CHA News Article

CDPH Provides Guidance for Submitting End of Life Option Act Forms

 California’s new End of Life Option Act — which allows terminally ill patients to obtain a prescription from their attending physician for medication to end their life — requires physicians who write such prescriptions to submit specified documentation to the California Department of Public Health (CDPH).  While the Act itself does not specify how the documentation should be submitted, CDPH recently announced those details.

According to CDPH, the Attending Physician Checklist & Compliance form, Consulting Physician Compliance form and the Attending Physician Follow-up form required by the Act must be submitted either by mail or by fax. If mailed, the completed forms should be sent in envelopes marked “confidential” to the CDPH Public Health Policy and Research Branch at:

Attention: End of Life Option Act
MS 5205
P.O. Box 997377
Sacramento, CA  95899-7377

Alternatively, providers may fax the completed forms to a secure fax line at (916) 440-5209. To protect confidentiality, CDPH has not established an email address for form submission.

The End of Life Option Act becomes effective June 9. The new law allows individuals who have a terminal disease and who meet certain requirements to ask their physician for, and be provided with, prescription medication to end their life. While hospitals and other providers are not required to participate in the activities authorized by the Act, all hospitals should develop and implement policies and procedures to respond appropriately.

Commands