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AR 129/91 MEDICAL PROFESSION BY-LAWS

(Consolidated up to 239/2006)

ALBERTA REGULATION 129/91

Medical Profession Act

MEDICAL PROFESSION BY-LAWS

Table of Contents

                1       Definitions


                2       Part I and II registration requirements

             2.1       Review of registration in Alberta Medical Register

                3       Courtesy Register

                4       Special Register

             4.1       Educational and training requirements

             4.2       Compliance with section 2(1)

             4.3       Conditions, limitations and restrictions

             4.4       Removal from the Special Register

                5       Educational Register

                6       Application requirements

             6.1       Registration information form

             6.2       Liability Insurance

             6.3       Appeals under Act s50

                8       Repeal

Schedule

Definitions

1   In these By-laws,

                                 (a)    “Act” means the Medical Profession Act;

                                 (b)    “certificate of registration from the Medical Council of Canada” means a certificate indicating that the examination requirements of the Medical Council of Canada have been met;

                              (b.1)    “special emergency” means a state of immediate need for medical services due to an actual or potential threat of serious harm to safety, health or welfare of the public, as determined by the Registrar, which may include, but is not limited to, a state of emergency or a state of local emergency declared pursuant to the Disaster Services Act, and a state of public health emergency or a local state of public health emergency declared pursuant to the Public Health Act;

                                 (c)    “telemedicine” means the provision of a medical service or opinion to a patient in Alberta by a physician located outside Alberta, based on information about the patient transmitted to the physician by electronic or other means.

AR 129/91 s1;110/94;64/2002;62/2005

Part I and II registration requirements

2(1)  Every applicant for registration in Part I of the Alberta Medical Register shall

                                 (a)    complete an application or other form prescribed by the registrar;

                                 (b)    send to the registrar

                                           (i)    a certificate of registration from the Medical Council of Canada;

                                          (ii)    a certificate from the College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada, as evidence of satisfactory completion of a period of post‑doctoral training;

                                         (iii)    the registration fee and the annual fee;

                                         (iv)    evidence satisfactory to the registrar of the applicant’s identity, including a recent dated photograph similar to a passport photograph;

                                          (v)    repealed AR 110/94 s3;

                                         (vi)    the names and addresses of at least 3 character references of recent acquaintance, acceptable to the registrar;

                                        (vii)    evidence that the applicant is a Canadian citizen or meets the immigration or entry requirements set by the Government of Canada;

                                 (c)    satisfy the registrar that upon registration the applicant will forthwith commence the practice of medicine in the Province of Alberta;

                                 (d)    satisfy the registrar of his ability to communicate in one of Canada’s official languages;

                                 (e)    satisfy the registrar that he is of good character and reputation, that his name has not been struck off a register of any licensing authority and that he is not or has not been suspended by any licensing authority or tribunal in Canada or elsewhere.

(1.1), (1.2)  Repealed AR 64/2002 s3.

(1.3)  Every applicant for renewal of registration in Part I of the Alberta Medical Register shall send to the registrar the annual fee as set out in the by-laws of the council.

(2)  Every applicant for registration in Part II of the Alberta Medical Register shall

                                 (a)    fulfil the requirements of subsection (1) except clause (b)(ii);

                                 (b)    send to the registrar

                                           (i)    satisfactory evidence of having successfully graduated from a school of osteopathy accredited by the American Osteopathic Association;

                                          (ii)    repealed AR 29/95 s2;

                                         (iii)    satisfactory evidence of having successfully completed the Universities Co-ordinating Council Examination;

                                         (iv)    evidence of having completed a period of satisfactory post-qualification training of 2 years duration at an allopathic institution approved by the council of the College of Physicians and Surgeons of Alberta.

                                 (v) ‑ (ix)    repealed AR 110/94 s3;

                          (c), (d)    repealed AR 110/94 s3.

AR 129/91 s2;110/94;264/94;29/95;64/2002

Review of registration in Alberta Medical Register

2.1(1)  The council may review the medical practice of a person registered in Part I or Part II of the Alberta Medical Register for the purpose of satisfying itself that the medical practice of that person reflects competence in the care of patients.

(2)  If the council is not satisfied as to the competence of a registered practitioner, it may

                                 (a)    initiate an investigation, or

                                 (b)    direct the registered practitioner to complete any educational or training program specified by it.

