ACDF Application and Notification Forms

The purpose of the application, notification and assessment process is to establish and administer province-wide diagnostic services based on the rational distribution of services and actual need. For more information regarding the application and assessment process, please see the Policies and Guidelines of the ACDF.

Any publicly or privately-owned Diagnostic Facility in British Columbia intending to bill BC’s Medical Services Plan for outpatient diagnostic services must obtain a Certificate of Approval, granted by the Advisory Committee on Diagnostic Facilities or the Medical Services Commission.

All Certificates of Approval are site-and-owner specific and cannot be transferred or assigned.  If a facility is sold, the new owner must apply for a new Certificate of Approval in order to bill for the provision of outpatient services.

Other changes such as to a facilities hours of operation, equipment, signing authority, ownership (changes of less than 10%), diagnostic services, payment number or cease of operations (temporary or permanent), must be submitted by using the Operational Changes Notification form.

Publicly-Owned Facilities - Health Authorities

Privately-Owned Facilities

Operational Changes Notification

Publicly-Owned Facilities - Health Authorities

Form # Form Name and Information

1928A
Form A

Form A – New Certificate of Approval
This application is solely for those seeking approval to bill BC’s Medical Services Plan for provision of a new service, or in advance of implementing services at a newly constructed public diagnostic facility.

1928B
Form B
 

Form B – Expansion: Services, Facility, Capacity
This application is solely for those seeking approval to:

  • physically expand an existing diagnostic facility
  • add new or replacement equipment to an existing diagnostic facility
  • make a significant change in the capacity of an existing diagnostic facility
  • add a service to an existing Certificate of Approval
1928C
Form C

Form C – Relocation: Services, Facility, Capacity
This application is solely for those seeking approval to relocate a modality or services listed on a facility’s existing Certificate of Approval.

1951
Form D

Form D – Distance-Reading (Diagnostic Ultrasound Telemetry Certificate of Approval)
This application is solely for those seeking approval to add Distance-Reading (Diagnostic Ultrasound Telemetry) or to make any changes to their Distance-Reading Certificate of Approval that include adding new services or changing the receiving site.

 

Privately-Owned Facilities

Form # Form Name and Information

1929A
Form A

Form A – New Certificate of Approval
This application is solely for those facilities seeking first-time approval to bill BC’s Medical Services Plan for provision of an outpatient medical service.

Diagnostic Outpatient Electromyography Application Letter of Support
If an individual is seeking a privately-owned Certificate of Approval to be operated within a publicly-owned diagnostic facility, the application must include an appropriate letter of support from the representative, or authorized delegate, of the owner of the publicly-owned diagnostic facility.

1929B
Form B

Form B – Expansion: Services, Facility, Capacity
This application is solely for those seeking approval to:

  • physically expand an existing diagnostic facility
  • add new or replacement equipment to an existing diagnostic facility (that may increase the capacity or capability of an approved diagnostic facility)
  • make a significant change in the capacity of an existing diagnostic facility
  • add a service to an existing Certificate of Approval
1929C
Form C

Form C – Relocation: Services, Facility, Capacity
This application is solely for those seeking approval to relocate a modality or services listed on a facility’s existing Certificate of Approval.

1951
Form D

Form D – Distance-Reading (Diagnostic Ultrasound Telemetry Certificate of Approval)
This application is solely for those seeking approval to add Distance-Reading (Diagnostic Ultrasound Telemetry) or to make any changes to their Distance-Reading Certificate of Approval that include adding new services or changing the receiving site.

1953
Form E

Form E – Application for Transfer of Material Financial Interest of an Existing Privately Owned Diagnostic Facility
This application is solely for the transfer of material financial interest (an interest of more than 10% of the shares in a corporation, partnership or association).

 

Operational Changes Notification

Form # Form Name and Information

1954
Form F

Form F – Operational Changes Notification
This notification form is intended to enable outpatient diagnostic facility owners/administrators to notify the ACDF concerning facility-related changes that do not require a formal application.