the original cause of death information.
X. Pursuant to RSA 290:1, the funeral director, next of kin, or designated agent shall ensure the medical certification has been completed prior to filing the death record with the state registrar.
XI. In cases where the result of an autopsy, police investigation, laboratory report, or a similar source is needed before a final determination of the cause of death can be made, the attending physician, APRN, or physician associate or the medical examiner shall utilize the term "pending" for the applicable items on the death record. The physician, APRN, or physician associate shall file a statement of findings with the division within 90 days of the date of death, or as soon as practicable. The findings shall be in writing and submitted to the division on a supplemental death certificate information form supplied by the division or on the physician's, APRN's, or physician associate's letterhead and include information necessary for the completion of a supplemental death certificate.
XII. The division shall follow up with the certifying physician, APRN, or physician associate or the medical examiner on any death record where cause of death was shown as "pending". The division shall attempt to obtain the missing information by initiating a written query to the certifying physician, APRN, or physician associate or the medical examiner 90 days from the date of death to determine current status of the investigation and shall initiate monthly contact thereafter until the final determination of death has been made.
XIII. When an autopsy finding differs from the original cause of death reported on the death record, the attending physician, APRN, or physician associate who was responsible for the original death record shall send the division a supplemental death certificate information form to reflect the revised cause of death. The supplemental report shall be made part of the existing death record, and the division shall amend the death record with the cause of death as reported on the autopsy.
XIV. If there is any question on the part of the physician, APRN, or physician associate as to whether he or she qualifies as the attending physician, APRN, or physician associate under RSA 290:1, a determination shall be made by the medical examiner.
XV. If it is not possible to determine who is the attending physician, APRN, or physician associate for purposes of preparing the death certificate, the matter shall be brought to the attention of the state registrar who shall make a request to the state medical examiner, or designee, to determine who the attending physician, APRN, or physician associate is upon review of the facts submitted.