AR 110/94 s4

Courtesy Register

3   Every applicant for registration in the Courtesy Register must

                                 (a)    satisfy the registrar as to the applicant’s training and competence,

                                 (b)    fulfil the requirements of section 2(1) except clauses (b)(i) and (ii) and (c), and

                                 (c)    advise the registrar of the period for which registration in the Courtesy Register is needed.

AR 129/91 s3;110/94

Special Register

4(1)  The Special Register may be divided into the following Parts:

                                 (a)    Part 1 - conditional non-specialty practice;

                                 (b)    Part 2 - conditional defined practice;

                                 (c)    Part 3 - military practice;

                                 (d)    Part 4 - administrative medical practice;

                                 (e)    Part 5 - provisional practice;

                                  (f)    Part 6 - telemedicine practice;

                                 (g)    Part 7 - physician extenders;

                                 (h)    Part 8 - psychiatric residents;

                                  (i)    Part 9 - special emergency practice.

(2)  Part 1 of the Special Register includes the names of registered practitioners who meet the requirements of section 4.1(1) and conduct or will be conducting a general medical practice in a specified underserviced community.

(3)  Part 2 of the Special Register includes the names of registered practitioners who meet the requirements of section 4.1(2) and conduct or will be conducting a medical practice limited to the activities of a specialty discipline in a specified practice setting.

(4)  Part 3 of the Special Register includes the names of registered practitioners who meet the requirements of section 4.1(3) and practise or will be practising medicine on a military base.

(5)  Part 4 of the Special Register includes the names of registered practitioners who meet the requirements of section 4.1(4) and act or will be acting in an administrative capacity where licensure by the College is required.

(6)  Part 5 of the Special Register includes the names of registered practitioners who meet the requirements of section 4.1(5) and practise or will be practising medicine in a community designated as having an emergency requirement under section 4.3(3).

(7)  Part 6 of the Special Register includes the names of registered practitioners who meet the requirements of section 4.1(6), practise or will be practising telemedicine from a location outside Alberta and are not registered in the Alberta Medical Register or another part of the Special Register.

(8)  Part 7 of the Special Register includes the names of post‑graduate medical students who meet the requirements of section 4.1(7) and practise or will be practising medicine in a hospital‑based program approved by the registrar for that purpose.

(9)  Part 8 of the Special Register includes the names of post‑graduate medical students who meet the requirements of section 4.1(8) and practise or will be practising medicine in a psychiatric program in a facility designated under the Mental Health Regulation (AR 309/89).

(10)  Part 9 of the Special Register includes the names of registered practitioners who meet the requirements of section 4.1(9) and practise or will be practising medicine for the period of time and the extent necessary to address a special emergency.

AR 129/91 s4;110/94;158/99;64/2002;62/2005

Educational and training requirements

4.1(1)  Each applicant for registration in Part 1 of the Special Register must

                                 (a)    be a graduate of

                                           (i)    a medical school approved or accredited by the committee on Accreditation of Canadian Medical Schools of the Association of Canadian Medical Colleges and the Canadian Medical Association or the Liaison Committee on Medical Education of the Association of American Medical Colleges and the American Medical Association, or

                                          (ii)    a school of medicine that is listed in the Directory of the World Health Organization and has carried on a medical education program for more than 10 years and offers a medical training program of at least 48 months in duration,

                                 (b)    hold a certificate of registration from the Medical Council of Canada,

                                 (c)    satisfy the registrar that the applicant has satisfactorily completed a 24‑month training program with a 60‑week training course that includes 12 weeks in family medicine and at least 8 weeks in each of medicine, surgery, obstetrics and gynaecology, paediatrics, psychiatry and emergency medicine,

                                 (d)    complete a period of peer assessment in Alberta, satisfactory to the registrar, and

                                 (e)    complete a period of supervised integration into the practice of medicine in Alberta, satisfactory to the registrar.

(2)  Each applicant for registration in Part 2 of the Special Register must

                                 (a)    comply with subsection (1)(a), (b), (d) and (e), and

                                 (b)    satisfy the registrar that the applicant has completed a specialty certification outside Canada that is substantially equal to the specialty certification recognized by the council and required for registration in the Alberta Medical Register.

(3)  Each applicant for registration in Part 3 of the Special Register must

                                 (a)    comply with subsection (1)(a), (b), (d) and (e), and

                                 (b)    comply with either subsection (1)(c) or (2)(b).

(4)  Each applicant for registration in Part 4 of the Special Register must comply with subsection (1)(a) and (b).

