Get Canada 3890-22e - Ontario 2023-2026

This guide provides users with a clear and supportive walkthrough for filling out the Canada 3890-22E form, designed for medical practitioners and nurse practitioners involved in providing medical assistance in dying. By following these steps, users can ensure they complete the form accurately and efficiently.

Follow the steps to complete the Canada 3890-22E form online.

1. Press the ‘Get Form’ button to access the document and open it in an online editor.
2. Fill out Section 1 – Patient Information. Provide details such as the patient's last name, first name, date of birth, and health insurance number. If the patient did not consent to provide certain information, indicate this in the specified fields.
3. Complete Section 2 – Practitioner and Preliminary Assessor Information. Enter your last name, first name, college registration number, and primary area of specialty. Confirm your independence from the patient and describe any pertinent relationships or connections.
4. In Section 3 – Confirmation of Patient’s Eligibility, confirm the eligibility criteria for the patient, ensuring they meet all necessary medical conditions. Indicate the decline in capability and the nature of suffering experienced by the patient.
5. Proceed to Section 4 – Confirmation of Safeguards. Declare adherence to required safeguards and the patient's understanding of the process, ensuring they were informed of alternative options.
6. If applicable, complete Section 5 – Additional Request Details. Include any relevant information regarding the patient’s access to disability support or palliative care.
7. For non-reasonably foreseeable deaths, fill out Section 6 – Confirmation of a Period of Assessment, noting assessment dates and agreement on eligibility.
8. For reasonably foreseeable deaths, complete Section 7 – Waiver of Final Consent, verifying the patient’s consent and any arrangements made.
9. Finalize the declaration of eligibility in Section 8 and ensure to sign and date the document.
10. Complete any subsequent sections applicable to the patient’s situation, including withdrawal of request or death notification procedures.
11. Upon completing the form, save changes, download it, print it, or share it directly as needed.

Start filling out your Canada 3890-22E form online today to ensure compliance with the necessary medical assistance in dying procedures.