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Regulations for the Monitoring of Medical Assistance in Dying

Version of the schedule from 2018-11-01 to 2022-12-31:


SCHEDULE 1(Subsection 4(1), paragraph 5(1)(a), subsections 6(1) and 7(1) and (2), section 8, paragraph 9(a) and subsection 16(1))Basic Information — Request for Medical Assistance in Dying

  • 1 The following information in respect of the patient:

    • (a) date of birth;

    • (b) sex;

    • (c) health insurance number and the province or territory that issued it or, in the case where they do not have a health insurance number, the province or territory of their usual place of residence on the day on which the practitioner received the request;

    • (d) the postal code associated with the patient’s health insurance number or, in the case where they do not have a health insurance number, the postal code of their usual place of residence on the day on which the practitioner received the request.

  • 2 The following information in respect of the practitioner:

    • (a) name;

    • (b) an indication of whether they are a medical practitioner or nurse practitioner;

    • (c) if they are a family physician, an indication to that effect;

    • (d) if they are a medical practitioner other than a family physician, their area of specialty;

    • (e) the province or territory in which they practise and, if they practise in more than one province or territory, the province or territory in which they received the request;

    • (f) the licence or registration number assigned to them in the province or territory in which they received the request;

    • (g) the mailing address and email address that the practitioner uses for work;

    • (h) to the best of their knowledge or belief, an indication of whether, before they received the request, the patient consulted them concerning the patient’s health for a reason other than seeking medical assistance in dying.

  • 3 The following information in respect of the request:

    • (a) the date on which the practitioner received the request;

    • (b) an indication of whether the practitioner received the request from the patient directly, another practitioner, a care coordination service or another third party.


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