Registration as a Pharmacy Technician Student

New Brunswick College of Pharmacists September, 2014 2

Application for Registration as a Pharmacy Technician Student

Please read all pages carefully to be sure you understand the

requirements for you to be registered as a pharmacy technician

student in New Brunswick.

Table of Contents Apprenticeship and Time Service ............................................................................................................ 5

Responsibilities of Preceptors and Students ........................................................................................... 6

RESPONSIBILITIES OF THE STUDENT ........................................................................................................ 7

RESPONSIBILITIES OF THE PRECEPTOR .................................................................................................... 9

Application Form .................................................................................................................................... 11

Certification statements ......................................................................................................................... 13

Statutory Declaration of Good Character .............................................................................................. 14

In the Regulations of the New Brunswick College of Pharmacists, Section 25.1 states students must be covered by personal professional liability (errors and omissions) insurance that (b) for pharmacy technicians, pharmacist students and pharmacy technician students provides a minimum of $1,000,000 per claim or per occurrence and a minimum $2,000,000 annual aggregate;

For more information about the New Brunswick College of Pharmacists, please visit

www.nbpharmacists.ca.

NBCP Policy Statement and Privacy Policy ........................................................................................... 15

http://www.nbpharmacists.ca/LinkClick.aspx?fileticket=Ow2EDuG3g%2b4%3d&tabid=244&mid=686

http://www.nbpharmacists.ca/


Pharmacy Technician Students - Application Requirements Checklist

1. (Select either a, b or c)

a ) Enrolled in a Pharmacy technician education program approved by the Canadian Council for

Accreditation of Pharmacy Programs or Accreditation Council for Pharmacy Education in US

(CCAPP & ACPE): This is confirmed in Section 2 (a) of the application form for registration. (Path

2)

or

b) Successful completion of a Pharmacy technician education program approved by the

Canadian Council for Accreditation of Pharmacy Programs or Accreditation Council for Pharmacy

Education in US (CCAPP & ACPE): This is confirmed in Section 2 (b) of the application form. (Path

2)

or

c) Successful completion of the four bridging modules (must be approved by the Canadian

Council for Accreditation of Pharmacy Programs CCAPP) and the PEBC evaluating exam as a

requirement for licensure as a pharmacy technician. This is confirmed in Section 3 of the

application form. (Path 1)

2. Submission of the application form to the NB College of Pharmacists for registration as a Pharmacy

Technician student.

3. Proof of identity: You must provide identification documents that prove your legal name and date of birth

and that preferably contain a photo. Valid Canadian or provincial government-issued photo ID (such as a

passport or driver’s license) are accepted. Canadian Birth or Citizenship Certificates may be accepted if

accompanied by a notarized passport-sized photo of the applicant.

NOTE: A copy of the identification document(s) will only be accepted if they are an exact replica and have

been notarized* by a Commissioner of Oaths or a lawyer. The copied photo must be clear enough to identify

the applicant or it will be rejected.

4. Language Proficiency: Must be proficient in either of Canada’s official languages (English or French)

5. Criminal Record Check Original document required; dated within 6 months prior to application date. (Royal

Canadian Mounted Police (RCMP) or any other Canadian police service (includes a Canadian Police

Information Centre (CPIC) assessment) documenting that you do not have a record of conviction under the

Criminal Code (Canada), the Controlled Drugs and Substances Act (Canada), the Food and Drugs Act (Canada).

6. Personal Liability Insurance - (minimum $1,000,000 per claim or per occurrence and a minimum

$2,000,000 annual aggregate)

7. Signed Certification statement

8. Signed Statutory Declaration of Good Character

9. Read the Policy Statement and the Privacy Policy

(https://nbcp.in1touch.org/document/2373/Privacy%20Policy%20Approved%20Nov2015%20EN_grb.pdf)

https://nbcp.in1touch.org/document/2373/Privacy%20Policy%20Approved%20Nov2015%20EN_grb.pdf


10. Signed statement regarding the NBCP Policy Statement and Privacy Policy

11. Payment of all applicable fees

*Notarized documents: A pharmacist’s signature is not accepted.


Pharmacy Technician Students

Apprenticeship and Time Service

All applicants must be registered with the NB College of Pharmacists as a Pharmacy Technician Student to be eligible to complete the required training as described below. Path 1 - If you are not enrolled in an accredited pharmacy technician program

You may apply for registration after successfully completing the four bridging modules and the evaluating exam at PEBC

Successful completion of the Pharmacy Technician Assessment (PTA) is required.

Path 2 - If you are enrolled in or have graduated from an accredited pharmacy technician program

A minimum of 14 weeks of practical training in New Brunswick is required for licensure as a pharmacy technician to be served as follows:

a minimum of 8 weeks of structured practice experience as part of the accredited education program

a minimum of 6 weeks practice experience to be served in New Brunswick following graduation which shall include the Structured Practical Evaluation (SPE).

