ACKNOWLEDGEMENT & UNDERTAKING

Standard of Practice for Intravenous Infusion Therapy

This Acknowledgement & Undertaking relates to a decision to relinquish the Standard of Practice for IVIT. It is a legally binding document between the undersigned Registrant of the College and the College of Naturopaths of Ontario.

I, the undersigned, hereby acknowledge and undertake as follows:

1. Status of Registration

I am currently a Registrant of the College, registered in the General class.

2. Standard of Practice for IVIT

I have met the Standard of Practice for Intravenous Infusion Therapy as set out in sections 5(3) and 5(5) of the General Regulation made under the Naturopathy Act, 2007.

3. Relinquishing the Standard

I have advised the College that, as of the date set out on my Application to Relinquish the Standard of Practice for IVIT, I have ceased or will cease any activity in my practice relating to the Standard of Practice for IVIT.

4. Outcome of Relinquishment

I understand and acknowledge that relinquishing the Standard of Practice for IVIT means that I cannot perform, delegate, or accept delegation of the following controlled acts authorized to the profession, as set out in section 4 of the Naturopathy Act, 2007:


a.    administering a substance by intravenous infusion therapy,

b.    compounding a substance for the purposes of administration by intravenous infusion therapy.

5. Naturopathic Doctor Register Notice

I acknowledge that as a result of my decision, the following information will be posted on the College’s Naturopathic Doctor Register on the Effective Date as follows:


As of “Effective Date”, the Registrant is not authorized to administer a substance by intravenous infusion therapy or compound a substance for the purposes of administration by intravenous infusion therapy.

6. Resumption of Performing the Controlled Acts

I acknowledge that in accordance with section 5(5) of the General Regulation, I must successfully complete a course in IVIT, approved by Council, and the College's IVIT examination, in addition to maintaining the Standard of Practice for Prescribing, prior to resuming the controlled acts noted in paragraph 4 of this Acknowledgment and Undertaking.

7. With Full Understanding

I fully understand the terms of this Acknowledgment and Undertaking.

8. Entered into Voluntarily

I am signing the Acknowledgment and Undertaking voluntarily, and without compulsion or duress.

9. Breach of Agreement

A breach in any of the terms of this Acknowledgment and Undertaking may constitute professional misconduct on my part for which the College may take action against me and this document is admissible in any such proceeding

10. Legal Advice

I have been strongly advised by the College to obtain independent legal advice prior to signing this Acknowledgment and Undertaking and that I have either done so or I have had an adequate opportunity to do so.

Please enter your full and proper name as it appears on the public register using the format Dr. Jane Doe, ND.

Signature


By checking the box below, I am hereby affixing my digital signature to this Agreement & Undertaking indicating that that I have read and agreed to all of the provisions set out herein and that this Agreement is bound directly to me.


If for any reason you cannot affix your digital signature, please contact the Registration Team at registration@collegeofnaturopaths.on.ca to discuss your questions or concerns.


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