ACDF Application Forms
Before submitting an application, please refer to important information found in the right hand boxes "Ultrasound Temporary Moratorium" and " ACDF Meetings and Key Decisions" which may affect your application.
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Here you will find new, expansion, and relocation application forms for publicly-owned and privately-owned facilities.
The purpose of the application 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.Application Forms for Publicly-Owned Facilities – Health Authorities
Publicly-Owned Facilities - Health Authorities
- Form A – New Certificate of Approval – 1928A
- Form B – Expansion: Services, Facility, Capacity – 1928B
- Form C – Relocation: Services, Facility, Capacity – 1928C
- Form D – Distance-Reading (Diagnostic Ultrasound Telemetry) Certificate of Approval
Privately-Owned Facilities
- Form A - New Certificate of Approval – 1929A
- Form B – Expansion: Services, Facility, Capacity – 1929B
- Form C – Relocation: Services, Facility, Capacity – 1929C
- Form D – Distance-Reading (Diagnostic Ultrasound Telemetry) Certificate of Approval
| Form Name | Form Number | Description | Form |
|---|---|---|---|
|
Form A – New Certificate of Approval |
1928A | 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. | Form A - Application for a New Certificate of Approval (PDF, 608KB) |
| Form B – Expansion: Services, Facility, Capacity | 1928B |
This application is solely for those seeking approval to:
|
Form B - Application for Physical Expansion/Expansion of Services or Significant Change of an Existing Diagnostic Facility (PDF, 644KB) |
| Form C – Relocation: Services, Facility, Capacity | 1928C | This application is solely for those seeking approval to relocate a modality or services listed on a facility’s existing Certificate of Approval. | Form C - Relocation of an Existing Certificate of Approval or Relocation with a Physical Expansion/Expansion of Services/Significant Change in Capacity (PDF, 636KB) |
| Form D – Distance-Reading (Diagnostic Ultrasound Telemetry Certificate of Approval) | 1951 | 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. | Form D - Add or Change of Distance-Reading (Diagnostic Ultrasound Telemetry) Certificate of Approval |
| Form Name | Form Number | Description | Form |
|---|---|---|---|
| Form A – New Certificate of Approval | 1929A | 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. | Form A - Application for a New Certificate of Approval (PDF, 600KB) |
| Diagnostic Outpatient Electromyography Application Letter of Support | N/A | 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 | Application Letter of Support |
| Form B – Expansion: Services, Facility, Capacity | 1929B |
This application is solely for those seeking approval to:
|
Form B - Application for Physical Expansion/Expansion of Services or Significant Change of an Existing Diagnostic Facility (PDF, 640KB) |
| Form C – Relocation: Services, Facility, Capacity | 1929C | This application is solely for those seeking approval to relocate a modality or services listed on a facility’s existing Certificate of Approval. | Form C - Relocation of an Existing Certificate of Approval or Relocation with a Physical Expansion/Expansion of Services/Significant Change in Capacity (PDF, 628KB) |
| Form D – Distance-Reading (Diagnostic Ultrasound Telemetry Certificate of Approval) | 1951 | 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. | Form D - Add or Change of Distance-Reading (Diagnostic Ultrasound Telemetry) Certificate of Approval |
