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physicians.
HQCA REPORT PANEL FORM Email primaryhealthcarereports@hqca.ca or call 403.521.7101. Clinic-level Report Recipient. The clinic-level report recipient is the primary contact for the clinic. As this person, you are authorized to request and receive the clinic report on behalf of the clinicphysicians.
HQCA REPORT PANEL FORM Email primaryhealthcarereports@hqca.ca or call 403.521.7101. Clinic-level Report Recipient. The clinic-level report recipient is the primary contact for the clinic. As this person, you are authorized to request and receive the clinic report on behalf of the clinicphysicians.
HQCA REPORT PANEL FORM Email primaryhealthcarereports@hqca.ca or call 403.521.7101. Clinic-level Report Recipient. The clinic-level report recipient is the primary contact for the clinic. As this person, you are authorized to request and receive the clinic report on behalf of the clinicphysicians.
HQCA REPORT PANEL FORM Email primaryhealthcarereports@hqca.ca or call 403.521.7101. Clinic-level Report Recipient. The clinic-level report recipient is the primary contact for the clinic. As this person, you are authorized to request and receive the clinic report on behalf of the clinicphysicians.
HQCA REPORT PANEL FORM Request a Primary Healthcare Panel Report. Join the more than 1,500 physicians in Alberta who receive their HQCA Primary Healthcare Panel Report annually. These reports help family physicians and clinics with their quality improvement work by providing information on their patients’ continuity, as well as valuable data on screening and vaccination rates, chronic conditions, pharmaceutical HQCA REPORT PANEL FORM Email primaryhealthcarereports@hqca.ca or call 403.521.7101. Clinic-level Report Recipient. The clinic-level report recipient is the primary contact for the clinic. As this person, you are authorized to request and receive the clinic report on behalf of the clinicphysicians.
HQCA REPORT PANEL FORM Email primaryhealthcarereports@hqca.ca or call 403.521.7101. Clinic-level Report Recipient. The clinic-level report recipient is the primary contact for the clinic. As this person, you are authorized to request and receive the clinic report on behalf of the clinicphysicians.
HQCA REPORT PANEL FORM Request a Primary Healthcare Panel Report. Join the more than 1,500 physicians in Alberta who receive their HQCA Primary Healthcare Panel Report annually. These reports help family physicians and clinics with their quality improvement work by providing information on their patients’ continuity, as well as valuable data on screening and vaccination rates, chronic conditions, pharmaceutical HQCA REPORT PANEL FORM Email primaryhealthcarereports@hqca.ca or call 403.521.7101. Clinic-level Report Recipient. The clinic-level report recipient is the primary contact for the clinic. As this person, you are authorized to request and receive the clinic report on behalf of the clinicphysicians.
HQCA REPORT PANEL FORM Email primaryhealthcarereports@hqca.ca or call 403.521.7101. Clinic-level Report Recipient. The clinic-level report recipient is the primary contact for the clinic. As this person, you are authorized to request and receive the clinic report on behalf of the clinicphysicians.
HQCA REPORT PANEL FORM Request a Primary Healthcare Panel Report. Join the more than 1,500 physicians in Alberta who receive their HQCA Primary Healthcare Panel Report annually. These reports help family physicians and clinics with their quality improvement work by providing information on their patients’ continuity, as well as valuable data on screening and vaccination rates, chronic conditions, pharmaceutical HQCA REPORT PANEL FORM Email primaryhealthcarereports@hqca.ca or call 403.521.7101. Clinic-level Report Recipient. The clinic-level report recipient is the primary contact for the clinic. As this person, you are authorized to request and receive the clinic report on behalf of the clinicphysicians.
HQCA REPORT PANEL FORM Email primaryhealthcarereports@hqca.ca or call 403.521.7101. Clinic-level Report Recipient. The clinic-level report recipient is the primary contact for the clinic. As this person, you are authorized to request and receive the clinic report on behalf of the clinicphysicians.
