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        • Total Joint Replacement Video
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      • Breast Imaging
        • Mammography
        • Ontario Breast Screening Program
      • Cardiac Combine
      • Computed Tomography (CT)
      • Echocardiography
      • Electroencephalography (EEG)
      • Fluoroscopy (Gastric Imaging)
      • Forms/Requisitions
      • General Radiography (X-Ray)
      • Interventional Radiography
      • Magnetic Resonance Imaging (MRI)
      • Nuclear Medicine
      • Pockethealth - Imaging Records
      • Providers: Ocean eReferral Network
      • Ultrasound
    • Emergency Services
      • Community Health Clinics
      • Consent to Join Virtual Home Waiting Room
      • ED Wait Time Clock
      • Emergency Dept. FAQs
      • Virtual Home Waiting Room
    • Hospitalist Program
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      • Addictions Services
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      • Addictions Treatment Clinic
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        • 01. Signs of Problematic Substance Use
        • 02. The Science of Addiction
        • 03. Harm Reduction
        • 04. Overdose/Drug Poisoning
        • 05. Navigating the System
        • 06. Staying Connected
        • 07. Family Dynamics
        • 08. Support for Yourself
        • 09. Support Systems
        • 10. Local SSM Resources
      • Sexual Assault
      • Social Work
    • Pharmacy Services
      • Inpatient Pharmacy Services
      • Outpatient Pharmacy - SAH iCcare Pharmacy
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      • Foot Clinic
      • Hand Program
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      • Feeding Your Newborn
      • Labour & Delivery
        • When Do I Come To The Hospital?
      • Neo-Natal ICU
      • Paediatrics
      • Post Partum Information
      • Prenatal Care Clinic
        • Prenatal Clinic Intake Form
      • SeamlessMD for Maternity Patients
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      • Supportive
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Sault Area Hospital
  • About
    • Accessibility
      • Report A Barrier
    • Accountability and Transparency
      • Annual Reports & Financial Statements
      • BPSAA Attestation Form
      • Disclosure
      • Freedom of Information
      • Ministry of Energy Reporting
      • Supply Chain Accountability Act Attestation
    • Artificial Intelligence
    • Awards & Recognition
      • Dr. William Hutchinson Award
        • Nomination Form
      • iCcare Awards
        • Nomination Form
    • Choosing Wisely Hospital
    • History
    • Hospital Leadership
      • Board of Directors
        • Board Meeting Information
        • Board Recruitment
      • Physician Leadership
      • Senior Leadership Team
        • Dr. John Heintzman
        • Dr. Stephen Smith
        • Greg Zambusi
        • Ila Watson
        • Mindy Lindstedt
        • Shauna Hynna
        • Sue Roger
    • Land Acknowledgement
    • ONE Initiative
    • Patient, Family and Caregiver Declaration of Values
    • Sault Area Hospital Foundation
    • Smoke-Free Property
    • Strategic Plan
  • Contact
  • Indigenous Health
    • Indigenous Self Identification
      • Voluntary Indigenous Self-Identification Form
  • Join Our Team
    • Application Process
    • Attracting & Retaining Staff
    • Board & Community Member Recruitment
    • Career Opportunities
    • Employee Safety Programs
    • Partner Opportunities
    • Patient and Family Advisory Program
    • Physician Opportunities
      • Locum Opportunities
    • Volunteering
      • Apply Today
      • Volunteer LMS
      • Volunteer VicNet Login
  • Newsroom
    • News
    • SAH Logo
    • Social Media
    • Spotlight
  • Patients
    • Advance Care Planning
    • Consent for Email and Text Communication
    • Health Information Centre
    • Hospital to Home
    • Meal Services
    • Medical Rates
    • Patient and Family Advisory Program
      • Strengthening Engagement
    • Patient Billing Portal
    • Patient Experience Survey
    • Patient Relations
    • Patients Coming To SAH
      • Bring Your Health Card
    • Quality & Safety
      • Patient Safety
      • Patient Safety Indicators
      • Quality Improvement Plan
    • Text with 911
    • Your Privacy
      • Your Health Information
  • Programs & Services
    • Algoma District Cancer Program
      • ADCP Health Care Professionals
      • ADCP New Patient Referral Form
      • ADCP Resources
      • Financial Assistance
    • Algoma Geriatric Services
      • Algoma Geriatric Clinic
      • Behavioural Supports Ontario
      • Falls Prevention
      • Geriatric Emergency Medicine
      • Inpatient Geriatric Consult Team
      • Seniors Mental Health
