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The Royal Australian College of General Practitioners

1. POLICY TITLE ASSESSMENT OF OVERSEAS GENERAL PRACTICE
EXPERIENCE AND AUSTRALIAN GENERAL PRACTICE
EXPERIENCE

1.1 Policy number: AS-E-022.0
1.2 Category: Organisational
1.3 Approval date:
1.4 Revision due date: May 2013
1.5 Unit responsible Assessment

2. POLICY DECLARATION

This policy defines assessment of Overseas General Practice Experience and Australian General
Practice Experience to enable the RACGP to determine a prospective Practice Eligible assessment
candidate’s eligibility to participate in one of the College’s pathways to Fellowship. Applications for
assessment of general practice experience will be assessed in the context of the definitions of general
practice as set out in this policy.

This policy is approval by Council and authorisation by the CEO.

3. BACKGROUND

i) Objectives

The objectives of this policy are to:

• Define assessable general practice experience for applicants wanting to attain
Fellowship of the College via the Practice Eligible route
• Provide guidelines for applicants preparing an application for the assessment of
Overseas General Practice experience and/or Australian General Practice experience
• Recognise the variety of settings in which general practice experience can be gained

The intention of this policy is to set out the rules for assessment of general practice experience to the
standard required for eligibility to participate in any of the College’s assessments that culminate in the
award of Fellowship. This policy ensures that the College maintains appropriate standards for
determining eligibility, whilst recognising alternative pathways to Fellowship.

ii) Specific Aims

The specific aims of this policy are to:

• Inform applicants, applying through the practice eligible route, of the requirement for a
general practice experience assessment to determine eligibility to participate in any of
the College assessments.
• Provide a comparable set of requirements of general practice experiences that meet the
standards for eligibility to participate in any of the College assessments.

3.1 Related documents

“Standards for General Practice Education and Training Requirements for Fellowship 2005” available
to view at: http://www.racgp.org.au/fellowship

“Academic Misconduct” available at: http://www.racgp.org.au/assessment/policy

ID number: AS-E-022.0 Page 1 of 27
Assessment of Overseas General Practice Experience and Australian General Practice Experience policy (May 2010)

The Royal Australian College of General Practitioners

“Special Consideration Policy” available at: http://www.racgp.org.au/assessment/policy

“Appeals” available at: http://www.racgp.org.au/assessment/policy

“Definition of general practice and general practitioner” available at:
http://www.racgp.org.au/whatisgeneralpractice

4. BODY OF POLICY

Applicants must submit detailed and complete documentation of their general practice experience to
allow for appropriate assessment.

Intending Practice Eligible applicants who have overseas general practice experience must have their
general practice experience assessed prior to enrolling in the college assessment segments.

4.1 Assessment of general practice experience

In order to establish eligibility to participate in any of the College assessments applicants following the
Practice Eligible route will be required to undergo assessment of their general practice experience in
overseas and Australian general practice.

All candidates with overseas general practice experience must provide full details of the nature of their
overseas general practice experience and how it is similar to that in Australia, to enable the college
censors to assess its equivalence to general practice in Australia. This can be done by applying for the
following assessments of time in general practice prior to enrolling in the college assessment
segments via the Practice Eligible route.

Only general practice experience within the past 10 years, from the indemnity date shown on the
application form, can be assessed by the College Censors.

4.2 General Practice

General practice is the provision of primary continuing comprehensive whole-patient medical care to
individuals, families and their communities.

General practice involves the ability to take responsible action on any medical problem the patient
presents, whether or not it forms part of an ongoing doctor-patient relationship. In managing the
patient, the general practitioner may make appropriate referral to other doctors, health care
professionals and community services.

General practice is the first point of contact for the majority of people seeking health care, and often
therefore the first point of referral. In the provision of primary care, much undifferentiated illness is
seen; the general practitioner often deals with problem complexes rather than with established
diseases. The general practitioner must be able to make a total assessment of the person's condition
without subjecting a person to unnecessary investigations, procedures and other treatment.

4.2.1 Queensland Medical Superintendants

The experience of medical superintendents of country hospitals in Queensland has been assessed for
equivalence to general practice. Details of these assessments may be obtained from the RACGP
Queensland Faculty Censor.

4.2.2 Australian Defence Force Experience

The College may accept armed services posts for their equivalence to general practice after
consideration of whether the post meets the definition of general practice.

