GUIDANCE DOCUMENT

How to Complete the Application for a

New Medical Device Licence

Published by authority of the

Minister of Health

Date Adopted 1999/01/06

Revised Date 2015/04/10
Effective Date 2015/07/16

Health Products and Food Branch

 Our mission is to help the people of Canada The Health Products and Food Branch’s mandate is to take
maintain and improve their health. an integrated approach to the management of the risks and
Health Canada benefits to health related products and food by:
• minimizing health risk factors to Canadians
while maximizing the safety provided by the
regulatory system for health products and food;
and,
• promoting conditions that enable Canadians to
make healthy choices and providing information
so that they can make informed decisions about
their health.
Health Products and Food Branch

© Minister of Public Works and Government Services Canada 2015

Également disponible en français sous le titre Ligne directrice - Comment remplir une nouvelle
demande d’homologation pour un instrument médical
Health Canada How to Complete the Application for a
Guidance Document New Medical Device Licence

FOREWORD

Guidance documents are meant to provide assistance to industry and health care professionals on how
to comply with the policies and governing statutes and regulations. They also serve to provide review
and compliance guidance to staff, thereby ensuring that mandates are implemented in a fair,
consistent and effective manner.

Guidance documents are administrative instruments not having force of law and, as such, allow for
flexibility in approach. Alternate approaches to the principles and practices described in this
document may be acceptable provided they are supported by adequate scientific justification.
Alternate approaches should be discussed in advance with the relevant program area to avoid the
possible finding that applicable statutory or regulatory requirements have not been met.

As a corollary to the above, it is equally important to note that Health Canada reserves the right to
request information or material, or define conditions not specifically described in this guidance, in
order to allow the Department to adequately assess the safety, efficacy or quality of a therapeutic
product. Health Canada is committed to ensuring that such requests are justifiable and that decisions
are clearly documented.

This document should be read in conjunction with the accompanying notice and the relevant sections
of other applicable guidance documents.

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Document Change Log

Replaces
Date 2015-06-XX Date 2008-05-01

Change Location (section, paragraph) Nature of and/or Reason for Change

1 Full Document Rewritten to add clarity and conform to Good
Guidance Practices.
2 Section 2.2, Item 2: Manufacturer Clarified that the ‘contact person’ is the person at the
Information location of the legal manufacturer
3 Section 2.2, Item 6, Class II Licence Removed reference to attestation of labelling
Application requirements
4 Section 2.2, Item 6, Class III and IV Revised text for clarity
Licence Applications
5 Section 2.2, Item 7: Purpose of Intended Revised text for clarity
Use of Device

6 Section 2.2, Item 11: Radiation Emitting The Radiation Emitting Medical Devices section has
Medical Devices been added to provide manufacturers with more
information about declaring a device that emits
radiation.
7 Section 2.2, Item 13: Identifier of Device This section has been revised to provide Information
on how to declare if your device contains nano-scale
material.
8 Section 2.2, Item 15: List of Recognized Revised text for clarity
Standards Complied with in the
Manufacture of the Device.
9 Section 2.2: Item 16: Review Included reference to two In-Vitro Diagnostic Devices
Documents, Class III Licence (IVDD) guidance documents.
Applications
10 Section 2.2: Item 16: Review Included reference to two In-Vitro Diagnostic Devices
Documents, Class IV Licence (IVDD) guidance documents.
Applications
11 Section 2.2: Class II Licence Change as a result of the fee form being separated
Application: Item 17: Refer to the from the application form.
Medical Device Licence Application Fee
Form
12 Section 2.2: Class III Licence Change as a result of the fee form being separated
Application: Item 17: Refer to the from the application form.
Medical Device Licence Application Fee
Form

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13 Section 2.2: Class IV Licence Change as a result of the fee form being separated
Application: Item 18: Refer to the from the application form.
Medical Device Licence Application Fee
Form
14 Section 2.3: Before Submitting a Medical In item b): Included the acceptance of e-signature
Device Licence Application In Item c): Revised text for clarity and added
reference to the Cost Recovery Guidance Document

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TABLE OF CONTENTS

1.0 INTRODUCTION ....................................................................................................................... 1

1.1 Policy Objective ....................................................................................................................... 1
1.2 Scope and Application ............................................................................................................. 1
1.3 Definitions ................................................................................................................................ 1
2.0 GUIDANCE FOR IMPLEMENTATION ................................................................................... 2
2.1 When is a New Medical Device Licence Required.................................................................. 2
2.2 The Medical Device Licence Application Form ...................................................................... 2
2.3 Before Submitting a Medical Device Licence Application ................................................... 12
3.0 REFERENCES .......................................................................................................................... 13
APPENDIX 1 - Table 1. Chemical Identity of Bisphenol A ................................................................ 14
APPENDIX 2 - Table 2. Chemical Identity of Di(2-Ethylhexyl)Phthalate ......................................... 15

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1.0 INTRODUCTION

Medical devices are classified into one of four classes by means of classification rules, where Class I
represents the lowest risk and Class IV represents the highest risk.

