Department of Health

Center for Health Statistics

Policy Statement

Title:

Amending Death or Fetal Death Records

Number:

CHS-D9-2023

References:

RCW 70.58A.040, 70.58A.500

Contact:

Katie Hutchinson, State Registrar and Director

Phone:

360-236-4307

Email:

[email protected]

Effective Date:

January 1, 2023

Supercedes:

September 1, 2011

Approved By:

Katie Hutchinson

Under specific circumstances a death or fetal death record may need to be amended after being registered by

the State Registrar. The State Registrar may amend a death or fetal death record after receiving a complete

Affidavit for Correction form (DOH 422-034) or Facility Affidavit for Correction form (DOH 422-192).

A death or fetal death record filed and registered with the Department of Health (department), may be

amended only by authorized staff, delegated by the State Registrar. Authorized staff may only make changes

to a death or fetal death record upon receipt of properly completed and signed Affidavit for Correction

form or Facility Affidavit for Correction form and the completion of any other steps or forms required by

this policy, department rules, or Chapter 70.58A RCW. The department will permanently retain the

Affidavit for Correction form or the Facility Affidavit for Correction form as documentation of the change

on the record.

A death or fetal death record may be amended with a complete amendment application. If the amendment

application is not complete and filed in accordance with this policy, department rules, or Chapter 70.58A

RCW, the State Registrar will deny the amendment application.

Section 1: Amendment applications submitted by the public

Complete amendment application

For each amendment application, the requestor must submit the following:

• A completed and signed Affidavit for Correction form

• Copy of their government issued identification card

• Any required proof documentation

Complete Affidavit for Correction form

A complete Affidavit for Correction form must include:

• The record type to be amended

• Information to identify the record

o First, middle, last name listed on the record

o Date of event

Policy Statement: CHS-D9-2023 Page 2 of 7

o Place of event

o Parent(s) first, middle, last name listed on the record

• Information about the person making the request

o Name

o Relationship to subject of the record

o Mailing address

o Telephone number or email address

• Incorrect information as it appears

• The correct information as it should appear

• Signature of the person making the request

An Affidavit for Correction form cannot be used to amend items in the confidential section of the fetal

death record or make stylistic changes to the certification (See Policy CHS B-10).

Original signatures on a death or fetal death record will not be amended.

Death or fetal death records registered through a court order can only be amended or corrected with a court

order. An Affidavit for Correction form cannot be used.

Acceptable Proof Documents

Acceptable proof documents include:

• Hospital/medical record

• Full Numident Report (Social Security)

• Social Security Abstract

• Birth, marriage, or divorce record

• Copy of passport or enhanced identity document

• Certificate of Naturalization

• Permanent resident card (I-551)

• Health or life insurance policy

• Military record (DD-214)

• Official school transcripts (do not have to be in a sealed envelope to be valid)

• Government agency records for establishment of benefits (such as social services or Medicaid)

Driver’s License, Social Security Card, family bible, or hospital decorative birth certificate are not allowable

proof documents.

Proof documents must:

• Show the true facts that are being requested to be changed

• Include full name and date of birth

• Match exactly the correction requested on the Affidavit for Correction. Example, if you are

requesting a correction from “Mary Doe” to “Mary Ann Doe”, the proof must show the name

to be Mary Ann Doe. Proof cannot show “Mary A. Doe” or “M. Ann Doe”.

• Be from independent sources, when more than one proof document is required

• Have been established over five years ago (it could have been printed more recently) OR have

been established within five years of birth, if correcting the child's information and child is under

five.

Policy Statement: CHS-D9-2023 Page 3 of 7

Only documents listed below are exempt from the five-year rule and will be accepted from any period of

time:

• Passport

• Permanent resident card (I-551)

The State Registrar may request additional proof documents be provided by the requestor if there is cause to

question the validity or adequacy of the documents submitted.

The State Registrar will not accept any documentation that is clearly altered (e.g. scratched out information,

information in different fonts, or white out).

What can be amended on a death or fetal death record

Only the entities listed below can request an amendment to the demographic section of a death or fetal

death record.

Eligible Entity

Requirements

Informant listed on the record

The person who provided the information

for the report of death.

• Affidavit for Correction form and at least one (1) proof

document for any changes beyond administrative data

entry errors.

• The informant listed on the record can sign an Affidavit

for Correction form identifying a new informant

without proof documentation.

Qualified applicant (other than informant)

For death records this means decedent's

spouse or registered domestic partner,

parent, sibling or adult child or stepchild,

or next of kin as specified in RCW

11.28.120.

For fetal death records this means parent,

sibling, or grandparent.

• Affidavit for Correction form and at least one (1) proof

document.

• Must provide documentation to prove relationship

status.

Legal representative

A licensed attorney representing either the

subject of the record or qualified applicant.

• Affidavit for Correction form and at least one (1) proof

document.

• Must submit certified copy of court records, legal

documentation, or letter of representation that

authorizes them to act as the legal representative.

• The State Registrar will only consider requests to change the marital status on the death record

under the following circumstances:

o The informant listed on the record requests to change marital status with an Affidavit for

Correction form and at least one (1) proof document;

Policy Statement: CHS-D9-2023 Page 4 of 7

o The alleged surviving spouse/partner provides a notarized affidavit signed by the informant

and the alleged surviving spouse/partner stating that an error was made and stating the

correct information, and a certification of the marriage/partnership or divorce record

showing that the person to be listed as the surviving spouse/partner was married

to/partnered or divorced with the decedent prior to death; or

o The alleged surviving spouse/partner or their legal representative provides a certified court

order from a probate court if a probate court made a determination on the martial status as

part of the decedent’s estate.

