DOH Form 422-192 Facility Affidavit for Death Correction - Washington

What Is DOH Form 422-192?

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 422-192?
A: DOH Form 422-192 is the Facility Affidavit for Death Correction specific to the state of Washington.

Q: What is the purpose of DOH Form 422-192?
A: The purpose of DOH Form 422-192 is to correct any errors or make amendments to death certificates generated by a facility.

Q: Who is required to fill out DOH Form 422-192?
A: Facilities, such as hospitals, nursing homes, or funeral homes, that reported the original incorrect information on a death certificate are required to fill out DOH Form 422-192.

Q: What information is needed to complete DOH Form 422-192?
A: The facility will need to provide the correct information, such as the deceased person's full name, date of birth, date of death, and any other relevant details, along with an explanation of the correction needed.

Q: Are there any fees associated with submitting DOH Form 422-192?
A: No, there are no fees associated with submitting DOH Form 422-192.

Q: What is the deadline for submitting DOH Form 422-192?
A: There is no specific deadline for submitting DOH Form 422-192, but corrections should be made as soon as the error is discovered.

Q: Can DOH Form 422-192 be submitted electronically?
A: No, DOH Form 422-192 cannot be submitted electronically. It must be submitted by mail or in-person.

Q: What happens after submitting DOH Form 422-192?
A: After submitting DOH Form 422-192, the Washington State Department of Health will review the request and make the necessary corrections to the death certificate.