FPSC Protecting Patient Information Course Application Form - Jan - April 2025

Participation Criteria

Please answer the below eligibility criteria.
To be eligible for this course, you need to be currently employed as an MOA in practice, if you are employed by the Division of Family Practice, please reach out to DTOinfo@doctorsofbc.ca for more information regarding Protecting Patient Information training opportunities in your community.

Course dates will be weekly on Tuesday evenings from 6:30-8:30pm from Jan 28, 2025 - April 8, 2025 (no classes between March 4-April 7, 2025)

Applications will be reviewed by Doctors of BC and spaces in the course will be offered by email from Doctors of BC between Dec 12-18, 2024 and Jan 2-Jan 8, 2025. Please reply to Doctors of BC within 2 business days of receiving the email to hold your space in the course. If no response is received, the space will be offered to another applicant.

Question Title

* 1. UFV Registration: Applicant information (Please provide your personal email and phone number as this will be used for UFV registration)

First Name / Last Name

Former Last Name (if applicable)

HOME Address

Address 2

City/Town

Province

Postal Code

Personal Email Address

Personal Phone Number

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* 2. Clinic Information

Clinic Name

Clinic Address

City

Province

Postal Code

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* 3. Clinic Type

Family Practice

Specialist

Other (please specify)

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* 4. Date of Birth (Required for UFV Registration)

DD/MM/YYYY

Date

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* 5. Gender (Required for UFV Registration)

Male

Female

Other

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* 6. How many full time physicians do you have at your clinic?

0-2

3-6

more than 6

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* 7. Have you been an MOA for 2 or more years?

Yes