Class II, III and IV medical devices must be licenced prior to importation or sale in Canada.

A licence is issued to the device manufacturer for each application submitted, provided the
requirements of the Medical Devices Regulations (MDR) are met.

1.1 Policy Objective

To provide information to manufacturers and regulatory correspondents on how to complete an

application form for a new medical device licence.

1.2 Scope and Application

This guidance applies to all new Class II, III and IV medical devices.

1.3 Definitions

BISPHENOL A [BPA; Phenol, 4,4’ -(1-methylethylidene)bis-] is an industrial raw material that was
identified for screening assessment under the Canadian Environmental Protection Act (CEPA, 1999).
BPA is primarily used as a raw material in the production of polycarbonates and epoxy resins. BPA
or BPA-based polymers are used in the manufacture of a variety of medical devices, including resin-
based dental composite restorative and prosthodontic materials, dental sealants, hemodialyzers,
hemofilters and blood oxygenators. Please refer to Table 1 for the chemical identity of BPA,
including its Chemical Abstracts Services (CAS) Registry Number and synonyms.

DEVICE ID refers to the device identification number assigned by Health Canada.

DI(2-ETHYLHEXYL)PHTHALATE (DEHP) is a chemical additive that is used to make polyvinyl

chloride (PVC) soft, flexible and kink resistant. PVC plasticized with DEHP is currently used in a
variety of medical devices, including blood bags, catheters, intravenous tubing and medical gloves.
A medical device shall be considered to contain DEHP if the amount of DEHP in the device is
more than or equal to 0.1% of the device’s mass [that is (i.e.), ≥0.1% w/w]. Please refer to Table
2 for the chemical identity of DEHP, including its Chemical Abstracts Services (CAS) Registry
Number, synonyms and known trade names.

MEDICAL DEVICE means a device within the meaning of the Act, but does not include any device
that is intended for use in relation to animals.

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IDENTIFIER means a unique series of letters or numbers or any combination of these or a bar code
that is assigned to a medical device by the manufacturer and that identifies it and distinguishes it from
similar devices. Examples of an identifier for a device are a catalogue, model or part number.

LICENCE APPLICATION TYPE means the application can be submitted either as a single device, a
system, a test kit, a device group, a device family or a device group family. The term “test kit”
applies only to in vitro diagnostic devices. For more information on licence application types, refer
to the Guidance for the Interpretation of Sections 28 to 31: Licence Application Type, which is
available on the website.

MANUFACTURER means a person who sells the medical device under their own name, or under a
trade-mark, design, trade name or other name or mark owned or controlled by the person, and who is
responsible for designing, manufacturing, assembling, processing, labelling, packaging, refurbishing
or modifying the device, or for assigning to it a purpose, whether those tasks are performed by that
person or on their behalf. “Person” includes a partnership, firm or association.

NEAR PATIENT IN VITRO DIAGNOSTIC DEVICE means an in vitro diagnostic device (IVDD)
that is intended for use outside a laboratory, for testing at home or at the point of care, such as a
pharmacy, a health care professional’s office or the bedside.

2.0 GUIDANCE FOR IMPLEMENTATION

2.1 When is a New Medical Device Licence Required

Under the MDR, a new device licence is a pre-market requirement for:

a) any new device that was imported or sold in Canada after July 1, 1998;

b) a licensed device whose licence type is being modified from the type in the original licence
application, as defined in the Guidance for the Interpretation of Sections 28 to 31: Licence
Application Type;

c) a device previously authorized for sale for investigational testing, or under the special access
provisions of the MDR, that is now to be offered for general sale.