(5)  Each applicant for registration in Part 5 of the Special Register must

                                 (a)    comply with subsection (1)(a), (d) and (e), and

                                 (b)    provide evidence satisfactory to the registrar that the applicant is competent to practise medicine.

(6)  Each applicant for registration in Part 6 of the Special Register must provide to the registrar

                                 (a)    a copy of the applicant’s certificate of standing from the licensing authority in the jurisdiction in which the applicant practises medicine, and

                                 (b)    satisfactory evidence of having successfully completed training in the discipline in which telemedicine services will be provided, that is in the registrar’s opinion equivalent to the training that is required in Alberta of a registered practitioner providing those services.

(7)  Each applicant for registration in Part 7 of the Special Register must comply with subsection (1)(a), (b) and (e) and

                                 (a)    must meet the following requirements:

                                           (i)    be registered in Class One of the Educational Register;

                                          (ii)    have successfully completed 18 months of training in the post‑graduate medical program in which the applicant is registered;

                                         (iii)    have obtained the approval of the director of the post‑graduate medical program in which the applicant is registered prior to making the application,

                                     or

                                 (b)    must hold a clinical fellowship or research position and have completed medical training that the registrar has determined to be substantially equivalent to the training required under clause (a)(ii).

(8)  Each applicant for registration in Part 8 of the Special Register must

                                 (a)    comply with subsection (1)(a) and (b),

                                 (b)    have successfully completed 18 months of training in a psychiatric residency program, and

                                 (c)    have obtained the approval of the director of the psychiatric residency program in which the applicant is registered prior to making the application.

(9)  Each applicant for registration in Part 9 of the Special Registry must

                                 (a)    comply with subsection (1)(a), and

                                 (b)    satisfy the registrar that the applicant is actively registered and permitted to practise medicine in another province or a territory of Canada or in the United States of America.

AR 110/94 s6;207/95;64/2002;62/2005

Compliance with section 2(1)

4.2(1)  Subject to this section, an applicant for registration in any Part of the Special Register must comply with section 2(1).

(2)  An applicant for registration in Parts 1 to 4 of the Special Register need not comply with clause (b)(ii) of section 2(1).

(3)  An applicant for registration in Part 5 of the Special Register need not comply with clause (b)(i) or (ii) of section 2(1).

(4)  An applicant for registration in Part 6 of the Special Register need not comply with clause (b)(i), (ii) or (vii) or (c) of section 2(1).

(5)  An applicant for registration in Part 7 or 8 of the Special Register need not comply with clause (b)(ii) of section 2(1).

(6)  An applicant for registration in Part 9 of the Special Register need not comply with clause (b)(i), (ii), (iii), or (vi) of section 2(1).

AR 110/94 s6;64/2002;62/2005

Conditions, limitations and restrictions

4.3(1)  Each applicant for registration in any Part of the Special Register must

                                 (a)    agree to begin practising medicine or begin employment in Alberta forthwith after being registered in the Special Register, and

                                 (b)    agree, in writing, to comply with the conditions, limitations and restrictions imposed on the applicant by the council, including any of the following:

                                           (i)    that the applicant practise medicine only in a specified location or employment setting;

                                          (ii)    that the applicant practise medicine only in a specified type of practice;

                                         (iii)    that the applicant refrain from practising medicine outside of the applicant’s employment;

                                         (iv)    that the applicant practise medicine under supervision specified by the council;

                                          (v)    that the applicant complete a documented period of peer assessment in Alberta, satisfactory to the registrar;

                                         (vi)    that the applicant complete a period of supervised integration into the practice of medicine in Alberta, satisfactory to the registrar.

(2)  Each registration in Part 5 of the Special Register is valid for up to 30 months after the date the applicant’s name is added to the register.

(3)  The Minister of Health and Wellness must approve an Alberta community as having an emergency requirement for a registered practitioner before an application for registration in Part 5 of the Special Register may be made.

(4)  Each person registered in Part 7 of the Special Register must

                                          (a)    maintain an academic standing that is satisfactory to the director of the training program in which the person is registered,

                                          (b)    maintain competence in the post‑graduate program as evidenced by semi-annual reports provided by the post‑graduate dean of the faculty of medicine at the University of Alberta or the University of Calgary,

                                 (c)    maintain professional liability insurance that is satisfactory to the registrar, and

                                 (d)    comply with the terms of the agreement between the Council of Teaching Hospitals of Alberta and the Provincial Association of Residents of Alberta.

