Standardized Patient Reservation Form
(you may add the date and time of the recurring sessions of the same type)
REMINDER: Please be advised that sessions longer than three (3) hours must include a 15 minute break and sessions longer than five (5) hours must include a meal break.
Number of encounters per SP
NOTE: Training should be scheduled within the same pay-period as the session. A table of pay-periods can be found HERE. If this is not possible, training should be scheduled within seven (7) days of the session.
Please submit case notes (if applicable) with your request, including all checklists and feedback forms via email to the SPC. List of designated SPC can be found in http://umanitoba.ca/faculties/medicine/education/ed_dev/clsf/4986.html
To ensure prompt and efficient service please provide your requests 4-6 weeks in advance of training. Standardized Patient program fees:
Level of payment will be determined in conjunction with the SPC depending on the case requirements for the SP.
Please see SPP Fee Schedule for description of Standardized Patient Levels and corresponding fees.
Please note that there will be a minimum charge of 3hrs per session for all sessions lasting less than 3 hours. Our commitment to You:
Confirmation of your request will be sent within 24-48hrs upon receipt of this form.
We will inform you in the event of our inability to complete your request with 5 working days
Notification of booked SPs will be sent to the contact individual within 10-14 days of initial request.
Once this request is processed we will provide you with an estimate for this project. Please return the accepted estimate along with the authorizing signature.