Return to Clinical Practice (Service Form)

Return to Clinical Practice

Service Form

Please complete this form to submit a Return to Clinical Practice on behalf of a paramedic. Once submitted, an RPPEO staff member will be in contact with you to follow up with a plan.

Paramedic Name(*)

Please enter paramedic's name.

EHSN

EHSN is a five digits number.

RSOP

Invalid Input

Last Date of Clinical Activity(*)

Please enter a date yyyy-mm-dd.

Expected Return to Clinical Activity(*)

Please enter a date yyyy-mm-dd.

Describe your service RTCP plan for this paramedic(*)

0/1000

Please provide the detail of your request.

Name of person submitting(*)

Please enter your full name.

Email(*)

Please enter a valid email address.

RPPEO Forms

Patient Safety Incident Report
Elective CME Pre-Approval Request
Data Request
Loss or theft of controlled substances
MedicASK
Service Forms
Return to Clinical Practice (Service Form)
Downloads and Resources
Case Review Request Form