Application Form

Application Form to join the PRCSG. All fields except "Address2" are required.

 

For Physician applicants, please describe the following information in the text box below:

1) Your pediatric rheumatology fellowship (for those performing fellowship out side of Canada or US please see PRCSG bylaws for required additional information),

2) Your involvement in the treatment of children with pediatric rheumatic diseases (e.g. number of days in pediatric rheumatology clinic per week) and approximate number of pediatric rheumatology patients or visits per month or year,

3) Your pediatric hospital including availability of other pediatric subspecialities such as ophthalmology, ICU, etc.

 

For nurse practitioner and physician assistant applicants, please provide a description of the following:

1) Letter of support from a PRCSG member confirming your active involvement in clinical practice or clinical research that has an element related to pediatric rheumatology,

2) Letter of support from a PRCSG member physician working in the same location confirming adequate training in the field of pediatric rheumatology,

3) Standard of care arrangement document (or other document as per state laws) with one or more PRCSG physician members in a PRCSG Clinical Center.