Enrollment Form

City *

Please enter a valid City.

Please enter a valid City before select a Clinic.

No Clinics are available for the entered City.

Clinic *

Please select a valid Clinic.

Participant Type *

Please select a Participant Type.

Please select a Participant Type before entering Participant Name(s).

Participant Name(s) *

Please enter valid Participant Name(s).

Supporting Coach Name(s) *

Please enter valid Supporting Coach Name(s).

If multiple providers are participating do you wish to survey as: *

A clinic All participants complete the same questions and results are aggregate.

As individuals with the same survey questions All participants have the same survey questions but separate results.

As individuals with different survey question Participants have different survey questions and results.

Not yet decided

Do you agree to PSP sharing aggregate data with your local division? *

Yes

Not yet decided

You must accept the Terms of Use before enrolling.

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I accept the

Add New Clinic

Health Authority *

Please select the Health Authority.

Division *

Please select the Division.

Clinic Name *

This Clinic Name is already used. Please add a new Clinic Name.

Please enter a Clinic Name.

Street Address *

Please enter the Street Address.

Postal Code *

Please enter the Postal Code.

Clinic Contact Person

Primary Clinic Phone Number

Please enter a valid phone number.

Clinic Contact Email

Please enter a valid email. (name@example.com)

Primary Care Network

Add New Participant

MSP #

First Name *

Please enter the First Name.

Last Name *

Please enter the Last Name.

Email *

Please enter a valid Email. (Ex: name@example.com)

This Email is already taken. Please add a new Email.

PSP Sharing Aggregate Data

By selecting "Yes," you agree to share aggregated patient experience survey data with your local Division of Family Practice. This shared data will not contain any identifiable personal information on a patient or provider and will only be shared once a minimum of seven clinics agree to participate. The Division will use this information to understand the priorities of your practice and determine how to support you better. Your information will not be shared without your consent and until a minimum number of clinics participate.

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Alert

Clinic data has been successfully updated, and your enrollment request has been sent successfully.

Confirmation

Are you sure you want to change this value?

Alert

Before adding a new clinic, please search and confirm whether the clinic already exists in the system. Click the Search button to look for an existing clinic, or click Add to continue creating a new one.

Patient Experience Tool Terms of Use

Ownership and Privacy Compliance

The FPSC Patient Experience Tool (the “Tool”) website is owned by the Doctors of BC Practice Support Program. Doctors of BC is subject to the BC Personal Information Protection Act (PIPA) regarding the collection, use, disclosure, and retention of personal information. Although it is not anticipated that personal information will be collected by the Tool, the Doctors of BC will apply the same principles to any information gathered.

Participant Information Collection and Data Sharing

Clinics participating in the Tool acknowledge that the clinic information and responses by their clients/patients will be collected in a non identifiable format. By using this tool, you agree to share the collected data for analysis, using the document procedures, and with Doctors of BC’s Practice Support Program to provide ongoing support for the Tool usage.

Security Measures

Doctors of BC will ensure the information is accessed and used only as outlined in these Terms and to protect the security, confidentiality, and privacy of all Information in compliance with BC privacy legislation. The server is firewalled and uses block-level encryption. Administrative access is through Secure Shell, and the primary server environment is located in a Tier III (minimum) Canadian-owned Canadian data center with Type II SSAE 16 SOC 2 Certification and ISO 9001 Certification.

Requests for Information Access

The Doctors of BC is responsible for responding to requests for access to personal information made under BC’s Personal Information Protection Act. Clinics will have access to any information submitted by their participants (patients). Doctors of BC will not share participating clinics information outside of aggregate reporting requirements to the Family Practice Services Committee (FPSC).

Confidentiality and Reporting

Patient experience information collected within the Tool will be collected through close-ended questions. Internal Reports will be created once at least five (5) respondents from a Clinic have submitted information. External Reports will solely feature aggregated information, with minimum cell sizes of seven (7), and will not include any identifiable personal information on a patient or provider side.

Term

Doctors of BC will retain custody of the aggregate data and associated reports for five (5) years from the participant's active date.

Should you have any questions regarding the terms of use of this site please contact

fpscpatientexperience@doctorsofbc.ca

Should you have any questions related to the Doctors of BC privacy policies and practices please contact

privacy@doctorsofbc.ca