OAR 333-009-0010: Reporting

(1) To comply with ORS 127.865(2), within seven calendar days of writing a prescription for medication to end the life of a qualified patient the attending physician shall send the following completed, signed and dated documentation by regular mail to the State Registrar, Center for Health Statistics, 800 NE Oregon Street, Suite 205, Portland OR 97232, by facsimile to (971) 673-5332, or by secure electronic mail: (a) The patient's completed written request for medication to end life, either using the “Written Request for Medication to End My Life in a Humane and Dignified Manner” form prescribed by the Oregon Health Authority (Authority) or in substantially the form described in ORS 127.897; (b) One of the following reports prescribed by the Authority: (A) “Attending Physician’s Compliance Form”; or (B) “Attending Physician’s Compliance Short Form” accompanied by a copy of the relevant portions of the patient's medical record documenting all actions required by the Act; (c) “Consulting Physician's Compliance Form” prescribed by the Authority; and (d) “Psychiatric/Psychological Consultant’s Compliance Form” prescribed by the Authority, if an evaluation was performed. (2) Within 10 calendar days of a patient’s ingestion of lethal medication obtained pursuant to the Act, or death from any other cause, whichever comes first, the attending physician shall complete the “Oregon Death with Dignity Act Attending Physician Interview” form prescribed by the Authority. (3) To comply with ORS 127.865(1)(b), within 10 calendar days of dispensing medication pursuant to the Death with Dignity Act, the dispensing health care provider shall file a copy of the “Pharmacy Dispensing Record Form” prescribed by the Authority with the State Registrar via regular mail to the Center for Health Statistics, 800 NE Oregon St., Suite 205, Portland, OR 97232, via facsimile to (971) 673-5332 or by secure electronic mail. Information to be reported to the Authority shall include: (a) Patient's name and date of birth; (b) Prescribing physician's name and phone number; (c) Dispensing health care provider's name, address and phone number; (d) Medication dispensed and quantity; (e) Date the prescription was written; and (f) Date the medication was dispensed. Note: Forms referenced are available from the agency at https://www.oregon.gov/oha/PH/PROVIDERPARTNERRESOURCES/EVALUATIONRESEARCH/DEATHWITHDIGNITYACT/Pages/pasforms.aspx