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  1. My SP of record (I work in a group practice with 9 MDs and 3 other PAs) is gone this week, and today I was designated to handle his incoming requests--FAX, emails, the works. No biggie, do it all the time, and we all cover for each other, PAs for MDs and vice versa. But today, I got two requests: 1) Hospice initiation orders for Ms. X., a very elderly lady who was seen two days ago and was discharged home to comfort care. in big bold letters, "MUST BE SIGNED BY AN MD--NO COVERING PROVIDERS" or some such language is all over the FAX cover sheet. Wasn't the first time I'd seen such language; I usually just shrug and throw that paperwork into the already-overworked doc-of-the-day's inbox. This time, though... 2) The statewide Electronic Death Reporting System notification that Ms. X (yes, that's the same Ms. X as above) had died yesterday at home and that her cause of death needed to be certified within 48 hours, before my SP returned. Now, as Washington State PAs already know, PAs can do that. I had actually gotten set up on the system well over a year ago, but never needed to use it until today. Turns out it's pretty straightforward, and there was nothing particularly confusing about what caused this patient's demise, so I just went ahead and did it. Ironic that I am authorized to legally state why a patient died (in cases where the county coroner has no interest in taking on investigative responsibility on him or herself, of course) but not to initiate hospice orders. Sad that hospice is a political football where PAs are pointlessly restricted from authorizing care.
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