(5)  Each person registered in Part 8 of the Special Register must

                                 (a)    maintain an academic standing that is satisfactory to the director of the training program in which the person is registered,

                                 (b)    successfully complete an in‑service training program relating to the Mental Health Act and the issuance of admission certificates under that Act,

                                 (c)    maintain professional liability insurance that is satisfactory to the registrar, and

                                 (d)    comply with the terms of the agreement between the Council of Teaching Hospitals of Alberta and the Provincial Association of Residents of Alberta.

AR 110/94 s6;206/2001;64/2002

Removal from the Special Register

4.4(1)  If the council is not satisfied as to the competence of a person registered in the Special Register, the council may direct that the person’s name be removed from the Special Register and added to the Educational Register.

(2)  A person whose name has been added to the Educational Register under subsection (1) must begin the training program required by the council within 3 months of his or her name being added to the Educational Register.

(3)  If a person referred to in subsection (2) fails to satisfactorily complete the training program required by the council, the council may remove the person’s name from the Educational Register.

AR 110/94 s6

Educational Register

5   The Educational Register is divided into 2 classes as follows:

                                 (a)    Class One - post-graduate medical training;

                                 (b)    Class Two - undergraduate medical training.

AR 129/91 s5;110/94;264/94

Application requirements

6(1)  An applicant for registration in Class One of the Educational Register must

                                 (a)    fulfil the requirements of section 2(1) except clause (b)(i) and (ii),

                                 (b)    be a graduate of

                                           (i)    a Canadian medical school,

                                          (ii)    a medical school in the United States of America, approved by the council,

                                         (iii)    a school of medicine listed in the Directory of the World Health Organization that has carried on a medical education program for more than 10 years and offers a medical training program of at least 48 months in duration, or

                                         (iv)    a school of osteopathy accredited by the American Osteopathic Association,

                                 (c)    be undergoing a period of post-graduate medical training in Alberta, and

                                 (d)    have passed Part 1 of the Qualifying Examination set by the Medical Council of Canada.

(2)  An applicant for registration in Class Two of the Educational Register must

                                 (a)    fulfil the requirements of section 2(1) except clauses (b)(i), (ii) and (vi) and (c), and

                                 (b)    submit evidence satisfactory to the registrar that the applicant is

                                           (i)    an undergraduate enrolled in a faculty of medicine at a university in Alberta, or

                                          (ii)    an undergraduate of another medical school who is completing an undergraduate medical education at a university in Alberta.

AR 129/91 s6;110/94;264/94

Registration information form

6.1   For the purposes of sections 20(1)(b), 23(2) and 29 of the Act, a registration information form must be in the form set out in the Schedule.

AR 242/95 s2;251/2001

Liability insurance

6.2(1)  For the purposes of registration as a limited liability partnership under Part 2.1 of the Partnership Act, a registered practitioner or professional corporation must obtain and maintain professional liability insurance or other protection against professional liability in an amount of at least $2 000 000 per occurrence, insuring the registered practitioner or professional corporation against any debt, obligation or liability of the registered practitioner or professional corporation, limited liability partnership or another partner that arises from or relates to the negligence, wrongful acts or omission, malpractice or misconduct of the registered practitioner, professional corporation or another partner, employee, agent or representative of the partnership for whom the registered practitioner or professional corporation is responsible.

(2)  Not later than December 31 of each year, a partnership that is registered as a limited liability partnership under Part 2.1 of the Partnership Act must provide to the Registrar proof that the insurance or other protection required under subsection (1) has been obtained or is maintained, to the satisfaction of the Registrar.

(3)  On registration as a limited liability partnership under Part 2.1 of the Partnership Act, a partnership must provide to the Registrar proof that the notice required by section 79.5 of the Partnership Act has been given.

AR 64/2002 s8

Appeals under Act s50

6.3(1)  The council may establish an appeals committee, consisting of the members of the council appointed under subsection (2), to hear appeals and make directions under section 50(1) of the Act.

(2)  The appeals committee shall consist of at least 3 members of the council, at least one of whom must be a member appointed under section 10(b) of the Act.

(3)  A person may be appointed as a member of the appeals committee for a term of not more than one year, and is eligible for reappointment.


(4)  The council shall appoint one of the members of the appeals committee to be chair of the appeals committee.