2.2 The Medical Device Licence Application Form

Device Classification

The rules to classify medical devices are outlined in Schedule 1 (Parts 1 and 2) of the MDR. Part 1 of
Schedule 1 addresses medical devices other than in vitro diagnostics and Part 2 addresses in vitro
diagnostic devices. For further guidance on the classification of medical devices, refer to the

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documents Guidance for the Risk-based Classification System, or Guidance for the Risk-based
Classification System of In Vitro Diagnostic Devices. After ascertaining the class of the device, use
the appropriate application form:

New Class II Medical Device Licence Application Form (http://www.hc-sc.gc.ca/dhp-

mps/alt_formats/pdf/md-im/applic-demande/form/licapp_demhom_cla2-eng.pdf);
New Class III Medical Device Licence Application Form (http://www.hc-sc.gc.ca/dhp-mps/md-
im/applic-demande/form/licapp_demhom_cla3-eng.php); or
New Class IV Medical Device Licence Application Form (http://www.hc-sc.gc.ca/dhp-mps/md-
im/applic-demande/form/licapp_demhom_cla4-eng.php)

The document entitled Keyword Index to Assist Manufacturers in Verifying the Class of Medical
Devices (http://www.hc-sc.gc.ca/dhp-mps/md-im/applic-demande/guide-ld/keyword_motscles2-
eng.php) is an alphabetical listing of all the short descriptors for devices that are entered into the
Medical Devices System (MDS). The document contains synonyms and industry words that are
commonly used to describe these devices, along with their respective classifications.

Item 1: NAME OF THE DEVICE (as it appears on the label)

The device name indicated for a system, medical device family or a medical device group family
must appear, at least in part, on the label of each member device. Only one name is to be entered in
Item 1. The device name on the application form will be used as the licence name unless the
application is for a family of medical devices. In this case, a generic licence name that covers all
possible trade names [for example (e.g.,) urinary catheters], should be indicated. The licence name
usually reflects the types of devices that are contained within the licence and sometimes may vary
from the device name.

Item 2: MANUFACTURER INFORMATION (as it appears on the label)

This is the name and address of the manufacturer of the device and the name and address to which the
licence will be issued. A complete address must include: name and title of a contact person (contact
person at the location of the legal “manufacturer”); Company ID (if known, this number is assigned
by Health Canada); telephone number, Fax number and e-mail address of the contact person; street
name and number or Post Office Box; city, province or state; postal or zip code; and country.

Item 3: REGULATORY CORRESPONDENT INFORMATION

All regulatory correspondence will be sent to this address (if different from Item 2), but the licence
will be issued to the Manufacturer. A medical device licence application can be submitted by a third
party; the mailing address and name of this authorized Regulatory Correspondent will be entered
here.

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Item 4: INVOICING INFORMATION

Enter the name, address and contact information of the party which will receive all invoicing and
billing information; it may be the same as Item 2 or 3, or it may be a third party.

Item 5: QUALITY MANAGEMENT SYSTEM CERTIFICATE

Enter the certificate number and the name of the recognized registrar that has issued the certificate. A
legible copy of the certificate must accompany each medical device licence application. For more
information on the content and acceptance of quality management system certificates, refer to
GD207: Guidance on the content of ISO 13485 quality management system certificates issued by
Health Canada recognized Registrars. The certificate must be issued by a Health Canada recognized
registrar. Refer to the Health Canada web site for a current list of recognized registrars.

Item 6: ATTESTATIONS

Class II Licence Applications

Attestation of Compliance with the Applicable Requirements of sections 10 to 20

Manufacturers of Class II medical devices must attest that they have objective evidence establishing
that they are compliant with section 10, subsections 11(1) and 12(1) and sections 13 to 20 of the
MDR.

In the case of decorative contact lenses, manufacturers must attest that they have objective evidence
establishing that they meet section 10, subsections 11(2) and 12(2) and sections 13 to 17 of the MDR.

Attestation of Investigational Testing for in vitro diagnostic devices (IVDDs)

Manufacturers of Class II near patient IVDDs must attest here that investigational testing of their
device was conducted using human subjects representative of the intended patients and under
conditions similar to the intended conditions of use of the device.

Near Patient Attestation

Manufacturers are to attest here that the device(s) is NOT a near patient IVDD, if applicable.

Signature

The manufacturer of the device must sign and date the application.

