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NB Health Link Substitute Decision Maker Declaration (v.2, 2019)Where no other person has been legally designated in writing, pursuant to s.25(1) (d) (m) of the Personal Health Information Privacy
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How to fill out substitute decision maker request

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How to fill out substitute decision maker request

01
Obtain the Substitute Decision Maker request form from the relevant healthcare facility or online.
02
Fill out the form with your personal information, including your name, contact information, and relationship to the patient.
03
Provide information about the patient, including their name, date of birth, and reason for needing a substitute decision maker.
04
Indicate who you would like to appoint as the substitute decision maker, including their name, contact information, and relationship to the patient.
05
Sign and date the form, and ensure that the appointed substitute decision maker also signs and dates the form.
06
Submit the completed form to the healthcare facility or relevant authority for processing.

Who needs substitute decision maker request?

01
Anyone who is unable to make decisions for themselves due to illness, injury, or incapacity may need a substitute decision maker.
02
This could include elderly individuals with dementia, patients in a coma, or individuals with severe mental or physical disabilities.
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A substitute decision maker request is a formal document submitted to designate an individual who will make decisions on behalf of someone who is unable to make decisions for themselves.
The person who is unable to make decisions for themselves is required to file a substitute decision maker request.
The substitute decision maker request must be filled out by providing the necessary information about the designated decision maker and the reasons for the request.
The purpose of a substitute decision maker request is to ensure that decisions can be made on behalf of someone who is unable to make decisions for themselves in a legal and appropriate manner.
The substitute decision maker request must include information about the designated decision maker, their relationship to the person needing a decision maker, and the reasons for the request.
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