Regulations for the Monitoring of Medical Assistance in Dying

1 The following information in respect of the person who made the request for medical assistance in dying:

• (a) date of birth;

• (b) sex at birth and gender identity;

• (c) race or Indigenous identity, and any disability of the person, if they consented to providing that information;

• (d) usual place of residence and living arrangement on the day on which the preliminary assessor or the practitioner received the request;

• (e) 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 preliminary assessor or the practitioner received the request; and

• (f) the postal code associated with the person’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 preliminary assessor or 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 telephone number, mailing address and email address that they use for work; and

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

2.1 The following information in respect of the preliminary assessor:

• (a) name;

• (b) profession or occupation;

• (c) the province or territory in which they work; and

• (d) the telephone number, mailing address and email address that they use for work.

3 The following information in respect of the request:

• (a) the date on which the person made the request; and

• (b) an indication of whether the preliminary assessor or the practitioner received the request from the person who made it directly or from a preliminary assessor, a practitioner, a care coordination service or another third party.

4 If known, an indication by the preliminary assessor or practitioner of whether the person had previously made a request for medical assistance in dying, and if so, the outcome of that request.