College of Physicians and Surgeons of British Columbia300–669 Howe Street Vancouver BC V6C 0B4 www.cpsbc.ca

Telephone: 604-733-7758 Toll Free: 1-800-461-3008 (in BC) Fax: 604-733-3503

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NON-HOSPITAL MEDICAL AND SURGICAL FACILITIES ACCREDITATION PROGRAM

Approved by NHMSFP Committee March 2009 Updated January 2018

Appropriate Procedures ListOBSTETRICS/GYNECOLOGY

Physician name: CPSID:

Facility applying to:

Please indicate only the procedures you wish to perform at the above-mentioned facility.

Abscess – irrigation and debridementAmniocentesis, transabdominalBartholin's cyst/abscess marsupializationBiopsy – perineum, vagina, cervixBiopsy – cervix – with D&CBladder – tension-free vaginal tape insertion, revision, Monarch TOT, urodynamicsCervical/vaginal lacerationsCervix – repair, biopsy, cryosurgery, cone biopsy, LEEP, Shirodkar suture/removalColposcopyCystocoele/urethrocoele/rectocele repairDilatation and curettageExamination under anestheticHydrotubationHymenoplastyHysteroscopy – diagnostic/biopsy/proceduralLabiaplastyLaparoscopic oophorectomy/salpingectomy – bilateralLaparoscopic ovarian cystectomy – bilateralLaparoscopic tubal ligation

Laparoscopy – diagnostic, biopsies, lysis of adhesions, cautery of endometriosis, aspirationLaser vaginal resurfacingMicro salpingostomy – bilateralMyomectomy (vaginal)Pelvic examination under GAPerineal, sphincter, vaginal repairPolypectomy – cervicalRemoval foreign bodySalpingolysis via laparoscope – bilateralSalpingostomy via laparoscopy – bilateralSurgical uterine evacuation up to 13 weeks + 6 days (may be performed by GPs)

Surgical uterine evacuation 14 weeks up to 17 weeks + 6 days (limited to OB/GYN only)

Fertility treatmentArtificial inseminationTransvaginal egg retrievalHuhner's testEmbryo transferTESA/PESA/MESA/micro TESEMicrosurgical tubal reanastomosis

I hereby certify that the procedures selected in this application are within the scope of my current practice.

Physician signature: Date: