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Supporting documentation

Checklist for appointment to a medical facility

Certificate of professional conduct

Physicians and podiatric surgeons must request a certificate of professional conduct from the registration department and submit it to the facility medical director with the application package. The fee will be waived for initial applications to an accredited private medical/surgical facility.

Dentists must request a letter of standing from the BC ºÚÁÏÉç of Oral Health Professionals and submit it to the medical director with the application package (fees may apply).

Hospital letter

A letter must be submitted for all physicians who hold current hospital privileges.

The letter must specify

• the physician’s specialty,
• type of privileges held (e.g. active, provisional, locum), and
• that the physician is in good standing.

For physicians who hold locum privileges, a full description of those privileges must be provided, including the type and number of procedures performed in the past three years.

If a physician making application holds active privileges at more than one hospital, the letter must come from the hospital where the physician performs the broadest scope and highest volume of procedures.

Hospital letters must be on health authority or hospital letterhead.

Registrant designate form

Physicians who do not hold current health authority privileges must have a designate to ensure continuity of care.

NHMSFAP Registrant Designate form

Curriculum vitae (CV)

Applicants who do not hold current health authority privileges must provide a current CV that outlines:

• education
  • post-secondary professional education (institution(s), date(s), degree(s))
  • internship, residencies, clinical, teaching, or research fellowships
  • specialist qualifications/fellowship/certification by appropriate bodies
  • other graduate education
     
• experience
  • clinical experience
  • hospital appointments and professional associations
  • teaching, research, public health, administration experience
  • other experience (special interests, community involvement, etc.)
     
• publications

References (two)

A reference from each of the following is required:

1. head of hospital department or division/senior medical administrator/program director with accountability for monitoring the quality of medical care provided by the applicant
2. medical colleague that has observed the applicant’s clinical skills related to the requested privileges

References must have current knowledge of the applicant and their practice.

Reference for Applicants for Privileges form

Basic life support certification (for health-care providers)

A copy of current basic life support (BLS) certification or recertification must be included with the application. Online courses without a hands-on component are not accepted. BLS certification is valid for two years from date of issuance.

Note: Anesthesiologists with current hospital practice are exempt from BLS requirements.

Advanced cardiac life support certification (if applicable)

A copy of current advanced cardiac life support (ACLS) certification or recertification must be included with the application. Online courses without a hands-on component are not accepted. ACLS certification must be renewed every two years.

Current ACLS certification is required for:

• all physicians requesting to administer or monitor patients receiving IV procedural sedation when an anesthesiologist is not present for the case
• anesthesiologists that have not held active or provisional privileges in the health authority within the previous three years

Difficult airway management course (if applicable)

A current difficult airway management course is required for anesthesiologists that have not held active or provisional privileges in the health authority within the previous three years. Difficult airway management courses must be renewed every three years.

Other skills and training documentation relevant to the requested procedures

Examples:

• PALS
• radiation safety
• laser certification