ID number: AS-E-022.0 Page 2 of 27
Assessment of Overseas General Practice Experience and Australian General Practice Experience policy (May 2010)

4.7 Accredited Medical Deputising Service Work in an accredited medical deputising service for a minimum of three sessions per week may count as general practice experience to a maximum of 2. and also a curriculum vitae containing in particular detail regarding the number of sessions worked in general practice.2.au/assessment/pathways) • conjoint examination with the RACGP (Malaysia and Hong Kong). Three sessions per week is considered to be equivalent to 30% of full time general practice. ID number: AS-E-022.org. The time requirement for eligibility for admission to Fellowship for doctors working part time in general practice is limited to a maximum of 10 years in part time general practice.racgp.5 years (full time equivalent).0 Page 3 of 27 Assessment of Overseas General Practice Experience and Australian General Practice Experience policy (May 2010) . 4. will be counted as equivalent to one third of the time in Australian general practice experience. The Royal Australian College of General Practitioners 4. Working longer hours in a week will not be calculated to accrue the doctor more than a week’s working time if the doctor is seeking an assessment of general practice experience.3 Overseas General Practice experience There are various categories of overseas general practice experience.4 Full Time General Practice Full time general practice is 37 hours worked per week in typical general practice activities. Full time general practice must include work spread over at least five working days per week and must include a minimum of nine sessions per week.5 Part Time General Practice Part time experience in general practice must be for a minimum of three sessions (equivalent to a minimum of 10. none of which may be less than 3. training and assessment that may lead to eligibility to participate in any of the College assessments: • accepted postgraduate qualifications in general practice for RACGP membership (see Specialist Pathway web pages – www. 4. Employment in non-accredited after hours deputising services is not considered equivalent to general practice.5 hours.3 Academic General Practice Part time work in academic general practice. Experience greater than three sessions per week but less than full time will be calculated on a pro-rata basis as determined by the number of sessions and hours worked.5 hours) per week in the one practice for a minimum of one month. 4.6 Locum Work Full time locums in general practice are regarded as equivalent to full time general practice provided the locum period is greater than one week duration in any one practice. If evidence of continuity of care can be provided. Any other overseas clinical experience claimed as equivalent to Australian general practice is assessed by the Board of Censors upon presentation of a detailed submission by the applicant. combined with working a minimum of three sessions per week in general practice. Working full time with the Australian Royal Flying Doctor Service is regarded as equivalent to full time general practice. provided that they: • demonstrate continuity of care • work no less than 30% equivalent of full time general practice • submit to the College (if requested) a log diary of 100 consecutive patient consultations to demonstrate the depth and nature of their general practice experience. a further six months of this time may count as general practice experience. 4.

org. see: “Appeal”. Applications for assessment of Australian only general practice experience are to be submitted on the Assessment of Australian General Practice Experience form (see Appendix 2) Applicants are required to submit a complete application. (ii) at least one year full time general practice experience (of the required four years full time) to have been gained in Australian general practice. 5.org. PROCEDURES 5. and “Board of Censor’s Decisions Review Committee” policies at http://www.0 Page 4 of 27 Assessment of Overseas General Practice Experience and Australian General Practice Experience policy (May 2010) . The Royal Australian College of General Practitioners 4. Applicants are strongly advised to submit their application for assessment as early as possible.1 Overseas and/or Australian general practice experience assessment Applications for assessment of overseas general practice experience or a combination of overseas general practice experience in conjunction with Australian general practice experience are to be submitted on the Assessment of Overseas and Australian General Practice Experience form (see Appendix 1).au/assessment/FAQs 5. Requests from the College for clarification and/or additional information for an application will delay the progress of the application. Applicants must forward the complete application form with the required application fee of: ƒ $500.racgp.00 (GST free) for non-members ƒ $300.au/assessment/policy 5.2 Right of appeal There is an appeal process that an applicant can pursue. Once the complete application form is sent to the College Censors for assessment. ID number: AS-E-022. assessment may take up to three weeks depending on circumstances and the number of applications received.8 Eligibility for the Practice Eligible Route Applicants wishing to participate in any of the College assessments via the Practice Eligible route must have: (i) four years full time approved Australian equivalent general practice experience (or part time equivalent) and.racgp.3 Review of this policy The review cycle for policy is three years.00 (GST free) for financial associate members A Word version of the application form for assessment of Overseas General Practice Experience can be obtained at www.

