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Adobe PDF   Clinician Aid B - (Primary) "Medical Practitioner" or "Nurse Practitioner" Medical Assistance in Dying AidThe file you are about to download will ONLY work properly if opened with an Adobe Reader 10 or later client. Please do not open this file in a browser.Fill, Print & Save1072.0 kb

Form Classification
Classification / Identification:
 Form Number:014-3890-22EEdition date: 2019/06 
 Title:Clinician Aid B - (Primary) “Medical Practitioner” or “Nurse Practitioner” Medical Assistance in Dying Aid
 Ministry:Health and Long-Term Care  
 Branch/ABC:Strategic Policy Branch  
 Program:Strategic Policy – Medical Assistance in Dying  
 Purpose of Form:The use of this aid is voluntary. It is being provided to assist you in maintaining records of requests for medical assistance in dying. Please use this aid if you are a “Medical Practitioner” or “Nurse Practitioner” and a patient is requesting medical assistance in dying and it is your intention to provide medical assistance in dying to the patient. You should also include the completed aid in the patient's medical records.  

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