Regulations for the Monitoring of Medical Assistance in Dying
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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