Appendix 1 Assessment Department NOTES TO ASSIST YOU IN THE CORRECT COMPLETION OF THE Application Form for Assessment of OVERSEAS & AUSTRALIAN GENERAL PRACTICE EXPERIENCE YOU HAVE BEEN REQUESTED TO PROVIDE CERTIFIED COPIES OF RELEVANT DOCUMENTATION E Refer to the “Witnessing and Certification of Documentation Policy” for those people eligible to certify documentation PL www. REFER TO THE M ‘ENGLISH LANGUAGE PROFICIENCY POLICY’ BEFORE PROCEEDING FURTHER SA www.au/assessment/policy IF YOU ARE AN INTERNATIONAL MEDICAL GRADUATE (IMG).org.au. You may obtain a full copy of the College’s Policy from our website: www.org.org.au/assessment/policy PRIVACY POLICY The RACGP has a Privacy Policy that reflects recent changes in Federal and State Privacy Legislation.racgp.racgp. IF YOU ARE UNABLE TO PROVIDE ANY DOCUMENT REQUESTED DO NOT PROCEED WITH YOUR APPLICATION YOUR APPLICATION FORM WILL BE RETURNED TO YOU Please post your complete application to: Assessment Department RACGP 1 Palmerston Crescent South Melbourne Victoria 3205 Australia THE CENSOR-IN-CHIEF MAY REQUEST FURTHER INFORMATION UPON REVIEW OF YOUR APPLICATION Page 5 of 27 Assessment of Overseas and Australian General Practice Experience .racgp.

au/assessment/policy)? Has overseas clinical time in section C1 been stated? Have all the columns within section C1 been completed? M Is this overseas general practice experience within ten (10) years of submitting the application? SA Has a separate section C2 been completed for each overseas medical position listed in Section C1 and for which an assessment is being sought? Have the hours for each workday been stated for each overseas medical position listed in Section C1? Were all the hours worked in each Overseas medical position listed in Section C1 as ‘general practice is defined on Page C of this application? If no. the RACGP will be unable to process your application. If you have marked the NO box for any of the following questions.org.org.racgp.au/assessment/policy)? E Is your Statutory Declaration witness signatory one which is listed in the RACGP’s PL Witnessing and Certification Policy (www. Appendix 1 RACGP Assessment Department Criteria for Assessment of Time in Overseas General Practice The following table is a checklist which provides the criteria required to submit this application.racgp. We highly recommend that you ensure all the criteria are met for an efficient and positive outcome. has an outline of the duty rotations been indicated on the table provided in Section C2? Has a separate page been used to describe each of the A to F criteria listed within Section C2? Does each of the A to F criteria listed within Section C2 contain more than 5 sentences of relevant detail? Has a description of patients for each overseas medical position listed in Section C1 been provided? Has a description of illnesses for each overseas medical position listed in Section C1 been provided? Has a description of a medical record system for each overseas medical position listed Page 6 of 27 Assessment of Overseas and Australian General Practice Experience . Please ensure that you complete the checklist before submitting your application to the RACGP. Requirement Completed Yes No Have all relevant sections of the form been ‘typed’ only? Are the personal contact details complete? Is the purpose for which an assessment is required complete? Have three copies of the application and all supporting documentation been sent? Is your Indemnity form witness signatory one which is listed in the RACGP’s Witnessing and Certification Policy (www.

Appendix 1 in Section C1 been provided? E PL M SA Page 7 of 27 Assessment of Overseas and Australian General Practice Experience .

