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MOC Track Form

Maintenance of Certification Plan Application Form

Please complete all applicable fields.

Proactively submit this form to request approval for activities which may fulfill MOC requirements.

Paramedic Information

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Track 1
  • No documentation required, no need to submit this form
Track 2
  • Complete Simulated Patient Encounter Session
  • Submit Alternate Clinical Experience or CME for approval
Track 3
  • Individualized process
  • Requires both Service and CPER approval

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TRACK 2: ALTERNATE CLINICAL EXPERIENCE (Approx. amount & context)

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TRACK 3: Administrative Certification

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All statements must be true

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Individual Needs Self-Assessment Form

Individual Needs Self Assessment Form

The goal of CPER’s Return to Practice (RTP) process is to offer a Paramedic the opportunity to reorient themselves to the clinical environment after a period of absence, in a supportive and educational manner. Please complete this form and return it to your Service. The information gathered will be used in a partnership approach with you to develop your Individualized RTP plan and to help prepare you for a safe return to the road. Confidence in a particular area is important to recognize while we touch base in all required areas.

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AskMED Form

AskMED Submission Form

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Question must be between 150 and 1000 characters.
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CareREPORT

CPER CareREPORT Form

INSTRUCTIONS FOR USE

CareReports can be completed by Paramedics, Service Operators or others wishing to communicate with CPER's Quality Program. Please complete the form with as much detail as possible to provide context for full analysis.

Note: please do not include any patient health information (PHI) in your responses.

More Information

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Return to Clinical Practice

  • Return to Practice Form

    When a Paramedic is inactive from clinical practice for a period of greater than 90 days, the Paramedic is administratively deactivated. While on administrative deactivation does not relate to the performance of the Paramedic in any way, they are required to undergo a Return to Practice (RTP) process prior to having their certification reinstated. This RTP process will allow for a safe and comfortable re-entry to clinical practice for the Paramedic.

    The RTP process will begin upon CPER receiving the appropriate RTP documentation from the Service Operators. A RTP plan is created by CPER and the details of this plan are forwarded to the Service Operator for completion.

    When creating a RTP plan, CPER follows a set of guidelines, while at the same time considering any relevant activities the Paramedic may have been performing while away from clinical practice. With that in mind, the RTP plan is personalized to the needs of the Paramedic, to encourage a seamless transition back to full duties. The RTP process is specifically designed to be supportive in nature and may include scenarios, skills assessments, clinical rotations, written evaluations, Paramedic interviews and/or other requirements that may be deemed necessary by CPER.

    Download the PDF

  • Individual Needs Self Assessment Form

    The goal of CPER’s Return to Practice (RTP) process is to offer a Paramedic the opportunity to reorient themselves to the clinical environment after a period of absence, in a supportive and educational manner. Please complete this form and return it to your Service. The information gathered will be used in a partnership approach with you to develop your Individualized RTP plan and to help prepare you for a safe return to the road. Confidence in a particular area is important to recognize while we touch base in all required areas.

    Download the PDF

Read more …Return to Clinical Practice

CME Credit Request Form

CME Credit Request Form

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Please provide a valid email address
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The general test for CME credit allocation is – "Does the educational activity enhance the clinical practice of paramedicine at the certification level of the paramedic?"

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Certification Request Forms

Certification Request Forms

Please ensure to download the approprate PDF form and send the completed electronic file to education@cper.ca.

Compatible with Adobe Pro and Adobe Reader 8 or later.

The Certification Request Form PDF documents are working documents which require the user to fill out the required fields electronically.

Please do not scan or print the document when attempting to submit a form. Submitting the PDF as a scanned copy removes the ability to fill out the remaining fields with the document.

When filling out the digital signature field, DO NOT check the box "Lock Document After Signing" see image.

The forms below must be downloaded to be completed.

Data will not be saved if fields are completed online.

Read more …Certification Request Forms