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Hong KongCollege of Physicians
Basic Physician Training
Trainee Registry (Effective May 2014)
Instruction for entry
Read carefully before completing this form. All items must be completed before acceptance into Registry.
Special notes on specific items**
14Rank
Hospital Authority Staff: MO (Medical Officer), RES (Resident), SMO (Senior Medial Officer)
AC (Associate Consultant).
University Staff: Asso P (Associate Professor), Assist P (Assistant Professor).
17-21Enter dates on relevant certificates.
18Date of 1st MO appointment
Enter date of first MO (Medical Officer), or Asso P (Associate Professor) or SHO (Senior House Officer) or Res (Resident) appointment. This date should not indicate appointment as intern.
19Date of full registration
Enter exact date on recognised registration certificate issued by the Hong Kong Medical Council or General Medial Council.
20Higher qualifications
IECIntermediate Examination Certificate, Hong KongCollege of Physicians
MRCPMembership of the RoyalCollege of Physicians (UK, Lond, Edin, Glasg)
22 Training record
Training Type (as defined by JCIMT Guidelines, July 1993, p 13 (III) Structure)
AMAcute medicine
NAMNon-acute medicine
OSOther specialties related to Internal Medicine, including
A&E (Accident & Emergency) except for rotation of Basic Physician Trainees to A&E after 01 Jan 2000; From 1 January 2004 onward accredited for 6 Months
Anae (Anaesthesia)
ClinPath (Clinical Pathology)
Paed (Paediatrics)
Primary Care (Except 1 Jan 2000 to 19 August 2002, from 1 July 2007 till now were not accredited)
Psy (Psychiatry)
Rad (Diagnostic Radiology)
As from I Jan 2000, training in Radiotherapy & Oncology (Clinical Oncology) will not be accredited.
HPTHigher Physician training
Hospital
Programmes accredited for 3 years
AHNH (Alice Ho Miu Ling Nethersole Hospital) (as from 22 January 1998till 22 Nov 2004); CMC (Caritas Medical Centre) (as from 24 April 1995); KWH (Kwong Wah Hospital) (as from 24 April 1995); NDH (North District Hospital) (as from 1 June 2000); PMH (Prince Margaret Hospital) ( as from 24 April 1995);POH (Pok Oi Hospital) (as from 6 September 1995 till 19 May 1997); PWH (Prince of Wales Hospital) (as from 24 April 1995); PYNEH (Pamela Youde Nethersole Eastern Hospital) (as from 24 April 1995); QEH (Queen Elizabeth Hospital) (as from 24 April 1995); QMH (Queen Mary Hospital) ( as from 24 April 1995; RH (Ruttonjee Hospital) ( as from 6 September 1995);TKOH (Tseung Kwan O Hospital) (as from 1 July 2000); TMH (Tuen Mun Hospital) (as from 24 April 1995); UCH (United Christian Hospital) (as from 24 April1995); YCH (Yan Chai Hospital) (as from 24 April 1995).
Programmes accredited for 2 ½ years
AHNH (AliceHoMiuLingNethersoleHospital) (as from 23 Nov 2004)
Programmes accredited for 2 years
GH (Grantham Hospital: Medicine (as from 31 October 1995 to 14 January 2002); GH (Grantham Hospital: TB & Chest (as from 6 September 1995 till 14 January 2002);HOHH (Haven of Hope Hospital: Geriatrics, Pulmonary & Palliative Care Unit) (as from 6 September 1995); KH (Kowloon Hospital: Respiratory Medical Unit) (as from 6 September 1005till 14 Jan 2002); OLMH (Our Lady of Maryknoll Hospital) (as from 1 June 2000); POH (Pok Oi Hospital) (as from 20 May 1997 till 14 March 2005, and as from 26 February 2009); SH (Shatin Hospital) (as from 28 November 1995 till 19 May 1997 and as from 15 January 2002); TWH (Tung Wah Hospital) (as from 6 September 1995); TWEH (Tung Wah Eastern Hospital) (as from 31 October 1995 till 28 April 1997, and as from 20 May 1997); TWH (Tung Wah Hospital as from 6 September 1995).
Programmes accredited for 18 months
GH (Grantham Hospital: Medicine) (as from 6 September 1995 till 30 October 1995 and as from 15 January 2002 till 14 March 2005); GH (Grantham Hospital: TB & Chest) (as from 15 January 2002); HKBH (Hong Kong Buddhist Hospital: Medicine Extended Care, Medical Unit) ( as from 15 March 2005), KH (Kowloon Hospital: Extended Care) (as from 6 September 1995 till 30 July 1997) KH Kowloon Hospital: Rehabilitation, Respiratory Medical Unit: as from 15 January 2002),;OLMH Our Lady of Maryknoll Hospital (as from 6 September 1995 till 30 October 1995, as from 20 May 1997 to 31 May 2000); POH (Po Oi Hospital: Department of Medicine & Geriatrics) (as from 15 March 2005 till 25 February 2009); SH (Shatin Hospital) (as from 20 May 1997 till 14 January 2002) TPH (Tai Po Hospital: Medicine and Extended Care) (as from 1 June 2000); TWEH (Tung Wah Eastern Hospital (as from 6 September 1995 till 30 October 1995 and as from 29 April 1997 till 19 May 1997); WTSH (Wong Tai Sin Hospital: TB & Chest) (as from 6 September 1995 till 25 February 2009).