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Class III and IV Licence Applications

Attestation Section

Along with the application form, a manufacturer must submit an attestation that the information
requested in section 32, subsection (3) or (4) of the MDR is complete. Refer also to the document
Guidance on supporting evidence to be provided for new and amended licence applications for Class
III and Class IV medical devices, not including In Vitro Diagnostic Devices (IVDDs) (http://www.hc-
sc.gc.ca/dhp-mps/md-im/applic-demande/guide-ld/md_gd_data_im_ld_donnees_ciii_civ-eng.php)
and Guidance Document: Preparation of Summary Technical Documentation (STED)-based Class III
and Class IV Premarket Medical Device Licence Applications, not including In Vitro Diagnostic
Devices (IVDDs) (http://www.hc-sc.gc.ca/dhp-mps/md-im/applic-demande/guide-
ld/md_gd_im_ld_sted-eng.php) and the Guidance Document - Preparation of a Premarket Review
Document for Class III and Class IV Device Licence Applications.

Signature

The manufacturer of the device must sign and date the application.

Item 7: PURPOSE OR INTENDED USE OF DEVICE

Information provided for Item 7 is crucial to establishing the appropriate device class and should
include the following:
 intended purpose, indications for use, conditions for which the device is used (the intended
use statement should be verbatim as it appears on the device labelling);
 patient population for which the device is intended including age range, if applicable, and
specific diagnoses;
 anatomical and physiological particulars related to the patient using the device, if applicable;
 whether or not the device uses an energy source and whether energy is transferred to the
patient;
 the document, document version number and the date where the formal intended use appears.

For licence amendments, if there are changes to the instructions for use/package insert, a red-lined
version of the revised pages should be submitted. In addition, a clean copy of the latest version of the
IFU/PI should be submitted with the application.

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Item 8: LICENCE APPLICATION TYPE

A manufacturer may apply for the following types of device licence:

A single medical device:

A single medical device is defined by a unique device name, is sold as a distinctly packaged entity
and does not meet the criteria for a medical device group, a medical device family, a medical device
group family, a system, or a test kit. It may be offered in a range of package sizes. Examples
include: an acupuncture needle, an aneurysm clip, a larynx prosthesis or dental cement.

A medical device family:

A medical device family is a group of medical devices that are made by the same manufacturer, that
differ only in shape, colour, flavour or size, that have the same design and manufacturing process and
that have the same intended use. Examples include: intra vascular catheters, insulin syringes, feeding
tubes or vascular access grafts.

A medical device group:

A medical device group is comprised of a collection of medical devices, such as a procedure pack or
tray, that is sold under a single name. Examples include: a denture repair kit, a declotting tray, a
parenteral administration kit or disposable circumcision tray.

A medical device group family:

A medical device group family is a collection of medical device groups that are made by the same
manufacturer, that have the same generic name specifying their intended use, and that differ only in
the number and combination of products that comprise each group. Examples include: intravenous
(IV) administration sets, dressing trays, contact lens care kits or irrigation trays.

System:

A system is a medical device comprising a number of components or parts intended to be used

together to fulfil some or all of the device’s intended functions, and that is sold under a single name
and are manufactured by the same manufacturer. Examples include hip prostheses, knee prostheses
or an ultrasonic imaging system.

Test Kit:

A test kit is an in vitro diagnostic device that consists of reagents or articles, or any combination of
these, and that is intended to be used to conduct a specific test.

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For further assistance in ascertaining the appropriate licence Application type for your product,
consult the Guidance for the Interpretation of Sections 28 to 31: Licence Application Type.

Item 9: PLACE OF USE

Indicate on the application form by checking the appropriate boxes.

Item 10: MEDICAL DEVICES CONTAINING DRUGS

Non-IVD Devices Containing Drugs

Do not complete this item if the device is an IVDD. If the device contains a drug or drug substance,
which includes a pharmaceutical or biological drug, or a natural health product, specify its brand
or trade name, active ingredient(s), manufacturer, and its Drug Identification Number (DIN) or
Natural Product Number (NPN). Health Canada’s Drug/Medical Device Combination Products
Policy (http://www.hc-sc.gc.ca/dhp-mps/prodpharma/applic-demande/pol/combo_mixte_pol_2006-
eng.php) addresses the regulation of products that are comprised of both a drug and a medical device.

IVDD Test Kits containing Controlled Substances

Please note that if the device is a test kit containing a substance listed in Schedule I, II, III or IV of
the Controlled Drugs and Substances Act (CDSA), it would need to be registered with the Office of
Controlled Substances. For information on how to apply for a Test Kit Number (T. K. Number),
please refer to the Office of Controlled Substances Guidance Document entitled Registration of a
Test Kit for Medical, Laboratory, Industrial, Educational or Research Purposes or contact the Office
of Controlled Substances at (613) 952-2219 or (613) 957-1063.

