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Nova Scotia Palliative Care Drug Program Application

People receiving end-of-life care at home in Nova Scotia can get a list of comfort and symptom-control drugs at no cost through the province's Palliative Care Drug Program. This two-page application enrols a patient once a palliative care clinician confirms the end stage of a terminal illness. Coverage lasts six months from the date the form is signed.

Who completes it

A palliative care physician or nurse completes Section I and the authorizer's signature block; the patient, or their substitute decision-maker, signs the Section 2 consent, and the clinician records why if the patient cannot sign.

Submitting and payment

How to submit it
Fax the completed application to the Nova Scotia Pharmacare office; processing takes 2 to 3 business days, and coverage begins on the enrolment date on the form.

Good to know

  • Eligibility requires Nova Scotia residence, a valid Health Card number (new residents wait 3 months), a prognosis under six months, and end-of-life care at home, including family homes or long-term care.
  • Pharmacies bill private insurance, NIHB or DVA first, so patients are told to keep any other private or Pharmacare drug coverage they have.
  • Renewals use the same form with the renewal box ticked and an explanation; the form asks clinicians to consider moving the patient to another coverage program instead.
  • If the need is urgent, the form suggests calling the patient's pharmacy, since processing takes 2 to 3 days; patients should tell the pharmacy each time they fill a prescription.

Get the official form

Download the current version from the source each time; forms change without notice.

Palliative Care Drug Program Application Form

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

Who can authorize Nova Scotia's Palliative Care Drug Program application?

Section I is completed by a palliative care physician or nurse, who confirms the patient is in the end stage of a terminal illness and that care now focuses on palliation rather than cure. The authorizer prints and signs their name, role, contact details and palliative care team or NSHA area.

How long does Nova Scotia palliative drug coverage last?

Six months from the date the form is signed. If the patient still needs coverage after that, the clinician submits a renewal on the same form with an explanation, and the form asks whether the patient could be transitioned to another coverage program.

Does the patient pay anything under the Palliative Care Drug Program?

Nova Scotia says there is no cost to the patient for medications approved under the program. Pharmacies bill private insurance, NIHB or DVA first and send any remaining amount to the program electronically, which is why patients are told to keep their other coverage.