Fee Code Program Locum Registration

Physicians undertaking a locum tenens for a family physician enrolled in the FPRP Fee Codes Program are eligible to bill FPRP fee codes if:

a) The physician for whom the locum is covering is already a registrant; AND
b) The locum is providing a period of replacement that is greater than three months, with at least 20 days in one calendar month considered one month of replacement service.

Name of Practice Physician:

First Middle Last

College of Physicians and Surgeons License No.

Practice Address:

Street Address Address Line 2 City Province Postal Code

Name of Locum Physician:

First Last

College of Physicians and Surgeons License No

Locum Start Date:

Locum Finish Date:

Comments

Signature of Practice Physician

Signature of Locum Physician

Note:

If you have questions as you complete the registration form, please refer to supporting resources.
After you submit your completed registration form, our program staff will notify you when you can start billing. Please note this could take up to 10 business days.