Guidance on clinical evidence requirements for medical devices: Overview

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Organization: Health Canada

Date published: March 2023

Cat.: H164-347/1-2023E-PDF

ISBN: 978-0-660-47994-1

Pub.: 220811

Date published: November 15, 2022

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This document provides guidance to manufacturers of Class II, III and IV medical devices and regulatory representatives on the clinical evidence requirements for medical devices. Guidance is provided on:

Specifically, this guidance document outlines:

The Medical Devices Regulations (Regulations) use a risk-based approach to regulating products within their scope. The safety and effectiveness evidence requirements are identified in sections 10 to 20.

The evidence required to support a medical device licence application is proportional to the risk of the device. This is determined by applying the classification rules for medical devices detailed in Schedule 1 of the Regulations. Medical devices are categorized into 4 classes based on the risk associated with their use. Class I devices present the lowest potential risk (for example, a tongue depressor) and Class IV devices present the greatest potential risk (for example, a pacemaker).

To demonstrate the safety and effectiveness of a medical device, manufacturers should submit the required, applicable information outlined in this guidance.

Scope and application

All medical devices sold in Canada must be safe and effective. This document is intended to provide guidance on the clinical evidence requirements for Class II, III and IV medical devices.

This guidance should be read along with the following guidance documents:

This guidance expands upon:

This guidance also outlines the general principles and criteria for clinical evidence that supports:

The clinical evidence described in this document should be submitted for review as part of either:

This guidance does not apply to in vitro diagnostic devices (IVDDs).

Manufacturers should also consult other relevant guidance documents as appropriate, including for their device type. For a list of related guidance, see the related links section below.

Please also read the companion document Clinical Evidence Requirements for Medical Devices: Examples. It contains examples of when clinical evidence is more likely or less likely to be required for different types of devices.


In line with international standards, this guidance document adopts many terms defined in the following references:

Clinical data: Safety, clinical performance and/or effectiveness information that is generated from the clinical use of a medical device.

Clinical evidence: Clinical data and its evaluation pertaining to a medical device.

Clinical evaluation: Assessment and analysis of clinical data to verify the safety, clinical performance and/or effectiveness of a medical device when used as intended by the manufacturer.

Clinical investigation: A systematic investigation (or clinical study) in human subjects undertaken to assess the safety and/or effectiveness of a medical device.

Clinical investigation plan: Document that states the rationale, objectives, design and proposed analysis, methodology, monitoring, conduct and record-keeping of a clinical investigation.

Comparator device: Any medical device with one or more characteristics as the subject device. If the comparator device is being used to supplement or replace clinical evidence for the subject device, then similar design, technology and usually intended use and/or indications for use will be required.

A comparator device should be licensed in Canada. If not, please provide objective evidence of safety and effectiveness to Health Canada, along with a side-by-side comparison of device specifications.

Established technology: A technology that is well understood through recognized standards, pre-clinical data, extensive literature, real-world data and clinical data, and has an established risk/benefit/uncertainty profile.

Indications for use: A general description of the disease or condition the medical device or the in vitro diagnostic device (IVD) will diagnose, treat, prevent, cure or mitigate, including a description of the patient population for which the medical device or IVD medical device is intended.

Intended use/intended purpose: The objective intent regarding the use of a product, process or service as reflected in the specifications, instructions and information provided by the manufacturer. (Note: The intended use can include the indications for use.)

Manufacturer: A person who:

Real World Data (RWD): Clinical data on patient status and/or the delivery of health care collected from a variety of sources (for example, data collected from data registries, electronic health records).

Real World Evidence (RWE): Clinical evidence on the usage and potential benefits or risks of a medical product derived from analysis of real-world data (for example, information derived from multiple RWD sources).

Sex and Gender-Based Analysis Plus (SGBA+): An analytical process used to assess how diverse groups of women, men, girls, boys and gender-diverse people may be impacted by products or federal initiatives by considering biological factors related to sex, socio-cultural factors related to gender, race and ethnicity, and other identity factors. Federal initiatives include research, legislation, policies, regulations, programs and services.

Subject device: The medical device referred to in the medical device application.

Note about guidance documents in general

Guidance documents provide assistance to industry and health care professionals on how to comply with governing statutes and regulations. They also provide assistance to staff on how Health Canada mandates and objectives should be implemented in a manner that is fair, consistent and effective.

Guidance documents are administrative instruments. Because they do not have force of law, they allow for a flexible approach. Alternate approaches to the principles and practices described in this document may be acceptable provided they are supported by adequate 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's equally important to note that Health Canada reserves the right to request information or material, or define terms and conditions not specifically described in this document. This allows us to adequately assess the safety, effectiveness or quality of a medical device. We are committed to ensuring that such requests are justifiable and that decisions are documented clearly.

Related links

Health Canada:

International Medical Device Regulators Forum:

International Organization for Standardization:

Association for the Advancement of Medical Instrumentation:


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