Independent Practice

Application Package Independent Practice For Physiotherapists Who Are Currently Registered in Another Canadian Province/Territory April 2016 2016 College of Physiotherapists of Ontario

Independent Practice Application Package Independent Practice is the College s general registration category. If you have passed the Physiotherapy Competency Exam or an equivalent and wish to use the title of physiotherapist or physical therapist in Ontario you are required to hold an Independent Practice certificate. This package includes an application form and guide for applicants who are currently registered in another Canadian jurisdiction. Section 1 Independent Practice Application for Registration Guide page 3 Section 2 Independent Practice Application Form page 10 For questions about registration and applying to the College, please contact: Entry to Practice team 416-591-3828 ext. 222 or 1-800-583-5885 ext. 222 registration@collegept.org College of Physiotherapists of Ontario 375 University Avenue, Suite 800, Toronto, ON M5G 2J5 Tel: 416-591-3828 or 1-800-583-5885 Fax: 416-591-3834 www.collegept.org Page 2

The College of Physiotherapists of Ontario is committed to the principles of labour mobility and the movement of registered physiotherapists/physical therapists across Canadian provinces as articulated in the Agreement on Internal Trade (AIT) 2009 (Chapter 7). A Brief History of the Agreement on Internal Trade The Agreement on Internal Trade is an undertaking of the federal, provincial and territorial governments in Canada to eliminate labour mobility barriers between provinces and territories. The objective is to make it possible for any worker qualified for an occupation in one part of Canada to have access to employment opportunities in that occupation in any other province or territory. The Agreement on Internal Trade became law in Ontario with the introduction of the Ontario Labour Mobility Act (OLMA) in 2010. Does the Agreement on Internal Trade Apply to Me? The movement of physiotherapists/physical therapists under the Agreement on Internal Trade is based on the similarities of categories of registration, otherwise known as permit on permit. If you are a physiotherapist who is currently registered with a practice certificate/licence in another Canadian jurisdiction, your application to register in Ontario will be considered under the rules of the labour mobility agreement as follows: Where the registration categories are similar, no new requirements will be expected with the exception of a review of previous discipline history and other administrative matters (e.g. fees, form, liability insurance). Where the categories of registration are not similar, the College s existing registration requirements apply. Currently Registered in Another Canadian Province/Territory Independent Practice Application for Registration Guide Section 1 Page 3

Applying for Registration for Independent Practice from another Canadian Province Application Guide The College of Physiotherapists of Ontario is pleased to provide this guide to help you complete your application for an Independent Practice certificate. Please review this guide prior to completing your application form. Practice Name You are required to ensure that the name you use in practice is the same as the way that your name appears on the Public Register. Your practice name will appear on the College s Public Register. The Public Register is a list of all currently registered and past registered physiotherapists in Ontario. It provides the public with the physiotherapist s information and history with the College and acts as proof of registration for physiotherapists. Previous Last Name Enter your previous last name(s) if you have changed your name since completing your physiotherapy education. If the name which you wish to register under is different than the name on your educational qualifications or your immigration or citizenship documents, you must provide a photocopy of your marriage certificate, divorce decree, or legal name change document. Home Mailing Address Please provide your home mailing address. The College will occasionally mail you important information. The College does not provide your home address to any source outside the College, unless you have indicated that this is also your business address. Please ensure that you provide complete information. Email Address The College requires that all members have an active email address used for communication with the College. Confidential information may be sent by email, so please ensure that the email address that you provide is secure. Language(s) Indicate the languages in which you are capable of providing physiotherapy services. This information will be provided to members of the public who are seeking physiotherapy services in a specific language. You must also indicate the language in which you prefer to receive official documents. The College will attempt to accommodate this preference whenever possible. Education Provide information about your initial physiotherapy education in this section. Include the name of the educational program, the year of graduation, the academic institution and the location of the academic institution (province/state if Canada or US and country). Currently Registered in Another Canadian Province/Territory Independent Practice Application for Registration Guide Section 1 Page 4

