Interdepartmental Initiative Meeting Claim Form

Physician Information

Medical Staff Type(Required)
Are you registered with FEMS?(Required)
Do you want to be contacted for assistance with FEMS registration?(Required)

Meeting Information

MM slash DD slash YYYY
Start Time(Required)
End Time(Required)

Meeting Evaluation

Please identify the level of engagement that characterized your role in the meeting (pick only one!):(Required)

Criteria for approval (all must be met for payment to be confirmed):

  • Meetings initiated by physicians in non HA roles only.
  • Meetings focused on joint patient management on topics identified by the physician.
  • Dept Heads can be inivited to participate and would be compensated as long participation is not implied by reason of title or for maintenance of privelges.
  • Not already being reimbursed for participation via another funding source.

Submitted claims will be reviewed by LMH FE leads for approval.

  • Approved payments will be calculated using current GPSC/SSC sessional rates. Time rounded to nearest ¼ hour.
  • Approved payments will be direct deposit via LMH Facility Engagement Management System (FEMS) and Versapay. Go online to and ; and follow instructions to enroll.
  • Payment will be contingent on LMH FE funding availability for this initiative in the given fiscal term.
  • Deadline: Claim forms must be submitted within one month of the meeting date.
  • Repeated (>6) meetings are asked to submit separate LMH FE Project Intent (Project Intent forms available upon request from or online
Physician Declaration