Item 11: RADIATION EMITTING MEDICAL DEVICES

In this section, please indicate whether or not any of the devices contained in this application contain
radiation emitting devices. A radiation emitting device is defined as any device that is capable of
producing and emitting electromagnetic or acoustic radiation, and any component of or accessory to
such a device.

Please note that if any of the devices listed on this application emit radiation, you may also be
required to meet the requirements of the Radiation Emitting Devices (RED) Act. Please contact the
Consumer and Clinical Radiation Protection Bureau to discuss these requirements at ccrpb-
[email protected] or 613-954-6699.

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Item 12: DEVICE HISTORY

Indicate if the device has been previously authorized for sale in Canada under the investigational
testing or special access provisions of the MDR. If the device has been previously authorized for sale
under the investigational testing provisions of the MDR, it will have a Device Identification (ID)
number. If the device had been previously authorized for sale by the special access provisions of the
MDR, it will have an Authorization number. The appropriate number must be supplied.

Item 13: IDENTIFIER OF DEVICE

Only devices, components, parts and accessories listed on the application will be considered for
licensing. Spare parts that do not represent medical devices on their own should not be listed. If
additional space is required, photocopy the Item 12 page and attach it to the application form.

For a single device, enter the name of the device in the first column and enter the identifier for the
device (bar code, catalogue, model or part number) in the second column. If the device contains
≥0.1% by mass of DEHP, check the third column. If the device is manufactured from raw materials
containing or derived from BPA, check the fourth column.

For a medical device group, a medical device family, or a medical device group family, the names
of the constituent members must be listed in the first column. Associated identifiers must be entered
in the second column. If a constituent member contains ≥0.1% by mass of DEHP, check the
associated row in the third column. If a constituent member is manufactured from raw materials
containing or derived from BPA, check the associated row in the fourth column.

Please refer to the Policy Statement on Health Canada's Working Definition for Nanomaterial found
on the Health Canada website at http://www.hc-sc.gc.ca/sr-sr/pubs/nano/pol-eng.php.

Although the working definition indicates that a nanomaterial is a material within 1 to 100
nanometers in at least one dimension, for the purposes of medical device licensing, the Medical
Devices Bureau is requesting notification for devices containing nano-scale materials with a particle
size between 1 and 1000 nanometers.

Please identify the specific type of nano-scale material that is present in each device listed on the
licence application. Examples of a specific type of nano-scale material could include nano titanium
dioxide, nano silver, quantum dots, nano polymers, nano glasses, nano ceramics, carbon nanotubes
and nano-fibres.

The last column is for Health Canada (HC) use only.

Refer to the definition of “BPA”, “DEHP” and “identifier” in section 3 of this guidance document.
Please note that it is the manufacturer’s responsibility to determine whether a medical device

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contains ≥ 0.1% w/w of DEHP or is manufactured from raw materials containing or derived
from BPA. The absence of a check mark in the third and fourth column in line with a specific device
will be taken to indicate that the device does not contain ≥0.1% w/w of DEHP or is not manufactured
from raw materials containing or derived from BPA.

Item 14: COMPATIBILITY OF INTERDEPENDENT DEVICES

For a device intended to be used with another Class II, III, or IV device, a list of all medical devices
that this device is intended to be used or function with (including their licence number), is required.
This is intended to be for system components from the same manufacturer.

An important requirement in demonstrating compliance with the applicable requirements of sections

10 to 20 of all medical devices intended to be used together is compliance with section 18 of the
MDR. Section 18 requires that when medical devices are intended to be used with other medical
devices, they must be compatible with every other medical device with which they interact, and don’t
adversely affect the performance of the combination of medical devices.

Failure to submit compatibility information for interdependent medical devices may lead to delays in
the pre-market review of device licence applications while the Medical Devices Bureau requests the
necessary information and manufacturers assemble and submit it for review.

Manufacturers are therefore reminded that the submission of evidence of compatibility for inter-
dependent medical devices is a requirement under the MDR.

See also Notice to Industry - Licensing Requirements of Interdependent Medical Devices (April 30,
2002) (http://www.hc-sc.gc.ca/dhp-mps/md-im/applic-demande/guide-ld/notice_avis_syst_reqt_exig-
eng.php).

Item 15: LIST OF RECOGNIZED STANDARDS COMPLIED WITH IN THE

MANUFACTURE OF THE DEVICE

Refer to the documents on Recognition and Use of Standards under the Medical Devices Regulations.