When asked to provide additional physiotherapy education and other education, please provide information about any other formal education that you completed. The College does not require information about continuing education programs or certifications. Only programs where degrees are granted should be included in this section. Eligibility to Work in Canada To register with the College you must be legally eligible to work in Canada. This means you must provide one of the following with your application: 1. Proof of Canadian Citizenship A photocopy of your Canadian birth certificate, a photocopy of your Canadian passport photo page or a photocopy of both sides of your citizenship card must be provided as proof of Canadian citizenship. 2. Permanent Resident/Landed Immigrant of Canada A photocopy of your permanent resident card or document must be included with your application. 3. A valid work permit A photocopy of your valid work permit indicating that you are eligible to work in Canada must be included. This work permit must not prohibit you from working as a physiotherapist. Your Practice History in Physiotherapy The College is required to provide de-identified information to the Ministry of Health and Long-Term Care which is used for health human resources planning and to better understand labour mobility patterns. Professional Conduct If you answer YES to any questions, please provide further information. Your application will then be referred to the Registration Committee for a decision related to your registration application. The College will contact you to inform you of the process and what to do next. Practice Hours Please list your practice hours for each of the last five years. Practice hours may be claimed for employment or other activities resulting from the possession of physiotherapy credentials and experience. Work Hours Include: practice in a clinical setting, consultation, administration, academia, sales, hours related to vacation, sick leave, statutory holiday, leaves of absence and special leaves are not included Currently Registered in Another Canadian Province/Territory Independent Practice Application for Registration Guide Section 1 Page 5

Professional Activity Hours Include: volunteer activity which require the use of physiotherapy theory and knowledge, continuing education hours and/or participation in physiotherapy professional/regulatory organizations, No more than 30 professional activity hours per year can be counted towards total practice hours. Professional Liability Insurance According to the College s by-law on professional liability insurance, if you are going to provide patient care, you are required to hold professional liability insurance. You must declare that you have or will have professional liability insurance before you begin to provide patient care in Ontario. Professional liability insurance should: 1. Be obtained individually or through your employer 2. Have a minimum coverage of $5 million for any one patient and for the policy year 3. Have no deductible Patient Care The College defines Patient Care as assessing people for physiotherapy needs, consulting with people, and providing treatment in settings such as schools, companies, fitness centres, or institutions. It includes weekend and relief work, and taking over when someone is on vacation. If you assign others to work with patients, the College also considers this to be patient care. One interaction with one patient per year is defined as patient care. Registration, Licensure & Past Practice When applying under the Agreement on Internal Trade, you must be registered in another Canadian province to practice Physiotherapy. You must provide the College with proof of registration/ licensure AND good standing. You can submit any one of the following: a letter of professional standing, verification of registration form, or by providing the College with a website address where the information can be verified online Letters of professional standing must be dated within six (6) months of the application date. You must also declare to the College any other locations you have practiced physiotherapy or have been licenced to do so. In places where a regulatory body exists, you must provide proof of registration/ licensure AND good standing for all regulated locations. Currently Registered in Another Canadian Province/Territory Independent Practice Application for Registration Guide Section 1 Page 6

Information about Your Work Site The College collects details about each work site that you are working at. This means that if you work for one employer, but at two different work sites, you need to provide information about each location. This information is made public on the College Public Register and must be accurate and up-to-date. You must notify the College of any change to your employment within 30 days of the change happening. Declaration You must sign, check off and date the declaration section of the form in order for your application for registration to be complete. The declaration confirms that all of the information you have provided in the application is true and correct. If you provide incorrect or false information, you could be denied registration or any registration issued to you could be revoked (taken away). Currently Registered in Another Canadian Province/Territory Independent Practice Application for Registration Guide Section 1 Page 7

