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MAID Clinician Aid C (3891-22E): Second Assessor

Ontario's Ministry of Health offers Clinician Aid C to the secondary medical practitioner or nurse practitioner asked to give a written opinion confirming that a patient meets the eligibility criteria for medical assistance in dying. It records independence from the patient and the primary practitioner, the eligibility confirmation, additional request details and the approval status. The completed aid belongs in the patient's medical records.

Who completes it

The secondary (assessing) physician or nurse practitioner completes the whole aid and signs Section 5, Approval Status. The primary practitioner uses Clinician Aid B, and the patient's request may be recorded on Clinician Aid A.

Submitting and payment

How to submit it
The aid is not sent to an agency: the assessor includes the completed aid in the patient's medical records, as its instructions say.

Good to know

  • The assessor declares independence: no mentoring or supervisory relationship with the primary practitioner, no benefit from the patient's death, and no connection or conflict that could affect objectivity.
  • When natural death is not reasonably foreseeable, the aid asks whether the assessor has expertise in the condition causing the suffering, or which expert clinician was consulted.
  • Section 5 records whether the patient is eligible and which safeguards apply: Track 1 for reasonably foreseeable natural death, Track 2 for other cases, or not yet known.
  • Section 4 captures details such as palliative care received, disability support services, and how communication was supported if the person had difficulty communicating.

Get the official form

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

Clinician Aid C - (Secondary) "Medical Practitioner" or "Nurse Practitioner" Medical Assistance in Dying Aid

Outil Clinique C - Médecin ou infirmier praticien (consultant) fournissant les services d'aide médicale à mourir

Official pagePDFVersion française

Fill it with Vero

Upload the fillable PDF 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 completes MAID Clinician Aid C?

A medical practitioner or nurse practitioner who has been asked by another physician or nurse practitioner to give a written opinion confirming that the patient meets the MAID eligibility criteria. They must be independent of both the patient and the primary practitioner, and they sign the approval status section.

What is the difference between Clinician Aid B and Clinician Aid C?

Aid B is for the primary practitioner who intends to provide MAID and covers safeguards, provision and coroner notification. Aid C is for the independent second assessor and ends with their approval status, including whether Track 1 or Track 2 safeguards apply.

Is Clinician Aid C available in French?

Yes. The French version, Outil Clinique C, is posted with the English 3891-22E (2023/01) in Ontario's Central Forms Repository. It is an XFA-based form that opens and fills correctly only in Adobe Acrobat or Reader.