|Classification / Identification:|
| ||Form Number:||014-3890-22E||Edition date: ||2018/10 |
| ||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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