The use of this aid is voluntary. It is being provided to assist you in maintaining records of requests for medical assistance in dying. Please use this aid if you are a “Medical Practitioner” or “Nurse Practitioner” and a patient is requesting medical assistance in dying and it is your intention to provide medical assistance in dying to the patient. You should also include the completed aid in the patient's medical records.
The objective of the Regional Development Program – Eastern Ontario Development Fund and Southwestern Ontario Development Fund is to provide financial assistance and incentives to support Eastern and Southwestern Ontario by helping municipalities, Indigenous Communities, economic development agencies, sector associations, and consortia.
Applications can be processed at any ServiceOntario centre. Visit ServiceOntario.ca/FindServices to find the centre nearest you.
This form is available on the Ontario Drug Benefit Program Online Applications and Forms website:
https://forms.ontariodrugbenefit.ca/.
If you are not able to complete the form online, please contact the TDP at 416-642-3038 (Toronto area) or 1-800-575-5386 (outside Toronto) for a paper version of this form.