has a Certificate of Good Standing from the registering body been provided for each medical position for which an assessment of time is being sought? Has a certified copy of your internship certificate been provided? Is there evidence of Postgraduate training ie General Practice/other specialities and availability of supervision during training? Is there verification of involvement with other general practitioners and specialists? (please provide three letters of reference) Is there verification of involvement with other health professionals in the practice or the community? (please provide three letters of reference) Has a detailed curriculum vitae (CV) been provided? Has the tax invoice been completed? Page 8 of 27 Assessment of Overseas and Australian General Practice Experience . Appendix 1 Has a description of the availability of drugs and details of prescribing processes for each overseas medical position listed in Section C1 been provided? Has a description of all procedural work undertaken for each overseas medical position listed in Section C1 been provided? Has a description of the consulting rooms for each overseas medical position listed in Section C1 been provided? Has each of the five ‘Domains of General Practice’ listed on Page 5 of the application been addressed? Has the domain of Communication Skills and the Patient – Doctor Relationship been addressed? Has the domain of Applied Professional Knowledge and Skills been addressed? Has the domain of Population Health and the Context of General Practice been addressed? Has the domain of Professional and Ethical Role been addressed? E Has the domain of Organisational and Legal Dimensions been addressed? PL Has a separate description of the health system for each of the countries of experience listed on Page 6 of the application been provided? If the Primary Medical Degree is not in English. has an official and endorsed translation to English been provided? M Has a certified copy of a Primary Medical Degree been provided? SA Has a certified copy of current medical registration been provided? If overseas registration was issued more than 2 years ago.

Tel: 1800 626 901 or +61-3-8699 0400 or Email: assessment@racgp. please contact the Assessment Department before completing this application.org. South Melbourne Victoria 3205 Tel (03) 8699 0414 Fax (03) 8699 0400 ACN 000 223 807 ABN 34 000 223 807 RECOGNISED OVERSEAS QUALIFICATIONS FOR GENERAL PRACTICE Please indicate 9 or 8 to each of the following questions If you hold any of the post graduate qualifications. Appendix 1 THE ROYAL AUSTRALIAN COLLEGE OF GENERAL PRACTITIONERS College House. 1 Palmerston Crescent.au Country Qualification Yes No 9 8 Belgium Specialist Certificate in General Practice / Family Medicine Canada Certificate in Family Medicine from College of Family Physicians of Canada (CFPC) + Evidence of Canadian Qualifying Examinations Part 1 + 2 post 1992 E Certificate in Family Practice from the College of Family Physicians of Canada PL Denmark Specialist Certificate in Family Medicine Ireland Graduate of ICGP holding MICGP membership Netherlands Certificate of Specific Training for General Practice M New Zealand Fellow of The Royal New Zealand College of General Practitioners (FRNZCGP) SA Norway Certificate of Specific Training for General Medical Practice Singapore Master of Medicine in Family Medicine South Africa Member of The College of Family Practitioners of the South African College of General Practice Registration as a Family Physician with the Health Professions Council of South Africa Master of Family Medicine Master of Prax Medicine Sweden Certificate of Specific Training for General Practice United Kingdom Membership of the Royal College of General Practitioners Certificate of the Joint Committee in Postgraduate Training for General Practice Certificate from the Post Medical Education Training Board United State of Certificate of the American Board of Family Practice America Page 9 of 27 Assessment of Overseas and Australian General Practice Experience .

............................................................................…...../..Phone No: [ ] .......... SA Home Address: ......... Appendix 1 Assessment Department Application Form for Assessment of OVERSEAS & AUSTRALIAN GENERAL PRACTICE EXPERIENCE THIS ENROLMENT FORM MUST BE TYPED OR WRITTEN IN BLOCK LETTERS E PL Office Use Only:…………………………............................... RACGP Number:……………………........... Gender: M / F Preferred mailing address: Practice Home Other University Graduated From: …………………………………………………….......................... Given Names:.................................... Country: ............ Surname: ...................................... Country: .............. M Practice Address:............................... Fax No: [ ] .........../......................... Email:.......... Date Received:……………………....... Fax No: [ ] ..................…... DOB:............... Postcode: .................... State: ... Postcode: ............…......................................................................................................................... Year Graduated: ………………………… entry into a Rural recruitment Scheme enrolment in the next College Exam Page 10 of 27 Assessment of Overseas and Australian General Practice Experience ... State: ..........................................................................Mobile: ............................................................................................Phone No: [ ] ..................................................................................................