HQCA REPORT PANEL FORM Request a Primary Healthcare Panel Report. Join the more than 1,500 physicians in Alberta who receive their HQCA Primary Healthcare Panel Report annually. These reports help family physicians and clinics with their quality improvement work by providing information on their patients’ continuity, as well as valuable data on screening and vaccination rates, chronic conditions, pharmaceutical REQUEST A PRIMARY HEALTHCARE PANEL REPORT Join the more than 1,300 physicians in Alberta who receive their HQCA Primary Healthcare Panel Report annually. These reports help family physicians and clinics with their quality improvement work by providing information on their patients’ continuity, as well as valuable data on screening and vaccination rates, chronic conditions, pharmaceutical use, and emergency and hospital visits. The HQCA has partnered with CII-CPAR. For those interested in receiving a Confirmed Patient List (CPL) report, if you, or the physician(s) you support, are participating in CII-CPAR you do not need to submit your CPL to the HQCA. Your CII-CPAR list can be used to generate your CPL report. We appreciate your interest in the HQCA’s 2020 panel reports. To support the efforts of our healthcare system to combat the spread of COVID-19, THE PRODUCTION OF PHYSICIAN REPORTS WILL BE POSTPONED. However, we encourage you to complete the request process so we can be prepared to respond to your request in the future. The HQCA is closely monitoring the situation and we will update you as appropriate. The fields below must be completed by the requesting physician(s) or with physician permission.REQUESTER
I'm a...
Family Physician__
I am a physician requesting a report about my patient panel (Physician Primary Healthcare Panel Report). Clinic Representative__ I am a physician or clinic representative requesting a report about the patients in our clinic (Clinic Primary Healthcare Panel Report). Note: A minimum of two physicians are required to produce this report, because it is an aggregate of results. The clinic will receive an aggregate report and each individual participating physician will receive their own report, with the ability to compare their results to their clinic and their PCN.Delegate__
I am a delegate or an authorized designate for a physician and wish to request a physician or clinic report.TYPE OF REPORT
Physician Confirmed Patient List (CPL) Report__ Request this report if you would like your report to be based on your confirmed patient list (CPL). This means that you have undergone a paneling process to produce a list of patients who agree that you are their main family physician (e.g., CPAR). You'll receive your access to the digital report when we receive a completed Information Sharing Agreement (ISA) and a list of patient health numbers (PHNs) of patients on your CPL. If you have previously signed an ISA with the HQCA, you do not need to sign a new one. Physician Proxy Panel Report__ Request this option if you cannot provide a confirmed patient list (i.e., a list of patients who agree that you are their main family physician) and you'd like the HQCA to estimate your panel for you. The HQCA proxy panel is an estimate of a physician's active panel, based on the pattern of family physician billing claims over a three year period. The algorithm predicts which family physician – from all those seen by a patient – is most likely to be the patient's main family physician. It is an estimate of your patient panel and most accurate for those who have worked in a stable practice for the lastthree fiscal years.
TYPE OF REPORT
Clinic Confirmed Patient List (CPL) Report__ Request this report if you would like your report to be based off of your confirmed patient list (CPL). This means that you have undergone a paneling process to produce a list of patients who agree that you are their main family physician (e.g., CII - CPAR). You'll receive your access to the digital report when the HQCA receives a completed information sharing agreement and a list of PHNs of patients on yourCPL.
Clinic Proxy Panel Report__ Request this option if you cannot provide a confirmed patient list (i.e., a list of patients who agree that you are their main family physician) and you'd like the HQCA to estimate your panel for you. The HQCA proxy panel is an estimate of a physician's active panel, based on the pattern of family physician billing claims over a three year period. The algorithm predicts which family physician – from all those seen by a patient – is most likely to be the patient's main family physician. The algorithm is most accurate for physicians who have worked in a stable practice for the last three fiscal years.LEVEL OF REPORT
Physician
Clinic
TYPE OF REPORT
Clinic Confirmed Patient List (CPL) Report__ Request this report if you would like your report to be based off of your confirmed patient list (CPL). This means that you have undergone a paneling process to produce a list of patients who agree that you are their main family physician (e.g., CII - CPAR). You'll receive your access to the digital report when the HQCA receives a completed information sharing agreement and a list of PHNs of patients on yourCPL.
Clinic Proxy Panel Report__ Request this option if you cannot provide a confirmed patient list (i.e., a list of patients who agree that you are their main family physician) and you'd like the HQCA to estimate your panel for you. The HQCA proxy panel is an estimate of a physician's active panel, based on the pattern of family physician billing claims over a three year period. The algorithm predicts which family physician – from all those seen by a patient – is most likely to be the patient's main family physician. The algorithm is most accurate for physicians who have worked in a stable practice for the last three fiscal years. Physician Confirmed Patient List (CPL) Report__ Request this report if you would like your report to be based off of your confirmed patient list (CPL). This means that you have undergone a paneling process to produce a list of patients who agree that you are their main family physician (e.g., CII - CPAR). You'll receive your access to the digital report when the HQCA receives a completed information sharing agreement and a list of PHNs of patients on yourCPL.
