Get Canada Hlth 1634 2021-2026

This guide provides clear and supportive instructions on how to properly fill out the Canada HLTH 1634 form, known as the Medical Assistance in Dying assessment record. With step-by-step guidance, users can navigate each section effectively.

Follow the steps to efficiently complete the HLTH 1634 form.

1. Press the ‘Get Form’ button to access the HLTH 1634 assessment record and open it in your preferred editor.
2. Begin by entering the patient information required in the first section. This includes details such as last name, first name, personal health number, birthdate, gender, and the province or territory that issued the health number.
3. In the next section, provide the information of the practitioner conducting the assessment, including their name, contact details, and professional identifiers.
4. Document the receipt of the written request for medical assistance in dying. Include the date the request was received and from whom, noting whether the patient consulted regarding their health for reasons other than seeking MAiD.
5. If a professional interpreter was used, fill in their details in the respective section, including the date of service.
6. Move on to the eligibility criteria. Independently assess and note whether the patient meets the specified criteria related to their medical condition and consent.
7. Complete the conclusion section. Indicate whether the patient meets all criteria for medical assistance in dying or if they are deemed ineligible, providing a reason if applicable.
8. Before finalizing the document, ensure all signatures are collected and dates are noted where required. This includes practitioner signatures and any necessary patient consent.
9. After filling out all sections, save your changes, download, print, or share the completed form as needed.

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