Preceptorship Contract – Member Preceptorship Contract - Member 11203 70 Street NW Edmonton, AB T5B 1T1 registration@theccoa.ca Preceptorship Application and Contract between the College of Chiropractors of Alberta (CCOA) and the CCOA Member Date(Required) DD slash MM slash YYYY Student:(Required) First Last Name of student's college:(Required)CCOA member:(Required)Email:(Required) Clinic address:(Required)Preceptorship start date:(Required)Preceptorship end date:(Required) Regulated members eligible for approval as a preceptor have: A minimum of five years practice experience and is a member in good standing Completed their most recent practice review satisfactorily with no outstanding issues or requirements (the most recent practice review may not have been a remedial review) No discipline activity currently or for the previous five years Demonstrates appropriate liability protection for supervising chiropractic students I hereby agree to abide by the following directions set by the CCOA. I understand this contract can be cancelled at any time by the CCOA. I further understand that I must supervise all the procedures performed by the student at my office — meaning that I will be physically present and available to assist. I also agree that written consent will be obtained from any patient treated by the student. I agree that the student can perform the following procedures: Obtain information for a patient entry Obtain a case history Conduct an examination, including a diagnosis that must be confirmed by me Use a deliberate, brief, fast thrust to move the joints of the spine beyond the normal range but within the anatomical range of motion, which generally results in an audible click or pop Insert or remove instruments, devices or fingers beyond the cartilaginous portion of the ear canal Insert or remove instruments, devices or fingers beyond the point in the nasal passages where they normally narrow and beyond the anal verge Reduce a dislocation of a joint Order any form of ionizing radiation in medical radiography, and nuclear medicine Apply any form of ionizing radiation in medical radiography Order non-ionizing radiation in magnetic resonance imaging, and ultrasound imaging Assist in rendering treatment for ultrasound, electro therapy, massage or trigger point therapy I agree that the student will not perform the following activities or any advance restricted activities even if I am authorized to do so: Needle acupuncture Setting or resetting a fracture of a bone