Physician Proxy Panel Report__ Request this option if you cannot provide a confirmed patient list (i.e., a list of patients who agree that you are their main family physician) and you'd like the HQCA to estimate your panel for you. The HQCA proxy panel is an estimate of a physician's active panel, based on the pattern of family physician billing claims over a three year period. The algorithm predicts which family physician – from all those seen by a patient – is most likely to be the patient's main family physician. The algorithm is most accurate for physicians who have worked in a stable practice for the last three fiscal years. PHYSICIAN INFORMATION *Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext.
*Prac ID: 08 __
This is the identifier the physician uses for billing. *Select your PCNNo PCNAlberta HeartlandAspenBig CountryBighornBonnyvilleBow ValleyCalgary FoothillsCalgary RuralCalgary West CentralCamroseChinookCold LakeDrayton ValleyEdmonton NorthEdmonton OliverEdmonton SouthsideEdmonton WestGrande PrairieHighlandKalyna CountryLakelandLeduc/Beaumont/DevonLloydminsterMcLeod RiverMosaicNorth WestPalliserPeace RegionPeaks to PrairiesProvostRed DeerRocky Mountain HouseSaddle HillsSherwood Park- Strathcona CountySouth CalgarySt. Albert and SturgeonWainwrightWestviewWetaskiwin and AreaWolf CreekWoodBuffalo __
Select your PCN (using the drop down list) or choose "no PCN". If you work in more than one PCN, please choose your primary PCN as your comparator in the report.DELEGATES (UP TO 3)
This individual will be given access to your Primary Healthcare Panel Report. Delegate access permissions must be renewed on an annual basis. You have the right to remove delegate access at any time by emailing primaryhealthcarereports@hqca.caDelegate 1:
Last Name
First Name
Phone Number
ext.
Delegate 2:
Last Name
First Name
Phone Number
ext.
Delegate 3:
Last Name
First Name
Phone Number
ext.
QUESTIONS?
Email primaryhealthcarereports@hqca.ca or call 403.521.7101 CLINIC-LEVEL REPORT RECIPIENT The clinic-level report recipient is the primary contact for the clinic. As this person, you are authorized to request and receive the clinic report on behalf of the clinic physicians. By requesting a clinic report, you confirm that all of the physicians listed below have agreed to participate in the clinic report. If you are also one of the clinic physicians, please include your information in the ‘Physicians to include in the clinic report’ section below.*Last Name
*First Name
*Phone Number
ext
*Clinic Name
*Select your PCNNo PCNAlberta HeartlandAspenBig CountryBighornBonnyvilleBow ValleyCalgary FoothillsCalgary RuralCalgary West CentralCamroseChinookCold LakeDrayton ValleyEdmonton NorthEdmonton OliverEdmonton SouthsideEdmonton WestGrande PrairieHighlandKalyna CountryLakelandLeduc/Beaumont/DevonLloydminsterMcLeod RiverMosaicNorth WestPalliserPeace RegionPeaks to PrairiesProvostRed DeerRocky Mountain HouseSaddle HillsSherwood Park- Strathcona CountySouth CalgarySt. Albert and SturgeonWainwrightWestviewWetaskiwin and AreaWolf CreekWoodBuffalo __
Select your PCN (using the drop down list) or choose "no PCN". If you work in more than one PCN, please choose your primary PCN as your comparator in the report. PHYSICIANS TO INCLUDE IN THE CLINIC REPORT (UP TO 20) A minimum of two physicians are required to produce this report.PHYSICIAN #1
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #2
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #3
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #4
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #5
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #6
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #7
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #8
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #9
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #10
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #11
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #12
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #13
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #14
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #15
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #16
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #17
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #18
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #19
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #20
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.__Add New Physician
DELEGATES (UP TO 3)
This individual will be given access to your Primary Healthcare Panel Report. Delegate access permissions must be renewed on an annual basis. You have the right to remove delegate access at any time by emailing primaryhealthcarereports@hqca.caDelegate 1:
Last Name
First Name
Phone Number
ext.
Delegate 2:
Last Name
First Name
Phone Number
ext.
Delegate 3:
Last Name
First Name
Phone Number
ext.
QUESTIONS?
