Multidisciplinary Meeting Claim Form

Physician Information

Name(Required)
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 Feedback

Please indicate what objectives of the Facility Engagement Initiative’s Memorandum of Understanding were met, if any (check all that apply):(Required)
Please identify the type of engagement that was achieved during this event (pick only one!):(Required)

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

  • Multidisciplinary meeting (i.e. not physicians only).
  • Meeting focused on LMH Operations (LMH patient care, quality, work environment).
  • Invited by LMH Manager, Senior Admin, or Dept Head.
  • Participation not implied by reason of title (eg Dept Head) or for maintenance of privileges.
  • 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 fems.facilityengagement.ca and versapay.com ; and follow instructions to enrol.
  • 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 (eg monthly committee meetings) are asked to submit separate LMH FE Project Intent (Project Intent forms available upon request from lmhpa@facilityengagement.ca or https://msalmh.ca/physician-engagement/facility-engagement/)
Physician Declaration