    • Algoma Regional Renal Program
      • Patient Education
    • Ambulatory Care
      • Hematology Clinic
      • Internal Medicine Rapid Access Clinic
      • Medical Daycare
      • Minor Medical / Surgical Procedures
      • Ophthalmology
      • Orthopedic Clinic
        • Total Joint Replacement Video
      • Pre-Admission
      • Rapid Access Centre
      • Urology
    • Antimicrobial Stewardship
      • Resources
      • Respiratory Pathogen Reports
    • Axia Health
    • Be An Organ Donor
    • Blood Conservation Program
    • Cardiac Care Services
      • PocketHealth - Cardio Imaging Records
      • Requisitions / Referral Forms
    • Central Ambulance Communication Centre (CACC)
      • Behind the Scenes: CACC
      • Calling an Ambulance
      • Fit2Sit Program
    • Diagnostic Imaging
      • Breast Imaging
        • Mammography
        • Ontario Breast Screening Program
      • Cardiac Combine
      • Computed Tomography (CT)
      • Echocardiography
      • Electroencephalography (EEG)
      • Fluoroscopy (Gastric Imaging)
      • Forms/Requisitions
      • General Radiography (X-Ray)
      • Interventional Radiography
      • Magnetic Resonance Imaging (MRI)
      • Nuclear Medicine
      • Pockethealth - Imaging Records
      • Providers: Ocean eReferral Network
      • Ultrasound
    • Emergency Services
      • Community Health Clinics
      • Consent to Join Virtual Home Waiting Room
      • ED Wait Time Clock
      • Emergency Dept. FAQs
      • Virtual Home Waiting Room
    • Hospitalist Program
    • Infection Prevention and Control
    • Intensive Care Unit
    • Laboratory
    • Medical Program
    • Mental Health & Addictions
      • Addictions Services
        • Addictions Services - Continuum of Care
        • Northway Wellness Centre
      • Addictions Treatment Clinic
      • Adult Mental Health
      • Child & Adolescent Mental Health
        • Child & Adolescent Mental Health Resources
        • Parent and Family Resources
        • SAH Child and Adolescent Consultation Clinic
      • Crisis Services
      • Eating Disorders Program
      • Group Schedules
      • Parents like us.
        • 01. Signs of Problematic Substance Use
        • 02. The Science of Addiction
        • 03. Harm Reduction
        • 04. Overdose/Drug Poisoning
        • 05. Navigating the System
        • 06. Staying Connected
        • 07. Family Dynamics
        • 08. Support for Yourself
        • 09. Support Systems
        • 10. Local SSM Resources
      • Sexual Assault
      • Social Work
    • Pharmacy Services
      • Inpatient Pharmacy Services
      • Outpatient Pharmacy - SAH iCcare Pharmacy
        • Staff Prescription Transfer Form
    • Physician Recruitment
    • Rehabilitation
      • Foot Clinic
      • Hand Program
      • Inpatient Rehabilitation
      • Outpatient Occupational Therapy - Neuro Service
      • Physiotherapy
      • Referral Forms
      • Registered Dietitians
      • Speech, Language, and Swallowing
    • Research
      • Research Approval Pathway and Forms
        • Research Ethics Board (REB) - Forms
      • Research Ethics Board (GHC/SAH)
        • Research Ethics Screening Tool
    • Respiratory Therapy
    • Spiritual Support Services
    • Stroke Program
      • Code Stroke
      • Stroke Services
      • Video Resources: Stroke Patients and Caregivers
    • Surgical Services
      • SeamlessMD - Remote Surgical Support
    • Telemedicine Program
    • Women & Children’s Health Program
      • Feeding Your Newborn
      • Labour & Delivery
        • When Do I Come To The Hospital?
      • Neo-Natal ICU
      • Paediatrics
      • Post Partum Information
      • Prenatal Care Clinic
        • Prenatal Clinic Intake Form
      • SeamlessMD for Maternity Patients
  • Staff
    • Abilities Management
    • Education
      • FAQ's
    • Employee & Family Assistance Program (EFAP)
    • Employee Services
    • Health Sciences Library
    • Medical Staff Reappointment
      • Active - Associate
      • Active Reciprocal
      • Dentists – Supportive
      • Supportive
      • Term - Locum
    • Occupational Health
      • Blood Borne Pathogen and/or Body Fluid Exposure
      • Infectious Disease
    • ONE Information
    • Remote Access (VDI)
    • SAH Medical Directives Sign-off
    • SAH Orientation Portal
      • Clinical Students
        • Clinical Students Orientation
      • Medical Learners
        • Medical Learners Orientation
          • Medical Learners Orientation Checklist
      • Researchers and Research Assistants
        • Researchers and Research Assistants Orientation
    • Shining Star
    • Staff Wellness
      • Health and Fitness
    • Ventures Menu
  • Visitors
    • Best Wishes Program
    • Caregiver ID Program
    • Finding Your Way
    • Parking & Transit Services
    • Smoke-Free Property