General Application Information Incomplete Applications Applicants who submit incomplete applications will be notified by email. A list of missing documentation will be provided. Applications will not be processed until they are complete. The processing time for applications will not begin until the completed application, all additional documentation and fees have been received. Processing Time The College will attempt to process your application for registration within ten business days of receiving the completed application form and all required documentation. If there is doubt whether your application meets all of the registration requirements, it will be referred to the Registration Committee for review. You will be contacted by College staff with more information if your application is referred to the Registration Committee. Longer timelines will apply under these circumstances. Confirmation of Registration An email will be sent to you to confirm your registration once your application has been processed. Privacy The personal information collected on this form is used by the College of Physiotherapists of Ontario for its regulatory purposes (e.g., the registration and identification of College members, the administration of statutes governing physiotherapists in Ontario and the administration of the College) and to develop and provide statistical information for human resource planning, demographic and research studies and ehealth Ontario. It is collected under the authority of the Regulated Health Professions Act, the Health Professions Procedural Code, the Physiotherapy Act and the regulations and by-laws made under the authority of these statutes. The College does not sell this information, nor does it provide the information to commercial entities in a format that facilitates mass marketing. For more information about the Privacy Code, please contact the College. Document Retention The College has moved to electronic maintenance and storage of member files. Electronic copies of member applications and documents will be stored indefinitely. When you submit your application to the College, if there are any hard copy documents that you would like us to return to you, please let us know. Currently Registered in Another Canadian Province/Territory Independent Practice Application for Registration Guide Section 1 Page 8

Document Checklist Please ensure that your application includes all of the following: Independent Practice Application Form A photocopy of Canadian citizenship, permanent resident status or an authorization under the Canadian Immigration Act to work in Ontario Proof of registration/licensure and professional standing in all other jurisdictions where you have been registered/licenced as a physiotherapist The appropriate fees If this applies to you: A photocopy of your name change document Currently Registered in Another Canadian Province/Territory Independent Practice Application for Registration Guide Section 1 Page 9

INDEPENDENT PRACTICE APPLICATION FORM This form is for all members who are currently registered Physiotherapists in any other Canadian province/territory under a similar registration category who wish to apply under the Agreement on Internal Trade. The member must have a valid registration and submit a verification of good standing from that jurisdiction. 1. Personal Information Last name: Previous Last Name: (if you had a different last name in the past, please provide it) First name: Middle name: Name you use to practice physiotherapy: Home address: City/Town: Province: Country: Postal code: Home telephone: Cell phone: Email: Birth Date: Gender: q Female q Male (mm/dd/yy) 2. Language I can provide physiotherapy services in: (choose all that apply) q English q French q Other: I prefer to receive College documents in*: (choose one) q English q French *Communication is primarily in English and this selection will be accommodated for official documents only whenever possible. FOR OFFICE USE ONLY Date Received: Date Complete: Registration Date: Registration Number: Processed By: Pre-Registered: q Yes q No Section 2 Page 10

