Follow the steps to accurately fill out the Canada HLTH 1634 form.

1. Press the ‘Get Form’ button to obtain the HLTH 1634 form and access it within the online editing platform.
2. Provide patient information in the designated fields, including the last name, first name, personal health number, second name(s), birthdate, and gender. Make sure to include any relevant additional identifiers.
3. Input the medical diagnosis that is pertinent to the request for medical assistance in dying in the corresponding section.
4. Fill in the details of the practitioner conducting the assessment. This includes their last name, first name, mailing address, contact numbers, and professional registration numbers.
5. If a professional interpreter was used, input their initials, last name, first name, ID number, and the date of service.
6. Confirm eligibility and informed consent by initialing each box that reflects the assessments made. Ensure all findings are documented in the health record.
7. Indicate the assessment date and location where the evaluation was conducted, selecting from the options for home or facility settings as applicable.
8. Complete sections on patient diagnosis and prognosis by selecting the appropriate options that reflect the patient's condition and expected timeline.
9. Initial and sign the acknowledgments regarding the patient's identity and consent. Ensure all statements are accurately confirmed to maintain compliance.
10. Proceed to the conclusion regarding eligibility section where you will determine whether the patient meets the required criteria for medical assistance in dying.
11. Sign and date the form at the designated practitioner signature section to finalize the assessment.
12. At the end of the process, you can choose to save changes, download the completed form, print it out for records, or share it as necessary.

Complete the Canada HLTH 1634 form online to ensure proper documentation for medical assistance in dying.