(5)  The appeals committee shall forthwith after making a direction under section 50(1) of the Act in respect of an appeal, make a report to the council on the particulars of the appeal and its direction.

AR 62/2005 s6

7   Repealed AR 110/94 s8.

Repeal

8   The Medical Profession By-laws (Alta. Reg. 322/86) are repealed.

AR 129/91 s8

Schedule   

College of Physicians and
Surgeons of Alberta

Registration Information Form

1.   PERSONAL INFORMATION - The CPSA classifies the data in this section as public, with the exception of the registration number, which is classified as confidential

1.  Registration Number:

 

2.  Surname

                                                                       

If your surname has changed, include official documentation

3.  Given Names

                                                                       

4.  Preferred Name

                                                                       

If you work professionally under a different name, please indicate that name above

5.  Languages Spoken                                                                                                                                                                                         

   other than English

                                                           

languages in which you are sufficiently fluent to practise Medicine

2.   ADDRESS INFORMATION - The CPSA classifies the data in this section as confidential, except for the e‑mail address in section D and the address in section E when designated for public release by the physician

A.  Primary Professional Address

If you work at more than one location, please provide both a Primary and Secondary Address.

1.  Address Line 1                               Address Line 1                                  

2.  Address Line 2                               Address Line 2                                  

3.  City                                                City                                                   

4.  Province/State/Country                  Province/State/Country                    

5.  Postal/Zip Code                             Postal/Zip Code                                

6.  Business Phone                              Business Phone (     )                        

7.  Business Fax                                   Business Fax (     )                            

8.  Business Phone (Direct Line)         Business Phone (     )                        

9.  Pager                                               Pager                                                 

10. Cellular Phone                               Cell Phone (     )                                

B.  Secondary Professional Address

1.  Address Line 1                               Address Line 1                                  

2.  Address Line 2                               Address Line 2                                  

3.  City                                                City                                                   

4.  Province/State/Country                  Province/State/Country                    

5.  Postal/Zip Code                             Postal/Zip Code                                

6.  Business Phone                              Business Phone (     )                        

7.  Business Fax                                   Business Fax (     )                            

8.  Business Phone (Direct Line)         Business Phone (     )                        

C.  Home Address - (Optional)

1.  Address Line 1                               Address Line 1                                  

2.  Address Line 2                               Address Line 2                                  

3.  City                                                City                                                   

4.  Province/State/Country                  Province/State/Country                    

5.  Postal/Zip Code                             Postal/Zip Code                                

6.  Phone                                              Phone (     )                                       

7.  Listed? (Yes/No)                            Listed?                Yes         No

8.  Fax (Private)                                   Fax (     )                                            

D. Electronic Address

1.  E‑Mail Address                    E‑mail                                                          

                                                    For Public Release?       Yes       No

E.   Published Address Designation

1.        Which address would you prefer to have published in the Medical Directory?  You must choose one of the following:

       Primary Professional       Secondary Professional
  Home

F. College Mail Address Designation

1.        To which address would you like College mail delivered?

           You must choose one of the following:

             Primary Professional      Secondary Professional
  Home

                                       For sections 3 through 6, please add, change or delete information as appropriate.

                                       Your responses will not affect your licence or registration status.

                                       If there is insufficient space to record information, please list additional information on a separate page.

G. Emergency Contact Information ‑ Alberta location

1.        24‑hour emergency contact telephone number(s):
(
    )                                 
(
    )                                 

(best contact number(s) where you can be reached in the event of a public health crisis or other disaster)

2.        Dissemination of information:

(preferred method to receive information related to a public health crisis or other disaster)

  Fax:   (      )                               
  E‑mail address:                                      

3.   TRAINING AND LICENSING - The CPSA classifies the data in this section as public, except for the data under section C, Other Medical Licences, which is classified as confidential

A.  Accredited Post Graduate Training

                                       Please include ALL pertinent post‑graduate training whether or not it led to certification (exclude short CME Courses)

                                       If training was at an institution outside of Canada, only the name of the country is required.

