#432 PALLIATIVE CARE CERTIFICATE: (to accompany article “When does pain treatment become palliative care treatment) here in Medium

JATH Educational Consortium, LLC**

David J. Williams

This is a form that can only be filled out by a licensed medical person, a physician or practitioner such as a Physician Assistant or Nurse Practitioner.

Since the CDC Guideline and most all states exempt palliative care from restrictions in care, this certificate should exempt you from restrictions on your treatment plan. If it does not then the person refusing to honor the certificate needs to explain why. Palliative Care is for treatment of pain, and suffering from a variety of symptoms when there is no cure for the underlying condition. If the CDC and the states exempt it- it is exempted. The certificate is a plan for incurable disease with intractable pain and discomfort. This is the basis of humane medical practice going back centuries. If we healers cannot provide comfort to our patients, we need to find other professions.

This is a general form that offices can fill out for you. Also see the companion piece here on Medium “When does pain treatment become Palliative Care Treatment” or google: Medium when does pain kline

Editable version of form (pdf) can be found here. Please note that in order to edit, the form must be downloaded to your pc and opened in the program Adobe Reader. Using web browser plugins for Adobe will not allow you to edit the form!!

Please see the below link:


Email me at thomasklinemd@gmail.com if you want a editable version of the pdf file you can store and fill out on the computer. If you cannot copy this certificate then I can also sent you a word file. The fee is two jelly donuts mailed to the creator of the form David Williams of Goldsboro, NC

Thomas Kline MD
Raleigh, North Carolina

**JATH Educational Consortium is an enterprise with a mission to provide unbiased, researched medical information for patients and doctors based in North Carolina. David J. Williams, Chief of Research. Thomas F. Kline, MD, PhD.

Written by

42 years varied primary care • former Chief, Hospital in Home Service @harvardmed • formerly: @UofMaryland, @StanfordDeptMed, @uoregon • thomasklinemd.com

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