Oregon's Death with Dignity Act requires a consulting physician to confirm the attending physician's findings. This one-page form records the consultant's report: that the patient has a terminal disease, has six months or less to live, is capable, is acting voluntarily and has decided after being fully informed. It also records the consultant's view on the patient's mental status and any referral.
The consulting physician completes Sections A to E, checking each determination and signing with name, address and date. The attending physician makes the same determinations on their own compliance form.
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Consulting Physician's Compliance Form
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No. The form instructs the consultant to deliver it to the attending or prescribing physician. The attending physician then sends it to the OHA Center for Health Statistics with their own compliance form and the patient's written request, within 7 calendar days of writing the prescription.
Section D requires a choice. If the consultant cannot state that the patient has no psychiatric or psychological disorder, or depression, causing impaired judgment, they record a referral for evaluation, naming the psychiatric consultant and date. That consultant then completes the Psychiatric/Psychological Consultant's Compliance Form.