Email primaryhealthcarereports@hqca.ca or call 403.521.7101CLINIC NAME
*Clinic Name
DELEGATE/DESIGNATE INFORMATION*Last Name
*First Name
*Phone Number
ext
*Select your PCNNo PCNAlberta HeartlandAspenBig CountryBighornBonnyvilleBow ValleyCalgary FoothillsCalgary RuralCalgary West CentralCamroseChinookCold LakeDrayton ValleyEdmonton NorthEdmonton OliverEdmonton SouthsideEdmonton WestGrande PrairieHighlandKalyna CountryLakelandLeduc/Beaumont/DevonLloydminsterMcLeod RiverMosaicNorth WestPalliserPeace RegionPeaks to PrairiesProvostRed DeerRocky Mountain HouseSaddle HillsSherwood Park- Strathcona CountySouth CalgarySt. Albert and SturgeonWainwrightWestviewWetaskiwin and AreaWolf CreekWoodBuffalo __
Select your PCN (using the drop down list) or choose "no PCN". If you work in more than one PCN, please choose your primary PCN as your comparator in the report.*IMA
Yes
No__
An Information Management Agreement (IMA) is an agreement specifying that the HQCA can share the physician's Primary Healthcare Panel Report with you, a PCN representative, or your PCN. The IMA must be signed by the physician and provided by email to the HQCA (primaryhealthcarereports@hqca.ca). If you do not have an IMA, you can also use a Delegate Access form. The report will not be provided until a copy of the IMA or Delegate Access form is received and reviewed bythe HQCA.
DELEGATE/DESIGNATE INFORMATION*Last Name
*First Name
*Phone Number
ext
*IMA
Yes
No__
An Information Management Agreement (IMA) is an agreement specifying that the HQCA can share the physician's Primary Healthcare Panel Report with you, a PCN representative, or your PCN. The IMA must be signed by the physician and provided by email to the HQCA (primaryhealthcarereports@hqca.ca). If you do not have an IMA, you can also use a Delegate Access form. The report will not be provided until a copy of the IMA or Delegate Access form is received and reviewed bythe HQCA.
PHYSICIANS TO INCLUDE IN THE CLINIC REPORT (UP TO 20) A minimum of two physicians are required to produce this report.PHYSICIAN #1
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #2
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #3
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #4
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #5
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #6
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #7
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #8
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #9
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #10
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #11
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #12
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #13
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #14
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #15
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #16
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #17
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #18
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #19
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.PHYSICIAN #20
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing.__Add New Physician
PHYSICIAN
*Physician Last Name *Physician First Name*Physician Email __
The HQCA digital panel reports requires individual contact information for each physician, because it is the most secure and only way they can receive their respective reports. Please provide a personal email address that can be used for login and security purposes. *Physician Phone Numberext
*Prac ID: 08 __
This is the identifier the physician uses for billing. *Select your PCNNo PCNAlberta HeartlandAspenBig CountryBighornBonnyvilleBow ValleyCalgary FoothillsCalgary RuralCalgary West CentralCamroseChinookCold LakeDrayton ValleyEdmonton NorthEdmonton OliverEdmonton SouthsideEdmonton WestGrande PrairieHighlandKalyna CountryLakelandLeduc/Beaumont/DevonLloydminsterMcLeod RiverMosaicNorth WestPalliserPeace RegionPeaks to PrairiesProvostRed DeerRocky Mountain HouseSaddle HillsSherwood Park- Strathcona CountySouth CalgarySt. Albert and SturgeonWainwrightWestviewWetaskiwin and AreaWolf CreekWoodBuffalo __
Select your PCN (using the drop down list) or choose "no PCN". If you work in more than one PCN, please choose your primary PCN as your comparator in the report.DELEGATES (UP TO 3)
This individual will be given access to your Primary Healthcare Panel Report. Delegate access permissions must be renewed on an annual basis. You have the right to remove delegate access at any time by emailing primaryhealthcarereports@hqca.caDelegate 1:
Last Name
First Name
Phone Number
ext.
Delegate 2:
Last Name
First Name
Phone Number
ext.
Delegate 3:
Last Name
First Name
Phone Number
ext.
QUESTIONS?
Email primaryhealthcarereports@hqca.ca or call 403.521.7101 NEED MORE INFORMATION? YOUR PRIMARY HEALTHCARE PANEL REPORT Since 2011, the HQCA has been providing Primary Healthcare Panel Reports upon request to family physicians across Alberta. Learn moreabout these reports
.
YOUR PRIVACY
We are collecting this personal information for the purpose of creating and providing you with your Primary Healthcare Panel Report. The information is used only for the purpose it was collected or for a consistent purpose. Further, we keep the information only for the length of time necessary to fulfill the purpose for which it was collected. Your personal information is protected by the privacy provisions of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection of this information please contact the HQCA at 403-521-7101 or primaryhealthcarereports@hqca.ca. HEALTH QUALITY COUNCIL OF ALBERTA * Toll Free: 855.508.8162 * Email: primaryhealthcarereports@hqca.ca 210, 811 – 14 Street NW Calgary, Alberta, Canada T2N 2A4©2019 HQCA
* Privacy Policy
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