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New York MAID Reporting Form (Health Commerce System)

New York's Medical Aid in Dying Act, Public Health Law Article 28-F, took effect August 5, 2026 and requires the attending physician who prescribes aid-in-dying medication to report it to the Department of Health within five days. The online MAID Reporting Form on the Health Commerce System captures the patient, the attending and consulting physicians, the mental health professional and the medication prescribed.

Who completes it

The attending physician completes the report online; the attending physician section is pre-filled from the physician's NYS license certificate. The patient's own written request is made separately on form DOH-5847.

Submitting and payment

How to submit it
Log in to the MAID smart form with an HCS account and multi-factor authentication, add the patient, answer the questions, check both attestation boxes and submit within five days of issuing the prescription. Drafts can be saved, and a PDF copy can be printed for records.

Good to know

  • Patient fields include name, date of birth, gender, county of residence and care setting: private residence, adult care facility, hospice facility, nursing home or hospital.
  • For the consulting physician and the mental health professional who determines decision-making capacity, give the name, license title and license number as shown on the NYS license certificate.
  • Medication details are the prescription date, drug name, dosage form and strength or amount in correct units. A later prescription for the same patient is added to that patient's record.
  • Physicians without an HCS account must first set up a paperless medical professional account. The statute requires the patient's oral request to be recorded on video or audio.

Get the official form

Download the current version from the source each time; forms change without notice.

MAID Reporting Form

Official page

Get the note ready with Vero

New York State Department of Health takes this form through its online services or your EMR, so there is no PDF to fill. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

How long do New York physicians have to file the MAID report?

Five days from issuing the aid-in-dying prescription. The report is filed online through the MAID smart form on the Health Commerce System, which requires an HCS account with multi-factor authentication, and the physician can print a PDF copy of the report at any point.

Is there a paper MAID reporting form in New York?

No. Reporting is online only through the Health Commerce System. The Department of Health's reporting guidance walks through logging in, adding a patient and completing the form. The patient's written request uses the separate form DOH-5847, available in English, Spanish and 25 other languages.

What if a New York patient receives a second MAID prescription?

Open the patient's existing record with the Select button, click Add Another in the Medications section and choose the prescription sequence, such as 2nd Prescription, then submit or save a draft. Each prescription is reported within five days of being issued.