COVID-19 Active Planning Hours Form - Medical Staff Association of Children's and Women's Hospital

COVID-19 Active Planning Hours Submission Form (BCCHW Medical Staff)

- Please note all Department and Division Heads (and physicians invoicing for PHSA work) should not use this form but submit their invoices directly to Madonna Follett at PHSA (mfollett@phsa.ca).

- Currently, this one-time funding allocation is only applicable to physician MSA members. We will continue to advocate for our midwifery and dentistry members to be represented in future allocations.

First Name

Last Name

Email Address

MSP Number
Please double check and ensure this number is correct, errors will result in payment issues.

GP/SP

Primary Site

Department

Number of hours
Please enter the number of hours you spent on active COVID-19 planning initiatives. (20 hours max)

Activity Description
Please briefly describe how you were involved in active planning for COVID-19.

Have you submitted or do you plan on submitting any hours to PHSA for this round of COVID Funding?

Do you already have an active FEMS account?
(You would have created a FEMS account to receive payments from Doctor's of BC/Facility Engagement)

Do you already have a VersaPay account?
(You would have created a VersaPay account to receive payments from Doctor's of BC/Facility Engagement)