University
(please indicate CANADIAN University, rather than training site)

Country, (for training completed OUTSIDE OF CANADA)

Discipline/ Area of  Study

Date Started(Month/Year)

Date Completed(Month/ Year)

Example: U of T

 

Orthopaedic Surgery

07/98

06/00

 

USA

Orthopaedic Surgery

07/00

06/02

 

 

 

 

 

B. Fellowships:

                                       Please provide ALL pertinent fellowships, indicating the type of fellowship as follows:

CLIN = Clinical fellowship                           RES = Research        
C/R = Clinical/Research Fellowship

Type of Fellowship (include codes as above)

University (please indicate CANADIAN University, rather than training site)

Country (for training completed OUTSIDE OF CANADA)

Discipline/ Area of Study

Date Started (Month/ Year)

Date Completed (Month/ Year)

Example: C/R

 

USA

Spine Surgery

11/01

01/02

 

 

 

 

 

 

 

 

 

 

 

 

C.  Other Medical Licenses

Please list the medical licences you have held (current or lapsed) in jurisdictions other than Alberta.

  Not Applicable

Province/State/ Country

Year Obtained

Licence Number

Active?

 

 

 

 

Yes

No

 

 

 

Yes

No

 

 

 

Yes

No

 

 


4.   PROFESSIONAL WORK - The CPSA classifies the data in this section as confidential and it is only released in aggregate format

         Please indicate the average percentage of your professional time spent in each of the following activity areas, even if the amount is zero (0%).

         A percentage must be indicated for each category.

         Physicians who hold a licence to practise but who are also undergoing post‑graduate training are to complete this section with respect to their private practice only (e.g. not residency or fellowship related work).

             The total percentage (from A to H, excluding A.1) must equal 100%.

 

1.

Activities

0%

1-5

6-15

16-25

26-40

41-60

61-75

76-85

86-95

95-100

 

A.

Direct patient Care in a Clinical Setting* (Hospital in-patient, ambulatory, day care, as well as non-hospital practice).

A.1

*Of this portion of your practice, what percentage included your functioning in a teaching role.

B.

Other Patient Care (charting, writing letters and reports, phone calls concerning patient care, meeting with family members and dealing with other health care providers).

C.

Teaching - not involving Patient Care (direct contact with students, preparation, marking, reporting, etc.).

D.

Administration (management and/or administration; may also include management of university programs, preceptorships, etc.).

E.

Research (includes management of research, preparing publications, etc.).

F.

Health Facility Committees (RHA, Hospital and University Committees, etc.).

 

 

G.

Managing your practice (office staff, facilities, equipment, pharmaceutical representatives, etc.).

H.

Other Activities (participation in professional or specialty organizations.  Do not include CME activities).

2.   On average, how many hours per week do you spend in the above activities?

≤10 hrs

11‑20 hrs

21‑35 hrs

36‑45 hrs

46-55 hrs

56-65 hrs

66-75 hrs

> 75 hrs

3.  In the past 12 months, how many weeks did you spend in the above activities?

≤8 wks

9‑16

17‑24

25‑32

33‑40

41‑44

45‑48

49‑52

4.  On average, how many hours per week do you spend on‑call?

≤10 hrs

11‑20

21‑35

36‑45

46‑55

56‑65

66‑75

> 75

5.  Do you expect the amount you work to change significantly in the upcoming year?

□  Somewhat lower next year

□  Much lower next year

□  Basically the same

□  Somewhat higher next year

□  Much higher next year

 


5.   CLINICAL PRACTICE - The CPSA classifies the data in this section as public

                                       When completing the practice description, please choose codes that reflect your actual practice (i.e. “What do you”), rather than the certifications you may hold.

                                       If you list more than one code, please estimate the percentage of time you spend in each area, ensuring the total equals 100%.

                                       Physicians who hold a licence to practise but who are also undergoing post‑graduate training are to complete this section with respect to their private practice only (e.g. not residency or fellowship work).

1.  Practice Description:

CODE

PRACTICE DESCRIPTION

PERCENTAGE

Example: 01

Anaesthesia

100%

 

 

 

 

 

 

 

 

 

 

ANAESTHESIA
01 Anaesthesia

02 Chronic Pain Management without General/Spinal Anaesthesia

 

03 GENERAL PRACTICE*

OBSTETRICS AND GYNECOLOGY

50 Gynecologic Oncology

51 Gynecologic
 Reproductive
 Endocrinology and
 Fertility

52 Gynecologic Surgery
 without labor and
 delivery

78 Colorectal Surgery

79 General Surgery

80 General Surgical Oncology

81 Neurosurgery

82 Ophthalmology

83 Orthopaedic Surgery

84 Otolaryngology

85 Plastic Surgery

 

     * If any other code listed on this table makes up 20% or more of your practice, please include those codes when completing the table.

