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Personal Directives Act Referral Regulations
made under Section 42 of the
Public Trustee Act
R.S.N.S. 1989, c. 379
O.I.C. 2010-71 (February 16, 2010), N.S. Reg. 32/2010
1 These regulations may be cited as the Personal Directives Act Referral Regulations.
Form for referral to Public Trustee
2 An individual must complete Form 1: Referral to Public Trustee (Personal Directives Act) to make a referral to the Public Trustee under Section 8A of the Public Trustee Act regarding a person who is being placed in a continuing-care home or is to be provided home-care services in accordance with a decision made under Section 14 of the Personal Directives Act.
Form for declaration of competency
3 A duly qualified medical practitioner may use Form 2: Declaration of Competency (Personal Directives Act) for the written opinion required by subsection 8A(2) of the Public Trustee Act when assessing the capacity of a person who is the subject of a referral described in subsection (1) to manage their financial affairs.
Form 1: Referral to Public Trustee (Personal Directives Act)
Regarding Finances of Person Requiring Continuing-Care or Home-Services Care
(subsection 8A(1) of Public Trustee Act)
I, _____________________________________________________________ (full name), am
❑ the person in charge of _____________________________________________, a continuing-care home, as defined in the Personal Directives Act, where the person who is the subject of this referral resides.
❑ the person in charge of _____________________________________________, a provider of home-care services, as defined in the Personal Directives Act, to the person who is the subject of this referral.
❑ the person who made the decision to accept placement in a continuing-care home or regarding provision of home-care services for the person who is the subject of this referral under Section 14 of the Personal Directives Act.
❑ the delegate named in the personal directive of _____________________________
_________________ (name of person who is the subject of the referral).
______________________________________________________ (full name of person who is subject of referral) has been examined by _________________________ (full name and professional designation), a duly qualified medi[c]al practitioner and has been found to be not capable of managing their financial affairs.
❑ The written opinion of the duly qualified medical professional or prescribed health-care professional is attached.
I hereby advise you that circumstances are such that the Public Trustee should consider immediately assuming management of the financial affairs of ___________________________ (full name of person who is subject of referral).
(date of signature)
(witness’s name – printed)
1) This form must be used by a person in charge of a continuing-care home, a home-care services provider or by a person making the decision to place a person in a continuing-care home or have home-care services provided for them.
(s. 8A(3) of Public Trustee Act)
2) This form must be accompanied by the written opinion of a duly qualified medical professional or prescribed health-care professional.
(s. 8A(2) of Public Trustee Act)
Form 2: Declaration of Competency to Administer Estate (Personal Directives Act)
Regarding Person Requiring Continuing-Care or Home-Services Care
(subsection 8A(2) of the Public Trustee Act)
I, ___________________________________ (full name), a duly qualified medical practitioner personally examined ______________________ (full name of person assessed) on _____/_____/_____ (dd/mm/yyyy) at ______ a.m./p.m. at ____________________________ ______________ (location of examination).
In my opinion, the person (check one):
❑is competent to administer their estate.
❑is not competent to administer their estate.
In arriving at this opinion I have considered all of the following:
• the nature and degree of the person’s condition
• the complexity of the estate
• the effect of the person’s condition on their conduct in administering the estate
• any other circumstances that I consider relevant to the estate and the person and their condition
The following information supports my opinion:
A) Observations from my examination of the patient:
B) Information from other sources:
Sources of above information (identify specific sources):
(date of signature)