BridgePoint Medical Specialists [ Physician Application Form ]

Physician Application Form

BridgePoint Medical Specialists
BPMS E-Mail
Status
Name

First NameLast Name
Phone
Format: (000) 000-0000.
E-Mail
*E-Mail required to use the "SAVE & CONTINUE LATER" button below
Applying for a Prac ID

To help guide you through the process of applying for your Prac ID and completing your registration as a fully licensed Internal Medicine physician at BridgePoint, we've provided a guide below, broken into three stages.

If you are currently in your PGY-4 year, you may begin this process early, as the College utilizes your Royal College Examination results to verify suitability for independent practice starting July 1st.

As the process has multiple steps, you can enter your E-Mail address above and use the "SAVE & CONTINUE LATER" button at the bottom of the form to save your progress. You will be shown and E-Mailed a URL that allows you to continue editing your form from where you left off.

Once you’ve uploaded all the required documents, click the "SUBMIT APPLICATION" button.

NOTE: Upon submission, BridgePoint will package your documents (including your AHC11234 Practitioner Request form to link you to our Business Arrangement) and we will submit the completed package to Alberta Health on your behalf.

This information is a general guide based on Chris Oleynick's "Getting Set Up for Independent Practice / Locuming in Alberta" guide. It is not all-inclusive and parts of it may be outdated. If you find the application process has changed, please let us know.
- PhysiciansApply
  - Visit https://mcc.ca/portals/ and begin your application with PhysiciansApply
  - Select "Applications for Medical Registration", followed by the "AB" designation
  - A fee of $750 is required to process this initial assessment of your qualifications
  Once assessed, you will receive notifications from both PhysiciansApply and the CPSA to proceed to the next stage of the application.
- CPSA Application
  - The CPSA requires 3 professional references who must complete a specific "Reference Request" form
  - You must provide a Criminal Record Check completed within the last 3 months
  - A "Certificate of Professionalism" must be obtained from every medical college with which you have been registered since receiving your MD
- Approval & Training
  - Upon conditional approval, a registration fee of approximately $2,700 must be paid to the CPSA
  - Applicants must complete 1-2 hours of interactive online training modules and assessments to satisfy provincial medical standards
- CMPA Coverage
  
  You must ensure your Canadian Medical Protective Association (CMPA) code is current:
  - Code 14 (Resident Moonlighting): This code is suitable for locum work but only covers independent practice for consecutive periods of up to 14 days
  Note that CMPA fees are generally refunded through the CPSA membership program.
- CPSA Practice Permit
  - Once training and fees are finalized, the CPSA will issue your Practice Permit
  - This document includes your Category of Registration and confirms your status on the General Registrar
- Attach your CPSA Practice Permit below:
  
  File must be a .pdf .png or .jpg
  Cancelof
- Specialty Recognition Letter
  - This letter is delivered via E-Mail and formally recognizes you as a Specialist in Internal Medicine
  - This document is vital for your Alberta Health application, as it dictates your eligibility for specialist-level billing
- Attach your Specialty Recognition Letter below:
  
  File must be a .pdf .png or .jpg
  Cancelof
- Registration and Understanding Agreement
  - Complete the CPSA's Registration and Understanding Agreement (RUA) form
  - A witnessed signature will be required
- Attach your Relationship and Understanding Agreement below:
  
  File must be a .pdf .png or .jpg
  Cancelof
- Practitioner Request Form (AHC11234)
  
  Download this pre-filled AHC11234 form. Alberta Health requires your wet signature, so you'll have to print the form to sign it, then scan it back in at a high resolution and attach it below. Make sure all of the Light Green boxes have been filled in. Once we submit this form to Alberta Health the typical turnaround time is ~2 weeks.
  
  NOTE: In the "Specialities and Certifications" box, we have pre-filled "INTERNAL MEDICINE" but if you hold additional subspecialties (ie - Nephrology, GI, etc), please write them in the same box immediately following "INTERNAL MEDICINE".
- Right-click and "Save As..." to save BPMS_prefilled_AHC11234_practitioner_request.pdf
- Attach your wet-signed Practitioner Request form below:
  
  File must be a .pdf .png or .jpg
  Cancelof
- Business Arrangement and Relationships Application Form (AHC11236)
  
  Download this pre-filled AHC11236 form. Alberta Health requires your wet signature, so you'll have to print the form to sign it, then scan it back in at a high resolution and attach it below. Make sure all of the Light Green boxes have been filled in. Once we submit this form to Alberta Health the typical turnaround time is ~2 weeks.
- Right-click and "Save As..." to save BPMS_prefilled_AHC11236_business_arrangement_and_relationships_application.pdf
- Attach your wet-signed Business Arrangement and Relationships Application Form below:
  
  Cancelof
- Submission Date
  
  YearMonthDay
Should be Empty:

Physician Application Form

Applying for a Prac ID

PhysiciansApply

CPSA Application

Approval & Training

CMPA Coverage

CPSA Practice Permit

Specialty Recognition Letter

Registration and Understanding Agreement

Practitioner Request Form (AHC11234)

Business Arrangement and Relationships Application Form (AHC11236)