53 Gynecology

54 Obstetrical Practice
 without Labor and
 delivery

55 Obstetrics

 

PEDIATRICS

60 Neonatology

61 Pediatrics

86 Surgical Practice without operative treatment

87 Thoracic Surgery

88 Urology

89 Vascular Surgery

875 Transplant Surgery

MEDICINE

10 Allergy

11 Cardiology

12 Clinical
     Immunology

13 Clinical Associates ‑
Medical

14 Clinical
Pharmacology

646 Pediatric
  Anaesthesia

62 Pediatric Cardiology

647 Pediatric
   Emergency Medicine

63 Pediatric Nephrology

64 Pediatric Neurology

65 Pediatric Surgery

66 Pediatric

OTHER

17 Emergency Medicine / Emergentology

90 Acupuncture

91 Administrative Medicine

92 Community Medicine       (Public Health)

93 Palliative Care

15 Critical Care
     Medicine 16 Dermatology 18 Endocrinology

19 Gastroenterology

20 Genetics

21 Geriatric Medicine

22 Hematology

23 Infectious Disease

24 Internal Medicine

25 Medical Oncology

   Allergy/Clinical
Immunology

67 Pediatric Oncology 68 Pediatric Orthopedics

625 Pediatric
  Gastroenterology

627 Pediatric   Hematology

628 Pediatric    Hematology/
  Oncology

95 Sport Medicine

96 Clinical Fellows for up to 24 months of additional training immediately following basic PGT without moonlighting

98 Postgraduate Trainee without moonlighting

99 Postgraduate Trainee with moonlighting

26 Nephrology

27 Neurology

28 Nuclear Medicine

29 Occupational
Medicine

30 Physical Medicine &
Rehabilitation

31 Respiratory Medicine

32 Rheumatology

629 Pediatric Infectious   Diseases

645 Pediatric   Respiratory   Medicine

 

PSYCHIATRY

94 Psychiatry

944 Psychotherapy

945 Child and
  Adolescent Psychiatry

947 Substance Abuse/   Addiction

954 Aviation Medicine

955 Hyperbaric/Diving   Medicine

956 Sleep Medicine

 

LABORATORY MEDICINE

40 Medical Biochemistry

41 Medical Microbiology

42 Pathology ‑ Anatomic

43 Pathology ‑ General

44 Pathology ‑ Hematological

45 Pathology ‑ Neurological

948 Forensic Psychiatry

949 Geriatric Psychiatry

 

RADIOLOGY

70 Diagnostic Imaging

71 Therapeutic Radiology

/Radiation Oncology

 

SURGERY

74 Laser Surgery

75 Surgical Assistance ‑ No other professional work

76 Cardiovascular
     Surgery

77 Clinical Associates ‑
     Surgical

UNLISTED

100 use this code for any   practice types not   listed in the table,   then describe your   practice

2.  Have you limited your practice exclusively to any specific area(s)?

       (e.g. Psychiatry - Child, Adolescent; No Obstetrics, etc.)

       Yes         No  

       If “Yes”, please specify:                                                                         

 


3.  Service Location

             Please indicate the Community(ies) you practise in, and the percentage of time you practise in each.  Respond to the appointment and privileges questions for each entry you listed, expanding the focus to include not only the Community you listed but others within the same regional boundary.

 

Practice Location Community

Percentage of  Time

Do you hold an appointment to the Medical Staff in this regional boundary?

Do you have investigation and treatment privileges in a hospital within this regional boundary?

Do you have admitting privileges to a hospital within this regional boundary?

Do you provide services in conjunction with the Cancer Board?

Percentage of Time

 

 

  Yes

  No

  Yes

  No

  Yes

  No

  Yes

  No

 

 

 

  Yes

  No

  Yes

  No

  Yes

  No

  Yes

  No

 

 

 

  Yes

  No

  Yes

  No

  Yes

  No

  Yes

  No

 

 

 


4.  University Affiliation:

If you currently hold a university position in Alberta, please indicate Position/Rank, Department and University.

 

POSITION / RANK

DEPARTMENT

UNIVERSITY

Example: Associate Professor

Medicine

University of Alberta

 

 

 

 

 

 

5.    a)       Are you accepting new patients?    Yes    No

       b)       If “Yes”, at which Professional address?

         Primary Address    Secondary Address

       c)       If “Yes”, are there any restrictions upon the type of new patients your practice is accepting?

