Published on Jun 10, 2026
Complaints have been received concerning delays or refusals by practitioners to sign death certificates. Providers are reminded that completing the death certificate is a required professional responsibility and constitutes the final act of care for the patient. Timely and accurate completion of the death certificate is essential to support the family’s emotional closure and to provide the legal documentation necessary for settling the decedent’s personal and administrative affairs.
Code of Virginia Section 32.1-263 is the Virginia Department of Health law governing the completion of death certificates. Subsection C outlines the responsibilities of physicians and autonomous advanced practice RN’s.
“…The medical certification shall be completed and filed electronically with the State Registrar of Vital Records using the Electronic Death Registration System within 24 hours after death by the physician or autonomous nurse practitioner in charge of the patient's care for the illness or condition that resulted in death except when inquiry or investigation by the Office of the Chief Medical Examiner is required by § 32.1-283 or 32.1-285.1, or by the physician or autonomous nurse practitioner who pronounces death pursuant to § 54.1-2972. If the death occurred while under the care of a hospice provider, the medical certification shall be completed by the decedent's health care provider and filed electronically with the State Registrar of Vital Records using the Electronic Death Registration System for completion of the death certificate.
In the absence of such physician or autonomous nurse practitioner or with his approval, the certificate may be completed and filed by the following: (i) another physician or autonomous nurse practitioner employed or engaged by the same professional practice; (ii) a physician assistant supervised by such physician; (iii) an advanced practice registered nurse who is not an autonomous nurse practitioner practicing in accordance with the provisions of § 54.1-2957; (iv) the chief medical officer or medical director, or his designee, of the institution, hospice, or nursing home in which death occurred; (v) a physician or autonomous nurse practitioner specializing in the delivery of health care to hospitalized or emergency department patients who is employed by or engaged by the facility where the death occurred; (vi) the physician who performed an autopsy upon the decedent; (vii) an individual to whom the physician or autonomous nurse practitioner has delegated authority to complete and file the certificate, if such individual has access to the medical history of the case and death is due to natural causes; or (viii) a physician who is not licensed by the Board of Medicine who was in charge of the patient's care for the illness or condition that resulted in death. A physician described in clause (viii) who completes a certificate in accordance with this subsection shall not be required to register with the Electronic Death Registration System or complete the certificate electronically. As used in this subsection, "autonomous nurse practitioner" has the same meaning as provided in § 54.1-2972.”
Section 32.1-263(D) of the Code of Virginia states:
“…If the Office of the Chief Medical Examiner refuses jurisdiction, the physician last furnishing medical care to the deceased shall prepare and file the medical certification portion of the death certificate.” Section 32.1-263(E) states that the physician or autonomous advanced practice registered nurse shall “use his best medical judgment to certify a reasonable cause of death or contact the health district physician director in the district where the death occurred to obtain guidance in reaching a determination as to a cause of death and document the same.”
If you are not currently registered with the Electronic Death Registration System (EDRS), you may register here. Training for the EDRS is available as an online web tutorial.
Virginia Board of Nursing