For Class II licence applications, the manufacturer is to list the recognized standards complied with,
or attest that they possess objective evidence that the device either meets an equivalent or better
standard or has been tested and alternate evidence of compliance with the applicable requirements of
sections 10 to 20 exists.

For Class III and IV licence applications, the manufacturer must respond “YES” where applicable
and provide appropriate documentation:

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• if the device conforms with recognized standards, the manufacturer can provide a
Declaration of Conformity (http://www.hc-sc.gc.ca/dhp-mps/md-im/applic-
demande/form/md_doc_im_ddc_form-eng.php) form indicating the standard(s) or
submit detailed information as evidence of compliance;
• if the device does not conform with the listed recognized standards, but instead meets
an equivalent or better standard, the manufacturer can provide a Declaration of
Conformity (http://www.hc-sc.gc.ca/dhp-mps/md-im/applic-
demande/form/md_doc_im_ddc_form-eng.php) form to indicate these equivalent or
better standards; and
• if the device does not conform with the listed recognized standards nor meet an
equivalent or better standard, the manufacturer shall include detailed information as
evidence of compliance with the applicable requirements of sections 10 to 20.

If the manufacturer does not comply with any of these three options, a licence will not be issued.

Class II Licence Applications

Item 16: REVIEW DOCUMENTS

Indicate which review documents listed on the table are included as attachments to the application.
For details regarding content and format of labelling material for Class II medical devices, consult
Guidance for the Labelling of Medical Devices and Guidance for the Labelling of In Vitro Diagnostic
Devices.

Item 17: Refer to the Medical Device Licence Application Fee Form (http://www.hc-
sc.gc.ca/dhp-mps/alt_formats/pdf/md-im/applic-demande/form/md_licapp_demhom-eng.pdf)

Instructions are provided on the form itself. The instructions given for each item must be carefully
followed to avoid delays in application processing. Consult also the Guidance Document on Cost
Recovery - Fees for the Review of Medical Device Licence Applications (http://www.hc-sc.gc.ca/dhp-
mps/md-im/applic-demande/guide-ld/guidedoc_feesmd_docorient_fraisim-eng.php).

Class III Licence Applications

Item 16: REVIEW DOCUMENTS

Indicate which review documents listed on the table are included as attachments to the application.
For details regarding content and format of review documents for Class III and IV medical devices,
consult the Guidance on supporting evidence to be provided for new and amended licence
applications for Class III and Class IV medical devices, not including In Vitro Diagnostic Devices
(IVDDs) (http://www.hc-sc.gc.ca/dhp-mps/md-im/applic-demande/guide-
ld/md_gd_data_im_ld_donnees_ciii_civ-eng.php) and Guidance Document: Preparation of Summary

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Technical Documentation (STED)-based Class III and Class IV Premarket Medical Device Licence
Applications, not including In Vitro Diagnostic Devices (IVDDs) (http://www.hc-sc.gc.ca/dhp-
mps/md-im/applic-demande/guide-ld/md_gd_im_ld_sted-eng.php) or for IVDDs, Draft Guidance
Document: Preparation of Summary Technical Document (STED)-based Class III and IV Premarket
In Vitro Diagnostic Device Licence Applications and Amendments (http://www.hc-sc.gc.ca/dhp-
mps/consultation/md-m/md_gd_data_im_ld_donnee_ciii_civ_ivdd-eng.php) and Draft Guidance
Document: Guidance on Supporting Evidence to be Provided for Class III and IV In Vitro Diagnostic
Device Licence Applications and Amendments (http://www.hc-sc.gc.ca/dhp-mps/consultation/md-
im/md_gd_data_im_ld_donnee_ciii_civ_ivdd-eng.php).

Items 17: Refer to the Medical Device Licence Application Fee Form (http://www.hc-
sc.gc.ca/dhp-mps/alt_formats/pdf/md-im/applic-demande/form/md_licapp_demhom-eng.pdf)

Instructions are provided on the form itself. The instructions given for each item must be carefully
followed to avoid delays in the processing of your application. Consult also the Guidance Document
on Cost Recovery - Fees for the Review of Medical Devices Regulations (available on the website at
http://www.hc-sc.gc.ca/dhp-mps/md-im/applic-demande/guide-
ld/guidedoc_feesmd_docorient_fraisim-eng.php).

