Preceptorship Form

Date:

September 13, 2025

All fields are required (including uploading of files) (Value Required)

Full Name (Value Required)

Email Address (Value Required)

Phone Number (Value Required)

Area of practice/discipline: (Value Required)

Family physician

Specialist

Nurse Practitioner

RPN

Other

What health authority are you working in? (Value Required)

Health Authority Other

What location(s) are you currently practicing as an OAT prescriber? (Value Required)

College ID # (Value Required)

Who was your preceptor? If you had multiple preceptors, please select multiple names. (Value Required)

For RN/RPN preceptorships, please indicate whether you completed hours with a CP-OUD Preceptor. Note: these hours should not be entered below.

Tell us about your experience with your preceptor (Value Required)

Please indicate the dates and times of your preceptorship: (Value Required)

Please note the required hours of preceptorship for:
MD/NP: 8 hours (1 full day or 2 half-days)
RN/RPN Full Oral Opioid Agonist Treatment Training: 40 hours (5 full days or 10 half days 40 hours)
*Please note full day is 8 hours and half day is 4 hours.

Preceptorship Total Hour (Value Required)

No Preceptorship Date and Time Entered!

Which preceptorship did you complete? (Value Required)

full opioid agonist treatment training (MD/NP)

full opioid agonist treatment training (RN/RPN)”

injectable opioid agonist treatment training only

Please upload a copy of your government-issued photo identification. (Value Required)

Please upload CME certificate of completion for online course. (Value Required)

Do you have any additional Feedback for the BCCSU Education Team?

If you are a RN or RPN that has completed the preceptorship, please click on this link to complete an additional survey to provide your feedback on your training experience: https://ubc.ca1.qualtrics.com/jfe/form/SV_8js9fvo019UF7IG.

Thank you for submitting this form, your preceptor will now be sent an assessment form to complete. We will be in touch with a formal letter of completion once this is completed. If you do not receive a letter of completion, please email bccsu_education@bccsu.ubc.ca.

Preceptorship Form

Preceptorship Date Time