 |
||
  |
|
|
|
Greater Dufferin Area
Physician Search Committee
http://www.physicianswanted.ca/ Locums The Greater Dufferin Area Physician Search Committee is in the process of establishing a Locum matching service. Local family practice physicians are invited to submit information that a Locum is required. Current need is for an obstetrician for six months. Locums seeking a position in our area are requested to provide their information to our database. The Committee will use this information to create a match with physicians’ needs. The local physician will contact the candidate to work out details. Complete the appropriate form below and e-mail to opportunities@physicianswanted.ca Physician Seeking Locum Coverage Locum Seeking Position Greater Dufferin Area Physician Search Committee http://www.physicianswanted.ca/ Physician Seeking Locum Coverage Date: ___________________________ Name: _______________________________________________________ Address: ______________________________________________________ City: ____________________________ Province: ____________________ Postal Code: ______________________ Phone (home): ________________________ (office): ___________________ Pager: _______________________________ Fax: ______________________ Specialty: _______________________________________________________ Patient Load: ______________________ Patient Profile: ___________________ Practice Type: group ____ walk in clinic _________ solo _____ no doctor patients _________ On-call required: yes ______ How often: ____________________ no ______ Hospital Privileges: yes _______ Hospital location: _____________________ no _______ Accommodation provided: yes ________ no __________ Electronic billing: yes ______________ no __________ Dates Locum Required: start: ________________ end: _________________ start: ________________ end: _________________ start: ________________ end: _________________ Special situations incoming Locum should be aware of: Greater Dufferin Area Physician Search Committee http://www.physicianswanted.ca/ Locum Seeking Position Date: ___________________________ Name: _____________________________________________________________ Address: ___________________________________________________________ City: __________________________________ Province: ___________________ Postal Code: ____________________________ Phone (home): __________________________ (office): _____________________ Pager: _________________________________ Fax: ________________________ Best time to call: ____________________________ E-mail: ____________________________________ Specialty: ___________________________________ Licensed in Ontario: yes: __________ no: _________ Years in Practice: ___________ Practice Interests: group: __________ solo: __________ walk in clinic: ____________ ER: ____________ no doctor patients: ________________________ Desire Hospital Privileges: yes: ______________ no: ______________ Have worked in the Greater Dufferin area area previously: yes: __________ no: _________ Details: Registered for electronic billing: yes: _________ No: _________ OHIP billing number: ______________________________________ Dates available to do Locum: start: ___________________ end: ___________________ start: ___________________ end: ___________________ start: ___________________ end: ___________________ Will be travelling alone: yes: __________ no: __________ Accommodation requirements: Special needs: Recreation/Family Interests: biking: ______ birding: _________ boating: __________ camping: _________ fishing: _________ golf: ________ hiking: ________ riding: ________ swimming: ________ shopping: ___________ galleries/museums: ___________ theatre/music: _____________ other:_________________ |
|
|