.. action. Professional Services Review Director. I hereby indemnify RACGP and will keep RACGP indemnified for any loss. I also undertake to provide all details of any current or pending investigations. Appendix 1 INDEMNITY I acknowledge that The Royal Australian College of General Practitioners (‘RACGP’) will rely upon the accuracy and truth of the statements and information that I provide in this application in order to assess the time I have spent overseas in general practice.racgp. Title: …………………………………………………………………. M *Refer to the “Witnessing and Certification of Documentation Policy” for those people eligible to witness your indemnity form SA www. inquiry or sanction by a Medical Board. demand or proceeding brought by any person in respect of loss or damage arising from any false.. whether in Australia or overseas. Signature of witness*:………………………………………………… E PL Print Name: …………………………………………………………… Date: ………………………………. cost or expense incurred by RACGP as a result of any claim.org. misleading or inaccurate statement or information provided by me in this application. Signature of applicant: ……………………………………………… Print Name: …………………………………………………………… Date: ………………………………. review.au/assessment/policy Page 11 of 27 Assessment of Overseas and Australian General Practice Experience . Medicare Australia or any similar body in relation to my professional practice or behaviour..

201____ SA Before me.org. Commonwealth of Australia and subject to the penalties provided by that Act for the making of false statements in statutory declarations. conscientiously believing the statements contained in this declaration to be true in every particular. (3) ____________________________________________________________ (4) ____________________________________________________________ (1) Here insert name. true and correct And I make this solemn declaration by virtue of the Statutory Declarations Act 1959. (2) Signature of person making the declaration. Refer to the “Witnessing and Certification of Documentation Policy” for those people eligible to witness your Statutory Declaration form http://www. Appendix 1 Statutory Declaration I.au/assessment/policy Page 12 of 27 Assessment of Overseas and Australian General Practice Experience . (4) Here insert title of person before whom the declaration is made. (3) Signature of person before whom the declaration is made (see over page for a list of persons before whom a Statutory Declaration may be made). E (2) ______________________________________________________________ PL Declared at _______________________________________________ M On the ______________________ day of ________________ . address and occupation of person making the declaration.(1) ______________________________________________________ do solemnly and sincerely declare that the information and statements contained in my application for assessment of overseas time in general practice and in the attachments provided with my application are accurate.racgp.

NOTE: Full time general practice is considered 37 hours per week. South Melbourne Victoria 3205 Tel (03) 8699 0414 Fax (03) 8699 0400 ACN 000 223 807 ABN 34 000 223 807 C1 Section 1 . Do you consider Dates this position dd/mm/yy Position Name & Address & Country Full Time General Practice Office Use Only Yes / No as defined on From To Page B Yes / No ± E PL M SA Page 13 of 27 Assessment of Overseas and Australian General Practice Experience .org. Appendix 1 THE ROYAL AUSTRALIAN COLLEGE OF GENERAL PRACTITIONERS College House.Overseas Clinical Experience NOTE: Please refer to the RACGP’s definition of the a general practitioner http://www. 1 Palmerston Crescent.5 hours (3 sessions) per week in the one position for a minimum of one month.au/whatisgeneralpractice NOTE: Only overseas general practice experience within ten (10) years prior to the application date will be considered for this assessment.racgp. Minimum acceptable part-time general practice is 10.

Please describe the consulting rooms. For example: how many male/female patients. E. Page 14 of 27 Assessment of Overseas and Australian General Practice Experience . Description of patients. How were these patients followed up and by whom? C. Description of medical record system used. Please outline the details of all procedural work done. Description of procedural work undertaken. D. what was the age distribution. Please outline the types of illnesses seen.Copy this page and complete BOTH part 1 & part 2 Part 1 ± Position Name (from Section 1) : ________________________________________________ Start Date : _____________________ Finish Date : _____________________ dd/mm/yy dd/mm/yy For this position only. Please outline the medical record system used. Please outline the availability of drugs and details of prescribing processes. what hours did you work each day? (eg. 1 Palmerston Crescent. Description of consulting rooms. Description of availability of drugs. South Melbourne Victoria 3205 Tel (03) 8699 0414 Fax (03) 8699 0400 ACN 223 807 ABN 34 000 223 807 C2 Applications should be TYPED – if hand-written use BLOCK letters Section 2 . Please outline the types of patients seen. A. please outline the amount of time per week you spent in the following PL duties: Inpatient care Work in Hospital wards Operating theatres Emergency M Outpatient clinics Community clinics General Practice Other: SA Part 2 Please address ALL the following criteria for ONLY the general practice part of this position Please ensure that each description requested below is detailed enough to enable the RACGP Censors to gain a clear understanding of your general practice experience. Please give a description of how your General Practice experience correlates across these domains. Please use a separate page for each description. G. Domains of General Practice On the following page is a list of the “Domains of General Practice”. These domains define the role of Australian General Practitioners within the Australian Primary Healthcare system. B. F. 8am to 5pm) Monday Tuesday Wednesday Thursday Friday Saturday Sunday Were ALL the hours worked in this position in general practice as it is defined in Australia? E Yes No If No. Description of illnesses seen. or if you are unsure. Appendix 1 THE ROYAL AUSTRALIAN COLLEGE OF GENERAL PRACTITIONERS College House.

