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In some states such as Washington, physicians, advanced registered nurse practitioners and physician assistants can sign a death certificate. They can only do this however, if they were the deceased's primary caregiver.
Medical examiners are responsible for signing the death certificates of any decedents in their jurisdiction. They will sign all death certificates in those instances when there is no primary caregiver. In some situations a medical examiner will also be responsible for investigating the cause of death as well.
Health officers can sign the death certificate if there is no primary care giver and the
decedent died of natural causes. If an investigation into the death is required, the responsibility of the death certificate is no longer the health officer's. It is then the responsibility of the coroner, or medical examiner.
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