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Medical Assistance in Dying ASSESSMENT RECORD (PRESCRIBER) Patient Label Prescriber Form 18 10 16 For cases involving a health authority (HA), fax or mail a copy of this Assessment to applicable HA
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How to fill out medical assistance in dying

How to fill out medical assistance in dying
01
Make sure you meet the eligibility criteria for medical assistance in dying.
02
Discuss your wish for medical assistance in dying with your healthcare provider.
03
Obtain written confirmation of your request from a physician or nurse practitioner.
04
Complete the necessary forms and provide all required information.
05
Submit the completed forms to the appropriate healthcare authority.
06
Wait for the healthcare authority to review your request and provide a decision.
07
If approved, make necessary arrangements for medical assistance in dying, including location and support from healthcare professionals.
08
Follow all instructions and guidelines provided by healthcare professionals during the process.
09
Have a support system in place during the process.
10
After medical assistance in dying, ensure proper documentation and reporting is done as required by law.
Who needs medical assistance in dying?
01
Individuals who have a grievous and irremediable medical condition.
02
Individuals who are in an advanced state of irreversible decline in capability.
03
Individuals who experience enduring and intolerable physical or psychological suffering.
04
Individuals who have the mental capacity to make an informed decision about medical assistance in dying.
05
Individuals who are eligible for and willing to undergo the necessary process and fulfill the legal requirements.
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What is medical assistance in dying?
Medical assistance in dying is a procedure where a qualified physician provides medications that allow a terminally ill patient to end their life peacefully.
Who is required to file medical assistance in dying?
The physician who administers the medical assistance in dying is required to file the necessary documentation.
How to fill out medical assistance in dying?
The physician must follow the guidelines and protocols set out by the government to properly fill out the documentation for medical assistance in dying.
What is the purpose of medical assistance in dying?
The purpose of medical assistance in dying is to provide terminally ill patients with a compassionate and dignified option to end their suffering.
What information must be reported on medical assistance in dying?
The documentation for medical assistance in dying must include the patient's medical history, consent to the procedure, and details of the medications administered.
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