Registration and Licensure as a Pharmacy Technician

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1 Registration and Licensure as a Pharmacy Technician For applicants who are currently licensed to practise as a pharmacy technician in a Canadian jurisdiction outside New Brunswick.

2 Please read all pages carefully to be sure you understand the requirements to be registered and licensed as a pharmacy technician in New Brunswick. Table of Contents Contents Application Requirements... 3 Application Form... 5 Certification Statements... 7 Statutory Declaration of Good Character... 8 Policy Statement... 9 Statement of Completion of Required Hours of Practice Declaration of Currency with Legislation and Practice Standards In the Regulations of the New Brunswick College of Pharmacists, Section 25.1 states pharmacy technicians must be covered by personal professional liability (errors and omissions) insurance that (b) for pharmacy technicians, pharmacist students and pharmacy technician students provides a minimum of $1,000,000 per claim or per occurrence and a minimum $2,000,000 annual aggregate; For more information about the New Brunswick College of Pharmacists, please visit New Brunswick College of Pharmacists-December 2014 (PT Currently Licensed outside NB) Page 2

3 Application Requirements [Regulations 12.1, 12.4(1)] 1. Successful completion of the PEBC Pharmacy Technician Qualifying Exam, Part 1 and Part Letter(s) of standing sent directly from the Pharmacy Regulatory Authority (licensing body) where the applicant is currently or previously licensed. 3. Successful completion of the NB College of Pharmacists Pharmacy Technician Jurisprudence Exam. 4. Submission of the application form for Registration and Licensure as a Pharmacy Technician with the NB College of Pharmacists (for applicants currently licensed to practise as a pharmacy technician in a Canadian jurisdiction outside New Brunswick). 5. Submission of the Statement of Completion as evidence of a minimum of 400 hours of practise in a direct client care setting in the previous 2 years if applying for enrollment on the Direct Client Care register. 6. Canadian government-issued photo ID (e.g., driver s license, birth certificate, passport or Canadian Citizenship Certificate.) A notarized passport sized photo of the applicant is required if photo is not provided on identification. NOTE: This may be delivered to NBCP office in person or a copy, notarized* by a Commissioner of Oaths or a lawyer, may be mailed to the NBCP office.*notarized documents: A pharmacist s signature is not accepted. 7. Language Proficiency: Must be proficient in either of Canada s official languages (English or French) 8. Criminal Record Check Original document required; dated within 6 months prior to application date. (Royal Canadian Mounted Police (RCMP) or any other Canadian police service (includes a Canadian Police Information Centre (CPIC) assessment) documenting that you do not have a record of conviction under the Criminal Code (Canada), the Controlled Drugs and Substances Act (Canada), the Food and Drugs Act (Canada). 9. Personal Liability Insurance - (minimum $1,000,000 per claim or per occurrence and a minimum $2,000,000 annual aggregate) 10. Proof of certification in First Aid & CPR* Equivalent to Red Cross Emergency First Aid & CPR Level C 11. Submission of signed Certification Statement 12. Submission of signed Statutory Declaration of Good Character 13. Submission of signed Policy Statement 14. Submission of signed Declaration of Currency with Legislation and Practice Standards form (includes declaration of fulfillment of continuous professional development requirements and personal liability New Brunswick College of Pharmacists-December 2014 (PT Currently Licensed outside NB) Page 3

4 insurance). 15. Payment of all applicable fees A licence to practise as a pharmacy technician in New Brunswick expires on December 31st and must be renewed each year. The requirements to renew this licence to practise include maintaining a Continuing Professional Development portfolio, requirements for practice in Direct Client Care and certification in First Aid and CPR. Please contact the office if you have any questions about the registration process or require additional information. Phone: New Brunswick College of Pharmacists-December 2014 (PT Currently Licensed outside NB) Page 4

5 Application Form Pharmacy Technician Registration and Licensure (For applicants who are currently licensed to practise as a pharmacy technician in a Canadian jurisdiction outside New Brunswick) *All fields must be complete SECTION 1 (Please print) First Name: Middle Name(s): Last Name: Street Address: Apt. #: City: Province: Postal Code: Phone (home): Phone (cell): address: Date of Birth: Gender: Male Female Year Month Day PEBC Certification #...PEBC Registration Date Place of Birth: City, Province and Country SECTION 2 I would like to be enrolled on the following pharmacy technician register (choose one): Active Direct Client Care (Statement of Completion of Required Hours of Practice must be submitted) Active Non-direct Client Care Non-active Application Form; Page 1 of 2 New Brunswick College of Pharmacists-December 2014 (PT Currently Licensed outside NB) Page 5