6 Counselling Skills 1.4 Information management – patient and practice 4.2 Maintenance of professional standards 5.15 Critical appraisal Professional and Ethical Role Organisational and Legal Dimensions 4. illnesses 3.3 Knowledge of Medical Conditions – preventable special groups M 2.3 Adherence to contemporary ethical principles 5.5 Consultation Models 1.4 Cultural aspects of health care serious 3.masquerading 3.9 Communication with patients from difft cultural backgrounds 1.5 Socio-political dimensions of health SA 2.14 Cost-effective treatment and investigations 2.7 Patient context .uncommon.3 Establishing Rapport 1.5 Knowledge of Medical Conditions .1 Special duty of care 5.7 Research. 3.7 Advocacy Role for the individual patient 1.8 Professional networks 4.1 The General Practitioner as a therapeutic agent 1.8 Practice management 4.7 Legal responsibilities 4.1 Knowledge of Medical Conditions – common 2.1 Demographic & epidemiological issues .13 Written communication skills PL Applied Professional Knowledge and Skills Population Health and the Context of General Practice 2.9 Self and family care Page 15 of 27 Assessment of Overseas and Australian General Practice Experience . evaluation & audit skills 5.5 Information technology development 5.4 Communication with patients' significant others 1.8 Information gathering 2.family.8 Interaction of Family Dynamics with health and illness 1.12 Continuity of Care 2. Appendix 1 Domains of Australian General Practice Communication Skills and the Patient – Doctor Relationship 1. but 3.4 Reflective skills and self-appraisal 5.health needs of 2.3 Population-based preventive strategies 2.dysfunctional.1 Arrangements for availability and accessibility 4.6 Knowledge of Medical Conditions .4 Knowledge of Medical Conditions .3 Screening and recall systems 4. referrals and networking E 1.13 Integration of care 2.6 Medical records 4.10 Communication with special needs groups 1.10 Procedural skills 2.8 Community resources 2.2 Knowledge of public health problems disabling or life-threatening 3.11 Clinical decision making 2.6 Teaching role 5.2 Knowledge of Medical Conditions – treatable 3.2 Patient-Centeredness 1.11 Individual & opportunistic health education promotion 1.6 Advocacy role in the community--.2 Safety-netting 4.9 Physical examination skills 2. work and significant others 2.7 Approach to undifferentiated problems 3.5 Lifelong learning and continuous professional 5.12 Care coordination.

Appendix 1 A THE ROYAL AUSTRALIAN COLLEGE OF GENERAL RACTITIONERS College House. South Melbourne Victoria 3205 Tel (03) 8699 0414 Fax (03) 8699 0400 ACN 223 807 ABN 34 000 223 807 Australian Clinical Experience SECTION 1 HOSPITAL EXPERIENCE – Including registration year – Australia only Dates Hospital Discipline Duration Office From To Years and Months Use Only E PL TOTAL SECTION 2 GENERAL PRACTICE EXPERIENCE .racgp. A full copy of the College’s policy is available from our website: www.Australia only M Dates Full Part Time Duration Office From To sessions Practice Names and Address Time Years & Use Only per Week SA Months TOTAL PRIVACY POLICY: The RACGP has a Privacy policy that reflects Federal and State privacy legislation.org. 1 Palmerston Crescent.au Page 16 of 27 Assessment of Overseas and Australian General Practice Experience .

