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 Forms Under the Health Care Consent Act

Official versions of all CCB Application Forms are available through the Ontario Government

Click here for Official Versions of the CCB Application Forms

Form letter

Form Name

Section of the HCCA

Who Signs

When

A

Application to the Board to Review a Finding of Incapacity

32(1)
50(1)
65(1)

Person determined to be incapable

 

 

 

 

Once a finding is made that a person is incapable of making decisions with respect to treatment, admission to a care facility or personal assistance services

B

Application to the Board to Appoint a Representative

33(1)
51(1)
66(1)

Person determined to be incapable

Once a finding is made that a person is incapable of making decisions with respect to treatment, admission to a care facility or personal assistance services in a nursing home or home for the aged

C

Application to the Board to Appoint a Representative

33(2)
51(2)
66(2)

Anyone who is at least 16 years of age and wishes to be appointed as the representative for a person who has been determined to be incapable

Once a finding is made that a person is incapable of making decisions with respect to treatment, admission to a care facility or personal assistance services in a nursing home or home for the aged

D

Application to the Board for Directions

35(1)
52(1)
67(1)

Substitute decision-maker or health care practitioner

The substitute decision-maker or health care practitioner requests assistance because a prior wish of the incapable person is not clear or it is not clear if the wish:
- was expressed when the person was capable and at least 16 years old, or
- is applicable in the circumstances.

E

Application to the Board for Permission to Depart from Wishes

36(1)
53(1)
68(1)

Substitute decision-maker or health care practitioner

When the prior capable wishes require the substitute decision-maker to refuse treatment, admission or personal assistance services

The application may only be granted if the Board finds that the incapable person, if capable, would probably consent because the likely result is significantly better than would have been anticipated in comparable circumstances at the time the wish was expressed.)

F

Application to the Board for Review of Someone Else's Decision to Consent to Admission for the Purpose of Treatment

34(1)

Patient

When a health practitioner has made a finding of incapacity to consent to treatment and the substitute decision-maker has consented to the admission

G

Application to the Board to Review Compliance with Rules for Substitute Decision-Making

37(1)
treatment)

Health practitioner who proposed the treatment

When the applicant is of the opinion that the substitute decision-maker has given or refused consent in a manner that violates the rules for substitute decisions found in the Act

G

(cont'd)

54(1)
admission to a nursing home or home for the aged)

Official of the Community Care Access Centre responsible for authorizing the admission

When the applicant is of the opinion that the substitute decision-maker has given or refused consent in a manner that violates the rules for substitute decisions found in the Act

G

(cont'd)

69(1)
personal assistance services in a nursing home or home for the aged)

Member of the service providers staff responsible for the personal assistance service

When the applicant is of the opinion that the substitute decision-maker has given or refused consent in a manner that violates the rules for substitute decisions found in the Act

H

Application to Amend the Conditions of the Appointment of a Representative

33(7)
51(6)
66(6)

Any person

At any time after the Board has appointed a representative to make decisions on behalf of an incapable person with respect to treatment, admission to a care facility or personal assistance services in a nursing home or home for the aged

 

Or
Application to Terminate the Appointment of a Representative

33(8)
51(6)
66(6)

 

 

 

 

   

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