3. Education 3.1 Initial Physiotherapy Education What is the initial physiotherapy education you completed? Level of Education: q Diploma q Baccalaureate q Masters q Professional Doctorate q Other: Year of Graduation: Name of Educational Institution: Province/State: Country: 3.2 Do you have more Physiotherapy Education? Starting with the most recent, please tell us about formal physiotherapy programs where you obtained a degree or diploma after your initial physiotherapy education? Level of Education: qbaccalaureate qmaster qprofessional Doctorate qdoctorate Level of Education: qbaccalaureate qmaster qprofessional Doctorate qdoctorate Level of Education: qbaccalaureate qmaster qprofessional Doctorate qdoctorate Name of Educational Institution: Name of Educational Institution: Name of Educational Institution: Province/State: Country: Year of Graduation: Province/State: Country: Year of Graduation: Province/State: Country: Year of Graduation: 3.3 Education Other than Physiotherapy Please tell us about other formal education where you obtained a degree or diploma. The College does not require information about all continuing education courses. GRS MLS HAM PAD PHE KIN GER PSY OHP BBS General Rehabilitation Science Medical Laboratory Science Health Administration/ Management Public Administration Public Health Kinesiology/Exercise Science Gerontology Psychology Other Health Profession/Related Clinical Sciences Biological and Biomedical Sciences PHY SAH EDU LAW BMM MCI ENG OSC OFS *Field of Study Please use the applicable 3 letter code in the above section Physical Sciences Social Sciences, Arts and Humanities Education Law Business, Management, Marketing and Related Mathematics, Computer Information Sciences Engineering Other Sciences Other Field of Study *Field of Study: Level of Additional Education: qdiploma qbaccalaureate qmaster qprofessional Doctorate qdoctorate *Field of Study: Level of Additional Education: qdiploma qbaccalaureate qmaster qprofessional Doctorate qdoctorate *Field of Study: Level of Additional Education: qdiploma qbaccalaureate qmaster qprofessional Doctorate qdoctorate Section 2 Page 11

Name of Educational Institution: Name of Educational Institution: Name of Educational Institution: Province/State: Province/State: Province/State: Country: Country: Country: Year of Graduation: Year of Graduation: Year of Graduation: 3.4 Educational Bridging Program Did you complete an Ontario Bridging Program for Internationally Educated Physiotherapists? q Yes q No If yes, what year: Where: q Ryerson University q University of Toronto 4. Information about the Physiotherapy Competency Exam I have successfully completed the written and clinical components of the Physiotherapy Competency Examination (PCE): q Yes If yes, date of completion: q No 5. Registration, Licensure and Past Practice 5.1 Your practice of PHYSIOTHERAPY IN ONTARIO: Have you ever been registered to practice physiotherapy in Ontario? q Yes: I was registered from: to Registration number: q No 5.2 Your practice of PHYSIOTHERAPY OUTSIDE OF ONTARIO: Please provide details of all locations you have practiced physiotherapy or have been licenced to do so outside of Ontario: Province/State Country Licence/Reg. No. Dates Section 2 Page 12

5.3 Your practice in OTHER PROFESSIONS: Have you ever been registered or licenced in any other regulated health profession? q Yes: Please provide details to all locations and regulated professions. q No Profession Province/State, Country Licence/Reg. No. Dates 6. Your Practice History in Physiotherapy By law, The College must provide general information about the physiotherapy profession to the Ministry of Health and Long Term Care in Ontario. We do not give the Ministry your name or link your name to the answers you provide below. You must answer these questions. 6.1. Is Canada or the United States the first country where you have practiced physiotherapy? q Yes q No a. If yes: Which province or state did you practice in? What Year did you first register there? b. If no: Where was the first Country you practiced? What was the name of the province or state? What Year did you first start? 6.2 Is Canada or the United States the most recent previous Country of practice? q Yes q No a. If yes: Which province or state did you practice in? When did you last practice? b. If no: Where is the most recent previous country you practiced Physiotherapy? What was the name of the province or state? Are you still practicing Physiotherapy or registered in this country? q Yes If yes, what is the expiry date? q No Section 2 Page 13

7. Professional Conduct If you answer YES to any of the following questions please provide more information. 7.1 Have you ever had a finding of professional misconduct, incompetence or incapacity against you? q No q Yes If Yes, Where? When? More information: 7.2 Have you ever had an application for a physiotherapy practice certificate or licence refused? q No q Yes If Yes, Where? When? More information: 7.3 Have you ever had a physiotherapy practice certificate or licence suspended or taken away (revoked)? q No q Yes If Yes, Where? When? More information: 7.4 Have you ever been found guilty of an offense, professional negligence or malpractice? q No q Yes If Yes, Where? When? More information: 8. Practice Hours Requirement List all practice hours for the previous 5 years, beginning with the most recent year. Please note that practice includes employment or other activities resulting from the possession of physiotherapy credentials and experience. Practice hours include worked hours and professional activity hours. Worked hours include hours of practice in a clinical setting, consultation, administration, academia and sales. Hours related to vacation, sick leave, statutory holidays, leaves of absence and special leaves are not included. Professional activity hours include hours of volunteer activity which require the use of physiotherapy theory and knowledge, continuing education hours and/or participation in physiotherapy professional/regulatory organizations. No more than 30 professional activity hours per year may be counted toward total practice hours. Year Practice Hours Completed Section 2 Page 14

