DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT REPORTING AND COLLECTING MEDICAL AID-IN-DYING MEDICATION INFORMATION 6 CCR 1009-4 [Editor’s Notes follow the text of the rules at the end of this CCR Document.] _________________________________________________________________________ Adopted by the Board of Health on April 19, 2017. Effective June 14, 2017.

I. Definitions A. “Attending physician,” as used herein, shall be the attending physician defined in Section 25-48- 102 (2), C.R.S., who prescribes medical aid-in-dying medication pursuant to Article 48, Title 25, C.R.S.

B. “Health Care Provider,” as used herein, shall be the person defined in Section 25-48-102(4), C.R.S., who fulfills the attending physician’s written prescription for medical aid-in-dying medication, dispenses the medical aid-in-dying medication directly to the patient, the attending physician or an individual expressly designated by the patient.

II. Requirements for Reporting Medical Record Information to the Department A. Within 30 calendar days of writing a prescription for medical aid-in-dying medication to end the life of a qualified patient, the attending physician or the attending physician’s designee, shall submit, in the form prescribed by the Department, the following:

1. 1. Patient's name and date of birth;
2. 2. Dates of all oral requests made by the patient;
3. 3. The prescribing attending physician's name, mailing address and phone number;
4. 4. The patient's completed written request for medical aid-in-dying medication to end life that complies with Section 25-48-112, C.R.S.;
5. 5. The attending physician’s:
   1. a. Diagnosis of a terminal disease;
   2. b. Prognosis of six months or less;
   3. c. Mental capacity determination that documents that the individual is making a voluntary and informed request;
   4. d. Notation(s) of notification provided to the patient of the right to rescind a request made for medical aid-in-dying medication;
   5. e. Notation of the medical aid-in-dying medications prescribed, dose and date prescribed to the patient;
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   6. f. If applicable:
      1. i) Notation and date when the medical aid-in-dying medication was dispensed directly by the attending physician, or ii) If the attending physician delivered a written prescription to a licensed pharmacist, the name and phone number of the pharmacist and the pharmacy, and a notation that the pharmacy was informed that medical aid-in-dying medication was prescribed pursuant to Article 48, Title 25, C.R.S., and the date of the notification, and;
   7. g. Notation that all requirements under Article 48, Title 25, C.R.S. have been satisfied and indicating the steps taken to carry out the patient’s request.
6. 6. The consulting physician’s name, mailing address and phone number and a copy of the consulting physician’s written confirmation of the attending physician’s diagnosis, prognosis, and mental capacity determination.
7. 7. If obtained by the physician, a written confirmation of mental capacity from a licensed mental health provider.

B. All information submitted pursuant to this Section II will be submitted by mail or secure e-mail as directed by the Department.

III. Requirements for Reporting Dispensing Record Information to the Department A. Pursuant to Section 25-48-111(2)(b), C.R.S., within 10 calendar days of dispensing medication pursuant to the Act, the health care provider dispensing a medical aid-in-dying medication shall submit to the Department a completed, signed and dated copy of the dispensing record. The health care provider shall submit, in the form prescribed by the Department, the following:

1. 1. Patient's name and date of birth;
2. 2. Prescribing physician's name and phone number;
3. 3. Dispensing health care provider's name, address and phone number;
4. 4. Medication dispensed and quantity;
5. 5. Date the prescription was written, and;
6. 6. Date the medication was dispensed.

B. All information submitted pursuant to this Section III will be submitted by mail or secure e-mail as directed by the Department.

IV. Confidentiality Except as otherwise required by law, all information collected pursuant to Section 25-48-111(2), C.R.S. and this rule, is confidential.

_________________________________________________________________________ 2 CODE OF COLORADO REGULATIONS 6 CCR 1009-4 Editor’s Notes History Entire rule emer. rule eff. 01/18/2017; expired 05/18/2017. Entire rule eff. 06/14/2017.

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