Facilities standard revision request and prescribed health services feedback form - College of Physicians & Surgeons of Alberta

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This field is for validation purposes and should be left unchanged.

Name*

First Last

Title / position

Facility / Organization

Phone Number*

Email*

This is the email address we will send a submission confirmation notification to.

Enter Email Confirm Email

Date (should be typed in the format mm/dd/yyyy, as in 03/15/2023)

What would you like to provide feedback on? (Select all the apply).*

Accreditation standard(s)
Prescribed health services list

Standard feedback

Standard name*

Standard section / number (#)*

Suggested revision

Rationale for revision

Supporting documentation*

Upload any references or documents to substantiate your request. Attached documents must be: jpeg, png, jpg, doc, docx or pdf. Please do not password protect your files.

Drop files here or

Accepted file types: jpeg, png, jpg, doc, docx, pdf, Max. file size: 5 MB.

Prescribed health services

The prescribed health services list in CPSA’s Bylaws identifies all procedures that can only be provided to the public within a facility accredited by CPSA or in a hospital-based setting. These procedures may not be provided in an unaccredited office-based setting.

Suggested revision and/or addition you would like to suggest for the prescribed health services list

Rationale for revision and/or addition