Hospice Palliative Care Ontario - Health Care Consent Advance Care Planning Community of Practice (HPCO HCC ACP CoP) Membership Form

Welcome
Communities of practice are groups of people who share a concern or a passion for something they do and learn how to do it better as they interact regularly. The Health Care Consent Advance Care Planning Community of Practice (HCC ACP CoP) was created to respond to the need for a provincial resource for health care consent and advance care practice utilizing an Ontario legal framework. HPCO remains dedicated to hosting and supporting the HCC ACP CoP, and continuing with the work that encourages HCC ACP discussions, reinforces the connections, and participates in the shared dialogue and opportunities of CoP collaboration.

Goals

To create opportunities to influence policy and system issues related to Health Care Consent and Advance Care Planning in an Ontario legal framework.

To develop as an active and engaged community of practice advancing the goals as defined by its members.

To create awareness and educational materials and opportunities about health care consent and advance care planning within an Ontario legal framework.

Question Title

* Address

Name

Position/Title and Organization/Affiliation

The Town/City in which you live or work (your choice)

Email Address

Alternate email address

Phone Number

Question Title

* Areas of Interest:

1a. Are you interested in becoming involved in the CoP?
CoP members are healthcare practitioner, administrator, caregiver, policymaker, researcher, educator and leader who are interested in coming together to exchange information and promote HCC ACP in Ontario. These community members make a commitment to support and learn from one another and to develop new knowledge to advance a field of practice.

Yes

No

Question Title

* 1b. If yes to 7a above, please briefly describe your current role( i.e. healthcare practitioners and adminstrators, caregivers, policy makers, researchers, educators and leaders etc.), interest and capacity to contribute.

Question Title

* 1c. Communities develop their practice through a variety of activities, some of which are listed below. Please indicated which activities you would be most interested in the CoP supporting?

	Yes	No
Problem Solving	Problem Solving Yes	Problem Solving No
Requests for Information	Requests for Information Yes	Requests for Information No
Seeking experience	Seeking experience Yes	Seeking experience No
Reusing assets	Reusing assets Yes	Reusing assets No
Coordination & Synergy	Coordination & Synergy Yes	Coordination & Synergy No
Discussing Developments	Discussing Developments Yes	Discussing Developments No
Repository and Documentation	Repository and Documentation Yes	Repository and Documentation No
Site Visits	Site Visits Yes	Site Visits No
Creation of Materials and Resources	Creation of Materials and Resources Yes	Creation of Materials and Resources No
Mapping Knowledge	Mapping Knowledge Yes	Mapping Knowledge No
Identifying Gaps	Identifying Gaps Yes	Identifying Gaps No
Other	Other Yes	Other No

Other (please specify)

Question Title

* 2a. Are you interested in becoming a CoP Organizational Champion (or Sector) or support in HCC ACP?

Organizational Champions are individuals that have a lead role for promoting and implementing HCC ACP within their organization, sector or community. The CoP provides a forum for information exchange, knowledge transfer and sharing information about HCC ACP initiatives within the Ontario framework.
(Note: You must have senior level endorsement by your organization to assume this lead role).

Yes

No