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Get Canada Planned Death At Home (PDAH) Form - Ontario 2018-2024

Nosis with my physician, . Patient s name Print Physician name - Print I request to have comfort (palliative) measures only, including interventions or therapies considered necessary to provide comfort and alleviate pain. has been appointed as the substitute decision-maker in the event the above named patient is incapable Print - Name & Relationship (POA, SDM) of making, or understanding their own health care decisions.

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