Form HLTH1936 Rn(C) Practitioner Information Profile: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by entering the date in the format YYYY/MM/DD at the top of the form.
In the 'Practitioner Information' section, fill in your name and MSP Practitioner Number accurately.
Provide details for your primary clinic, including name, address, city, phone number, postal code, after-hours number, fax number, cell, pager, and service options.
Select your preferred report return method from the options: Excelleris, Auto Fax, or Hard Copy Delivery.
If applicable, repeat steps 4 and 5 for any additional clinics you wish to include.
Finally, complete the laboratory information section with relevant fax numbers and emails for submission.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (119 Votes)
2013	4.2 Satisfied (40 Votes)

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