DOH Form 422-063 Request for Medication to End My Life in a Humane and Dignified Manner - Washington

DOH Form 422-063 Request for Medication to End My Life in a Humane and Dignified Manner - Washington

What Is DOH Form 422-063?

This is a legal form that was released by the Washington State Department of Health - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is DOH Form 422-063?
A: DOH Form 422-063 is a form used in Washington to request medication to end one's life in a humane and dignified manner.

Q: Who can use DOH Form 422-063?
A: Only terminally ill adults with less than six months to live can use DOH Form 422-063.

Q: How do I request medication to end my life using DOH Form 422-063?
A: To request medication, you need to fill out DOH Form 422-063, have it witnessed by two people, and submit it to the Washington State Department of Health.

Q: What are the requirements for requesting medication using DOH Form 422-063?
A: The requirements include being a mentally competent adult, having a terminal illness with a life expectancy of less than six months, and meeting other specific criteria outlined on the form.

Q: Is use of DOH Form 422-063 legal in all states?
A: No, DOH Form 422-063 is specific to Washington state. Each state has its own laws regarding end-of-life options.

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Form Details:

  • Released on June 1, 2016;
  • The latest edition provided by the Washington State Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of DOH Form 422-063 by clicking the link below or browse more documents and templates provided by the Washington State Department of Health.

Download DOH Form 422-063 Request for Medication to End My Life in a Humane and Dignified Manner - Washington

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