• The cause of death section of a death or fetal death record cannot be amended using the Affidavit

for Correction form submitted by the public.

Section 2: Amendment applications submitted by a funeral home, Medical Examiner, Coroner,

medical certifier, or Local Health Officer

Complete amendment application

For each amendment application, the requestor must submit the following:

• A completed and signed Facility Affidavit for Correction form

• Any required proof documentation

Complete Facility Affidavit for Correction form

A complete Facility Affidavit for Correction form must include:

• Information to identify the record

o First, middle, last name listed on the record

o Date of event

o Place of event

o Parent(s) first, middle, last name listed on the record

• Incorrect information as it appears

• The correct information as it should appear

• Information about the person making the request

o Name

o Title

o Mailing address

o Telephone number

• Signature of the person making the request

All requested corrections or changes to the record must be identified on the Facility Affidavit for Correction

form and listed on separate lines.

A Facility Affidavit for Correction form cannot be used to amend items in the confidential section of the

fetal death record or make stylistic changes to the certification (See Policy CHS B-10).

Any signature on a death or fetal death record will not be amended.

Death or fetal death records registered through a court order can only be amended or corrected with a court

order. A Facility Affidavit for Correction form cannot be used.

Policy Statement: CHS-D9-2023 Page 5 of 7

What can be amended on a death or fetal death record

Only the entities listed below can request an amendment to the demographic section of a death or fetal

death record:

Eligible Entity

Requirements

Funeral director or funeral establishment

staff listed on the record within twelve (12)

months from the date of event

• Facility Affidavit for Correction form for administrative

errors only. Excludes date and time of death.

• The funeral director or funeral establishment staff must

submit the intake form as a required proof document.

Medical certifier, medical examiner,

coroner, or local health officer listed on

the record

• Medical certifier, medical examiner, coroner, or local

health officer changes are only permitted when no

funeral home is listed on the record.

• Facility Affidavit for Correction form.

• No proof documentation is required.

• Once the record is filed with the state or local registrar, date of death and time of death can only be

changed by the medical certifier, medical examiner, coroner, or local health officer who has

jurisdiction.

Only the entities listed below can request an amendment to the cause of death section of a death or fetal

death record:

Eligible Entity

Requirements

The original certifier* who signed or electronically

approved the cause of death section

*certifier includes medical certifier, medical

examiner, coroner, or local health officer

• Facility Affidavit for Correction form.

• No proof documentation is required.

Another medical examiner or coroner within the

same office as the original listed on the record

• Facility Affidavit for Correction form.

• No proof documentation is required.

Another certifier* when the original certifier is no

longer available or not available for a month or

*certifier includes medical certifier, medical

examiner, coroner, or local health officer

• The administrator of the location or facility

indicates on the Facility Affidavit for

Correction form that the original certifier is not

available (ex. death or retirement) and that

another certifier will be submitting the Facility

Affidavit for Correction form.

• No proof documentation is required.

• This will not change the original certifier name

listed on the record unless such a change is

specified on the Facility Affidavit for

Correction form by the new certifier.

Policy Statement: CHS-D9-2023 Page 6 of 7

Medical examiner or coroner taking over

jurisdiction

• Must use the Facility Affidavit for Correction

form and clearly indicate that they are taking

jurisdiction

• Must include the current medical certifier listed

on the record and provide their own

information

• A medical certifier, coroner, medical examiner, or local health officer must submit a Facility

Affidavit for Correction form within five calendar days of receipt of an autopsy result or other

information that completes or amends the cause of death from that originally filed with the

department. RCW 70.58A.200(12).

For the purposes of this policy the following terms are defined as follows:

1) Affidavit for Correction form. The standard form (DOH 422-034) used by the public prescribed

and approved by the CHS that identifies the record, the specific information to be changed, the new

or amended information, and the identity and signature of the requestor.

2) Coroner. The person elected or appointed in a county under chapter 36.16 RCW to serve as the

county coroner and fulfill the responsibilities established under chapter 36.24 RCW. RCW

70.58A.010(6).

3) Facility Affidavit for Correction form. The facility form (DOH 422-192) prescribed by the State

Registrar that can be used by funeral home, medical examiner, coroner, medical certifier, and local

health officer. It identifies the record, the specific information to be changed, the new or amended

information, and the identity and signature of the requestor.

4) Funeral director. A person licensed under chapter 18.39 RCW as a funeral director. RCW

70.58A.010(14).

5) Funeral establishment. A place of business licensed under chapter 18.39 RCW as a funeral

establishment. RCW 70.58A.010(15).

6) Local health officer has the same meaning as in chapter 70.05 RCW. RCW 70.58A.010(24).

7) Medical certifier for a death or fetal death means an individual required to attest to the cause of

death information provided on a report of death or fetal death. Each individual certifying cause of

death or fetal death may certify cause of death only as permitted by that individual's professional

scope of practice. These individuals include:

(a) A physician, physician's assistant, or an advanced registered nurse practitioner last in attendance

at death or who treated the decedent through examination, medical advice, or medications within

the twelve months preceding the death;

(b) A midwife, only in cases of fetal death; and

months and the person died a natural death. RCW 70.58A.010(25).

8) Medical examiner. The person appointed under chapter 36.24 RCW to fulfill the responsibilities

established under chapter 36.24 RCW. RCW 70.58A.010(26).

Policy Statement: CHS-D9-2023 Page 7 of 7

9) Midwife. A person licensed to practice midwifery pursuant to chapter 18.50 RCW. RCW

70.58A.010(27).

10) Physician. A person licensed to practice medicine, naturopathy, or osteopathy pursuant to

Title 18 RCW. RCW 70.58A.010(28).