Programmes accredited for 15 months
WTSH (WongTaiSinHospital: TB & Chest, Extended Care (as from 26 February 2009)
Programmes accredited for 1 year
FYKH (FungYiuKingHospital: Department of Geriatrics) (as from 28 November 1995);GH (GranthamHospital: Medicine) (as from 15 March 2005); GH (GranthamHospital: Acute Geriatric Unit (as from 1 February 2004); HKBH (Hong KongBuddhistHospital: Medicine &Extended Care) (as from 6 September 1995 till 19 May 1997.) HKBH (Hong Kong Buddhist Hospital: Medical Unit) (as from 6 September 1995 till 14 January 2002, and as from 23 July 2002 till 14 March 2005);KH (Kowloon Hospital: Extended Care) (as from 20 May 1997 till 14 January 2002),KH (Kowloon Hospital: Rehabilitation) (as from 6 September 1995 till 14 January 2002);OLMH (Our Lady of Maryknoll Hospital: as from 31 October 1995 to 19 May 1997);PWH (Prince of Wales Hospital: Clinical Oncology & Radiotherapy)(as from 23 June 1997 and from 1 July 2002 onward); WTSH (Wong Tai Sin Hospital: Extended Care) (as from 6 September 1995 till 14 January 2002).
Programmes accredited for 6 months
DH (Department of Health: TB & Chest Service ) (as from 27 February 1996 till 28 October 1999);GH (Grantham Hospital: Palliative Medical Unit) (as from 15 March 2005) HKBH (Hong Kong Buddhist Hospital: Medicine & Extended Care)( as from 20 May 1997 till 14 March 2005); HKBH (Hong Kong Buddhist Hospital: Medical Unit as from 15 January 2002 till 22 July 2002); KH (Kowloon Hospital: Extended Care) (as from 15 Jan 2002), NLH (Nam Long Hospital: Hospice) (As from 15 January 2002), PWH (Prince of Wales Hospital: Clinical Oncology) (as from 24 September 1996 till 19 May 1997, Clinical Oncology & Radiotherapy: as from 20 May 1997 6 months for each till 22 June 1997); WCHH (Wong Chuk Hang Hospital) (as from 20 May 1997 till 15 January 2004)
Programmes accredited for 3 months
MMRC (Maclehose Medical Rehabilitation Centre) (as from 15/1/2002 ); SCH (Shatin Cheshire Home) (as from 29/4/2008)
Duration
Exact number of days is only required for programmes commencing after the first day of the month.
Supervisor
Enter name of Chief of Service (COS) or Department Head.
HONG KONGCOLLEGE OF PHYSICIANS
TRAINEE REGISTRY
1Title
2Surname3Firstname
4Chinese Name Code (as on ID card) 5Sex* M/F
6ID Number7Date of Birth D------M------Y------
8Home Address
9Home Telephone10Pager
11Hospital12Region* HK/Kowloon/NT
13Unit14Rank**
15Primary medical 16University
qualification
17Acquired on D------M------Y------
18Date of 1st MO posting* D----M-----Y------19Date of full registration** D------M------Y------
20Higher qualification*IEC/MRCP/equivalent** (specify:______)
21Acquired on D------M------Y------
22Training Type** Hospital** Unit Period from Period to Duration Supervisor**
D M Y D M Y Mths Days
22.1AM/NAM/OS/HPT*
22.2AM/NAM/OS/HPT*
22.3AM/NAM/OS/HPT*
22.4AM/NAM/OS/HPT*
22.5AM/NAM/OS/HPT*
22.6AM/NAM/OS/HPT*
22.7AM/NAM/OS/HPT*
22.8AM/NAM/OS/HPT*
22.9AM/NAM/OS/HPT*
22.10AM/NAM/OS/HPT*
22.11AM/NAM/OS/HPT*
22.12AM/NAM/OS/HPT*
22.13AM/NAM/OS/HPT*
22.14AM/NAM/OS/HPT*
*delete as appropriate
**see accompanying instructions
23E-MAIL ADDRESS:______
Authorisation for Release of Information
I hereby consent to the release by any hospital, educational institution, governmental agency, physician, professional society, or other person possessing or requiring the same whether or not listed above, of any and all information in any way pertaining to my personal character, training, experience or professional competence.
I hereby consent to the release of any and all information in any way pertaining to the Intermediate Examination result to the Hospital Authority (HA), Specialty Programme Directors (SPD) and Chief of Service (COS) or any government agency requiring the same whether or not listed above.
I hereby consent to the release of any and all information in any way pertaining to all my Exit Assessment results to Hospital Authority (HA), Specialty Programme Director (SPD) and Chief of Service (COS) or any government agency requiring the same whether or not listed above.
I hereby release from any liabilities any and all individuals and organisations or their authorised representatives who provide this information in good faith and without malice subject to this consent.
I hereby release from all liabilities the Hong Kong College of Physicians and any and all individuals for their acts performed in good faith and without malice in connection with the evaluation of my application and my credentials and qualifications.
Applicant’s Signature______Date______
24A cheque in the sum of HK$3,000.00 is enclosed as Registration Fee for the entire BPT period.
Bank______ChequeNo______
25 The following section should be completed by Chief of Service/Head of Department from Department of Medicine or relevant medical units:
I have vetted and supported the above BPT application.
Name of Chief of Service/Department Head:______
(in block letters)
Signature: ______
Date: ______