DEFINITION OF A SCOPE OF PRACTICE: i) Every physician s scope of practice is unique. ii) A physician s scope of practice is determined by the patients the physician cares for, the procedures performed, the treatment provided, and the practice environment. iii) A physician s ability to perform competently in his or her scope of practice is determined by the physician s knowledge, skills and judgment, which are developed through training and experience in that scope of practice. Royal College use only: Royal College ID: Identification: Surname: Given name: 1. How would you best describe your practice (e.g. Civil, correctional, hospital based, Academic Health Science Centre, assessments, managing Review Board patients, etc.)? 2. In the chart below, please indicate in which location you see patients, the number of patients seen and the number of hours spent in direct patient contact during a typical work week. Practice Settings A. OFFICE PRACTICE Private Office Community Health Centre Academic Teaching Unit B. HOSPITAL Community Hospital Inpatients Outpatients # of patients seen weekly # of hrs spent in direct forensic patient contact Page 1 of 5
Practice Settings Academic/Teaching Hospital Inpatients Outpatients Special Clinics C. CORRECTIONAL FACILITY Youth Facility Provincial Federal D. OTHER (please specify) Courts # of patients seen weekly # hrs spent in direct forensic patient contact Page 2 of 5
3. In the community in which you work, do you have: Yes No a) Access to basic laboratory services (e.g. hemoglobin, urine, blood glucose analyses, etc.)? b) Access to advanced laboratory services (e.g. bone density, cardiac stress test, electromyography, etc.)? c) Access to basic radiological services? d) Access to CT or MRI? e) Access to other specialists for referral or consultation? f) Regular contact and interaction with physicians in the same discipline in your community? g) Phallometric testing? h) Psychological testing? Page 3 of 5
4. In a typical week, please estimate the percentage of your patient visits that fall within each of the following categories (please note that the total should equal 100 percent) Category % of patient visits NEW PRESENTATIONS/ACUTE CONDITION MANAGEMENT New or known patients with new complaints or conditions requiring the formulation of a diagnosis in an office or practice setting. CURRENT CASELOAD ASSESSMENT PATIENTS Inpatients, Outpatients REVIEW BOARD PATIENTS Inpatients, Outpatients CORRECTIONAL PATIENTS Custody, Probation and Parole COURT ORDERED ASSESSMENTS Fitness to Stand Trial, Not Criminally Responsible, Risk Assessments, Dangerous/Long Term Offender Assessments, Review Board Patients CIVIL CASES PSYCHOSOCIAL CARE Patients to whom you provide general counseling, psychotherapy sessions or referrals to various supportive social agencies in his/her community Total 100% Page 4 of 5
5. In a typical week, please estimate the number of each of the following you currently perform in your practice. Court Appearances Court Reports Tribunal Appearances Tribunal Reports Medico-legal Reports % of patient visits 6. Please list a minimum of 10 of the most common assessments that you CURRENTLY see/perform in your practice. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Note: The information provided is subject to verification by the Royal College. Page 5 of 5