Physician Compensation Forms

The following forms are available for physicians wishing to enroll in the Alternative Payments Program (APP), the Primary Health Care Blended Funding Model, or any of the Rural Practice Programs.

Alternative Payments Program Forms

1914
(was 7200)

Apply for new services or funding for physician sessional arrangements.

Rural Practice Programs

2804

Approved physicians must complete this form in order to be paid for travel expenses under the NITAOP.

2854

Physicians wanting to apply for Advanced Skills and Training funding through the Rural Education Action Plan (REAP) must complete this form.

2856

Health authorities complete this form to apply for recruitment incentive payments for physicians recruited to eligible rural communities.

2857

Health authorities complete this form to apply for funding to assist with physician recruitment to eligible rural communities.

Rural GP Locum Program

2801

Locums providing an assignment under the RGPLP must complete this form to assign payment to the host physician.

2802

Host physicians in eligible rural communities must complete this form to request general practice locum services.

2803

General Practitioners wanting to provide service through the Rural GP Locum Program (RGPLP) must complete this application form.

2805

Locums who have provided an assignment through the Rural GP Locum Program (RGPLP) must complete this application to be reimbursed for their expenses for getting to and from the community to provide the locum assignment.

2867

Locum physicians must submit this form to be paid the guaranteed daily rate for approved general practice locum assignments.

2869

When applying to provide locum services, the physician must provide a minimum of three references.  The references are required to complete this form.

Rural Specialist Locum Program

2851

Host physicians in designated specialties in eligible rural communities must complete this form to request specialist locum services.

2852

Specialists wanting to provide service through the Rural Specialist Locum Program (RSLP) must complete this application form.

2853

Specialist locums who have provided approved locum services submit this form to request payment of their guaranteed daily rate and the travel time honorarium.

2866

Specialist locums must submit this form to indicate if they are providing an office based or hospital based locum assignment.

2868

Locums who have provided an assignment through the Rural Specialist Locum Program (RSLP) must complete this application to be reimbursed for their expenses for getting to and from the community to provide the locum assignment.

2894

When applying to provide locum services, the physician must provide a minimum of three references.  The references are required to complete this form.

Rural GP Anaesthesia Locum Program (RGPALP)

1960

Host GP/Anaesthesia in eligible rural communities must complete this form to request locum services.

1961

GP/Anesthesia locums who have provided approved locum services submit this form to request payment of their guaranteed daily rate and the travel time honorarium.

1962

Locums who have provided an assignment through the Rural GP/Anesthesia Locum Program (RGPALP) must complete this application to be reimbursed for their expenses for getting to and from the community to provide the locum assignment.

1963

GP/Anaesthetists wanting to provide service through the Rural GP/Anesthesia Locum Program (RGPALP) must complete this application form.

1964

When applying to provide locum services, the physician must provide a minimum of three references.  The references are required to complete this form.

1965

Locums must complete this form to indicate if they are providing hospital based or providing an office based locum assignment under the RGPALP.

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