Regulations for the Monitoring of Medical Assistance in Dying

1 The following information in respect of the patient:

• (a) date of birth;

• (b) sex;

• (c) health insurance number and the province or territory that issued it or, in the case where they do not have a health insurance number, the province or territory of their usual place of residence on the day on which the practitioner received the request;

• (d) the postal code associated with the patient’s health insurance number or, in the case where they do not have a health insurance number, the postal code of their usual place of residence on the day on which the practitioner received the request.

2 The following information in respect of the practitioner:

• (a) name;

• (b) an indication of whether they are a medical practitioner or nurse practitioner;

• (c) if they are a family physician, an indication to that effect;

• (d) if they are a medical practitioner other than a family physician, their area of specialty;

• (e) the province or territory in which they practise and, if they practise in more than one province or territory, the province or territory in which they received the request;

• (f) the licence or registration number assigned to them in the province or territory in which they received the request;

• (g) the mailing address and email address that the practitioner uses for work;

• (h) to the best of their knowledge or belief, an indication of whether, before they received the request, the patient consulted them concerning the patient’s health for a reason other than seeking medical assistance in dying.

3 The following information in respect of the request:

• (a) the date on which the practitioner received the request;

• (b) an indication of whether the practitioner received the request from the patient directly, another practitioner, a care coordination service or another third party.