Reappointment Application – Supportive

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  • Reappointment Application – Supportive

Reappointment Application - Supportive (July 1, 2025 to June 30, 2026)



Instructions


Please complete the following reappointment application.


Make sure you have proof of your documentation, membership with the Canadian Medical Protective Association (CMPA) or evidence of professional liability insurance coverage to submit with your application as you will be asked to upload. (Group Health Centre provides a copy of their physician’s insurance coverage therefore GHC physicians do not need to attach)


You will not be able to save this application and return to add your documentation.


(enter your name)

Please indicate any CHANGES to the following information:

Education

In making this application, I provide the following record of my continuing education and contribution to the hospitals' operation:

1. Continuing Medical Education:

Did you satisfy the requirements of the CPSO for Continuing Medical Education participation as outlined by either the CFPC or the RCPSC at the time of your last renewal of licensure in Ontario?

2. Service to Other Hospitals and Health Organizations During the Past Year:

(Other Health Organizations include the O.M.A., local allied health groups,etc.)

Professional Conduct

3. Have you been the defendant in any malpractice litigation or any litigation related to the practice of medicine during the past five (5) years in which a finding of negligence was made against you or in which negligence was admitted by you or on your behalf?(Required)
4. Since July 1st of last year, have you ever been found guilty of professional misconduct?(Required)
5. Since July 1st of last year, have you ever agreed to a settlement to avoid anyproceeding or disciplinary action in respect of your professional conduct?(Required)
6. Since July 1st of last year, have you been the subject of an investigation by any licensing body in Ontario, or anywhere else?(Required)
Drop files here or
Max. file size: 100 MB.
    7. Since July 1st of last year, has your name been placed on a list restrictingyour purchasing or prescribing of narcotic or restricted drugs?(Required)
    8. Are you currently suffering from a condition that impairs your ability to practice medicine? A condition that impairs your ability to practice medicine means a condition that adversely affects your judgment or your ability to practice medicine in a safe, competent, ethical and professional manner. Conditions that are being treated such that they do not impair your ability to practice medicine do not need to be disclosed. You should consult with your treater(s) if you are uncertain if your condition is being sufficiently treated and does not require disclosure.(Required)
    Note: SAULT AREA HOSPITAL recognizes that physicians, like their patients, experience physical and mental health conditions. Physicians should seek treatment, as needed, to ensure they are not practicing medicine while impaired. Resources available to physicians suffering from a medical condition include the OMA’s Physician Health Program, which provides confidential support (https://php.oma.org), as well as a variety of supports set out on the Physician Wellness page of the CPSO’s website (https://www.cpso.on.ca/en/Physicians/Your-Practice/Physician-Advisory-Services/Physician-Wellness). Additionally, applicants are advised that disclosure of any medical conditions in this credentialing application will be kept in strict confidence and will only be used to evaluate what privileges will be granted to a physician for the upcoming credentialing year.
    9. Since July 1st of last year, have you been convicted of a criminal offence inCanada or else where for which you have not received a pardon?(Required)
    10. Since July 1st of last year, have you been charged with any criminal offences in Canada or elsewhere that currently remain outstanding?(Required)

