Notification of Closing or Taking Leave from a Medical Practice

All physicians who are closing their medical practice or taking leave from practice of three (3) months or longer must comply with the Standard of Practice: Closing or Taking Leave from a Medical Practice and notify the College in advance of the intended closure.

Please refer to the Frequently Asked Questions and the Physician Checklist, which provide general advice to support the understanding of the College's expectations.

If you have further questions, please email us at compliance@cpsnl.ca

Physician Information

Full Name(Required)

Licence Number(Required)

Mailing Address (for College use only)(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Closure Information

I am discontinuing my practice of medicine at:(Required)

Name of Medical Practice Address City/Town Province Postal Code

Intended date of closure/leave(Required)

Intended date of return (if applicable)

Has another physician assumed care of your patients?(Required)

Yes

No

New practice address (if applicable)

Address City/Town Province Postal Code

Location of Patient Medical Records

Physicians must notify the College of the location of their patient medical records, including contact information and any instructions for how patients can obtain a copy of their medical records. This information will be made available to the public upon request. Should the location of the medical records change, the College must be notified by email at compliance@cpsnl.ca

Please refer to Medical Records Documentation & Management for further information.

My patient medical records have been/will be transferred to:(Required)

Another physician

A secure file storage facility

Other

Please provide the full address and contact information for the location of patient medical records(Required)

Attention (e.g., name, estate, facility) Address City/Town Province Postal Code

Phone(Required)

Email (for public use)

Special Instructions (if applicable)

Do you intend to maintain your Licence to Practice Medicine after your closure of practice or during your leave from practice?(Required)

Yes

No

I acknowledge that I have read and understand the above statement.

Resignation of Licence to Practice Medicine

Once I resign, my Licence to Practice Medicine expires and I must cease practicing medicine, including prescribing medications, in Newfoundland and Labrador immediately.(Required)

I acknowledge that I have read and understand the above statement.

Once I resign, my Professional Medical Corporation Licence expires. (This may not apply to all physicians. If this does apply to you, the College will follow up with you appropriately.)(Required)

I acknowledge that I have read and understand the above statement.

I have read the College's Standard of Practice: Closing or Taking Leave from a Medical Practice(Required)

I acknowledge that I have read and understand the College's Standard of Practice.

Full Name(Required)

Submission Date(Required)

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