CPSA

Clinic Registry - Tell us about your facility

Thank you for your interest in CPSA's Medical Clinic Registry. In order to determine if your facility meets our criteria for registration, please answer the following questions.

If you have any questions or concerns, please contact the CPSA Clinic Registry at 780-969-5001 or clinicregistry@cpsa.ab.ca.

Attention New Medical Clinics: Do not complete this application until you have secured a location, selected a clinic name, and confirmed that will be at least one CPSA registered physician practicing at this location.

Title (Mr./Ms./Dr.)*

First name*

Last name*

Clinic title/role*

Direct phone number*

Email address*

Facility/Clinic Name*

Address Search*

Apt#/Unit/Suite

Formatted*

CPSA Registered Physicians

1. Are any physicians practicing at this location, registered with the College of Physicians & Surgeons of Alberta (CPSA)?*

Yes - CPSA Physician(s) practice at this location.

No - There are no CPSA registered physicians practicing at this location.

THERE ARE NO CPSA REGISTERED PHYSICIANS PRACTICING AT THIS LOCATION

All physicians, surgeons and osteopaths practicing medicine in Alberta must be registered with the CPSA. Since you have indicated that there are no CPSA registered physicians practicing at this location, registration in CPSA's Clinic Registry will not e required. We thank you for your cooperation.

Clinic Ownership

2. Is this location owned by a provincial or federal health authority or jurisdiction?*

Yes - This location is owned and operating under a provincial or federal health authority (i.e. Alberta Health Services, Health Corrections Canada, Department of National Defence, First Nations Health or RCMP).

No - This location is privately owned and operated (i.e. private medical practice, and/or affiliated with PCN or other medical groups).

THIS CLINIC IS NOT PRIVATELY OWNED AND/OR INDEPENDENTLY OPERATED OR AFFILIATED WITH A PRIMARY CARE NETWORK (PNC).

You have confirmed that your facility currently owned and operating under a provincial or federal health authority (i.e. Alberta Health Services, Health Corrections Canada, Department of National Defence, First Nations Health or RCMP). Registration in CPSA's Clinic Registry is not required. No further information is needed at this time, and we thank you for your cooperation.

CPSA Accreditation

Facilities that offer any of the prescribed health services listed in Part 5, Section 46 of the CPSA Bylaws (pages 30-39), must be accredited by the CPSA.

Prescribed health services requiring accreditation include, cardiac stress testing, diagnostic imaging, diagnostic laboratory medicine, hyperbaric oxygen therapy, neurodiagnostic, non-hospital surgical facilities (NHSF) and/or sleep medicine diagnostics. Please review Section 46 of the CPSA Bylaws to determine if your location provides any of the prescribed health services that require accreditation by CPSA.

Medical clinics that do not offer any of the prescribed health services listed in Part 5, Section 46 of the CPSA Bylaws, are not required to be accredited and should therefore respond "No" to this question.

3. Does this location provide services and/or procedures that require accreditation (Cardiac Stress Testing, Diagnostic Imaging, Diagnostic Laboratory Medicine, Hyperbaric Oxygen Therapy, Neurodiagnostics, Non-Hospital Surgical Facility, Pulmonary Function Testing, Sleep Medicine Diagnostics) by CPSA?*

Yes - This location offers one or more of the prescribed health services an is or is in the process of seeking accreditation with CPSA.

No - This facility is a medical clinic and does not offer prescribed health services that requires accreditation by the CPSA.

Please identify which program accreditation(s) you have received from CPSA and provide your facility ID.

Program Area* (select all that apply)

CPSA Accredited Facility ID (if known)

Cardiac Stress Testing

Diagnostic Imaging

Diagnostic Laboratory Medicine

Hyperbaric Oxygen Therapy

Neurodiagnostics

Non-Hospital Surgical Facility

Pulmonary Function Diagnostics

Sleep Medicine Diagnostics

Shared Office Space

Does this facility also share office space and resources with a medical clinic where CPSA registered physicians work?*

No – This location does not share space or resources with a medical clinic.

Yes – This location shares space or resources with a medical clinic.

Provide name of medical clinic.

THIS CLINIC IS ALREADY AN CPSA ACCREDITED FACILITY

The College ensures the safety and quality of Alberta medical facilities and services. We develop and maintain accreditation standards, assess facilities, register radiation equipment, monitor performance and provide approval for physicians to perform a variety of services. As you have indicated that this location is already accredited or is seeking accreditation by CPSA, no further information is needed at this time, and we thank you for your cooperation.

Based on the responses provided above, we have confirmed that your clinic location meets the criteria for registration in CPSA's Medical Clinic Registry.

NEXT STEPS

Upon submission of this form, you will be re-directed to a page to create and activate a login account to access CPSA's Clinic Registry Dashboard.

Once your login account has been activated, follow the instructions provided to log into the Clinic Registry to submit a short clinic questionnaire which will complete the clinic registration process.

A CPSA Clinic Registration Confirmation Letter will be generated and sent to your email address within 5 business days.

Questions? Contact us at clinicregistry@cpsa.ab.ca or 780-969-5001.

Street Number

Street Name

Postal Code

Province

City

Country

Latitude

Longitude

GW Clinic ID

Activity ID

Queue ID

Reviewer

Reviewer Email

SurveyDate

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