       (e.g.: Obstetrical only, Fatigue Disorders, Sports Medicine, etc.)

         Yes    No

       If yes, please specify:                                                                             

6.    Do you make house calls?    Yes    No

7.    Is your practice wheelchair accessible?    Yes    No

8.    Non‑Certified Interest Area (NCIA)

                                       This is strictly an area of interest in which you welcome public awareness (e.g.: Diabetes, Arthritis, Cerebral Palsy, Multiple Sclerosis, etc.)

                                       Please provide information regarding medical areas in which you have a personal interest and understanding.

                                       No further education and/or training is required to list an NCIA.

                                                                                                                       
                                                                                                                       

6.   CONTINUING MEDICAL EDUCATION (CME) - The CPSA classifies the data in this section as confidential, and it is only released in aggregate format

                                       The time spent in activities listed in questions 1 and 2 of this section are not intended to overlap.  We are trying to address different aspects of CME activity.

1.    On average, in the past 12 months, how many hours per week have you spent on the following CME activities?

 

< 0.5 hours

.5 to 1.5 hours

1.5 to 2.5 hours

2.5 to 2.5 hours

3.5 to 5 hours

> 5 hours

Reading (journals etc.)

 

 

 

 

 

 

Audiotapes

 

 

 

 

 

 

Videos

 

 

 

 

 

 

Rounds at Health Care Facility

 

 

 

 

 

 

Consultation with Colleagues

 

 

 

 

 

 

Computer-Based Learning

 

 

 

 

 

 

Journals Clubs

 

 

 

 

 

 

Other (please specify:

                   )

 

 

 

 

 

 

2.    Over the past 12 months, how many days have you spent at each of the following CME activities ?

 

0 days

1‑2 days per year

3-5 days per year

6-10 days per year

11-20 days per year

> 20 days per year

Conferences (Scientific Meetings)

 

 

 

 

 

 

Courses, Workshops, Traineeships, etc.

Specify:                                                                                                                    

 

 

 

 

 

 

Self directed Learning Activities

Specify:                                                                                                                    

 

 

 

 

 

 

Other Formal Learning Activities

Specify:                                                                                                                    

 

 

 

 

 

 

3.    Last year, did you record your CME activities in the MAINCERT Program of the Royal College of Physicians and Surgeons of Canada or the MAINPRO Program of the College of Family Physicians of Canada?

  Yes    No

7.   SIGNATURE

I affirm that, to the best of my knowledge, the information contained in this Registration Information Form is true and accurate.

__________________________                                                     

PHYSICIAN’S SIGNATURE                     DATE

TAX RECEIPTS WILL BE ISSUED ONLY UPON RECEIPT OF YOUR PAYMENT AND COMPLETED REGISTRATION INFORMATION FORM.

 

 

 

 

Questions?             Office hours are 8:15 a.m. to 4:15 p.m.

                               Outside Edmonton:  Please call  1‑800‑320‑8624

                               Edmonton:  Please call  780-423‑4764

                               Website Address:  www.cpsa.ab.ca

 

                               College of Physicians and Surgeons

                               Province of Alberta

                               900 Manulife Place

                               10180 101 Street

                               EDMONTON  AB  T5J 4P8

Appendix

Protection of Information

The College of Physicians and Surgeons of Alberta respects physicians’ right to privacy, and has policies and procedures in place to protect it.  Any personal information the College collects is in compliance with the Medical Profession Act.  The College collects only what is necessary for its operation and uses that information only for the purpose(s) for which it was collected, or for a use consistent with that purpose.

The College occasionally discloses information to authorized researchers for planning resource allocation, health system management, health policy development or provision of health services.  In these cases the least amount of information is disclosed at the highest level of anonymity to fulfill the intended purpose(s), and confidentiality agreements are signed.  The information will be disclosed as per the classifications listed below:

INFORMATION CLASSIFICATIONS

Restricted:          Information that is sensitive and/or potentially damaging to the individual is closely protected and judiciously disclosed.

Internal:               Information that is used only for College internal purposes and will not be disclosed to external parties.

Confidential:       Information that is primarily for College use but may be disclosed to authorized users for specific purposes such as Alberta Health, Alberta Medical Association, Universities, and Regional Health Authorities.

Public:                  Information that is used and disclosed freely.

If you have any questions about the collection, use or disclosure of information relative to you, you may call (780) 423-4764.

AR 242/95 s3;23/2000;62/2005;239/2006

 
 
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