6 SECTION 3 I have successfully completed all of the requirements to be licensed by the New Brunswick College of Pharmacists as a Pharmacy Technician. All of the documents required for registration and licensure have been provided to the New Brunswick College of Pharmacists or are enclosed with this application form. Signature of Applicant Date.. SECTION 4 Payment must be included with form. See the Fee Schedule on website for applicable fee. Cheque, MasterCard or Visa are acceptable forms of payment. Credit Card #:... Expires (mm/yy):... 3-digit code on back of card:... Application Form; Page 2 of 2 New Brunswick College of Pharmacists-December 2014 (PT Currently Licensed outside NB) Page 6

7 Certification Statements I HEREBY CERTIFY THAT: I have sufficient ability to: Speak: English Read: English French French as to be competent to discharge my duties and obligations as a member of the New Brunswick College of Pharmacists. I am a: Canadian citizen Resident of Canada Landed Immigrant I hold a: Valid Employment Visa Valid Canadian work permit I have not been convicted in Canada or elsewhere of any offence that would be considered unprofessional conduct or conduct unbecoming of a person. I meet all the requirements necessary for registration/licensure as specified in the Pharmacy Act and Regulations of the New Brunswick College of Pharmacists. I currently practise pharmacy in a Canadian jurisdiction. Have you ever been convicted of an offence under the Controlled Drugs and Substances Act or the Food and Drugs Act? (See application requirements for Criminal Record Check). No Yes (if yes, provide particulars thereof on the back of this page) Date: Signature: New Brunswick College of Pharmacists-December 2014 (PT Currently Licensed outside NB) Page 7

8 1224 ch. Mountain Rd., Unit(é) 8 Moncton, N-B E1C 2T6 Tel: (506) Fax / Téléc: (506) Statutory Declaration of Good Character I, declare that 1. I have not been convicted in Canada or elsewhere of any offence that, if committed by a person registered under the Pharmacy Act, or any other profession or occupation, would constitute unprofessional conduct or conduct unbecoming of a person registered under these regulations. 2. My entitlement to practice pharmacy or any other health profession has not been limited, restricted or subject to any terms, limits or conditions or disciplinary action in any jurisdiction at any time. 3. At the present time, no investigation, review or proceeding is taking place in any jurisdiction which could result in the suspension or cancellation of my authorization to practice pharmacy or any other health profession. 4. My past conduct does not demonstrate any pattern of incompetence or untrustworthiness, which would make registration contrary to the public interest. 5. I am aware of and will practice at all times in compliance with the Pharmacy Act and the Regulations of the New Brunswick College of Pharmacists. 6. I shall provide the Registrar with the details of any action impacting on the above statements that relate to me, or that occur or arise prior, during, or after my registration with the New Brunswick College of Pharmacists: On a separate sheet of paper, provide details if any of the above are not true. Details to include: a. Criminal offence/disciplinary action/investigation b. Date when offence was committed/applicable health profession/applicable jurisdiction c. Disposition of charge including details of penalty-imposed d. Extenuating circumstances you wish taken into account for your application. I hereby declare, as indicated by my agreement below, that the contents of this application are true and complete to the best of my knowledge and belief. I understand and agree that if I make a false or misleading statement or representation in respect of my application, I shall be deemed not to have satisfied the requirements for registration/licensure. I further understand and agree that if registration/licensure is issued to me based upon a false or misleading statement or representation that registration/licensure is subject to immediate cancellation Name (please print) Signature Dated at (city) this day of(month) New Brunswick College of Pharmacists-December 2014 (PT Currently Licensed outside NB) Page 8