    Emergency Contact Information

    This information is helpful if the hospital needs to contact someone on your behalf:
    Name
    Home Address

    Requirements

    Please check your medical staff category to determine additional submission requirements:(Required)
    NOTE: Please attach a copy of your current professional liability insurance coverage satisfactory to the Board. (Group Health Centre provides a copy of their physician’s insurance coverage therefore GHC physicians do not need to attach.)
    Physicians(Required)
    RN (EC)(Required)
    Drop files here or
    Max. file size: 100 MB.
      Membership in the Canadian Medical Protective Association (CMPA), or evidence of individual insurance.
      Drop files here or
      Max. file size: 100 MB.
        Please attach evidence of professional liability insurance coverage satisfactory to the Board.

        Consent

        Consent - Reappointment(Required)
        MM slash DD slash YYYY
        Name(Required)
        A copy of your application will be sent to your preferred email address to verify successful submission.
        This field is for validation purposes and should be left unchanged.
        • About
          • Accessibility
            • Report A Barrier
          • Accountability and Transparency
            • Annual Reports & Financial Statements
            • BPSAA Attestation Form
            • Disclosure
            • Freedom of Information
            • Ministry of Energy Reporting
            • Supply Chain Accountability Act Attestation
          • Artificial Intelligence
          • Awards & Recognition
            • Dr. William Hutchinson Award
              • Nomination Form
            • iCcare Awards
              • Nomination Form
          • Choosing Wisely Hospital
          • History
          • Hospital Leadership
            • Board of Directors
              • Board Meeting Information
              • Board Recruitment
            • Physician Leadership
            • Senior Leadership Team
              • Dr. John Heintzman
              • Dr. Stephen Smith
              • Greg Zambusi
              • Ila Watson
              • Mindy Lindstedt
              • Shauna Hynna
              • Sue Roger
          • Land Acknowledgement
          • ONE Initiative
          • Patient, Family and Caregiver Declaration of Values
          • Sault Area Hospital Foundation
          • Smoke-Free Property
          • Strategic Plan
        • Contact
        • Indigenous Health
          • Indigenous Self Identification
            • Voluntary Indigenous Self-Identification Form
        • Join Our Team
          • Application Process
          • Attracting & Retaining Staff
          • Board & Community Member Recruitment
          • Career Opportunities
          • Employee Safety Programs
          • Partner Opportunities
          • Patient and Family Advisory Program
          • Physician Opportunities
            • Locum Opportunities
          • Volunteering
            • Apply Today
            • Volunteer LMS
            • Volunteer VicNet Login
        • Newsroom
          • News
          • SAH Logo
          • Social Media
          • Spotlight
        • Patients
          • Advance Care Planning
          • Consent for Email and Text Communication
          • Health Information Centre
          • Hospital to Home
          • Meal Services
          • Medical Rates
          • Patient and Family Advisory Program
            • Strengthening Engagement
          • Patient Billing Portal
          • Patient Experience Survey
          • Patient Relations
          • Patients Coming To SAH
            • Bring Your Health Card
          • Quality & Safety
            • Patient Safety
            • Patient Safety Indicators
            • Quality Improvement Plan
          • Text with 911
          • Your Privacy
            • Your Health Information
        • Programs & Services
          • Algoma District Cancer Program
            • ADCP Health Care Professionals
            • ADCP New Patient Referral Form
            • ADCP Resources
            • Financial Assistance
          • Algoma Geriatric Services
            • Algoma Geriatric Clinic
            • Behavioural Supports Ontario
            • Falls Prevention
            • Geriatric Emergency Medicine
            • Inpatient Geriatric Consult Team
            • Seniors Mental Health
          • Algoma Regional Renal Program
            • Patient Education
          • Ambulatory Care
            • Hematology Clinic
            • Internal Medicine Rapid Access Clinic
            • Medical Daycare
            • Minor Medical / Surgical Procedures
            • Ophthalmology
            • Orthopedic Clinic
              • Total Joint Replacement Video
            • Pre-Admission
            • Rapid Access Centre
            • Urology
          • Antimicrobial Stewardship
            • Resources
            • Respiratory Pathogen Reports
          • Axia Health
          • Be An Organ Donor
          • Blood Conservation Program
          • Cardiac Care Services
            • PocketHealth - Cardio Imaging Records
            • Requisitions / Referral Forms