APPRENTICESHIP DOCUMENTATION AND PRECEPTOR ACCEPTANCE (RESPONSIBILITIES AND DUTIES)

The student is responsible for sending the required forms to the NB College of Pharmacists office. It is not the responsibility of the preceptor.

Apprenticeship Agreement:

o Must be completed and submitted to the NB College of Pharmacists before starting a block of time-service with a preceptor. Preceptor qualifications are stipulated in Section 12.23 of the Regulations of the NB College of Pharmacists. Preceptors must read the “Responsibilities of Preceptors and Students” document (attached) to understand their duties and responsibilities as a preceptor. The preceptor and the student must sign the Apprenticeship Agreement.

Evidence of Time Service:

o Must be filed with the NB College of Pharmacists no later than 2 weeks after completion of each time-service period.

Please contact the office if you have any questions about the registration process, or require additional information.

Email: [email protected] Phone: 506-857-8957

mailto:[email protected]


Responsibilities of Preceptors and Students

During Structured and Unstructured training periods


RESPONSIBILITIES OF THE STUDENT

As a student it is your responsibility to:

1. Be aware of the time required to process your registration and submission of relevant documentation to

the NB College of Pharmacists office before starting, during, and after completion of your

structured/unstructured placements.

2. Identify yourself as you are registered, either as a pharmacist student or pharmacy technician student.

Do not represent yourself as a pharmacist or pharmacy technician.

3. Review this document with your preceptor and give them a copy for their reference. Identify and agree on the objectives for your stay.

4. Be aware of, and adhere to, all of the policies and procedures of the practice site.

5. Exhibit a professional appearance in both manner and dress.

6. Assume responsibility for your own learning.

7. Approach your training with a commitment to all learning experiences.

8. Begin to develop lifelong learning skills: self-assessment, self-directed learning, etc.

9. Keep all store policies, operations, records and client information strictly confidential. If you are asked

to sign a Confidentiality Agreement, be sure to carefully read and understand what you are signing. Ask questions if you are unsure!

10. Acquire knowledge and develop new skills by:

- observing, - asking questions, - researching information, - being open-minded, and - being willing to cooperate

11. Perform a variety of tasks and activities to apply your acquired knowledge and skills in practice

situations under the direct supervision of your preceptor.

12. Do not make professional decisions or judgments without the approval or supervision of your

preceptor.

13. Do not question the advice, direction or criticism of your preceptor or a colleague in public. Discuss any

concerns in private.

14. Consult regularly with your preceptor to obtain feedback on your performance.


15. Seek help when you are unsure of what you should do.

16. Comply with the Pharmacy Act and the Regulations, codes, practice directives and standards of the

New Brunswick College of Pharmacists which govern the profession of pharmacy.

17. Evaluate your experience fairly and objectively offering constructive feedback to your preceptor.

18. If you withdraw from the training program or education program, you must notify the NB College of Pharmacists.

19. If you require a leave of absence (LOA) from the program, contact the NB College of Pharmacists

office for approval of the expected LOA period.

20. Be sure to complete any forms and documentation required for the training period. It is your

responsibility to ensure they are submitted to the NB College of Pharmacists immediately following the training period. If not submitted promptly, you may not receive credit for completed service.


RESPONSIBILITIES OF THE PRECEPTOR

Preceptor qualifications are stipulated in Section 12.23 of the Regulations of the NB College of Pharmacists.

Competency # 3 of the Standards of Practice identifies the pharmacist’s role as a preceptor. As a preceptor, it is your responsibility to:

1. Become knowledgeable about the goals and objectives of the structured/unstructured training program of the student for whom you are serving as preceptor.

2. Establish a learning plan (objectives) with the student for the training period. Take into consideration

the student’s academic background, previous experience in a pharmacy and the learning experiences and resources available at your practice site.

3. Be aware of the expected level of knowledge and skills of the student.

4. Act as a role model in the development of the student’s professional and

ethical values and attitudes.

5. Encourage active participation and involve the student in appropriate decision making situations

under supervision.

6. Provide time to answer questions or discussion with the student.

7. Provide instruction and demonstrate desired skills before the student is expected to undertake new

tasks or skills.

8. Make the student feel at ease by including him or her in informal discussions and any pharmacy

continuing education or social functions.

9. Encourage critical thinking and problem solving by frequently posing problems to the student and

asking him or her to formulate answers or responses.

10. Supervise the student and provide constructive feedback to assist in the further development of his or

her skills and competencies.

11. Review the student’s progress and revise the learning plan accordingly.

Discuss the student’s accomplishments and any areas that need improvement. Suggest constructive activities to strengthen any areas of weakness.

12. At the end of the training period, constructively review the student’s

training plan with him or her. Point out areas of strength and possible weaknesses of the

student’s skills, abilities and knowledge development over the period in a tactful, supportive manner.