All fees quoted are inclusive of GST. Page 17 of 27 Assessment of Overseas and Australian General Practice Experience . OFFICE USE ONLY Batch No.org.au. This form will become your tax invoice upon payment.00 FEES PAYABLE Including GST NON-MEMBER $500. (if applicable) WHAT IS YOUR PREFERRED DAYTIME CONTACT NUMBER DATE RACGP MEMBER … YES … NO … CHEQUE (make payable to the RACGP) … Amex … Visa … MasterCard CARD NUMBER ………… ………… ………… ………… CARDHOLDER NAME (please print clearly) EXPIRY DATE …… / …… CARDHOLDER SIGNATURE TOTAL AMOUNT $AUD DO YOU REQUIRE A RECEIPT? Yes No Please print clearly and keep a copy of this form for your records. ABN 34 000 223 807. For more information telephone 1800 626 901 or email assessment@racgp. Invoice No.00 M FIRST NAME SA SURNAME RACGP NO. Order No. Appendix 1 Assessment Department TAX INVOICE The Royal Australian College of General Practitioners 1 Palmerston Crescent South Melbourne VIC 3205 Australia ACN 000 223 807 ABN 34 000 223 807 PAYMENT DETAILS for APPLICATION FOR ASSESSMENT OF OVERSEAS & AUSTRALIAN GENERAL PRACTICE EXPERIENCE E PL MEMBER $300.

Appendix 1 E PL M SA Page 18 of 27 Assessment of Overseas and Australian General Practice Experience .

racgp.racgp.org. PLEASE READ THIS SECTION BEFORE PROCEEEDING FURTHER ENGLISH LANGUAGE REQUIREMENTS Please refer to the RACGP English Language Proficiency Policy www.au/membership E PL YOU HAVE BEEN REQUESTED TO PROVIDE CERTIFIED COPIES OF RELEVANT DOCUMENTATION THE COLLEGE WILL ONLY ACCEPT CERTIFICATION FROM A M REGISTERED JUSTICE OF THE PEACE (JP) (with evidence of their Registration Number) SA TO OBTAIN NAMES OF JPs IN YOUR LOCALITY PLEASE CALL 1300 365 567 IF YOU ARE AN INTERNATIONAL MEDICAL GRADUATE (IMG).au/assessment/policy Application for Assessment of Time in Australian General Practice March 2010 Page 19 of 27 . Appendix 2 Assessment Department NOTES TO ASSIST YOU IN THE CORRECT COMPLETION OF THE APPLICATION FORM for ASSESSMENT OF TIME IN AUSTRALIAN GENERAL PRACTICE IF YOU ARE NOT A CURRENT MEMBER OF THE RACGP WE ARE UNABLE TO PROCESS YOUR APPLICATION For information on how to become an RACGP member visit our website: www.org.

Appendix 2 ALL APPLICANTS WILL NEED TO PROVIDE THE FOLLOWING DOCUMENTATION CONFIRM THAT YOU CAN PROVIDE WHAT HAS BEEN REQUESTED BYMARKING EACH BOX WITH A TICK (√ ) Written confirmation (on practice letterhead) signed by the Principals from the practice(s) or relevant hospital(s) or clinic(s) indicating: ƒ the specific dates you were/are employed ƒ the exact nature of the work are/were required to cover (description of duties) ƒ whether you worked full-time or part-time ƒ duration of sessions A certified copy of your current medical registration (an expiry date must be shown). A copy of your current curriculum vitae. A certified copy of your primary medical degree. E PL THE CENSOR-IN-CHIEF MAY REQUEST FURTHER INFORMATION UPON REVIEW OF YOUR APPLICATION M SA IF YOU ARE UNABLE TO PROVIDE ANY DOCUMENT REQUESTED DO NOT PROCEED WITH YOUR APPLICATION YOUR APPLICATION FORM WILL BE RETURNED TO YOU Application for Assessment of Time in Australian General Practice March 2010 Page 20 of 27 . A letter of approval from the RACGP Censor-in-Chief indicating previous assessments of time (if applicable).

Appendix 2 Assessment Department APPLICATION FORM for ASSESSMENT OF AUSTRALIAN GENERAL PRACTICE EXPERIENCE T H I S A P P L I C AT I O N F O R M M U S T B E TYPED OR WRITTEN IN BLOCK LETTERS FOR WHAT PURPOSE DO YOU REQUIRE AN ASSESSMENT OF YOUR AUSTRALIAN GENERAL PRACTICE EXPERIENCE? E (tick relevant box) PL ENROLMENT IN THE NEXT ENTRY INTO THE COLLEGE RACGP SPECIALIST MEMBERSHIP College Practice Based Modular Assessment PATHWAY PROGRAM M Examination Assessment Pathway SA PERSONAL DETAILS FIRST NAME(S) MIDDLE NAME(S) SURNAME DATE OF RACGP NO. BIRTH if applicable CONTACT DETAILS PRACTICE ADDRESS Street / Road Number Street / Road Name Town City Post Code Application for Assessment of Time in Australian General Practice March 2010 Page 21 of 27 .