Class IV Licence Applications

Item 16: REVIEW DOCUMENTS

Indicate which review documents listed on the table are included as attachments to your application.
For details regarding content and format of review documents, consult the Guidance on supporting
evidence to be provided for new and amended licence applications for Class III and Class IV medical
devices, not including In Vitro Diagnostic Devices (IVDDs) (http://www.hc-sc.gc.ca/dhp-mps/md-
im/applic-demande/guide-ld/md_gd_data_im_ld_donnees_ciii_civ-eng.php) and Guidance
Document: Preparation of Summary Technical Documentation (STED)-based Class III and Class IV
Premarket Medical Device Licence Applications, not including In Vitro Diagnostic Devices (IVDDs)
(http://www.hc-sc.gc.ca/dhp-mps/md-im/applic-demande/guide-ld/md_gd_im_ld_sted-eng.php) or
for IVDDs, Draft Guidance Document: Preparation of Summary Technical Document (STED)-based
Class III and IV Premarket In Vitro Diagnostic Device Licence Applications and Amendments
(http://www.hc-sc.gc.ca/dhp-mps/consultation/md-m/md_gd_data_im_ld_donnee_ciii_civ_ivdd-
eng.php) and Draft Guidance Document: Guidance on Supporting Evidence to be Provided for Class
III and IV In Vitro Diagnostic Device Licence Applications and Amendments (http://www.hc-
sc.gc.ca/dhp-mps/consultation/md-im/md_gd_data_im_ld_donnee_ciii_civ_ivdd-eng.php).

Item 17: DEVICES CONTAINING BIOLOGICAL MATERIAL

This section of the application form must be completed in detail. If additional space is required,
photocopy the page and attach it to the application form.

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Items 18: Refer to the Medical Device Licence Application Fee Form (http://www.hc-
sc.gc.ca/dhp-mps/alt_formats/pdf/md-im/applic-demande/form/md_licapp_demhom-eng.pdf)

Instructions are provided on the form itself. The instructions given for each item must be carefully
followed to avoid delays in the processing of your application. Consult also the Guidance Document
on Cost Recovery - Recovery - Fees for the Review of Medical Device Licence Applications (http://hc-
sc.gc.ca/dhp-mps/md-im/applic-demande/guide-ld/guidedoc_feesmd_docorient_fraisim-eng.php).

2.3 Before Submitting a Medical Device Licence Application

Before submitting a new medical device licence application, ensure that:

a) The device licence application form and fee form are complete. The manufacturer may
choose to have a Regulatory Correspondent complete and submit the application on their
behalf.

b) The manufacturer signs the application form, certifying that all the information in the
application is accurate and complete. A faxed copy of the manufacturer’s signature is
acceptable, or an e-signature.

c) The applicable licence fee for a Class II, III or IV medical device is submitted with the
application when applicable, or upon receipt of an invoice. For further information on timing,
refer to the Guidance document on Cost Recovery - Fees for the Review of Medical Device
Licence Applications (http://www.hc-sc.gc.ca/dhp-mps/md-im/applic-demande/guide-
ld/guidedoc_feesmd_docorient_fraisim-eng.php).

d) The quality management system certificate is submitted with the application.

e) The Licence Application Disclosure Request is submitted with the application.

f) The manufacturer, or their Regulatory Correspondent, submits the application and any
supporting documentation to:

Manager, Device Licensing Division

Medical Devices Bureau
Therapeutic Products Directorate
Health Canada
2934 Baseline Road. Tower B
Address Locator 3403A
Ottawa, Ontario
K1A 0K9

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Health Canada How to Complete the Application for a
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3.0 REFERENCES

Cadogan D, Howick C. 1996. Plasticizers. In: Kroschwitz J, Howe-Grant M, eds. Kirk-Othmer

encyclopedia of chemical technology. New York: John Wiley & Sons Inc., 258-290.

Canada. 1999. Canadian Environmental Protection Act, 1999. S.C., 1999, c. 33, Canada Gazette Part
III. Vol. 22, No. 3. Available from: http://canadagazette.gc.ca/partIII/1999/g3
02203.pdf.

Howard PH, Meylan WM. 1997. Handbook of physical properties of organic chemicals. Boca Raton,
FL: Lewis Publishers.

HSDB. 1990. Hazardous Substances Data Bank. National Library of Medicine, National Toxicology
Information Program, Bethesda, MD. July 18, 1990.