13. Consider the role of preceptor as a learning experience and be open to new ideas and suggestions.

14. Discuss questions, criticisms or disagreements in private.

15. Seek feedback from the student in order to assess your contributions as a preceptor.


16. Evaluate the training program fairly and objectively, offering constructive feedback.

17. Evaluate the professional and communication skills of the student.

18. If the student withdraws, or ceases training at a site, the preceptor must notify the

NB College of Pharmacists office. UNSTRUCTURED TIME SERVICE When serving as a preceptor for unstructured practice experience (e.g. student hired for the summer months) the following activities and information should be reviewed with the student:

1. Orientation to the pharmacy

a. Dispensary layout b. Hours of operation c. Services offered d. Drug information resources e. Dress code f. Confidentiality g. Third party billing h. Staff roles and functions i. Store Policies and procedures j. Computer systems

2. Introduce the student to staff members

3. Review the role and functions of the following organizations:

1. New Brunswick College of Pharmacists (NBCP) 2. New Brunswick Pharmacists’ Association (NBPA) 3. Canadian Pharmacists Association (CPhA) 4. Canadian Society of Hospital Pharmacists (CSHP) 5. National Association of Pharmacy Regulatory Authorities (NAPRA)

4. Review the following with the student:

Food & Drugs Act

Controlled Drugs and Substances Act

The Pharmacy Act, Regulations, practice directives, standards and guidelines of the NB College of Pharmacists.

(These may be found at www.nbpharmacists.ca)

http://www.nbpharmacists.ca/


1224 ch. Mountain Rd., Unit(é) 8

Moncton, N-B E1C 2T6

Tel: (506) 857-8957 Fax / Téléc: (506) 857-8838

www.nbpharmacists.ca [email protected]

Pharmacy Technician Student Registration

Application Form *All fields must be completeSECTION 1 (Please print)

First Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Middle Name(s): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Last Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Street Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Apt. #: . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

City: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Province: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Postal Code: . . . . . . . . . . . . . . . . . . . . . .

Phone (home): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Phone (cell): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E-mail address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Date of Birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gender: Male Female Year Month Day

Place of Birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . City, Province and Country

SECTION 2 (a)-Complete this section if you are enrolled in an accredited pharmacy technician program.

My expected date of graduation is: ……………….. ……………… ………………… Year Month Day

Faculty Declaration - This is to certify that the above mentioned name is enrolled in a Pharmacy Technician Program

at: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (name and location of educational facility)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signature of Program Administrator or Approved Personnel Title

SECTION 2 (b)-Complete this section if you have graduated from an accredited pharmacy technician program.

My date of graduation was: ……………….. ……………… ………………… Year Month Day

A notarized copy of your certificate of graduation must accompany this application.

APPLICATION PAGE 1 OF 2




Tel: (506) 857-8957 Fax / Téléc: (506) 857-8838


SECTION 3

Complete this section if you have successfully completed the four bridging modules and the PEBC evaluating exam as a

requirement for licensure as a pharmacy technician.

An official transcript of successful completion of the bridging modules and proof of successful completion of the PEBC evaluating exam must accompany this application.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signature of Applicant Date

APPLICATION PAGE 2 OF 2

Payment must be included at time of application. See the Fee Schedule on website for

applicable fee. Cheque, MasterCard or Visa are acceptable forms of payment.

Cheque is attached

I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . authorize the New Brunswick College of (Name as it appears on credit card)

Pharmacists to use my credit card:

Credit Card #: .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Expires (mm/yy): .. . . . . . . . . . . .

3-digit code on back of card: ... . . . . .

Telephone: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

to pay the registration fees associated with the attached application/request.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Authorized Signature Date

Le paiement doit accompagner le formulaire. Voir la Liste de cotisations sur notre site Web

pour connaître les frais applicables. Les modalités acceptables de paiement sont les suivantes :

chèque, MasterCard ou Visa.

Le chèque est joint

Je . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . autorise l’Ordre des pharmaciens du Nouveau-Brunswick

(le nom tel qu'il apparait sur la carte)

Nº de carte de crédit .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Exp : . . . . . . . . . . .

Code à 3 chiffres au dos de la carte: .. . . . . . . . . . . . .

Téléphone : .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

payé les frais d'inscription associés à la demande ci-jointe.

…………………………………………… ………………………………………….

Signature Autorisé Date




Tel: (506) 857-8957 Fax / Téléc: (506) 857-8838


Certification statements

I HEREBY CERTIFY THAT:

I have sufficient ability to:

Speak: English Read: English

French French

as to be competent to discharge my duties and obligations as a member of the New Brunswick College of Pharmacists.

I am a: Canadian citizen Resident of Canada

I have not been convicted in Canada or elsewhere of any offence that would be consideredunprofessional conduct or conduct unbecoming of a person.