9. Professional Liability Insurance Physiotherapists involved in patient care are required to hold professional liability insurance that meets the by-law requirements related to professional liability insurance as described in the application guide. q I am compliant with the College s by-law on professional liability insurance or I will be compliant prior to commencing patient care. 10. Information about your Work Site Please complete the employment information for each site where you will be working. Work site #1 is the site that you are at most of the time. Each employment site must have a complete business address. All employment information is public and will be available on the Public Register. Do you work at more than three employment sites? q Yes* q No *If yes, please attach additional pages and provide all required information about each site. Work Site #1 Name of Work Site Start Date Street Address City Country Province/State Postal Code/Zip Code Business Phone No. Ext. Fax No. Work Site #2 Name of Work Site Start Date Street Address City Country Province/State Postal Code/Zip Code Business Phone No. Ext. Fax No. Work Site #3 Name of Work Site Start Date Street Address City Country Province/State Postal Code/Zip Code Business Phone No. Ext. Fax No. Section 2 Page 15

Your Position Type Please choose only one per site. First Site Second Site Third Site Permanent Employee q q q Temporary (Contract) Employee q q q Casual Employee q q q Employee (Other) q q q Self-Employed q q q Which Do You Work? Please choose only one per site. First Site Second Site Third Site Full-time q q q Part-time q q q Casual q q q Your Position or Job Title Please choose only one per site. First Site Second Site Third Site Manager q q q Owner/Operator q q q Service Provider q q q Consultant q q q Administrator q q q Instructor q q q Researcher q q q Quality Manager q q q Sales Person q q q Other q q q Describe Your Worksite Please choose only one per site. First Site Second Site Third Site Hospital q q q Solo Professional Practice q q q Group Professional Practice q q q Rehabilitation Facility q q q Residential/Long-Term Care Facility q q q Visiting Agency/Business (Client s Environment) q q q Community Care Access Centre (CCAC) q q q Post-Secondary Educational Institution q q q Assisted Living Residence/Supportive Housing q q q Community Health Centre (CHC) q q q Family Health Team q q q Section 2 Page 16

School or School Board q q q Children s Treatment Centre (CTC) q q q Other Pediatric Facility q q q Cancer Centre q q q Mental Health and Addiction Facility q q q Fitness Centre q q q Association/Government/Regulatory or Similar q q q Board of Health or Public Health q q q Telephone Health Advisory Services q q q Health-Related Business/Industry q q q Other Industry Manufacturing and Commercial q q q Spa q q q Correctional Facility q q q Nurse Practitioner Led Clinic q q q Group Health Centre (Sault Ste. Marie only) q q q Other q q q What is the focus of your Practice? Please choose only one per site. First Site Second Site Third Site Clinical Focus on Musculoskeletal System q q q Clinical Focus on Neurological System q q q Clinical Focus on Cardiovascular & Respiratory System q q q Clinical Focus on Skin & Related Structures q q q Clinical Focus on More than One System q q q Non-Clinical Focus q q q What is the main area of Practice you are involved in? Please choose only one per site. Patient Care: First Site Second Site Third Site General Practice q q q Sports Medicine q q q Burns and Wound Management q q q Plastics q q q Amputations q q q Orthopedics q q q Rheumatology q q q Vestibular Rehabilitation q q q Section 2 Page 17

