Series of 2002 - Philippine College of Physicians
Transcription
Series of 2002 - Philippine College of Physicians
REQUIREMENTS FOR APPLICATION AS PCP MEMBER AND OTHER INFORMATION (Effective March 11, 2015) I. Who are qualified to become Members of PCP? (PCP Amended By-Laws October 13, 2012): a. b. II. What are the requirements to become Members of PCP? a. b. c. d. III. Completed Residency Training in Internal Medicine in a PCP-Accredited Training Program; or Board Certified Member of a PCP Affiliate Society. Good moral character and good ethical standing in the profession. Completed application form with (2) passport size pictures. Endorsement letters from (2) PCP Fellows in good standing; or (2) current members of the Board of Directors of the component or affiliate society concerned. Certified true copy of the Diploma of Residency Training in Internal Medicine; or Board Certification from a PCP Affiliate Society. Payment of application fee. For physicians who had completed the Residency Training in Internal Medicine in PCP accredited training institutions or recognized institutions abroad, and has the intention of taking the PSBIM examination, what is the importance of becoming a PCP Member? One has to be a PCP Member before certification as Diplomate Status. IV. What are the requirements to maintain a Member status in good standing of PCP? V. What are the benefits of a PCP Member? VI. When is the deadline for submission of application: March 30. VII. When does the induction as Member take place? During the Annual Convention of the same year of a. b. a. b. c. d. Earn PCP – CME Units of 250 units annually (fiscal year June-May). Pay the corresponding annual dues from the time of induction as Member. Reduced registration fees to annual and midyear conventions. PCP Assistance Program. PCP PASA Clinic (Physicians’ Assistance to Start Up a Clinic) PCP Matching Programs application (Orientation for New Members). FOR INQUIRIES: The Secretariat : Philippine College of Physicians, 22 nd Floor, One San Miguel Avenue Building San Miguel Avenue corner Shaw Boulevard, Ortigas Centre, Pasig City 1605 Tel. nos: 910-2250, 910-2252 to 54 Fax no. 910-2251 pcp website: www.pcp.org.ph E-mail address: [email protected] PCP Application as Member 03112015 Passport Size Picture APPLICATION FORM AS PCP MEMBER (Effective March 11, 2015) I. II. PCP CHAPTER WHERE YOU ARE OR INTEND TO BECOME A MEMBER________________. BIODATA Last Name First name Middle Name Birthdate _____________________ Nationality____________________ Sex_________Marital Status_____ Name of Spouse_________________________________ Home address_________________________________________________________________ Telephone Numbers: a. Landline____________________________________ b. Cellphones__________________________________ E-mail address______________________________________ PRC NUMBER ________________ PMA NUMBER________________________ III. EDUCATION Institution Year Honors a. Pre-Med____________________________________________________________________ b. MD ___________________________________________________________________ c. Internship __________________________________________________________________ IV. RESIDENCY TRAINING IN INTERNAL MEDICINE Institution Year Honors ________________________________________________________________________________________ V. FELLOWSHIP TRAINING Institution Year Honors _____________________________________________________________________________________ VI. OTHER POST GRADUATE TRAININGS / COURSES ______________________________________________________________________________ Page 1/ of 3 PCP Application as Member 03112015 VII. ACADEMIC POSITIONS Institution / Address Position / Rank Inclusive Years ___________________________________________________________________________ ___________________________________________________________________________ VIII. HOSPITAL AFFILIATIONS / POSITIONS Institution / Address Position / Rank Inclusive Years ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ IX. AREA OF PRACTICE: CURRENT AREAS OF ACTIVE PRACTICE: Hospital / Clinic: Complete address including Town / City / Province / Region / Zip Code ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ X. OTHER PROFESSIONAL AFFILIATIONS: Society / Organization Membership Position Inclusive Dates ____________________________________________________________________________________ ___________________________________________________________________________ Page 2/ of 3 PCP Application as Member 03112015 I am applying for a Member status on a voluntary basis and I pledge to abide by the decisions of the PCP, as a purely private self-limiting organization on all matters related to this application, pursuant to the By-Laws, rules and regulations and policies of PCP. I further waive and/or quitclaim all rights, demands, or causes of action, past, present or future against PCP, its Board of Regents or any Board or individual member thereof in connection with, directly or indirectly, this application. I hereby certify that the above information is true and correct. I understand that the members of the Committee on Membership and Credentials may independently verify the data. SIGNATURE OF APPLICANT (Over Printed Name) Date NOTE : PCP would like to keep in constant communication with all its members and affiliates. Kindly inform/update us should there be any change in your current mailing address or contact number/s. FOR PCP USE ONLY: ☐ A. Application Form received on ________________________ by:___________________ ☐ B. Documents verified and favorably recommended by the Committee on Membership and Credentials. ☐ C. Approved by the Board of Regents. ☐ D. Inducted as Member on ________________________________________. Page 3/ of 3 PCP Application as Member 03112015