I meet all the requirements necessary for registration/licensure as specified in the Pharmacy Act andRegulations of the New Brunswick College of Pharmacists.

Have you ever been convicted of an offence under the Controlled Drugs and Substances Act or theFood and Drugs Act? (See application requirements for Criminal Record Check).

No

Yes (if yes, provide particulars thereof on the back of this page)

Date: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signature: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .




Tel: (506) 857-8957 Fax / Téléc: (506) 857-8838


Statutory Declaration of Good Character

I, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . declare that

1. I have not been convicted in Canada or elsewhere of any offence that, if committed by a person registered under the

Pharmacy Act, or any other profession or occupation, would constitute unprofessional conduct or conduct unbecoming of a person registered under these regulations.

2. My entitlement to practice pharmacy or any other health profession has not been limited, restricted or subject to any

terms, limits or conditions or disciplinary action in any jurisdiction at any time.

3. At the present time, no investigation, review or proceeding is taking place in any jurisdiction which could result in the suspension or cancellation of my authorization to practice pharmacy or any other health profession.

4. My past conduct does not demonstrate any pattern of incompetence or untrustworthiness, which would make

registration contrary to the public interest.

5. I am aware of and will practice at all times in compliance with the Pharmacy Act and the Regulations of the New Brunswick College of Pharmacists.

6. I shall provide the Registrar with the details of any action impacting on the above statements that relate to me, or that

occur or arise prior, during, or after my registration with the New Brunswick College of Pharmacists:

On a separate sheet of paper, provide details if any of the above are not true. Details to include:

a. Criminal offence/Disciplinary action/Investigation b. Date when offence was committed/Applicable health profession/Applicable jurisdiction c. Disposition of charge including details of penalty-imposed d. Extenuating circumstances you wish taken into account for your application. I hereby declare, as indicated by my agreement below, that the contents of this application are true and complete to the best of my knowledge and belief.

I understand and agree that if I make a false or misleading statement or representation in respect of my application, I shall be deemed not to have satisfied the requirements for registration/licensure.

I further understand and agree that if registration/licensure is issued to me based upon a false or misleading statement or representation that registration/licensure is subject to immediate cancellation.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name (please print) Signature

Dated at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . this . . . . . . . . . . . . . . . . . day of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20. . . . . . . . . . . .

(city) (month)

of 2

NBCP Policy Statement and Privacy Policy

All registrants must read the New Brunswick College of Pharmacists Policy Statement and Privacy

Policy on the Collection, Use and Disclosure of Registration Information by the NBCP.

The NBCP has a defined policy of protecting the privacy of its Registrants in all of the operations of the NBCP. The majority of personal information contained in each Registrant’s record is collected, stored and used by the NBCP for the Identified Purposes as defined in the NBCP Privacy Policy.

The Personal Information collected by the NBCP from its Registrants includes:

Demographic Information: Name, date of birth, home address, home telephone number, home fax

number, e-mail address, gender, place of birth

Education Information: Educational facility and credentials, date of graduation, Pharmacy Examination

Board of Canada registration number, all other certification in regards to the pharmacy profession

Registration Status: Registration Category, Conditions on practice, competency information, complaint or

discipline information, current or past registration with other jurisdiction or Pharmacy Regulatory

Authorities

Employment Information: Place of all employment, name of employer, address of employer, telephone, fax

number and e-mail address of employer.

The NBCP consent and disclosure statement for Registrants as it reads in the statement on the Registrant’s

application form and/or consent form will advise the Registrant that their Personal Information is being

Collected and will be Used and Disclosed for the following purposes:

a) Professional Development and educationb) Practice based Researchc) Health promotion programsd) Populating electronic health systemse) Workforce planning and managementf) Confirmation of registration and standing to other Pharmacy Regulatory Authoritiesg) Confirmation of registration to Third Party Payersh) Confirmation of registration to Medication distribution Centers (wholesalers and

manufacturers)i) Confirmation of registration to any member of the public or mediaj) Information access by an organization contracted to manage registration information for

conducting business that the NBCP is mandated to perform under provincial legislationk) Information access by an organization involved in providing the Registrants with communications for the

purposes of:i. Professional development and education


of 2

ii. Practice based informationiii. Health Canada Noticesiv. Practice based researchv. Health promotion programs

The NBCP collects Personal Information from its Registrants for the following Identified Purposes:

To admit and regulate Registrants and oversee their conduct;

To discipline, where appropriate;

To conduct business as mandated under federal and provincial legislation.

The NBCP Privacy Policy is available online:


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name (please print) Signature

Date: . . . . . . . . . . . . . . . . . . . . . . . . . . .

I certify I have read and understand the NBCP Policy Statement and the Privacy Policy on the

Collection, Use and Disclosure of Registration Information by the NBCP.


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