State Forms

Patient’s Written Request Form

Attending Physician Reporting Form

Consulting Physician Confirmation and Verification Form

Counseling Provider Statement of Determination Form

Patient’s Final Attestation Form

Attending Physician’s Follow-Up Form

Hawai‘i Department of Health

For Pharmacists

Your relationship with patients can help ensure they receive care they truly want.

Pharmacist2Pharmacist helps pharmacy professionals provide accurate information and up-to-date care to patients with prescriptions for aid-in-dying medications. It can be difficult to discuss a patient’s terminal illness and death — and crucial for pharmacists to knowledgeably consult directly with patients and caregivers about medications intended to bring about a peaceful death.

 

 

The knowledge you give to patients and caregivers will help patients understand the aid-in-dying medication protocols. A resource tailored to pharmacists, Pharmacist2Pharmacist, offers you important documents and a readily available, free and confidential telephone consultation with a pharmacist in Oregon or Washington experienced with medical aid in dying.

 

 

Pharmacist2Pharmacist is ready with information and guidance to answer questions about medical aid in dying.

 

 

Contact us.