Get Canada 3890-22e - Ontario 2017-2026

Filling out the Canada 3890-22E form online is a straightforward process designed for use by medical practitioners and nurse practitioners. This guide will provide you with step-by-step instructions to ensure that all necessary information is accurately entered.

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

1. Use the ‘Get Form’ button to access the form and open it in your online document editor.
2. Begin with Section 1, Patient Information. Fill in the patient's last name, first name, date of birth following the format yyyy/mm/dd, and gender. Additionally, enter the Ontario Health Insurance Plan (OHIP) number and version code. Confirm that you have received the patient's completed Patient Request (Clinician Aid A) for medical assistance in dying and record the date of request received.
3. Proceed to Section 2, Practitioner Information. Indicate whether you are a medical practitioner or a nurse practitioner by selecting the appropriate option. Fill in your college registration number, last name, first name, current business address including unit number, street number, street name, city or town, province, postal code, and telephone number.
4. In this section, declare your independence from the patient and any associated relationships that could affect objectivity. Provide your signature and the date in the designated fields.
5. Move to Section 3, Confirmation of Patient’s Eligibility. Confirm the patient's eligibility for health services, age, and capacity to make decisions regarding their health. Also, state your opinion about the patient's grievous and irremediable medical condition and discuss it with the patient. Secure their informed consent.
6. Complete Section 4, Confirmation of Safeguards, ensuring that all necessary written requests and discussions have taken place. Signature and date are required.
7. Fill out Section 5, Confirmation of a Period of Reflection for the Patient. Indicate whether the required reflection period will be observed and provide an appropriate term in days if applicable.
8. In Section 6, Withdrawal of Request, indicate if the patient withdrew their request or provided express consent before administering assistance, noting the method of consent.
9. For Section 7, provide the approval status regarding the patient's eligibility to access medical assistance in dying. Specify 'yes' or 'no' and explain if necessary.
10. Finally, in Section 8, provide details on the provision of medical assistance in dying, whether through prescription or administration of medication. Include dates, signature, and finalize your entries.
11. Once completed, ensure to save your changes, download the document, print it if needed, or share it as required.

Complete your Canada 3890-22E form online today for efficient documentation management.