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Adobe PDF Adobe PDF document  Clinician Aid C - (Secondary) "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 & Save1349.0 kb
Form Classification
Classification / Identification:
 Form Number:014-3891-22EEdition date: 2021/07 
 Title:Clinician Aid C - (Secondary) "Medical Practitioner" or "Nurse Practitioner" Medical Assistance in Dying Aid
 Ministry:Health  
 Branch/ABC:Strategic Policy Branch  
 Program:Strategic Policy – Medical Assistance in Dying  
 Purpose of Form:Complete this voluntary aid (Clinician Aid C) if you have been asked by a “Medical Practitioner” or “Nurse Practitioner” to provide a written opinion confirming that the Patient meets the eligibility criteria to receive medical assistance in dying. You should also include the completed aid in the patient's medical records.  

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