Montgomery JH, Welkom LM. 1990. Groundwater chemicals desk reference. Chelsea, MI: Lewis
Publishers, Inc., 93-95.

RTECS. 2000. Registry of Toxic Effects of Chemical Substances. National Library of Medicine,
National Toxicology Information Program, Bethesda, MD. February 2000.

Date Adopted: 1999/01/06; Effective Date: 2015/07/16 13

How to Complete the Application for a Health Canada
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APPENDIX 1 - Table 1. Chemical Identity of Bisphenol A

CHARACTERISTIC INFORMATION
Chemical Abstracts Services
80-05-7
(CAS) Registry Number
Domestic Substances List
phenol, 4,4' -(1-methylethylidene)bis-
name
phenol, 4,4'-(1-methylethylidene)bis- (TSCA, PICCS, ASIA-PAC)
4,4'-isopropylidenediphenol (EINECS, PICCS)
2,2-Bis(4'-hydroxyphenyl) propane (ENCS)
phenol, 4,4'-(1-methylethylidene)bis- (AICS, PICCS)
4,4'-(1-Methylethylidene)bisphenol (ECL)
4,4'-Bisphenol A (ECL)
phenol, 4,4'-(1-methylethylidene)bis- (SWISS)
bisphenol A (SWISS, PICCS)
National Chemical Inventories p,p'-isopropylidene diphenol (PICCS)
(NCI) names1 diphenol methylethylidene (PICCS)
bis[phenol], 4,4'-(1-methylethylidene)- (PICCS)
bisphenol-a (PICCS)
bisphenol, 4,4'-(1-methylethylidene)- (PICCS)
4,4-isopropylidene diphenyl (PICCS)
4,4'-dihydroxyphenyl-2,2-propane (PICCS)
2,2-di(4-hydroxyphenyl)propane (PICCS)
2,2-di(4-hydroxyphenyl) propane (PICCS)
2,2-bis-(4-hydroxy-phenyl)-propane (PICCS)
bisphenol A
Other names diphenylolpropane
BPA
Chemical group Discrete organics
Chemical subgroup Phenols
Chemical formula C15H16O2

Chemical structure

SMILES Oc(ccc(c1)C(c(ccc(O)c2)c2)(C)C)c1
1
National Chemical Inventories (NCI). 2006: AICS (Australian Inventory of Chemical Substances); ASIA-PAC (Asia-Pacific Substances
Lists)_Toc173920654; ECL (Korean Existing Chemicals List); EINECS (European Inventory of Existing Commercial Chemical Substances); ENCS
(Japanese Existing and New Chemical Substances); PICCS (Philippine Inventory of Chemicals and Chemical Substances); SWISS (Inventory of Newly
Notified Substances and Giflist 1 - List of Toxic Substances) and TSCA (Toxic Substances Control Act Chemical Substance Inventory).

14 Date Adopted: 1999/01/06; Effective Date: 2015/07/16

Health Canada How to Complete the Application for a
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APPENDIX 2 - Table 2. Chemical Identity of Di(2-Ethylhexyl)Phthalate

CHARACTERISTIC INFORMATION REFERENCE

Chemical name di(2-ethylhexyl)phthalate RTECS 2000
DEHP
Synonyms dioctylphthalate RTECS 2000
bis(2-ethylhexyl)phthalate
Bisoflex 81
Eviplast 80
Registered trade names Octoil RTECS 2000
Plantinol DOP
Staflex DOP
Chemical formula C24H38O4 RTECS 2000

Chemical structure Howard and Meylan, 1997

Identification numbers:
CAS Registry Number 117-81-7 Cadogan and Howick, 1996
NIOSH RTECS TI0350000 RTECS 2000
EPA hazardous waste U028 HSDB 1990
OHM/TADS 7216693 HSDB 1990
DOT/UN/NA/IMCO shipping No data
HSDB 334 HSDB 1990
NCI C52733 Montgomery and Welkom, 1990
CAS = Chemical Abstracts Services; DOT/UN/NA/IMCO = Department of Transportation/United Nations/North America/International
Maritime Dangerous Goods Code; EPA = Environmental Protection Agency; HSDB = Hazardous Substances Data Bank; NCI =
National Cancer Institute; NIOSH = National Institute for Occupational Safety and Health; OHM/TADS = Oil and Hazardous
Materials/Technical Assistance Data System; RTECS = Registry of Toxic Effects of Chemical Substances.

Date Adopted: 1999/01/06; Effective Date: 2015/07/16 15