CPSA

CPSA Medical Clinic Registry Application - 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 tell us about yourself and your clinic.

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*

Confidential Email address*

Facility/Clinic Name*

Suite/Unit #

Street Address Search (do not include unit/suite numbers)*

Formatted Address (Complete street address search to populate this field)*

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 be 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 FACILITY 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 provide any of the prescribed health services listed in Part 5, Section 46 of the CPSA Bylaws (pages 30–39) must be accredited by CPSA.

These prescribed health services include: cardiac stress testing, diagnostic imaging, diagnostic laboratory medicine, hyperbaric oxygen therapy, neurodiagnostics, non-hospital surgical facilities (NHSFs), and/or sleep medicine diagnostics.

Please review Section 46 of the CPSA Bylaws to determine whether your facility offers any of these services and requires CPSA accreditation.

PLEASE NOTE:

Medical clinics that do not provide 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 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 – I have reviewed CPSA Bylaws (Part 5) and confirmed that this location does not and will not provide health services that require CPSA accreditation as noted above.

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

Program Area* (select all that apply)

Please provide 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

Is there also a medical clinic, where CPSA-registered physicians practice, operating within the accreditation space?*

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 FACILITY IS ALREADY CPSA ACCREDITED

The College of Physicians & Surgeons of Alberta (CPSA) is committed to ensuring the safety and quality of medical facilities and services across Alberta. We develop and uphold accreditation standards, assess facilities, register radiation equipment, monitor ongoing performance, and grant approval for physicians to perform various regulated services.

As you have indicated that this location is either already accredited by CPSA or is in the process of seeking accreditation, no further information will be required at this time.

However, if you also indicated that a medical clinic is operating within the accredited facility, you will be redirected to complete registration through CPSA’s Medical Clinic Registry.

Thanks 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

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

2. Once your login credentials have been validated, please log into CPSA's Medical Clinic Registry to review and respond to any tasks or requests for information posted to your clinic's registry dashboard.

3. A CPSA Clinic Registration Confirmation Letter will only be generated following completion of any tasks or requests for information. Allow 3-5 days for review of your responses.

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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