          • Central Ambulance Communication Centre (CACC)
            • Behind the Scenes: CACC
            • Calling an Ambulance
            • Fit2Sit Program
          • Diagnostic Imaging
            • Breast Imaging
              • Mammography
              • Ontario Breast Screening Program
            • Cardiac Combine
            • Computed Tomography (CT)
            • Echocardiography
            • Electroencephalography (EEG)
            • Fluoroscopy (Gastric Imaging)
            • Forms/Requisitions
            • General Radiography (X-Ray)
            • Interventional Radiography
            • Magnetic Resonance Imaging (MRI)
            • Nuclear Medicine
            • Pockethealth - Imaging Records
            • Providers: Ocean eReferral Network
            • Ultrasound
          • Emergency Services
            • Community Health Clinics
            • Consent to Join Virtual Home Waiting Room
            • ED Wait Time Clock
            • Emergency Dept. FAQs
            • Virtual Home Waiting Room
          • Hospitalist Program
          • Infection Prevention and Control
          • Intensive Care Unit
          • Laboratory
          • Medical Program
          • Mental Health & Addictions
            • Addictions Services
              • Addictions Services - Continuum of Care
              • Northway Wellness Centre
            • Addictions Treatment Clinic
            • Adult Mental Health
            • Child & Adolescent Mental Health
              • Child & Adolescent Mental Health Resources
              • Parent and Family Resources
              • SAH Child and Adolescent Consultation Clinic
            • Crisis Services
            • Eating Disorders Program
            • Group Schedules
            • Parents like us.
              • 01. Signs of Problematic Substance Use
              • 02. The Science of Addiction
              • 03. Harm Reduction
              • 04. Overdose/Drug Poisoning
              • 05. Navigating the System
              • 06. Staying Connected
              • 07. Family Dynamics
              • 08. Support for Yourself
              • 09. Support Systems
              • 10. Local SSM Resources
            • Sexual Assault
            • Social Work
          • Pharmacy Services
            • Inpatient Pharmacy Services
            • Outpatient Pharmacy - SAH iCcare Pharmacy
              • Staff Prescription Transfer Form
          • Physician Recruitment
          • Rehabilitation
            • Foot Clinic
            • Hand Program
            • Inpatient Rehabilitation
            • Outpatient Occupational Therapy - Neuro Service
            • Physiotherapy
            • Referral Forms
            • Registered Dietitians
            • Speech, Language, and Swallowing
          • Research
            • Research Approval Pathway and Forms
              • Research Ethics Board (REB) - Forms
            • Research Ethics Board (GHC/SAH)
              • Research Ethics Screening Tool
          • Respiratory Therapy
          • Spiritual Support Services
          • Stroke Program
            • Code Stroke
            • Stroke Services
            • Video Resources: Stroke Patients and Caregivers
          • Surgical Services
            • SeamlessMD - Remote Surgical Support
          • Telemedicine Program
          • Women & Children’s Health Program
            • Feeding Your Newborn
            • Labour & Delivery
              • When Do I Come To The Hospital?
            • Neo-Natal ICU
            • Paediatrics
            • Post Partum Information
            • Prenatal Care Clinic
              • Prenatal Clinic Intake Form
            • SeamlessMD for Maternity Patients
        • Staff
          • Abilities Management
          • Education
            • FAQ's
          • Employee & Family Assistance Program (EFAP)
          • Employee Services
          • Health Sciences Library
          • Medical Staff Reappointment
            • Active - Associate
            • Active Reciprocal
            • Dentists – Supportive
            • Supportive
            • Term - Locum
          • Occupational Health
            • Blood Borne Pathogen and/or Body Fluid Exposure
            • Infectious Disease
          • ONE Information
          • Remote Access (VDI)
          • SAH Medical Directives Sign-off
          • SAH Orientation Portal
            • Clinical Students
              • Clinical Students Orientation
            • Medical Learners
              • Medical Learners Orientation
                • Medical Learners Orientation Checklist
            • Researchers and Research Assistants
              • Researchers and Research Assistants Orientation
          • Shining Star
          • Staff Wellness
            • Health and Fitness
          • Ventures Menu
        • Visitors
          • Best Wishes Program
          • Caregiver ID Program
          • Finding Your Way
          • Parking & Transit Services
          • Smoke-Free Property
        Help make outstanding care possible
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        Sault Area Hospital
        Sault Area Hospital
        Contact Us 750 Great Northern Road
        Sault Ste. Marie, ON P6B 0A8
        Connect With Us

