Midwifery Staff Appointment Application

Medical Affairs - Application - Appointment to the Midwifery Staff of Sault Area Hospital

Step 1 of 8

Privacy and Confidentiality Agreement – Medical Staff

Privacy and Confidentiality Policy

Internet Access Policy

Name(Required)

First Last

Signature(Required)

Date (mm/dd/yyyy)(Required)

Format: mm/dd/yyyy

Click next to complete the SAH Policy Acknowledgement

Occupational Health Compliance

To be approved for privileges, all physicians must comply with the Professional Staff Policy requirements. These standards are mandated by the Ministries of Health and Labour, as well as Accreditation Canada. Please confirm your compliance by checking off the following:

N95 Fit Mask Test(Required)

I have completed a current N95 Fit Test within the past two(2) years. Upload proof of completion.

My current N95 has expired and I will complete my N95 Fit Test as part of the SAH application.

Upload proof of N95 Fit Test

Max. file size: 100 MB.

Click here to book an N95 Fit Mask Appointment

Learning Management System (LMS) Training Modules

LMS: Health & Safety Awareness; Privacy; WHMIS; Accessibility; Workplace Violence; Safe Management of Healthcare Waste; Healthy, Well & Safe at Work.(Required)

I have completed mandatory Learning Modules through the LMS links provided and submitted to SAH Medical Affairs the Health & Safety Awareness certificate.

I will complete all mandatory Learning Modules through the LMS links provided and submitted to SAH Medical Affairs the Health & Safety Awareness certificate.

I have completed all mandatory Learning Modules through another hospital and will provide proof.

Upload your proof of Health & Safety Awareness certificate.

Max. file size: 100 MB.

Immunization

Immunity requirements for measles, mumps, rubella, varicella, pertussis, and hepatitis B vaccinations and TB testing as outlined in the policy.

Immunization(Required)

I have submitted my proof of immunization requested to the SAH Occupational Health Nurse email that was provided.

I will submit the proof of immunization and I understand it needs to be submitted before I can be approved for privileges at SAH.

Occupational Health Consent

Click next to complete final submission

Application for Appointment

To complete your SAH Medical Staff Appointment Application check consent, enter your name, preferred email and date and select submit.

Name(Required)

First Last

Preferred Email(Required)

A copy of your application will be sent to your preferred email address to verify successful submission.

Signature(Required)

Date (mm/dd/yyyy)(Required)

Format: mm/dd/yyyy

I am applying for privileges through the following contact person:(Required)

Lydia Foster

Stephanie Leask

Midwifery Staff Appointment Application

Medical Affairs - Application - Appointment to the Midwifery Staff of Sault Area Hospital

Sault Area Hospital Application for Midwifery Privileges

In addition to completion of the electronic application you will be asked to provide the following either by uploading where indicated in the application and/or by email to the SAH Medical Affairs contact.

Instructions

Please complete the following information:

Office Information

Emergency Contact Information

License Information

Educational Qualifications

Midwifery

Post Graduate Training/Qualifications

Graduate Training/

Eligibility to Sit Certificate Examinations

Midwifery Staff Appointments

Teaching Appointments/

Hospital Staff Privileges/

Professional Conduct

Continuing Medical Education

Professional References

Other Qualifications

Click next to complete the Authorization for Release of Information

Authorization for the Release of Information

Authorization for the Release of Information

Sault Area Hospital/

Click next to complete the Electronic Signature Authorization Form

Electronic Signature Authorization Form

Authentication Electronic Signature Policy

Click next to complete the Privacy and Confidentiality Agreement – Medical Staff

Privacy and Confidentiality Agreement – Medical Staff

Privacy and Confidentiality Policy Internet Access Policy

Click next to complete the SAH Policy Acknowledgement

Policy Acknowledgement

SAH Credentialing Policy Professional Staff Policy – Categories and Duties of the Professional Staff Incomplete Records Policy Completion and Documentation Policy Occupational Health On-Boarding Requirements

Click next to complete the SAH Medical Directives

Sault Area Hospital Medical Directives

Midwives

Consent - Medical Directives

Click next to complete Occupational Health Compliance