NBMS Section Status Application Form

Name(Required)

First Last

Email(Required)

Please select the type of section:(Required)

Community of Interest Section: Members that share collective social and clinical interests regarding advocacy, policy or knowledge-sharing, but do not wish to participate in the NBMS economics processes (i.e., retired members, social or health policy interests, etc.)

Economic Section: Members that seek formal participation in NBMS economics processes, including NBMS distribution, fee schedule adjustments, remuneration models, and Medicare insured services (i.e., salaried physicians, medical and surgical specialties, etc.)

Which one of the following does your group represent?(Required)

Family Medicine Specialty (Certificate of Added Competence (CACs))

Royal College-Recognized Specialty

Royal College-Recognized Subspecialty

Royal College-Recognized Area of Focused Competence (AFC)

Choose one of the following Certificate of Added Competences (CACs) under the College of Family Physicians:(Required)

Addiction Medicine

Care of the Elderly

Emergency Medicine

Sports and Exercise Medicine

Enhanced Surgical Skills

Family Practice Anesthesia

Obstetrical Surgical Skills

Palliative Care

Other

Choose one of the following Royal College-recognized specialties:(Required)

Choose one of the following Royal College-recognized subspecialties:(Required)

Choose one of the following Royal College–recognized Area of Focused Competences (AFCs):(Required)

What is the name of the proposed section?(Required)

Provide a clear statement of purpose outlining why you are seeking section status, the goals and objectives of the group, and the intended activities of the section.(Required)

What is the total number of eligible physicians in New Brunswick?(Required)

Estimate if uncertain.

How many members are supporting this application?(Required)

Describe the shared clinical or professional interest and how this scope of practice is relevant to New Brunswick.(Required)

Describe why the section is needed, how this proposed section differs from other existing sections, and if there is potential overlap, how it will be managed.(Required)

Describe the scope of the insured services, unique fee codes, service models, or practice patterns.(Required)

Identify any anticipated administrative or operational support required from NBMS:(Required)

At what frequency will the group meet?(Required)

Please attach a membership list, any supporting data or documentation, additional rationale/background materials, or any document you consider relevant.

Drop files here or

Max. file size: 24 MB.

Thank you for your interest in applying for Section Status.