        We acknowledge that Sault Area Hospital is situated upon the traditional territory of the Anishnaabeg, specifically Garden River First Nation and Batchewana First Nation, as well as the Métis People. This land, Baawaating, is the historic meeting place for Indigenous people across North America. This territory is included in the Robinson Huron Treaty of 1850. We say miigwetch to all Indigenous and Métis partners for sharing this land, and we recognize their enduring presence.

        • About
          • Accessibility
            • Report A Barrier
          • Accountability and Transparency
            • Annual Reports & Financial Statements
            • BPSAA Attestation Form
            • Disclosure
            • Freedom of Information
            • Ministry of Energy Reporting
            • Supply Chain Accountability Act Attestation
          • Artificial Intelligence
          • Awards & Recognition
            • Dr. William Hutchinson Award
              • Nomination Form
            • iCcare Awards
              • Nomination Form
          • Choosing Wisely Hospital
          • History
          • Hospital Leadership
            • Board of Directors
              • Board Meeting Information
              • Board Recruitment
            • Physician Leadership
            • Senior Leadership Team
              • Dr. John Heintzman
              • Dr. Stephen Smith
              • Greg Zambusi
              • Ila Watson
              • Mindy Lindstedt
              • Shauna Hynna
              • Sue Roger
          • Land Acknowledgement
          • ONE Initiative
          • Patient, Family and Caregiver Declaration of Values
          • Sault Area Hospital Foundation
          • Smoke-Free Property
          • Strategic Plan
        • Contact
        • Indigenous Health
          • Indigenous Self Identification
            • Voluntary Indigenous Self-Identification Form
        • Join Our Team
          • Application Process
          • Attracting & Retaining Staff
          • Board & Community Member Recruitment
          • Career Opportunities
          • Employee Safety Programs
          • Partner Opportunities
          • Patient and Family Advisory Program
          • Physician Opportunities
            • Locum Opportunities
          • Volunteering
            • Apply Today
            • Volunteer LMS
            • Volunteer VicNet Login
        • Newsroom
          • News
          • SAH Logo
          • Social Media
          • Spotlight
        • Patients
          • Advance Care Planning
          • Consent for Email and Text Communication
          • Health Information Centre
          • Hospital to Home
          • Meal Services
          • Medical Rates
          • Patient and Family Advisory Program
            • Strengthening Engagement
          • Patient Billing Portal
          • Patient Experience Survey
          • Patient Relations
          • Patients Coming To SAH
            • Bring Your Health Card
          • Quality & Safety
            • Patient Safety
            • Patient Safety Indicators
            • Quality Improvement Plan
          • Text with 911
          • Your Privacy
            • Your Health Information
        • Programs & Services
          • Algoma District Cancer Program
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        Sault Area Hospital | www.sah.on.ca | 750 Great Northern Road Sault Ste Marie, ON P6B 0A8 | (705) 759-3434
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        Holiday Hours

        Dec 20th-23rd 9:00 AM-5:00 PM

        Dec 24th Closed

        Dec 27th Closed

        Dec 28th-31st 9:00 AM-5:00 PM

        Jan 3rd Closed

        Jan 4th-7th 9:00 AM-5:00 PM

        Happy Holidays!