9 1224 ch. Mountain Rd., Unit(é) 8 Moncton, N-B E1C 2T6 Tel: (506) Fax / Téléc: (506) Policy Statement Collection, Use and Disclosure of Registration Information by the New Brunswick College of Pharmacists TERMS / DEFINITIONS Registrant- means all pharmacists, certified dispensers, pharmacy technicians and students entered on any register with the NBCP. Collection - means the collection of information regarding a registrant, personal or otherwise that is required by the NBCP for the purpose of registering/licensing that individual. Disclosure - means the release of information to an individual, organization, Pharmacy Regulatory Authority or an information manager who acts on behalf of a Pharmacy Regulatory Authority or an agency that is not a Pharmacy Regulatory Authority. Registration Information - information that is collected about an individual by the NBCP or by an information manager on behalf of the NBCP that is required for the purpose of registering that individual. Use - means the use of registration information by the NBCP or an information manager acting on behalf of the NBCP, for the purpose of fulfilling the legislated mandate of the NBCP. PRINCIPLES 1. Except as provided for in Regulation 11.7, a registrant s personal information is considered confidential and the disclosure of registration information requires the consent of the registrant. 2. NBCP may use registration information for conducting business that it is mandated under federal and provincial legislation. 3. NBCP may contract the management of registration information to an information manager. 4. The information manager will collect, use and/or disclose registration information as directed by the NBCP. 5. A registrant can access registration information on file about himself or herself. POLICIES 1. NBCP may collect the following registration information directly from registrants or indirectly from other Pharmacy Regulatory Authorities: Demographic Information: Name, date of birth, home address, home telephone number, home fax number, address, gender, place of birth Education Information: Educational facility and credentials, date of graduation, Pharmacy Examination Board of Canada registration number, all other certification in regards to the pharmacy profession Registration Status: Registration Category, Conditions on practice, competency information, complaint or discipline information, current or past registration with other jurisdiction or Pharmacy Regulatory Authorities Employment Information: Place of all employment, address of employer, telephone, fax number and address of employer. 2. Consent must be received from the member for disclosure of registration information about themselves, other than as provided in this document. - - POLICY STATEMENT PAGE 1 OF New Brunswick College of Pharmacists-December 2014 (PT Currently Licensed outside NB) Page 9

10 1224 ch. Mountain Rd., Unit(é) 8 Moncton, N-B E1C 2T6 Tel: (506) Fax / Téléc: (506) As per the policy established by Council as referenced in Regulation 10.3, the NBCP may disclose registration information for the following purposes: a) Professional development and education b) Practice based research c) Health promotion programs d) Populating electronic health systems e) Workforce planning and management f) Confirmation of registration and standing to other Pharmacy Regulatory Authorities g) Confirmation of registration to Third Party Payers h) Confirmation of registration to Medication distribution Centers (wholesalers and manufacturers) i) Confirmation of registration to any member of the public or media k) Information access by an organization contracted to manage registration information for conducting business that the NBCP is mandated to perform under provincial legislation l) Information access by an organization involved in providing the registrants with communications for the purposes of: I. Professional development and education II. Practice based information III. Health Canada Notices IV. Practice based research V. Health promotion programs Print Name: Signature: Date: POLICY STATEMENT PAGE 2 OF Statement of Completion of Required Hours of Practice For enrollment on the Direct Client Care register This is to certify that I, (print name) have worked a minimum of 400 hours in a direct client care setting in the previous 2 years. Signature: Date: New Brunswick College of Pharmacists-December 2014 (PT Currently Licensed outside NB) Page 10

11 1224 ch. Mountain Rd., Unit(é) 8 Moncton, N-B E1C 2T6 Tel: (506) Fax / Téléc: (506) Declaration of Currency with Legislation and Practice Standards DECLARATION I... confirm my knowledge of: (Print full name) 1. The legislation defined in: The Pharmacy Act and Regulations of the New Brunswick College of Pharmacists, The New Brunswick College of Pharmacists Practice Policies and Directives, The Food & Drugs Act and Regulations, and The Controlled Drugs & Substances Act. In particular, I certify that I have read and understand the differences in practice in New Brunswick enabled by the following legislation: Pharmacy Act - Practice of pharmacy defined in 49(1) - 50 Pharmacy Act Regulations Restriction on dispensing of targeted substances in sections 17.5(2)-17.5(4) Prescribing by pharmacists defined in Part XXI I further certify that I will work under supervision until I am confident I fully understand the legislation noted above and its application to my practice. 2. The practice standards defined in the Standards of Practice adopted by the NB College of Pharmacists. CE Declaration I declare I have continued my professional education as required by the current and previous licensing bodies to maintain a licence to practise pharmacy. Malpractice (Liability) insurance I have professional liability insurance that meets the following criteria: Provides the minimum per claim or per occurrence and the annual aggregate as required in the Regulations to the NB Pharmacy Act, Part XXV. Provides occurrence based coverage, or claims made with extended reporting period of at least 3 years. If not in the registrant s name, the group policy covers the registrant as an individual. Insurance provider: Signature: Date: New Brunswick College of Pharmacists-December 2014 (PT Currently Licensed outside NB) Page 11

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