Women s Health/Uro-genital q q q Cancer Care q q q Geriatric Care q q q Chronic Disease Prevention and Management q q q Cardiology/Cardiovascular q q q Continuing Care/Long-Term Care q q q Public Health q q q Critical Care/ICU q q q Mental Health and Addiction q q q Neurology/Neuroscience q q q Respirology/Cardio-respiratory q q q Health Promotion and Wellness q q q Palliative Care q q q Return to Work Rehabilitation q q q Ergonomics q q q Other Area of Direct Service q q q Infectious Disease Prevention and Control q q q Emergency q q q Other: Area of Practice Client Service Management/Case Management q q q Consultation q q q Administration q q q Teaching (Physiotherapy entry-level) q q q Physiotherapy-Related Continuing Education Teaching q q q Other Teaching q q q Quality Management q q q Research q q q Sales q q q What job sector do you work in? Please choose only one per site. First Site Second Site Third Site Public Sector q q q Private Sector q q q Combination of Public and Private q q q Not Sure q q q Section 2 Page 18

Main Category of Patients Please choose only one per site. First Site Second Site Third Site All Ages q q q Pediatric q q q Adult q q q Geriatric q q q Do you provide patient care? Please choose only one per site. First Site Second Site Third Site Yes q q q No q q q The College defines Patient Care as any component of assessment, analysis of findings or provision of treatments to patients for whom you are directly responsible. This includes the assignment of any portion of care to support personnel. Note: This includes roles involving assessment, consultation or provision of treatment in schools, industry, fitness centres, occasional weekend or relief work or short-term vacation coverage. Even an interaction with one patient per year is defined as patient care. Are you accepting new patients? Please choose only one per site. First Site Second Site Third Site Yes q q q No q q q This information will be used to assist the public in locating a physiotherapist. In your main work site, do you prefer to work: qfull-time qpart-time qcasual qnot applicable Section 2 Page 19

11. Fees All fees are prorated based on the day the application is processed. By checking off one of the selections below, you are agreeing to be charged up to the maximum indicated. If you are paying by cheque please indicate the maximum amount possible in that date range. Once the cheque is processed, you will be refunded back the amount you have overpaid. Please select the corresponding timeframe that applies to you. Application Fees Fee Check Selection Application Fee $100.00 q If you Register: Fee Check Selection On or Between April 1st to June 30th Max. $595.00 q On or Between July 1st to September 30th Max. $446.66 q On or Between October 1st to December 31st Max. $296.86 q On or Between January 1st to March 31st Max. $146.71 q Credit card payment (Please note: the College of Physiotherapists of Ontario does not accept Visa Debit) q Visa q MasterCard Authorized payment amount: $ Card Number: Expiry Date: Cardholder s Name: Cardholder s Signature: 12. Additional Information Please provide any additional information that you want the College to be aware of: Section 2 Page 20

13. Declaration q I hereby certify that the statements made by me in this application are complete and correct to the best of my knowledge and belief. I understand that a false or misleading statement may disqualify me from registration or may be cause for any registration which may be granted to me to be taken away (revoked). q I understand that I must notify the College through the online registration system, or in writing by fax, email or mail of any change to my address, phone number or employment information within thirty days of the change occurring. Applicant Signature Date (mm/dd/yyyy) Please note: The College maintains electronic copies of all application forms and submitted documents indefinitely. Please return this form to the College, by using any of the three methods below. Hours of Operation: Monday Friday (excluding statutory holidays) 8:30am 4:30pm By mail or in person: College of Physiotherapists of Ontario ATTN: Entry to Practice Associate 375 University Avenue, Suite 800 Toronto, ON M5G 2J5 Tel: 416-591-3828 ext. 222 Toll-free: 1-800-583-5885 ext. 222 By fax: 416-591-3834 By scanning and emailing: registration@collegept.org Section 2 Page 21