O-7, r. 13 - Regulation respecting the standards for the issue and holding of the permit authorizing an optometrist to administer medications

Schedule Disposition versions

2012-09-01

SCHEDULE I

(s. 1)

APPLICATION FOR THE PERMIT AUTHORIZING AN OPTOMETRIST TO ADMINISTER MEDICATIONS

I, the undersigned, ____________________________________________________________________________,

residing at __________________________________________________________________________________

hereby declare the following:

(1) I am entered on the roll of the Ordre des optométristes du Québec;

(2) my professional domicile is located at _________________________________________________________ and I also practise at __________________________________________________________________________;

(3) I have enclosed the documents establishing that my training complies with the training prescribed by the Regulation respecting the standards for the issue and holding of the permit authorizing an optometrist to administer medications (chapter O-7, r. 13);

(4) I am applying to the board of directors for the permit authorizing me to administer medications for eye examination purposes in accordance with the provisions of the Optometry Act, of the Regulation respecting the standards for the issue and holding of the permit authorizing an optometrist to administer medications and of the Regulation respecting the medications that an optometrist may administer (chapter O-7, r. 10).

Member’s signature _______________________________________________ Date _______________________

O.C. 1452-95, Sch. I.