End of Life Option Act (EOLA)
Frequently Asked Questions
Q: Do I need an account to submit an EOLA Form?A: Yes, a user account with CDPH is needed to submit and access your report. Please create an account on the sign up page.
Q: If I already have an account from the old website, do I need to create a new account?
A: Yes. For existing accounts, an invitation email for the new portal has been sent to the email address on file. If you did not receive an invitation, please find the instructions to create a user profile in the user guide.
Q: Which Physician and Patient forms are required for EOLA program?
A: This is the list of Physician forms
- Attending Physician Checklist & Compliance Form
- Consulting Physician Compliance Form
- Attending Physician Follow Up Form
This is the list of Patient forms
- Patient’s Request for Aid-in-Dying Drug
- Interpreter’s Declaration (optional)
Q: Which forms can be filled out electronically and which need to be uploaded?
A: You can access the new EOLA forms portal in the EOLA Homepage
- Attending Physician Checklist & Compliance Form
- Consulting Physician Compliance Form
- Attending Physician Follow Up Form
These forms need to be filled out on paper and scanned/uploaded to the Attending Physician Checklist & Compliance Form
- Patient’s Request for Aid-in-Dying Drug
- Interpreter’s Declaration (optional)
Q: Can I save my online form and return to finish it later?
A: Yes, the portal generates a unique web address for your online form, which you must save. You have 12 hours to complete the form through this unique web address. After 12 hours, the unique web address and form will expire, and you will need to start over.
Q: Can I fill out the forms on paper and mail them to CDPH? Where are the PDF forms located?
A: Yes, the scanned and signed forms can be
- Emailed to: EOLInfo@cdph.ca.gov
- Faxed to: (916) 636-6045
- Mailed to:
Research and Analytics Branch
Attention: End of Life Option Act
MS 5205 P.O. Box 997377
Sacramento, CA 95899-7377
Form PDFs can be found below:
- Attending Physician's Checklist & Compliance Form (PDF)
- Consulting Physician's Compliance Form (PDF)
- Attending Physician's Follow-up Form (PDF)
- Patient’s Request for Aid-in-Dying Drug (PDF)
- Interpreter’s Declaration (PDF)
Q: Where can I go for more support?
A: If you have questions about completing the report, please contact the California Department of Public Health’s Research and Analytics Branch - EOLInfo@cdph.ca.gov. If you’re experiencing issues with the website or with your account, please contact us