For questions or additional information, please contact bpsooht@RNAO.ca You must have JavaScript enabled to use this form. 1 Start 2 Preview 3 Complete 1. OHT name * 2. Contact name * 3. Contact email * 4. OHT status * Please indicate your status with the OHT application process: OHT candidate (approved) In development In discovery 5. Which sectors within your OHT are likely to participate in the BPSO OHT program? Select all that apply. * Public health Primary care Community, mental health, and social services Hospital Home care Long term care Other... 5. Which sectors within your OHT are likely to participate in the BPSO OHT program? Select all that apply. Other... 6. Please provide an explanation of why you would like to become a BPSO OHT. For example, how would participating in the BPSO OHT program help meet your OHT goals? (500 word max) * 7. Please provide a brief description of your readiness to join the BPSO OHT network For example, experience with RNAO best practice guidelines, participation of OHT partners within the BPSO program (500 word max) * 8. Please indicate your OHT's priority populations. Feel free to add details. * 9. Please include a draft of how you envision the governance structure for your BPSO OHT. More informationFiles must be less than 5 MB. Allowed file types: jpg jpeg png html pdf doc docx ppt pptx odp xls xlsx. Upload Please see HERE for an editable governance structure template. 10. Please include a link to your OHT's website 11. OHT Application OPTIONAL: Please include your OHT application as an appendix. More informationFiles must be less than 5 MB. Allowed file types: html pdf doc docx ppt pptx odp xls xlsx. Upload Preview
