Cross Certification Request - Paramedic

This is Part A.

Paramedic Information

Name

Invalid Input

Email Address

Invalid Input

EHS#

Invalid Input

Referring Base Hospital-Certifying Body

Service 1Service 2Service 3Service 4Service 5Service 6 Invalid Input

Work History

Please select all RBHP / Certifying body you have worked for in the past 10 years

A copy will be sent to each to verify the information provided.

Services - CEPCP

Haliburton
Kawartha Lakes
Northumberland

Peterborough
Durham
York

Invalid Input

Services - CPER

Brant/Brantford
Dufferin
Guelph-Wellington
Haldimand
Hamilton

Niagara
Norfolk
Waterloo
Six Nations

Invalid Input

Services - HSNCPC

HSNCPC -1
HSNCPC - 2

HSNCPC - 3
HSNCPC - 4

Invalid Input

Services - NWRPCP

Kenora
Naotkamegwanning
Rainy River
Superior North City
Superior North District Invalid Input

Services - RPPEO

Cornwall
Renfrew
Frontenac
Hastings-Quinte

Lanark
Leeds Grenville
Lennox & Addington
Ottawa

Invalid Input

Services - Sunnybrook

Sunnybrook - 1
Sunnybrook - 2
Sunnybrook - 3
Sunnybrook - 4

Sunnybrook - 5
Sunnybrook - 6
Sunnybrook - 7
Sunnybrook - 8

Invalid Input

Services - SWORBH

SWORBH - 1
SWORBH - 2
SWORBH - 3
SWORBH - 4

SWORBH - 5
SWORBH - 6
SWORBH - 7
SWORBH - 8

Invalid Input

Service - Ornge

Ornge Invalid Input

I authorize the release of information to the Regional Paramedic Program for Eastern Ontario from other Base Hospitals and/or Certifying Bodies regarding my certification status and skills as a Paramedic.(*)

Yes
No Invalid Input

Submit

Link to Part B - Service