• Patient Request Form (pdf) (7K) - Revised 04/2006
  
  
• Attending Physician Form (pdf) (66K) - Revised 11/2006
  
  

  or Attending Physician Short Form (pdf)
  Please Note: All information required in the standard two-page Attending Physician Form must be included in accompanying copies of the patient's chart notes. (See Attending Physician Form.) Most physicians use the two-page form to avoid call-backs for missing data items. (50K) - Revised 11/2006
  
  

• Consulting Physician Form (pdf) (66K) - Revised 11/2006
  
  
• Psychiatrist/Psychologist Form (pdf) (17K) - Revised 11/2006
  
  
• Pharmacy Dispensing Record Form (pdf) (18K) - Revised 11/2006

• Reporting Physician Interview Form (pdf) (19K)
  Data collected from follow-up interviews with physicians. This document may be completed by the attending physician in lieu of a follow-up interview. - Revised 11/2006
• Chronology and Death Certificate Extract Form (pdf) (8K)
  Completed by DHS Staff. Data collected from death certificates and physician reporting forms. - Revised 10/2006

The envelope used to return all forms should be marked as CONFIDENTIAL and mailed to:
Oregon Health Services
Center for Health Statistics
PO Box 14050
Portland OR 97293-0050
Attn: Jennifer Woodward, State Registrar

Contact Information

Copies of the rules and reporting forms are available from:
Oregon Health Services
Center for Health Statistics
PO Box 14050
Portland OR 97293-0050
Attn: Linda Reynolds
Phone (971) 673-1173