*1.First Name(Required.)

*2.Last Name(Required.)

*3.MSP #(Required.)

*4.Email Address(Required.)

*5.Member Type(Required.)

Family Physician

Specialist Physician

*6.Do you identify as a physician primarily working in the community?

You spend the majority of clinical time providing patient care from a private (non-facility/HA) office and may, or may not, rely on hospital/Health Authority to provide aspects of patient care. (Required.)

Yes

No

*7.Primary Practice Region (Health Authority or Community)(Required.)

Fraser Health region

Interior Health region

Island Health region

Northern Health region

Provincial Health Services

Vancouver Coastal Health/Providence Health Care region

*8.Please confirm the following:(Required.)

I have completed PQI Level 1 courses (IHI Open School QI 101, QI 102, QI 103 + Dr Don Berwick's presentation).