Introduction

Introduction

What is CII?

Community Information Integration (CII) allows providers to send consult letters to Alberta Netcare and contribute basic patient visit information to the Community Encounter Digest.

This CII Confirmation of Participation form is for community-based specialists that work in fields other than primary care. If you are a family physician or pediatrician, please contact us at ciicpar@albertadoctors.org for steps to sign up.

Who is eligible to participate in CII?

Specialist physicians are eligible to participate in CII if they are working in a community-based clinic. The criteria to participate in CII are:

  1. You must be using one of these electronic medical records in your clinic:
    1. Accuro
    2. Healthquest
    3. Med Access
    4. PS Suite
    5. Wolf
  2. Your clinic must be willing to or have implemented Alberta Netcare.
  3. Your practice needs a privacy impact assessment that reflects the current clinic environment.

Signing up for CII

The first step to signing up for CII is completing this Confirmation of Participation form. It should be completed by someone who has the authority to submit forms on behalf of the clinic.

Please allow adequate time to complete this form as it can take up to 30 minutes. You will receive an important email once you begin that provides a link to access this form if you cannot complete it in one session.

If you have any questions, please contact us at ciicpar@albertadoctors.org.

Contact Information
Your Contact Information

The information collected on this form is personal information as described in the Freedom of Information and Protection of Privacy Act (FOIP). This personal information is collected and used pursuant to sections 33(c) and 39(1)(a) of the FOIP Act, as the collection is related directly to and is necessary for administering provider participation in CII/CPAR. Alberta Health provides necessary information to the Alberta Medical Association to administer financial support under the IM/IT Physician Practice Support Program. If you have questions or concerns about the collection, use or disclosure of this personal information, please contact eHealth Support Services at 1-855-643-8649.

Once you click Next, you will receive an important email with a link that will allow you to access this form if you are not able to complete it in one session.

Electronic Medical Record
EMR Information

Please select the EMR that your clinic uses. If your EMR is not listed, contact us at ciicpar@albertadoctors.org.

Netcare Information
Clinic Information
Clinic Information
Clinic Manager
Primary CII/CPAR Site Liaison
The Primary CII/CPAR Site Liaison is designated by the clinic to be the CII/CPAR clinic contact who will coordinate the required paperwork and go-live activities. This is an administrative role, not a clinical one, and the person must be employed by the clinic. See the Roles and Responsibility document for more information.
Alternate CII/CPAR Site Liaison
The Alternate CII/CPAR Liaison cannot be the same person listed above.
Participating Providers

List the names of all providers who will participate in CII.

Click here to locate the Specialty Skill Code within your EMR

Click on an existing row to select/deselect it for Edit or Delete.

Provider First Name Provider Last Name PCN Consult Reports Encounter Data Specialty Skill Code
Governance & Privacy
Clinic Governance Structure

A custodian representative is a custodian that has been duly authorized to sign the CII PIA Endorsement Letter and any necessary updates on behalf of the other custodians at the facility organization. This authorization does not revoke the other custodians’ duties and powers under the Health Information Act.

Privacy Impact Assessment (PIA) Project Title

Use this AMA resource to help you find the clinic EMR or Netcare PIA number.

EMR
Expedited Netcare
EMR Data Awareness
Awareness of Privacy
A Health Collection Notice is available in our clinic. Choose all that apply.

By clicking submit, you are sending this information to the CII/CPAR teams from AMA and eHealth. Please ensure you have filled out all fields to the best of your ability.