Appendix 2 Country HOME ADDRESS Street / Road Number Street / Road Name Town City Post Code Country OTHER ADDRESS Street / Road Number Street / Road Name Town E PL City Post Code Country M My preferred mailing address is: Practice Home Other tick relevant box SA TELEPHONE / FAX NUMBER AND EMAIL ADDRESS Home (include area code) Practice (include area code) Fax (include area code) Mobile Email (mandatory) ACADEMIC BACKGROUND Office Use Only PRIMARY Date QUALIFICATION Awarded (attach additional page if Qualification required) University College Application for Assessment of Time in Australian General Practice March 2010 Page 22 of 27 .

Appendix 2 Country Office Use Only Date Awarded OTHER MEDICAL Qualification QUALIFICATIONS (attach additional page if University required) College Country Office Use Only Date Awarded OTHER MEDICAL Qualification QUALIFICATIONS (attach additional page if University E required) College PL Country Office Use Only Date Awarded M NON MEDICAL Qualification QUALIFICATIONS SA (attach additional page if University required) College Country Office Use Only Date Awarded NON MEDICAL Qualification QUALIFICATIONS (attach additional page if University required) College Country Office Use Only MEDICAL Registration REGISTRATION Number Status Start Date Application for Assessment of Time in Australian General Practice March 2010 Page 23 of 27 .

Appendix 2 Expiry Date Registration Body HOSPITAL EXPERIENCE inc REGISTRATION YEAR (attach additional page if required) Office use Only Date From To Hospital Discipline Duration Years E Months PL Office use Only Date From To Hospital M Discipline SA Duration Years Months Office use Only Date From To Hospital Discipline Duration Years Months Office use Only Date From To Hospital Application for Assessment of Time in Australian General Practice March 2010 Page 24 of 27 .

Appendix 2 Discipline Duration Years Months E PL M SA Application for Assessment of Time in Australian General Practice March 2010 Page 25 of 27 .

5 hours (three sessions per week) in the one practice for a minimum of one month Office Use Only Date From To Practice Name Location Part Time Years Full Time Hours Sessions Per Week Per week Months Office Use Only Date From To Practice Name Location Full Time Hours Part Time Years Per Week Sessions Application for Assessment of Time in Australian General Practice March 2010 Page 26 of 27 . Appendix 2 Office use Only Date From To Hospital Discipline Duration Years Months Office use Only Date From To Hospital Discipline E PL Duration Years Months M GENERAL PRACTICE EXPERIENCE (AUSTRALIA ONLY) (attach additional page if required) SA Note minimum acceptable part-time experience is 10.

inquiry or sanction by a Medical Board. cost or expense incurred by RACGP as a result of any claim. SA I also undertake to provide all details of any current or pending investigations. I hereby indemnify RACGP and will keep RACGP indemnified for any loss.racgp. demand or proceeding brought by any person in M respect of loss or damage arising from any false. contact: Assessment Department on Free Call 1800 626 901 PRIVACY POLICY Application The for Assessment RACGP has aofPrivacy Time inPolicy Australian thatGeneral reflectsPractice recent changesMarch 2010 and State Privacy Page in Federal 27 of 27 Legislation. Professional Services Review Director. review. Medicare Australia or any similar body in relation to my professional practice or behaviour in Australia.org. Name Signature Date APPLICATION FORM AND CERTIFIED DOCUMENTS MUST NOT BE EMAILED OR FAXED MAIL TO Assessment Department RACGP 1 Palmerston Crescent SOUTH MELBOURNE VIC 3205 AUSTRALIA For queries. Appendix 2 Per week Months Office Use Only Date From To Practice Name Location Part Time Years Full Time Hours Sessions Per Week Per week Months Office Use Only Date From To Practice Name Location Part Time Years Full Time Hours Sessions Per Week Months E Per week PL INDEMNITY I acknowledge that The Royal Australian College of General Practitioners (RACGP) will rely upon the accuracy and truth of the statements and information that I provide in this application in order to assess the time I have spent in Australian general practice.au. misleading or inaccurate statement or information provided by me in this application. action. . You may obtain a full copy of the College’s Policy from our website: www.